Potter & Perry Ch 23: Legal Implications of Nursing Practice

Criminal Laws

Protect society as a whole and provide punishment for crimes, which are defined by municipal, state and federal legislation.

Civil Laws

Protect the rights of individuals within our society and provide for fair and equitable treatment when civil wrong or violations occur.

Tort

A civil wrong made against a person or property

Statutory Law

Elected legislative bodies such as state legislatures and the U.S. Congress

Unintentional Tort

Negligence, malpractice

A student nurse employed as a nursing assistant may perform care A. As learned in school B. Expected of a nurse at that level C. Identified in the hospital's job description. D. Requiring technical rather than professional skills.

C. Identified in the hospital's job description.

The nurse hears a physician say to the charge nurse that he doesn't want that same nurse caring for his patients because she is stupid and won't follow his orders. The physician also writes on his patient's medical records that the same nurse, by name, is not to care for any of his patients because of her incompetence. What component(s) of defamation has the physician committed? (Select all that apply). A. Slander B. Invasion of privacy C. Libel D. Assault E. Battery

A. Slander C. Libel

Privacy

The right of patients to keep personal information from being disclosed.

Confidentiality

Protects private patient information once it ha been disclosed in health care settings.

A nurse forgets to put the call light within the client's reach and then leaves the room. The client reaches for it and falls out of bed. The nurse could be charged with which of the following? A. Assault B. Battery C. Negligence D. Criminal Intent

C. Negligence

A client comes to the clinic and is found to have an STD (sexually transmitted disease). The client states to the nurse, "Promise you won't tell anyone about my condition." the nurse, according to the Health Insurance Portability and Accountability (HIPAA) of 1996, must do which of the following? A. Honor the client's wishes B. Communicate only necessary information C. Not disclose any information to anyone D. Respect the client's privacy and confidentiality

B. Communicate only necessary information

Malpractice

One type of negligence and often referred to as professional negligence.

Mr. Nick Barber, a 47-year-old professor, is a trauma patient who sustained injuries when he was crossing the street on campus. He was struck by a fast-moving car that failed to stop at a stop sign. He was rushed to the emergency department and then to surgery to repair his injuries. After surgery he was transferred to the medical-surgical unit for postsurgical management. Brad is the nursing student assigned to Mr. Barber. Currently Mr. Barber is resting quietly in his room with his wife present. 1. Mr. Barber has a durable power of attorney for health care (DPAHC). This document means that Mr. Barber has expressed in written form that he does not wish to be sustained on life support. True False 2. Brad carries Mr. Barber's laboratory requisition slip to the laboratory in the basement of the hospital. He folds the paper so Mr. Barber's information is not visible to others in the halls and elevators. Brad is protecting Mr. Barber's _______________. 3. The driver of the car who struck Mr. Barber is guilty of which unintentional tort? Homicide Manslaughter Negligence Assault Battery

1. Answer: B Rationale: The DPAHC is a legal document that designates a person or person of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf. A living will is a written document of the patient's wishes in which the patient declares what he or she wants in the event of a terminal illness or condition. 2. Answer: Confidentiality Rationale: Confidentiality protects private patient information once it has been disclosed in health care settings. Privacy is the right of patients to keep personal information from being disclosed. 3. Answer: C Rationale: The driver of the car that struck Mr. Barber is guilty of negligence since running the stop sign is conduct that falls below a standard of care.

Informed consent

A person's agreement to allow something to happen such as surgery or an invasive diagnostic procedure, based on full disclosure of risks, benefits, alternatives and consequences of refusal.

A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier. The nursing student says, "I don't understand what the bid deal is. As my instructor, you are there to protect me and make sure I don't make mistakes." What is the best response from the nursing instructor? A. "You are expected to perform at the level of a professional nurse." B. "You are expected to perform at the level of a nursing student." C. "You are practicing under the license of the nurse assigned to the patient." D. "You are expected to perform at the level of a skilled nursing assistant."

A. "You are expected to perform at the level of a professional nurse."

An elderly adult fell at home and fractured a hip, which requires surgical repair. After admittance to the emergency department, the client was given sedation for pain before a surgical permit was signed. What is the best action necessary to obtain consent? A. The physician should have the client's wife sign the consent form. B. Since the client has been medicated, the nurse should thoroughly explain the consent form to the client. C. The physician should wait until the effects of the medication wear off and have the client sign. D. This would be considered an emergency situation and consent would be implied.

A. The physician should have the client's wife sign the consent form.

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

Answer: 1. 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.

Risk management

An organization's system of ensuring appropriate nursing care by identifying potential hazards and eliminating them before harm occurs.

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."

Answer 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 caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care 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's manual 5. The American Nurses Association standards of nursing practice

Answer: 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 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

Answer 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.

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

Answer 4. Adult patients such as those with specific religious objection are able to refuse treatment for personal religious reasons but there needs to be clear directions on who can make the decision.

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

Answer 4. 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

Answer 4. The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.

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

Answer: 1, 4. The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be

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.

Answer: 2. 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.

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

Answer: 2. The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complic

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.

Answer: 3, 4. 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.

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

Answer: 3. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.

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

Answer: 3. 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 persons who are not involved in the patient's treatment.

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

Answer: 3. 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.

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

Answer: 3. The Privacy Rule of HIPAA requires that patient information be protected from unnecessary publication.

Standards of care

Are legal requirements for nursing practice that describe minimum acceptable nursing care.

A 17-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct? A. Prepare the organ donation form for the patient to sign while he is still oriented. B. Instruct the patient to talk with his parents about his desire to donate his organs. C. Notify the physician about the patient's desire to donate his organs. D. Contact the United Network for Organ Sharing after talking with the patient.

B. Instruct the patient to talk with his parents about his desire to donate his organs.

Which of the following client cannot legally give consent? A. A married 14-year-old girl. B. A 70-year-old man who is alert and oriented but unable to write his name. C. A 40-year-old client who has been sedated. D. A 50-year-old woman who cannot stop crying during explanation.

C. A 40-year-old client who has been sedated.

You are about to administer an oral medication and you question the dosage. You should A. Administer the medication B. Notify the physician. C. Withhold the medication D. Document that the dosage appears incorrect.

C. Withhold the medication

Defamation

Communications that are false

Negligence

Conduct that falls below a standard of care

A client is to undergo an invasive procedure by a physician. The client is questioning some of the terminology in the consent form. Which of the following is the best response by the nurse? A. "You should have asked your physician when he was in here." B. "I'll explain whatever you don't understand." C. "Just sign the form, and I'll make sure your physician talks to you before he begins the procedure." D. "I'll call your physician back in the room to answer your questions."

D. "I'll call your physician back in the room to answer your questions."

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? A. An unintentional tort B. Assault C. Invasion of privacy D. Battery

D. Battery

Which of the following can be delegated to an UAP? A. Giving pain medication. B. Reporting to the doctor for an abnormal laboratory result. C. Inserting an IV catheter. D. Checking oral temperature.

D. Checking oral temperature.

Libel

Defamation by means of print, writing or picture

Slander

Defamation by spoken word

Nursing Practice Acts

Describe and define the legal boundaries of nursing practice within each state.

Felony

Is a crime of serious nature that has a penalty of imprisonment for longer than 1 year or even death.

Misdemeanor

Is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year.

Common Law

Judicial decisions made in court when individual legal cases are decided.

Health Care Proxy or Durable power of Attorney for health care (DPAHC)

Legal document that designates a person or persons of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf.

Regulatory Law or Administrative Law

Reflects decisions made by administrative bodes such as State Boards of Nursing when they pass rules and regulations

Living wills

Represent written documents that direct treatment in accordance with a patient's wishes in the even of a terminal illness or condition.

Delegation

The transfer of a responsibility for the performance of an activity from one person to another while retaining accountability for the outcome

Intentional tort

Willful acts that violate another's rights such as assault, battery, and false imprisonment.