Chapter 3 Legal and Ethical Aspects of Nursing

What does the reasonable and prudent nurse do for the patient that they can not do for them self?

1) Covers the patient's body 2) Protects him from public exposure 3) Preserves his dignity

What is the nurses role regarding informed consent?

1) Witnessing of the signature 2) Providing comfort and support to the patient 3) Explaining nursing care expected after the procedure

Malpractice

A negligence by professional person. The person does not act according to professional standards of care as a reasonable and prudent professional would. In nursing malpractice, a reasonably and prudent person is similarly educated, licensed, and experienced nurse. Example: 1) If a nurse did not check the patient's vital signs and condition after surgery, there was a hemorrhage, and the patient went into shock and died. To prove malpractice , four elements must be present; 1) Duty 2) Breach of duty 3) Causation 4) Injury or damages

Breach of duty

Failure to use due care. Example: 1) A nurse fails to check vital signs or condition of patient after surgery 2) A nurse begins CPR on a patient who has DNR orders.

Introduction

Hello, I'm Scott, the day shift nurse at Toledo hospital , 4 east. Are you ready for eport

ISBAR-R

I- Introduction S- Situation B- Background A- Assessment R - Recommendation R - Read back

Whistle-blowing

Reporting illegal or unethical actions.

Ethics committee

A committee formed to consider ethical problems.

Leave against medical advice ( AMA )

A commonly used release

Release

A legal form used to excuse one party from liability ( responsibility )

Competent

A person who is legally fit, mentally and emotionally. A person is considered incompetent if he is: 1) Unconscious 2) Under the influence of mind altering drugs( including narcotics used as " premedication " for the procedure. 3) Declared legally incompetent. In these situations a next of kin, appointed guardian, or one who holds a durable power of attorney has the legal authority to give consent. Minors ( younger than 18 ) may NOT give legal consent; their parents or guardians have this right Custodial parent is the legal representative if parents are divorced. Stepparents usually can not give consent unless they have legally adopted the child. These considerations are considered legally capable of signing consent form: 1) An emancipated minor 2) A minor who has established independence by moving away from parents. 3) Service in the armed forces 4) Marriage 5) Pregnancy

Tort

A violation of civil law Example: 1) If you harm a patient, for example by administering the wrong dose of medication.

A licensed practical nurse (LPN) may supervise which of the following? (Select all that apply.) A) Nursing assistants (NAs) B) Nurse technicians C) LPNs D) Registered nurses (RNs)

A) Nursing assistants (NAs) B) Nurse technicians C) LPNs

Psychiatric patients can be held against their will in which situation? A) Unable to provide for basic needs B) Major depression C) Homelessness D) Substance abuse

A) Unable to provide for basic needs

Liability

Responsibility

Ethical codes

Actions and beliefs approved of by a particular group of people, are different from laws.

Sentinel event

An unexpected patient care event that results in death or serious injury. Communication is The Joint Commission's most frequently cited cause of sentinel events.

Read back

Ask receiving nurse if there are any questions and to read back notes for clarification.

Implied consent

Assumed when, during a life threatening emergency, consent cannot be obtained from the patient or family. Consent may be obtained by: 1) Telephone if it is witnessed by two people who hear the consent of the family member.

Which is true regarding assisted suicide? A) A constitutional right exists for physician-assisted suicide. B) Participation in assisted suicide is a violation of the American Nurses Association (ANA) Code for Nurses. C) Assisted suicide is a crime in all states. D) Assisted suicide is the same as euthanasia.

B) Participation in assisted suicide is a violation of the American Nurses Association (ANA) Code for Nurses

Nurses work in patient situations that give them permission to do what is usually not permitted in other circumstances. This is consistent with which legal term? A) Ethics B) Privilege C) Advocacy D) Competency

B) Privilege

One of the most common charges brought against nurses is: A) Discrimination B) Defamation C) Incompetence D) Libel

C) Incompetence

Informed consent

Indicates the patient's participation in the decision- making process. The person signing must have knowledge of what the consent allows and be able to make a knowledgeable decision. Informed consent for surgery or treatment must include four ( 4 ) elements. The patient must be told, in terms he can understand; 1) The risks and benefits of the proposed treatment. 2) The possible consequences of NOT having the procedure done. 3) Alternatives to treatment 4) The name of the health care professional who will preform the procedure.

It is important to determine that proper consent has been obtained , both legally and ethically. Failure to obtain a valid informed consent may lead to changes of assault and battery or invasion of privacy

It is important to determine that proper consent has been obtained , both legally and ethically. Failure to obtain a valid informed consent may lead to changes of assault and battery or invasion of privacy

It is the nurse's responsibility to explain why a particular drug or treatment is important. However, if the patient still refuses, the nurse should obtain a release from liability because the treatment is not done or the drug is not taken.

It is the nurse's responsibility to explain why a particular drug or treatment is important. However, if the patient still refuses, the nurse should obtain a release from liability because the treatment is not done or the drug is not taken.

Statutes

Laws that nay be either civil or criminal

Discrimination

Making a decision or treating people based on a class or group to which they belong, such as: 1) Race 2) Religion 3) Sex

Recommendations

Monitor pulse oximeter readings with vital signs once a shift Administer antibiotics and neutralizer treatments on time. Ambulate one more time this evening.

Assessment

Mrs Smith has clear lungs, her pulse oximeter reads 98% on 2 L of Oxygen. Vital signs: T 98.8, P 86, R 22, BP 128/72. She ambulated twice this shift down the hall and denies shortness of breath

Background

Mrs Smith is a 65 year old patient who was admitted 3 days ago with pneumonia and shortness of breath. She has completed 3 days of antibiotics, neutralizer treatments every 4 hours

Nurses are required by law in most states to report information regarding: 1) child abuse 2) Elder abuse 3) Sexual abuse 4) Violent acts that may be crimes ( stabbing or gunshot wound)

Nurses are required by law in most states to report information regarding: 1) child abuse 2) Elder abuse 3) Sexual abuse 4) Violent acts that may be crimes ( stabbing or gunshot wound)

Incident Report

Occurrence report Used to document what happened, the facts about the incident, and who was involved or who witnessed it. It is a tool used by the Risk- Management department. Incident reports are generally NOT filed as part of the patient's medical record; NO reference to the incident report is made in the patient's medical record. These reports should be 1) Timely 2) Factual 3) Concise and should not contain unnecessary details such as explanations about why the event might have occured.

Invasion of privacy

Occurs when there has been a violation of the confidential and privileged nature of a professional relationship. Examples: 1) Unauthorized persons learn of the patient's history, condition or treatment from the professional caregiver. 2) The nurse giving information over the phone to a caller who asks about the patient's condition. 3) When health care workers are overheard carelessly discussing their patients in the elevator or cafeteria 4) When a nurse reads the medical report of a public figure who has been admitted to their unit but to whom the nurse is not assigned. 5) Releasing information to the newspaper, another health care agency , an insurance company, or person without the patient's valid consent

Patient advocate

One who speaks for and protects the rights of the patient.

Slander

Oral form of defamation

Prudent

Sensible and careful

Advanced directive

Sometimes called a " Living Will " A consent that has been constructed before the need for it arises. It spells out a patient's wishes regarding surgery and diagnostic and therapeutic treatments. Examples: 1) Do not resuscitate

Euthanasia

Sometimes called a mercy killing The act of ending another person's life , with or without the person's consent, to end actual or potential suffering.

Health care agent

Surrogate decision maker A person chosen by the patient to follow the patient's advance directives and make medical decisions o his behalf.

Accountability

Taking responsibility for one's actions

Injury or damages

The actual harm or disorder that results from the negligence . Injury or damage may be: 1) Physical 2) Emotional 3) Financial Examples: 1) Pain and suffering 2) Loss of ability to continue in a job 3) Physical or emotional disability 4) Extended hospitalization 5) Death

Battery

The actual physical contact that has been refused or that is carried out against the person's will. Example: 1) When a patient is held down to receive an injection he has refused. 2) It was include the rough physical handling of an excited , confused, or psychotic patient in ways that would be described as angry, violent, or negligent

Delegation

The assignment of duties to another person. It is the delegating nurse's duty to supervise and evaluate the care that a licensed or unlicensed person provides.

Occupational Safety and Health Administration ( OSHA )

The mission is to keep working conditions safe for all workers.

Causation

The nurses action or inaction causes injury or harm to the patient. There must be a direct link between the breach of duty and the injury. Example: 1) The nurse's failure to check the patient's condition led to an undetected loss of blood that caused the patient's death.

Duty

The obligation to use due care. Example: 1) A nurse has a duty to monitor the condition of the patient for whom she is caring.

Assault

The threat to harm another or even to threaten to touch another without that person's permission. The person being threatened must believe that the nurse has the ability to carry out the threat. Example: 1) the nurse says, " If you don't let me give you this injection, two other nurses will hold you down so I can give it to you".

Nurse practice act

These laws define the scope of nursing practice and provide for regulation of the profession by a state board of nursing. It is important to know the nurse practice act of the state in which you work because these can differ from state to state.

Confidential

To keep private. Meaning that only only directly associated with care of that patient have legal access to the information in the medical record.

Can consent be withdrawn at any time before the procedure or treatment is started? True or false

True

Performing a procedure without the proper consent is considered battery? True or false

True, except in emergencies when the patient is unable to give consent.

Occupational Safety and Health ( OSA ) Act

Was passed to improve work environment in areas that affect workers' health and safety. It includes: 1) Regulations for handling infectious or toxic material 2) Radiation safeguards 3) The use of electrical equipment

Defamation

When one person makes remarks about another person that are untrue, and the remarks damage the other person's reputation. There are two forms of defamation: 1) Slander- oral 2) Libel- written

Assignment

Which can be done to an unlicensed person, such as a nursing assistant. An LPN may supervise 1) Nursing assistants 2) Technicians 3) Other LPN's

Do - Not - Resuscitate ( DNR ) Orders

Written by a physician when the patient has indicated a desire to be allowed to die if they stop breathing or or their heart stops. In this situation no cardiac compression's or assisted breathing ( cardiopulmonary resuscitation {CPR}) would be started. Very important for nursing personnel to know who is to be resuscitated and who is NOT. A nurse who attempts to resuscitate a patient who has a physician's DNR order would be acting without the patient's consent and committing battery.

Libel

Written defamation

Situation

You are communicating the 3:00 change of shift report for the 65 year old patient who was admitted 3 days ago with pneumonia

Standards of care

Rules as defined in nursing procedure books, institutional manuals of procedures or protocols, and nursing journals that outline current skills or techniques.

Laws

Rules of conduct that are established by our government.. These laws come from The constitution and Bill of rights, Laws made by elected officials, Regulations made by agencies created by elected officials.

Ethics

Rules of conduct that have been agreed to by a particular group. They are based on the consensus ( agreement ) of the group that these rules are morally right and proper. Ethics are different from laws; they are voluntary.

Ethical principles

Rules of right and wrong from an ethical point of view

False Imprisonment

Preventing a person from leaving or restricting his movements in the facility.

Living will

Advanced directives A consent that has been constructed before the need for it arises. It spells out a patient's wishes regarding surgery and diagnostic and therapeutic treatments.

Nondisclosure Agreement ( NDA )

Also known as a confidentiality agreement. This gives the hospital legal recourse if they can prove a person broke confidentiality.

Which is a true statement? A) Employers may ask about health status on an employment application. B) Sexual harassment is illegal when it interferes with job performance. C) Student nurses are not held to the same standards as a licensed nurse. D) In a case of child abuse, the account of injury given by the caregiver is consistent with physical signs and symptoms.

B) Sexual harassment is illegal when it interferes with job performance.

Which statement is true regarding advance directives? A) Advance directives expire. B) Emergency medical technicians may honor advance directives. C) A living will is a type of advance directive. D) Do-not-resuscitate (DNR) orders are written by nurses.

C) A living will is a type of advance directive.

Nurse Licensure compacts

Certain participating states allow nurses to be licensed in one state and practice in any state belonging to the compct.

_________is a wrong against society.

Crime

An unexpected patient care occurrence that results in death or serious injury to the patient is: A) Negligence. B) Malpractice. C) A tort. D) A sentinel event.

D) A sentinel event.

Informed consent may be given by a: A) Stepparent of a non-adopted child. B) 80-year-old with dementia. C) 72-year-old who has just taken morphine sulfate. D) Competent 19-year-old who has just taken Tylenol.

D) Competent 19-year-old who has just taken Tylenol

Reciprocity

Recognition of one state's nursing license by another state

Sexual harassment

Defined by the Equal Employment Opportunity Commission as : 1) Unwelcome sexual advances 2) Request for sexual favors Sexual harassment is illegal when used a a condition of employment or promotion or when it interferes with job performance

Quality and Safety for nurses ( QSEN ) project

Designed to better prepare nurses to have the knowledge , skills, and attitudes they need to improve the quality and safety of the health care system in which they work.

Protective devices

Devices that limit a person's mobility These devices may be: 1) Mechanical, such as : a) Locks b) Rails c) belts d) garments that prevent getting out of a bed or chair 2) Chemical, such as: a) Sedatives or tranquilizers AN ORDER BY AN AUTHORIZED HEALTH CARE PROVIDER IS NECESSARY FOR ANY PROTECTIVE DEVICE, MECHANICAL OR CHEMICAL. These orders must be renewed daily

Negligence

Failing to meet the standard of care. Failing to be sensible or careful.

Consent

Permission given by the patient or his legal representative. Consent and releases are legal documents that record the patient's permission to perform a treatment or surgery or to give information to insurance companies or other health care providers. These considerations are considered legally capable of signing consent form: 1) An emancipated minor 2) A minor who has established independence by moving away from parents. 3) Service in the armed forces 4) Marriage 5) Pregnancy

Privilege

Permission to do what is usually not permitted in other circumstances, in respect to a patient's body and emotions. Laws define the boundaries of that privilege and make clear the nurse's rights and responsibilities.

Who's responsibility is obtaining informed consent?

The health care professional performing the procedure or treatment.