CHAPTER 7 - LEGAL DIMENSIONS OF NURSING PRACTICE

Unintentional tort occurs when the nurse did not intend harm, but harm occurred (administration of medication and client has an adverse reaction)

A nurse gives a medication and client has an adverse reaction.

The nurse can be charged with slander, which is a verbal attack on a person's character.

A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged?

A client admitted to a mental health unit has exhibited physical behaviors that put him and others at risk. The nurse applies four-point restraints on the client without obtaining a physician's order or the client's consent. The nurse is at risk of being accused of which of the following?

Battery

The second is licensure, which is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants a license to do so.

A license is a legal document that permits a person to offer to the public skills and knowledge in a particular jurisdiction, where such practice would otherwise be unlawful without a license. In addition to successfully completing an accredited nursing program of study and passing the National Council Licensure Examination (NCLEX), to maintain a license in good standing a nurse must meet other requirements as determined by the state or territory. These requirements typically include good moral character, continuing clinical competence or continuing education, the absence of a criminal record, English proficiency, and compliance with specific provisions of the state's nursing laws.

The client being admitted to the oncology unit conveys his wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in his best interest to obtain which document?

A living will

Which process evaluates and recognizes educational programs as having met certain standards?

Accreditation

Assault and Battery

Assault is a threat or an attempt to make bodily contact with another person without that person's con-sent. Battery is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person's body or clothes or anything attached to or held by that other person. Forcibly removing a pa-tient's clothing, administering an injection after the patient has refused it, and pushing a patient into a chair are all examples of battery. Threatening to do any of these actions if the patient does not cooperate is assault. If an aggressive patient threatens harm, only actions necessary for self-protection or the aid of another are permitted. Every individual has the right to be free from invasion of one's person, and adult patients who are alert and oriented have the right to refuse any treatment. The fact that treatment is desirable does not allow the nurse or physician to proceed without the consent of the patient or to go beyond the limits to which the patient has con-sented.

A nurse working in a coronary care unit resuscitates a client who had expressed wishes not to be resuscitated. Which tort has the nurse committed?

Battery The nurse has committed a mistake and can be sued for battery because of unlawfully carrying out a procedure that the client had refused.

A nurse exits the room of a confused client without raising the side rails on the bed. The failure to raise the side rails would constitute which element of liability related to malpractice?

Breach of duty

The nurse fails to contact the physician regarding a client who had an open-reduction internal fixation of the tibia and has experienced increasing leg pain (unrelieved by pain medication) for the past 4 hours. Which element of liability has been violated?

Breach of duty

A nurse fails to alert a physician after a client's condition worsens and the client dies. What type of the four elements indicates malpractice has occured?

Damages

Defamation of character is an intentional tort in which one party makes derogatory remarks about another that harms the other party's reputation.

Defamation of character in spoken words is called slander Libel is defamation of character in written words.

Defamation

Defamation of character is an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. Slander is spoken defamation of character; libel is written defamation. Defamation of character is grounds for an award of civil damages. Damages are awarded to the plaintiff based on the amount of harm done to the plaintiff. Nurses who make false or exaggerated statements about their pa-tients or coworkers run the risk of being sued for slander or libel. A person charged with slander or libel may be found not liable if it can be proved that the statement was made not to injure another but was made for a nonmalicious, justifiable purpose. Social media have created new opportunities for defamation

A nurse is named as a defendant in a malpractice lawsuit. Which action would be recommended for this nurse?

Do not volunteer any information on the witness stan The nurse on the witness stand should be polite, but not volunteer any information. The nurse should only answer the questions asked. The other examples are not examples of what a nurse should do in a malpractice lawsuit.

Fraud

Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Misrepresentation of a product is a common fraudulent act. A person fraudulently misrepresenting oneself to obtain a license to practice nursing may be prosecuted under the state's Nurse Practice Act. Also, misrepresenting the outcome of a procedure or treatment may constitute fraud.

During the orientation to the hospital, the staff development educator discusses unit and institutional-based policies. What is the source of the practice rules that result in unit and institutional-based policies?

Health care institution

Whether negligence has occurred depends on a standard of care—what a reasonably prudent person would or would not have done under similar circumstances. All nurses are responsible for following the standards of care for their particular areas of practice.

If hospital policy dictates an assessment of each woman in the early stages of labor every 30 minutes, for example, nurses must adhere to this standard unless they document a reason for doing otherwise.

An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which offense has the nurse committed?

Invasion of privacy

The first is accreditation, which is the process by which an educational program is evaluated and recognized as having met certain standards.

Legal accreditation of a school preparing nursing personnel by the state Board of Nursing is different from voluntary accreditation. The National League for Nursing Accrediting Commission (NLNAC) and the Ameri-can Association of Colleges of Nursing (AACN) are voluntary agencies that accredit schools when they meet certain criteria. Most schools choose to seek this voluntary accreditation, and many prospective students prefer selecting accredited schools. Accreditation by NLNAC or AACN is not a legal requirement for a school to exist; state accreditation is a legal requirement.

A client newly diagnosed with congestive heart failure has a prescription for digoxin (Lanoxin). The nurse counts the heart rate before administration of the medication and obtains a heart rate of 51 beats per minute. Which action by the nurse demonstrates adherence to the standards of nursing care?

Nurse withheld the medication and notified the health care practitioner

During the admission assessment of a female client age 40 years with a suspected mandibular fracture, the client discloses to the nurse that her injury came as a result of her husband hitting her. Which action should the nurse prioritize when responding to this disclosure?

Reporting the abuse to the appropriate authorities

A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged?

Slander

A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which of the following statements is true regarding the Good Samaritan law?

The Good Samaritan law will provide legal immunity to the nurse.

Legal safeguards are in place in the nursing practice to protect the nurse from exposure to legal risks as well as to protect the client from harm. What are examples of legal safeguards for the nurse? Select all that apply.

The nurse documents all client care in a timely manner. The nurse educates the client about The Patient Care Partnership. The nurse obtains informed consent from a client to perform a procedure.

False Imprisonment

Unjustified retention or prevention of the movement of another person without proper consent can constitute false imprisonment. For example, only a reasonable amount of restraint should be used in circum-stances that warrant it. The indiscriminate and thoughtless use of restraints on a patient can constitute false imprisonment. A person cannot be legally forced to remain in a health agency, such as a hospital, if that person is of sound mind, even when health practitioners believe that the individual should remain for additional care. Health agencies have special forms to use when a patient insists on being discharged against medical orders. The patient signs to indicate not holding the agency responsible for any harm that may result from leaving. People who are mentally ill may be committed to a psychiatric institution for treatment without their consent (involuntary commitment) only when it can be proved that they may be harmful to themselves or others.

Nurses are occasionally asked to witness a testator's (person who makes the will) signing of his or her will. Which of the following guidelines is true regarding a nurse's role is witnessing a testator's signature?

Witnesses to a signature do not need to read the will.

According to the National Council of State Boards of Nursing, a mutual recognition model of nurse licen-sure allows a nurse to have one license in his or her state of residency and to practice in other states (both physically and electronically) as well, subject to each state's practice law and regulation, unless otherwise re-stricted. This multistate nurse licensure model is governed by the Nurse Licensure Compact (NLC).

You must legally reside in an NLC state to be eligible for a multistate license.

An RN enters a client's room and observes the unlicensed assistive personnel (UAP) forcefully pushing a client down on the bed. The client starts crying and informs the UAP of the need to go to the bathroom. What action is the RN witnessing that should be immediately reported to the supervisor?

battery.

Which situation is an example of battery that the nurse may experience while performing her duties at the health care facility?

performing a surgical procedure without getting consent

• Unintentional Torts Negligence and Malpractice

• Failure to follow standards of care: for example, you fail to follow the standards for administering in-sulin or other injectable medications • Failure to use equipment in a responsible manner: for example, you attempt to use a bariatric patient lift for the first time without getting help and the patient falls • Failure to assess and monitor: for example, you fail to follow your hospital's standards for postopera-tive assessments after receiving a patient from the operating room and response to a ruptured suture line is delayed • Failure to communicate: for example, you fail to communicate your concerns about an elderly patient being discharged home; she lives alone and is soon rehospitalized because no provisions were made to secure the nursing care she needed after discharge • Failure to document: for example, you work up the chain of command when your repeated calls to a physician to see a patient that you believe is in danger of arresting are ignored. Before any physician sees the patient, he arrests and, despite a code, dies. You document the arrest, code, and death but fail to document all the steps you took to get the patient the medical attention he needed. Sixteen months later, the family sues and you try to remember what action you took that evening—most of which was never recorded. • Failure to act as a patient advocate or to follow the chain of command: for example, you are in the op-erating room and watch a surgeon break the sterile field twice. No one else seems to notice. You are intimidated by this surgeon and fail to bring this to anyone's attention. You learn that the patient de-veloped a serious infection postoperatively.