An exploration of the practice, policy and legislative issues of the specialist area of nursing people with intellectual disability: A scoping review

The specialist field of intellectual disability nursing has been subjected to a number of changes since the move towards deinstitutionalisation from the 1970s. Government policies sought to change the nature of the disability workforce from what was labelled as a medicalised approach, towards a more socially oriented model of support. Decades on however, many nurses who specialise in the care of people with intellectual disability are still employed. In Australia, the advent of the National Disability Insurance Scheme offers an apt moment to reflect upon these decades of specialised nursing care as the context of this nursing care will continue to evolve. A review of the published literature was conducted to explore what has shaped the field in the past and how this might inform the future of this speciality area under new policy and service contexts. People with intellectual disability have specific health and support needs that require a specialised workforce. Specialist nurses continue to be needed for people with intellectual disability.

[Prescriptions by nurses and the law on medications]

To prescribe means to issue a professional health criteria directed towards a patient in order to select materials, products and/or medication administered as part of nursing care. To prescribe consists in fulfilling medication or a medical formula. At present times, the countries which authorize prescriptions by nurses are Australia, France, the USA, Canada, Botswana, Zambia, New Zealand, South Africa, the United Kingdom, Ireland and Brazil. In Spain, studies show that nurses prescribe more than 200 pharmaceutical medications and other sanitary products every day; moreover, health professionals and management are aware of and approve this activity carried out by nurses.

[Analyses of criminal judgments as related to nursing services in the cases of the Supreme Court in Taiwan]

This paper briefly reviewed literature relating to medical disputes and investigated the criminal judgments of the Supreme Court in Taiwan in cases involving nurses and the delivery of nursing services. Past studies of criminal judgments involving medical dispute have usually been presented in the form of case studies. By contrast, this study used a retrospective data, and analyzed the judgments by content analysis and the quantitative research design method. The original written verdicts were obtained from two major online law databases. There have been a total of 70 criminal judgments related to medical disputes since 1927. Among them, 7 cases involved nurses and the delivery of nursing services. These 7 cases were analysed, and the findings will be instructive to those interested in lawsuits related to medical disputes.

Risk assessment and management: a community forensic mental health practice model

In Victoria, the Crimes (Mental Impairment and Unfitness to be Tried) Act (1997) reformed legal practice in relation to the detention, management and release of persons found by a court to be not guilty on the grounds of insanity or unfit to be tried. This Act provides a legal structure for such 'forensic patients' to move from secure inpatient facilities into the community. This new legislative landscape has generated challenges for all stakeholders and has provided the impetus for the development of a risk assessment and management model. The key components of the model are the risk profile, assessment and management plan. The discussion comprises theory, legislation, practice implications and limitations of the model. Practice implications concern the provision of objective tools, which identify risk and document strategic interventions to support clinical management. Some of the practice limitations include the model's applicability to risk assessment and management and its dependence on a mercurial multi-service interface in after-hours crisis situations. In addition to this, the paper articulates human limitations implicit in the therapeutic relationship that necessarily underpins the model. The paper concludes with an exploration of the importance of evaluative processes as well as the need for formal support and education for clinicians.

The UAP Dilemma

Although studies show adverse patient outcomes with increased use of unlicensed assistive personnel (UAPs), improvement in their training and an appropriate staff mix may assure quality care.

Medicare program; civil money penalties, assessments, and revised sanction authorities. Final rule with comment period

This final rule with comment period is a technical rule that updates our civil money penalty (CMP) regulations to add CMP authorities already enacted as part of the Balanced Budget Act of 1997 (BBA) and delegated to us. The rule delineates our authority to assess penalties for: failure to bill outpatient therapy services or comprehensive outpatient rehabilitation services (CORS) on an assignment-related basis, failure to bill ambulance services on an assignment-related basis, failure to provide an itemized statement for Medicare items and services to a Medicare beneficiary upon his/her request, and failure of physicians or nonphysician practitioners to provide diagnostic codes for items or services they furnish or failure to provide this information to the entity furnishing the item or service ordered by the practitioner. The rule also contains technical changes to further conform our current CMP rules to changes in the statute enacted by the BBA.

[Quality control in ambulatory health care. Results of an area-wide study by the public medical service of the Baden-Württemberg health insurance]

Discussions surrounding the quality of nursing care, fueled by recurring press reports, prompted the State Nursing Insurance Associations in Baden-Wuerttemberg to request the Health Insurance Medical Service to perform a quality control of outpatient nursing care services in the state. Based on a coordinated concept and for the first time in the Federal Republic of Germany, all authorized ambulatory institutions area-wide were subjected to a uniform assessment (total survey) during an official inquiry time period. The end results of these controls failed to verify the judgement often propagated by the press based on individual cases that high-quality nursing care can no longer be afforded under the present circumstances. On the average, 55% of the personnel provided to patients by outpatient nursing services were health care professionals. What is more, this professional staff rendered 75% of all nursing care services. The evaluation of the accompanied medical visits indicated that the vast majority attempted to take active nursing care into account. With regard to quality assurance, a great optimisation potential was indicated primarily in the area of nursing documentation. Only in about 35% of the nursing documents inspected was the nursing procedure always clearly evident. A future problem could arise from the fact that of all nursing professionals with leadership responsibilities, at the time of the survey only about 37% had completed the requisite professional training qualification programme of 460 training hours. If the time before the interim deadline (March 31, 2002) is not utilised, the institutions in question could face consequences that could threaten their very existence. It is evident that a large number of outpatient nursing care services in the state of Baden-Wuerttemberg do not have their economic foundation in the domain of the Nursing Care Insurance Law, which affects both patient structure and care intensity. As a consequence, there is no quality control or inspection whatsoever for the majority of nursing care services rendered by ambulatory nursing care services at present because they are not under the jurisdiction of the German Federal Social Legislation SGB XI.

Establishing a nursing center: learning from the literature and the experiences of others

In the midst of health care reform, academic nursing centers are well-positioned as cost-effective health care providers. As practice sites that are integral components of nursing academic units, these centers provide educational experiences for students, practice sites for faculty, nursing services to the community, and settings for nursing research. The success of these centers is determined by their ability to manage seven major issues of implementation: funding, integrating the center into the community, services, marketing, legal and regulatory issues, faculty issues, and research issues. While these issues require considerable attention, it is critical that centers capitalize on the opportunities provided by the current health policy climate.