L/E Final Exam

Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? 1. An unintentional tort 2. Assault 3. Invasion of Privacy 4. Battery

Battery ** willful touching of person w/o permission; another name is an intentional tort because the RN executed the act on purpose.

Battery vs. Assault

Battery: - touching another person w/o permission Assault: - the threat to touch w/o permission

Brewster's: Belmont Report

Belmont Report for research ethics: Respect for persons, beneficience and justice r/t the tyskegee study with syphillis rate and not treating any study participants with penicillin even after it was discovered and proven effective - Autonomy: importance of voluntary consent; requires obtaining informed consent of research participant before enrolling in a study - Beneficence: Promoiting well being of others "future patients"; requires researchers to make complete assessments of study risk/benefits, if unexpected outcomes then IRB or a data safety monitoring board can stop the study at any time - Justice: protect vulnerable population from exploitation, question benefit/risk, protect underserved, fair process of selecting participants

Which ethical principle supports the argument that all newborns should be screened for HIV?

Beneficence

Jurisdiction

the authority by which courts and judicial officers accept and decide cases - Subject matter jurisdiction: whether the court can hear a particular type of case - Personal jurisdiction: whether the case was filed in a court that has the power to render a judgment - Territorial jurisdiction: ability to bind the parties to the action. Determine scope of federal/state court power

Veracity

the duty to be honest and avoid deceiving or misleading a client - individuals shoul always tell the whole truth

Record retention

the general period of time in which suits may be filed is for 5-10 years

Statutes of limitations

time intervals set by individual state legislatures during which a case must be filed or the injured party is barred from bringing the lawsuit EX: wisconsin medical malpractice statute of limitations requires actions be brought

Questions of law

- application or interpretation of laws - determined by the judge in the court EX: is certain evidence admissible? - Is a witness an "expert" - Is a contract enforceable?

Beneficence

"Doing good" or acting for another's benefit

Res judicata

"a thing or matter settled by judgment" - employed to prevent duplication of litigation - prevents cases with the same parties and the same issues that have been decided by a court with jurisdiction ( and no further appeals are possible) from being tried again

paternalism

"parentialism:" - making the final decisions for others - seen as UNdesireable

A newly licensed RN complains to the preceptor about the amount of time spent documenting in the medical record. What is the preceptor's best response?

"The most important reason we document is to help us communicate the patient's condition to the rest of the health care team" Rationale: The primary reason for documentation is to communicate the patient's condition to others on the health care team. The preceptor should remind the newly licensed nurse of this fact

A nurse returning to practice remark that delegation is much more regulated and complicated that when she last practiced 20 years ago. what rationale would the nurse manager provide for this change?

"The shortage of nurses has been the major reason that there are so many rules to follow when delegating" rationale: The nursing shortage has led to the need to use other licensed and unlicensed personnel to provide patient care that previously may have been performed only by registered nurses. Because this is occurring more frequently in multiple settings, the need for rules and regulations regarding delegation has arisen.

Teleological Theory

"Utilitarianism" -rules of conduct from consequences of actions; usefulness of an action is determined by the amount of happiness it brings

Products considered unavoidably unsafe

- Benefits must greatly outweight the risks -Risks cannot be eliminated and no safer products exist - Manufacturer is only liable when there is a failure to warn of risks - Prescripiton drugs are uaually considered unavoidably unsafe

Question of Fact

- Determined by evidence presented by both sides in a legal controversy - Present the dispute that the jury answers -Fact finder (final authority on credibility of witnesses) weighs admissible evidence EX: which people were involved in an incident, what was the cost of an operation? EX: cost of hospital service

Immunity

- Dismiss certain causes of action - Makes negligent actions against HCPs at scenes of accidents are rare - Some states it applies only to those providing care until professional medical attention is available EX: The Good Samaritan Statue, Advance Directives

Expert Witness Criteria

- Lack of involvement with defendants - Clinical expertise, certification, recent continuing education in the area at issue - Ideally a graduate degree and author of publications in nursing - Approval by trial judge

correcting charting errors

- Note time, date, explanation of correction - sign correction - Misspelled words are self-evident and should be crossed out, corrected, and initialed -Discourage use of word "error" when correcting a chart for fear that it be interpreted as the entire entry is in error - Never obliterate an entire entry, tape a new entry over erroneous entry - NO ONE may alter nurse's note - Charts should never be destroyed, recopied, or altered - Records must be readable and charted in ink

Access to original medical records

- Patients generally have copies of original records. - Record must be completed prior to the patient's right to access - Patient may authorize the right of access to others - A facility must allow access within 30 days of the request. Request must be in writing - Access can be refused if family confidences or information about person other than the patient would be disclosed.

What does the court consider in determining the nurse's legal liability for standards of care?

- Professional Education - Experience - Specific Conduct

In given situations, the nature and degree of reasonable care expected of people providing care may differ depending upon which factor?

- Professional Judgement- Courts expect nurses and healthcare providers to use their professional judgement before blindly following written policy and procedures - There are internal standards (set by institutions) and standards can be specified to specialty practice areas.

National Standard

- a standard applied throughout the nation - offers all persons an acceptable minimal standard of care

To Protect confidentiality, incident reports must:

- be labeled and noted as confidential - have a priviledge log, identifying all incident or occurrence reports as they are received - be transmitted to an approp committee and be considered and acted on in regular course of operations - Have bylaws by the facility establishing committees, define the scope of responsibility, specify that deliberations and conclusions are confidential - Have the committee be mandated to meet on a regular basis ** USE CAUTION, in completing incident reports, use no language that admits liability, do NOT mention incident report in the patient's chart **to be privileged under the attorney-client privilege an incident report should be completed and forwarded directly to the hospital attorney or representative

Criminal law

- conduct that is offensive or harmful to society as a whole - Misdemeanors are lesser criminal actions generally enforced through monetary fines (< $1000) rather than jail time (< 1 year). - Felonies are MORE SERIOUS criminal actions involving fines (> $1000) and prison terms of greater than one year or by death EX: RN removes ventilator-dependent patient from ventilator and patient dies, state of board nursing may revoke RN's license (criminal act) and the family may file a wrongful death suit (civil suit)

Address moral distress in clinical practice:

- empower nurses to voice their ethical concerns - educate RNs about moral distress and allow discussion on the subject - I.D. and address impediments to delivery of quality nursing care - Incorporating conflict resolution and meditation techniques so RNs can bring their concern to closure - allowing RNs to serve on institution ethic committees - Opening communication

Professional Code of Ethics

- formal statements that serve to articulate values and beliefs of a given discipline - ICN (international council of nurses) - ANA (American Nurses Association)

Unavoidably unsafe products: - Learned intermediary rule

- manufacturer of a prescription drug or medical device does not have the responsibility for warning the patient of potential dangers

A patient says, "I was told that my back pain is the result of care i received when i was in the hospital a year ago. How long do i have to file a lawsuit?" Which statements made by the nurse are appropriate? Select all that apply.

-General rule is 2 years from the time you knew what caused your injury -State laws differ on the statute of limitation for personal injury In some cases it depends if the injury was due to trauma or disease

Tort Law

-Involves compensation to those wrongfully injured by others' actions. - Normally involved in malpractice claims that name specific health care providers.

Good Samaritan Law: * Three elements for a good samaritan defense are:

1) care rendered was given as the result of an emergency 2) Inital emergency/injury was not caused by the person invoking the defense 3) Emergency care was not administerd in a grossly neglige or reckless

Which nursing actions could result in malpractice?

1) forgets to complete the assessment of a client 2) Does not follow up on client's complaints

To file for Discrimination Lawsuit under the Age Discrimination Employment Act of 1967 1) Be 40-70y 2) Perform job responsibilities according to the employer's expectations 3) Be discharged 4) Be replaced by a substantially younger person

1,2,3,4

The nurse manager of an oncology unit is interviewing nurses for a position. Which statements, made by nurse applicants, would the manager evaluate as having an increased ability to respond appropriately to an ethical dilemma? 1) "I think nurses and physicians should discuss care decisions with patients and families." 2) "I worked an oncology unit for 10 years before we moved here." 3) "I think that most dilemmas can be solved by taking the option that is most logical." 4) "At my last job, we were required to take ethics training each year." 5) "As long as nurses follow orders and policy and procedures ethical dilemmas are unlikely to arise." A) 2,4,5 B) 1,2,4 C) 1.3.4 D) 2.3.5

1,2,4 * The nurse that perceives she has influence within the health care setting (i.e. nurses & physicians discuss decisions) is more likely to be able to respond appropriately to ethical dilemmas. A nurse with clinical expertise and competence will be more likely to respond appropriately to ethical dilemmas. A nurse that is concerned more about logical actions may not fully understand the ethics involved in a situation. Lack of ethical concern will adversely impact the nurse's ability to respond appropriately to ethical dilemmas. Past experience with ethics education will make the nurse more likely to respond appropriately to ethical dilemmas. By saying that ethical issues will not arise if nurses follow orders & policies and procedures, the nurse is dismissing the importance of monitoring for development of ethical problems. This nurse is not as likely to recognize her role in these issues.

The nurse is stopped at the scene of a motor vehicle accident with injury. What actions should the nurse take? SELECT ALL THAT APPLY. 1. Ask the injured person for permission to help. 2. Instruct someone to call for additional aid. 3. Graciously accept any payment the injured patient may offer. 4. Start assessing the injured as is required by all registered nurses. 5. Move the patient only if it is necessary to prevent further harm.

1,2,5

A representative from a drug company tells a group of nurses that one of the company's products is unavoidably unsafe. How should the nurses interpret this information? SELECT ALL THAT APPLY. 1. There is no safer medication to use an alternative. 2. Patients who have been administered this medication are very likely to have severe side effects. 3. The medication has been recalled by the manufacturer. 4. The drug has risks that cannot be eliminated. 5. The benefits of using the medication outweigh its risks.

1,4,5

A nurse is named in a lawsuit and has no professional malpractice insurance coverage. What is true of this situation? SELECT ALL THAT APPLY. 1. The nurse's best interests may not be protected during the case. 2. The nurse will be nonsuited from the filed lawsuit once this fact is known. 3. The nurse can be held personally responsible for all damages assessed. 4. The nurse can rely upon the hospital's insurance policy as protection from personal financial liability. 5. The nurse is considered judgment-proof and will not be required to pay damages.

1. The nurse's best interests may not be protected during the case. 3. The nurse can be held personally responsible for all damages assessed.

The nurse holds national certification as a wound care specialist and works in a small, rural hospital. What standard of skill and care applies to this nurse's practice? A) It should be the same as that of an average nurse who also holds national wound care certification. B) It should be the same as that of any nurse who provides wound care. C) It should be equal to the practice of a wound care specialist working in the largest facility in the state. D) It should be equal to that of any other wound care specialist in the nation.

A **This nurse does not have to have skills equal to all other wound care specialists. There may be those that have different or better skills. The nurse should have better skills and is held to a higher standard than a nurse who does not hold certification. There is no responsibility to be as skilled as a person working in a larger, better equipped hospital.

The nurse understands that the professional liability insurance provided by the hospital where he works is a claims-made policy. Which claim would the nurse expect this policy to cover? 1. Any claim filed as long as it was within 30 days of the end of the policy 2. A claim that was filed 3 months after the hospital purchased the policy 3. A claim that was filed while the hospital and insurance company were negotiating about the policy 4. A claim filed for an event that occurred during the coverage period that was filed after the hospital changed carriers

A claim that was filed 3 months after the hospital purchased the policy (Claims-made policies provide coverage only if the claim for an injury that has occurred is filed with the courts and is reported to the insurance company during the active policy period or during an uninterrupted extension of that policy period.)

The nurse understands that the professional liability insurance provided by the hospital where he works is a claims-made policy. Which claim would the nurse expect this policy to cover? A) A claim that was filed 3 months after the hospital purchased the policy B) A claim filed fro an event that occurred during the coverage period that was filed after the hospital changed carriers C) Any claim filed as long as it was within 30 days of the end of the policy D) A claim that was filed while the hospital and insurance company were negotiating about the policy

A claim that was filed 3 months after the hospital purchased the policy **Claims-made policies provide coverage only if the claim for an injury that has occurred is filed with the courts and is reported to the insurance company during the active policy period or during an uninterrupted extension of that policy period (see p. 189). The policy will not cover claims that were filed prior to the coverage being activated. The policy will not cover claims made after the end date of the policy, even if the claim was associated with an incident that occurred while the policy was in effect. There is no 30 day grace period associated with this claims-made coverage.

Moral distress

A major issue in nursing, occurs when nurses are unable to provide what they perceive to be best for the patient

In which scenarios would the nurse assume that apparent consent has been provided? Select all that apply A) The patient follows directions to swallow sips of water as the RN inserts a NG tube B) Patient smiled and held out arm when the RN said "I need to start an IV line"

A, B

In which situations would the state board of nursing have probable grounds for disciplining a nurse? Select all that apply A) RN fails to report a co-worker who is working outside his scope of practice B) The RN made a false statement on the licensure application

A, B

Depositions will be taken of witnesses in a wrongful termination suit filed against the hospital by a former employee. Which information should the attorneys provide to the witnesses that will be deposed? Select all that apply. A) The testimony provided is sworn testimony B) The witness may refer to notes during the deposition

A) The testimony provided is sworn testimony B) The witness may refer to notes during the deposition

A nurse is preparing information to be distributed at a national conference on HIV/AIDS. What should be included regarding mandatory disclosure of HIV/AIDS status? Select all that apply. A) All HIV/AIDS cases must be reported to the CDC or to the state health department B) In general HIV/AIDS status is considered confidential

A, B

A patient incident occurred on the nursing unit. What should the nurse caring for the patient do in regard to the incident report? Select all that apply. A) Documentation in the medical record about the event that mandated completion of an incident report B) Only facts and the nurse's observations in the incident report

A, B

A plaintiff's attorney decides to use the doctrine of res ipsa loquitor in a case against the urologist who perforated a patient's urethra during a cystoscopy. What must the plaintiff prove? Select all possible correct answers. A) The complication does not generally occur unless someone provided negligent care B) The plaintiff had no control over the development of the perforation

A, B

The patient brings suit against a health care provider. In which ways would the nurse expect this action will affect the confidentiality of the patient's medical record? Select all that apply. A) The patient's attorney will have access to the information in the record B) The record will be released to the defendant's attorney

A, B

What should the nurse consider about today's healthcare environment when making a decision about purchasing individual professional liability insurance? Select all that apply A) Having personal insurance does not increase one's risk of suit B) Most lawsuits are filed against nurses who are not specialized in any particular field

A, B

Which action could result in the nurse being charged with conversion of property? A) RN removes the patient's shirt and bra during treatment of a fractured ankle. B) RN removes a package of cigarettes from the patient's robe pocket

A, B

Which scenarios reflect the "two schools of thought" doctrine? (select all that apply) A) The nurse expert witness in a case describes two methods of providing the intervention in question B) Nurses on one unit vary in their choice of ways to deliver quality care C) An honest error in judgment prevented a nurse from providing quality care D) The nurse manager insists that standards are uniform and all nurses must act in the same manner E) The hospital policy and procedures manual lists both local and national nursing care quality standards.

A, B

A chief nursing officer has requested that additional budgetary funds to be allocated to nursing staff seeking a baccalaureate degree in nursing or specialty certification. Which information should this executive provide during discussions of this funding. Select all that apply A)Nurse specialty certification has been shown to lower patient mortality B) Higher rates of nurse specialty certification have been correlated with reduction of failure-to-rescue rates in the hospital setting C) Education at the BSN level, when coupled with special certification, has been shown to reduce adverse patient outcomes

A, B, C

A lawsuit has been filed against the hospital for terminating an employee for excessive tardiness and absenteeism. The defendant's attorney has contacted nurses who worked with this employee to testify in this case. Which statements would bet support the defendant's case? Select all that apply. A) "The employee called in sick on several consecutive Fridays" B) She often asked me to cover for her while she took her kids to school C) Her absences affected the work flow on our unit

A, B, C

The nurse in a physician's office recorded assessment data in the wrong patient's medical record about 1 hr ago. How should the nurse correct this error? Select all that apply. A) Indicate the reason the correction is being made by writing "wrong patient chart" along with the new information B) Indicate the date/time the correction was made C) Either sign or initial the correction

A, B, C

Hospital administration requires that the committee seeking to change nursing policy and procedures review external sources for these standards. Where should the committee look for these standards? (select all that apply) A) Federal organizations B) State boards of nursing C) Individual nurse's experience and education D) Current nursing literature E) The hospital's position job descriptions

A, B, D

The Board of Nursing received a complaint that a nurse blogged inappropriately on an online chat room. Which guidelines should the Board investigator use in evaluating the appropriateness of the nurse's blogs? (Select ALL that apply.) A) Evaluate any patient photos or videos included in the nurse's blogs for Board of Nursing confidentiality and privacy rule violations. B) Ignore blogs that do not discuss or refer to patients by name because patient rights to confidentiality and privacy have not been violated. C) Evaluate blogs about the nurse's employer and co-workers for unprofessional conduct, such as threatening, harassing, bullying, profane, obscene or sexually explicit comments. D) Ignore content that has been deleted from the chat room because it is no longer accessible. E) Use violations of the employer's organizational policy regarding work-related postings as the basis for recommending a Board of Nursing licensure action.

A, C **Disciplinary action could be taken by an employer for violations of organizational policies however, these policies are not the basis for licensure actions by a Board of Nursing. Deleted content may have been forwarded by other chat room participants and still be available. Patients may be identifiable even if names were not used. Unprofessional conduct would constitute a violation of the Board of Nursing rules and regulations. Breaches of confidentiality and privacy would constitute violations of the Board of Nursing rules and regulations. [See page 3 of the NCSBN White Paper: A Nurses Guide to the Use of Social Media].

The RN holds original licensure in a compact state and has practice privileges in two remote states Should the practice concerns arise with this nurse in a remote state, what is the status of the nurse's license? (select all that apply) A) Only the state in which the RN hold licensure can act to suspend or revoke that license B) The remote state can limit or stop the RN from practicing in that state C) Only the state in which the RN demonstrated poor practice can act to suspend or revoke the RN's license D) The remote state can place the RN's license on probation E) License suspension on vocation can only occur if all three states agree to the action

A,B

While vacationing in a different state, the nurse encounters an emergency in which a person needs immediate care. What should the nurse assume about the Good Samaritan law of this state? Select all that apply. A) A Good Samaritan law exists in the state B) The Good Samaritan law in this state may be different than the one in the state of licensure

A,B

The nurse manager walks in on a conversation in the break room concerning the hospital's plan to employ unlicensed assistant personnel (UAPs) to help relieve a nursing shortage. Which statements made by the manager would be correct? SELECT ALL THAT APPLY. A) "It will be important that the UAPs hired have adequate orientation to our nursing units." B) "The hospital will have to assure that the UAPs they hire are competent." C) "I can't believe our state board authorized this plan." D) "It will be even more important that we follow delegation policy and procedure." E) "I don't want to have these UAPs working under my license."

A,B,D

A patient has just discovered that a surgical error made 3 years ago was responsible for the loss of the patient's leg. How does the discovery rule relate to statutes of limitation in this case?

According to the discovery rule, pateints have 2 years frm the time that they knew or should have known of the injury to file a personal injury lawsuit in the majority of states. The time frames vary according to state law. It would have to be determined whether or not the patient "should have known" to see if the patient could file suit.

Equal Protection of the law

Applies only to state actions and not to actions of private citizens. - Guarantees all similarly situated persons will be affected similarly so that states may not enforce rules/regs based solely on classifications as determined by race, religion, and/or gender - emphasizes dispartity in treatment by a state between classes of individuals whose situations arguably are indistinguishable

An example of an abuse of power from a mentor entails: A) Asking a student to pick up coffee B) Asking a student to do a literature search for an article in which the student will not be listed as an author C) Asking students to work in the lab on saturdays D) Asking a student to copyedit page proofs of a journal article

Asking a student to pick up coffee

The cardiac telemetry unit nurses repeatedly cautioned a patient to not leave the floor because input from the telemetry monitors is limited to that area. The patient went to the cafeteria and suffered a fatal dysrythmia. What is the nurses' best defense in the negligence lawsuit brought for the patient's survivors?

Assumption of Risk Rationale: In this case, the nurses warned the patient "repeatedly" of the danger and the patient ignored the warning. Assumption of risk states that plaintiffs (in this case, the patient) are partially responsible for consequences if they understood the risk involved when they proceeded with the action.

Prior to surgery, the nurse checks to ensure that the patient has signed an informed consentform. Which ethical principle is the nurse supporting? A) Double effect B) Autonomy C) Veracity

Autonomy

Decision making capacity (DMC) is best assessed by evaluating: A) Whether the patient can perform basic daily tasks B) The patient's ability to understand their diagnosis and the reasonable treatment options C) The patient's ability to respond to questions and to express their preferences D) The patient's cognitive state according to a mental status exam as required in a court of law

B

The nurse is providing care for a patient who was just diagnosed with diabetes mellitus. Which statements reflect this nurse's use of the values-based decision model in this situation? 1) "tell me about what foods are important to your family celebrations." 2) Let me help you select your lunch menu as I know you are not familiar with your diet yet." 3) "You can make the decision of when you want to take your daily oral medication dose." 4) "I have written down several websites that will provide accurate information about your disease." A) 2,3,5 B) 1,4 C) 2,4,5 D) 3,5

B ** Asking the patient about what foods are important helps the nurse determine the patient's needs and desires. It will assist the nurse planning education for this patient. When the patient does not making care decisions (e.g. food choices) the nurse intervenes as an advocate for the patient's best interests. This is an example of the respect for persons model. When to take an oral medication best reflects the rights protection model or autonomy model. The values-based decision model is predicated on the sharing of information (e.g. website information) and assisting the patient to become empowered to speak on his or her own behalf. In the values-based decision model the nurse would educate the patient to speak for himself instead of relying on the nurse to speak with the physician.

Which statements would the nurse evaluate as correctly identifying difference between ethics and law? 1) Ethics applies to conduct and actions and the law applies to motive and attitude 2) Ethics focuses on the individual whereas law focuses on society as a whole 3) Ethics are externally determined 4) Law relies heavily on judicial enforcement 5) Ethics can change situationally, but laws are static and unchangeable A) 1,2,4 B) 2,4, C) 2.3.5 D) 1,5

B ** Both ethics and the law apply to conduct, actions, and motive. Attitude is more associated with ethics. Ethics is individualistic and is subject to philosophical, moral, and individual interpretations. The law focuses on rules and regulations that guide society in a formal and binding manner. Ethics describes conduct or principles that are internalized. The legal system, including the judicial branch, is founded on rules and regulations that guide society in a formal and binding manner. Ethical values are subject to philosophical, moral, and individual interpretations and may change as the person grows and develops. Laws are more formal, but can also be changed.

The patient brings suit against a health care provider. In which ways would the nurse expect this action to affect the confidentiality of the patient's medical record? A) The confidentiality of the record will remain intact; therefore, no one can have access to it B) The patient's attorney will have access to the information in the record C) The record loses confidentiality and is available to anyone interested D) The record will be released to the defendent's attorney E) Only the judge will have full access to the medical record

B, D **As being the primary source to describe the course of the patient's evaluation, treatment, and change in condition, the medical record is a discoverable record. The patient's attorney must have access to this information in order to pursue the lawsuit. Information in the medical record is not discoverable to anyone who is not involved in the suit. The defendant's attorney will have access to the medical record. Others other than the judge must have access to the medical record to establish and defend the suit.

The nurse is searching for information about nurses' responsibility and accountability for appropriate delegation of tasks. Where should this nurse look for this information? SELECT ALL THAT APPLY. A) Nursing rules and regulations as dictated by the state B) ANA Code of Ethics for Nurses C) State nurse practice acts D) ANA Nursing Scope and Standards of Practice E) State medical association bylaws

B,C,D

In which scenario is the nurse providing indirect supervision of a nursing assistant? A) The nursing assistant and nurse work on the same team, jointly providing care to inpatients. B) The nurse makes rounds on the patient care units, observing the nursing assistant's work, at least every two hours. C)The nurse is easily contactable by pager but is not present in the care environment. D) The nursing assistant receives constant instruction regarding patient care from the nurse.

C

The registered nurse who works in the obstetrics department is walking by the emergency department waiting room when a person cries out, "Help me! My mother is not breathing!" Does this nurse have a duty to assist? A) No, the nurse has no more duty to assist in this situation than a lay person B) No, the nurse is out of the normal working environment and should not interfere C) Yes, the general duty of care exists to help in times of crisis or immient harm D) Yes, the nurse has the duty to provide the same standard of care as an emergency department nurse

C ** Even if the nurse is not assigned to a particular patient, a general duty of care arises if the patient presents with an emergency or is in need of instant help. Therefore, this nurse has a duty to assist in this situation. The fact that the nurse is out of the normal working environment does not relieve the general duty of care. The nurse is an employee of the hospital; therefore, a general duty of care exists. This nurse has the duty to provide care at the level of a prudent registered nurse, not as an emergency department nurse.

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.

C ** a living will directs the client's healthcare inthe event of a terminal illness or condition. A durable POA is invoked when the client is no longer able to make decisions on his/her own behalf. The client may change advance directive at anytime.

The patient tells the nurse that the physician mentioned deep tissue massage as treatment for rheumatoid arthritis. As a part of the subsequent conversation, the nurse demonstrates techniques and encourages the patient to begin a regimen immediately. What is true regarding this situation? A) Since back massage is a standard skill taught in nursing school, the nurse has no liability for these actions B) The nurse's liabilty centers solely on the recommendation to begin a massage regime C) This nurse may be guilty of practicing massage without a licensure D) Since the physician initated the discussion, the nurse has no liability

C **The nurse is responsible for all nursing actions. The recommendation itself would probably not be a liability issue if the nurse was educated to make such a recommendation. The nurse is responsible for all nursing actions, such as demonstrating techniques & encouraging the patient to begin a regimen. Deep tissue massage goes beyond the bedtime "backrub" type of massage taught in nursing school and is used for a specific disease therapy, so the nurse may be guilty of practicing massage without a license. States differ on this licensure. (See pg. 218 of text.)

A nurse executive has requested that additional budgetary funds be allocated to support staff seeking a baccalaureate degree in nursing or specialty certification. Which information should this executive provide during discussions of this funding? 1) "Research shows no correlation between an increased number of BSN prepared nurses and increased nursing salaries." 2) "Nurse specialty certification has been shown to lower patient mortality." 3) "If our nursing staff is educated at a higher level and are certified we will see fewer lawsuits for negligence and malpractice." 4) Lower failure to rescue rates (i.e. higher rates of preventing patient injuries) 5) "Education at the BSN level, when coupled with specialty certification, has been shown to reduce adverse patient outcomes." A) 1,2,5 B) 3,4,5 C) 2,4,5 D) 2,3,5

C **Typically nurses do receive salary increases as educational level increases. Kendall-Gallagher and colleagues (2011) concluded that hospitals' nurse specialty certification lowers patient mortality. (See page 205 text) There is no evidence that there will be fewer lawsuits for negligence and malpractice. Higher rates of nurse specialty certification have been correlated with a reduction of failure-to-rescue rates in hospital settings. Researchers have noted a reduction of adverse patient outcomes when specialty certification exists along with education at the BSN level.

What should the nurse consider about today's healthcare environment when making a decision about purchasing individual professional liability insurance? SELECT ALL THAT APPLY A) The frequency with which nurses are named in lawsuits has not changed in the last several decades. B) Obstetrics is the only specialty in which risk of being sued has increased. C) Having personal insurance does not increase one's risk of suit. D) Most lawsuits are filed against nurses who are not specialized in any particular field. E) Monetary awards in cases where nurses have personal insurance are higher.

C, D **Due to the expanding role of nursing there is a heightened legal accountability and increased potential for being named in lawsuits. OB is NOT the only specialty in which the risk of being sued has increased. OB, critical care, and emergency nursing are all suit-prone. A common misconception is that having personal insurance will increase the nurse's risk of being sued. This is an incorrect argument. Monetary awards where the RN's have personal insurance are not higher, but is widely believed to be true. Current literature indicates the most malpractice cases involve non-specialized RNs (see p. 197 in text).

Which nurses would be most likely to be protected under the Age Discrimination Employment Act of 1967 if fired? (Select all that apply.) A) A 23-year-old nurse who was told that she was "too young" for the job B) A 72-year-old nurse who was fired from an OR scheduling position C) A 40-year-old nurse with excellent work history whose replacement is 35 years old D) A 49-year-old male nurse who held a position in obstetrics E) A competent 60-year-old nurse who discovers the nurse hired for his position is 50 years old

C, E

The hospital has a well-designed, fully functioning ethics committee. What ethical debate topics, concerning the entire social network rather than an individual patient, might now be addressed by this committee? SELECT ALL THAT APPLY A) DNR orders B) Effects of managed care on patient wellbeing C) Informed consent D) Autonomy E) Duplication of services

C, E **A do-not-resuscitate order is an issue focused on an individual patient or health care organization. Autonomy is a broad-based ethical theory that the committee would use to guide decision making. It is not a specific topic of discussion. Duplication of services is a topic that concerns the entire social network of provision of health care and is a much broader topic than the typical individual concerns addressed by maturing committees. Informed consent is an ethical concern directed at the individual health care organization and is not a broad based issue that affects larger populations.

Provide coverage only if the claim for an injury that has occurred is filed with the courts and is reported to the insurance company during the active policy period A) Claims made policy B) Occurrence based policy

Claims made policy

The hospital acts to revoke the clinical privileges of an independent physician (not employed by the hospital) who has repeatedly refused to respond to emergency calls from nursing staff. Under which doctrine is this action advisable? A) Respondeat superior B) Corporate Liability C) Borrowed Servant D) Dual Servant

Corporate liability *All doctrines only apply to employees (i.e. are vicarious liability), except corporate liability. Under the doctrine of corporate liability, corporations have a direct duty to the public they serve, ensuring that competent and qualified practitioners (i.e. employees, independent contractors & others) deliver quality health care to consumers

A patient brought into the emergency department was injured while he subsequently attacking his neighbor with a knife. After treatment for his wounds, the patient was arrested and charged with assault and battery. which classification or type of law would determine the case against this individual (the defendant)? A) Criminal law B) Statutory law C) Procedural law

Criminal law

The nurse bases individual nursing practice upon commitment to quality patient care and understanding of the nursing role. Under which broad classification of ethical theory does this fail? A) Paternalism B) Deontological theories C) Veracity D) Patient benefit

Deontological theory

Stephanie Brewster, 16 years-old, comes to the clinic with her mother for a routine physical. After greeting them both together in the exam room, you ask the mother to step outside so that you can perform a physical. You tell Stephanie that it looks like she has a sexually transmitted infection and that she should be treated. She consents to treatment. Which of the following should be communicated to her mother? A) Only Stephanie has an STI, and that she is being treated for it B) Nothing. Tell her mother that Stephanie is very healthy and that you'll see them next year C) Everything that Stephanie told you, including her sexual history D) Only what Stephanie has asked you to share with her mother

D

The school nurse is leaving campus after work when an accident occurs on the playground. The nurse responds and treats the injured students. Which standard of care would most likely determine liability? A) the reasonably prudent pediatric nurse B) The reasonably prudent school nurse C) The reasonably prudent general duty hospital nurse D) The reasonably prudent nurse in an emergency situation

D ** The primary focus of pediatric nursing actions is more specifically in the scope of care of a different specialty. General duty hospital nurses do not routinely provide emergency care, so this is not the standard used for this situation. Since these injuries have occurred outside of school hours, this nurse may be functioning outside the usual scope of employment as a school nurse. Because of the emergency nature of this situation the most likely standard would be that of a reasonably prudent nurse in an emergency situation.

Which information would the nurse provide as rationale to support mutual recognition of nurse licensure? A) The number of praciticing nurses holding more than one state licensure is increasing B) Multistate licensure will protect the safety of consumers who use call-in phone lines for health advice C) Some areas have an oversupply of nurses while others are still experiencing a nursing shortage D) Advancing technologies, especially telehealth and telephone triage makes single state licensure problematic

D ** Advancing technologies such as telehealth and telephone triage have expanded practice beyond geographic boundaries. Multistate licensure is not a logical means of correcting an imbalance in the supply of nurses. There is no guarantee that changes in licensure will protect consumers who use call-in phone lines for health advice. While this situation has some relation to mutual recognition and nurse licensure compacts it is not the most important force to consider.

A nurse has been called as a lay witness in a malpractice lawsuit. What information should be provided to the nurse regarding this testimony? Select all that apply.

D) These witnesses tell only what has transpired from their perspective. (Testimony is a presentation of factual information that an individual can relay relevant to his or her own perspective.) E) The lay witness must have a direct connection to the case. (Nurses may be called to serve as a lay witness to describe for the jury what, when and how a particular event occurred. The nurse must have a direct connection to the case in order to provide this information.)

Good Samaritan activities and limits of liability coverage are included in the ________________ portion of the policy.

Declaration

Policy holder's information plus covered time frame is named in the ______________ portion of the policy.

Declarations

The nurse has been named in a lawsuit claiming a patient was injured due to her negligence. The nurse dropped her personal professional liability insurance several months ago, but believes the policy may have been in effect at the time of the incident. In which part of the policy would the nurse look for information about the coverage period? 1. Deductibles 2. Declarations 3. Exclusions 4. Liabilities

Declarations **(Declarations include the "demographics" of the policy: the policyholder's name, address, covered professional occupation, and the covered time period.)

Which option reflects one of the more convincing arguments for the nurse having individual malpractice insurance? A) Filing a lawsuit is costly in today's society B) Having insurance makes it more costly for the plaintiff to file suit against the nurse C) Having insurance ensures that the RN will not be named in lawsuits D) Defending against a lawsuit is costly in today's society

Defending against a lawsuit is costly in today's society **Despite not having insurance, nurses are liable for their actions and can be held personally liable for damages. Nurses are never considered judgment-proof. RNs are not released from a suit because there is no insurance. The hospital's insurance policy does not always provide all the financial protection that may be needed. In some cases, RNs have not been adequately represented by legal counsel in the lawsuit.

The nurse is conflicted about the harmful effects of an intervention that also will have a beneficial effect for the patient. Which ethical consent gives direction to the nurse? A) Autonomy B) Double Effect C) Veracity D) Deontological theories

Double Effect

The nurse is conflicted about the harmful effects of an intervention that also will have abeneficial effect for the patient. Which ethical consent gives direction to the nurse? A) Autonomy B) Double effect C) Veracity

Double effect

Due Process vs. Equal Protection

Due process emphasizes fairness b/t state & individuals regardless of how other individuals in the same situation are treated. Equal Protection emphasizes disparity in treatment by a state b/t classes of individuals whose situations arguably are indistinguishable

Which common practice puts the nurse at liability for invasion of patient privacy?

During care the nurse reveals infomration about the patient to those in the room Rationale: Giving out information about a patient without permission is an invasion of privacy

A nurse has been called to testify in a malpractice lawsuit. Which information should the attorney provide about the process of cross-examination? A) This process allows opposing counsel to explain the meaning of the nurse's testimony B) Cross-examination allows the nurse to ask questions of the opposing counsel C) During the proces opposing counsel will try to refute the nurse's testimony D) Cross-examination is a process to ensure that both atttorney's question all witnesses

During the proces opposing counsel will try to refute the nurse's testimony **Attorneys do the questioning in a trial, not the parties to the lawsuit. Cross-examination of a witness is a specific strategy by the opposing attorney to discredit or negate the witness's testimony. While both attorneys have the option to question all witnesses, they are not required to do so. Attorneys do not explain testimony, but rather ask questions to support their client's case.

The board of director for general hospital, state funded hospital elects to limit surgical procedures for morbid obesity to male patients. Female patients receive pharmacologic therapy, counseling, and instruction for diet and exercise, but are excluded from operative procedures. Under which concept is this illegal? A) Resjudicata B) Jurisdiction C) Equal Protection of law

Equal Protection of Law Equal protection under the law holds that all similarly situated persons will be affected similarly.

Ethics as a discipline differs from law in which way?

Ethics focuses on the individual, rather than society as a whole

Ethics vs. Law

Ethics: - branch of philosophy concerned with evaluating human action. Encompasses a process of determining right vs. wrong. Interchangeable morals - personal principles acquired from life experiences Law: - a rule of conduct established an enforced by the government of a society

The patient demands to see the actual medical record of a hospitalization that occurred 1 year ago. How should the hospital handle this request?

Have the patient come to the hospital to review the original record Rationale: in this case, the patient should come to the hospital to review the original record. The patient should be monitored while reviewing this record.

The nurse believes that her need for individual malpractice insurance is decreased because she practices in a small-town home health agency. What is true about this situation?

Home Health care is an area in which the risk of lawsuit is higher than many other practice areas Rationale: Home Health care joins critical care, emergency departments, operating rooms, and maternal/child care as areas where the risk of lawsuits are higher

Parental accesss to minor medical records

If minor consented to their own care, parents do NOT have a right to access, unless parents pay for care. - A general release for medical records does not authorize the provider to disvulge the fact of substance abuse treatment. That requires a written release, signed by patient.

Incident Reports

Incident, variance, situational, or unusual occurrence report forms were designed to be part of the overall risk management/quality assurance effort of any health-oriented institution - Serve the hospital attorney

This type of policy covers the nurse 24/7 in the nursing practice scope

Individual coverage

Which statement indicates that a nurse understands how the doctrine of respondeat superior alters his liability for negligent conduct?

It makes the nurse liable to the employer.

Decision-making capacity (The right to refuse tx)

It's the clinicians job to make certain the patient understands the situation and tries to persuade the patient to make what the clinician thinks is the wise choice. It's the patient decision whether to accept the recommendation

Statutory Law * AMENDED, REPEALED, EXPANDED BY FUTURE LEGISLATIVE ACTION*

Laws made by the legislative branch of government that are designed to declare, command, or prohibit. Two subcategories: 1) CIVIL LAW -tort law -contract law -patent law -oil and gas law 2) CRIMINAL LAW -penal codes Important examples: *nurse practice acts *statutes of limitations *protective and reporting laws *natural death acts *informed consent laws

MORAL model

M = massage the dilemma. identify and define the issues in the dilemma O = Outline the options. Examine all options fully R= Resolve the dilemma. Review the issues and options, applying basic ethical principles to each option A = Act by applying. Most difficult step because it requires actual implementation L = Look back and evaluate the entire process, including implementation ** using decision-making model to arrive at an ethical solution helps avoid the slippery slope argument!!

A medical technician working in a physician's office routinely refers to herself as a nurse. which type of licensure protects that title as well as the professional actions associated with nursing

Mandatory licensure Rationale: Mandatory licensure requires that all persons who are compensated as a member of a licensed profession obtain licensure prior to practicing actions of the profession. It protects both the title "nurse" and the professional actions associated with the nursing

Consent by Minors

Mature minor doctrine recognizes that any minor capable of informed consent has the capactity to make their own decisions or simple modifications of the law that exists in most states EX: STI/tx for 16 y/o - there is no parental notification law for birth control - Every state must have an option of judicial bypass for cases where a minor fears no consequences of parents finding out she is considering ending her pregnancy - Refer patients to reliable and objective agency -If patient is capable of giving informed consent, then the patient has decision-making capacity

The nurse manager is conducting a performance review with a nurse who has worked on thte unit for 10 years. During the review, the nurse begins to cry and tells the manager, "I can't do this anymore, I can't sleep" A) Moral Distress B) Rights Protection Model C) Therapeutic jurisprudence D) Social Justice

Moral Distress

The nurse manager is conducting a performance review with a nurse who has worked on the unit for 10 years. During the review, the nurse begins to cry and tells the manager, "I just can'tdo this anymore. I can't sleep

Moral distress

Statutes of Limitations

Must be filed in specified time limits for initating claims or they are barred - Typically 1-2 years after becoming aware of injury - If child in case is a minor, the statue of limitation may not begin calculating until the child reaches the age of majority

A nurse has missed 10 days of work while involved as a defendant in a malpractice lawsuit. Must the hospital where this nurse is employed and that was also named in the suit pay the nurse for those days? A) No, since the nurse caused the lawsuit to be filed, the hospital has no responsiblilty for pay B) No necessarily, it depends upon the hospital's insurance policy and what it covers C) In most cases, the hospital is only required to pay the nurse for one-half of time missed. D) Yes, the hospital is always responsible for expense associated with work whether or not the expenses are r/t a lawsuit.

No necessarily, it depends upon the hospital's insurance policy and what it covers *Most hospital insurance policies do not have supplementary payments for the nurse-defendant. This means that if the RN incurs additional expenses in investigating the claim or loses days of work defending the claim, the RN must cover those expenses out of pocket. However, some policies do have this coverage, so this is the most accurate answer.

A nurse calls the newspaper and reports that circumstances surrounding several deaths in the local hospital are suspicious and that a cover-up is in action. The subsequent article identifies the nurse by name and the nurse is fired. Is the nurse protected under the whistleblower law? A) No, the report should have been made in person, not telephone B) Yes, the nurse's action is one that any reasonable and prudent citizen would take C) Yes, since a death occurred, any action to expose the situation is appropriate D) No, the allegations should have been made to the appropriate authorities

No, the allegations should have been made to the appropriate authorities **the method of communication is not the most concerning fact of this situation. Whistleblower protection is very specific and is not pertinent in this situation. The actions taken by this RN are not protected by whistleblower legislation. Whistleblowers are not protected if complaints are made to other than the proper authorities and agencies.

A nurse calls the newspaper and reports that circumstances surrounding several deaths in the local hospital are suspicious and that a cover-up is in action. The subsequent article identifies the nurse by name and the nurse is fired. Is the nurse protected under the whistleblower law?

No, the allegations should have been made to the appropriate authorities.

An out-of-state caller becomes irate when the nurse cannot provide information over the telephone about a hospitalized friend. The caller says, "If you know what is good for you, you had better tell me." Has a civil assault occurred?

No, threatening over the phone is no present ability to commit a harm, thus no tort has been committed. (not present to commit harm to you)

Unavoidable accident

Nothing other than an accident could have caused the patients EX: patient slips and falls in patient room where nothing is on the floor

What is the single most critical factor in determining whether a particular nurse acted with reasonable care in a given situation?

Nurses judgement in a particular situation is a critical factor in determining whether or not she acted with reasonable care a.Open and trusting nurse-patient relationship b. Patients and their families who are treated honestly, openly, and respectfully and who are apprised of all facets of treatment and prognosis are not likely to sue c. Communicating in a caring and professional manner has been shown to be a major reason why more people do not sued despite adequate grounds for a successful lawsuit

Insurance that covers the nurse for any injuries arising out of incidents that occurred during the time the policy was in effect A) claims made policy B) Occurrence based policy

Occurrence based Policy

Ethical dilemma for the Expert witness

Only has WRITTEN records/reports of the event on which to base conclusions and did not witness the event in person - legal consultant: an expert witness who DOES NOT want their name revealed to opposing side/who reports/comments -Recreate events at event where they were not present - Testify on what should have happened - Answer why what did occur was appropriate given the circumstances, community standard, and expertise and education of those inolved at time of event

Cross Examination

Part of trial process - when opposing side asks questions to witnesses in attempt to discredit their testimony

Which statement best explains the importance of electronic medical record use?

Patient care is improved.

The hospital has outsourced housekeeping services to an independent contractor. A patient, who was injured in a fall on wet flooring, brings suit against the company. Does the hospital also hold liability?

Perhaps, secondary to the doctrine of ostensible authority.

Brewster's: Informed Consent

Process of communication to help patients make informed decisions and to protect patients from coercion. Its original intent was to encourage clinicians to be patient-centered. - should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him/her to make an understanding and enlightened decision -Requirements: 1) give each person all the info they need to make informed decision 2) Make sure participant comprehends the info to weight risks vs. benefits 3) Know the decision of enrolling is entirely voluntary. Consent cannot be encouraged by leaving out info. Omission is an unacceptable as deliberate deception

Which statement most accurately reflects the ANA Code of Ethics position on nursing interventions for dying patients? A) Provision 2.3, Collaboration indicates it is ethical to provide nursing interventions to relieve pain and other symptoms that risk hastening death, as long as the nurse collaborates with others prior to implementation. B) Provision 4.2, Accountability for nursing judgment and action indicates it is unethical to provide nursing interventions to relieve pain and other symptoms, if the interventions entail risks of hastening death. C) Provision 2.1, Primacy of patient interests indicates it is ethical to provide nursing interventions with the sole intent of ending a patient's life, if the patient requests the intervention(s) and the nurse is motivated by compassion, respect for patient autonomy and quality of life considerations. D) Provision 1.3, The nature of health problems indicates it is ethical to provide nursing interventions to relieve pain and other symptoms, even when the interventions entail risks of hastening death.

Provision 1.3, The nature of health problems indicates it is ethical to provide nursing interventions to relieve pain and other symptoms, even when the interventions entail risks of hastening death. **However, nurses may not act with the sole intent of ending a patient's life even though such action may be motivated by compassion, respect for patient autonomy and quality of life considerations.

A lawsuit has been filed claiming that a nurse's actions cause by the death of a neonate. Why does the attorney fro the plaintiff want to prove proximate cause?

Proximate cause determines how far the nurse's liability extends for the consequences of the alleged negligent actions Rationale: Proximate cause attempts to determine if the defendant is liable for occurrences that happen after the negligent act took place.

An Emergency Department nurse has agreed to testify as an expert witness in a lawsuit involving a child. The opposing attorney questions the nurse's qualifications as a pediatric nurse. Which type of law does this scenario reflect?

Qualifying as an expert witness explains highly specialized technology or skilled nursing care to the jurors

The patient who has been diagnosed with metastatic cancer declines chemotherapy treatments. The nurse assists this patient in explaining this position to other health care providers. What advocacy model is this nurse exemplifying?

RIghts Protection Model

The parents of a 17-year-old who is receiving state-funded substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider? A) Refuse the request because of the provision of the common-law duty to disclose B) Refuse the request as it is likely to interfere with the treatment plan. C) Release the information immediately as parents always can receive information on minor children D) Release information only if the patient has signed consent to do so

Release information only if the patient has signed consent to do so *A minor must always sign consent for information about substance abuse to be released, even to a parent

The patents of a 17 y/o who is receiving state-funded substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider?

Release information only if the patient has signed consent to do so Rationale: A minor must always sign consent for information about substance abuse to be released, even to a parent.

Videotaped depositions

Replace the recorded depositions through a court reporter and can carry more weight than read evidence

In caring for a 6-year-old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that the child would remember to be good. What should the nurse do? A) Chart that the child is a victim of child abuse, so that there is a record of the abuse should such behavior reoccur B) Do nothing, because the nurse cannot prove the child was really abused, and saying anything could open the institution to a possible defamation lawsuit C) Downplay the child's comments, because children often exaggerate D) Report the incident immediately to the nursing supervisor or physician so that the incident will be reported to the proper authorities

Report the incident immediately to the nursing supervisor or physician so that the incident will be reported to the proper authorities *The RN must take all statements seriously regardless of the age of the patient

The foundational value in informed consent

Respect for autonomy

Self Defense vs. Necessity

Self Defense: - use reasonable force - Protecting yourself/others from violence Necessity: - patient piece of property is the threatening item allowing you to confiscate what they're threatening others with - EX: hand, gun, knife

When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patient was confined to bed. What is the nurse's best defense for applying restraints? 1. Consent 2. Privilege 3. Necessity 4. Self-defense

Self-Defense

Dr. Connolly has a 60 year-old patient who has been on dialysis for 20 years. The patient has become gradually more confused over the past 10 years and now lacks capacity. The patient often screams "Leave me alone--you're killing me!" during her dialysis three times a week. Her family stopped visiting her in the nursing home years ago, and they won't answer Dr. Connolly's phone calls. Dr. Connolly says that preserving life is the most important principle in medicine and, therefore recommends continuing dialysis. A nurse in the nursing home is skeptical of this point of view and asks for an ethics consult. What would be the best advice an ethics committee could give to Dr. Connolly? A) The patient should be listed for a kidney transplant so that she won't need dialysis anymore B) Dialysis is the only treatment always paid for by Medicare, so there is no reason to stop it C) This patient is demented, and so her cries are meaningless; because she lacks capacity, she cannot refuse treatment D) Since his patient is so distressed, continuing this treatment might violate "do no harm"

Since his patient is so distressed, continuing this treatment might violate "do no harm".

Expert Testimony Rules

Testimony is composed of opinions, and answers to hypothetical questions - May serve as legal consultant without testifying

A nurse has been named as defendant in a lawsuit claiming patient injury from misuse of equipment. The nurse says, "The small hospital where I work does not provide the same kind of continuing education training on use of equipment as larger, more modern hospitals." The attorney representing this nurse may choose to use which rule or doctrine? A) Res ipsa loquitur B) Tortfeasor C) The Locality Rule D) Foreseeability

The Locality Rule ** The locality rule attempts to set a standard for the professional similar to that of other professionals practicing in the same geographic area of the country. This rule arose because of wide variations that once existed in patient care, depending on whether the hospital was in an urban or a rural setting. Most states have abolished locality rules.

A nurse brings suit against the hospital after being terminated for excessive absenteeism. Who is the plaintiff in this lawsuit?

The Nurse A plaintiff believes he/she may have a valid cause of action against another individual so he/she initates the lawsuit

In which scenario is the nurse providing indirect supervision of a nursing assistant?

The RN is easily contactable by phone but is present in the care environment Rationale: indirect supervision occurs when the delegator is easily contactable, but does not directly oversee the interventions or activities being performed.

A person desires to bring suit for injuries sustained while hospitalized. What is this person's legal burden of proof?

The burden of proof refers to the obligation of a party to prove its allegations at a trial. Answer: the person's burden of proof would be to provide evidence and prove that the hospital was responsible for the injuries sustained by the pt.

A newly hired nursing assistant can work only when under direct supervision by a registered nurse. In which way can this assistant provide care?

The nurse and the nursing assistant work together to provide care to a team of 6 patients Rationale: Direct supervision is provided when the delegator is actually present, observes, works with, and directs the persons being supervised.

A physician reported a cased of possible nursing malpractice to the Florida Board of Nursing. What action will be taken by the board?

The complaint will be screened and an investigation initiated if appropriate. Rationale: A single complaint triggers action on the part of the board. The complaint is screened and an investigation is initiated, if appropriate.

What does the court consider in determining the nurse's legal liability for standards of care?

The court considers what a reasonable prudent nurse with like experiences and education would do in under the similar conditons in the same community Six elements that assist in determining whether an action is negligence or malpractice: 1.The injury is treatment-related or caused by a dereliction of professional skill 2.Expert evidence is required to determine whether the appropriate standard of care was breached 3.The act or omission involved an assessment of the patient's condition 4.The incident occurred in the context of the health care provider-patient relationship or was within the scope of activities a hospital or other care facility is licensed to perform 5.The injury occurred because the patient sough treatment 6.The act of omission was unintentional

In which case might a default judgment be entered? A) The defendant did not respond to the complaint and would otherwise have been shown to have liability B) The defendent did not respond to the complaint C) The plaintiff did not respond to the complaint D) The plaintiff did not respond to the complaint and would otherwise have been shown to have liability

The defendent did not respond to the complaint *default judgments are entered when a defendant does not respond to the complaint by the plaintiff

An employee asks for time off to be a juror in a case before the state appellate court. How should the nurse manager respond to this request?

The employer must grant time off to serve jury duty, however unless the employee is a government employee, employers are not generally required to pay salaries during the time the employee is serving jury duty.

A nurse brings suit against the hospital after being terminated for excessive absenteeism. Who is the defendant in this lawsuit?

The hospital A defendent is the answering party, who answers to the plaintiff

In which situations would the manufacturer of a drug designated as unavoidably unsafe be held liable for injuries to a patient receiving the drug? Select all that apply.

The information printed in the drug information sheet accompanying the medication was wrong. The physician prescribed the medication after being told that problems with the drug had been corrected.

A defendant invokes the locality rule as justification for a lower standard of patient care. How does the locality rule support this claim?

The locality rule holds the professional to a standard of care in a given geographic area, rather than the national standard of care.

A nurse is leaving the parking lot at the hospital and carelessly runs over a patient who was just discharged. Ironically, the nurse has been assigned to care for that patient that day. If the patient sues this nurse, which statement is true?

The nurse can be held liable fore negligence but not malpractice Rationale: The nurse may be considered negligent related to driving performance as driving action resulted in harm to an individual. this has nothing to do with the nurse's nursing practice and the care provided to the patient that day, so malpractice does not apply.

The hospital-employed nurse volunteered to assist with physical examinations for athletes at the local high school. How does this situation affect the nurse's hospital malpractice insurance?

The nurse is very likely not covered by any malpractice insurance Rationale: As a volunteer, the most likely situation is that the nurse is not covered by any insurance, unless a private insurance policy is in effect

A nurse has agreed to participate in a videotaped deposition in a malpractice case. What does this indicate?

The nurse's testimony can be presented in court, even though the nurse is unavailable for the trial date Rationale: taped depositions are frequently reserved for witnesses who will not be present for the actual trial

The occupational nurse has sponsored and taught first aid classes to workers throughout the factory. If a person, taught by the nurse, makes an error in providing first aid that causes further injury, does the nurse hold any liability? A) no, all liability is on the person who made the error B) The nurse may hold liability depending upon the circumstances C) No, the liability is on the person who caused the original accident causing the need for first aid D) The nurse holds all the liability

The nurse may hold liability depending upon circumstances **The liability is likely not limited to the person that caused the original accident. The person who made the error is not the only person likely to be found to hold liability. The nurse will not hold all the liability in this situation. If the occupational health nurse has the responsibility to teach first aid or to ensure that needed supplies for first aid intervention are available, the nurse may incur potential liability.

How should the nurse proceed when caring for a suit-prone patient?

The nurse should then attempt to react on a more human or personal basis such as expressing satisfaction with the patients cooperation, showing empathy and concern with their suffering and setbacks and repeating needed information to keep patients less fearful of unknown treatments and procedures. An atmosphere of attentiveness, caring, and patience may help prevent the suit-probe patient form filing future lawsuits

The nurse tells a patient that an immunization "will not hurt at all" when the nurse is aware that the injection will be painful. Which ethical principle has the nurse most clearly violated? A) Autonomy B) Double effect 3) Veracity

Veracity

Which nurse is exposed to the greatest risk of liability for malpractice because of the nature of the employment relationship? A) The home health care nurse B) The occupational health nurse C) The federally employed nurse D) The hospital-based staff nurse

The occupational health nurse *Hospital-based staff nurses do not face the same amount of liability as occupational health nurses. The home health care nurse does not face the same amount of liability as occupational health nurses. Federally employed nurses do not face the same amount of liability as occupational health nurses. The practice of occupational health nurses is greatly influenced by a variety of federal and state laws, particularly workers' compensation laws, mandatory-reporting laws, and occupational safety and health laws. These laws are the sole remedy for injured workers, even if an employer's negligence or a co-worker's negligence caused the injury. Therefore, occupational health nurses that are employed by a company are protected from liability like the employer. However, nurses who work independently (are not employed by the company) are not protected from liability. (See page 408 in text.)

A patient requests that records of her hospitalization for treatment of an infection following an abortion be destroyed. What is the likely outcome of this request?

The record will be sealed.

A nurse named in a malpractice case may wish to avoid the expense of a trail by going to arbitration. What is another rationale for using this process? A) arbitration is not binding, so if the parties do not like the outcome, nothing is lost. B) Witnesses do not testify under oath and are easier to obtain C) There is no formal record made of the arbitration process D) There is no need to have attorney representation

There is no formal record made of the arbitration process

A week after stopping to assist at an injury accident, the nurse receives a check for $100 from the patient's family as a thank-you for the care provided. What is the best description of the effect this gift has on the nurse's protection under the Good Samaritan law?

This gift may change the nurse's care to fee-for-service, changing Good Samaritan protection.

What should the nurse identify as the most basic purpose of standards of care?

To protect and safeguard the public as a whole Rationale: The standards are meant to protect the public from receiving varying degrees of quality of care

A person who was injured in a motor vehicle accident sued the driver to recover hospital and therapy costs. Which type of law would be enforced in this situation A) Procedural law B) Tort law C) Statutory law D) Criminal law

Tort law Only one that has a process for allowing the determination of damages and compensation for damages in this case scenario. Tort laws govern wrongful acts that are harmful to an individual

Nurses on one unit vary in their choice of ways to deliver quality care. Is an example of what doctrine?

Two Schools of Thought doctrine

Statues of limitations: Discovery Rule

Two years from when knew of, or should have known of, injury. EX: traumatic injury -- injury normally known by patient or should'be known immediately. Operation on opposite extremity or wrong area of body

The hospital has been sued for the actions of a nurse employee. The hospital proves that the nurse was not providing care within the scope of employment as a nurse. Can the hospital still hold liability in this case?

Yes, if the plaintiff can prove the nurse was incompetent and that the hospital was aware of the incompetence.

The registered nurse who works in the obstetrics department is walking by the emergency department waiting room when a person cries out, "Help me, my mother is not breathing." Does this nurse have a duty to assist?

Yes, the general duty of care exists to help in times of crisis or imminent harm

Co-signing of medical records

You're attesting to observations made - not liable for quality of care - is liable for interventions accuracy

Constitutional Law * AMENDED*

a system of fundamental laws or principles for the governance of a nation, society, corporation, or other aggregate of individuals. - The purpose is to establish the basis of a governing system. - The highest statutory law and is changed only by amendment. - Not repealed, expanded or redefined EX: Bill of Rights // Amendments of the Constitution // Due Process (5th/14th amendment) // Equal Protection (14th amendment)

Truth

a valid defense against defamatory statements EX: Drug seeking behavior -- using prior charting as evidence of patient's actuall behavior

Deposition

a witness's sworn statement made outside the court that is admissible as evidence in court of law

A patient refused to ambulate postoperatively and subsequently developed bilateral pneumonia, causing his hospital stay to be lengthened. After discharge, the patient filed a lawsuit claiming his primary nurse was negligent in allowing him to develop pneumonia. What is the nurse's best defense in this case?

a. Contributory & comparative negligence: hold plaintiff at fault if they had any part in the adverse consequences. (failure to follow prescribed treatment) b. Assumption of risk: plaintiffs are partially responsible for consequences if they understood the risks involved when they proceeded with the action.

The nurse is preparing a patient for a procedure. The patient has signed a consent form, but states, "I don't really know anything about this procedure. I wonder if there is something else I could do instead?" How should the nurse proceed?

a. Obligated to inform the primary health care provider that informed consent is lacking. Can be done by contacting the immediate supervisor and the primary health care provider.

Punitive damages of one million dollars were awarded to the family of a patient who died following a nursing medication error. What is true of these punitive damages?

a. Punitive (or exemplary) damages may be awarded if there is malicious, willful, or wanton misconduct b. The plaintiff must show that the defendant acted with conscious disregard for his/her safety c. Punitive damages are usually considerable and are awarded to deter similar conduct in the future

In caring for a 6-year-old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that the child would remember to be good. What should the nurse do?

a. Report to immediate supervisor and the treating physician. Document all information in pt's chart. If fail to report can be held liable for subsequent injuries.

When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patient was confined to bed. What is the nurse's best defense for applying restraints?

a. Self-defense and defense of others: if pt is combative and threat to self and others nurse is justified in restraining the patient without order for restraints.

Advocacy

active support of a cause or issue that has importance. - defend and speak for such cause/issue - RNs advocate for legal rights of patients and ethical concerns of patients and peers -Three models of advocacy employed in clinical practice settings are: *rights protection model * Values-based model * Respect for persons model

Res ipsa loquitor

applied to medical malpractice cases in which the injured party: - is unconscious - was in surgery - is an infant

Locality Rule

attempts to hold the standard of professional tot that of other professionals practicing in the same geographic area of the country - Abolished in 29 states due to 1) HCPs are no longer able to defend a lower standards of care in rural areas 2) Prof orgs and state standards of nursing practice have created acceptable standards for patients nationally 3) Standards for accreditation of health care facilities should be the same no matter the location of facilities

Deontological Theory

norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed - emphasizes on the dignity of human beings - intention of the action

Fidelity

being faithful to work-related commitments and obligations - keeping one's promises and commitments

Procedural law

concerns the process and rights of the individual charged with violating substantive law - may be contested include admissibility of evidence, the time frame for initating lawsuits, and the qualifications of expert witnesses - concerns the rights of the defendant EX: Rule of evidence - time frame for initating lawsuits - Qualifications for expert witnesses - Notice requirements for hearings (i.e. BON)

Good Samaritan Law

enacted to allow health care personnel to deliver medical assistance without fear of incurring criminal and civil liability

Pre-litigation Panels

ensure that there is an actual controversy or fact question before the case is presented at court. - ensure apropriateness of causes of actions - Ensure that there is actually a controversy - A panel of experts reviews evidence concerning the injury, its cause, and the extent of the injury - Evidence is presented

Lay witnesses

establishes facts at trial (i.e. facts of the event). Has direct connection with case. - States EXACTLY what transpired without drawing conclusions or forming an opinion - May include patients and their family, nurses not named in the suit, or other staff - Describe what, when, and how a particular event occurred -establishes facts -Can only testify to facts - Defines for jury what actually happened - Will present to represent both sides - Has a direct connnection with the case * Can be: - patients - patient's family - Nurses (not named in lawsuit) -other interdisciliplinry staff

Contributory negligence

holds patient accountable for providing false, misleading information to the RN

Electronic medical records

increase accuracy for recording facts and allow for prompt charting

Therapeutic Jurisprudence

interdisciplinary study of law as a social force aims to understand laws impact on peoples emotional and psychological well being challenges nurses to consider the outcome of actions acknowledges the fact that "well being" is a goal of the legal system

Justice

mandates that clients be treated impartially w/o discrimination according to age, gender, race, religion, SES, weight, marital status, or sexual orientation - distributive (social justice) - Retributive (correctional justice)

Standards of Proof

necessary to convince the judge and/or jury that a given proposition is true and to minimize an erroneous decision 1) Prepponderance of evidence - based on the probable truth of evidence presented, not the amount of evidence 2) Clear and Convincing evidence - intermediate standard of proof that a fact is highly probable 3) Beyond a reasonable doubt - Highest level of evidence. - Used in criminal cases

Autonomy

refers to a competent person's right to make his or her own choices w/o intimidation or influence -personal freedom - self determination

Res ipsa loquitor

rule of evidence that emerges when plaintiffs are injured in such a way that they cannot prove how the injury occurred or who was responsible for its occurrence. - Must prove three elements for doctrine to apply: * accident must be the kind that ordinarily does not occur in the absence of someone's negligence * accident must be caused by an agency or instrumentality within exclusive control of the defendant * accident must NOT have been due to any voluntary action or contribution on the part of the plaintiff.

Assumption of risk

with informed consent the patient cannot come back at the MD/hospital with suing them EX: patient lean on a door that opens from the other side. The patient is liable for their own actions

Why is proving proximate harm cause important in the outcome of a professional negligence suit?

•Proximate cause attempts to determine how far the liability of the defendant extends for consequences following negligent activity. •Proximate causes build on foreseeability. •Ex. Medical professional are not responsible for patients getting in a car accident after taking a med that makes them drowsy unless they failed to warn them of the side effects.

Two schools of Thought Doctrine

•Two schools of thought doctrine: supports the nurse who chooses among alternative means of delivering quality health care. In this instance, the court evaluated the standards of care given when the nurse chooses among the alternative modes of treatment. •Violations of standards open nurses to possible disciplinary action by the board.