Foundations of Nursing - Legal & Ethical Aspects of Nursing

Practitioner Assisted Suicide

Form of active euthanasia (as compared to passive euthanasia) The practitioner taking an active role in helping to end a patient's life

Doctrine of Informed Consent

refers to full disclosure of the facts the patient needs to make an intelligent decision before any invasive treatment or procedure is performed Duty of the doctor or NP who is performing the procedure to obtain the informed consent. As a nurse you are ONLY witnessing the signature!

Damages

Compensation sought by plaintiff

Justice

Concept of what is fair. All patients have the same right to nursing interventions.

Summons

Court order that notifies defendant of legal action

Deliberation

Decide guilt or innocence of defendant

Autonomy

Freedom of personal choice, a right to be independent and make decisions freely.

Patient's Rights

Goal is to promote the public's understanding of thier rights and responsibilities as consumer of health care

HIPAA

Health Insurance Portability and Accountability Act April 14, 2003 - Federal Law that establishes standards for the privacy and security of health information and a standard for electronic data interchange of health information

Sentence

Penalty based on the severity of the crime, defendants past criminal record, and applicable laws

Confidentiality

The nurse has a duty to protect information about a patient no matter how that information is received -Failure to maintain confidentiality gives rise to legal liability & legal remedies exist to address confidentiality breaches -Health Insurance Portability & Accountability Act of 1996 (HIPAA) set rules & limits on who can look at & receive health care information

Veracity

The obligation to tell the truth.

Good Samaritan Law

-provides immunity from liability in certain circumstances -encourages assistance in emergencies occuring outside of a medical facility

Statutory Law

Developed by federal, state, & local governments

National Federation of Licensed Practical/Vocational Nurses (NFLPN)

Developed code of what will be expected of LPN/LVNs. To know and function within the scope of practice for a licensed LPN/LVN. To maintain patient confidences. To provide health care without discrimination. To maintain a high degree of professional and personal behavior. To take an active role in the development of the LPN/LVN profession.

Common Law (case Law)

Developed in response to specific legal questions that come before court and usually follows previous ruling on an issue

American Nurses Association (ANA)

Developed the Code for Nurses, which defines the nurse's responsibility for upholding the client's rights.

Beneficence

Doing good or acting for someone's good.

Elements that must be present for Malpractice

Duty exist: the nurse -patient relationship establishes a duty Breach of Duty: The nurse fails to perform the duty in a reasonable, prudent manner Harm Occurs: This does not have to be physical injury Proximate Cause: The breach of duty was the proximate cause of the harm

Scope of Nursing Practice

Each LVN/LPN must be familiar with their scope of practice -The nurse CANNOT use ignorance as an excuse -Every nurse needs to know what they can & cannot do while providing nursing care

Legal Relationship

Nurse-Patient Relationship -when the nurse assumes responsibility for the patients care -failure to provide care to the expected level of expertise gives rise to legal liability

Depositions

Out-of-court statements made by a witness under oath

Plaintiff

The complaining party

Laws

prescribe proper behavior in society, they sanction acceptable behavior and prohibit unacceptable behavior

Malpractice

professional negligence

Ethical Dilemmas

situations that do not have a clear right or wrong answer: -identify the problem -assess the situation completely -consider any ethical principles that might apply

Occurrence Basis policy

this type of policy protects you against claims made about the events that occurred during the policy period or extended coverage period

Legal liability may occur in:

-expose the patient's body parts unnecessarily -discuss the patient inappropriately -disclose information about the patient -using any unauthorized patient's information

Legal

Legal Responsibilities Example in relations to establishing rules, legal aspects, involves regulatory mandates, and compliances with regulatory framework of conduct which may be controlled by local, state, or federal legislations

Commission

Liable for DOING an act

Omission

Liable for NOT doing an act

Negligent Acts

Medication errors, IV errors, Falls resulting from failure to provide safety, Failure to use sterile technique, Failure to check equipment, Burns resulting from failure to monitor bath temp, Failure to monitor, Failure to report changes in condition, and Failure to provide a complete report.

Practitioner-Assisted Suicide (PAS)

-form of active euthanasia -the practitioner taking an active role in helping to end a patient's life -ANA has taken a firm stand against PAS (state it is not consistent with the philosophy of nursing) -the right to autonomy and the right to self-determination are issues used to support PAS

Nurse Practice Act

-laws formally difining ang limiting the scope of nursing practice -all state have adopted nurse practice acts, although the specifics they contain often vary

Proper documentation

-medical record is used to prove in court that the standard of care was met or not met -"IF IT ISN'T CHARTED, IT WASN'T DONE"

Respect for people

-no one person is more important than another -each patient has the same worth and is always entitled to respect

Advocate

-one who will defend or plead a cause or issue on behalf of another -The nurse accepts the role of an advocate for the patient - A nurse advocate has a legal & ethical obligation to safeguard patient's interests

Values

-personal beliefs about the worth of an object, idea, custom or attitude -develop over time and change in response to changing circumstances -influences behavior and decisions -learned through experience, observation, and reasoning

Disciplinary defense insurance provides the following in the event that you are brought before the LVN/LPN Board of nursing for disciplinary actions:

-qualified nurse attorney to represent you -Wage, loss reimbursement -travel, food, lodging reimbursement -legal fees paid or reimbursement for payment

Ethical principals in nursing practice

-respect for people (view all human life as sacred) -autonomy (right to independence and to make decisions freely) -beneficence (doing good or acting for someones good) -nonmaleficence (to do no harm) -Justice (the concept of what is fair, all patients have the same right to nursing interventions)

Code of ethics for Nursing

-serve as a way to regulate the nurses actions and give guidelines for ethical behavior -promotes competent, trusthworthy, and accountable health care practitioners in order to safeguard society

Do Not Resuscitate (DNR) order

-the patient is usually incapacitated with little hope for recovery -physician after consultation with the patient's family, will write the order in the medical records -nurse has the duty to follow the order.

Value clarification

-the process of self-evaluation that helps you gain insight into your personal values

Workplace violence includes:

-verbal abuse -emotional abuse -sexual harassment -physical assault -threatening behavior

What elements must be present for you to be held liable?

1. Duty exists 2. Breach of duty 3. Harm has occurred 4. The breach of duty was the proximate cause

Two trends that are affecting patient confidentiality:

1. Many smaller health care organizations are merging to form large corporations 2. Computer based health care records are becoming common

Code of ethics for LPN/LVN

1. know and function within the scope of practice for LVN 2. maintain patient confidences 3. provide health care without discrimination 4. maintain a high degree of professional and personal behavior 5. take an active role in the development of the LPN profession

How do you clarify values?

1. select the belief or behavior and consciously examine it 2. decide its value 3. incorporate the value into your set of everyday responses and behaviors

Child Abuse Prevention Treatment Act

1973 made reporting of child abuse mandatory. Face possible fines, imprisonment, or both if you fail to report suspected cases of child abuse to appropriate authorities. Withholding treatment is a form of child abuse.

Board of Nursing

Alleged breaches of standard of care or infractions of patient safety practices are governed. Investigates allegations, hearings and appeals of alleged breach. Dismiss charges, investigations agreements, letter of reprimand (formal or informal), probation with stipulations, mandated diversion programs, suspension with stipulations, and revocation of license are some of the possible results of hearings.

Proxy

Another person who will speak for the patient and make decisions regarding care.

Passive Euthanasia

Withholding lifesaving treatment and care is medical neglect and carries the risk of professional neglect (medical malpractice) charges.

Advance Directives

Written document recognized by state law that provides directions concerning the provision of care when a client is unable to make his or her own treatment choices. Two basic types are wills and durable powers of attorney. Including the use of life support if incapacitated.

Interrogatories

Written questions that must be answered in writing

Refusal to Treat

Your right to disqualify yourself from assisting with an abortion does not extend to excusing yourself from providing care to the patient after the abortion. do not abandon the patient, instead, ask for another assignment. Patient has the right to receive care, and the nurse has the responsibility to provide nursing interventions.

Right to refuse treatment

a competent adult has the right to determine what is done, or not to be done to them, even if the refusal has the potential or is certain to result in death.

Civil battery ( technical battery)

unlawful touching of a person; an intent to harm is NOT necessary

Ethics

values that influence a persons behavior and the individuals feelings and beliefs about what is right or wrong

Liability

-A legal responsibility -A nurse can be charged with civil or criminal liability depending on particular circumstances surrounding the case

Informed Consent

-A person agrees to allow a particular treatment based on full disclosure of the facts needed to make an intelligent decision -Consent must be obtained before any invasive treatment or procedure -Patient needs to be aware of the benefits of the treatment, the risks involved, any alternative treatments, & the consequences of refusing the treatment. -The patient has the right to accept or reject the proposed care -Failure to secure informed consent may result in civil liability for battery

Standards of Care

-Acts that are permitted to be performed or are prohibited from being performed -Give direction to the practicing nurse, defining what should or should not be done for patients. -Every nurse is obligated to know and follow the established standards of care -Failure to adhere to these standards gives rise to legal liability. -The legal test is what a reasonably prudent nurse of similar education and experience would have done under similar circumstances -Federal, state, laws, rules, regulations & other professional agencies define standards

Criminal Law

-Conduct at issue is offensive to society in general -Conduct at issue is detrimental to society as a whole -The law involves public offenses (robbery, murder etc) -The laws purpose is to punish for the crime and deter and prevent further crimes

Civil Law

-Conduct violates a person's rights -Conduct is detrimental to that individual -Involves an offense that is against an individual -Law's purpose is to make the aggrieved person whole again, to restore them to where they were

Criminal Trial

-Defendant is arrested for a crime against the people -People's attorney & defendant's attorney present their cases in court -Judge or jury deliberates

Answer

-Detailed response to charges outlined in the complaint -Usually prepared and filed by an attorney hired by the defendant -Will either admit or deny any or all of the allegations made in the complaint

Customs

-Habits, ways of acting -Members of a family expected to behave in a certain way

Verdict

-Is rendered based on facts of case -Evidence and testimony presented -Credibility of witness -Laws that pertain to issue

Licensure

-all licensed practical nurses must apply for licensure in the state or province in which they wish to practice -applicants are carefully screened. -upon approval of the Board of Nursing, the applicant is eligible to take the computerized licensing examination and maintain a current license -once a license is granted, it can be suspended or revoke for unprofressional, unethical, immoral or criminal conduct -interstate compact (license by endorsement) - allows for multistate practicing of nursing. The nurse must be licensed in her or his home state, and privileges are then granted to practice in other states that have signed the interstate compact

Basic legal mandates to practice as an LPN/LVN:

-apply for licensure in the state or providence in which they wish to practice -meet all licensing requirements -pass the computerized licensing exam -maintain a current license

Medical Records

-are NOT public documents -the information they contain must be guarded -records may be used by both parties in a lawsuit to argue facts of the case -all entries in the medical record must be permanent, accurate, complete, and legible

Factors that put older adults at risk for physical, emotional or financial abuse include:

-declining physical health -declining mental ability -decreased strength and mobility -loss of independence -isolation -loss of loved ones, friends and relatives

Accountability

Being responsible for one's own actions

Health care proxy

Assigns durable power of attorney to make decisions regarding medical treatment in the event that the patient becomes unable to make them.

Overview of legal system

Laws: -Prescribe how a person should act in society -Sanction acceptable behavior & prohibit unacceptable behavior -Provide protection for all members of the health care system

Civil Litigation

Lawsuit in a civil court begins when the plaintiff contacts an attorney

What can happen from investigation of a claim by the state board of nursing regarding licensure issues or disciplinary actions?

-dismissed charge -investigations agreement -letter of reprimand (formal or informal) -Probation with stipulations -mandated diversion program for drug or alcohol related charges or based on mental condition -suspension with stipulations -revocation of license

Nursing liability falls into what areas?

Practice Monitoring Communication

Discovery

Pretrial process allowing both sides to interview witnesses and/or look at documents

How to avoid a lawsuit

Provide compassionate, competent nursing care -Nurse-patient relationship must be one based on trust and respect -Use open and honest communication -Follow the standards of care and adhere to the scope of practice for a LVN/LPN -Professional liability insurance

Appeal

Request to review of decision May be filed by either party if the disagree with the outcome of the lawsuit

Patient Self-Determination Act

Requires that institutions maintain written policies and procedures regarding advanced directives, the right to accept or refuse treatment and the right to participate fully in health care related decisions

Complaint

Statement by the plaintiff Written & filed in the appropriate court States the facts involved in the legal issues raised & outlines the damages

Defendant

States facts involved in legal issues raised outlines the damages The alleged person is liable

Violations and Invasions of Client Privacy

Taking photos, Release of medical information to unauthorized person, Use of client's name or photo, Intrusion, Publication of info or embarrassing facts, Public disclosure of private info, Leaving curtains or door open during treatment, Allowing observation of treatment w/o consent, Leaving confused client in hallway, Interviewing where conversation can be overheard, and Accessing medical records while unauthorized.

Fidelity

The duty to do what one has promised.

Reporting Abuse

The law prescribes when a healthcare professional must report certain information to authorities (certain communicable diseases, gunshot wounds, signs of abuse) -be alert to signs of abuse (children and elderly) -The healthcare professional is protected from liability when acting in good faith

Malpractice Insurance

The nurse may want to purchase individual coverage even if the employer carries insurance. Personal malpractice insurance provides more protection for the nurse while off and on duty. Most institutions policies cover liability only if the nurse is on duty and acting within the proper capacity.

Invasion of Privacy

The right to be left alone and go unnoticed if the patient chooses

Nonmaleficence

To do no harm

Paternalism

Undesirable outcome of beneficence, in which the health care provider decides what is best for the client and encourages the client to act against his or her own choices.

Living Will

becomes effective when the patient is incapacitated and is not able to make his or her own wishes known

"tail" agreement

offers extended coverage for periods when a nurse is exposed to professional liabilities but no longer has a claims made policy

claims made policy

this type of policy protects you when the claims for nursing or negligence is made while the policy is in force