What is the primary purpose of standard of nursing practice?

10.1.3 Looking for effectiveness

Standard practices lead to faults associated with the search for effectiveness. At this stage, we have to mention the question raised by Perriault: “Is the notion of logic of usage integral part of the concept of individual as a whole or can the two be separated?”. This is also what Jauréguiberry and Proulx propose:

“We prioritize motivations in terms of effectiveness, profit and viability, leaving out factors of emotional or relational affection, belonging or identity. The choice made in terms of communication technologies is mainly presented as the result of an economic way of reasoning. It is a matter of managing emergencies, making down-time profitable, optimizing tasks in real time or, in short, being efficient” [JAU 11].

Therefore, a company that reaches its goals is effective. It pivots around the mediation of rationality, which is made of relations and individuals. From a functionalist point of view, society is a sum of elements, namely the individuals, relations and institutions that make it up. It comes before these elements, functions in a specific way and makes use of tools. By means of tools, society has at its disposal some specific dynamics that enable it to solve situations of instability. It has a natural tendency to resist change. All of this results in a form of rationality that is often described only afterwards. This notion of effectiveness or accomplishment, which could present itself in the medical field as the treatment of every patient, should not be confused with that of efficiency, which consists of treating while spending as little as possible.

Informed Consent

Standard practice requires that clients give informed consent for all diagnostic and therapeutic procedures. The implication of this requirement is that clients receive an explanation about all procedures, including their potential risks and benefits and any information that may influence their decision regarding the proposed treatment. With therapies thought to be complementary or alternative, health care professionals also should consider informing clients what is not known about the intervention and what has not been evaluated so that clients are able to include this information in their decision to give or not give consent for treatment.13 Further discussions also should include the risks and benefits of combining standard care with a complementary therapy versus providing just the standard care or just the CAM approach.31 Documentation of such discussions in the client's chart can help to decrease the risk of malpractice liability for the health care professional.

Areas of Future Research

Standard practice for patients with IVCFs is based almost solely upon “expert opinion,” anecdotal evidence, and case series. Research in the field of IVCFs is challenging, given the lack of standardized indications for these devices, practice pattern variations, differences in the devices themselves, and the heterogenous population in which these devices are employed. In June 2007, the Society of Interventional Radiology (SIR) convened a multidisciplinary panel of experts in IVCFs to establish and prioritize a research agenda for IVCFs. To address the fundamental gaps in our knowledge of IVCF efficacy, safety, and cost-effectiveness, the panel determined the clinical priority topics in which well-designed clinical trials are urgently needed.259 The role of prophylactic IVCFs in trauma patients was voted as the top clinical research question. Obviously, any undertaking of a large randomized controlled trial will require formal collaboration with multiple centers and disciplines to engage all stakeholders in areas with significant clinical equipoise.

5.3 Report of Results

Standard practice in pharmaceutical industry in reporting stability results is only to report those that exceed the ICH reporting thresholds even if the analytical method is capable of accurately determining the degradation product at a much lower level. For example, for a drug substance with a maximum daily dose of ≤ 2 g/day, the reporting threshold is 0.05% (ICH Q3A (R2), 2006). If the degradation products method has a limit of quantitation of 0.02%, only the results above 0.05% need to be reported; those between 0.02% and 0.05%, although accurately determined, are not reported. The reason for such a practice is that ICH approach is threshold based; and the reporting threshold is not directly linked to the specification limit of degradation products. In contrast, APS is a quantitative and statistics-based approach, a lower DL/QL and additional data contribute to the precision of expiry prediction of the drug. Hence, it is recommended to report all stability data from an APS study at or above the method quantitation limit for data fitting.

Areas of Future Research

Standard practice for patients with IVCFs is based almost solely on “expert opinion,” anecdotal evidence, and case series. Research in the field of IVCFs is challenging, given the lack of standardized indications for these devices, practice pattern variations, differences in the devices themselves, and the heterogeneous population in which these devices are employed. In June 2007, the Society of Interventional Radiology (SIR) convened a multidisciplinary panel of experts in IVCFs to establish and prioritize a research agenda for IVCFs. To address the fundamental gaps in our knowledge of IVCF efficacy, safety, and cost-effectiveness, the panel determined the clinical priority topics in which well-designed clinical trials are urgently needed.260 The role of prophylactic IVCFs in trauma patients was voted as the top clinical research question. Obviously, any undertaking of a large RCT will require formal collaboration with multiple centers and disciplines to engage all stakeholders in areas with significant clinical equipoise. In the absence of randomized clinical trials, large prospective multicenter observational studies should be undertaken to determine the efficacy and safety of different IVC filters for each of the proposed indications for use. The PRESERVE study (NCT02381509), a multicenter observational study of IVC filters, is currently enrolling and should provide valuable data regarding filter efficacy and safety.

Industry Standard Practice (ISP)

An ISP is an operational plan or activity that is common to healthcare security operations as a basic concept or premise. As such the implementation of the ISP may vary in detail unique to an individual facility or organization but will generally produce, or is intended to yield, a common outcome. An example of a healthcare ISP is to provide designated security officer coverage in the hospital setting. This practice is applicable to most hospitals; however, it should be noted that some very small facilities located in rural areas, or in very low crime areas, may not need the services of designated security officer coverage. They do, however, need to have a plan for security and especially a plan for response to security-critical incidents. Another ISP is the training and education of all facility staff. Staff must be trained in the basics of organizational security and their individual responsibility in support of the overall security program.

Industry security practices may emanate from outside sources such as accreditation/regulatory organization (i.e., CMS, OSHA, TJC, State Health Departments) and resource organizations that have developed information with relevancy to healthcare security (i.e., NCMEC, NFPA, ASIS, IAHSS). The NCMEC efforts in regard to infant abductions is a good example of how an outside resource can shape an ISP and even relate directly to a standard of care. Their publication, “For Healthcare Professionals: Guidelines on Prevention of and Response to Infant Abduction,” 9th Edition, 2009, in effect sets a nationally recognized healthcare security standard.9 The support of the “guidelines” by various organizations, as shown on the cover of this document, provides a strong consensus of agreement in this very important area of healthcare security. It is perhaps one of the most “prescriptive” of our ISPs which has de facto transitioned into a basic standard of care involving hospital infant security.

Gua sha alone: descriptive clinical recommendations for specific conditions (121 articles)

Standards of practice in Western medicine are intended to be based on evidence from clinical trials. Traditional East Asian medicine practice is based on an archive of experience, expressed in case descriptions and treatment recommendations recorded through history in texts as well as in the present-day peer-reviewed journals. The following sets of discursive articles provide an indication of how Gua sha is used clinically: what Chinese medicine doctors want other providers to know about their use of Gua sha. Only in the last few decades have modern research techniques been applied to traditional East Asian medical modalities to qualify their use in the modern clinical setting.

Table 2.3 (see Appendix D) lists the articles that discuss the use of Gua sha alone in treating specific conditions. Of the 121 articles in this group, 15 describe the use of Gua sha in the treatment of ‘sha syndrome’, a main feature being fever. Several more articles discuss the historical application of Gua sha for fever, including fever related to cholera. The term ‘sha’, translated as ‘red millet-sized rash’, i.e. petechiae, is also translated as cholera (see Chapters 1 and 5Chapter 1Chapter 5). According to Dr James Tin Yau So Gua sha was historically used to treat cholera and cholera-like disorders (So 1987) and is similar to the technique of frictioning used in early Western medicine to treat cholera (Jackson 1806). These articles also point to the importance of Gua sha and its historical use in fevers associated with serious life-threatening illness.

Gua sha alone is also recommended for respiratory infection, cough, throat infection and mastitis, as well as autoimmune disorders such as rheumatoid arthritis and lupus. Another important area of clinic application of Gua sha alone is that of musculoskeletal problems, including neck pain, frozen shoulder (periarthritis), tennis elbow, lumbar disc herniation and soft tissue injury, as well as for facial paralysis, head and face neuralgia and postherpetic neuralgia.

Other indications include skin problems, cardiovascular problems, pediatric diarrhea, digestive problems, stress, insomnia, chronic fatigue, athletic fatigue and ‘sub-health’. Gua sha alone is also considered to have a positive role in health maintenance and self-care, promoting vitality, and even beauty.

What is the purpose of the standards of nursing practice quizlet?

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