Chapter 23: Legal Implications in Nursing Practice (Legal Implications in Nursing)
The nurse is floated to work on a nursing unit where the assignment is beyond the nurse's capability. Which is the best nursing action to take first.
*A. Call the nursing supervisor to discuss the situation* B. Discuss the problem with a colleague C. Leave the nursing unit and go home D. Say nothing and begin work Rationale: Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff. Pg. 311
The nurse wraps and ties a cloth to prevent bleeding form the site of injury for a patient who is a victim of a traffic accident. The patient is taken to the hospital and presents with signs of infection. Which action will be taken against the nurse?
*A. The nurse will not face any action.* B. The nurse will be given a warning for gross negligence. C. The nurse will face liable charges for not getting an informed consent. D. The nurse will be sued for not obtaining orders from the primary healthcare provider before intervening. Rationale: The nurse has wrapped a cloth to control bleeding in the patient, thus providing appropriate care at the accident site. The nurse cannot be blamed for the patient's infection, because the infection could be due to many reasons. The nurse has not shown gross negligence in this case. The nurse does not need informed consent in the case of a life-saving emergency, nor does the nurse need an order from the healthcare provider before intervening in this case. Test-Taking Tips: If you knew that the purpose of the Good Samaritan laws is to encourage health care professionals to assist in emergencies, answering this question would have been easy. If you did not remember about the Good Samaritan laws, though, you could notice that the other three choices all involve warnings. After considering the reasons for each warning. You would realize that the reasons were not substantiated. Pg. 307
The nurse assesses a child in a psychiatric facility. The nurse finds that the child has suicidal thoughts. How should the nurse instruct the child's parents?
A.
The nurse is assessing a post-surgical patient who is in acute pain. The patient is not willing to change position for x-ray. The nurse tells the patient that a sedative injection will be administered if the patient does not cooperate for the procedure. Which tort is indicated?
A. Assault B. Battery C. Invasion of privacy D. False imprisonment Rationale: Assault places an apprehensive patient within harmful or offensive contact without consent. In this case, the nurse is threatening to give sedative injections if the patient does not cooperate with the procedure. This is an example of an assault on the patient. Battery is intentional touching without consent. Invasion of privacy refers to the unwanted intrusion into the private affairs of the patient. False imprisonment is an intentional tort in which a patient is restrained without a legal warrant. Test-Taking Tip: To distinguish assault from battery in your mind, think of battery as batting; battery involves intentional touching without consent. No contact is necessary for assault to take place. Pg. 308
The nurse is caring for a patient who is in early stages of cardiac failure. The patient tells the healthcare provider and the nurse that he wishes to end his life without any suffering as soon as possible. Which would be the most appropriate action?
A. Assist the patient in suicide as per his wish. B. Explain to the patient that his life can be extended. C. Ask the patient's family to make decisions regarding the patient's death. D. Ask the patient to wait for court orders regarding the decision. Rationale: The patient does not have end-stage cardiac failure; thus medical interventions would be of help for the patient to extend his life. Assisted suicide violates the Code of Ethics for nurses, is illegal is most states, and is not appropriate in a patient with a non-terminal disease. Because the patient could be managed by means of drugs and other medical interventions, there is no need for the patient's family to make decisions concerning the patient's death. Test-Taking Tip: Do not choose answers that are illegal, controversial, or that violate the Code of Ethics for nurses. Pg. 308
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patient assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which action violates the Health Insurance Portability and Accountability Act (HIPAA)?
A. Discussing patient conditions in the nursing report room at the change of shift B. Allowing nursing students to review patient charts before caring for patients to whom they are assigned *C. Posting medical information about a patient on a message board in the patient's room* D. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared Rationale: Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment, which violates the Health Insurance Portability and Accountability Act (HIPAA). Pg. 306
A patient is brought to the hospital after a motor vehicle accident. Which law makes it mandatory for the healthcare facility to provide emergency care to patients before transferring them to other hospitals?
A. Good Samaritan Law B. Mental Health Parity Act C. Americans with Disabilities Act *D. Emergency Medical Treatment and Active Labor Act* Rationale: The Emergency Medical Treatment and Active Labor Act states that a patient who is brought to the emergency room of any hospital should be stabilized before being transferred. The Good Samaritan Law protects people who provide help or first aid to victims with good intention. The Mental Health Parity Act forbids health plans form placing lifetime or annual limits on mental health coverage. The Americans with Disabilities Act protects the rights of people with physical or mental disabilities. Pg. 304
A homeless man enters the emergency department seeking health care. The healthcare provider indicates that the patient needs to be transferred to the city hospital for care. Which law does this action most likely violate?
A. Health Insurance Portability and Accountability Act (HIPAA) B. Americans with Disabilities Act (ADA) C. Patient Self-Determination Act (PSDA) *D. Emergency Medical Treatment and Active Labor Act (EMTALA)* Rationale: The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that in an emergency situation the patient must be stabilized before a transfer is appropriate. Health Insurance Portability and Accountability Act (HIPAA) addresses privacy issues, the Patient Self-Determination Act (PSDA) addresses a patient's right to refuse treatment and formulate advance directives, and the Americans with Disabilities Act (ADA) deals with equal access for all individuals. Pg. 304
When witnessing a patient giving informed consent prior to undergoing surgery, which actions should the nurse perform? Select all that apply.
A. If the patient refuses to sign the consent, leave the situation as it is. B. Confirm that the patient has understood the information about the surgery. C. Inform the healthcare provider if the patient refuses to undergo the surgery. D. Sign the consent form as a witness, once the patient voluntarily gives consent. E. Ask a nursing student to witness the informed consent if the nurse is busy. Rationale: The patient needs to understand the surgical procedure and voluntarily give consent, so the nurse should enquire about the patient's understanding and answer any questions. If the patient refuses to undergo the sugery, the nurse should inform the healthcare provider, so any harmful consequences of refusal can be explained to the patient. The nurse's signature witnessing the consent means that the patient voluntarily gave consent, that the signature is authentic, and that the patient appears to be competent to give consent. If the patient refuses to sign the consent in spite of repeated explanations, this rejection should be documented, signed, and witnessed. Due to the legal nature of the document, a nurse student should not be asked to witness informed consent forms. Pg. 309
A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy?
A. Inform the patient's spouse about the disease. B. Do not inform the patient or the family members about the disease. *C. Obtain permission from the patient to inform the patient's spouse about the disease.* D. Obtain informed consent form the spouse to reveal the illness to the patient Rationale: Hepatitis B is a sexually transmitted disease, and the patient may be unwilling to reveal the information about the disease to the spouse. Thus, the nurse should request consent from the patient to let the spouse know about the illness. The patient's spouse should not be informed about the illness without the patient's consent. The nurse should abide by the patient's right to be informed about the disease. The nurse must obtain the patient's consent to inform family members about the disease. Obtaining informed consent from the spouse to reveal the illness to the patient is an inappropriate nursing action. Test-Taking Tip: Do not choose responses that violate confidentiality of patient health care information, even to spouses. The patient must be the one to give consent for anyone else to gain access to healthcare information. You could think of this point as the legal extension of patient-centered care. Pg. 308
The nurse notes that the healthcare unit keeps a listing of the patient names at the front desk in easy view for healthcare providers to more efficiently locate the patient. Which does this action violate?
A. Mental Health Parity Act (MHPA) B. Patient Self-Determination Act (PSDA) C. Health Insurance Portability and Accountability Act (HIPAA) D. Emergency Medical Treatment and Active Labor Act (EMTALA) Rationale: The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) requires patient information to be protected from unnecessary publication. The Mental Health Parity Act (MHPA) addresses the needs of the mental health patient, the Patient Self-Determination Act (PSDA) addresses a patient's right to refuse treatment and formulate advance directives, and the Emergency Medical Treatment and Active Labor Act (EMTALA) ensures appropriate screening and stabilization of the patient in an emergency setting. Pg.306
The nurse is learning about nursing malpractice. Which statements should the nurse consider as good nursing practice? Select all that apply.
A. Nursing notes can be illegible as long as the nurse can read them *B. Nursing notes should be maintained properly* *C. Nursing records should be properly preserved* *D. Institutions should maintain complete nursing records* E. Only basic duties should be recorded in nursing records. Rationale: Nursing notes are important, because they contain evidence needed to understand the care received by a patient. The notes should be legible to all people, not just the nurse. Similarly. complete nursing records should be properly preserved, because they may be required to show what care was provided. Basic nursing duties as well as advanced nursing care should be recorded in the nursing records. Study Tips: Rest is essential to the body and brain for good performances; think of it as recharging the battery. A run-down battery provides only substandard performance. For most students, it is better to spend 7 hours sleeping and 3 hours studying than to cut sleep to 6 hours and study 4 hours. The improvement in the efficiency of the rested mind will balance out the difference in the time spent studying. Knowing your natural body rhythms will help you determine the amount of sleep you need for most efficient learning. Pg. 309
A women who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The healthcare provider ordered two units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. What is the nurse's responsibility?
A. Obtain a court order to give the blood B. Coerce the husband into giving the blood C. Call security and have the husband removed from the hospital *D. Abide by the husbands's wishes and inform the healthcare provider.* Rationale: Adult patients such as those who are Jehovah's Witnesses are able to refuse treatment for personal religious reasons. Test-Taking Tip: Once you have decided on an answer, look at the question again. Does your choice answer the question that was asked? If the question stem asks "why," be sure the response you have chosen is a reason. Many times, checking the make sure that the choice makes sense in relation to the question will reveal the correct answer. Pg. 309
What should the nurse do to avoid malpractice and the resulting professional negligence? Select all that apply.
A. Strictly follow the given standards of care. B. Regularly update current nursing knowledge. C. Properly document all assessments and interventions. D. Avoid explaining medical procedures to patients. E. Complete health documentation at the end of the shift. Rationale: As a rule, nurses should follow given standards of care to avoid malpractice. Regularly updating current nursing knowledge keeps nurses well informed of the latest medical knowledge and techniques and health care policies and laws. Properly documenting all assessments, interventions, and evaluations is necessary for future reference and communication with other healthcare team members. Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other healthcare team members and to avoid negligence. Test-Taking Tip: Another way to evaluate a choice is to ask yourself the question, "Would it be right to ....?" So for the option "Avoid explaining medical procedures to patients," you would ask, "Would it be right to avoid explaining medical procedures to patients?" Certainly not! So you can eliminate that choice. Pg. 309
Which criteria can be sued establish nursing malpractice? Select all that apply.
A. The nurse owed a duty to a patient. B. The nurse followed the instructions given for a patient. C. The nurse did not follow an ordered intervention for a patient. D. The nurse conveyed appropriate discharge instructions to the patient. E. The nurse's failure to carry out the duty caused as injury to the patient. Rationale: If the nurse owed a duty to a patient, did not perform the given duty, and if failure to perform that duty caused injury to the patient, then the nurse could be liable for nursing malpractice. Following the given instructions for a patient and conveying appropriate discharge instructions are both examples of good and ethical nursing practice. These actions would not make the nurse liable for nursing malpractice. Pg. 309
The nurse has been charged for committing a misdemeanor. Which action will be taken against the nurse?
A. The nurse will be given a warning. B. The nurse will be asked to pay a fine. C. The nurse will be suspended from duty. D. The nurse will be imprisoned for more than 1 year. Rationale: A misdemeanor is a crime that has a penalty of a fine or imprisonment of less than 1 year. Therefore, the nurse will be asked to pay a fine. The nurse has committed a crime so a warning is an inadequate legal action. A felony is a serious crime that has a penalty of imprisonment for more than 1 year or suspension from duty. The nurse's action is not a felony and does not call for penalty of imprisonment for more than 1 year. Pg. 303
The nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. Which would probably cover the nurse in this situation?
A. The nurse's automobile insurance B. The nurse's homeowner's insurance *C. The Good Samaritan laws, which grant immunity from suit if there is no gross negligence* D. The Patient Care Partnership, which may grant immunity from suit if the injured party consents Rationale: The Good Samaritan law holds healthcare providers immune from liability as long as they function within the scope of their expertise. Automobile and homeowner insurance would not cover the nurse in this situation. The Patient Care Partnership may grant immunity from suit if the injured party consents, which is not the case in this scenario. Pg. 307
The nurse is preparing to give cardiopulmonary resuscitation (CPR) to a patient with cardiac arrest. The healthcare provider orders the nurse and code team to avoid resuscitation the patient. Which is the most appropriate reason for this?
A. The patient is unlikely to benefit from CPR B. The patient does not have a written order for CPR *C. The patient has given a Do Not Resuscitate (DNR) order* D. The patient's family has not yet given the consent to resuscitate the patient Rationale: According to the healthcare law in the United States, cardiopulmonary resuscitation (CPR) is to be given to all appropriate patients unless the patient has given a Do Not Resuscitate (DNR) order. CPR has been known to be very effective in reviving patients with cardiac arrest. There is no written order required for performing CPR; performing CPR is based on the patient's condition. The healthcare provider or the nurse need not obtain consent from the patient's family to give CPR. Study Tip: If you have not yet done so, check your state bar association website for the correct forms and create an advanced directive and durable power of attorney for health care (or hire an attorney to prepare these important documents). Consider what instructions you would want healthcare providers to follow in the event of cardiac arrest or other life-threatening conditions. Experiencing the process of creating your own instructions will help you remember the terms for these types of questions. Pg. 305
An 8-year-old girl is brought to the emergency room with severe abdominal pain. The nurse has to get consent before medical treatment can be started. The parents of the child are divorced, and the mother has custody. The patient is accompanied by her mother, father, and elder sister, who is 19 years old. Who should sign the consent form of the patient?
A. The patient's father B. The patient's sister C. The patient herself *D. The patient's mother* Rationale: When the patient is a minor, consent is given by parents or guardians. In this case, the parents are divorced, so the consent is given by the parent who has custody of the child, the mother. Pg. 309
The nurse is studying the Emergency Medical Treatment and Active Labor Act. What is the meaning of the term patient dumping?
A. Transferring a patient from a private to a public hospital on patient's request B. Transferring a patient from a private to a public hospital after the patient is stabilized C. Transferring a patient from a private to a public hospital on consent of the healthcare provider *D. Transferring a patient form a private to a public hospital without appropriate screening and stabilization* Rationale: Patient dumping refers to transferring a patient form a private to a public hospital without appropriate screening and stabilization. The Emergency Medical Treatment and Active Labor Act was established to reduce the incidence of patient dumping. According to this act, patients can be transferred from a private to public hospital on their own request, after being stabilized, or by consent of a healthcare provider. Pg. 304
