ATI chapter 4- Legal Responsibilities

negligence

when a nurse fails to implement safety measures for a client at fall risk (Negligence can be defined as a failure to take reasonable care or steps to prevent loss or injury to another person. Nursing negligence is when a nurse who is fully capable of caring does not care in the way a reasonably prudent nurse would, and as a result the patient suffers unnecessarily.)

Client responsibilities for consent

› Gives informed consent. › To give informed consent, the client must » Give it voluntarily (no coercion involved). » Be competent and of legal age or be an emancipated minor. When the client is unable to provide consent, another authorized person must give consent. » Receive enough information to make a decision based on an understanding of what to expect.

Provider's orders

unless the provider write in the Pt's chart a DNR or AND order, the nurse has the right to start CPR when the client has no pulse

what organizations determine the standards of care?

american Nurses association (ANA) american association of critical care nurses (AACN) american association of occupational health nurses (AAOHN)

what is informed consent and how does it work?

-legal process where a client gives written consent for a procedure or treatment. -the provider will explain the procedure and ensure that the pt understands: the reason for procedure the benefits the risks other options of treatment

What does the law confine nurses to be accountable for?

-shield themselves from liability -advocate for clients -provide care within nursing scope -determine what can be delegated to other personnel -provide safe/proficient care that is consistent

4. A client is about to undergo an elective surgical procedure. Which of the following actions are appropriate for the nurse who is providing preoperative care regarding informed consent? (Select all that apply.) A. Make sure the surgeon obtained the client's consent. B. Witness the client's signature on the consent form. C. Explain the risks and benefit of the procedure. D. Describe the consequences of choosing not to have the surgery. E. Tell the client about alternatives to having the surgery.

A,B

1. A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells him she will put a diaper on him if he does not use the urinal more carefully next time. Which of the following torts is the AP committing? A. Assault B. Battery C. False imprisonment D. Invasion of privacy

1. A.CoRRECT: By threatening the client, the AP is committing assault. Her threats could make the client become fearful and apprehensive. B. INCORRECT: Battery is actual physical contact without the client's consent. Because the AP has only verbally threatened the client, battery has not occurred. C. INCORRECT: Unless the AP restrains the client, there is no false imprisonment involved. D. INCORRECT: Invasion of privacy most often involves disclosing information about a client to an

2. An adult client who is competent tells the nurse that he is thinking about leaving the hospital against medical advice. The nurse believes that this is not in the client's best interest, so she administers a PRN sedative medication the client has not requested along with his usual medication. Which of the following types of tort has the nurse committed? A. Assault B. False imprisonment C. Negligence D. Breach of con dentiality

2.INCORRECT: Assault is an action that threatens harmful contact without the client's consent. The nurse has made no threats in this situation. B. CoRRECT: The nurse gave the medication as a chemical restraint to keep the client from leaving the facility against medical advice. This is false imprisonment because the client neither requested nor consented to receiving the sedative. C. INCORRECT: Negligence is a breach of duty that results in harm to the client. It is unlikely that the medication the nurse administered without his consent actually harmed the client. D. INCORRECT: The nurse has not disclosed any protected health information, so there is no breach of con dentiality involved in this situation.

a competent adult

A competent adult must sign the form for informed consent. The person who signs the form must be capable of understanding the information from the health care professional who will perform the service, such as a surgical procedure, and the person must be able to communicate with the health care professional. if they cannot communicate due to language barrier then get an interpreter

tort law

A tort, in common law jurisdictions, is a civil wrong that unfairly causes someone else to suffer loss or harm resulting in legal liability for the person who commits the tortious act, called a tortfeasor.

6. A nurse is teaching a group of nursing students about avoiding liability for negligence. Use the ATI Active Learning Template: Basic Concept to complete this item to include the following: A. Underlying Principles: List the five elements necessary to prove negligence. B. Nursing Interventions: List at least four ways nurses can avoid liability for negligence.

A. Underlying Principles ● Duty to provide care as de ned by a standard ● Breach of duty by failure to meet standard ● Foreseeability of harm ● Breach of duty has potential to cause harm ● Harm occurs B. Nursing Interventions ● Following standards of care ● Giving competent care ● Communicating with other health team members ● Developing a caring rapport with clients ● Fully documenting assessments, interventions, and evaluations

mandatory reporting for nurses

Abuse-Nurses must report any suspicion of abuse (child or elder abuse, domestic violence) following facility policy. Communicable diseases (to the cdc): ☐ Ensure appropriate medical treatment of diseases (tuberculosis). ☐ Monitor for common-source outbreaks (foodborne, hepatitis A). ☐ Plan and evaluate control and prevention plans (immunizations). ☐ Identify outbreaks and epidemics. ☐ Determine public health priorities based on trends.

who identifies pt.'s rights?

American Hospital Association

Licensure

In general, nurses must have a current license in every state in which they practice. The states (about half of them) that have adopted the nurse licensure compact are exceptions. This model allows licensed nurses who reside in a compact state to practice in other compact states under a multistate license. Within the compact, nurses must practice in accordance with the statues and rules of the state in which they provide care.

3. A client who will undergo neurosurgery the following week tells the nurse in the surgeon's of ce that he will prepare his advance directives before he goes to the hospital. Which of the following statements by the client indicates to the nurse that he understands advance directives? A. "I'd rather have my brother make decisions for me, but I know it has to be my wife." B. "I know they won't go ahead with the surgery unless I prepare these forms." C. "I plan to write that I don't want them to keep me on a breathing machine." D. "I will get my regular doctor to approve my plan before I hand it in at the hospital."

C

5. A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, she found the nurse asleep in a chair in the break room when she was not on a break. Which of the following actions should the nurse take? A. Remind the nurse that safe client care is a priority on the unit. B. Ask others on the team whether they have observed the same behavior. C. Report her observations to the nurse manager on the unit. D. Conclude that her coworker's fatigue is not her problem to solve.

C

civil laws

Civil laws protect individual rights. One type of civil law that relates to the provision of nursing care is tort law.

refusal of treatment

Competent adults have the right to refuse treatment, including the right to leave a health care facility without a discharge prescription from the provider. If the client refuses a treatment or procedure, the client signs a document indicating that he understands the risk involved with refusing the treatment or procedure and that he has chosen to refuse it. ● The nurse asks the client to sign an "Against Medical Advice" form and documents the incident.

● Nurses can avoid liability for negligence by

Following standards of care ◯ Giving competent care ◯ Communicating with other health team members ◯ Developing a caring rapport with clients ◯ Fully documenting assessments, interventions, and evaluations

standards of care

Health care facilities' policies and procedures, which establish the standard of practice for employees of that facility. They provide detailed information about how the nurse should respond to or provide care in specific situations and while performing client care procedures. Nurses should refuse to practice beyond the legal scope of practice or outside of their areas of competence regardless of reason (staf ng shortage, lack of appropriate personnel). ● Standards of care define and direct the level of care nurses should give, and they implicate nurses who did not follow these standards in malpractice lawsuits.

impaired Coworkers

Impaired health care providers pose a signi cant risk to client safety. ● A nurse who suspects a coworker of any behavior that jeopardizes client care or could indicate a substance use disorder has a duty to report the coworker to the appropriate manager. ● Many facilities' policies provide access to assistance programs that facilitate entry into a treatment program. ● Each state has laws and regulations that govern the disposition of nurses who have substance use disorders. Criminal charges could apply.

The client has the right to

Understand the aspects of care to be active in the decision-making process ◯ Accept, refuse, or request modi cation of the plan of care ◯ Receive care from competent individuals who treat the client with respect

intentional torts

When the person that acts wrongly actually intends to perform the action

Nurses responsibilities for consent

Witnesses informed consent. › This means the nurse must » Ensure that the provider gave the client the necessary information. » Ensure that the client understood the information and is competent to give informed consent. » Have the client sign the informed consent document. » Notify the provider if the client has more questions or appears not to understand any of the information. The provider is then responsible for giving clarification. » Document questions the client has, noti cation of the provider, reinforcement of teaching, and use of an interpreter.

Living Will

a legal document that expresses a client's wishes regarding medical treatment in the event of an emergency/facing death

malpractice

a nurse administers a large dose of meds due to calculation error ( professional negligence)

breach of confidentiality

a nurse releases a client's medical diagnoses to a member of the press (A breach of confidentiality occurs when a patient's private information is disclosed to a third party without his or her consent. )

defamation of character

a nurse tells a coworker that she believes a client has been unfaithful to her spouse. occurs when someone makes a false statement about you that causes you some type of harm

false imprisonment

a person is confined or restrained against his will pt is restrained to prevent them from leaving the facility

The terms "reasonable and prudent" generally describe

a person who has the average judgment, intelligence, foresight, and skill that a person with similar training and experience would have.

Quasi-intentional torts

breach of confidentiality defamation of character A wrongful act based on speech committed by a person or entity against another person or entity that causes economic harm or damage to reputation, e.g., a defamation of character or an invasion of privacy.

Durable power of attorney for HC

document that assigns a health proxy to make medical decisions for them if they are unable to do so

professional negligence

failure of a person who has professional training to act in a reasonable and prudent manner.

Federal regulations consist of:

federal laws and criminal/civil laws

Nursing students face liability if they

harm clients as a result of their direct actions or inaction. They should not perform tasks for which they are not prepared and should have supervision as they learn new procedures. If they harm a client, they, the instructor, and the facility share liability for the wrong action or inaction.

Board of nursing laws

have the authority to adopt rules and regulations that further regulate nursing practice. ◯ Boards of nursing have the authority to issue and revoke a nursing license. ◯ Boards also set standards for nursing programs and further delineate the scope of practice for RNs, licensed practical nurses, and advanced practice nurses.

battery

intentional and wrongful physical contact with a person that involves an injury or offensive contact a nurse does wrongful physical contact, ex: uses restraints to administer an injection against pt wishes

when must informed written consent be used over implied consent?

invasive procedure or surgery

criminal/civil laws

is a subsection of public laws and relates to individual government If a nurse falsifies a claim or covers something up they are guilty of breaking a criminal law.

types of advances directives

living will durable power of attorney for health care providers orders

unintentional torts

negligence malpractice

Who can grant consent for another person?

parent of a minor legal guardian court specified rep person with durable power of attorney emancipated minors

The Patient Self-Determination Act (PSDA)requires

requires asking all clients on admission to a health care facility whether they have advance directives.

The Patient Self-Determination Act (PSDA)

stipulates that staff must inform clients they admit to a health care facility of their right to accept or refuse care.

Assault

the conduct of one person makes another person fearful and apprehensive a nurse threatens a pt with something

Provider responsibilities for consent

› Obtains informed consent. › To do so, the provider must give the client » The purpose of the procedure. » A complete description of the procedure. » A description of the professionals who will perform and participate in the procedure. » A description of the potential harm, pain, or discomfort that might occur. » Options for other treatments. » The option to refuse treatment and the consequences of doing so.

federal laws made by:

■ Health Insurance Portability and Accountability Act (HIPAA) ■ Americans with Disabilities Act (ADA) ■ Mental Health Parity Act (MHPA) ■ Patient Self-Determination Act (PSDA)

Clients' rights

● Nurses are accountable for protecting the rights of clients. Examples include informed consent, refusal of treatment, advance directives, confidentiality, and information security.

advance directives

● The purpose of advance directives is to communicate a client's wishes regarding end-of-life care should the client become unable to do so.

State Laws

◯ Each state has enacted statutes that de ne the parameters of nursing practice and gives the authority to regulate the practice of nursing to its state board of nursing. Although the practice of nursing is similar among states, it is critical that nurses know the laws and rules governing nursing in the state in which they practice.

Negligence issues that prompt most malpractice suits include failure to

◯ Follow professional and facility-established standards of care ◯ Use equipment in a responsible and knowledgeable manner ◯ Communicate effectively and thoroughly with clients ◯ Document care the nurse provided