Leadership- Legal and Legislative Issues

The minimal level of expertise that may be delivered to a patient; the conduct of a reasonably prudent nurse in similar circumstances

Standard of Care

Laws that govern; -Voted on and passed by legislative bodies -Compiled into codes, statues, or city ordinances -Ex- Nurse Practice Act

Statutes

True or False: Hospitals have a duty to detain person who are confused, disoriented, or mentally ill persons who are threat to society or themselves

TRUE

(outcome focus) -A person must take those actions that lead to good outcomes -Emphasis on results -The end justifies the means -Right consistent actions that have good consequences and wrong consistent actions that have bad consequences

Teleology

Four principal elements that are included in the international council of Nurses' Code of ethic for nursing:

o Nurses and people o Nurses and practice o Nurses in the profession o Nurses and coworkers

• Nurses have four fundamental responsibilities:

o Promote health o Prevent illness o Restore health o Alleviate suffering

RN licensure is a ______

privilege

The primary purpose of law and legislation is to

protect the patient and the nurse

Purpose- establish the basis of a governing system for the future and present

Constitution

System of fundamental laws that govern a nation, society, corporation, or another aggregate of individuals

Constitution

What are the different sources of law?

Constitutions, Statutes, Administrative, Judicial

Violation of criminal law and is prosecuted by the government

Criminal Law

What are the two types of law?

Criminal and Civil

Communicating to a third party false information that injures a person's reputation • Slander: spoken/oral • Liable: written

Defamation of character

(duty focused) -Actions are based on moral rules and unchanging principles -All persons are worthy of respect and thus should be treated the same -Right or wrong is determined on the persons duty to act, not on consequences of ones actions • Ex. Abortion and euthanasia are never acceptable because they violate the duty to respect the sanctity of life

Deontology

What are the five components necessary for malpractice to occur

Duty of care, breach of duty, foreseeability of harm must exist, causation, actual patient injury must occur

Making a choice between two or more equally undesirable alternatives EXAMPLE: Assisted suicide: Family might be opposed to seeing a love one suffering during last months of life but on the other head they are equally opposed to an earlier death

Ethical Dilemma

Deontology and teleology

Ethical Theories

Purpose is to→establish common ground between nurse, patient, family, other healthcare professionals & society to discuss ethical questions & make ethical decisions; permit people to take a consistent position on specific or related issues; provide an analytical framework by which moral problems can be evaluated

Ethical principles:

-The branch of philosophy that concerns the distinction of right from wrong on the basis of a body of knowledge -Provides a framework for determining the right course of action

Ethics

what is the FLAT charting acronym?

F- factual L- legible A- accurate and complete T- timely

Any unlawful confinement • Can be physical, emotional, or chemical • The use of physical restraints has led to claims of false imprisonment • Some circumstances do require detainment

False imprisonment

True or False: "Just following physician orders" IS a defense for malpractice

False- it is NOT

• The principle of promise keeping, faithful to commitments • Don't make promises when you cannot deliver • Ex. Something as simple as telling a patient you will be back in 30 minutes to reassess there pain medication would instill this principal of fidelity

Fidelity

Ex- the omission of an ordered insulin injection of a known diabetic will most likely result in an abnormally high serum glucose level • Med errors, patient falls

Foreseeability of harm must exist

The failure of a person with professional training to act in a reasonable and prudent manner--- also called?

Malpractice (also called professional negligence)

• The principle of doing no harm • Duty to prevent doing harm whether intentional or unintentional

Nonmaleficence

A legal instrument that defines what the functions of nursing shall be and sets standards for licensure

Nurse Practice Act

What are the two types of negligence?

Ordinary and Professional

-An unreasonable risk of harm exists -There is a concept of foreseeability that's included here (harm could be anticipated) -Includes both acts of commission (doing something you shouldn't be doing) and omission (not doing something you should be doing)

Ordinary negligence

Deviation from the standard of care that a reasonable person would use in a particular set of circumstances (plain old carelessness)

Ordinary negligence

-Beliefs chosen are cherished

Prizing

(aka malpractice) - the failure of a person with professional training to act in a reasonable and prudent (wise, judicious, sensible) manner

Professional negligence

-Involves the conduct of professionals that falls below a professional standard of care -Much more specific→ looks at a professional standard of care as well as the professional status of the care giver

Professional negligence

Four ways to prevent malpractice

o Follow a chain of command o Follow establish policies and procedures o Question improper provider orders o Safeguard patient legal interests

when an act is performed by a nonprofessional→ result is _______. When the same act is performed by a professional person→ the act is the basis for a ____________

negligence and malpractice suit

failure to meet the standard of care

"Breach of Duty"

a standard of care is in place

"Duty of care"

Regulates conduct between private individuals and businesses

Civil Law

•Formal statement that provides values standard and principals to help nursing function as a profession •Not a legal document but a guide for nurses •Stresses obligation to patient and include protecting patient from incompetent, unethical, or illegal practice

ANA Code of Ethics for Nurses

-The selected beliefs are demonstrated consistently through behavior

Acting

Physical, financial, or emotional injury resulted from the breach of duty

Actual patient injury must occur

(aka regulatory): gives authority to act by the state and legislative body, and creates rules and regulations that enforce statutory laws

Administrative

Ex- State Board of Nursing→ responsible for implementing and enforcing the Nurse Practice Act

Administrative

Conduct that makes a person fearful and produces a reasonable apprehension --- No touching is required

Assault

• Respect for a person's right to self-determination, the right to choose without interference • Not all cultures value autonomy to the same degree • Ex. Informed consent, respecting another choice even if you don't agree

Autonomy

Intentional or wrongful physical contact with a person that entails an injury or offensive touching

Battery

(caring in the truest sense) • The duty to do good to others and to maintain a balance between benefits and harms • Obtain from injuring others and remove conditions that could cause harm

Beneficence

-There must be a provable correlation between care and harm -Injury must have been incurred directly by the breach of duty owed to the patient

Causation

-Beliefs are chosen freely -Making an analysis of the consequences of various alternatives

Choosing

What is the process of valuing?

Choosing, Prizing, Acting

Tort- violation of a civil law in which another person is wronged Enforced through the courts as damages or monetary compensation The area of law that is normally involved in medical malpractice claims

Civil

Direct invasion of someone's legal rights -Assault and battery, false imprisonment, defamation of character

Intentional tort

(aka court decisions): to interpret legal issues that are in dispute

Judicial

• The principle of fairness • Have no regard to age, socioeconomic status, or any other variable • Involves the allocation of scares resources

Justice

Is not an exact science, but an organized and ongoing system of change in response to current conditions and public expectations

Law

• The right of people to make their own decisions (highest principal and incorporates all other principals)

Respect for others

-Designed to identify and correct system problems that contribute to errors in patient care or employee injury -Emphasis is on quality improvement and protection of the institution from financial liability

Risk Management

One of the most important tools for all providers in a malpractice claim is the medical record→ the _______ _______are most often the first part of the record to be examined*

nurses notes

A civil wrong committed against a person or the persons property

Tort

The accountable person failed to meet his/her responsibility or performed an action below the allowable standard of care

Tort

True or False: Nurses have an independent responsibility to take appropriate steps to safeguard patients

True

the question of whether a nurse acted with reasonable and prudent care is determined by the testimony of expert nursing witnesses

Under ordinary circumstances

Individual personal beliefs about the truth of ideals, standards, principles, objects, and behaviors that give meaning and direction to life

Values

The process of analyzing one's own values to better understand what is truly important

Values clarification

• The obligation to tell the truth • For trust to develop, there must be truthful communication • Ex. If a patient who suspects her diagnosis is cancer and asks do I have cancer, if you were abiding by the principal of veracity, especially if her family asked that she not be told the truth, what would you do?

Veracity

Statement of affirmation and acceptance of the personal and ethical responsibilities of being a member of the nursing profession

Written pledge for nurses:

Upon conviction, a crime might be punished by→

imprisonment, parole conditions, loss of privilege (for us, this would include loss of license), fine, or combo

Crimes are classified as→

misdemeanor or felony