Legal and Ethical Issues
What is informed consent and why is it important?
A written agreement to participate in a study made by an adult who has been informed of all the risks that participation may entail. Must be followed by an oral description.
Code of Ethics for Nurses
A formal statement by the ANA of the nursing profession's code of ethics. Key you must maintain the right to practice then must keep competent in the practice.
Good Samaritan Act
protects the actions performed by health care facility, as long as they act within the scope of their training
Nurse Scope and Standards of Practice/Standards of Professional Performance (ANA, 2010)
9 standards that describe compententcare using the nursing process. Foundation of clinical decision making and critical thinking.
Tort
A civil wrong committed against a person or property, excluding breach of contract. Tort actions compensate for damages
A nurse changes a patient's dry sterile dressing. How is he nurse functioning when performing this task? * Interdependently * Collaboratively * Independently * Dependently
A nurse is not permitted to legally prescribe wound care. The nurse needs an order from a primary health-care provider to implement wound care.
A student nurse about to graduate is actively developing a personal ethical foundation for nursing practice. Place the following actions in the order in which they should progress. * Clarify personal values and beliefs * Identify ethical issues when working * Work continuously to improve ethical decision-making abilities * Integrate one's personal ethical foundation within the ethics of the profession
A nurse must know oneself before helping others and clarify personal values and beliefs. Once values and beliefs are explored, then a basis for an ethical foundation of nursing practice can be identified for oneself. After nurse identifies ethical issues when working in the nursing profession, they facilitate nursing actions without imposing one's own values/beliefs A nurse's ethical decision-making abilities should never remain static. They should grow and mature within the profession.
Which of the following patients requires a co-signature for a valid consent for surgery? * 15 year old mother whose infant requires exploratory surgery * 40 year old resident in a home for developmentally disabled adults * 90 year old adult who wants more information about the risks of surgery * 50 year old unconscious trauma victim who needs insertion of a chest tubes
A person living in a protected environment such as a home for developmentally disabled adults may not have the mental capacity to make medication decisions and requires the signature of a court appointed legal representative.
A primary health-care provider asks a nurse to witness informed consents by several patients. Which patients identified by the nurse are UNABLE to give an informed consent for surgery? SELECT ALL THAT APPLY * 16 year old boy who is married * 50 year old woman who is confused * 35 year old woman who is depressed * 50 year old woman who does not speak English * 65 year old man who has received a narcotic for pain
A person who is confused is unable to understand the risks and benefits associated with making an informed decision. A person is designated as a health-care proxy. Narcotics depress the central nervous system including decision making abilities. This person is considered functionally incompetent.
Uniform Determination of Death Act
A proposal that established uniform guidelines for determining when death has occurred for cardiopulmonary death and brain death.
Intentional Tort
A tort committed by one who intends to do the act that creates the harm. Example is assault, battery, false imprisonment
Quasi Intentional Tort
A voluntary act that directly causes damage to a person's privacy or emotional well-being, but without the intent to injure or to cause distress. Example invasion of privacy, defamation of character
When choosing a nursing school in the United States that awards an associate degree, a future student nurse should consider schools that have met the standards of nursing education established by which organization? * Accreditation Commission for Education in Nursing * North American Nursing Diagnosis Association * American Nurses Association * Sigma Theta Tau International
ACEN, is an organization that appraises and grants accreditation status to nursing programs that meet predetermined structure, process, and outcome criteria.
Federal legislation for nursing
ADA, EMTALA, Mental Health Parity Act, HIPPA, PSDA, Uniform Anatomical Gift Act
When attempting to administer a 10 p.m. sleeping medication, the nurse assesses that the patient appears to be asleep. Which should the nurse do? * Withhold the drug * Notify the primary health-care provider * Awaken the patient to administer the drug * Administer it later if the patient awakens during the night
Administering medication is a dependent function of the nurse. Follow the prescription as it is a standing order.
What is a criminal offense?
An act against society which generally violates statutory law. Felony or misdemeanor. Misuse of a controlled substances is an example of criminal conduct.
How is the nurse functioning when administering a drug that has PRN as part of the prescription? * Collegially * Dependently * Independently * Interdependently
An interdependent intervention requires primary health-care provider's order associated with a set parameter. PRN requires the nurse use judgement in implementing the order.
A primary health-care provider orders out of bed to a chair as the activity level for a patient. How is the nurse functioning when moving this patient out of bed to a chair? * Interdependently * Collaboratively * Independently * Dependently
Determining the extent of activity desirable for a patient is within the primary health-care providers not the nurses scope of practice. This is a dependent function of a nurse.
ANA Standards of Nursing Practice
Assessment Diagnosis Outcomes identification Planning Implementation Evaluation
A nurse says, "If you do not let me do this dressing change, I will not let you eat dinner with the other residents in the dining room." Which legal term is related to this statement? * Battery * Assault * Negligence * Malpractice
This statement is an unjust threat. Assault is the threat to harm another person without cause
A patient sustained a serious injury as a result of malpractice by a nurse. Several legal elements must be met to prove the nurse committed malpractice in a civil suit. Which statements are associated with the element of causation? SELECT ALL THAT APPLY * A nurse-patient relationship existed between the nurse and the patient * A nurse's omission or commission of an act failed to meet standards of care * A nurse's action or inaction was the immediate reason fro the plaintiff's or injury to the patient * A nurse should have known that the action or inaction could result in harm or injury to the patient * A nurse's action or inaction that did not meet a standard of care resulted in a patient experiencing pain, suffering, and disability
Causation relates to malpractice when a patient's injury is directly the result of a nurse's actions/inaction Causation relates to malpractice when a nurse should have known that an action or inaction that is a breach of a nursing standard could result in harm or injury to a patient.
When a nurse is administering a medication to a confused patient, the patient says "The pill looks different from the one I had before." Which should the nurse do? * Ask what the other pill looked like * Explain the purpose of the medication * Check the original medication prescription * Encourage the patient to take the medication
Check medication prescription because it goes to the original source of the prescription.
Patient Bill of Rights
Considerate and respectful care Complete information Informed consent Access to treatment Confidentiality Continuity of care Information re financial liabilities
Criminal Law vs. Civil Law
Criminal Law: Cases involving a violation of local, state, or federal laws (Public Law) Civil Law: Cases involving one party attempting to seek payment or resolution of damages caused by another party.
For which are state legislatures responsible? * Standardized care plans * Enactment of Nurse Practice Acts * Accreditation of education nursing programs * Certification in specialty areas of nursing practice
Every state has its own Nurse Practice Act that describes and defines the legal boundaries of nursing practice within the state.
What are some common Nursing Malpractice Issues
Failure to ensure pt. safety Improper treatment Failure to monitor and report Medication errors Failure to follow agency procedure Documentation
Patient autonomy is MOST accurately defined as the?
General consent upon admission Implied in a medical emergency Patient may refuse treatment AMA - nurses responsibility is patient education and advocacy.
A patient is asked to participate in a medical research study. Which document should the nurse explain to the patient because it protects the patient's rights? * Code of Ethics * Informed Consent * Nurse Practice Act * Constitution of the United States
Informed consent is an agreement by a person to accept a course of treatment or procedure after receiving complete information in order to make an informed knowledgeable decision.
A patient is scheduled to have surgery, and informed consent is to be obtained. Place the following steps in the order in which they should be performed. * The patient is willing to sign the consent voluntarily * The patient signs the consent in the presence of the nurse * The nurse determines that the patient is alert and competent to give consent * The primary health-care provider informs the patient of the risks and benefits of the procedure
It is the responsibility of the primary health care provider to include all the information necessary to make a knowledgeable decision. Patients must be competent to sign a consent form Patient must give their consent voluntarily without coercion. The heath-care provider witnessing the signing of the consent must ensure that the signature is genuine.
What are the three organizational regulation bodies?
Joint Commission JCAHO
Which element of ethical practice is associated with fair policies and procedures guiding allocation of organs for transplantation? * Justice * Fidelity * Veracity * Nonmaleficence
Justice refers to fairness and that all patients should be treated equally, impartially and without prejudice regardless of individual factors.
When considering legal issues the word CONTRACT is to LIABLE as STANDARD is to which word? * Rights * Negligence * Malpractice * Accountability
Liable means a person is accountable for fulfilling a contract that is enforceable by law. Accountable means a person is responsible for meeting standards, which are expectations established for making judgments or comparisons.
Who is primarily protected by the licensure of Registered Professional Nurses? * Nurses * Patients * Common law * Health-care agencies
Licensure indicates that a person has met minimal standards of competency thus protecting the public's safety.
Nursing Malpractice
Negligence where nursing care has fallen below the standard of care. 4 criteria must be met: Owed a duty Duty was breached Client was injured Nurses breach caused the injury Can be errors of commission or omission.
What is damage?
Nurse failure to perform the duty caused damage; proof of harm required. Liability denotes legal responsibility to pay damages.
Standards of care are derived from:
Nurse practice Act Hospital policy and procedure Professional/legal regulations of nursing practice
When preparing to administer a medication the nurse identifies that the does is larger than the standard dose recommended by the manufacturer. Which should the nurse do? * Inform the supervisor * Give the drug as prescribed * Give the average does of the medication * Discuss the prescription with the primary health-care provider
Nurses have a professional responsibility to know or investigate standard dosages for medications. The nurse should question the primary provider when something appears unusual.
When caring for a terminally ill patient a family member says, "I need your help to hasten my mother's death so that she is no longer suffering." Which should the nurse do, based on the position of the America Nurses Association in relation to assisted suicide? * Not participate in active euthanasia * Participate based on personal values and beliefs * Participate when the patient is experiencing severe pain * Not participate unless two primary health-care providers are consulted and the patient has had consulting
Nursing actions must comply with the law and the law states euthanasia is legally wrong and can lead to criminal charges of homiside or civil lawsuits.
Which factor is unique to malpractice when comparing negligence and malpractices? * The action did not meet standards of care * The inappropriate care is an act of commissions * There is harm to the patient as a result of the care * There is a contractual relationship between nurse and patient
Only malpractice is misconduct performed in professional practice, where there is a contractual relationship between patient and nurse that results in harm to the patient.
What is the State Board of Nursing (SBON) responsible for?
Oversees adherence Approve educational programs licensure legal standards Disciplines Legal Standards Administrates Law
What is a nursing duty?
Relationship between plaintiff and defendant. Responsible for: Accurate assessment Altering responsible healthcare professionals to change Competent execution of safety
A nurse administers an incorrect dose of a medication to a patient. Which is the primary purpose of documenting this event in the Incident Report? * Record the event for future litigation * Provide a basis for designing new policies * Prevent similar situations from happening again * Ensure accountability for the cause of the accident
Risk management use statistical data about accidents and incidents to identify patterns of risk and prevent future accidents and incidents.
Identify the actions that are examples of slander. SELECT ALL THAT APPLY * Volunteer telling another volunteer a patient's age * Nurse explaining to a patient that another nurse is incompetent * Personal care assistant sharing information about a patient with another patient * Unit manager documenting a nurse's medication error in a performance appraisal * Housekeeper who is angry at a nurse falsely telling another staff member that the nurse uses cocaine
Slander is a falsely spoken statement resulting in damage to a person's character or reputation. Nurse explaining to another patient that another nurse is incompetent is an example as well as housekeeper who is angry at a nurse falsely telling another staff member that the nurse uses cocaine
A patient living in Oregon has been receiving hospice care in the home. One day the patient tells the nurse, "Dying takes forever, I hate it that I am a burden to my family. I can't stand this anymore. Can you help me end my life?" The nurse's personal ethical values do not include complying with this patient's request. Which is the Nurse's BEST response? * I will inform your primary health-care provider of your desire to die * Your family members probably do not consider you a burden * I can't help you because I do not believe in assisted suicide * Let's talk a little more about your wanting to die
The "Let's Talk a little more about your wanting to die" is an open ended statement that encourages the patient to share and discuss feelings.
For which primary reason is a nurse expert called to testify in a lawsuit regarding professional nursing malpractice? * Strengthen the defense * Support the prosecution * Present standards of nursing care as they apply to the facts in the case * Make judgments associated with laws governing the practice of nursing
The ANA standards of clinical nursing practice are authoritative statements by which the national organization for nursing describes responsibilities. These criteria help a judge or jury determine if a nurse committed malpractice or negligence.
Which is the primary purpose of the American Nurses Association (ANA) Standards of Clinical Nursing Practice? * Establish criteria for quality practice * Define the philosophy of nursing practice * Identify the legal definition of nursing practice * Determine educational standards for nursing practice
The ANA standards of clinical nursing practice describes the nature and scope of nursing practice and the responsibilities for which nurses are accountable.
A nurse is informed that a credentialing team has arrived and is in the process of assessing the quality of care delivered at the hospital. Employees who are reviewers of which one of the following organizations are associated with the credentialing of hospitals? * The Joint Commission * National League for Nursing * American Nurses Association * National Council Licensure Examination
The Joint Commission evaluates the healthcare organization compliance to provide quality care.
Which organization is responsible for ensuring that Registered Nurses are minimally qualified to practice nursing? * State Board of Nursing * American Nurse Association * Sigma Theta Tau International * Constituent Leagues of the National League for Nursing
The National Council of State Boards of Nursing is responsible for the NCLEX exam, however the licensing authority in the jurisdiction in which the graduate takes the examinations verifies the acceptable score on the exam.
A faculty member of a nursing program is conducting an informational session for potential nursing students. Which information about licensure to practice nursing upon completion of a nursing program should the faculty member include in the session? * "It is a responsibility of the American Nurses Association" * "It is granted on graduation from a nursing program" * "It is approved by the National League for Nursing" * "It is required by law in each individual state"
The Nurse Practice act in a state stipulates the requirements for licensure within the state.
What is causation?
The act must have CAUSED the plaintiff's injuries
A nurse must administer a medication. Which should the nurse do FIRST? * Verify the prescription for accuracy * Check the patient's identification armband * Ensure the medication is in the medication card * Determine the appropriateness of the prescribed medication
The administration of medication is a dependent function of the nurse. The primary health-care provider's prescription should be verified for accuracy and include the pt. name, the drug, the size of dose, route of admin, number of times a day and any related parameters.
Nursing practice is influenced by the doctrine of RESPONDEAT SUPERIOR. Which is the basic concept related to this theory of liability? * Nurses must respond to the Supreme Count when they commit acts of malpractice * Health-care facilities are responsible for the negligent actions of the nurses whom they employ * Nurses are responsible for their actions when they have contractual relationships with patients * The laws absolve nurses from being sued for negligence if they provide inappropriate care at the scene of an accident
The ancient legal doctrine Respondeat Superior means "let the master answer" by virtue of the employer-employee relationship the employer is responsible for the conduct of its employees.
When the nurse attempts to administer a medication to a patient, the patient refuses to take the medication because it causes diarrhea. The nurse provides teaching about the medication, but the patient continues to adamantly refuse the medication. What should the nurse do first? * Document the patient's refusal to take the medication. * Notify the practitioner of the patient's refusal to take the medication. * Discuss with a family member the need for the patient to take the medication. * Explain again to the patient the consequences of refusing to take the medication.
The nurse should document the patient's refusal and withhold the medication. A patient always has a right to refuse care.
A patient's diet order is "clear liquids to regular as tolerated." How is the nurse functioning when progressing the patient's diet to full liquid? * Dependently * Independently * Collaboratively * Interdependently
The nurse uses clinical judgment based on the providers orders to progress the diet as tolerated. This is an interdependent action.
A student nurse is about the graduate from an accredited nursing program. Which does the student nurse understand are actions UNRELATED to a state Nurse Practice Act? SELECT ALL THAT APPLY * Setting guidelines for nurse's salaries in the state * Establishing reciprocity for licensure between states * Determining minimum requirements to be licensed as a nurse * Maintaining a list of nurses who can legally practice in the state * Providing legal counsel for a nurse who is being sued for malpractice
The salary of nurses is determined through negotiations between nurses or their representatives such as a union or a professional nursing organization. A state's nurse practice act defines the criteria for licensure within the state however actual function is the state board of nursing State Nursing Practice Acts do not provide legal counsel for a nurses who is sued for malpractice.
An older adult male is admitted to the hospital after sustaining a brain attack (cerebrovascular accident, stroke). Intravenous fluids, resuscitative medications, and mechanical ventilation are instituted in the emergency department. Eventually, testing indicates absence of brain functions. A nurse interviews the patient's son and daughter and reviews the patient's advanced directives. Legally, which is the MOST likely outcome in this scenario? * The son will request that life-sustaining interventions be stopped * The daughter will legally be able prevent the withdrawal of medical interventions * The nurse should refer this situation to the agency's ethics committee for consideration * The primary health-care provider should concur with another health-care provider to arrive at a course action
The son by law as a result of the patient's health care proxy can make the health-care decisions for his father including withdrawing all life-sustaining interventions.
A nurse completes an Incident Report after a patents falls while getting out of bed unassisted. Which is the purpose of this report? * Ensure that all parties have an opportunity to document what happened * Help establish who is responsible for the incident * Make data available for quality-control analysis * Document the incident on the patient's chart
The use of an incident report is helpful to identify patterns of risk so that corrective action plans can take place.
An anxious patient repeatedly uses the call bell to get the nurse to come to the room. Finally the nurse says to the patient, "If you keep ringing, there will come a time I won't answer your bell." What legal term is related to this statement? * Slander * Battery * Assault * Libel
This is an example of assault because it is a verbal attack or unlawful threat causing a fear or harm.
Which is the main role of the American Nurses Association? * Establish standards of nursing practice * Recognize academic achievement in nursing * Monitor educational institutions granting degrees in nursing * Prepare nurses to become members of the nursing profession
To establish standards of care and standards of professional performance. These standards reflect the values of the nursing profession, provide expectations for nursing practice, facilitate the evaluation of nursing practice, define the profession's accountability to the public.
A nurse working in a hospital administers a medication to the wrong patient and is sued by the patient. Under contract law which liability occurs when the hospital is additionally identified as a defendant in the legal action? SELECT ALL THAT APPLY * Vicarious Liability * Borrowed Servant * Captain of the ship * Respondeat superior * Quasi-intentional tort
Vicarious liability applies when accountability for a wrong is assigned to a person or entity that did not directly cause an injury but has a contractual relationship with the person who did cause the wrong. The liability of Captain of the Ship applies to this situation. The nurse functions as a representative of the institution. Respondeat superior applies when the agency hires a nurse to the institution and must perform within its policies.
A Registered Nurse witnesses an accident and assists the victim who has a life-threatening injury. Which should the nurse do to meet an important standard of care when acting as a Good Samaritan at the scene of an accident? * Seek consent from the injured party before rendering assistance * Implement every critical-care intervention necessary to sustain life * Stay at the scene until another qualified person takes over responsibility * Insist on helping because a nurse is the best-qualified person to provide care
When a nurse provides emergency care the nurse has an ethical responsibility not to abandon the injured person. The nurse should not leave the scene until the injured person leaves or another qualified person arrives to assume responsibility.
A nurse initiates a visit from a member of the clergy for a patient. How is the nurse functioning when initiating this visit? * Interdependently * Independently * Dependently * Collegially
When the nurse initiates a referral to a member of clergy the nurse is acting independently. The nurse is legally permitted to diagnose and treat human response for actual or potential health problems.
Public Health Law
all statements relating to health written by any of the three branches of government at the federal, state, and local level.
Negligence
conduct that falls below a standards of care which are established to protect others from harm
What are the four elements of liability?
duty, breach of duty, causation, damages
ANA Standards of Professional Performance
ethics, education, *evidence-based practice and research, quality of practice, *communication, leadership, collaboration, professional practice evaluation, resources, *environmental health *most recently added
What is breach of duty?
failure to conform to standards of care.
Unintentional Tort
negligence and malpractice
How does a nurse jeopardize their license?
negligence, incompetence physical/mental impairment, violation of Pt. bill of rights, abusive behavior, drug/alcohol abuse, fraud, criminal behavior.
Nurse Practice Act (NPA)
the most important law affecting your practice and defines Scope for standards of care education professional governance SBON licensure tasks that can be delegated