Nursing in Today's World Ch. 7 (Stegan & Sowerby 11th ed.)

The failure to exercise the standard of care that a reasonable person would exercise in similar circumstances.

negligence

voluntary informed consent

no coercion, individual clearly understands choices presented

1. used as last resort 2. require MD orders 3. w/o orders used in emergency situation where individual poses a threat to others/self; obtain orders immediately after pt is stable/secure 4. secure w/ room for 2 fingers 5. assess q15min (mental, physical injuries/wounds) 6. release q2h for ROM 7. renew orers q24h 8. w/ current orders UAP can remove to assist pt to ambulate and then replace

restraints

Consent may be withdrawn after it is given: true of false

true (Stegen & Sowerby 11th ed. p. 250)

Action causing harm to another person or property that was not intended to happen; negligence

unintentional tort

An action causing harm to another person/property that was not intended; negligence intentional tort -or- unintentional tort

unintentional tort (Stegen & Sowerby 11th ed. p. 236)

Interventions harmful to a patient- do you follow MD orders?

1. Nurses have responsibility to critically examine MD orders for a patient 2. Nurses are responsible for the actual order but nurse's education provides background to identify obvious discrepancies or problems 3. Nurses should understand the plan of care and communicate w/ the healthcare provider any discrepancies or conflicts

implied consent

A patient's action indicating/reflecting consent for treatment

Legal document that provides information on preferences regarding end-of-life issues such as types of care to provide and whether to use various resuscitation measures. If the physician does not agree w/ the decision of the client, the physician must withdraw from care and refer the case to another physician; these documents can address other aspects of care in addition to resuscitation efforts (tube feeding, surgery, IV fluids, ventilator support). A) Living will/directive to physician B) Durable Power of Attorney for Healthcare C) Physician Orders for Life-Sustaining Treatments D) Patient Self-determination Act

A) Living will/directive to physician (Stegen & Sowerby 11th ed. p. 250)

The person must found to have failed to fulfill their responsibility; failing to do what should have been done; doing what should not have been done; failing to act as a reasonably prudent person A) breach of duty B) duty C) harm D) causation

A) breach of duty (Stegen & Sowerby 11th ed. p. 237)

You discover that a primary care provider has ordered a very large dose of pain management medication for one of your clients. What should you do? A) call the PCP B) notify the pharmacy C) hold the meds and chart not given D) give the med, chart your concern

A) call the PCP

The nursing student is studying contributory negligence. Which of the following best illustrates this concept? A) fails to follow discharge instructions and is readmitted to the hospital B) receives the wrong dose of medication and suffers kidney damage C) client experiences N/V when taking an antibiotic and returns to the hospital D) client reported a rash after an initial unit of blood and required prolonged hospital stay

A) fails to follow discharge instructions and is readmitted to the hospital Contributory negligence is based on the concept that the *client contributed* to the injury by not acting prudently in that circumstance.

professional negligence; liability resulting from improper based on standards of care required by the profession for which the person has been educated A) malpractice B) libel C) slander D) liability

A) malpractice (Stegen & Sowerby 11th ed. p. 237)

The patient has the right to leave the healthcare institution regardless of medical advice to the contrary; document efforts to teach the patient the need for restriction; document and report the patient's behavior to supervisor/physician.

AMA (Stegen & Sowerby 11th ed. p. 256-257)

Requires that on admission to any healthcare service clients be given an opportunity to determine what lifesaving or life-prolonging actions they want carried out. A) Living will/directive to physician B) Durable Power of Attorney for Healthcare C) Physician Orders for Life-Sustaining Treatments D) Patient Self-determination Act

D) Patient Self-determination Act (Stegen & Sowerby 11th ed. p. 253)

The harm or injury must be shown to have been caused by the breach of duty. A) breach of duty B) duty C) harm D) causation

D) causation (Stegen & Sowerby 11th ed. p. 237)

Living will/directive to physician Durable Power of Attorney for Healthcare Physician Orders for Life-Sustaining Treatments Patient Self-determination Act

Advanced directives: legal documents stating the wishes of individuals regarding healthcare in situations in which they are no longer capable of giving personal informed consent. (Stegen & Sowerby 11th ed. p. 250-254)

Legal document designating a decision maker should an individual become incapacitated; also referred to as healthcare proxy; provides individuals with the opportunity to identify a preferred legal decision maker if they become incapacitated; can be combined w/ living will that contains specific advanced directives; *supersedes all general legal designations for decision makers A) Living will/directive to physician B) Durable Power of Attorney for Healthcare C) Physician Orders for Life-Sustaining Treatments D) Patient Self-determination Act

B) Durable Power of Attorney for Healthcare (Stegen & Sowerby 11th ed. p. 252)

Negligent person must have been in a situation where they had a responsibility toward the person harmed A) breach of duty B) duty C) harm D) causation

B) duty (Stegen & Sowerby 11th ed. p. 237)

As a new nurse, you help a coworker put a combative client who is a danger to himself and other in restraints *before getting an order. What might you be guilty of doing? A) assault B) illegal detainment C) battery D) unsupervised detention

B) illegal detainment

published/written false statements that is damaging to a person's reputation; written defamation A) malpractice B) libel C) slander D) liability

B) libel

The nurse is reviewing intentional torts. Which of the following illustrates an intentional tort in nursing practice? A) rendering assistance in a MVA/MVC B) preventing a client from leaving AMA C) nursing care that causes injury to a pt D) volunteering in a healthcare setting

B) preventing a client from leaving AMA Intentional tort is one in which the outcome was planned, although a person involved may not have believed that the intended outcome would be harmful to the other person. Ex. preventing a pt leaving AMA based on concern for the client, but interfered w/ liberty and causes psychological harm- to do so is an intentional tort.

Most comprehensive order: DO NOT RESUSCITATE (DNR)/NoCode; no resuscitation measures of any kind are to be made and the patient be allowed to die naturally; individual may request limited resuscitation effort (CPR, medication but no ventilative support); orders may be written for "comfort measures only" where focus is on maximum comfort in the face of impending death. A) Living will/directive to physician B) Durable Power of Attorney for Healthcare C) Physician Orders for Life-Sustaining Treatments D) Patient Self-determination Act

C) Physician Orders for Life-Sustaining Treatments (Stegen & Sowerby 11th ed. p. 252-253)

Injury (basis of harm) must have occurred to an individual; damages (include consequences to person of injury) A) breach of duty B) duty C) harm D) causation

C) harm (Stegen & Sowerby 11th ed. p. 237)

The nursing student is studying about factors that contribute to malpractice claims. Which of the following most likely increases the likelihood of malpractice claims. SATA A) communication B) maintaining standards of care C) public attitudes towards providers D) consequences of errors E) lack of self- awareness

C) public attitudes towards providers D) consequences of errors E) lack of self- awareness Consequences of error, public attitudes towards providers and lack of self-awareness are factors that increase the likelihood if suing your ass. Maintaining standards of care and communication are factors that DECREASE malpractice claims.

false spoken statements damaging to a person's reputation A) malpractice B) libel C) slander D) liability

C) slander

Right to agree or refuse healthcare treatment; acceptance of the intervention by the client (verbal or written)

Consent (Stegen & Sowerby 11th ed. p. 248)

Parent(s), legal guardian provide consent for minors (<18). Also obtain minor's consent when they are able to give it; allow minors voice when it concerns matters that they are capable of understanding

Consent of minors (Stegen & Sowerby 11th ed. p. 250)

To be an effective advocate for a client, the nurse must give safe and effective care in accordance with: A) state BoN B) office of the Chief Nursing Officer (CNO) of the employing facility C) National Council of State Boards of Nursing (NCSBN) D) NPA

D) NPA

The nurse is studying legal competence. Which of the following best illustrates the determination of competence in nursing practice? A) client illness B) client age C) legal guardian D) courts

D) courts Determining competence is a complex issue. Client's age, illness or condition *ALONE* do not determine competence. Legal competence is ultimately determined by the court. When a person is determined to be legally INCOMPETENT, a legal guardian is appointed and consent is obtained from the legal guardian......... unless there is a PoA for healthcare in place.....HAHAHA... you thought you knew.

Making a person stay in place against their will; verbally or physically A) assault B) battery C) negligence D) false imprisonment

D) false imprisonment You cannot confine/restrain a responsible adult against their wishes; document efforts to teach the patient the need for restriction; document and report the patient's behavior to supervisor/physician. (Stegen & Sowerby 11th ed. p. 256-257)

Educated professional legally responsible for own actions; supervisor/physician giving orders may also be liable if harm results. A) malpractice B) libel C) slander D) personal/student liability

D) personal/student liability (Stegen & Sowerby 11th ed. p. 239)

You stop at the scene of a MVA/MVC. After identifying yourself, what actions are appropriate? SATA A) you must know the Good Sam laws in your state B) you can offer to help but you cannot insist C) after assisting, you can leave the scene and get help D) you cannot be held liable unless there is gross negligence

D) you cannot be held liable unless there is gross negligence Nurses rendering aid in an emergency must behave as a reasonably prudent nurse in that situation; standards are higher than a nonprofessional person; responsibility to NOT abandon the person until care can be turned over to another competent person (EMS/paramedics); liability is only for gross negligence. (Stegen & Sowerby 11th ed.)

Protected health information; refers to individually identifiable data about a person's health/healthcare

HIPPA/PHI (Stegen & Sowerby 11th ed. p. 253)

Characteristics of Negligence

Harm, duty, breach of duty (Stegen & Sowerby 11th ed. p. 237)

Emancipated Minor Criteria

These minors may give full consent as an adult without parental involvement: ■ Legally married ■ Active duty in the armed forces (Stegen & Sowerby 11th ed. p. 248)

saying or doing something to make a person feel genuinely afraid that they will be touched without consent assault -or- battery

assault For an assault to occur the person must be afraid of what might happen because the individual appears to have the power to carry out the threat (Stegen & Sowerby 11th ed. p. 256)

touching a person without consent assault -or- battery

battery For battery to occur the touching must occur without consent (Stegen & Sowerby 11th ed. p. 256)

Wrongful act that results in injury to person/property, reputation; injured party is entitled to compensation; civil wrong committed against a person/property (intentional/unintentional) a) negligence b) harm c) tort d) duty

c) tort (Stegen & Sowerby 11th ed. p. 236)

Dementia, developmental disabilities, head injuries, stroke, medication, illness creating loss of consciousness

common causes of inability to make judgement; give consent (Stegen & Sowerby 11th ed. p. 249)

Obtained before procedure responsibility of healthcare provider nurse my only witness

consent for medical treatment (Stegen & Sowerby 11th ed. p. 248)

Legal competence is ultimately determined by

court of law (Stegen & Sowerby 11th ed. p. 249)

1. maintain excellent standards of care 2. self-awareness 3. adapting to proposed assignment 4. following policies, procedures, protocols 5. changing policies & procedures 6. effective documentation

how to prevent malpractice/lawsuits