Chapter 4: Legal and Ethical Aspects of Nursing

Covered Entity

Health plan, a health care clearinghouse, or health care provider that transmits any health information in electronic form.

Felony

serious crime

State boards of nursing

state agency with legislative power to initiate, regulate, and enforce provisions of the Nurse Practice Act

Informed consent

tests, treatments, medications, outcomes, possible complications and alternative procedures are to be explained, documented, and signed by client. usually obtained by physician.

Nurse Practice Act

the law that defines and regulates to practice of nursing in the US. in each state, province, or territory defines regulations for practice and registered nursing.

Electronic Data Interchange

the transfer of routine information or transactions from one computer to another in a standard format, using standard communications protocols

Assault

threat or an attempt to do bodily harm including physical or verbal intimidation

Invasion of privacy and confidentiality

trespassing, illegal search and seizure, need written consent to give out any info, protect private info when using technology

Privacy rule of HIPAA

unless clients object, providers can disclose information as needed. can share appropriate information when client is incapacitated. seek permission from client first to release info via phone and identify caller's identity based on facility's policy.

False imprisonment or restraint of movement

use of unnecessary restraints or solitary confinement. may be physical or chemical

Informed Consent

voluntary authorization by a client, who has been advised of and fully understands the risks involved, and is free of coercion, for participation in a study, immunization program, treatment regimen, and invasive procedure,

HIPAA requires

written privacy procedures, documented supervision, privacy officer, "need to know", contingency plan for emergency data backup, internal audits

Libel

written statement or photograph that is false or damaging

Crime

wrong committed against a person or property or public good; law is violated; intention to do wrong is also present

Clients' Responsibility

- Healthcare is a partnership - Provide accurate and up-to-date medical history - Request additional info and clarification as needed - Recognize impact of personal lifestyle choices - Ensure healthcare institution has copy of written advance directive - Inform healthcare providers if anticipate problems following prescribed treatment - Respect facility's rule and regulations and responsibilities to other clients and community - Provide necessary info and to assist in the process of payment for services

Safeguards for the Nurse and Student

- Personally liable for any harm client suffers as result of your own act. - Healthcare facilities may also be held liable for any harm as result of your actions - Legal actions involving negligent acts may become malpractice lawsuits

Cause for Revoking or Suspending a License

- drug or alcohol abuse - fraud - deceptive practices - criminal acts - previous disciplinary action - gross or ordinary negligence

Important Points to Remember

- facility and right to limit function of nurse. - may require additional education in specialized fields - education is a lifelong, continued process - always practice within limits you were taught - use good common sense and judgement - ask questions if unsure - report any errors immediately - report any defective equipment immediately

HIPAA Written authorization

A detailed document, signed by a patient, that gives a covered entity permission to use or disclose protected health information for a specific purpose not allowed under HIPAA, or to disclose protected health information to a third party.

A nurse in a pediatrician's office is speaking on the telephone with the guardian of a school-age child who will become a new client at the office. The nurse should instruct the guardian to call the child's previous provider's office to request which of the following?

A form authorizing release of copies of the child's medical records to be signed by the guardian

Clients' Rights

A patient Bill of Rights

Negligence

Harm done to a client as a result of neglecting duties, procedures, or ordinary precautions

Which of the following actions should the nurse take after witnessing a breach in confidentiality in a provider's office?

Complete a health information privacy complain form

Common sources of law

Constitutional: right to free speech Statutory: Nurse Practice Acts Administrative: State Boards of Nursing Criminal: Prosecution of malpractice Civil: HIPAA violations of privacy

Misdemeanor

Crime that is considered not as serious as a felony but is still serious and may be cause for revocation of a nursing license

HIPAA

Health Insurance Portability and Accountability Act. Law protects client info, makes sure info remains private

T or F: it is acceptable to give an injection to clients if they refuse, and without their written consent

False

T or F: in the case of a client who is terminally ill, has no relatives present, and request help, a nurse has the authority to help the client prepare a will or other legal document.

False. A nurse should never attempt to hella. client prepare a will or any other legal document.

T or F: it is vitally important for the nurse to ask permission from the client each time someone asks for info about the client's condition.

False. the client should have a completed ROI in the records which will let the nurse know who is authorized to receive info concerning the client's condition.

Common sense precautions

Follow accepted procedures, be competent in your practice, ask for assistance, document well, do not give legal advice to clients, do not accept gifts, do not help a client prepare a will, consider a malpractice insurance policy

A newly hired nurse is reviewing information about the HIPAA privacy rule during facility orientation. Which of the following statements by the nurse indicated understanding of the privacy rule?

I can give information about a client over the phone if the client gives permission

A nurse is teaching a newly licensed nurse about using a computer to document in a client's health record. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

I should remain aware of my surroundings when documenting in the computer

You are giving discharge instructions to a client. They tell you they would like a copy of their health record. What is the best response?

I would be happy to show you where the medical records department is located.

Protected health information (PHI)

Individually identifiable health information that is transmitted or maintained by electronic media.

A nurse in the emergency department is caring for a client following a motor vehicle crash. The client is unresponsive and the client's spouse is not present. Which of the following actions should the nurse take to assist with obtaining consent for the client's surgery?

Inform the provider of the spouse's contact information so consent can be obtained over the telephone

Tort

Injury that occurred because of another person's intentional or unintentional actions or failure to act

1st responsibility after completion of nursing program is pass what?

NCLEX-PN or NCLEX-RN

Professional nursing organizations

grouped by nurse interest such as specialty area or nurse role; provide collegiality, access to scholarly literature, and potential monies to support education and research

A client tells a nurse that they feel their privacy has been violated and wants to file a formal complaint with someone other than the medical facility. Through which of the following agencies should the nurse instruct the client to file the complaint?

Office for Civil Rights (OCR)

Ethical Issues in Treatment

Organ transplantation, criteria and questions, refusal of treatment, withholding treatment, termination of treatment, euthanasia

Privacy officer

Organizational employee appointed to develop, implement and maintain privacy policies. In a health care setting, this person ensures compliance with the HIPAA privacy rule

Security Officer

Organizational employee that creates a safe environment and protects the organization's assets. In a health care setting, this individual is responsible for administrative, physical, and technical safeguards to protect the confidentiality, integrity and availability of electronic protected health information.

Disclosure

Revelation or divulgence of information

professional sexual misconduct

Seductive, sexually demeaning, or harassing behavior

ROI

Signed release of information required from client before personal info can be given out legally.

A group of nurses on a clinical unit are planning to research the incidence of falls among clients following joint replacement surgery. Which of the following actions should the nurse is take to ensure the study complies with the HIPAA privacy rule?

Submit their proposal to the institutional review board for review and describe how they will de-identify client information

PHI can be released under certain circumstances

Title II Act: Regulates who can have access to client info. Sets standards for storage and transmission of client info. Requires policies allowing clients access to their own personal health info and right to request correction of any errors.

T or F: if a client has a living will kept on file in the healthcare facility, the nurse is forced to honor the will in the case of the client being unable to make their own decisions regarding care

True

T or F: the various laws and ethical standards which are in place are designated to ensure each client receives the best healthcare possible

True

Security rule

Under HIPAA, regulations related to the security of electronic protected health information that, along with regulations, related to electronic transactions and code sets, privacy, and enforcement, compose the Administrative Simplification provisions.

Patient Safety Act

Voluntary reporting system. encourages reporting in confidential manner without fear of increased liability risk

Which of the following methods of information exchange can occur without client authorization?

Walking rounds that involve two nurses discussing an assigned client at the client's bedside in a private room

Advance Directives

a legal document in which a person either states choices for medical treatment or names someone to make treatment choices if they close decision-making ability.

Traditional definition of death

absence of respirations and heartbeat

The Joint Comission (TJC)

accreditation and certification organization for healthcare organizations in the US

Defamation

act that harms a person's reputation or good name

Inferred consent

assumes client would provide consent in life-threatening circumstances

Vulnerable Persons

children and some adults, hospitalized individuals, mental illness, intellectual disabilities, older people, people living in isolation.

Quality of life

complicated ethical issue, can be used to determine who gets treatment

Brain death

considers irreversible cessation of all neurological function of entire brain, including brain stem. irreversible coma, vegetative state, permanent vegetative state.

Individually identifiable health information

demographic information which is created or received by a covered entity and that identifies an individual or offers a reasonable basis for identification and relates to a past, present, or future physical or mental health condition of an individual, provision of health care for an individual, or payment for healthcare

Power vs vulnerability

do not exploit the power to access private client info

Prejudice, personal values, and nursing

each individual brings own personal values. do not impose your own values on client.

Boundary violations

excessive personal disclosures

Right to privacy

expect property will be left alone

Nurse's role regarding ethics

expected to practice ethically, may be first to recognize ethical problem exists, responsible to report and help in making changes

Laws

formal, written rules of behavior that govern conduct, enforced by an authority

Magnet Recognition

grants status to health care organizations to designate excellence in nursing, including nurse leadership, nurse sensitive quality indicators, mutual respect, autonomy, and shared values

Malpractice

improper, injurious, or faulty treatment that results in illness or injury; harm result of action or lack of actions

Legal death

individual who has sustained loss of circulation and respiratory function

Your responsibility

know the legal and ethical standards before caring for clients

Liability

legal responsibility for one's actions or failure to act appropriately; commission or onission

Examples of advance directives

living will, directive to healthcare providers, durable power of attorney, mental health advance declaration

Slander

malicious verbal statements that are false or injurious

slander

malicious verbal statements that are false or injurious

Exceptions of death

marked hypothermia, severe depression of CNS after drug overdose with CNS depressant

The Ethics Committee

may consist of healthcare professionals, chaplains, social workers, and others. - chief functions: education, policy making, case review, consultation. acts as advocates for clients

Ethics

philosophic studies that examine actions, values, and moral principles of human behaviors; provide fundamental ideas of societal and cultural values of right versus wrong

Battery

physical contact with another person without that person's consent

Abandonment of care

prematurely stopped caring for a client

Limited data set

protected health information that excludes direct identifiers of the individual or of relatives, employers, or household members of the individual

Good Samaritan Act

protects against liability if give care within limits of first aid and act in reasonable and prudent manner in most states

Consent for care

provided by an individual, parent. 94 guardian if client minor, intellectual disability, or mentally incompetent

Emergency consent

provided by two physicians

Boundary crossings

questionable behavior

National Council of State Boards of Nursing (NCSBN)

responsible for creation of licensing examination