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Cultural, Legal, and Ethical Considerations

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Cultural, Legal, and Ethical Considerations Jan Bazner-Chandler RN, MSN, CNS, CPNP What are cultural influences? Level of patient compliance with the therapy regimen. – PowerPoint PPT presentation

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Title: Cultural, Legal, and Ethical Considerations


1
Cultural, Legal, and Ethical Considerations
  • Jan Bazner-Chandler
  • RN, MSN, CNS, CPNP

2
Federal Food and Drugs ACT
  • FFDA
  • Required drug manufactures to list on the drug
    product label the presences of dangerous and
    possible addicting substances.
  • U.S. Pharmacopeia

3
Drug Enforcement Administration
  • DEA is charged with the enforcement of Controlled
    Substance Act.

4
DEA
  • Individuals and companies legally allowed to
    handle controlled substances must register with
    DEA, keep accurate records of all transactions,
    and provide secure storage of drugs.
  • Physicians assigned number by DEA and must put
    number on all prescriptions of controlled
    substance.

5
DEA and the consumer
  • DEA will monitor the number of controlled
    substance prescriptions a consumer is using and
    from what physicians the prescriptions are being
    dispensed.

6
Schedule I Drugs
  • Drugs with high abuse risk. These drugs have NO
    safe, accepted medical use in the US. Some
    examples are heroin, marijuana, LSD, PCP and
    crack cocaine.

7
Schedule II Drugs
  • Drug with high abuse risk, but also have safe
    acceptable uses in the United States. These drugs
    can cause severe psychological or physical
    dependence.

8
Schedule II Drugs
  • Schedule II drugs include certain narcotic,
    stimulant and depressant drugs.
  • Morphine sulfate
  • Cocaine
  • oxycodone (Percodan)
  • dextroamphetamine (Dexedrine) for Attention
    deficit disorder

9
Schedule II Drugs
  • Must be kept locked and signed out only by
    registered personal.
  • On the wards need key or code to gain access to
    medications narcotics for pain relief.

10
Schedule II - prescription
  • At this time NP and PA do not have prescription
    writing ability.
  • In the hospitalized client narcotics often need
    to be re-ordered every 36 hours.
  • In the community number of pills dispensed is
    regulated.

11
Schedule III, IV or V
  • Drugs with an abuse risk lower than Schedule II.
    These drugs also have safe and accepted medical
    use in the US. Drugs may contain safer and small
    amounts of certain narcotic and non-narcotic
    drugs, anti-anxiety, tranquilizers, sedatives,
    stimulants, and non-narcotic analgesics.

12
Schedule III Drugs
  • Schedule III Less potential of abuse
  • acetaminophen with codeine or Tylenol 3
  • hydrocondone with codeine or Vicodin
  • diazepam or Valium

13
Schedule IV and V Drugs
  • Schedule IV Appetite suppressant drugs
  • Schedule V OTC pain medications

14
Student Nurse and Controlled Drugs
  • In the clinical you will always administer
    medication with the clinical instructor.
  • Narcotics cannot be accessed by student must be
    done with instructor or registered nursing
    personal.
  • Specific hospital procedures and protocols need
    to be followed.

15
New Drug Development
  • Pharmaceutical industry is a multibillion dollar
    industry.

16
Drug Development
  • FDA approves studies reviews lengthy testing
    protocol.
  • Animals
  • Randomized controlled studies on humans
  • Data collection
  • FDA approves drug for distribution

17
Food and Drug Administration
  • FDA
  • Purpose to protect the patient and ensure drug
    effectiveness.
  • Responsible for approving drugs for clinical
    safety and efficacy before they are brought to
    market.

18
Marketing of Drugs
  • A billion dollar industry
  • New drugs are protected by patent for 14 years
    during which time only the pharmaceutical that
    has developed it can market it
  • After the fourteen years drugs with similar
    chemical composition can be developed and sold as
    generic drugs cost less

19
Cost
  • Have you even wondered why a drug that costs
    pennies as an OTC can be so expensive when
    administered in the hospital setting?
  • The Tylenol given for fever may cost as much as
    5.00 a pill
  • This pays for the processing of the physician
    order, pharmacy and the nurse that administers
    the drug

20
The Million Dollar Pill
  • Research! Research! Research!

21
Legal Issues and Nursing Implications
  • Standards and scope and role of processional
    nursing.

22
Legal Framework
  • Federal and State Legislation
  • Standards of Care
  • Nurse Practice Act
  • Medication Administration

23
Ethical Practices
  • American Nurses Association Code of Ethics for
    Nurses
  • Serves as integral part of the foundation of
    professional nursing.
  • Ensures that the nurse is acting on behalf of the
    patient and with the patients best interest at
    heart.

24
Cultural Considerations
  • one size fits all

25
Cultural Implications
  • Culture
  • Culture competence
  • Ethnicity
  • Ethnopharmcology
  • Race

26
Culture
  • An integrated system of beliefs, values, and
    customs that are associated with a particular
    group of people and are generally handed down
    from generation to generation.

27
Cultural Competence
  • The ability to work with patients with proper
    consideration for cultural context, which
    includes patients belief systems and values
    regarding health, wellness and illness.
  • It involves learning about different patients
    and their specific responses to treatment,
    including drug therapies.

28
Ethnicity
  • Ethnic affiliation based on shared culture or
    genetic heritage or both.

29
Ethnopharmacology
  • Study of the effects of ethnicity on drug
    responses, specifically drug absorption,
    metabolism, distribution, and excretion.

30
Race
  • Class of individuals with common lineage. Race is
    often used to refer to geographical origins of
    ancestry.

31
Ethnicity and Genetics
  • Drug polymorphism

32
Drug Polymorphism
  • How the same drug may result in very different
    responses in different individuals.

33
What can influence response?
  • Age
  • Gender
  • Size
  • Body composition

34
What are cultural influences?
  • Level of patient compliance with the therapy
    regimen.
  • Cultural beliefs
  • Experiences with medications
  • Personal expectations
  • Family expectations
  • Family influence
  • Level of education

35
Alternative Therapies
  • Herbal
  • Homeopathic

36
Environmental Considerations
  • Diet
  • Malnutrition

37
Cultural Assessment
  • Health beliefs and practices
  • Past uses of medicine
  • Use of folk remedies
  • Use of home remedies
  • Use of over-the counter drugs OTC
  • Usual response to illness
  • Responsiveness to medical treatment
  • Religious practices and beliefs
  • Dietary habits
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