Ethics/Legal

Laws vs. Ethics

"Laws can generally be defined as rules of social conduct made by humans to protect society, and these laws are based on concerns about fairness and justice (Catalano, J.T., 2020)". Laws can be upheld federally or, and as is more often the case in nursing, on a state level and these laws are enforced by a policing force. Laws should be applied to all people equally. Ethics are defined as "declarations of what is right and wrong and of what ought to be (Catalano, J.T. 2020)". Ethics are values and beliefs held by an individual, community, or even a nation that are used to protect an individual's rights. Unlike laws, there are oftentimes no governing body offering punitive repercussions for individuals who violate these ethical ideals. With that in mind there are codes of ethics written for specific professions (eg. Nursing Code of Ethics written by the ANA) that outline and explain core values. In these cases licensing boards can issue disciplinary action when an individual who repeatedly and/or blatantly violates these principles (Catalano, J.T., 2020)

Describe how each organization is involved with health care safety and quality. List initiatives.

' Institute of medicine (IOM): 1.) establish leadership, research, tools, and protocols to enhance safety knowledge base. 2.) Develop a public mandatory national reporting system and encourage participation in voluntary reporting systems. 3.) Use oversight organizations, health-care purchasers and professional organizations to increase standards and expectations. 4.) implement safety systems at the point of care delivery in health-care organizations. (safe, effective, patient centered, timely, efficient, equitable. National Quality Forum (NQF): NQP Leadership Consortium NQP Action Team to Prevent Healthcare Workplace Violence NQP Action Team to Co-Design Patient-Centered Health Systems The Joint Commission: ID patient correctly, administers meds safely, prevent infection, prevent residents from from, prevent bed sores. Center for Medicare and Medicaid Services (CMS): Some initiatives focus on publicly reporting quality measures for nursing homes, home health agencies, hospitals, and kidney dialysis facilities. Consumers can use the quality measures information that is available on www.medicare.gov for these healthcare settings to assist them in making healthcare choices or decisions. Quality and Safety Education for Nurses (QSEN):patient-centered care, teamwork and collaboration, evidence-based practice (EBP), quality improvement (QI), safety, and informatics (QSEN, n.d.). The agency for Healthcare Research and Quality (AHRQ): track issues over time, prevent errors and enhance patient safety

What are grounds for disciplinary action by the MSBON?

(1) The practice of fraud or deceit in obtaining a license under this chapter or in connection with service rendered within the scope of the license issued; (2) Misuse of alcohol, drugs or other substances that has resulted or may result in the licensee performing services in a manner that endangers the health or safety of patients; (3) A professional diagnosis of a mental or physical condition which has resulted or may result in the licensee performing his duties in a manner which endangers the health or safety of his patients; (4) Aiding or abetting the practice of nursing by a person not duly licensed under this chapter and who represents himself to be so; (5) Incompetency in the practice for which he is licensed. A licensee shall be deemed incompetent in the practice if the licensee has: a. Engaged in conduct which evidences a lack of ability or fitness to discharge the duty owed by the licensee to a client or patient or the general public; or b. Engaged in conduct which evidences a lack of knowledge, or inability to apply principles or skills to carry out the practice for which he is licensed (6) Unprofessional conduct. A licensee shall be deemed to have engaged in unprofessional conduct if he violates any standard of professional behavior which has been established in the practice for which the licensee is licensed; (7) Subject to the limitations of Title 5, chapter 341, conviction of a crime which involves dishonesty or false statement or which relates directly to the practice for which the licensee is licensed, or conviction of any crime for which incarceration for one year or more may be imposed; (8) Any violation of this chapter or any rule adopted by the Board of Nursing; or (9) Engaging in false, misleading or deceptive advertising.

Applying ethics decision making steps to Case study on 145 Nursing Now

1. What are the key ethical principles involved in this situation? Veracity most certainly applies to this situation as well as non-maleficence. The value to be truthful regardless is a basic foundation for the trusting relationship between the healthcare worker and the client. Non-maleficence is a requirement to do no harm intentionally or unintentionally. This situation was unintentional, in the haste of the emergent situation the nurse did not check to see if the Oxygen tank was full. This factor contributed to the subsequent death of the patient. This situation provides an ethical dilemma for the nurse, having to make a choice between two unfavorable outcomes. Withholding the truth from the man's family is going against the Code of Ethics this nurse abides by. While providing the truth to the wife and family will have devastating effects potentially in the nurse, the other staff at the hospital and the hospital as well. 2. Are there any statements in the ANA Code of Ethics that may help resolve this dilemma? Ana Code of Ethics statements that may help resolve this issue would be Provisions 5 and 9. Provision 5 states the nurse owes the same duties to self as to others, including to promote health,safety, preserve wholeness of character, integrity, maintain competence and continue professional & personal growth. The first part of this statement, if upheld by the nurse, would involve veracity as well as non maleficence. The value to do no harm and to uphold truthfulness. Additionally provision 9 would be applied here as well to maintain social justice as in a Nursing setting, to uphold moral, legal, humanistic principles related to healthcare. 3. What would be the consequences of informing the client's wife of the truth? Veracity is an obligation for nurses and it is a right of the client to know the information in what happened. Truth can be hard and uncomfortable, but the wife deserves to know why this occurred. Think of this like the nursing process, we need to collect data on what happened and analyze it. What is our issue and what are our choices? Then we will analyze again with positives and negatives and finally make a decision and act on it. The consequences would be swift and severe. Negligence by the whole team (health care is a collaborative effort) not to check and make sure equipment was functioning properly is a failure at the basic level. The nurse, resident, and possibly others risk losing their licence to practice, pay fines, and possibly lose their job. The hospital would take a major hit in its view from the community and also face a potential large lawsuit if not settled out of court. 4. What are the consequences of not informing her? The consequences of not telling the wife could be seen in two ways. The first scenario is only the nurse knows about the mistake and how she would process this. First of all she would be breaking most of the values of ethics. Knowing that the family would be confused and lost not understanding what occurred. Financially this could ruin the family, now having to pay medical bills, losing a source of income, and financing a funeral. The secrets and knowledge of this can weigh heavy and break someone down mentally and physically, potentially leading to further mistakes down the road. In the second possible scenario, all the team members know as well. This would lead to a lack of faith in your ability as a co-worker and most certainly trust.

Delineate the four elements required to make a claim of negligence/malpractice.

1. Duty - A duty is owed to the client (professional relationship). 2. Breach of Duty - the professional violates the duty and fails to conform to the standard of care. 3. Causality - The professional's failure to act was the proximate cause of the resulting injuries. 4. Damages - Actual injuries resulted from the breach of duty.

Differentiate misdemeanors and felonies.

A misdemeanor is a crime usually punishable by a fine, community service, probation, penalty, or brief confinement Can be injurious but does not inflict serious harm Stealing medications/drug possession/use, elder/dependent adult abuse, and breach of privacy A felony is more serious than a misdemeanor and is usually punishable by imprisonment for over a year, and possibly even death A serious offense that results in significant harm to another person or society Typically targeting patients who are in hospitals and nursing homes because these patients are defenseless, vulnerable and easily accessible Murder, serious bodily harm or violence, aggravated assault, sexual assault

Give examples of nursing malpractice

A nurse administers a large dose of medication due to a calculation error. The client has a cardiac arrest and dies.A nurse fails to question a discharge order for a patient who is presenting with new symptoms. It is the nurse's responsibility to relay changes in the patient's condition to the doctor, and it is also their responsibility to question an order should they not agree/see something different. Failing to obtain a proper informed consent

Provide an example of defamation of character. When might a nurse become involved in such behavior? How does talking in a public place put a nurse at risk?

A nurse may become involved in defamation of character if they are discussing a client or even another coworker in common areas where the conversation can be overheard (elevator, cafeteria, bathroom, etc.). All public areas put a nurse at risk for defamation due to the likely chance of being overheard.

Statute of limitation

A statute of limitations is a law that sets the maximum amount of time that parties involved in a dispute have to initiate legal proceedings from the date of an alleged offense, whether civil or criminal. However, the length of time the statute allows for a victim to bring legal action against the suspected wrong doer can vary from one jurisdiction to another and the nature of the offense

What are the limitations of the Good Samaritan Act for nurses and other health care providers/workers? (p. 197)

A: The limitations of the Good Samaritan Act for nurses and other health care providers/ workers is that if such workers act in accordance beyond their scope of practice and education, they can be held liable for civil cases even if they provide life saving care for a client in an emergency situation.

Client Abandonment

Abandonment occurs when there is a unilateral severance of the professional relationship with the client without adequate notice and while the requirement for care still exists. Can be viewed as a breach of contract or in cases where the injury occurs malpractice.

Go to the MSBON website and document how MSBON defines abandonment (Chapter 4). Why is this important for nurses in practice?

According to MSBON, abandonment is when the nurse/patient relationship ends without the patient's consent or without having arrangements for continued care by someone else. The nurse/patient relationship only begins when it is accepted by the nurse. This is important for nurses in practice because it makes sure the nurse is using effective communication with the patient and is professional standards for nursing care.

Effective communication

According to The Joint Commission, the top reason for medical errors is miscommunication among health-care workers. Effective communication is absolutely necessary to avoid such errors from occurring. When such medical errors occur, lawsuits surely follow. To prevent a lawsuit from occurring at the root, a standard communication among healthcare workers is necessary and exactly what the Joint Commission had requested. The communication tool that is commonly being used in nursing education is the SBAR system. It is a simple communication style that can be used for each individual client. It goes over the situation, background, assessment, and recommendation for the client. When healthcare professionals use the SBAR communication tool, avoiding lawsuits from mis-communication errors becomes much easier.

Standards of Care

Action taken by a reasonable person in the same/similar circumstances. Measured against the standards that are established in the profession.Based on subjective and objective factors. Objective factors- the action to be performed. Subjective factors (emotional and mental state of the nurse) Conflicts occur between institutional and professional standards such as staffing issues/nurse to patient ratio. Legally safer to follow professional standards. Internal standards- defined in specific hospital policy and procedure manuals that relate to the nurse in the particular institution. Job description and employment contract → define duties of the nurse. Criteria for good care → ensure proper, consistent and high-quality nursing

Administrative Law

Administrative law is rules and regulations that are legally enacted to support some statutory law, both Federal and State. (Berman and Synder, 2012) Examples: Nursing boards enact administrative rules and regulations relating to state enacted laws such as the state's nurse practice act and legislated continuing education requirements for the re-licensure of nurses the licensing and regulation of nursing practice, as well as areas such as collective bargaining

Give a general definition of ethical systems

An ethical system doing what is considered most useful/ beneficial

Refer to the case study on p. 188. Answer the questions and explain what standard of care is breached.

Are all the elements present in this case for a bona fide malpractice lawsuit? Yes, the night nurse violated the duty owed to the client and to conform to the standards of care as it was her duty to ensure his safety, advocate on his behalf, and report any changes in his condition to the physician. The charge nurse, although they contacted the client's physician, also violated their duty to the client as they should have more aggressively advocated on the client's behalf or contacted another physician immediately. They also failed to report the health care providers negligence in failing to act. The physician also violated their duty and standards of care as it was their responsibility to ensure proper medical care. Their decision to not act is grounds for a lawsuit based on negligence. Yes, the professionals' failure to act was the proximate cause of the resulting injuries. Yes, actual injuries resulted from the breach of duty What could have been done to prevent this situation from happening? The night nurse could have contacted the physician as soon as she noted the changes. The charge nurse could have spoken more emphatically with the physician to relay the severity of the situation. The provider could have taken the nurses' concerns more seriously and provided some sort of action such as coming to assess the client's leg. How should the nurse deal with reluctant or hostile health care providers? Use a communication strategy similar to one known as CUS: C- I'm concerned... U- it's unsafe S- Stop

Veracity

Being completely truthful with patients. Nurses should not withhold any truth from the patient even if it would cause the patient to be in distress.

Justice

Being impartial and fair. Giving a patient treatment regardless of ethnicity, economical status or sexual orientation.

Common Law

Common law is law that results from previous legal decisions. They are based on legal precedent (Berman and Synder, 2012) Examples: Informed consent, the patient's right to refuse treatment, negligence, and malpractice

Defamation of character

Communication of information that is false or detrimental to a person's reputation.

Comparative negligence

Comparative negligence is a principle of tort law that applies to casualty insurance in certain states. Comparative negligence states, that when an accident occurs, the fault and/or negligence of each party involved is based upon their respective contributions to the accident.

Constitutional Law

Constitutional law is law that is included in the Constitution of the United States of America and its amendments (Berman and Synder, 2012) Examples: Right to due process, Equal protection, Freedom of speech, etc

Give a general definition for the following possible defenses against malpractice suits:

Contributory negligence - pg. 196. Contributory negligence is the failure of an injured plaintiff to act prudently, considered to be a contributory factor in the injury suffered, and sometimes reducing the amount recovered from the defendant. example : Nurse raises the stretcher to care for the patient but forgets to lower bed back down after. Nurse gives the patient their call bell to use if they need help or assistance with anything, pt does not call out, attempts to get out of bed and falls.

Crimminal Law

Criminal law, part of public law, covers acts that are illegal and against the law. Criminal law includes felony and misdemeanor infractions of the law (Berman and Synder, 2012) Examples: revolving around Medical malpractice, Medicare Fraud (billing & coding), patient care & ethical dilemmas

Defense of the fact

Defense of the fact is based on the claim that the actions of the nurse follow the standards of care or that even if the actions were in violation of the standards of care the actions themselves or not the direct cause of injury.

Informed Consent

Definition:It is the voluntary permission by a client or by the client's designated proxy to carry out a procedure on the client. Purpose: The main purpose is to protect the client. The legal role of the nurse regarding written consent is to collaborate with the provider. This includes witnessing a patient's signature, determining that the details of informed consent are in place, communicate the patient's need for more information or provide feedback if the patient wishes to change their consent.

Refer to box 8.6 on p. 205; "Some Documentation Guideline" What are the key elements in your experience for effective documentation?

Effective documentation includes being short and concise, mentioning all people that were involved with care (providers, nurses, techs/cnas, etc.), and making sure to include time and patient responses.

Define risk and quality management.

Evaluating the risk of clients and staff for injuries and for potential liabilities and implementing corrective and preventative measures.

Review Box 8.7 on p. 208; "What to look for in an insurance policy" Should you have your own liability/malpractice insurance?

Even if liability is included in your employment package, you should still haveyour own liability insurance to protect yourself from any claims that occur outside your place of employment (ex. Providing care at a motor vehicle crash)

Give examples of how nurses can be involved in each type of intentional tort.

Example of Battery by a nurse-when a nurse physically restrains a client against the clients will and administers an injection against the client's wishes Example of assault when a nurse tries to bathe a client without their consent or attempt a medical intervention such as the insertion of a straight catheter Example of false imprisonment by a nurse when a competent, alert, and normally oriented, client of sound mind wants to leave against medical advice and the nurse physically restrains him Example of Breaches of privacy or confidentiality. An example of a breach of privacy would be a famous person being a patient and a nurse sharing information about them to the general public. Examples of Slander and libel. An example of slander would be a nurse speaking false claims about someone to another whereas libel would be a nurse writing or posting false claims online. These could both happen when a nurse is frustrated with a manager and decides to share false information about them out of frustration. Basically, any sort of untrue gossip could fall under these categories.

What are some example of how nurses violate criminal law? What is the most common violation?

Failure to renew nursing license.(Catalano, 2020). Negligence Illegal diversion of drugs, particularly narcotics, from the hospital. More serious crime which may lead to imprisonment. It can involve intentional or unintentional deaths of clients. Assisted suicide cases have also led to criminal action against nurses.

False Imprisonment

False imprisonment occurs when a competent client is confined or restrained with the intent to prevent him or her from leaving the hospital. The use of restraints alone does not constitute false imprisonment when they are used to maintain the safety of a confused disoriented or otherwise incompetent client. Mentally impaired clients can be detained against their will only if they are at risk for injuring themselves or others. The use of threats or medications that interfere with the client's ability to leave the facility can also be considered false imprisonment.

Rapport with clients

Having a good rapport with clients can be important for avoiding lawsuits. No one is perfect, and sometimes errors do occur. It is essential for the nurse or healthcare worker to provide respectful care that shows the client they are acting in the client's best interest. If the client understands this, then small errors will most likely be excused.

When must a parent or guardian provide consent?

In most states, parents have the right to make healthcare decisions on behalf of their minor children. That is, individuals younger than 18 years of age. The presumption is that before reaching the age of majority (18 in all but four states), young people lack the experience and judgment to make fully informed decisions. "Emancipated minor" refers to an individual under the age of 18 that is no longer restricted to the choices of their parents or legal guardians and can make their own decisions. Specifically, the medical emancipation of a minor allows the individual to make their own decisions regarding medical treatment. Which means they can legally consent to or refuse treatment. The following are exceptions to the above mentioned requirement to seek parental consent prior to medical intervention: 1) If a minor is legally emancipated, thus considered a competent adult with the authority to accept of refuse medical treatment 2) Minors with certain health conditions such as sexually transmitted diseases, sexual abuse or cetain mental health conditions 3) Minors needing emergency treatment

Read through the Critical Thinking Exercise on p. 209 and answer the questions, discussing the nurse's role in preventing lawsuits.

In the case of Thomas vs. Corso the mistakes made by the nurses in this case are: 1. The nurse should not have attributed the client complaints to the effect of alcohol or other medication side effects. 2. The nurse should have noted all the changes in the client's health with respect to decreased blood pressure and the fluctuating respiratory rates and pulse. 3. The nurse should have kept the provider informed on the changes to avoid complications. 4. The nurse should have notified the provider of the continued concern of the pain in the right anterior thigh. The nurses incurred legal liability for poor judgement. The dismissal of the complaints of pain lead to the lack of attention and interventions. The leg pain should have been further investigated. Diagnostic testing should have been recommended. To prepare for the trial the nurses should go over the timeline and highlight interventions and prepare explanations for the steps they took and also justification for the steps they didn't take. To avoid a lawsuit the nurse needed to follow up on all complaints of pain, especially pain in an area where no injury is evident. The nurse's attitude toward inebriated clients affected their judgement. Clients who are drunk are at higher risk of bleeding due to thinning of the blood. The risk of internal bleeding in this case was high in this situation and the nurse should have been looking for possible signs of internal bleeding.

Incompetent's right to self-determination?

Incompetent client's right to self determination: a legal court decision, power of attorney or next to kin that happens when a client is no longer able to make decisions about medical care themselves. The courts require a high standard of proof before termination of any life sustaining treatments. Two examples: Nancy Cruzan Case from 1983 and Terri Schiavo case of 1990.

Autonomy

Independence in making decision. The nurse's role is to help patients communicate wishes to the rest of the team.

Give a general definition of intentional torts.

Intentional meaning done willfully and also causing harm. Nursing examples include false imprisonment, assault, battery, breaches of privacy or confidentiality, slander and libel. Assault and battery-assault is the unjustifiable attempt to touch another person or the threat of doing so. Battery his actual harmful or unwarranted contact with another person without his or her consent. Battery is the most common intentional tort seen in the practice of nursing. For a nurse to commit assault and battery there must be an absence of client consent. Negligence does not have to be proved for a person to be successful in a claim for assault and battery False imprisonment-. False imprisonment occurs when a competent client is confined or restrained with the intent to prevent him or her from leaving the hospital. The use of restraints alone does not constitute false imprisonment when they are used to maintain the safety of a confused disoriented or otherwise incompetent client. Mentally impaired clients can be detained against their will only if they are at risk for injuring themselves or others. The use of threats or medications that interfere with the client's ability to leave the facility can also be considered false imprisonment. Breaches of privacy or confidentiality- public revelation of confidential or privileged communications without the client's consent. Information concerning the client must be honored and kept confidential. Defamation of Character- most common of the quasi-intentional torts injures a person's reputation by diminishing the esteem, respect, goodwill or confidence that others have for the person especially damaging when false statements are made about a criminal act or an immortal act or where there are false allegations about a client having a contagious disease. Includes Slander and Libel- speaking/writing

Malpractice

Is negligence committed by a professional such as a nurse or physician such as assault, battery, invasion of privacy and defamation of character. The person who caused the accident did so inadvertently and typically because they were not being careful.

Assault and battery-assault

Is the unjustifiable attempt to touch another person or the threat of doing so. Battery his actual harmful or unwarranted contact with another person without his or her consent. Battery is the most common intentional tort seen in the practice of nursing. For a nurse to commit assault and battery there must be an absence of client consent. Negligence does not have to be proved for a person to be successful in a claim for assault and battery

Knowledge of clients

Knowledge of the client can play a fundamental role in avoidance of lawsuits. Being able to distinguish client's that tend to complain about care or are known for bringing lawsuits against healthcare facilities is crucial knowledge for nurses to have. To piggyback on this, it is also vital to include the client in their own care plan so that their own satisfactions can be voiced and therefore met. When a client feels that their voice and needs are being met, they are much less likely to file a lawsuit against those caring for them.

Liability insurance

Liability insurance refers to an insurance product that provides an insured party with protection against claims resulting from injuries and damage to other people or property. Liability insurance policies cover any legal costs and payouts an insured party is responsible for if they are found legally liable.

Medical Records

Medical records are essential for avoidance of lawsuits in the healthcare field. Charting and documenting appropriately on how the client had been medically treated at the specific healthcare facility can give a direct reference if any concerns about the treatment arise. When documenting, it is important for all records to be objective so that the observations made are as clear and direct as possible.

Describe ways that common law applies to nurses (with examples).

Negligence Failure to monitor the patient and missing a change in vital signs. Failure to identify allergies with patient and giving medicine that the patient is allergic to. Malpractice Misreading or ignoring lab results. A performing procedure that the patient has not consented for.

Difference between negligence and malpractice.

Negligence- the primary form of unintentional tort. Omission of an act that a reasonable person would perform in a similar situation or commission of something a reasonable person would not do in that situation. Malpractice: is negligence committed by a professional such as a nurse or physician such as assault, battery, invasion of privacy and defamation of character. The person who caused the accident did so inadvertently and typically because they were not being careful.

What type of law is the Nurse Practice Act?

Nurse Practice Acts are an example of statutory laws. The rules and regulations that they adopt are administrative laws The NPA is then interpreted into regulations by each state and territorial nursing board with the authority to regulate the practice of nursing care and the power to enforce the laws. Each state/territory have their own state boards of nursing (BON) that are responsible for regulating their individual NPA The boards enforce these laws as defined by their respective state or territorial legislative bodies Only the BON has the power to discipline a nurse who may pose a danger to the public

example of deontology

Nurse caring for patient while struggling with her own persona life. Nurse still provides adequate care. Provides care for the greater good.

Beneficence

Nurses actions should promote all good. Everything the nurse does is in the best interest of the patient.

What is the nurses role in safety and quality?

Nurses are in a pivotal position to positively influence quality and safety at local, state and national levels.Nurses play an instrumental role in enacting the changes necessary to overhaul the health-care system.

Fidelity

Nurses being faithful to professional promises they have made to provide competent, quality care to their patients.

Non-maleficence

Nurses do no harm intentionally

Ethical Dilemma

Occur when decisions about care need to be made where there is no clear answers on what the "right" or "wrong" answer to make is. - Also described as "knowing the right thing to do but not able to do it"

What are specific QSEN Competencies?

Patient centered care, safety, informatics

Deontology

Places value on the intentions of the individual rather than the outcomes of any action. The theory suggests actions are good or bad according to a clear set of rules.

Negligence

Primary form of unintentional tort. Omission of an act that a reasonable person would perform in a similar situation or commission of something a reasonable person would not do in that situation.

Nursing Code of Ethics: 2015 version.

Principles: fidelity and autonomy, beneficence, veracity, justice, non maleficence. 9 provisions. Provision 1 : The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. - Fidelity & Autonomy - Provision 2: The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. - Beneficence & Autonomy - Provision 3 : The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. - Beneficence - Provision 4 : The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. - Autonomy, Fidelity, Veracity - Provision 5 : The nurse owes the same duties to oneself as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. - Nonmaleficence & Fidelity - Provision 6 : The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. - Veracity & Justice - Provision 7 : The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy - Justice, Nonmaleficence & Veracity - Provision 8 : The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. - Nonmaleficence & Justice - Provision 9 : The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. Justice, beneficence, nonmaleficence.

What is privileged communication? Do nurses have privileged communication?

Privileged communication is protected by law and exists in certain well-defined professional relationships. It ensures that the professional who obtains any information from the client cannot be shared, even in court of law. Nurses do not have privileged communication with clients but there are laws that protect them.

Civil Law

Protects the rights of individuals and provides for fair and equitable treatment when civil wrongs or violations occur. Civil law, also part of public law, covers torts and contract laws (Berman and Synder, 2012) deals with behavior that constitutes an injury to an individual or other private party such as negligence resulting in injury or death, malpractice, breach of contract, & property damage

Define quality assurance.

Quality Assurance in healthcare attempts to guarantee that when an action is performed by a healthcare professional it is performed correctly the first time and each time thereafter.

Unintentional Torts

Refer to any unplanned event that leads to injury. Typically, these are caused by negligence or malpractice. .

What is the role of a risk manager?

Risk management focuses on identifying, analyzing, and evaluating risks and then trying to reduce those risks to decrease the likelihood of harm to patients. Risk management is interdisciplinary and includes detection, education, and interventions.

Ethics

Set of moral principles, beliefs and values that help guide us in making medical decisions for ourselves or our patients

example of utilitarianism

Single mom with 4 kids. Pregnant. Abortion would be best because it provides the greatest good for the greatest amount of people.

What is the principle of stare decisis? What impact can it have on legal issues in the future?

Stare decisis means to "stand on the things decided". It's a doctrine in which a court follows rules/standards/principles to make decisions based on similar cases from the past. This could be good, creating consistency for punishments and stability of law. But it could also be seen as too rigid, and interpretation of different crimes could change over time

Statutory (regulatory) law (Nurse Practice Act, P. 203)

Statutory law is law that is passed by a legislative body such as the state's legislature or the US Congress (Berman and Synder, 2012) These laws as defined by their respective state or territorial legislative bodies Examples: Traffic violations, Regulations on Nursing Practices

Utilitarianism

TRUE UTILITARIANISM An ethical system doing what is considered most useful/ beneficial ACT UTILITARIANISM: The particular situation in which a nurse find himself or herself determines the rightness of wrongness of a particular act.

What is a DNR

The Do-Not-Resuscitate (DNR) order is written by a doctor and documents the patient's wishes that CPR will not to be performed in the event of cardiac or respiratory failure.

What is the Patient Self-Determination Act

The Patient Self-Determination Act (PSDA) is a federal law that requires all federally funded healthcare institutions to: -Inform all patients of their right to make advanced directives-Document within the patient's record the presence or absence of advanced directives -Educate staff and patients on advance directives-Treat all patients equally regardless of advanced directives status

Good Samaritan Act

The doctrine that protects a volunteer who comes to the aid of an injured or ill stranger from being sued for contributory negligence, if the volunteer aid-giver (the Good Samaritan) acted with reasonable care. Ex. Performing CPR on someone who has collapsed with no signs of respirations

Nursing, the Patient Self-Determination Act and end of life care

The nurse acts as a patient advocate to ensure that the patient has the right to self determination, which includes cultural and spiritual beliefs. -Listen to the patient's concerns, expectations and hopes regarding end of life care. -Nurses must review the patient's documented preferences upon admission. -It is the nurse's responsibility to make sure that all of the patients health care decisions are being followed and respected.

What happens if a nurse is found liable?

The nurse may be required to provide monetary compensation to the client for general damages that were the direct result of the injury which includes pain, suffering, disability, and disfigurement. They may be responsible for special damages as well, which include medical expenses, out of pocket expenses, and lost wages. They could be held responsible for optional damages, which include emotional distress, mental suffering, and counseling. If it is shown that the nurse acted with conscious disregard for the client's safety, or acted maliciously, willfully, or in a wanton manner, and the injury was a result of any of those, the nurse may have additional punitive or exemplary damages awarded (extra fines)

What is the purpose of licensing nurses?

The purpose of licensing nurses is to protect the public from harm by setting minimal competencies and qualifications for nurses at entry level. Nursing is a profession where there is a risk for injury and even death if a person is not qualified with the state, meaning they are legally required to provide the best care. By requiring a license, people who are sick can expect adequate care at all healthcare facilities, and trust that the nurse is knowledgeable and will know and support the best course of treatment for them.

Advanced directives

There are two types of legal written advance directive: Living Will: A living will gives directions to others regarding a person's wishes pertaining to life-prolonging treatments if the person becomes unable to make those decisions. -The individual must be alert and oriented when the document is written -Legal requirements vary from state to state Durable Power of Attorney for Health Care or Health Care Proxy (DPOA): A DPOA identifies a person (surrogate decision maker) who will make healthcare decisions in the event the patient is unable to. -The surrogate has the right to make decisions for as long as the patient is not able to do so

Compare definition of laws and ethics.

Unlike laws, in ethics there is oftentimes no governing body offering punitive repercussions for individuals who violate these ideals. With that in mind, there are codes of ethics written for specific professions (eg. Nursing Code of Ethics written by the ANA) that detail core values. In these cases, licensing boards can issue disciplinary action when an individual repeatedly and/or blatantly violates these principles.

Advantages of Utilitarianism and Deontology

Utilitarianism - primary focus is society, teaches society it is wrong to harm people, focuses on democracy Deontology - creates more personal responsibility for individuals to carry their own weight for society, creates a higher moral standard

What are nurses' responsibilities when procedures for physical and chemical restraints are used?

When physical and chemical restraints are used, the nurse is responsible for assessing and determining the need for restraints, after using other alternative measures and communicating with the family and/or patient about the use and reasoning for the restraints (physical or chemical). A doctor's order is needed for physical or chemical restraints. It is then the nurses' responsibility to assess and evaluate the continuation of use for the restraints.

In terms of quasi-intentional torts, what impact do social media have on nurses? Why are nurses and nursing students at risk? Why are social media considered public in this context? How can a nurse avoid being at risk through use of social media?

With social media, it is important for nurses and nursing students to be aware of posting anything online about their work environment to prevent any possibility of leaking private information. Even if it is unintentional, it can still be classified as a tort. Social media is considered public in this context because it is a place where anyone can read what is put online. Nurses can avoid being at risk through use of social media by just simply not posting anything work related or having their personal devices on the unit with them.

Refer to the case study on p. 189. Answer the questions at the end of the case study. Do you agree with the jury's decision against the nurse? Why?

Yes we agree with the jury's decision because the nurse was responsible for the patient's safety. Leaving a disoriented patient unattended with bed rails down is not a safe practice. Although the standing orders were to allow the client to ambulate, that does not mean that the client would be able to get out of bed on his own or ambulate safely while recovering from the effects of the anesthesia. Therefore, the bedrails should have been up, with the bed alarm on

Assumption of risk

a doctrine that a person may in advance relieve another person of the obligation to act towards him or her with due care and may accept the chance of being injured.

List categories of never events and provide examples.

a list of reasonably preventable medical errors that occur in hospitals that will no longer be paid for Medicare in an attempt to control costs. Ex: not getting consent for blood, wrong body part operated on etc.

Quasi-intentional torts

a violation of a person's reputation or personal privacy.

Invasion of privacy

a violation of a person's right to protection against unreasonable and unwarranted interference with one's personal life. To prove that an invasion of privacy has occurred, the client must show that: The nurse intruded on the their seclusion and privacy That intrusion is objectionable to a reasonable and prudent person The act committed intrudes on private or published facts or pictures of a private nature Public disclosure of private information was made

Unavoidable accident

an accident that is not proximately caused by the negligence of any party or that is unforeseeable or not preventable by exercise of reasonable precautions and for which liability based on fault is not imposed — compare act of God.

Culture of safety

an organization's shared perceptions, beliefs, values, and attitudes that combine to create a commitment to safety and an effort to minimize harm

List 5 or more sentinel events

blood transfusion error, wrong site of surgery, inpatient suicide, foreign body retention, delay in treatment

How may these tools be helpful in preventing lawsuits:

effective communication, medical records, report with clients, knowledge of clients.

Breach of confidentiality

failure by one of the parties in a contract to fulfill all the terms of the agreement.

How is consent handled in emergency situations?

he AAP policy statement "Consent for Emergency Medical Services for Children and Adolescents" recommends that medical screening examination and appropriate medical stabilization of the pediatric patient with an urgent or emergent condition should never be withheld or delayed because of problems with obtaining consent. Hence, the emergency treatment exception allows minors to be treated in an emergency or life-threatening situations when a parent or guardian can't be reached to give consent. The legal definition of an emergency medical condition is any condition that threatens the loss, impairment, or serious dysfunction of life or causes severe pain.

Review the American Nurses' Association (ANA) definition of delegation. What are 5 right of delegation?

he definition of delegation: "Delegation generally involves the assignment of the performance of activities or tasks related to patient care to unlicensed assistive personnel while retaining accountability for the outcome. The registered nurse cannot delegate responsibilities related to making nursing judgments." 1.The right task 2.The right person 3.The right circumstances 4.The right directions and communication 5.The right supervision and evaluation

Informed consent

is the voluntary permission by a client or by the client's designated proxy to carry out a procedure on the client.

Tort Law

law: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in the nurse patient relationship (Berman and Synder, 2012) Some torts specific to nursing and nursing practice include things like malpractice, negligence and violations relating to patient confidentiality Willful acts that violate another's rights -- intentional, quasi-intentional, unintentional Threatening to administer injection, intentional touching, actually giving the injection, verbal or offensive abuse, etc.

What is quality care?

level of excellence based on established criteria.

Slander

oral defamation of character

Give 5 examples of quality indicators

prevention, inpatient, patient safety, rate of readmission,nurse 2 patient ratio, and pediatric.

Emancipated minor

refers to an individual under the age of 18 that is no longer restricted to the choices of their parents or legal guardians and can make their own decisions. Specifically, the medical emancipation of a minor allows the individual to make their own decisions regarding medical treatment. Which means they can legally consent to or refuse treatment

Root cause analysis (CA)

tracks events leading to error, identifies faulty systems, and processes and develops a plan to prevent further errors. 1 example is improve safety of using medications.

Define sentinel events, serious reportable events (SRE) or "never" events.

unexpected occurrence involving death of serious physical or psych injury, or risk thereof. Immediate need for investigation and response.

Libel

written defamation of character