Barkley Theories, Research, Role and Scope

duty to help others

Do good; at least do no harm

avoidance of harmful behavior

the clinician has the duty to exercise reasonable care when undertaking and providing treatment to the patient when a pt -clinician relationship exists.

the clinician violates the applicable standard of care in treating the patient 's condition.

there is a causal relationship between the breach in the standard of care and the patient's injuries.

There are permanent and substantial damages to the patient as a result of malpractice

Health Care Quality Improvement Act of 1986

The term managed care or managed health care is used in the United States to describe a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care ("managed care techniques") for organizations that use those techniques or provide them as services to other organizations

frequently excluded NPs from being designated as PCPs so the only option is for NP to work as a salaried employee. Job security risk- ghost provider status

developed as flagging system
keeps info on NP, malpractice suits against them

Preferred provider organization/ Participating provider organization/ Preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.

PPOs have gained popularity in the past decade because, although they tend to have slightly higher premiums than HMOs and other more restrictive plans, they offer patients more flexibility overall.

Preferred provider organizations themselves earn money by charging an access fee to the insurance company for the use of their network (unlike the usual insurance with premiums and corresponding payments paid either in full or partially by the insurance provider to the medical doctor). They negotiate with providers to set fee schedules, and handle disputes between insurers and providers.

Medicare and medicaid
Federal and State Benefit Plans (FEBP)
TRICARE
Out of pocket payment

85% of the scheduled amount paid to the MD

individual states

Family unified whole, dynamic, parts interact and dependent on each other, must change with time to cope/ adapt and maintain homeostasis

Social system that form interdependent, independent, relationships within and outside the family.
Subsystems (parent-child etc.)
Suprasystem-outside family
Ecomap; dx/illness can create dysfunction, poor coping

Erickson, Piaget, Duval

interaction, verbal and nonverbal communication

Crisis is normal and growth producing, everyone experiences it. Stress is a major factor.

We REJECT the null hypothesis when in reality it is TRUE.

We ACCEPT the null hypothesis when in reality it is FALSE.

POSITIVE

Probability that a test will be positive when dx is present.

NEGATIVE

Probability that a test will be negative when a dx is not present.

probability that a test will be negative when a dx is present

probability that a dx is present when test is positive

directed at preventing dx from occurring

Interventions at the subclinical stage, directed at early detection of the illness or problem to reduce the severity of the dx

Genetic testing in newborns
lead screening
vision and hearing screening
smoking cessation programs
cholesterol screening
mammography
testicular self examination

treatment and rehab of illness to prevent or minimize progression or it's sequelae

Education
Exercise
Nutrition
Water Fluoridation
Immunizations
Food handling Regulations
Pollution Control p 29

Use of inhaled steroids for asthma
use of PCN Prophylaxis in pt's with SS dx
Vitamin therapy in pregnancy

colonization and multiplication of an organism in the host, typically producing an IMMUNUNE RESPONSE but NO SIGNS OR SYMPTOMS. p 29

Stage when an infection PRODUCES SIGNS OR SYMPTOMS (including pathologic changes). Some organisms are capable of infection w/ or w/o dx, other organisms always produce dx, but severity may vary.

organism invades the host at a particular site, multiplies and acts as a parasite, but DOESN'T PRODUCE INFECTION, IMMUNE RESPONSE OR DX.

Persistence of an organism in a host; this stage may follow infection, dx, or colonization and may be infective to others.

ability of an organism to invade and multiply in a susceptible host. (varicella is highly infective, TB has low infectivity.

ability of an organism to produce dx (TB has low pathogenicity, rabies and rhinovirus is high) p 29

severity of dx that an organism can produce.
fatality rate, seriousness of sequelae, # of hospital days p 30

ability to produce a lasting and effective immunity

Organism is not shedding or obtainable. (likely hidden in the host cells)

organism is shedding/ obtainable from such areas as feces, urine, blood, reps tract. Can be permanently patent (some hep B), or intermittent (herpes) or can be latent and then reactivate to produce dx (TB, Herpes zoster)

time when sufficient # of organisms are shed to cause transmission; usually concurrent with dx

time from exposure to onset of dx

interval b/t receipt of infection and the maximal communicability of host

Erickson
Piaget
Bowen
Sadavoy

explains family situations in term of past relationships and family histories

Geriatric age related stresses

infancy and adolescence

test development from birth to 6 yrs

Model to explain why healthy people do/ don't take advantage of screening programs
Perceptions of susceptibility
Seriousness of a dx
Benefits of tx
Barriers to change
Expectations of efficacy
optimal interventions consider all of these factors

Some needs are more important the others and must be met before other needs can be considered

6 Predictable Stages of Change

1 Pre contemplation
2 Contemplation
3 Preparation
4 Action
5 Maintenance
6 Termination

self-efficacy is the perception of 1's ability to perform a certain task at a certain level of accomplishment
Behavior change and maintenance are a function of outcome expectations and efficacy expectations

1 Survival needs: Water, food, sleep
2 Safety and security: Protection from hazards
3 Love and belonging: Affection, intimacy, companionship
4 Self esteem: Sense of worth
5 Self actualization: Achieving potential

"Following the rule"

Doing the Greatest Good for the Greatest Number of people

Beliefs of a Particular Society, Culture, or Religion are Paramount
Deficiency: Only Consequences to the Group Matter

If I Believe it is Right, It is Right


The Individual Determines Consequences for self; Consequences to Others are Irrelevant

Ethics is concerned with the “good of the individual.”

Agreement

Autonomy- Individual and Uniqueness of Each Patient

a person's capacity to take INDEPENDENT ACTION based on his evaluation of his situation

Ability to deal with the reality of one's situation

Right to control of one’s time and effort

Faithfulness to the terms of an agreement