Chapter 23 Legal Implications in Nursing Practice
standard of proof
What a reasonably prudent nurse would do under similar circumstances in the geographic area in which the alleged breach occurred
Emergency Medical Treatment and Active Labor Act
When a patient presents to an emergency department, they must be treated
torts
Wrongful acts or omissions for which an injured party can take legal action against the wrongdoer for monetary damages
Death with Dignity or Physician-Assisted Suicide
a competent individual with a terminal disease could make an oral and written request for medication to end his or her life in a humane and dignified manner. -the ana believes the nurses involvement violates nursing code of ethics
assault
a violent attack
nurse experts determine that no conflict of interest exists before?
accepting a case
Quasi-intentional
acts in which a person may not intent to cause harm to another but does
Omnibus Budget Reconciliation Act
altered the way in which care was provided to older adults. -addresses both physical and chemical restraints
battery
any intention offensive toughing that may result in criminal and civil actions
neglicence
careless neglect, often resulting in injury
scope of nursing practice
defines nursing and reflects the values of the nursing profession -reflect the knowledge and skill ordinarily possessed and used by nurses
constitutional law
derived from state and federal constitution Ex: every patient has the right to refuse treatment
the uniform determination of death act
determines actual death
Health Insurance Portability and Accountability Act (HIPAA)
establishes patient rights regarding privacy of their health care information and records
nurse experts base their opinions on?
existing standards of practice
public health law
laws affect individuals, populations, and communities that are intended to improve the health of people
risk management includes
-identify possible risks -analyze risks -acting to reduce risks -evaluate the steps to take to reduce risk
A nurse may refuse an assignment when
-lack of knowledge to provide care -care exceed nurse practice act -health of nurse or nurse unborn child is threatened -safety is at risk -documents concise objection to moral and ethics -nurse clinical judgment is impaired
malpractice
Failure by a health professional to meet accepted standards
A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) 1.Failure to document a change in assessment data 2.Failure to provide discharge instructions 3.Failure to follow the six rights of medication administration 4.Failure to use proper medical equipment ordered for patient monitoring 5.Failure to notify a health care provider about a change in the patient's condition
1. , 5. The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.
Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.) 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."
1., 2., 3. Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees to be involved in decision making. Nurses have a powerful voice in the legislature.
A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) 1.The nurse does not need any representation. 2.The patient must prove injury, damage, or loss occurred. 3.The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4.The patient must prove that a breach in the prevailing standard of care caused an injury. 5.The burden of proof is always the responsibility of the nurse.
1., 2., 3. The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage.
Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Taking or selling controlled substances 2.Refusing to provide health care information to a patient's child 3.Reporting suspected abuse and neglect of children 4.Applying physical restraints without a written physician's order 5.Completing an occurrence report on the unit
1., 4. The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a health care provider on the basis of The Joint Commission and Medicare guidelines.
You are about to administer an oral medication and you question the dosage. You should: 1. administer the medication. 2. notify the physician. 3. withhold the medication. 4. document that the dosage appears incorrect.
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➢ Consumer rights and protections ➢ Affordable health care coverage ➢ Increased access to care ➢ Quality of care that meets the needs of patients
Patient Protection and Affordable Care Act
A nurse is caring for a patient who recently had coronary bypass surgery and now is on the postoperative unit. Which are legal sources of standards of care that the nurse uses to deliver safe health care? (Select all that apply.) 1. Information provided by the head nurse 2.Policies and procedures of the employing hospital 3.State Nurse Practice Act 4.Regulations identified in The Joint Commission manual 5.The American Nurses Association standards of nursing practice
2., 3., 4., 5. All of these sources govern the legal standards of care and are individualized by state and agency. Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.
A student nurse employed as a nursing assistant may perform care: 1. as learned in school. 2. expected of a nurse at that level. 3. identified in the hospital's job description. 4. requiring technical rather than professional skills.
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A nurse is caring for a patient who states, "I just want to die." For the nurse to comply with thisrequest, the nurse should discuss: 1. living wills. 2. assisted suicide. 3. passive euthanasia. 4. advance directives.
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Depositions are
A form of discovery involving oral statements to provide honest complete answers
Uniform Anatomical Gift Act
A law permitting a person of legal age and sound mind to give all or any part of his body to take effect upon his/her death or gives the right to another.
A nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow? 1.A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. 2.A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3.The patient cannot make changes in the advance directive once admitted to the hospital. 4.A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.
You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first? 1.Call the nursing supervisor to discuss the situation 2.Discuss the problem with a colleague 3.Leave the nursing unit and go home 4.Say nothing and begin your work
Call the nursing supervisor to discuss the situation Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.
A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Document her findings and treat the patient 2.Instruct the mother on safe handling of a 2-year-old child 3.Contact a child abuse hotline 4.Discuss this story with a colleague
Contact a child abuse hotline Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.
You are the night shift nurse caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the priority nursing action? 1.Give the family the record 2.Discuss the issues that concern the family with them 3.Call the nursing supervisor 4.Determine from the medical record if the family has been granted permission by the patient to access his or her medical information
Determine from the medical record if the family has been granted permission by the patient to access his or her medical information Family members do not have the right to private personal health information without the consent of the patient. Confidentiality protects private patient information once it has been disclosed in health care settings.
A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? 1.Health Insurance Portability and Accountability Act (HIPAA) 2.Americans with Disabilities Act (ADA) 3.Patient Self-Determination Act (PSDA) 4.Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed
Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.
A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nurse manager because this action is a violation of which act? 1.Patient Protection and Affordable Care Act (PPACA) 2.Patient Self-Determination Act (PSDA) 3.Health Insurance Portability and Accountability Act (HIPAA) 4.Emergency Medical Treatment and Active Labor Act
Health Insurance Portability and Accountability Act (HIPAA) The Privacy Rule of the HIPAA requires that patient information be protected from unnecessary publication.
Statutory Law
Law passed by the U.S. Congress or state legislatures
Nurse Practice Act
Law that defines the scope nursing practice in a given state.
A woman has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? 1.Obtain a court order to give the blood 2.Coerce the husband into giving the blood 3.Call security and have the husband removed from the hospital 4.More information is needed about the wife's preference and if the husband has her medical power of attorney
More information is needed about the wife's preference and if the husband has her medical power of attorney Adult patients such as those with specific religious objection are able to refuse treatment for personal religious reasons, but there need to be clear directions on who can make the decision.
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? 1.Discussing patient conditions in the nursing report room at the change of shift 2.Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3.Posting medical information about the patient on a message board in the patient's room 4.Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
Posting medical information about the patient on a message board in the patient's room Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by people who are not involved in the patient's treatment.
patient self determination act
Requires health care institutions to provide written information to patients concerning their rights to make decisions about their care, including the right to refuse treatment and to formulate an advance directive
A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager
Surgeon The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.
A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? 1. The nurse's automobile insurance 2. The nurse's homeowner's insurance 3. The Good Samaritan law, which grants immunity from suit if there is no gross negligence 4. The Patient Care Partnership, which may grant immunity from suit if the injured party consents
The Good Samaritan law, which grants immunity from suit if there is no gross negligence The Good Samaritan law holds the health care provider immune from liability as long as he or she functions within the scope of his or her expertise.
Enhanced Nurse Licensure Compact
license that allows nurses to practice in other states
Good Samaritan Law
limits liability and offer legal immunity if a nurse helps at the scene of an accident
State laws intended to protect citizens, make nurses accountable and assure that care is consistent with best practice within the scope and standards of nursing
nurse practice act
Health insurance Technology Act
nurses must ensure phi is protected
common law
originates from decisions that were made in the absence of law EX: right of privacy
criminal law
protect the rights of individuals and provide fair and equitable treatment when civil wrongs or violations occur
patient safety and improved care are the goals
quality improvement
Administrative Law
regulatory law more clearly defines expectations of civil and criminal law
Mental Health Parity and Addiction Act
requires health insurance companies to provide coverage for mental health and substance use disorder treatment
termination of pregnancy
right of privacy about a women deciding to terminate her pregnancy
when you are asked to float as a nurse you must?
state you do not have the proper training and request an orientation
case law
the rules of law announced in court decisions
unintentional torts
when a person is harmed and the person inflicting the harm knew or should have known that their practices were less than the scope of pracitce
slander
when one speaks falsely about another
libel
written defamation -writing false info in a patient chart
defamation of character
wrongfully hurting a person's good reputation
informed consent and health care acts
➢ An explanation of the procedure or treatment ➢ The names and qualifications of people performing and assisting in the procedure ➢ A description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort ➢ Knows that he or she has the right to refuse the procedure/treatment ➢ Knows that he or she may refuse the procedure/treatment