Intro to Nursing- Chapter 4 (Legal)

civil or private wrong- An Assault Is Both a Tort and a Crime Because It Hurts The Individual and Poses a Threat To All Members of Society

A TORT IS CONSIDERED A _________________RATHER THAN A CRIMINAL WRONG, BUT SOMETIMES A TORT IS ALSO A CRIME! Give an example of a tort being a crime as well

punishing the person who committed the crime EVEN IF THERE is no damage ex: attempted robbery, attempted manslaughter

A crime focuses on ...

assault battery

A nurse threatens a client with an injection after the client refuses to take the medication orally. This is an example of ______ If the nurse follows through with the above threat, then the nurse is committing _______

manslaughter (second degree murder)

A nurse who accidently gives an additional and lethal dose of a narcotic can be accused of _________________

Answer: 4 Rationale: A sterile invasive procedure that places the client at significant risk for infection is generally outside the scope of practice of a UAP. Even though the UAP is a nursing student, the agency job description should be followed.

A nursing student is employed and working as an unlicensed assistive personnel (UAP) on a busy surgical unit. The nurses know that the UAP is enrolled in a nursing program and will be graduating soon. A nurse asks the UAP if he has performed a urinary catheterization on clients while in school. When the UAP says yes, the nurses asks him to help her by doing a urinary catheterization on a post surgical client. What is the best response by the UAP? 1. "Let me get permission from the client first." 2. "Sure, which client is it?" 3. "I can't do it unless you supervise me." 4. "I can't do it. is there something else I can help you with."

tortfeasor

A person who commits a tort interferes with another person's rights. They are called

Anything that violates the practice act is considered unprofessional conduct. Practicing medicine without a license Fraud misrepresentation criminal abortion false statements failure to protect patients by failing to follow infection prevention Conviction of a felony

BRN can take disciplinary action toward?

Criminal Law involves A Crime- which is a Wrong Committed Against the Public Good Tort Law involves A Tort - which is a Wrong Committed Against a Particular Person or Property

Difference between Criminal Law and Tort Law.....

Assault: Threatening to Harm An Innocent Person Assault Occurs As Soon As You Are Afraid Of Immediate Harm to Your Body Battery: Unlawful, Unwanted Touching of Another Person. Battery Can Also Be Touching Something Closely Associated With a Person's Body (Backpack, Cap)

Difference between assault and battery

1. authenticate signature, make sure it was voluntary, make sure patient was competent 2. advocate for their client

In regards to consent, 1. What are the Nurse's legal responsibilities? 2. What are the Nurses ethical responsibilities?

legislators

It is important for nurses to keep their _____________________informed about nursing because it is their ___________________ that passes laws that affect nursing practice.

statutory laws

Laws enacted by any legislative body are called __________________.

implied contract

an __________is one that has not been explicitly agreed to by the parties, but that the law nevertheless considers to exist. An ex: nurse is expected to be competent and to follow hospital procedures/policies even thought these expectations were not written or discussed.

licensure, certification, and accredidation

competence in nursing practice is determined and maintained by various credentialing methods such as _________________, _________________, and ____________________

within the legal boundaries of their practice and within boundaries of agency policies and procedures

competent practice is a major legal safeguard for nurses. Nurses need to provide care that is...

unprofessional conduct

gross negligence, conviction of practicing without a license, falsification of clients records, and illegally obtaining, using, or possessing controlled substances are all examples of ________________________

suspending judgement, issuing a letter of public repruval (a warning letter) placing on probation suspending right to practice nursing for a period not exceeding one year and revoking his license

how can the BRN discipline?

9 4 are non nurses

how many members are on the BRN? Of those how many are non nurses?

malpractice 1. duty 2. breach of duty 3. foreseeability 4.causation 5. harm 6. damages

negligence that occurred while the person was performing as a professional is considered _____________. What 6 elements must be present for a nurse to be accused of the above?

assault and battery false imprisonment invasion of privacy defamation

nurses can be held liable for intentional torts such as

know your nursing responsibilities and the scope of practice of members on your nursing team (LVN, UAP, etc)

the best defense against a professional negligence claim is to...

1. failure to monitor 2. failure to perform assessment and notify health care provider 3. failure to document and report a deteriorating condition

the most common causes of nursing professional negligence include> (3)

Libel- consists of Lies About A Person in Written, printed or recorded form. Slander- Consists of Verbal or Spoken Lies that Damage a Person's Reputation.

what are the two types of defamation?

take steps to protect the client and THEN notify appropriate agency personnel

when a client is accidentally injured or involved in an unusual situation, the nurse's first responsibility is to...

-when death is sudden -if death occurs within 48 hours of admittance to hospital -yes it requires consent from the hospital who will perform it.

when will an autopsy be performed? does it require consent?

practice guidelines to help legally protect nurses

-Function within the scope of your education, job description, and NPA - follow the policies and procedures of the employing agency - ****build and maintain goo rapport with client -always check identity of client - observe and monitor the client accurately - promptly and accurately document all assessments and care given - be alert when implementing nursing interventions - perform procedures correctly and appropriately - make sure the correct medication/ dosage is given - when delegating nursing responsibilities, make sure the person who is delegated the task understands what to do and that the person has the required knowledge and skill - protect clients from injury - report all incidents involving clients - ALWAYS check any order that a client questions - Know your own strengths and weaknesses - maintain your clinical competence

1. Implied- based on non verbal consent (putting arm out for immunization) 2. Expressed- consent is one in which you ask

1. Implied consent 2. Expressed consent

Answer: 1 Rationale: All elements such as duty, foreseeability causation, harm/injury and damages must be present for malpractice to be proven.

A primary care provider prescribes one tablet, but the nurse accidentally administers two. After notifying the primary care provider, the nurse monitors the client carefully for untoward effects of which there are none. Is the client likely to be successful in suing the nurse for malpractice? 1. No, the client was not harmed 2.No, the nurse notified the primary care provider 3. Yes, a breach of duty exists 4. Yes, foreseeability is present

Answer: D Rationale - floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.

A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action? A. refuse to float in the ICU B. call the hospital lawyer C. call the nursing supervisor D. report to the ICU and identify tasks that can be safely performed

B. False Rationale: You may only perform functions that you are licensed to perform while on the job.

A student nurse who is employed as a nursing assistant may perform any functions that she taught in school. A. True B. False

compensating the victim for damages ex: damage to property would be a tort

A tort focuses on...

negligence

Another term for unintentional tort is...

1. - crime and tort -is crime also because it is against the public good; is tort because it related to specific patients 2. Crime and Tort- oxygen was the hospitals property; wasn't being used for the greater good (beneficence) 3. a pet is a persons property, would be a tort if you kill them to put them out of their misery/ suffering ; if you just kill them then it would be a crime 4. people in high places made decisions that would amount to the common good of the public- (in this case did no good came from the decisions) would be a CRIME

Are these crimes or torts? 1.euthanasia of the patients in 5 days at memorial 2. oxygen being misused in 5 days at memorial, 3. euthanizing pets in 5 days at memorial 4. Flint water?

a- nurse practice act (NPA)

As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the A. Nurse Practice Act (NPA). B. American Nursing Association (ANA) C. National Council for Lisensure Examinations D. State Board of Licensure

Duty: you have agreed to take care of the patient. The patient is assigned to you. When you come into work and you get report on patients: that is implied consent that you are engaging in the duty to care for the patients Breach of Duty: an RN not observing infection control practices

Explain or give examples of an RN's "Duty" and "Breach of Duty"

1, 2, 5

Following a motor vehicle crash, a nurse stops and offers assistance. Which of the following actions are most appropriate? Select all that apply 1. The nurse needs to know the Good Samaritan Act for the state. 2. The nurse is not held liable unless there is gross negligence 3. After assessing the situation, the nurse can leave to obtain help. 4. The nurse can expect compensation for helping. 5. The nurse offers to help but cannot insist on helping.

monetary remedies ($$$$$) can be used toward: Damages can be awarded for pain and suffering, to pay medical expenses to replace/repair damaged property to pay for lost wages.

Give examples of remedies resulting in Tort Law

False Imprisonment. Ex: having all 4 bedrails up, client cannot get out of bed= imprisoned ex: chemical imprisonment occurs when person is given continual medication to alter their state of mind (makes them unable to leave, make decisions, etc.)

If Someone Interferes With a Person's Right to Move About Freely, Then That Person Has Committed_____________ Give examples of this:

Breaking the NPA doesn't make it a crime -it is unprofessional conduct -crimes have very defined definitions

If someone breaks the NPA, are they committing a crime?

Someone with specialized knowledge of a specific field ( oncology nurse, nurse midwife, etc)

In a tort case, who can be an Expert Witness? what are the qualifications?

The RN must know 1. their Nurse Practice Act (NPA) 2. the employers policies and procedures for delegation 3. the UAP's job description 4. the UAP's skill level

In order for an RN to delegate a task to a competent unlicensed assisted personnel (UAP), what must the RN first consider?

-it is extreme or outrageous, reckless, -person has to have experienced a large amount of emotional distress -ex: Generally intentional in hospital setting sedating people so that they don't have to actually have 6 people holding them down ex: you know someone is claustrophobic but you still confine them to a small space for an MRI causing emotional distress

In regards to Intentional Infliction of Emotional Distress (IIED), how is emotional distress defined? give example:

1. question any order a client questions (ex: patient states that the the dr. changed a medication from injection to oral, must recheck the order before giving medication) 2. question any order if the clients condition has changed ex: patient is receiving an intravenous infusion and suddenly develops a rapid pulse and chest pain. An RN must notify the physician immediately and question continuing of the infusion. 3. question and record verbal orders to avoid miscommunication ex: during phone convo, documents the orders and rereads the orders back to the physician to make sure it is correct. 4. question any order that is illegible, unclear or incomplete

In regards to carrying out physicians orders, an RN must protect themselves legally by questioning ... (4)

c- prizing a value

Miss Magu, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value

C. Assess the client's point of view and prepare to articulate this point of view. Rationale: Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.

Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.

A. The physician Rationale: The physician is RESPONSIBLE for obtaining an informed consent.

Obtaining informed consent is the responsibility of A. The physician B. The RN manager C. The nurse D. The CNA

extreme negligence

Professional negligence and malpractice are interchangeable terms. However, Gross negligence is

to compensate for the damage (physical injury, emotional injury, etc) If no injury= no tort Doesn't mean what you did was right

Purpose of Tort law is to ...

Tort (NOT a Crime) Because It Only Hurts An Individual Slander is the use of false words by which a reputation is damaged

Slander is considered a .... What is slander?

To enforce those rights and duties

TORT LAW IS BASED ON THE IDEA THAT EVERYONE IN OUR SOCIETY HAS CERTAIN RIGHTS. What is the purpose of a Tort Law?

Unintentional Example:

TORTS CAN BE INTENTIONAL OR UNINTENTIONAL AGAINST PERSONS AND PROPERTY. What is the most common type of tort? Give an example

a) recognize advanced directives b) as clients whether they have advanced directives c) provide educational materials advising clients of their rights to declare their personal wishes regarding treatment decisions, including their right to refuse medical treatment.

The Patient Self-Determination Act implemented in 1991 requires all health care facilities receiving Medicare and Medicaid reimbursement to:

civil

The client's right to refuse treatment is an example of _________ laws.

negligence and be the basis for tort liability

The clients medical chart is a legal document and can be produced in court as evidence. For this reason, nurses need to provide accurate and complete documentation of the nursing care provided to clients. Failure to do so can result in ______________

D. The order is an error, violates hospital policy, or would be detrimental to the client.

The nurse is obligated to follow a physicians order unless: A. The order is a verbal order B. The order is illegible C. The order has not been transcribed D. The order is an error, violates hospital policy, or would be detrimental to the client

C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. Rationale: A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.

The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? A. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state B. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. D. The client cannot make changes in the advance directive once the client is admitted into the hospital.

1, 3, 4

The nurse notices that a colleague's behaviors have changed during the past month. Which behaviors could indicate signs of impairment? Select all that apply 1. Is increasingly absent from the nursing unit during the shift. 2. Interacts well with others 3. "Forgets" to sign out for administration of controlled substances. 4. Offers to administer prn opiates for other nurse's clients 5. Is able to say "no" to requests to work more shifts.

Answer: False Rationale: Nurse practice acts fall under Statutory law

The nurse practice acts are an example of civil law. A. True B. False

B. False Rationale: Battery is physical in nature. Assault is a threat.

The nurse puts a restraint jacket on a client without the client's permission and without the physicians order. The nurse may be guilty of assault. A. True B. False

Answer: #3 Rationale: The only person entitled to information without written consent is the client and those providing direct care. The nurse has open access to information regarding assigned clients only.

The nurse's partner/spouse undergoes exploratory surgery at the hospital where the nurse is employed. Which practice is most appropriate 1, Because the nurse is an employee, access to the chart is allowed. 2. The relationship with the client provides the nurse special access to the chart. 3. Access to the chart requires a signed release form 4. The nurse can ask the surgeon to discuss the outcome of the surgery.

plaintiff

The person injured, can also be called the Victim, the innocent party in a lawsuit.

Answer: #3 Rationale: A DNR order only controls CPR and similar life-saving treatments. All other care continues as previously ordered. Competent clients can still decide about their own care (including the DNR order.)

The primary care provider wrote a do-not-resuscitate (DNR) order. The nurse recognizes that which applies in the planning of nursing care for this client? 1. The client may no longer make decisions regarding his or her own health care. 2. The client and family know that the client will most likely die within the next 48 hours. 3. The nurses will continue to implement all treatments focused on comfort and symptom management. 4. A DNR order from a previous admission is valid for the current admission

protect society from criminal offenders by punishing them. Penalties for criminal offenses are very serious.

The purpose of Criminal Law is to...

state law

The regulation of nursing is a function of ___________________

law

The sum total of rules and regulations by which a society is governed. Exists to regulate all persons

defendant

The tortfeasor in a lawsuit is known as the?

1. The Possession of Certain Rights by an Innocent Party 2. A Violation of Those Rights by the Tortfeasor 3. A Resulting Injury That Somehow Hurts The Person Whose Rights Were Violated

There are 3 elements to any tort. What are these elements?

1. provides framework (est. which actions are legal) 2. differentiates nurses responsibilities from other HCP 3. Establishes boundaries of independent nursing action 4. helps maintain standard of nursing (makes nurse accountable under law)

What are 4 main functions of Law in nursing

Living will- provides specific instructions about what medical treatments a patient wants to omit or refuse. Healthcare Proxy (aka surrogate)- notarized or written statement that appoints someone else with the right to make health care treatment decisions if client is unable to do so. ( in CA, this person cannot be related to you, nor can they benefit from your estate)

What are the 2 types of health care directives?

1. private (civil law)- deals with relationship among private individuals 2. criminal law- deals with actions against safety/ welfare of public 3. public law- deals with relationship between individual and government and government agencies 4 .contract law- involves enforcement of agreements among private individuals or payment of compensation for failure to fulfill agreements 5. Tort law- involves a Wrong Committed Against a Particular Person or property

What are the 5 types of law? briefly describe each

1. Duty 2. Breach of Duty ( ex: not observing infection control practices) 3. Foreseeability 4. Causation 5. Harm 6. Damages

What are the 6 components of Nursing Professional Negligence

1. stress 2. access 3. lack of education (regarding addictive process, signs and symptoms) 4. attitude (thinking its ok to take the drugs if it helps them to keep working/helping others)

What are the top 4 risk factors that make nurses susceptible to substance use disorders in the workplace

Ask their client to state in their own words what they have been told about the procedure or treatment.

What can a nurse do in order to advocate for his/her patient and make sure they received enough information to give consent for a procedure or treatment?

A tort is a private wrong committed by one person against another.

What is a Tort?

federal law state laws

When federal and state laws conflict, _________ law supersedes. likewise, ____________ laws supersede local laws

defamation

When someone is exaggerating or embellishing a truth; saying things that shouldn't be said Doesn't always have to be lies. This is called______________

2 & 3

Which nursing actions could result in malpractice? Select all that apply 1. Learns about a new piece of equipment 2. Forgets to complete the assessment of a client 3. Does not follow up on client's complaints. 4. Charts client's drug allergies 5. Questions primary care provider about an illegible order

1.minors (unless: pregnant, in military,, already a parent, or emancipated) 2. individual who is unconscious or injured and is unable to give consent 3. people with mental illness who are proven to not be competent

Who are the 3 groups of people who cannot legally provide consent?

the person doing the procedure is responsible for getting this consent (ex: dr, pa, etc) Nurse can ask, tell me about the procedure you are about to have... if the PT doesn't know much, it is not the nurses responsibility to give the info. Must get person who is.

Who is responsible for getting informed consent?

Rests with the victim. They have to prove they were injured or hurt as a result

With whom does the burden of proof lie in a Tort case?

HIPAA (health insurance portability and accountability act) ex: SSN name address phone number email

_______ of 1996 was the first nationwide legislation to protect the privacy of health information. Give examples of what kind of information is protected by the above act

advanced health care directives

_________ includes a variety of legal and lay documents that allow persons to specify aspects of care they wish to receive should they become unable to make or communicate their preferences.

Nurse Practice Act (NPA)

__________ legally define and describe the scope of the nursing practice that the law seeks to regulate

The Good Samaritan Act

______________ protects health professionals from claims of professional negligence when they offer assistance at the scene of an emergency, provided that there is no willful wrongdoing or gross departure from normal standards of care.

Standards of Practice

________________ is expected to be used every time an RN interacts with any client

Interdependent functions RN could be able to do standardized procedures, (only if their name is on the standardized procedure policy) .ex: IV push chemotherapy, pronouncing that a patient has expired (died), suturing.

___________________ are those actions which by law are the practice of medicine (RN's are not allowed to do it by law) but physicians and RN's have agreed that RN's should be allowed to perform it. The way that it becomes legal is by standardizing and implanting standardized procedures. Give example of above

dependent function ex:Administer medications and implement treatment regimens for clients based on Physicians orders

______________________ per the NPA is that before doing an action, the nurse requires an order from someone who is allowed to give that order.

standards of professional performance

__________________________ is more about what we expect of each other. people held to these standards because it is what we are expected to.

policy and procedure

___________________________ are institutional standards. Statements that a setting has established to tell you what you are allowed to do or not do there. Often followed by a procedure that tells you how to do it.

independent

____________________functions are those that by law, do not require authorization or order from anyone else. The nurse is legally permitted to do it on the nurse's own decision.

negligence

____________is the Failure to Exercise the Degree of Care That a Reasonable Person Would Have Exercised.

intentional tort ex: Assault Battery False Imprisonment Defamation Invasion of Privacy Infliction of Emotional Distress

___________are most often actions that deliberately hurt, embarrass or scare people. The most common types are?

DNR ( it allows for a natural death)

_____is generally written when a client or proxy has expressed the wish for no resuscitation in the event of a respiratory or cardiac arrest.