DNP 840 Topic 5 DQ 1

What is the reasoning behind the need for doctorally prepared advanced practice nurses to be politically active? How is this accomplished? What ethical or other considerations must be taken into account as a nurse becomes politically active?

Discuss a barrier to health care delivery resulting from state or federal policy or law. What changes might you recommend to the policy/law and what positive or negative impact might you anticipate on patient care?

Most recently the U.S Supreme Court overturned Roe vs. Wade and eliminated the constitutional right to an abortion. Since then, accessing abortion care has become increasingly difficult as many states move towards taking action to deny abortion care. Currently, in the state of Texas, abortion is banned with no exceptions for rape or incest. The Texas Heartbeat Act was signed into effect in 2021 and prohibits abortions once a fetal heartbeat is detected (Haining et al., 2022).

This bill causes a barrier to healthcare delivery as it limits a woman’s autonomy to decide about their sexual and reproductive health. Furthermore, the bill limits evidence-based medical practice as providers might not be willing to terminate a pregnancy that threatens the well-being of the mother or that could lead to mortality (Haining et al., 2022). Taking these things into consideration, regardless of law, abortions might pose a health threat. This is because some women might opt to have an unsafe abortion leading to other medical problems.

The American College of Obstetricians and Gynecologists states that restrictions on abortions create obstacles to safe medical care and disproportionately impacts underserved communities (ACOG, n.d.).  Therefore, the change that would be recommended is for these laws to be overturned and women have the right to choose if they have a child. Personal decision-making by women and their doctors should not be replaced by political ideology. This change would positively impact patient care as women would have a better psychological well-being knowing that they were able to make the best decision for them and their circumstance. As previously mentioned, unsafe abortions can lead to maternal death.  Therefore, women would be able to have safe abortions with the proper medical care.  Lastly, social and economic factors can impact a patient’s health. Factors such as financial stability and poverty status could worsen if women are restricted by laws that prevent abortions. Overall, as doctoral prepared nurses we should understand that women might have varying beliefs when it comes to this discussion. It is our duty to provide and ensure quality and the safest care is delivered regardless of what choice a woman might make.

DNP 840 Topic 5 DQ 1 Reference

ACOG. (n.d.). Increasing access to abortion. value is what Coveo indexes and uses as the title in Search Results.–> ACOG. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/12/increasing-access-to-abortion

Haining, C. M., Keogh, L. A., & Savulescu, J. (2022). The unethical Texas heartbeat law. Prenatal Diagnosis, 42(5), 535-541. https://doi.org/10.1002/pd.6136

RESPOND HERE

I agree with you that the U.S Supreme Court’s decision to overturn Roe vs. Wade depicts a barrier to

healthcare delivery. The bill denies U.S women the right to make a choice about their bodies, especially when they are pregnant. The Texas Heartbeat Act was signed into effect in 2021 and prohibits abortions (Cohen et al., 2021). The bill protects unborn babies from when they heart become functional.  However, in the state of Texas there is exemption when the pregnancy is out of rape or incest. Unfortunately, women are denied the right to choose on whether to have abortion or not. The bill ignores pertinent reasons that trigger women to engage in abortion.

Furthermore, the bill limits evidence-based medical practice (Gordon et al., 2022). Healthcare stakeholders are denied from engaging in research that seeks to improve the safety of abortion due to legal barriers created by this law.  The Texas Heartbeat Act exposes expectant women willing to take abortion at risk since some women may trust unreliable healthcare workers for abortion services.

DNP 840 Topic 5 DQ 1 References

Cohen, I. G., Adashi, E. Y., & Gostin, L. O. (2021). The Supreme Court, the Texas abortion law (SB8), and the beginning of the end of Roe v Wade?. JAMA, 326(15), 1473-1474. doi:10.1001/jama.2021.17639

Gordon, M. R., Coverdale, J., Chervenak, F. A., & McCullough, L. B. (2022). Undue burdens created by the Texas Abortion Law for vulnerable pregnant women. American Journal of Obstetrics and Gynecology, 226(4), 529-534. https://doi.org/10.1016/j.ajog.2021.12.033

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The Clinical Laboratory Improvement Amendments (CLIA) Program was established to ensure regulation of specimens. It ensures the public that human lab will be accurate, dependable, and receive results in a timely manner. This program is not specific to healthcare offices but to all settings that provide lab services. The law requires specific federal requirements and certification, and it is not limited to only those who file Medicare claims. Federal agencies involved include Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and Centers for Disease Control and Prevention (CDC). To get certification an application process is needed, along with paying applicable fees, and a complete survey. The cost of the certification fees varies and are based on the complexity of labs.

It is evident that this process requires preparation and requires financial stability to be able to meet requirements. According to the literature over the past 20 years CMS has continued to increase fees to approximately a 20% (AACC Calls for CLIA Improvements as Fees Rise, 2019).  Despite the benefits of this law there are also barriers that present with this process. It prevents the ability for quick implementation of testing. Having the ability to do this is important in situations of medical emergency such as the COVID 19 pandemic.

A proposed solution to this problem is that legislators are called to help prepare for future health crisis (AACC urges congress to fund training programs, keep CLIA standards strong, 2020). Literature discuss that this can be done by funding of medical laboratory scientist training programs. Currently, a lack of staffing is also a problem in this field. During the COVID pandemic it was released that 58% of labs reported having difficulties with staffing. From 1990 to current years the training programs available decreased from 720- 608. Another statement made by the American Association of Clinical Chemistry (AACC) is for leaders to allocate funding into hospital laboratories.

This allocation will provide the opportunity for clinical rotations and opportunities for supervised experiences. Funds in loan forgiveness programs for clinical lab specialist who decide to work in areas that are underserved areas is also recommended. These proposed solutions entail the assistance of multiple leaders and may take time to established. However, it is imperative for the future of everyone’s wellbeing it will assist in better preparing for future health risk events while also meeting the safety needs in the healthcare system.

DNP 840 Topic 5 DQ 1 References:

AACC Calls for CLIA Improvements as Fees Rise. (2019). Clinical Laboratory News, 45(3), 4.

AACC urges congress to fund training programs, keep CLIA standards strong. (2020). Clinical Laboratory News, 46(8), 4.

RESPOND HERE

I agree with you that the Clinical Laboratory Improvement Amendments (CLIA) Program was initiated to ensure regulation of specimens. Therefore, the program is crucial in guiding nursing research. CLIA initiative guarantees accurate, dependable, and timely lab results (Maxwell et al., 2020). Using right specimens enable healthcare workers and researchers to get valid and reliable laboratory findings with a positive impact on healthcare practice. The program requires specific federal requirements and certification when conducting human research (Zneimer & Hongo, 2021).

Healthcare providers and workers rely on factual information from research. Thus, using inaccurate and inappropriate specimens interfere with the accuracy of research findings. Various regulatory bodies work on ensuring the success of CLIA program. Federal agencies involved in CLIA initiatives include Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), and Centers for Disease Control and Prevention (CDC). The COVID-19 pandemic intensified research activities in the intervention phase. Therefore, there were more CLIA programs at the peak of the pandemic.

DNP 840 Topic 5 DQ 1 References

Maxwell, J. E., Gule-Monroe, M. K., Subbiah, V., Hu, M., Perrier, N. D., Cabanillas, M. E., … & Grubbs, E. G. (2020). Novel use of a Clinical Laboratory Improvements Amendments (CLIA)-certified cyclin-dependent kinase N2C (CDKN2C) loss assay in sporadic medullary thyroid carcinoma. Surgery, 167(1), 80-86. https://doi.org/10.1016/j.surg.2019.03.041

Zneimer, S. M., & Hongo, D. (2021). Preparing for Clinical Laboratory Improvement Amendments (CLIA) and College of American Pathologists (CAP) Inspections. Current protocols, 1(12), e324.  https://doi.org/10.1002/cpz1.324

HIPAA, the Healthcare Information Portability and Availability Act of 1996, became law on August 21, 1996. With it came the promise of sweeping changes to the management and operation of security for healthcare organizations and the data they possess. The primary focus of HIPAA was to mandate that healthcare information become portable and available by legislating the use of uniform electronic transactions and other administrative measures. HIPAA is, however, a barrier to access to care in various ways. For example, HIPAA established rules that require healthcare organizations to control who has access to health data, restricting who can view health information and whom that information can be shared with (Theodos & Sittig, 2021). Patients are also given control over whom their data is released and whom it is shared with.

In addition, organizations handling health data must have business associate agreements (BAA) with any partner that transmits data. If you offer hosting, messaging, or any other healthcare IT service, you must have a BAA with each healthcare client and their IT service partners. You also need to ensure you are offering HIPAA cloud hosting. Part of the challenge may be that the HIPAA Omnibus Rule changed the requirements for business associates when it was introduced in 2013. BAAs must define all uses of PHI by the business associate that are permitted or required and put strict limits on data sharing. Recognizing that poor records match feeds providers’ fears of being held liable for malpractice if they operate on inaccurate or incomplete records. Erroneous matches can also cause providers to mistakenly exchange information about a patient who has requested that her information not be shared.

These issues exacerbate providers’ unwillingness to share information electronically (Theodos & Sittig, 2021). I recommend the proposed change, which may be implemented this year. The difference includes changing the maximum time to provide access to PHI from 30 days to 15 days. Improved access to medical records could pose problems for healthcare providers, who will need to ensure they have sufficient staffing and efficient procedures for providing copies of documents, as the time frame for delivering those records will be shortened from 30 days to 15 days (Moore, & Frye, 2019). The extension will also be shortened to 15 days, giving healthcare organizations 30 days to provide the requested records.

Theodos, K., & Sittig, S. (2021). Health Information Privacy Laws in the Digital Age: HIPAA Doesn’t Apply. Perspectives in health information management, 18(Winter).

Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: history, protected health information, and privacy and security rules. Journal of nuclear medicine technology, 47(4), 269–272.

RESPOND HERE

I concur with you that the Healthcare Information Portability and Availability Act of 1996 (HIPAA) is mandated to protect health data. Healthcare facilities interact with many patients and stakeholders. As a result, healthcare workers access wide range of health information (Heath et al., 2022). At the same time, some healthcare stakeholders may be compromised when handling confidential and private health data. Some healthcare professionals may use health information for malicious reasons.

At the same time, strangers may misuse the same information when leaked. HIPAA ensures that healthcare workers and providers remain discipline when handling patient health information (Williams & Colomb, 2020). Healthcare facilities and workers are held responsible of their actions and decision once the health information is used inappropriately. The law demands healthcare institutions to develop strong security systems protect health data. Confidentiality and privacy are among ethical and legal considerations that guide healthcare professionals when handling critical health information. However, in the legal space, healthcare workers and providers may breach confidentiality without their patient consent.

DNP 840 Topic 5 DQ 1 References

Heath, M., Porter, T. H., & Silvera, G. (2022). Hospital characteristics associated with HIPAA breaches. International Journal of Healthcare Management, 15(2), 171-180. https://doi.org/10.1080/20479700.2020.1870349

Williams, K., & Colomb, P. (2020). Important considerations for the institutional review board when granting health insurance portability and accountability act authorization waivers. Ochsner Journal, 20(1), 95-97. DOI: https://doi.org/10.31486/toj.19.0083

HIPAA, the Healthcare Information Portability and Availability Act of 1996, became law on August 21, 1996. With it came the promise of sweeping changes to the management and operation of security for healthcare organizations and the data they possess. The primary focus of HIPAA was to mandate that healthcare information become portable and available by legislating the use of uniform electronic transactions and other administrative measures. HIPAA is, however, a barrier to access to care in various ways. For example, HIPAA established rules that require healthcare organizations to control who has access to health data, restricting who can view health information and whom that information can be shared with (Theodos & Sittig, 2021). Patients are also given control over whom their data is released and whom it is shared with.

In addition, organizations handling health data must have business associate agreements (BAA) with any partner that transmits data. If you offer hosting, messaging, or any other healthcare IT service, you must have a BAA with each healthcare client and their IT service partners. You also need to ensure you are offering HIPAA cloud hosting. Part of the challenge may be that the HIPAA Omnibus Rule changed the requirements for business associates when it was introduced in 2013. BAAs must define all uses of PHI by the business associate that are permitted or required and put strict limits on data sharing. Recognizing that poor records match feeds providers’ fears of being held liable for malpractice if they operate on inaccurate or incomplete records. Erroneous matches can also cause providers to mistakenly exchange information about a patient who has requested that her information not be shared.

These issues exacerbate providers’ unwillingness to share information electronically (Theodos & Sittig, 2021). I recommend the proposed change, which may be implemented this year. The difference includes changing the maximum time to provide access to PHI from 30 days to 15 days. Improved access to medical records could pose problems for healthcare providers, who will need to ensure they have sufficient staffing and efficient procedures for providing copies of documents, as the time frame for delivering those records will be shortened from 30 days to 15 days (Moore, & Frye, 2019). The extension will also be shortened to 15 days, giving healthcare organizations 30 days to provide the requested records.

Theodos, K., & Sittig, S. (2021). Health Information Privacy Laws in the Digital Age: HIPAA Doesn’t Apply. Perspectives in health information management, 18(Winter).

Moore, W., & Frye, S. (2019). Review of HIPAA, Part 1: history, protected health information, and privacy and security rules. Journal of nuclear medicine technology, 47(4), 269–272.