Ch 2 legal and ethical

When is a healthcare professional protected from liability?

When reporting abuse. Law stipulates that healthcare professionals required to report certain information to appropriate authorities. The report should be given to a supervisor or directly to the police according to agency policy

What are the factors that put elder adults at the risk for physical, emotional, or financial abuse?

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

Describe negligence.

• different from malpractice. • refers to the absence of due care •general action that can be attributed to being careless • refers to failure to act in a manner demonstrating the care and knowledge any prudent individual would

Miners under the age of 18 may consent for treatment if they meet what criteria?

• marriage • court approved emancipation • living apart from parents or guardians for at least 60 days and independent of parental support • Service in the Armed Forces

List some concerns related to privacy

• physical exposure or disclosure of patient information to others •When providing care, protect the patient from unnecessary exposure with use of drapes remember to close the door or use available sinus to restrict admission to rooms doing a procedure

What are some ways that a nurse can avoid a lawsuit?

• provide compassionate and competent nursing care • Open and honest communication to establish a therapeutic relationship • follow the standards of care and the scope of practice

What is value clarification?

Process of self evaluation that helps gain insight into personal values

What is the discovery step in the legal process?

Discovery allows both sides to case review documents and interview witnesses.

What situations with a minor be able to consent for care?

• STI • drug and alcohol abuse • sexual assault •Family planning

The nurse's first job as an LPN/LVN is on a unit that cares for terminally ill children. What action should be taken by the nurse before helping families cope with their children's illnesses? 1. Study the nurse practice act to find rules relating to the medical care of terminally ill children 2. Spend time performing value clarification to aid in identifying her feelings about this new role 3. Evaluate her own personal mores and customs that may affect the practice of nursing in general 4. Review the state and federal laws that prescribe how a child may be treated when near death

.3

6. The nurse believes that all patients should be treated as individuals. The ethical principle that this belief reflects is: 1. autonomy. 2. beneficence. 3. nonmaleficence. 4. respect for people.

1

An alert adult patient has refused an intramuscular injection. The nurse waits until the patient is asleep and gives the injection anyway. The nurse could be charged with: 1. civil battery. 2. malicious homicide. 3. criminal assault. 4. invasion of privacy.

1

The nurse loves photography and brings his camera to work at the nursing home. He takes a picture of one of his coworkers walking a patient. What best describes the actions taken by the nurse? 1. He violated the patient's right to privacy. 2. He failed to get proper medical clearance. 3. He performed an act of nursing malpractice. 4. He legally obtained a realistic picture.

1

The patient admitted for surgery has a lump in her breast. The patient's daughter asks the LPN/LVN if her mother should have the surgery. Which issue must be considered before responding? 1. Confidentiality and invasion of privacy 2. Informed consent, beneficence, and respect 3. Respect for people and personal autonomy 4. Nonmaleficence, justice, and liability

1

A federal regulation that came into effect April 14, 2003, has impacted the health care field regarding privacy of a patient's health information. What is this regulation? 1-Health Insurance Portability and Accountability Act 2-Joint Commission on Accreditation of Healthcare Organizations 3-Patient Self-Determination Act 4-Patient's Bill of Rights

1 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) came into effect on April 14, 2003, to safeguard a person's health information. It sets rules and limits on who can look at and receive health information. The Joint Commission (TJC) is an organization that accredits health care facilities. The Patient Self-Determination Act requires that institutions maintain written policies and procedures regarding advance directives, the right to accept or refuse treatment, and the right to participate fully in health care-related decisions. The Patient's Bill of Rights is the list of things that patients have the right to do or refuse to do.

Social media use can have positive benefits including which outcomes? (Select all that apply.) 1. Networking between professionals 2. Reduction in the amount of lateral violence between staff members 3. Provides readily available education opportunities 4. Access to mentoring answer 5. Use of social media is an inexpensive answer

1,3,4

Describe the code of ethics of LVN's established by the national Federation of license practical nurses.

1-To knowfunction within the scope of practice for a licensed LVN 2- To maintain peace and confidences 3-to provide healthcare without discrimination 4-to maintain a high degree of professional personal behavior 5-To take an active role in the development of the LVN profession

Healthcare institutions are obligated to uphold the patients right to...

1-access to healthcare without any prejudice 2-treat me with respect and dignity at all times 3-privacy and confidentiality 4-personal safety 5-Complete information about one's own condition and treatment

What are the two types of policies?

1. Claims made policy: this type of policy provides protection in the clean for nursing or negligence is made while the policy is in force( During the policy period Or during extended coverage) 2. Occurrence basis policy; the type of policy protects against claims made about events that occurred during the policy period Or extended coverage.

Name the four elements of malpractice in order for liability to be established.

1. Duty-Refers the establish relationship between the patient and the nurse 2-breach of duty is failure to perform the duty any a reasonable, prudent manner 3-Harm has occurred; this does not have to be physical injury 4-The breach of duty was the proximate cause of the harm; the occurrence of harm depended directly on the occurrence of the breach

What are the two basic types of advance directives?

1. Living wills 2. Durable power of attorney for healthcare

Patient responsibilities to the healthcare institution include...

1. Providing accurate information about themselves 2. Giving information regarding their known conditions 3.Participating in decision making regarding treatment and care

What are the four options for establishing the levels of responsibility?

1. The individual may be personally responsible for the act of negligence or malpractice committed 2. A manager or supervisor may be implicated if there was inappropriate supervision or delegation by another member of the healthcare team 3. The employer may be found responsible for the employees actions if there are deficits in education or inappropriate credentials for the role 4. The employer is also responsible for ensuring the staff members have the needed supplies and equipment

The nurse must be aware of cultural differences and should avoid what?

1. Transferring personal expectations to patients 2. Making generalizations based on personal views 3.Assuming patients can understand what is being said just because they speak English 4.Trading each patient the same. To meet patients needs respect for their cultural heritage is vital

What happened in the case of darling versus Charleston community Memorial Hospital?

18-year-old with a cast that was too tight ended up getting gangrene and his leg had to be amputated.

When was the Patients bill of rights developed and who was it developed by?

1972, the American hospital Association (AHA)

When was the Mental health patients bill of rights and the pregnant patients bill of rights adopt it?

1980, they were adopted into law.

LPN/LVNs have a code of professional and personal ethics to follow. The purpose of a code of ethics is to: 1. establish penalties for any unethical behavior. 2. promote trustworthy, accountable LPN/LVNs. 3. make certain that all nurses are competent and always honest. 4. give the nurse guidelines for ethical decision making.

2

The LPN/LVN is reviewing the patient's medical record. The nurse notes the presence of an advance directive. The nurse recognizes that the purpose of this documentation is to: 1. help every person exercise the right to die with dignity. 2. encourage a person to determine how he or she will die. 3. allow a patient to exercise the right of autonomy. 4. provide a means to prevent medical maltreatment.

2

The health care provider's order read "assist the patient with walking." The nurse allowed the patient to walk alone. The patient fell, fracturing the humerus. Which verdict is the most likely occurrence? 1. The nurse will be found guilty of malpractice. 2. The nurse will be guilty of negligence. 3. The nurse will be charged with technical battery. 4. The nurse will not be found liable for any harm.

2

The newly licensed nurse is assigned a patient who needs catheterization. The nurse has not performed the procedure before. What would be the best action for the nurse? 1. Contact the nursing supervisor and explain that the procedure will need to be done by another nurse. 2. Review the agency procedure for catheterization in the unit's resource area and see the assistance of another experienced nurse for help during the procedure. 3. Immediately advise the charge nurse that someone else will need to assume care of this patient. 4. Promptly notify the staff development office that an instructor needs to do this procedure.

2

The nurse knows that all patients have the right to nursing interventions regardless of their race, religion, or gender. The ethical principle that best describes this concept is: 1. nonmaleficence. 2. justice. 3. autonomy. 4. beneficence.

2

A nurse reported that she did post on a social media site about her clinical experiences. The nurse reports she did not use the patient's name. Which information should be given to the nurse? (Select all that apply.) 1. "Names are the only identifiers that are of concern when considering patient privacy." 2. "Any patient information that can aid in the identification of the patient's identity can be problematic and a violation." 3. "As long as the information is erased there is not a problem." 4. "Any distribution of information regarding the patient or clinical assignment is a violation of confidentiality." 5. "Personal emails are lesser violations than posting on large websites."

2,4

What resource would the LPN/LVNs refer to in order to know what they can and cannot do within their scope of practice? 1-ANA 2-The nurse practice act of their licensing state 3-Their employing institution 4-Interstate compact

2- The nurse practice act of their licensing state The state in which the nurse receives licensing has adopted a nurse practice act that defines the scope of nursing practice for the LPN/LVN within that state. The interstate compact is a legal agreement that allows the multistate practice of nursing. ANA is involved in developing standards of care for nursing practice. The employing institution may further limit the scope of practice for an LPN/LVN, but it is for that institution only.

The LPN/LVN knows that building the nurse-patient relationship is important in providing patient care, and a legal relationship is being formed. If there is a breach in this relationship and harm to the patient has occurred, which legal action can the nurse be charged with? 1-Negligence 2-Malpractie 3-Slander 4- Assault

2-Malpractice Malpractice is the failure to meet a legal duty that results in harm to another. Assault is an intentional threat to cause bodily harm to another. Negligence is the commission or omission of an act that a reasonably prudent person would have done in a similar situation that leads to harm of another person. Slander in malicious or untrue spoken words about another person or property.

The LPN/LVN knows that one of the best defenses against a lawsuit is for a nurse to: 1. work only in a large hospital or nursing home. 2. provide for every patient's needs as quickly as possible. 3. promote a positive nurse-patient relationship. 4. carry individual professional liability insurance.

3

The newly licensed practical/vocational nurse (LPN/LVN) has reviewed the nurse practice act (NPA) of the state of licensure. What is the purpose of this documentation? 1. Determine the quality of nursing care 2. Enforce the standards of nursing practice 3. Define the scope of nursing practice 4. Set the nurse's educational requirements

3

The nurse working in a nursing home correctly recognizes that duties include patient advocacy. Which role is considered a primary duty of patient advocacy? 1. To complete all nursing responsibilities on time 2. To maintain the patient's right to privacy 3. To safeguard the well-being of every patient 4. To act as the patient's legal representative

3

A nurse who has recently been promoted to unit manager questions her immediate supervisor if there is any potential liability for her as a result of the actions of her nursing staff member. What information included in the supervisor's response would be appropriate? (Select all that apply.) 1. "An individual nurse is solely responsible for their actions." 2. "As long as you are working in good faith you cannot be found liable." 3. "As a supervisor there is some liability if measures are not followed to ensure staff understand how to utilize the care equipment." 4. "A supervisor is required to assess the performance of their staff to ensure competency." 5. "Employer liability is limited to cases in which a death occurs."

3,4

When caring for patients, the nurse knows that part of the ethical principles include all patients having the same right to nursing interventions. What is the term for this principle? 1-Beneficence 2-Nonmaleficence 3-Justice 4-Autonomy

3- Justice Justice in nursing means that nurses must allocate time among all the assigned patients to meet their needs. Autonomy refers to personal freedom of choice, a right to be independent and make decisions freely. Nonmaleficence means to do no harm. Beneficence means doing what is good.

Which statement characterizes criminal law? 1-The purpose of criminal law is to restitute the victim. 2-Criminal law applies to conduct that violates a person's rights. 3-Criminal law applies to conduct that is detrimental to society. 4-Criminal law involves an offense against an individual.

3-Criminal law applies to conduct that is detrimental to society. Criminal law is concerned with offenses against society in general and applies to conduct that is detrimental to society as a whole. Civil law deals with personal rights and applies to conduct that is detrimental to an individual. The purpose of criminal law is to punish the crime and to deter and prevent further crimes. Civil law's purpose is to make the aggrieved person whole again.

The nurse gets a report, puts his patient assignment notebook in his pocket, and goes on break. His notebook has very specific information about his patients and is missing from his pocket when he returns to the unit. The book is found later on the floor in the cafeteria by a visitor and is returned to the information desk. The nurse: 1. may have breached the Patient Self-Determination Act. 2. is guilty of criminal misconduct. 3. could be fired for malpractice. 4. has violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

4

The patient refused to take the medication his doctor ordered for relief of pain. The LPN/LVN knows this is a patient right established by: 1. the principle of beneficence. 2. the doctrine of negligence. 3. specific nurse practice acts. 4. the Patient Self-Determination Act.

4

What is the term for injury to a person or the person's property that gives rise to a basis for a legal action against the person who caused the damage? 1-Negligence 2-Assault 3-Malpractice 4-Harm

4 Harm is the term for injury to a person or the person's property that gives rise to a basis for a legal action against the person who caused the damage. Assault is an intentional threat to cause bodily harm to another. It does not have to include actual bodily contact. Malpractice is the failure to meet a legal duty that results in harm to another. Negligence is the commission of an act or omission of an act that a reasonably prudent person would have done in a similar situation, leading to harm of another person.

The nurse is caring for a patient who is scheduled for surgery. Before going to surgery, the nurse would make sure that the patient has been fully informed about the procedure to be done. What would the patient sign to acknowledge that he or she is making an intelligent decision? 1-Patient's Bill of Rights 2-Accountability statement 3-Confidentiality statement 4-Informed consent doctrine

4- Informed Consent doctrine An informed consent doctrine is a person's agreement to allow a particular treatment based on full disclosure of the facts needed to make an intelligent decision. The Patient's Bill of Rights is a list of rights of the patient that includes the right of an informed consent. Accountability and confidentiality are the responsibilities of the nurse as part of the care to be given to the patient.

What is a summons?

A court order that notifies the defendant of the legal action

What is tort?

A type of civil law that involves wrongs against a personal property; torts includes negligence, assault, battery, defamation, fraud, false imprisonment, and invasion of privacy

What is a living will?

A written document that directs treatment in accordance with a patients wishes in the evened of terminal illnesses or condition. Living Wills are often difficult to interpret and are not clinically specific in unforeseen circumstances.

What is a interrogatory?

A written question that one party sends to the other party to which an answer is legally required

What is standards of care defined as?

Acts who's performance is required, permitted, or prohibited. The standards of care drive from federal and state laws, regulations, rules and codes that govern other professional agencies and organizations such as the ANA.

Autonomy? What is it?

Another ethical principle; it refers to freedom of personal choice, right to be independent and make decisions freely.

What are PHI or protected health information?

Anything that can Identify patient. This includes not only physical chart forms but technological resources like EMR 's. Information that can be used to identify patient is considered a protected health information. These identifiers include • admission and discharge dates • social Security • photographs • addresses • phone numbers • date of birth **Age of patients who are 89 years of age or older are also considered as an identifier

Accountability, what is it?

Being responsible for one's own actions is a concept that gives rise to legal duty

What is prudent?

Careful or wise

Which act protects the rights of handicap newborns to proper treatment and care?

Child abuse amendments in 1984. These regulations make any institution that receives federal funds legally responsible to investigate the withholding of medical treatment to an infant

What is Justice?

Concept of what is fair

Which organization developed a code of ethics for LPN/LVN's?

National Federation of licensed Practical nurses

What is a "request for production of documents and things "?

Formal request by agents filing the charges for all items that are deemed to be related to the case at hand. For medical related case these items may include policies and procedures, standards of care, medical records, assignment sheets, personnel files, equipment maintenance records, birth certificates, marriage certificates, medical bills

What is a durable power of attorney?

Healthcare designate an agent, surrogate or proxy to make healthcare decisions on the patient's behalf based on the patient's wishes

What is civil litigation?

Involves illegal exchange between individuals as opposed to legal concerns that involve a criminal matter, which would involve the state or federal government bringing charges.

What are Nurse Practice Acts?

Laws that formally define and limit the scope of nursing practice

What is liability

Legal responsibility

What is libel?

Malicious or entry writing about another person that is brought to the attention of others.

What is slander?

Malicious or untrue spoken words about another person that I brought to the attention of others

NONMALEFICENCE?

Means do no harm. It is Paramont to nursing practice

What is BENEFICENCE?

Means doing good acting for someone's good; this principle is one of the primary importance to nurses

Give some examples of negligence.

Medication errors, patient falls, use of restraints, and equipment injuries, they forgot to check Mr. Bustas vital signs

What are laws that formally define and limit the scope of nursing practice called?

Nurse practice acts.

What is "tail agreement "?

Offers extended coverage for periods When the nurse is exposed to professional liability's but no longer has claimed made policy

What is the Health insurance portability and accountability act (HIPPA)?

Passed in 1986, lost its rules and limits on who has permission to look at and receive health information and assigns penalties for wrongful disclosure of individually identifiable health information

Values, what are they?

Personal beliefs about the worth of an object, and idea, a custom or an attitude

What is laws?

Prescribe proper behavior in society; they sanction acceptable behavior and prohibit unacceptable behavior. Nurses must have a basic understanding of the legal system which mandates and protects

What is the doctrine of informed consent?

Refers to full disclosure of the facts the patient needs to make an intelligent or informed decision before any invasive treatment or procedure is performed. Patient has a right to except or reject the proposed care but only after understanding fully what is being proposed That is benefits of treatment, risk involved, alternative treatments, and consequences of refusing treatment or procedure

Describe malpractice.

Refers to professional negligence. Nursing responsibilities include actions taken in those omitted. The concept of malpractice miss contain for key elements which must be present for liability to be established.

What is ethics?

Refers to values that influence a persons behavior and individuals feelings about what is wrong or right

What is the patient self determination act?

Requires institutions to maintain written policies and procedures regarding advance directives, including life support, the right to except or refuse treatment, and the right to participate fully in healthcare related decisions.

What is the first and most fundamental principle of ethics in nursing.?

Respect for the people. This principle leads us to view all human life is sacred with each individual having inherent worth as a person

What are advance directives?

Signed and witnessed documents that provide specific instructions for health care treatment if a person is unable to make these decisions personally at the time they are needed

What is an ethical dilemma?

Situations that do not have a clear right or wrong answer. They are complex confusing and often frustrating situations that come for careful rational analysis.

What is defamation?

Spoken or written statements made maliciously and intentionally That may injure the subjects reputation

What is defamation?

Spoken or written statements made maliciously and intentionally that may injure subjects reputation

As part of their right to refuse treatment, patients may prepare advance directives specifying what lifesaving treatments they do or do not wish to receive. When determining the legality of an advance directive, what applicable laws should the nurse know? 1-local 2-county 3-state 4-federal

State laws vary on the legalities of the various forms of advance directives, so the nurse needs to know the applicable state laws.

Which act made reporting child abuse mandatory?

The federal child abuse prevention and treatment act of 1973

Describe invasion of privacy.

The legal concept of invasion of privacy involves a person's right to be left alone and remain anonymous if here she chooses. Consent for treatment is not waive the right to privacy.

What is the best defense against a lawsuit?

To provide compassionate, competent nursing care. The nurse patient relationship should be based on trust and respect. Open and honest communication is the key to building a therapeutic relationship and often helps resolve patient to satisfaction before the patient resorts to legal action.

The patient self determination act requires healthcare institutions to...?

To provide written information to patients concerning the patients rights under the state law to make decisions, including the right to refuse treatment and formulate advance directives.

What legally has to happen for either type of advance directive to be enforceable?

The patient must be legally incompetent or lack capacity to make decisions regarding health care treatment. The termination of legal competency is made by a judge and the determination of decisions capacity usually made by physician and the family.

What is the science of ethics?

The relationships between moral actions and values and how they affect society

What is civil battery?

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

What is "admission of facts"?

This to request the party to admit or deny certain statements to streamline the factual presentation of the case

If health care workers follow the directions of the living will, they are immune from liability. True or false?

True

Under the patient self determination act whether the patient has signed an advance directive must be documented in the patient's record. Hospitals is required to ensure the state laws followed. True or false?

True

Use of any patient information like name, photograph, Specific facts regarding an illness and so on, without authorization is a violation of the patients legal rights. True or false

True

Nurses are not responsible for explaining procedures are answering the patients questions about the procedure. True or false?

True, the nurse is only responsible to witness the patient signing a consent form. Answers to any unanswered questions that the patient has about the procedure is the responsibility of the healthcare provider who will perform the procedure

Destroy report sheets and communication till the end of each shift before leaving the worksite. True or false?

True.

True or false. The standards of care follow those laws of the individual state.

True.

How many witness are required when the patient signs the document of a living will?

Two witnesses; neither can be a relative or physician

What is assault?

Unintentional threat to cause bodily harm to another; does not have to include actual bodily contact

What is passive euthanasia?

Withholding of life-saving treatment and care, and medical neglect

What population is most at risk for abuse?

Women and the elderly

What is abandonment of care?

Wrong for termination of providing patient care

What does disciplinary defense insurance or license protection insurance provide for the nurse?

• A qualified nurse attorney or attorney to represent the nurse • wage loss reimbursement • travel, food, lodging reimbursement • Legal fees paid or reimbursement for payment