Level 1.5 - RNSG 1341 - Legal & Ethical

doctrine of respondent superior

- The employer is liable (responsible) for the actions of employees - if an employee of the health care facility is negligent, the facility may be sued for malpractice. - if the employee and the facility are found guilty, the facility may in turn sue the employee to recover the damages. However, if the employee was following all policies and procedures correctly, the facility is fully liable.

A nurse may refuse an assignment when.,

- (1) the nurse lacks the knowledge or skill to provide competent care; (2) care exceeding the Nurse Practice Act is expected; (3) health of the nurse or her unborn child is directly threatened by the type of assignment;(4) orientation to the unit has not been completed & safety is at risk; (5) the nurse clearly states & documents a conscientious objection on the basis of moral, ethical, or religious grounds; or (6) the nurse's clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the patient.

To prove liability for negligence or malpractice, 4 elements must be proven

- Duty: the person must have a reasonable responsibility to exercise care - Breach of Duty: failure to meet the standards of care - causation: failure to meet standards of care results in harm to a patient - damages: the patient must have suffered an actual harm or injury,called damages

common sources of negligence include

- failure to assess and/or monitor., failure to document care & evaluation of care provided to patient in a timely manner., failure to notify the healthcare provider of significant changes in a patient's status., & failure to follow policies & procedures

Types of torts

- fraud - defamation (libel, slander) - assault - Battery - false imprisonment - invasion of privacy - negligence - malpractice

Tort of invasion of privacy

- intentional intrusion into the private concerns of another individual in a manner offensive to a reasonable person. - Typically, invasion of privacy is the release of a patient's medical information to an unauthorized person such as a member of the press, the patient's employer, the patient's family, or online.

the Good Samaritan law

A law that provides civil immunity to professionals who stop and render care in an emergency. Care rendered cannot be done so in a grossly negligent manner.

the Uniform Anatomical Gift Act

An individual who is at least 18 years of age has the right to make an organ donation. Donors need to make the gift in writing with their signature. In many states, adults sign the back of their driver's license, indicating consent to organ donation. In most states there is a law requiring that at the time of death a qualified health care provider ask a patient's family members to consider organ or tissue donation. Individuals are approached in the following order., - (1) spouse, (2) adult son or daughter, (3) parent, (4) adult brother or sister, (5) grandparent, & (6) guardian

If a nurse decides to withhold a medication because it might further lower the patient's blood pressure, the nurse will be practicing the principle of: A. responsibility. B. accountability. C. competency. D. moral behavior.

Answer: B Rationale: If a nurse decides to withhold medication, despite a provider's order, the nurse is then accountable for his or her actions, as the nurse made the independent decision because of his or her knowledge of the patient and the patient's situation at that moment in time.

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of: A. autonomy. B. fidelity. C. justice. D. nonmaleficence.

Answer: D Rationale: Sometimes to improve a patient's condition, it is necessary to perform a procedure that will cause pain for the patient. The nurse must weigh the benefits and the risks with the patient in his or her quest to do no harm.

what are the 6 standards of practice?

Assessment., Diagnosis., Outcomes identification., Planning., Implementation., & Evaluation

nurse practice act is the most important law affecting your nursing practice.

Each state has a nurse practice act, therefore the definitions and descriptions of nursing differ from state to state.

Americans with Disabilities Act

Passed by Congress in 1991, this act banned discrimination against the disabled in employment and mandated easy access to all public and commercial buildings. - housing, employment, education, and health care - includes persons with AIDS and substance abuse

What are the 3 types of Values?

Personal, Societal, & Professional

what government is directly involved that regulates relationships between people?

Private Law

what government is directly involved that regulates the relationship between individuals and the government?

Public Law

Processing an Ethical Dilemma

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values. Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action.

Bioethical issues

Subjects that raise concerns of right and wrong in matters involving human life for example., - euthanasia, or abortion

What if a nurse follows a physician's order, even though they know it may harm the patient?

The nurse can expect to be held personally liable for any harm that does result in their actions.

Plaintiff

The person who files the lawsuit and is seeking damages for a perceived wrongdoing. In medical malpractice, the patient and/or the patient's family.

what is an example of malpractice?

a nurse forgets to give the patient the call light and the person falls,

torts - battery

actually touching without consent

Bioethics

are Ethics concerning life

creativity

is having a vision of how nursing care can be, and making it better. it Requires thinking reflectively, critically and imaginatively to create healing environments and enhance care-giving practices. creativity requires the nurse to develop the qualities of envisioning, risk-taking, openness and resourcefulness. It results in integrating new insights into existing nursing knowledge & awareness. & it creates the potential for the nurse to individualize care & embrace change.

nonmaleficence

is the avoidance of harm or hurt

practicing outside of one's scope is considered

malpractice

Professional values

are identified by practitioners of a profession & are held in common by members of that profession. they May be similar to many societal values, but may differ in which are most and least important. Professional values are acquired.

Personal values

are individual. They are shaped and influenced by family, peers, religion, education, & experiences

which ethical principle is involved in the following example? The nurse encourages the patient recovering from a stroke to perform his own hygiene as much as possible.

autonomy

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

what is mandatory to report to law?

child abuse., crime (GSW, stabbing)., or communicable diseases

Regulatory law, also known as administrative law,

defines your duty to report incompetent or unethical nursing conduct to the Board of Nursing

A health care proxy or durable power of attorney for health care (DPAHC) is a legal document that

designates a person, or people, of 1's choosing to make health care decisions when the patient is no longer able to make decisions on their own behalf. This agent makes health care treatment decisions on the basis of the patient's wishes.

protecting yourself against malpractice

- Establish good relationships with your patients. People who feel cared about seldom sue. Do patient teaching. - Do careful assessments & be knowledgeable about the conditions of the patients you are caring for. If you don't know something, know who to ask! - Get consent for procedures you perform. Include your patient in their care.

RESPONSIBILITY OF NURSES POLITICALLY

- Obligation of nurses to serve as voice in political arena for those least well served: - Homeless - Women and children - Delivery and funding of healthcare services - Nurses are powerful block of voters - Join professional organizations

osha legal regulations.,

- Set legal standards to ensure safe & healthful working conditions for workers., & Has increased responsibilities for nurses - Potential sources of violations include., - Use of electrical equipment., Use of isolation techniques for patients with infections (equipment & supplies)., Use of radiation., & Use of chemicals

The tort of false imprisonment

- intentional - occurs with unjustified restraint of a person without a legal reason, & prevention of movement without consent. - This occurs when nurses restrain a patient in a confined area to keep the person from freedom or even the threat of restraining a patient. False imprisonment requires that the patient be aware of the confinement.

Examples of malpractice

- medication errors - failure to observe/report/take appropriate action in response to significant symptoms (failure to rescue) - falls - mistaken identity - loss/damage to pt property - burns from hot liquids - sponge counts in the operating room

code of ethics

- philosophical ideals of right and wrong that define principles used to provide care. - It is important for you to incorporate your own values and ethics into your practice. - Ask yourself: How do your ethics, values, and practice compare with established standards?

torts - assault

- threat or attempt to touch another person without consent - an assault preceded a battery

tort of Negligence

- unintentional - failure to exercise reasonable care that results in harm to another person - the nurse is judged against what an ordinary reasonable lay person would do or not do in a similar circumstance

Issues in Health Care Ethics

-quality of life: Central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and Do Not Resuscitate (DNR) -disabilities: Antidiscrimination laws enhance the economic security of people with physical, mental, or emotional challenges -care at the end of life: Interventions unlikely to produce benefit for the patient -health care reform: Facilitated access to care for millions of uninsured Americans

ANA Standards of Nursing Practice

1. Assessment: The registered nurse collects comprehensive data pertinent to the patient's health and/or the situation. 2. Diagnosis: The registered nurse analyzes the assessment data to determine the diagnoses or issues. 3. Outcomes Identification: The registered nurse identifies expected outcomes for a plan individualized to the patient or the situation. 4. Planning: The registered nurse develops a plan that prescribes strategies and alternatives to attain expected outcomes. 5. Implementation: The registered nurse implements the identified plan. 5a. Coordination of Care: The registered nurse coordinates care delivery. 5b. Health Teaching and Health Promotion: The registered nurse uses strategies to promote health and a safe environment. 5c. Consultation: The graduate level-prepared specialty nurse or advanced practice registered nurse provides consultation to influence the identified plan, enhance the abilities of others, and effect change. 5d. Prescriptive Authority and Treatment: The advanced practice registered nurse uses prescriptive authority, procedures, referrals, treatment, and therapies in accordance with state and federal laws and regulations. 6. Evaluation: The registered nurse evaluates progress toward attainment of outcomes.

Durable power of attorney for healthcare

A document that allows a person to name someone else to make medical decisions for them if they are unable to do so. This spokesperson's authority begins only when the patient is incompetent to make those decisions.

an Expert witness

A person who has specific knowledge, skills, and experience regarding a specific area and whose testimony will be allowed in court to prove the standard of care.

Interrogatory

A process of discovering the facts regarding a case through a set of written questions exchanged through the attorneys representing the parties involved in the case.

advance directive (living will)

A written statement of a person's wishes about how they would like healthcare decisions to be made if they ever loses the ability to make such decisions independently.

A nurse is caring for a patient who states, "I just want to die." For the nurse to comply with this request, the nurse should discuss:

Advance directives- they are written documents that outlay the patient's wishes, should he or she become incapacitated

5 values ESSENTIAL to the professional nurse

Altruism: concern for welfare & well-being of others Autonomy: right to self-determination Human Dignity: respect for worth of individuals Integrity: honesty Social Justice: working together to assure equal treatment under law and access to quality healthcare, nondiscrimination, lobby

conscience

directs moral, ethical and legal decision-making. It motivates us to increase the knowledge and skills needed to respond appropriately to moral, ethical and legal issues faced by one and others. It directs us to adhere to the standards of professional nursing practice. It directs us to respond to social injustices. It is the increased awareness of local, national and global health concerns and current trends in health care that affect all ages and populations. It is the sense of accountability, responsibility and leadership for patient care.

Jurisdiction

The court's authority to accept and decide cases. May be based on location or subject matter of the case.

competence

acquiring & using evidence-based scientific & humanistic knowledge & skill in the application of therapeutic interventions in the current practice of nursing. It is the knowledge of the role of the nurse in the health care delivery systems of the hospital and the community. It is reflected in the cognitive, affective and psychomotor domains of learning.

Ethical dilemmas

almost always occur in the presence of conflicting values. To resolve them, one needs to distinguish among values, facts, and opinion.

autonomy

an essential element of professional nursing that involves the initiation of independent nursing - commitment to include patients in decisions

Learned values

are chosen in adulthood out of mature understanding

Societal values

are held in common by most members of a society. They are part of a culture and are influenced by the history and social needs of the society

ANA Standards of Professional Performance

ethics, education, evidence-based practice and research, quality of practice, communication, leadership, collaboration, professional practice evaluation, resources, environmental health

torts - defamation

false statements that diminish a person's reputation - libel: written or pictures - slander: spoken

which ethical principle is involved in the following example? The nurse checks on each patient every hour, per facility protocol.

fidelity

A student nurse employed as a nursing assistant may perform care:

identified in the hospital's job description. Student nurses should never perform a task that is not in the job description of the facility with which they work.

Torts - fraud

intentional - deliberate misrepresentation that could or does cause loss or harm to a person or property

Values Clarification

is The process of becoming more conscious of and naming what we value or consider worthy

A value

is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. Your values guide your behavior., & Values shape ethical decisions

Why is clarifying values important in nursing?

it Improves our ability to make value decisions., & Promotes a closer fit between our words and actions

which ethical principle is involved in the following example? The nurse spends as much time caring for an unpleasant, demanding patient as for a sweet, cheerful patient.

justice

commitment

maintaining and elevating the standards & obligations of the nursing profession & assuring the delivery of excellence in nursing care. It is the loyal endeavor to devote ourselves to the welfare of patients. It assures that caring will be part of every nurse patient interaction. Commitment is a conscious effort to grow within the nursing profession through dedication to continuing education, life-long learning, & becoming more skilled, socially conscious, ethical, politically competent & caring.

what can be included in malpractice?

med error., falls., burns from hot liquid., & failure to observe, report, & rescue

You are about to administer an oral medication and you question the dosage. You should:

notify the physician. If you find 1 to be erroneous or harmful, further clarification from the health care provider is necessary. If the health care provider confirms an order & you still believe that it is inappropriate, use the agency chain of command to inform your direct supervisor.

what is an unintentional tort?

patient slips on a wet floor

the nurse practice act defines nurse's

professional and legal responsibilities and obligations.

Advocacy

promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

Torts

refers to duties and rights between individuals not based on contracts. It is a legal wrong committed against an individual or an individual's property.

Criminal Law

refers to relationships between individuals and the government. Violations of these laws are punishable by fines or imprisonment - felony - serious crime (rape, murder, assault and battery, fraud, etc) - misdemeanor - less serious, fines and/or short jail sentence

Civil law

refers to relationships between individuals not between individuals and the state. - contract law: written or verbal agreements, the enforcement of these agreements, and the penalties for failure to fulfill agreements (tuition, sales contracts, leases, ect.) - Lawsuit: a legal action in court for civil offences

what is an intentional tort?

restraints without order

Beneficence

taking positive actions to help others

tort of Malpractice

the Improper performance of professional duties; a failure to meet the standards of care, resulting in harm to another person. Professional practitioners are held to a higher standard of care

fidelity

the agreement to keep promises

example of negligence

the failure to lock the brakes on a wheelchair before transferring a patient and the patient falls.

comportment

the professional presentation of us as nurses to others in behavior, attitude, appearance, dress & language that communicate a caring presence. it's how we behave and present ourselves. It includes the need for self-awareness, awareness of impact of self on others, and accepting responsibility for our actions.This extends to responsibility for the healthcare environment and the behavior of others who contribute to it.

what is the mandatory reporting law?

the reporting of., - child abuse., crime (GSW, stabbing)., & communicable diseases

Ethics is

the study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large. The A.N.A. code of ethics provides a foundation for professional nursing.

compassion

to be with another in their suffering. It is empathy & sensitivity to human pain & joy that allows 1 to enter into the experience of another. It is the understanding of whom that person truly is for whom 1 is caring. (listen to patient and be present in the moment)

confidence

trust in one's ability to care for others. It is the belief that our skilled, professional presence can make a difference. It Is necessary to effectively implement the roles of the nurse as caregiver, teacher, counselor, advocate, leader, manager & researcher. Confidence in our own ability to create caring environments serves as a catalyst for change and empowers both us and others to define and accomplish goals. Confidence is developed through the successful utilization of knowledge and experience.

nurses are responsible for keeping (all/controlled) substances in special locked compartments and careful documentation under the controlled substance act. (1 answer)

violation of this law is considered a criminal act.

accountability

you are responsible professionally and legally for the type and quality of nursing care provided.