Ethical and legal considerations ATI Notes

examples of anesthesia related sentinel event

- anesthesia medication error -airway management event

examples of protection sentinel event

- client elopement -infant abduction -self-harm

examples of implied consent

- insertion of a urinary catheter -Initiation of an IV Site -Administration of pain medication

EMTALA

-All clients must have a medical screening evaluation (MSE). -If the client is, in fact, experiencing an emergency, the hospital must stabilize the client. If the hospital cannot provide the specific level of care (treatment and management) of the emergency condition, they must transfer the stabilized client to a facility that can. -In the event the client cannot be stabilized in said ED, a physician or another qualified medical professional must verify and sign off transfer, clearly indicating that the benefits of transfer outweigh the risks of transferring an unstable client.

Maltreatment may present itself in many forms, including but not limited to the following:

-Physical maltreatment or denying food, shelter, or comfort -Neglect, denial or delaying of care -Verbal or emotional maltreatment -Sexual maltreatment -Financial exploitation -Educational maltreatment or neglect -Lack of protection from harm

Five Rights of Delegation

-Right task: The task being delegated must be within the job description of the delegatee. Expectations and limitations of the task should also be clearly outlined in the policies and procedures of the facility. -Right circumstance: The nurse should ensure that the client's condition is stable. The delegatee must also communicate any changes in the client's condition. -Right person: The delegatee must have the ability and knowledge to perform the task. -Right directions and communications: The nurse must communicate specific instructions to the delegatee. The delegatee should clarify these instructions and ask questions, if needed. -Right supervision and evaluation: When delegating, the nurse is responsible for monitoring and ensuring that the task is completed appropriately. The nurse must also evaluate the client outcome and ensure that appropriate documentation is completed.

Which of the following documentation scenarios is an example of falsification of health records?

-The nurse checks the client's level of pain, but doesn't document the finding. -The nurse realizes that they missed checking the client's vital signs, so they document findings that were similar to the previous data. -The nurse talks with the dietician about the client's request for a vegan diet, but doesn't document the communication. -The nurse forgets to ambulate a client as prescribed, but documents that the client ambulated in the hall with assistance.

Provisions 4 to 6 of the Code refer to the duty and loyalty that the nurse is expected to show to their clients and themselves

-The nurse should demonstrate authority, accountability, and responsibility for promoting best practices. -The nurse should promote health and provide the best care they can for each client. -The nurse should maintain competence, practice the accepted values of the nursing profession, and promote a healthy and safe practice environment. -The nurse should adhere to the ethical principles of the nursing profession.

Provisions 7 to 9 of the Code refer to the duty and loyalty the nurse is expected to show beyond direct client encounters and to the nursing profession as a whole

-The nurse should promote the profession of nursing through research and inquiry. -The nurse should participate in the development of standards of practice and policies governing nursing and health care. -The nurse should collaborate with other members of the interprofessional team to protect the rights of all individuals and decrease health disparities. -The nurse should promote the integrity of the nursing profession.

Provisions 1 to 3 of the Code refer to the fundamental values of the nursing profession and the nurse's commitment to those that they care for

-The nurse should provide compassionate care and respect for the client. -The nurse should recognize that each client is unique, has worth, and deserves to be treated with dignity. -The nurse should be an advocate for each client's rights and needs. -The nurse should promote and protect the health and safety of each client.

A nurse works in a small community hospital ED and receives a report from EMS that they are en route with a pediatric client who has severe burns to the upper body and difficulty breathing. The nearest burn center is 75 min away. Which of the following actions should the nurse and ED team take to adhere to EMTALA?

Attempt to stabilize the client in the ED before transport to the burn center.

Ethical Principles

Autonomy Beneficence Nonmaleficence Justice Fidelity Veracity

A nurse is caring for a client who requests help to get out of bed and ambulate to the bathroom. Before assisting the client to get out of bed, the nurse makes sure that the client has on nonskid footwear and that the room is free from clutter that the client could trip over. Which of the following ethical principles is the nurse practicing when taking these actions?

Beneficence

The provider who is performing the procedure or treatment is legally responsible for obtaining informed consent and must provide the client with the following information prior to asking a client to give informed consent and sign the consent form:

-The proposed treatment or procedure -Who will perform the treatment or procedure -The purpose of the proposed treatment or procedure -The expected outcomes of the proposed treatment or procedure -The benefits of the proposed treatment or procedure -The possible risks associated with the proposed treatment or procedure -The alternatives to the particular treatment or procedure -The benefits and risks associated with alternatives to the proposed treatment or procedure -The client's right to refuse a proposed treatment or procedure

examples of criminal sentinel event

-assault -false imprisonment

examples of care management sentinel events

-client fall -restraint related event -pressure injury

examples Informed consent

-colonoscopy to screen for colon cancer -Scheduled cesarean section -Elective cosmetic surgery

Standards of Professional Performance

-ethics -culturally congruent practice -communication -collaboration -leadership -education -evidence-based practice -quality of practice -professional practice evaluation -resource utilization -environment health

examples of product or device sentinel event

-failure of intravenous infusion device

examples of environmental sentinel event

-fire

negative effects on the nurse (fatigue)

-increased risk of chronic illnesses -increased risk of mental health disorders -decreased clinical judgment -decreased communication with the interprofessional team

negative effects on the client (fatigue)

-increased risk of medication errors -increased risk of receiving unsafe care -increased client mortality rate

Which of the following would be included in advance directives?

-living will -durable power of attorney for health care -organ donation form -do not intubate (DNI) ordeer

causes of nurse fatigue

-long and varying shifts -increased client load -nursing shortages

manifestations of nurse fatigue

-physical exhaustion -psychological exhaustion

examples of suicide sentinel events

-suicide while receiving care -suicide within 72 hours of discharge

examples of surgical or invasive procedure sentinel events

-wrong procedure -wrong site -wrong client

ANA's Principles for Social Networking

1. Nurses should not transmit or post any identifiable client information. 2. Nurses should maintain professional boundaries if communicating with a client through social media. 3. Nurses should expect posted information to be potentially viewed by the client, peers, and supervisors. 4. Nurses should use privacy settings provided by social media platforms and attempt to keep personal versus professional information separate. 5. Nurses should advocate for client rights and report any instances of client information or communication on social media that is in violation of legal and ethical standards. 6. Nurses should work with their employer to develop effective policies and procedures to ensure professional communication with clients and to safeguard client information on social media.

The code of ethics includes __ provisions

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Cynthia's team has completed Step 1 of the ethical decision-making process and has determined that an ethical dilemma does exist. Moving to Step 2 of the ethical decision-making process, identify the ethical dilemma. Identify at least three possible solutions that could be presented during Step 3 of the ethical decision-making process when addressing this ethical dilemma.

Cynthia Parker is a 19-year-old client who is unresponsive and receiving ventilator support. The client's provider recommends discontinuation of ventilator support. Cynthia's parents do not agree on their feelings, values, or thoughts about what Cynthia's decision would be regarding whether or not to continue ventilator support. Possible solutions to this ethical dilemma include: Discontinuing ventilator support at this time Continuing ventilator support indefinitely Discontinuing ventilator support after a period of time has elapsed if Cynthia's status is unchanged

Code of Ethics

Developed by the ANA, this document outlines rules for nurses about client privacy, nursing conduct, and nursing behaviors to protect clients and the profession. -the ideals, duties, and obligations that nurses are expected to uphold as members of the nursing profession.

falsification can occur if the nurse does any of the following:

Doesn't document a client assessment Doesn't document communication with members of the interprofessional team Documents inaccurate assessment data Documents care, events, assessments, or activities that did not actually occur

Nonmaleficence

Doing no harm, or the least amount of harm to the client, while trying to achieve the best possible outcome.

Emergency Medical Treatment and Labor Act (EMTALA)

Ensures that all individuals, regardless of their insurance or financial status, have equal access to emergency medical care.

standards of practice

Explanatory statements that describe a competent level of care for all nurses, using the critical thinking model known as the nursing process

good samaritan laws

Good Samaritan laws protect and encourage people (including nurses) to provide aid in the event of an emergency, without fear of being held liable for their well-intentioned actions. These laws will protect a nurse if they perform reasonable behavior to protect the life of an injured person and save this person from further harm until emergency personnel arrive to assume the care.

Suppose you are caring for a client who is friends with one of the other nurses on the unit. The other nurse asks you how their friend is doing today. How would you respond and why?

If asked to discuss a client's protected health information you should state that you cannot discuss the client's health status without the client's consent. Even though the other nurse works on the unit, they do not have authorized access to the client's PHI unless they are assigned to the client's care. If appropriate, it could be suggested that the other nurse talk to their friend directly to see how they're doing. This response protects the client's right to confidentiality and abides by HIPAA guidelines.

In the video the charge nurse is informed that the client's protected health information (PHI) is displayed on a computer. Which of the following actions should the nurse take first?

Log out the client's nurse from the computer.

ethical decision making

Process of evaluating and choosing options in an ethically consistent manner using ethical principles.

Malpractice insurance is designed to protect nurses from financial burdens, licensing restrictions, and loss of work. Nurses can help protect themselves from civil and criminal action by taking these steps.

Research insurance coverage for malpractice and consider purchasing a separate policy. Diligently follow the rules, guidelines, policies, and procedures for the facility and state in which they work. Review the protection coverage of their employer. Be knowledgeable about the Nurse Practice Act of the state in which they are employed Put the client first in their practice.

ethical dilemmas

Situation where a critical choice must be made, but the solution may not be ethically acceptable.

Ethical Decision Making Process

Step 1: Is there an ethical dilemma? Step 2: Clearly identify the ethical dilemma Step 3: Identify possible solutions Step 4: Apply ethical principles to the solutions Step 5: Include all relevant individuals and factors Step 6: Decide on a solution Step 7: Review the decision Step 8: Put the decision into action

Health Insurance Portability and Accountability Act of 1996 (HIPPAA)

The Health Insurance Portability and Accountability Act, also known as the Privacy Act, is legislation to protect insurance coverage and private information of clients. Its purpose is to protect client privacy and personal health information for security breaches, particularly electronic data. It was established by the federal government with the goal of making health care more efficient. Established in 1996 to reduce fraud and deter inappropriate use of client health care information.

A nurse is caring for a client who doesn't want her family to know she is in the hospital. The nurse receives a phone call from the client's neighbor asking if the client had been admitted and how they are doing. The nurse should recognize that which of the following statements is correct regarding the client situation?

The client and health care workers involved in their care are the only people who have access to the health information.

autonomy

The ethical principle of ------ refers to the nurse's obligation to respect the client's right to make their own decisions regarding their health care, including the right to refuse care.

Beneficence

The ethical principle of beneficence refers to the nurse's obligation to minimize harm and practice in a way that benefits the client. Beneficence also means going above what is required. Nurses often practice beneficence by providing additional care or support for a client because they know it will benefit the client.

Fidelity

The ethical principle of fidelity refers to the nurse's obligation to demonstrate loyalty, to keep promises, and to uphold commitments. Following through with agreements or promises made to clients is critical to build and strengthen the nurse-client relationship.

Justice

The ethical principle of justice refers to the nurse's obligation to provide treatment, care, and resource allocation that is impartial, fair, and equitable to all clients regardless of age, sex, race, or economic status. All clients have a right to be treated fairly and provided the same standards of safety and compassionate care. Nurses have an obligation to ensure that all clients receive equitable care, even when resources are scarce.

Veracity

The ethical principle of veracity refers to the nurse's obligation to provide truthful and accurate information to the client. This truthfulness is an integral component of nursing and helps strengthen the nurse-client relationship by establishing a sense of trust.

There are two types of advance directives.

The first type is a living will, which is a document where a client can clearly state which life-sustaining treatment(s) they wish to have performed if they become incapacitated and are unable to make decisions for themselves. The second type of advance directive is the durable power of attorney for health care. In this document, a client can appoint an individual to make health care decisions on their behalf if they are unable to do so. These two documents promote autonomous decision making by the client and provide the health care providers and the client's family members with a guide if the need of this type of decision

just culture

Values-supportive model of shared accountability and mindfulness.

Which of the following tasks is the nurse's responsibility when assisting in this process?

Witness Mr. Aniston's signature on the consent form.

PNs are expected to

adhere to the values, ideals, duties, and obligations outlined in the Nursing Practice Standards established by the National Association for Licensed Practical Nurses (NALPN). The NALPN states, the PN "shall recognize and have a commitment to meet the ethical and moral obligations of the practice of nursing".

5 professional values of nursing

altruism human dignity integrity autonomy social justice

sentinel event

an occurrence that resulted in the permanent disability, temporary severe injury, or the death of the client. Nurses at the point of care have an opportunity to identify errors and prevent them from occurring. However, when errors do occur, nurses have a responsibility to report the incident.

Advance directives

are legal documents in which a client's decisions related to health care are documented. It is important for nurses to promote the development of advance directives with clients.

Whistleblowing

describes a nurse formally reporting on illegal acts, wrongdoing, or unethical practice within an organization to the national and/or state agency that is responsible for regulation of the organization. Whistleblowing is a serious matter that can result in punitive actions against the organization, but can also cause stress and fear of reprisal or retaliation for the whistleblower. For example, a nurse might be aware that there is an illegal practice happening at their workplace, but fears retaliation from their employer or colleagues.

Implied consent

differs from that of informed consent in that the client is not required to express their permission for care, an intervention, or other activities, verbally or in writing. In other words, it is implied by the circumstances or actions surrounding a medical or nursing action, and the client isn't required to verbally state that they give consent.

Human Dignity

implies that each individual, regardless of race, religion, gender, sexual orientation, culture, ethnicity, socioeconomic status, or any of our characteristics or personal preferences, has intrinsic value and should be respected and treated equally. Maintaining client privacy, showing respect, providing culturally competent care, and ensuring confidentially are all aspects of preserving human dignity.

Standards of Professional Performance

include ethics, culturally sensitive practice, effective communication with clients and members of the health care team, collaboration with clients and stakeholders, professional leadership, continuing education, evidence-based practice, maintaining quality nursing practice, evaluations of self and peer nursing practice, correct utilization of resources, and practicing effectively in a safe environment.

Genetic Testing

involves examining a client's DNA to reveal the individual genetic markings that make that client unique Clients undergoing genetic testing are often searching for answers and concerned about hereditary diseases they may not be able to avoid such as familial breast cancers. Genetic testing can also be done prenatally to detect disorders such as Down syndrome. Nurses need to be aware of the legal and ethical issues associated with genetic testing. Legal issues include concerns that clients could face possible discrimination such as increased health insurance premiums if found to be at an increased genetic risk for health disorders.

Tort

is carrying out an act, or failing to act, against what is considered reasonable and acceptable, which results in injury or harm to a client. Torts exist to protect the public, to determine liability, and to settle claims for illness or damages.

informed consent

is permission to provide care given by the client after relevant information is provided.

altruism

is the selfless concern and actions for the benefit of someone else. An example of altruism is a nurse rushing to help someone in need, sometimes ignoring risk to themselves and putting the needs of the client first.

It is estimated that 40.3 million Americans aged 12 or older suffer from

substance use disorder, and nurses are among these. Nurses develop substance use disorders for a variety of reasons, including genetic predispositions, mental and physical fatigue, pain control, and personal or work-related stressors.

Social Justice

the awareness of the basic right to health and well-being of every individual. The ANA Code of Ethics with Interpretive Statements states that it is the nurse's obligation to support and protect the rights of clients throughout the world and fight for social justice.

Autonomy

the right to self-determination.

Professional Values

those beliefs and behaviors attributed to nursing, include a number of concepts that are pertinent regardless of the nurse's background and are central to the identity of nursing as a profession.

Values

what we believe as individuals to be important, good, and meaningful. These become our personal value system, which drives our behaviors and is used throughout our lives when making decisions about our actions and how we respond toward others. Further, personal values are an integral part of self-concept. Personal values are developed over time by exposure to cultural heritage, family values, the education system, and the community in which we live.

Integrity

when a nurse demonstrates honesty, even when circumstances challenge the nurse's character, and it can be difficult to sustain. The AACN describes integrity for nurses as upholding the professional standards of the Code, even in difficult situations. Integrity is exhibited in nursing when the nurse is honest and provides care to clients using the ethical framework that is accepted within the profession.