NUR2239 ATI Leadership

Nursing Role in Advocacy

-Nurses must ensure that clients are informed of their rights and have adequate information on which to base health care decisions -Nurses must be careful to assist clients w/making health care decisions and not direct or control their decisions -Nurses may need to mediate on the client's behalf when the actions of others are not in the client's best interest or changes need to be made in the plan of care -Situations that a nurse may need to advocate for clients or assist them to advocate for themselves: end-of-life decisions access to health care protection of client privacy informed consent substandard practice -Nurses are accountable for their actions even if they are carrying out a provider's prescription

Mandatory reporting

-abuse: child or elder abuse, domestic violence -communicable diseases (according to CDC) such as hepatitis and TB

Informed Consent Guidelines

-consent is required for all care given in a health care facility. -the client provides implied consent when she complies w/ the instructions provided by the nurse. -for an invasive procedure or surgery, the client is required to provide written consent. -State laws regulate who is able to give informed consent and laws vary regarding age limitations and emergencies. Nurses are responsible for knowing the laws in the state of practice. -Nurse must verify that consent is informed and witness the client sign the form

Nursing role in advance directives

-providing written information regarding advance directives -documenting the client's advance directives status -ensuring that advance directives are current and reflective of the client's current decisions -recognizing that the client's choice takes priority when there is a conflict between the client and family, or between the client and the provider -informing all members of the health care team of the client's advance directives

Elements necessary to prove negligence

1. duty - care that should be given or what a reasonably prudent nurse would do 2. breach of duty - failure to give the standard of care that should have been given 3. knowledge of harm - knowledge that failing to give the proper standard of care can cause harm to the client 4. breach of duty has potential to cause harm - failure to meet the standard had potential to cause harm 5. harm occurs - occurrence of actual harm to the client

A nurse witnesses an assistive personnel they are supervising reprimanding a client for not using the urinal properly. The AP threatens to put a diaper on the client if the urinal is not used more carefully next time. Which of the following torts is the AP committing? A. assault B. battery C. false imprisonment D. invasion of privacy

A

A nurse manager is observing the actions of a nurse they are supervising. Which of the following actions by the nurse requires the nurse manager to intervene? (SATA) A. Reviewing the health care record of a client assigned to another nurse B. Making a copy of a client's most current laboratory results for the provider during rounds C. Providing information about a client's condition to hospital clergy D. Discussing a client's condition over the phone with an individual who has provided the client's information code E. Participating in walking rounds that involve the exchange of client-related information outside clients' rooms

A, B, C, E

A nurse is serving as a preceptor to a newly licensed nurse and is explaining the role of the nurse as advocate. Which of the following situations illustrates the advocacy role? (SATA) A. verifying that a client understands what is done during a cardiac catheterization B. discussing treatment options for a terminal diagnosis C. informing members of the health care team that a client has a DNR status D. reporting that a health team member on the previous shift did not provide care as prescribed E. Assisting a client to make a decision about their care based on the nurse's recommendations

A, C, D

Intentional torts

Assault: the conduct of one person makes another person fearful and apprehensive (threatening to place a nasogastric tube in a client who is refusing to eat) Battery: intentional and wrongful physical contact with a person that involves an injury or offensive contact (Restraining a client and administering an injection against their wishes) False imprisonment: a competent person not at risk for injury to self or others is confined or restrained against their will (using restraints on a competent client to prevent their leaving the health care facility)

A newly licensed nurse is preparing to insert an IV catheter in a client. Which of the following should the nurse to review the procedure and the standard at which it should be performed? A. Website B. Institutional policy and procedure manual C. More experienced nurse D. State nurse practice act

B

A nurse is caring for a child who is being treated in the ED following a head contusion from a fall. History reveals the child lives at home with one parent. The provider's discharge instructions include waking the child every hour to assess for indications of a possible head injury. In which of the following situations should the nurse intervene and attempt to prevent discharge? A. the parent states they do not have insurance or money for a follow-up visit B. the child states, "my head hurts, and I want to go home." C. the nurse smells alcohol on the parent's breath D. the parent verbalizes fear about taking the child home and requests they be kept overnight

C

A nurse is caring for a client who is scheduled for surgery. The client hands the nurse information about advance directives and states, "Here, I don't need this. I am too young to worry about life-sustaining measures and what I want done for me." Which of the following actions should the nurse take? A. Return the papers to the admitting department with a note stating that the client does not wish to address the issue at this time B. Explain to the client that you never know what can happen during surgery and to fill the papers out just in case C. Contact a client representative to talk with the client and offer additional information about the purpose of advance directives D. Inform the client that surgery cannot be conducted unless the advance directives forms are completed

C

Confidentiality and information security

Clients have the right to privacy and confidentiality in relation to their health care information and medical recommendations. Nurses who disclose client information to an unauthorized person can be liable for invasion of privacy, defamation, or slander The security and privacy rules of HIPAA were enacted to protect confidentiality of health care information and to give the client the right to control the release of information. Specific rights provided by the legislation include the following: The rights of clients to obtain a copy of their medical record and to submit requests to amend erroneous or incomplete information A requirement for health care and insurance providers to provide written information about how medical information is used and how it is shared with other entities (permission must be obtained before information is shared) The rights of clients to privacy and confidentiality

Interventions to deter disruptive behaviors

Create an environment of mutual respect among staff Model appropriate behavior Increase staff awareness about disruptive behavior Make staff aware that offensive online remarks about employers and coworkers are a form of bullying and are prohibited even if the nurse is off-duty and it is posted off-site from the facility Avoid making excuses for disruptive behavior Support zero tolerance for disruptive behavior Establish mechanisms for open communication between staff nurses and nurse managers Adopt policies that limit the risk of retaliation when disruptive behavior is reported

A nurse is reviewing a client's health care record and discovers that the client's DNR prescription has expired. The client's condition is not stable. Which of the following actions should the nurse take? A. assume that the client does not want to be resuscitated, and take no action if they experience cardiac arrest B. write a note on the front of the provider prescription sheet asking that the DNR be represcribed C. anticipate that CPR will be instituted if the client goes into cardiopulmonary arrest D. call the provider to determine whether the prescription should be immediately reinstated

D

A nurse manager is providing information to the nurses on the unit about ensuring client rights. Which of the following regulations outlines the rights of individuals in health care settings? A. American Nurses Association Code of Ethics B. HIPAA C. Patient Self-Determination Act D. Patient Care Partnership

D

Federal regulations

HIPAA Americans with Disabilities Act (ADA) Mental Health Parity Act (MHPA) Patient Self-Determination Act (PSDA) Uniform Anatomical Gift Act (UAGA) National Organ Transplant Act (NOTA) Emergency Medical Treatment and Active Labor Act (EMTALA)

Information Security

Health information systems (HIS) are used to manage administrative functions and clinical functions. The clinical portion of the system is often referred to as the clinical information systems (CIS). The CIS can be used to coordinate essential aspects of client care. In order to comply with HIPAA regulations, each health care facility has specific policies and procedures designed to monitor staff adherence, technical protocols, computer privacy, and data safety. Information security protocols Log off from the computer before leaving the workstation to ensure that others cannot view protected health information (PHI) on the monitor. Never share a user ID or password with anyone Never leave a client's chart or other printed or written PHI where others can access it Shred any printed or written client information used for reporting or client care after it is no longer needed

Legal practice

In order to be safe practitioners, nurses must understand the legal aspects of the nursing profession. Understanding the laws governing nursing practice allows nurses to protect client rights and reduce risk of nursing liability. Nurses are accountable for practicing nursing in accordance with the various sources of law affecting nursing practice. It is important that nurses know and comply with these laws. By practicing nursing within the confines of the law, nurses are able to do the following: provide safe, competent care advocate for clients' rights provide care that is within the nurse's scope of practice discern the responsibilities of other members of the health care team provide care that is consistent with established standards of care Shield oneself from liability

Information technology

Informatics is the use of computers to systematically resolve issues in nursing. The use of technology in health care is increasing and most forms of communication are in electronic format. Examples of how a nurse can use the electronic format while providing client care include laptops for documentation and use of an automated medication dispensing system to dispense medications. Databases on diseases and medications are available for the nurse to review. These databases can also be used as a teaching tool when nurses are educating clients. The nurse can review medications, diseases, procedures, and treatments using an electronic format. Computers can be beneficial for use with clients who have visual impairments. The internet is a valuable tool for clients to review current medications and health questions. This is especially true for clients who has chronic illnesses. Nurses should instruct clients to only review valid and credible websites by verifying the author, institution, credentials, and how current the article is. A disclaimer will be presented if information is not medical advice. Clients can access their electronic health record which is part of e-health. E-health enables the client to make appointments online, review lab results, refill an electronic prescription, and review billing information. The goal of e-health is improved health care outcomes due to 24 hr access by the client and provider to the client's health care information.

Quasi-intentional torts

Invasion of privacy: intrusion in to a client's private affairs or a breach of confidentiality (A nurse releases the medical diagnosis of a client to a member of the press) Defamation: False communication or communication with careless disregard for the truth with the intent to injure an individual's reputation. - Libel: Defamation with the written word or photographs (a nurse documents in a client's health record that a provider is incompetent) Slander: Defamation with the spoken word (a nurse tells a coworker that she believes a client has been unfaithful to the spouse)

The nursing role in confidentiality

It is essential to be aware of the rights of clients in regard to privacy and confidentiality. Facility policies and procedures are established in order to ensure compliance with HIPAA regulations. It is essential that nurses know and adhere to the policies and procedures. HIPAA regulations also provide for penalties in the event of noncompliance with the regulations

Living will

Legal document that expresses a client's wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues. Types of treatments that are often addressed in a living will are those that have the capacity to prolong life. Examples of treatments are CPR, mechanical ventilation, and feeding by artificial means. Living wills are legal in all states. However, state statutes and individual health care facility policies can vary. Nurses need to be familiar with their state statute and facility policies. Most state laws include provisions that health care providers who follow the health care directive in a living will are protected from liability.

Standards of Care (practice)

Legal parameters of practice, define and direct the level of care that should be given by a practicing nurse. They are used in malpractice lawsuits to determine if that level was maintained.

Components of advance directives

Living will Durable power of attorney for health care Provider's prescriptions

Malpractice (Professional Negligence)

Malpractice is the failure of a person with professional training to act in a reasonable and prudent manner. The terms "Reasonable and prudent" are generally used to describe a person who has the average judgment, foresight, intelligence, and skill that would be expected of a person with similar training and experience. Professional negligence issues that prompt most malpractice suits include failure to do the following: Follow either professional or facility established standards of care Use equipment in a responsible and knowledgeable manner Communicate effectively and thoroughly with the client Document care that was provided Nurses can avoid being liable for negligence by doing the following: Following standards of care Giving competent care Communicating with other health team members Developing a caring rapport with clients Fully documenting assessments, interventions, and evaluations

Unintentional Torts

Negligence: practice or misconduct that does not meet expected standards of care and places the client at risk for injury (a nurse fails to implement safety measures for a client who has been identified as at risk for falls) Malpractice: Professional negligence (A nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies)

Transcribing medical prescriptions

Nurses might need to receive new prescriptions for client care or medications by verbal or telephone prescriptions When transcribing a prescription into a paper or electronic chart, nurses must do the following: Be sure to include all necessary elements of a prescription: date and time prescription was written; new client care prescription or medication including dosage, frequency, route of administration; and signature of nurse transcribing the prescription as well as the provider who verbally gave the prescription Follow institutional policy with regard to the time frame within which the provider must sign the prescription (within 24 hr) Use strategies to prevent errors when taking a medical prescription that is given verbally or over the phone by the provider Repeat back the prescription given, making sure to include the medication name, dosage, time, and route Question any prescription that seems contraindicated due to a previous or concurrent prescription or client condition

Advocacy

Nurses' role in supporting clients by ensuring that they are properly informed, that their rights are respected, and that they are receiving the proper level of care. One of the most important roles of the nurse, especially when the client is unable to speak or act for themselves. Nurse ensures that the client has the information they need to make decisions about health care. Nurses must act as advocates even when they disagree with the clients' decisions. The complex health care system puts clients in a vulnerable position. Nurses are clients' voice when the system is not acting in their best interest. Nursing profession also has responsibility to support and advocate for legislation that promotes public policies that protect clients as consumers and create a safe environment for their care.

Organ donation

Organ and tissue donation is regulated by federal and state laws. Health care facilities have policies and procedures to guide health care workers involved with organ donation Donations can be stipulated in a will or designated on an official card Federal law requires health care facilities to provide access to trained specialists who make the request to clients and/or family members and provide information donated, and how burial or cremation will be affected by donation Nurses are responsible for answering questions regarding the donation process and for providing emotional support to family members

Informed consent responsibilities

Provider: obtains informed consent. To do so, the provider must give the client the following: Complete description of the treatment/procedure Description of the professionals who will be performing and participating in the treatment Description of the potential harm, pain, and/or discomfort that might occur Options for other treatments and the possible consequences of taking other actions The right to refuse treatment The risk involved if the client chooses no treatment Client: gives informed consent. To give informed consent, the client must do the following: Give it voluntarily (no coercion involved) Be competent and of legal age, or be an emancipated minor Receive sufficient information to make a decision based on an informed understanding of what is expected Nurse: Witnesses informed consent. The nurse is responsible for the following: Ensuring that the provider gave the client the necessary information Ensuring that the client understood the information and is competent to give informed consent Having the client sign the informed consent document Notifying the provider if the client has more questions or does not understand any of the information provided (provider is responsible for giving clarification) The nurse documents the following: Reinforcement of information originally given by the provider That questions the client had were forwarded to the provider Use of an interpreter

Advance directives

Purpose of advance directives is to communicate a client's wishes regarding end-of-life care should the client become unable to do so The PSDA requires that all clients admitted to a health care facility be asked if they have advance directives A client who does not have advance directives must be given written information that outlines their rights related to health care decisions and how to formulate advance directives A health care representative should be available to help with this process

Essential Components of Advocacy

Skills: Risk-taking Vision Self-confidence Articulate communication Assertiveness Values: Caring Autonomy Respect Empowerment

Behaviors Consistent with a substance use disorder

Smell of alcohol on breath or frequent use of strong mouthwash or mints Impaired coordination, sleepiness, shakiness, and/or slurred speech bloodshot eyes mood swings and memory loss neglect of personal appearance excessive use of sick leave, tardiness, or absences after a weekend off, holiday, or payday frequent requests to leave the unit for short periods of time or to leave the shift early Frequently "forgetting" to have another nurse witness wasting of a controlled substance Frequent involvement in incidences where a client assigned to the nurse reports not receiving pain medication or adequate pain relief (impaired nurse provides questionable explanation) Documenting administration of pain medication to a client who did not receive it or documenting a higher dosage than has been given by other nurses Preferring to work the night shift where supervision is less or on units where controlled substances are more frequently given

Privacy Rule

The Privacy Rule of HIPAA requires that nurses protect all written and verbal communication about clients. Components of the Privacy Rule: Only health care team members directly responsible for the client's care are allowed access to the client's records. Nurses cannot share information with other clients or staff not involved in the care of the client. Clients have a right to read and obtain a copy of their medical record, and agency policy should be followed when the client requests to read or have a copy of the record. No part of the client record can be copied except for authorized exchange of documents between health care institutions, for example - Transfer from a hospital to an extended care facility or exchange of documents between a general practitioner and a specialist during a consult Client medical records must be kept in a secure area to prevent inappropriate access to the information. Using public display boards to list client's names and diagnosis is restricted. Electronic records should be password-protected, and care must be taken to prevent public viewing of the information. Health care workers should use only their own passwords to access information. Client information cannot be disclosed to unauthorized individuals, including family members who request it and individuals who call on the phone. Many hospitals use a code system in which information is only disclosed to individuals who can provide the code Nurses should ask any individual inquiring about a client's status for the code and disclose information only when an individual can give the code Communication about a client should only take place in a private setting where it cannot be overheard by unauthorized individuals. The practice of "walking rounds", where other clients and visitors can hear what is being said, is no longer sanctioned. Taped rounds also are discouraged because nurses should not receive information about clients for whom they are not responsible. Change-of-shift reports can be done at the bedside as long as the client does not have a roommate and no unsolicited visitors are present.

Ethical practice

The ability to integrate core values, integrity, and accountability throughout all organizational and business practices.

State laws

The core of nursing practice is regulated by state law. Each state has enacted statutes that define the parameters of nursing practice and give the authority to regulate the practice of nursing to its state board of nursing. Boards of nursing have the authority to adopt rules and regulations that further regulate nursing practice. Although the practice of nursing is similar among states, it is critical that nurses know the laws and rules governing nursing in the state in which they practice. The laws and rules governing nursing practice in a specific state can be accessed at the state board's website. Boards of nursing have the authority to both issue and revoke a nursing license. Boards can revoke or suspend a nurse's license for a number of offenses, including practicing without a valid license, substance use disorders, conviction of a felony, professional negligence, and providing care beyond the scope of practice. Nurses should review the practice act in their states. Boards also set standards for nursing programs and further delineate the scope of practice for registered nurses, licensed practical nurses, and advanced practice nurses. State laws vary as to when an individual can begin practicing nursing. Some states allow graduates of nursing programs to practice under a limited license, whereas some states require licensure by passing NCLEX before working.

Signing an informed consent form

The form for informed consent must be signed by a competent adult Emancipated minor from their parents can provide informed consent for themselves The person who signs the form must be capable of understanding the information provided by the health care professional who will be providing the service. The person must be able to fully communicate in return with the health care professional. When the person giving the informed consent is unable to communicate due to a language barrier or hearing impairment, a trained medical interpreter must be provided. Many health care agencies contract with professional interpreters who have additional skills in medical terminology to assist with providing information.

Use of social media

The use of social media by members of the nursing profession is common practice. The benefits to using social media are numerous. It provides a mechanism for nurses to access current information about health care and enhances communication among nurses, colleagues, and clients and families. It also provides an opportunity for nurses to express concerns and seek support from others. However, nurses must be cautious about the risk of intentional or inadvertent breaches of confidentiality via social media. The right to privacy is a fundamental component of client care. Invasion of privacy as it relates to health care is the release of client health information to others without the client's consent. Confidentiality is the duty of the nurse to protect a client's private information. The inappropriate use of social media can result in a breach of client confidentiality. Depending on the circumstances, the consequences can include termination of employment by the employer, discipline by the board of nursing, charges of defamation or invasion of privacy, and in the most serious of circumstances, federal charges for violation of HIPAA. Protecting yourself and others Become familiar with facility policies about the use of social media, and adhere to them Avoid disclosing any client health information online. Be sure no one can overhear conversations about a client when speaking on the telephone Do not take or share photos or videos of a client Remember to maintain professional boundaries when interacting with client, employer, or coworker Never post a belittling or offensive remark about a client, employer, or coworker Report any violations of facility social media policies to the nurse manager

Provider's prescriptions

Unless a do not resuscitate (DNR) or allow natural death (AND) prescription is written, the nurse should initiate CPR when a client has no pulse or respirations. The written prescription for a DNR or AND must be placed in the client's medical record. The provider consults the client and the family prior to administering a DNR or AND. Additional prescriptions by the provider are based on the client's individual needs and decisions and provide for comfort measures. The client's decision is respected in regard to the use of antibiotics, initiation of diagnostic tests, and provision of nutrition by artificial means

Licensure

Until the year 2000, nurses were required to hold a current license in every state in which they practiced. This became problematic with the increase in electronic practice of nursing. For example, a nurse in one state interprets the reading of a cardiac monitor and provides intervention for a client who is physically located in another state. Additionally, many nurses cross state lines to provide direct care. For example, a nurse who is located near a state border makes home visits on both sides of the state line. To address these issues, the mutual recognition model of nurse licensure has been adopted by many states. This model allows nurses who reside in a NLC state to practice in another NLC state. Nurses must practice in accordance with the statues and rules of the state in which the care is provided. State boards can prohibit a nurse from practicing under the NLC is the license of the nurse has been restricted by a board of nursing. Nurses who do not reside in a NLC state must practice under the state-based practice model. In other words, if a nurse resides in a non-NLC state, the nurse must maintain a current license in every state in which they they practice. Some states now require background checks with licensure renewal. It is illegal to practice nursing with an expired license. The Enhanced Nurse Licensure Compact (eNLC) was revised in 2017. It aligned licensing standards (Criminal history background checks) in an effort to bring more states into the compact. Nurses in eNLC states have one multistate license, with the ability to practice in-person or via telehealth in both their home state and other eNLC states.

Good Samaritan Law

Vary state to state Protect nurses who provide emergency assistance outside of the employment location The nurse must provide a standard of care that is reasonable and prudent

Durable power of attorney for health care

a legal document that designates a person to make health care decisions on behalf of a patient in the event the patient becomes incapacitated The person who serves in the role of health care surrogate to make decisions for the client should be very familiar with the client's wishes Living wills can be difficult to interpret, especially in the face of unexpected circumstances. A durable power of attorney for health care, as an adjunct to a living will, can be a more effective way of ensuring that the client's decisions about health care are honored.

Impaired Coworkers

a nurse who suspects a coworker of any behavior that jeopardizes client care or could indicate substance use disorder has a duty to report the coworker to the appropriate manger. each state has laws and regulations that govern the disposition of nurses who have substance use disorders. criminal charges could apply.

Autonomy

ability of the clients to make personal decisions, even when those decisions might not be in the client's own best interests

Ethical theory

analyzed varying philosophies, systems, ideas, and principles used to make judgments about what is right and wrong, good and bad. Two common types of ethical theory are utilitarianism and deontology. Utilitarianism (teleological theory): decision-making based on what provides the greatest good for the greatest number of the individuals Deontological theory: decision-making based on obligations, duty, and what one considers to be right or wrong Unusual or complex ethical issues might need to be dealt with by a facility's ethics committee

Beneficence

care that is in the best interest of the client

Ethical decision-making in nursing

ethical dilemmas are problems for which more than one choice can be made, and the choice is influenced by the values and beliefs of the decision-makers. These are common in health care, and nurses must be prepare to apply ethical theory and decision-making.

Justice

fair treatment in matters related to physical and psychosocial care and use of resources

Ethics

foundation is based on an expected behavior of a certain group in relation to what is considered right and wrong

Types of disruptive behavior

incivility: -action that is rude, intimidating, and insulting Lateral Violence: -occurs between workers who are at the same level within the organization bullying behavior: -persistent and relentless and is aimed at an individual who has limited ability to defend themselves -perpetrator is at a higher level than the victim cyberbullying: -disruptive behavior using the internet or other electronic means

Fidelity

keeping one's promise to the client about care that was offered

Client rights

legal guarantees that clients have with regard to their health care Nurses are accountable for protecting the rights of clients. Nursing role in client rights: Must ensure that clients understand their rights. Also must protect clients' rights during nursing care. Inform client about all aspects of care and client can take an active role in the decision-making process Clients can accept, refuse, or request modification to the plan of care. Clients receive care that is delivered by competent individuals who treat the client with respect.

Informed Consent

legal process by which a client has given written permission for a procedure or treatment to be performed. Consent is considered to be informed when the client has provided with and understands the following: Reason the treatment or procedure is needed How the treatment or procedure will benefit the client Risks involved if the client chooses to receive the treatment or procedure Other options to treat the problem, including the option of not treating the problem Risk involved if the client chooses no treatment Nurse's role in the informed consent process is to witness the client's signature on the informed consent form and to ensure that informed consent has been appropriately obtained. Nurse should seek the assistance of an interpreter if the client does not speak and understand the language used by the provider.

Disruptive behavior

nurses experience incivility, lateral violence, and bullying at an alarming rate. The perpetrator can be a provider or a nursing colleague. Consequences of disruptive behavior include poor communication, which can negatively affect client safety and productivity, resulting in absenteeism, decreased job satisfaction, and staff turnover. Some nurses can choose to leave the profession due to these counterproductive behaviors. If disruptive behavior is allowed to continue, it is likely to escalate. Over time, it can be viewed as acceptable in that unit or department's culture.

Professional Responsibilities

obligations that nurses have to their clients. To meet their professional responsibilities, nurses must be knowledgeable in the following areas: Client rights Advocacy Informed consent Advance directives Confidentiality and information security Information technology Legal practice Disruptive behavior Ethical practice

Individuals authorized to grant consent for another person

parent of a minor legal guardian court-specific representative client's health care surrogate (individual who has the client's durable power of attorney for healthcare/healthcare proxy) spouse or closest available relative (state laws vary)

Civil law

protect the individual rights of people. One type of civil law that relates to the provision of nursing care is tort law. Torts can be classified as unintentional, quasi-intentional, or intentional.

Ethical principles

standards of what is right/wrong with regard to important social values and norms

Criminal law

subsection of public law and relates to the relationship of an individual with the government. Violations of criminal law can be categorized as either a felony (a serious crime such as homicide) or misdemeanor (a less serious crime such as petty theft). A nurse who falsifies a record to cover up a serious mistake can be found guilty of breaking a criminal law

Refusal of Treatment

the Patient Self-Determination Act (PSDA) stipulates that staff must inform clients they admit to a health care facility of their right to accept or refuse care. if client refuses a tx. they sign a document indicating he or she understands the risk involved with refusing and that they have chosen so. when clients decide to leave the facility against medical advice the nurse notifies the provider and discusses with the client the risks to expect when leaving the facility prior to discharge. nurse then ask client to sign an "Against Medical Advice" form and documents the incident. If client refuses to sign the form, this is also documented by the nurse.

Veracity

the nurse's duty to tell the truth

Nonmaleficence

the nurse's obligation to avoid causing harm to the client

Morals

values and beliefs held by a person that guide behavior and decision-making