chapter 44 legal
Which are client privacy and security safeguards in an electronic medical record system? Select all that apply. 1.Passwords and PIN numbers 2.Having the client sign a release of information 3.Encrypting 4.Workstation privacy filters 5.Not being able to share protected health information
1,3,4
delegation
Many errors in practice are based on improper ________. This is an essential element of practice for the nurse, who cannot be everywhere. The nurse must know the elements of delegation and implement them accordingly.
Which are elements of the Good Samaritan law? Select all that apply. 1.Care was provided in an emergency situation. 2.A person was harmed as a result of care provided. 3.Care was voluntary and payment was not provided. 4.A health-care provider is required to provide care in an emergency situation. 5.Care is provided in a reasonably competent manner.
1,3,5
Which questions are examples of bioethics considerations? Select all that apply. 1.Should a client be allowed to die? 2.Should a nurse practice outside of scope? 3.Should a nurse question an order? 4.Should a nurse sign with "RN" behind her name? 5.Should a client be told about a medical error?
1,3,5
According to the Health Information Portability and Accountability Act Privacy Rule, protected health information can only be shared for which purposes? Select all that apply. 1.Treatment 2.To ensure everyone on a nursing unit is aware of the client 3.Reassurance to family 4.Payment 5.Operations 6.Understanding past treatments
1,4,5
Which are examples of beliefs? Select all that apply. 1.Elderly people cannot provide a good medical history. 2.A family should be told if a medical error occurs. 3.A nurse should not be allowed to work while impaired. 4.A person should not accept blood or blood products from another person. 5.Arriving 15 minutes before shift will give the appearance of dedication.
1,4,5
Which expectations are covered by the American Hospital Association Patient Care Partnership? Select all that apply. 1.High-quality care 2.No unexpected costs 3.Explanation of a diagnosis 4.Involvement in care 5.A clean and safe environment
1,4,5
A nurse suspects a colleague is taking a client's narcotics. The colleague has been behaving erratically at work and his or her clients complain of uncontrolled pain. The nurse reports this concern to the colleague's supervisor. Which is this an example of?
Whistleblowing
Contract law
involves a written or oral agreement between two parties in which one party accepts an offer made by the other party to perform (or not perform) certain acts in exchange for something of value. A breach of contract occurs if either party does not comply with the terms of the agreement. An example would be an employment contract
Remember the adage, "If it was not documented, it was not done." Documentation is one of the most effective risk management tools. Learn and practice proper documentation.
"If it was not documented, it was not done."
Nurse practice acts are designed to
-Protect patients or society. -Define the scope of nursing practice. -Identify the minimum level of nursing care that must be provided to clients.
Which are the purposes of the Health Insurance Portability and Accountability Act of 1996? Select all that apply. 1.Mandate the informed consent process before procedures. 2.Protect health insurance benefits for workers who change jobs. 3.Establish standards to protect client privacy and confidentiality. 4.Protect coverage for individuals with preexisting conditions. 5.Guarantee payment to health-care facilities by Medicare.
2,3,4
Which describes an ethical dilemma?
A pregnant woman may miscarry if she takes a strong chemotherapy agent, but if she doesn't, her cancer will progress quickly.
Which are examples of protected health information? Select all that apply. 1.Client's diagnosis 2.Treatment for depression 3.Account turned over to collections 4.Appointments 5.Employer records of treatment
1,2,3,4
Statutory Law
A statute is a law passed by a federal Congress or by a state legislative body. Congress passes laws for the benefit of society as a whole, whereas states use their police power to pass laws to ensure the general health, safety, and welfare of their citizens. The Nurse Practice Act (NPA) is an example of statutory law. The legislative body of each state passes regulation (laws) that govern the profession of nursing, known as Nurse Practice Acts.
damages
In civil cases, the remedy for the harm the patient suffered is money. The judge or jury will award the plaintiff money to compensate him or her for pain and suffering, lost wages, additional medical bills, and other losses. In some cases, the plaintiff may be awarded punitive damages for grossly negligent or wrongful behavior by the healthcare provider.
crime
A __________ is a violation of a law as defined by a legislative body. The legislature also specifies the punishments for the crime. State-level criminal laws vary from state to state..
Which represents an Americans with Disabilities Act (ADA) accommodation?
A nurse who has had a stroke is not physically able to perform client care and is given a position in scheduling, with an associated pay cut.
The Americans with Disabilities Act (ADA)
Amendments Act of 2008 provides protection against discrimination of individuals with disabilities.
Which civil laws deal with wrongs done by one person to another without a contract involved?
tort laws
Nurse practice acts
are statutory laws passed by each state's legislative body that define the practice of nursing.
Observing for changes
after interventions and treatments. You must know the expected outcomes and side effects of medications and treatments so you can accurately interpret and document anticipated and adverse responses.
Which are examples of protected health information? Select all that apply. 1.Client's diagnosis 2.Treatment for depression 3.Account turned over to collections 4.Appointments 5.Employer records of treatment
1,2,3,4
Which describes the ethical concept of fidelity?
Duty to keep promises
A 49-year-old uninsured and unemployed client arrives at the emergency department of the local private hospital closest to home complaining of chest pain radiating between the shoulder blades, tightness in the neck, and nausea. The triage nurse calls the on-call provider, who instructs the nurse to send the client to the county hospital several blocks away. What federal law protects this client against refusal of care at the private hospital?
EMTALA
What are steps to help avoid malpractice? Select all that apply 1.Don't blame or criticize other health-care providers. 2.Recognize "problem" clients. 3.Recognize significant assessment cues. 4.Know and follow standards of care. 5.Be sure medical equipment has been properly inspected.
1,2,3,4
When creating a password for computer usage, what are some important factors that should be kept in mind? Select all that apply. 1.Use combinations of letters, numbers, and symbols. 2.Don't use words or numbers that are easy to guess. 3.Change passwords frequently. 4.Never share passwords with others. 5.Use the same password for multiple accounts so it is not forgotten.
1,2,3,4
When using the MORAL model for ethical decision making, what principles will help the nurse to function effectively as an advocate? Select All That Apply. 1.Know and document facts. 2.Know the argument. 3.Avoid getting into a power struggle. 4.Be aware of client vulnerability. 5.Assess the group's willingness.
1,2,3,4
Which regulation requires health-care facilities to provide emergency care to clients who seek health care regardless of ability to pay?
Emergency Medical Treatment and Active Labor Act
Good Samaritan laws
are designed to protect from liability those who provide emergency care to someone who has been injured
plaintiff
The __________ in a civil lawsuit is the alleged wronged person and not the state, as in a criminal case.
Which must a nurse remember when accessing articles on the Internet related to nursing practice?
The article may not be reliable.
Causation
The breach of duty or deviation from acceptable standards of care by the nurse must be the direct and proximate cause of the injury suffered by the patient. Causation is usually established based on the testimony of experts, such as physicians, advanced practice nurses, or other healthcare professionals, who can clearly show the connection between the nurse's action or omission and the resulting injury to the patient
Which are examples of negligence? Select all that apply. 1.A nurse inadvertently giving a wrong dose of a medication 2.a nurse documenting vital signs in a medical record when they have not been taken 3.A nurse not turning and repositioning a bedridden client, resulting in the development of bedsores 4.A nurse not administering pain medications as needed for a hospice client 5.A client falling after the client has called for assistance in getting up, for which nobody responded after 25 minutes
3,4,5
How can a nurse recognize a client is struggling with an ethical issue?
The client experiences conflict in some form.
disability
A person has a _________ if he or she has a physical or mental impairment that substantially limits one or more major life activities (EEOC, updated 2012). In general, the ADA provides that employers must provide reasonable accommodations within the work setting to allow employees with disabilities to perform their jobs
defamation of character
All four of the following essential elements of __________ must be present. The communication (written or oral) about the person: -Was false -Was made to another person or persons -Caused the defamed person to experience shame and ridicule and had a negative impact on the person's reputation -Was made as a statement of fact rather than as an opinion
Malpractice lawsuit
An important element of _____________ or disciplinary actions is whether the nurse complied with applicable standards of practice. In malpractice, attorneys look to several sources of information to identify the standards of care and determine what a reasonable and prudent (careful) nurse would have done in the same or a similar situation. These sources include the nurse practice acts (NPAs), job descriptions, hospital policies and procedures, textbooks, professional standards and guidelines developed by professional organizations, and the nursing code of ethics.
Failure to assess and diagnose
As the first step in the nursing process, the failure to conduct an adequate assessment can lead to numerous breaches of duty. Failure to analyze the data and make correct nursing diagnoses can lead to incorrect or no actions.
Which nursing value describes the right to self-determination and to choose and act on that choice?
Autonomy
Which describes the entry of orders directly into an electronic health record by a provider?
Computerized physician order entry
What would be an appropriate nursing diagnosis for a client who is uncertain about which course of action to take in his or her treatment?
Decisional Conflict
Fair access to care and allocation of resources are examples of what type of justice?
Distributive
A nurse discharges a client without answering any questions or teaching him or her how to treat a wound care at home. What type of malpractice claim could be brought against this nurse?
Failure to implement a plan of care
A client is placed under involuntary confinement for suicidal ideation. During this time, the nurse applies restraints to insert a urinary catheter. Which situation has occurred?
False imprisonment
Under ________ rules, healthcare agencies and their employees must take steps to ensure the confidentiality of the patient information and medical records
HIPAA
tort
In a _________, which is a civil wrong against another person, the law provides for remedies that are monetary; in contrast with criminal law, in which the offender can face jail time.
What is one major drawback of applying the Golden Rule way of thinking when addressing a client's wishes?
It is presumptuous in that nursing actions may not really be what the client wants.
Slander
Oral defamatory statement
How can nurses use computers to ensure they are following best practices?
Perform a literature search.
A nurse has been caring for a client and appears to make excessive visits to the client's room. The nurse states he or she has the best understanding of the client's needs while behaving as if no one else can care for the client. When asked about this behavior, the nurse becomes defensive. What could possibly be the issue in this scenario?
Potential boundary issues
Minimizing Malpractice Risk
Practice proper documentation. Observe standards of practice. Use nursing process; follow professional standards. Avoid medication and treatment errors. Report and document accurately. Obtain informed consent. Attend to client safety.
Minimizing Malpractice Risk: contd
Practice proper documentation. Observe standards of practice. Use nursing process; follow professional standards. Avoid medication and treatment errors. Report and document accurately. Obtain informed consent. Attend to client safety.
Which is a barrier to adoption of an electronic health record?
Purchase and installation cost
A client is being discharged after being admitted for myocardial infarction. The physician wants the client to be monitored for vital signs while he or she is engaging in rehabilitation protocol. What type of informatics system could be suggested for reliable interface with client data?
Real-time health monitor system
After assessing a client who has just been weaned from the ventilator, the nurse determines the client is not yet able to ambulate and does not follow the physician's order. What protects the nurse from being terminated or disciplined for not following orders?
Safe harbor laws
Nurse practice acts are an example of what type of law?
Statutory
The provider prescribed Demerol 50 mg at 1400 as an initial dose for a post-operative client to be monitored for reactions and titrate accordingly every 3 to 4 hours prn for pain. The nurse documented the following: 1500Demerol 150 mg given intramuscularly. 1530R: 10 breaths/min; BP 98/62; skin pale.1600 Called provider. Prescription for naloxone (Narcan) 1 mg IV STAT1605 Narcan given as prescribed. R: 14 breaths/min, BP 112/68What important step could be called into question when reporting this incident?
The 30-minute delay in contacting the provider
Failure to plan
The ANA standards specifically require nurses to formulate a plan of care. The plan of care may be written or unwritten, depending on state regulations. Many agencies require nurses to complete nursing care plans or patient care tools as a means of measuring patient outcomes and progress. The plan of care should be consistent with standards of treatments acceptable for the given diagnosis or problem
Patient care partnership (PCP)
The _________ brochure is available in eight languages that explain in detail to patients that during hospitalization, they should expect high-quality care, a clean and safe environment, involvement in care, protection of privacy, help when leaving the hospital, and help with billing claims.
Existence of a duty
The nurse-patient relationship creates this legal obligation. A duty forms when the patient is assigned to the nurse or seeks treatment from the nurse, or when the nurse observes another person doing something that could harm the patient.
malpractice
To win and recover damages (money) in a ________ lawsuit, the plaintiff must prove four elements (duty, breach of duty, causation, and damages) by a "preponderance of the evidence;" in other words, with enough evidence to tip the scale in his or her favor
Which consequentialist theory requires a risk-benefit analysis?
Utilitarianism
Which process assists nurses with selecting correct medication and dosing?
bar coding
It is the nurse's responsibility to remain current in practice through _________ ___________, in-services, and additional training as need
continuing education
Which are discrete entities that are described objectively without interpretation?
data
tort laws
deals with wrongs done to one person by another person that does not involve contracts. A tort is a civil wrong and there are three types of torts: quasi-intentional torts, intentional torts, and nonintentional torts
Federal or state government prosecutes: Criminal law
deals with wrongs or offenses against society. It may result in prosecution (legal action) by the state or federal government for engaging in behavior that constitutes a crime.
Nursing codes of ethics
describes the standards of professional responsibility for nurses and provides insight into ethical and acceptable behavior. It describes nurses' obligations for safe, compassionate, nondiscriminatory, and quality care, while defining commitments to self, the patient, the employer, and the profession.
The US Constitution
establishes three branches of government: executive, legislative, and judicial. Each branch has specified powers that are designed to equalize power among the three and provide a system of checks and balances.
Which is a description of nurses being able to apply standards of ethical conduct to professional practice and participate in ethical decision making?
ethical agency
The nurse must practice under the legal and ________ __________ governing nursing practice
ethical framework
A nurse taking care of a client who has been involved in a motor vehicle accident while intoxicated is an example of which principle?
ethics
A client has called the nurse to the room several times over the course of the past hour because he or she keeps getting up and wandering and is having difficulty getting back into bed. On the last visit to the client, the nurse gives the client a sedative to cause drowsiness. What can this treatment be considered?
false imprisionment
Felonies
involve crimes punishable by more than 1 year in jail (e.g., murder, assisted suicide, rape/sexual assault, stealing drugs and equipment, felony abuse). A person convicted of a felony loses the right to vote, hold public office, serve on a jury, and possess firearms. The person may also lose any professional licenses
Misdemeanors
involve less than a year in jail. They include crimes such as assault, battery, and petty theft. You may also lose your nursing license if you are convicted of a misdemeanor that involves crimes against persons or that can cause harm to others.
Law
is a binding practice, rule, or code of conduct that guides a community or society and is enforced by a controlling authority. The basic function of laws is to protect society by establishing acceptable patterns of behaviors. Nurses can use legal principles from the various sources of law to guide their actions, minimize the possibility of lawsuits, and promote defensible decisions. The legal framework that governs nursing practice consists of laws, regulations, and standards of practice. The common theme under this framework is that the nurse is legally responsible for his or her own actions, and this legal responsibility cannot be delegated
Common (judicial) law
is a compilation of laws made by judges or courts. Also referred to as case law, common law is based on common customs and traditions. It comes from legal principles and guidelines that judges use to determine the outcome of legal cases
ANA Nurses' Bill of Rights
is a policy statement adopted by the American Nurses Association (ANA) to identify the seven conditions nurses should expect from their workplace that are necessary for sound professional practice. It provides a framework for employers to understand what nurses need for a safe work environment and to support nurses as they address such issues as unsafe staffing, workplace violence, and mandatory overtime
battery
is committed when 1) an offensive or harmful physical contact is made with the patient without his or her consent or 2) there is unauthorized touching of a person's body by another person
Malpractice
is one source of legal liability. It means that a professional person has failed to act in a reasonable and prudent manner. If someone is harmed, the professional may be held liable.
Negligence
is the failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent (careful) manner. In many cases, an expert witness is used to determine the nurse's adherence to or deviation from standards of practice.
fraud
is the false representation of significant facts by words or by conduct. It can occur through making false statements, falsifying documentation, or concealing information that should have been disclosed. It is intentionally misleading or deceiving another person to act (or not act) for the personal gain of the one committing the ______.
the bill of rights
is the first ten Amendments to the U.S. Constitution. The Bill of Rights clearly identifies, and in many ways, limits the role of government in individuals' lives.
False Imprisonment
is the restraining of a person without proper legal authorization. It includes any type of unjustified restriction on a person's freedom of movement. Nurses may be accused of false imprisonment when they restrain patients without their permission or when patients are involuntarily committed to mental health units. False imprisonment can involve the use of physical restraints (e.g., vest or wrist restraints) or chemical restraints (e.g., sedative or narcotic medications). You may restrain patients who pose a threat or harm to themselves or others for safety; however, you must immediately obtain the proper authorization to continue the restraint.
Slander
is the spoken or verbal form of defamation of character. A person is not guilty of defamation of character if the statement made about the other person is true or if the person has the protection of a "privilege," such as reporting possible child abuse
Libel
is the written or published form of defamation of character
liability
means that the person is financially or legally responsible for something. Nurses are legally responsible for their own actions and this legal responsibility cannot be delegated—this is the basis for liability in nursing practice
An assault
occurs when a nurse intentionally places a patient in immediate fear of personal violence or offensive contact. An________ must include words expressing an intention to cause harm and some type of action
Breach of a duty
occurs when the nurse fails to meet standards of care. Attorneys look to several sources of information to identify the standards of care and to determine what a reasonable and prudent (careful) nurse would have done in the situation.
An assault and battery
occurs when there is the intent to cause a person fear, combined with an offensive or harmful contact.
Patient Self-Determination Act (PSDA)
of 1991 recognizes the client's right to make decisions regarding his own healthcare, based on the information provided to him by the healthcare provider regarding the medical or surgical treatment options available, the benefits, risks, and alternatives.
Administrative law
refers to the laws that govern the activities of administrative agencies. Administrative agencies are created at the federal level by Congress and at the state level by its legislative bodies. As applied to nursing, within each state's Nurse Practice Act, the state legislative body created a Board of Nursing to enforce the NPA. The Board of Nursing creates rules and regulations that are necessary to ensure compliance with its statutory mission—regulate the practice of nursing.
The Emergency Medical Treatment and Active Labor Act
requires healthcare facilities to provide emergency medical treatment to patients who seek healthcare in the emergency department, regardless of their ability to pay, legal status, or citizenship status. The obligation is for the medical facility to provide medical screening to determine if an emergency exists and to stabilize the patient before transferring him or her to another healthcare facility.
Recognizing significance of the change, documenting or reporting symptoms
to the appropriate person. If a change is significant, you have a legal duty to report the change to the appropriate provider and to document this change in the appropriate medical record.
Institutional polices and procedures
usually are more specific and detailed than standards set by professional organizations. They describe care that is reasonable, appropriate, and expected in the context of that facility. You must be familiar with these policies and procedures because they can be used as evidence of a violation of a standard of care if you failed to follow them
Invasion of privacy
violates a person's right to be left alone. The law recognizes that a person's personal life should not be opened up for public scrutiny and the person has the right to freedom from unwanted interference in his or her private affairs.
Health Information Technology for Economic and Clinical Health (HITECH) Act
• Under the HITECH Act data breach notification provision, healthcare agencies are required to notify clients of breaches without unreasonable delay and by no longer than 60 days. In addition, its enhanced enforcement provisions increase civil penalties for breaches caused by willful neglect up to $250,000, with a maximum penalty of $1.5 million for repeated or uncorrected violations. Posting client information online can trigger HITECH violations.
Mandatory reporting laws
• in various states require healthcare workers to report communicable diseases. You also have a duty to report physical, sexual, or emotional abuse or neglect of children, older adults, or the mentally ill, whether you suspect it or have actual evidence of it. The intent is to protect people who cannot protect themselves and protect society against the spread of communicable diseases. Mandatory reporting laws also protect you when reporting abuse. In most instances, the identity of the reporter is kept confidential.
The Health Insurance Portability and Accountability Act (HIPAA)
•Was passed by Congress in 1996 to: -Protect health insurance benefits for workers who lose or change their jobs. -Protect coverage to persons with preexisting medical conditions. -Establish standards to protect the privacy of personal health information.
