CHAPTER 6 Ethical and Legal Issues

Organ donation and transplantation

1. A client has the right to decide to become an organ donor and a right to refuse organ transplantation as a treatment option. 2. An individual who is at least 18 years old may indicate a wish to become a donor on their driver's license (state-specific) or in an advance directive. 3. The Uniform Anatomical Gift Act provides a list of individuals who can provide informed consent for the donation of a deceased individual's organs. 4. The United Network for Organ Sharing sets the criteria for organ donations. 5. Some organs, such as the heart, lungs, and liver, can be obtained only from a person who is on mechanical ventilation and has suffered brain death, whereas other organs or tissues can be removed several hours after death. 6. A donor must be free of infectious disease and cancer. 7. Requests to the deceased's family for organ donation usually are done by the primary health care provider (PHCP) or nurse specially trained for making such requests. 8. Donation of organs does not delay funeral arrangements; no obvious evidence that the organs were removed from the body shows when the body is dressed; and the family incurs no cost for removal of the organs donated.

Ethical dilemma

1. An ethical dilemma occurs when there is a conflict between two or more ethical principles. 2. No correct decision exists, and the nurse must make a choice between two alternatives that are equally unsatisfactory. 3. Such dilemmas may occur as a result of differences in cultural or religious beliefs.

Disciplinary action

1. Boards of nursing may deny, revoke, or suspend any license to practice as a registered nurse, according to their statutory authority. 2. Some causes for disciplinary action are as follows: a. Unprofessional conduct b. Conduct that could affect the health and welfare of the public adversely. c. Breach of client confidentiality d. Failure to use sufficient knowledge, skills, or nursing judgment e. Physically or verbally abusing a client f. Assuming duties without sufficient preparation g. Knowingly delegating to unlicensed personnel nursing care that places the client at risk for injury h. Failure to maintain an accurate record for each client i. Falsifying a client's record j. Leaving a nursing assignment without properly notifying appropriate personnel

Hospital staffing

1. Charges of abandonment may be made against nurses who "walk out" when staffing is inadequate. 2. Nurses in short staffing situations are obligated to make a report to the nursing administration.

Reporting Responsibilities Impaired nurse

1. If the nurse suspects that a coworker is abusing chemicals and potentially jeopardizing a client's safety, the nurse must report the individual to the nursing supervisor/nursing administration in a confidential manner. (Client safety is always the first priority.) 2. The nursing administration notifies the board of nursing regarding the nurse's behavior.

Good Samaritan laws

1. May vary from state to state. 2. These laws encourage health care professionals to assist in emergency situations and limit liability and offer legal immunity for persons helping in an emergency, provided that they give reasonable care. 3. Immunity from suit applies only when all conditions of the state law are met, such as that the health care provider (HCP) receives no compensation for the care provided and the care given is not intentionally negligent.

Negligence

1. Negligence is conduct that falls below the standard of care. 2. Negligence can include acts of commission and acts of omission. 3. The nurse who does not meet appropriate standards of care may be held liable.

Professional liability insurance

1. Nurses need their own liability insurance for protection against malpractice lawsuits. 2. Having their own insurance provides nurses protection as individuals; this allows the nurse to have an attorney, who has only the nurse's interests in mind, present if necessary.

Occupational Safety and Health Act (OSHA)

1. OSHA requires that an employer provide a safe workplace for employees according to regulations.

False imprisonment

1. Occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the client. 2.Also occurs when restraining devices are used without an appropriate clinical need. 3. A client can sign an Against Medical Advice form when the client refuses care and is competent to make decisions. 4. The nurse should document circumstances in the medical record to avoid allegations by the client that cannot be defended.

Ethical codes

1. Provide broad principles for determining and evaluating client care. 2. Not legally binding, but the board of nursing has authority in most states to reprimand nurses for unprofessional conduct that results from violation of the ethical codes.

Nurse Practice Act

1. Series of statutes that have been enacted by each state legislature to regulate the practice of nursing in that state. 2. Set educational requirements for the nurse, distinguish between nursing practice and medical practice, and define the scope of nursing practice. 3. Additional issues covered by nurse practice acts include licensure requirements for protection of the public, grounds for disciplinary action, rights of the nurse licensee if a disciplinary action is taken, and related topics.

Rights for the mentally ill

1. The Mental Health Systems Act created rights for mentally ill people. 2. The Joint Commission has developed policy statements on the rights of mentally ill people. 3. Psychiatric facilities are required to have a Client's Bill of Rights posted in a visible area.

Occurrence reports

1. The occurrence report is used as a means of identifying risk situations and improving client care. 2. The report form should not be copied or placed in the client's record. 5. Make no reference to the occurrence report form in the client's record. 6. The report is not a substitute for a complete entry in the client's record regarding the occurrence. 7. If a client injury or error in care occurred, assess the client frequently. The PHCP must be notified of the incident and the client's condition.

Malpractice

5. Determined if the nurse owed a duty to the client and did not carry out the duty and the client was injured because the nurse failed to perform the duty.

Tort Law

A tort is a civil wrong, other than a breach in contract, in which the law allows an injured person to seek damages from a person who caused the injury.

Collective Bargaining

A. Formalized decision-making process between representatives of management and representatives of labor to negotiate wages and conditions of employment.

Types of Consents

Admission Agreement Immunization Consent Blood Transfusion Consent Surgical Consent Research Consent Special consents: Required for the use of restraints, photographing the client, disposal of body parts during surgery, donating organs after death, or performing an autopsy

Emancipated minor

An emancipated minor has established independence from his or her parents through marriage, service in the armed forces, or by a court order.

Religious beliefs: Organ donation and transplantation Jehovah's Witness

An organ transplant may be accepted, but the organ must be cleansed with a non-blood solution before transplantation.

The nurse has just assisted a client back to bed after a fall. The nurse and primary health care provider have assessed the client and have determined that the client is not injured. After completing the occurrence report, the nurse should implement which action next? 1. Reassess the client. 2. Conduct a staff meeting to describe the fall. 3. Contact the nursing supervisor to update information regarding the fall. 4. Document in the nurse's notes that an occurrence report was completed.

Answer: 1 Rationale: After a client's fall, the nurse must frequently reassess the client, because potential complications do not always appear immediately after the fall. The client's fall should be treated as private information and shared on a "need to know" basis. Communication regarding the event should involve only the individuals participating in the client's care. An occurrence report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nursing supervisor has been made aware of the occurrence, the supervisor will contact the nurse if status update is necessary.

The nurse calls the primary health care provider (PHCP) regarding a new medication prescription, because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the PHCP, and the medication is due to be administered. Which action should the nurse take? 1. Contact the nursing supervisor. 2. Administer the dose prescribed. 3. Hold the medication until the PHCP can be contacted. 4. Administer the recommended dose until the PHCP can be located.

Answer: 1 Rationale: If the PHCP writes a prescription that requires clarification, the nurse's responsibility is to contact the PHCP. If there is no resolution regarding the prescription because the PHCP cannot be located or because the prescription remains as it was written after talking with the PHCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.

Which identifies accurate nursing documentation notation(s)? Select all that apply. 1. The client slept through the night. 2. Abdominal wound dressing is dry and intact without drainage. 3. The client seemed angry when awakened for vital sign measurement. 4. The client appears to become anxious when it is time for respiratory treatments. 5. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema.

Answer: 1, 2, 5 Rationale: Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable, because it can be misunderstood. The use of vague terms, such as seemed or appears, is not acceptable because these words suggest that the nurse is stating an opinion.

Nursing staff members are sitting in the lounge taking their morning break. An assistive personnel (AP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. The registered nurse should inform the AP that making this accusation has violated which legal tort? 1. Libel 2. Slander

Answer: 2 Rationale: Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or offensive contact. Negligence involves the actions of professionals that fall below the standard of care for a specific professional group.

The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which best action? 1. Refuse to float to the ICU based on lack of unit orientation. 2. Clarify the ICU client assignment with the team leader to ensure that it is a safe assignment. 3. Ask the nursing supervisor to review the hospital policy on floating. 4. Submit a written protest to nursing administration, and then call the hospital lawyer.

Answer: 2 Rationale: Floating is an acceptable practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. That is why clarifying the client assignment with the team leader to ensure that it is a safe one is the best option. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Submitting a written protest and calling the hospital lawyer is a premature action.

The nurse has made an error in documentation of the dose administered of an opioid pain medication in the client's record. The nurse draws 1 mg from the vial and another registered nurse (RN) witnesses wasting of the remaining 1 mg. When scanning the medication, the nurse entered into the medication administration record (MAR) that 2 mg of hydromorphone was administered instead of the actual dose administered, which was 1 mg. The nurse should take which action(s) to correct the error in the MAR? Select all that apply. 1. Complete and file an occurrence report. 2. Right-click on the entry and modify it to reflect the correct information. 3. Document the correct information and end with the nurse's signature and title. 4. Obtain a co-signature from the RN who witnessed the waste of the remaining 1 mg. 5. Document in a nurse's note in the client's record detailing the corrected information.

Answer: 2, 3, 4, 5 Rationale: Electronic health records (EHR) will have a time-date stamp that indicates an amendment has been entered. If the nurse makes an error in the MAR, the nurse should follow agency policies to correct the error. In the MAR, the nurse can click on the entry (usually right-click) and modify it to reflect the corrected information. Since this is an opioid medication, the nurse should obtain a co-signature from the RN who witnessed the wasting of the excess medication, to validate that 1 mg, rather than 2 mg, was given. A nurse's note should be used to detail the event and the corrections made, and the nurse's name and title will be stamped on the entry in the EHR. An occurrence report is not necessary in this situation.

The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate initial nursing action? 1. Call the police. 2. Cut up the photograph and throw it away. 3. Call the nursing supervisor and report the occurrence. 4. Call the laboratory and ask for the name of the individual who sent the photograph.

Answer: 3 Rationale: Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. Sexually suggestive jokes, touching, pressuring a coworker for a date, and open displays of or transmitting sexually oriented photographs or posters are examples of conduct that could be considered sexual harassment by another worker and is an abusive behavior. If the nurse believes that he or she is being subjected to unwelcome sexual conduct, these concerns should be reported to the nursing supervisor immediately. Option 1 is unnecessary at this time. Options 2 and 4 are inappropriate initial actions.

A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? 1. Obtain a court order for the surgical procedure. 2. Ask the EMS team to sign the informed consent. 3. Transport the victim to the operating room for surgery. 4. Call the police to identify the client and locate the family.

Answer: 3 Rationale: In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action because it delays necessary emergency treatment.

The nurse who works on the night shift enters the medication room and finds a coworker with a tourniquet wrapped around the upper arm. The coworker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse? 1. Call security. 2. Call the police 3. Call the nursing supervisor. 4. Lock the coworker in the medication room until help is obtained.

Answer: 3 Rationale: Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This occurrence needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option 4 is an inappropriate and unsafe action.

The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the primary health care provider, and completes an occurrence report. Which statement should the nurse document on the occurrence report? 1. The client fell out of bed. 2. The client climbed over the side rails. 3. The client was found lying on the floor. 4. The client became restless and tried to get out of bed.

Answer: 3 Rationale: The occurrence report should contain a factual description of the occurrence, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options 1, 2, and 4 are interpretations of the situation and are not factual information as observed by the nurse.

A hospitalized client tells the nurse that an instructional directive is being prepared and that the lawyer will be bringing the document to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which is the most appropriate response to the client? 1. "I will sign as a witness to your signature." 2. "You will need to find a witness on your own." 3. "Whoever is available at the time will sign as a witness for you." 4. "I will call the nursing supervisor to seek assistance regarding your request."

Answer: 4 Rationale: Instructional directives (living wills) are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding instructional directives vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option 2 is non-therapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.

A nursing instructor delivers a lecture to nursing students regarding the issue of clients' rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right? 1. Performing a procedure without consent 2. Threatening to give a client a medication 3. Telling the client that he or she cannot leave the hospital 4. Observing care provided to the client without the client's permission

Answer: 4 Rationale: Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure without consent is an example of battery. Threatening to give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.

An older woman is brought to the emergency department for treatment of a fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. Which is the most appropriate nursing response? 1. "Oh, really? I will discuss this situation with your son." 2. "Let's talk about the ways you can manage your time to prevent this from happening." 3. "Do you have any friends who can help you out until you resolve these important issues with your son?" 4. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay."

Answer: 4 Rationale: The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with non-medical personnel or the client's family or friends without the client's permission. Clients should be assured that information is kept confidential, unless it places the nurse under a legal obligation. Options 1, 2, and 3 do not address the legal implications of the situation and do not ensure a safe environment for the client.

Advance Directives Durable power of attorney for health care

Appoints a person (health care proxy) chosen by the client to make health care decisions on the client's behalf when the client can no longer make decisions.

Morals

Behavior in accordance with customs or tradition, usually reflecting personal or religious beliefs.

Values

Beliefs and attitudes that may influence behavior and the process of decision making.

Religious beliefs: Organ donation and transplantation Islam (Muslim) beliefs

Body parts should not be removed or donated for transplantation.

Religious beliefs: Organ donation and transplantation Orthodox Church

Church usually discourages organ donation.

Civil Law

Civil law is concerned with relationships among persons and the protection of a person's rights. Violation may cause harm to an individual or property, but no grave threat to society exists.

Contract Law

Contract law is concerned with enforcement of agreements among private individuals.

Criminal Law

Criminal law is concerned with relationships between individuals and governments, and with acts that threaten society and its order; a crime is an offense against society that violates a law and is defined as a misdemeanor (less serious nature) or felony (serious nature).

The Health Insurance Portability and Accountability Act (HIPAA)

Describes how personal health information (PHI) may be used and how the client can obtain access to the information. Any client requests may need to be placed in writing; a fee may be attached to certain client requests.

The Joint Commission (JCAHO)

Developed policy statements on the rights of mentally ill individuals

Mental Health Systems Act (MHSA)

Developed rights for mentally ill clients ▪ Right to be treated with dignity and respect ▪ Right to communicate with persons outside the hospital ▪ Right to keep clothing and personal effects with them ▪ Right to religious freedom ▪ Right to be employed ▪ Right to manage property ▪ Right to execute wills ▪ Right to enter into contractual agreements ▪ Right to make purchases ▪ Right to education ▪ Right to habeas corpus (written request for release from the hospital) ▪ Right to an independent psychiatric examination ▪ Right to civil service status, including the right to vote ▪ Right to retain licenses, privileges, or permits ▪ Right to sue or be sued ▪ Right to marry or divorce ▪ Right to treatment in the least restrictive setting ▪ Right not to be subject to unnecessary restraints ▪ Right to privacy and confidentiality ▪ Right to informed consent ▪ Right to treatment and to refuse treatment ▪ Right to refuse participation in experimental treatments or research

American Nurses Association (ANA)

Developed the Code of Ethics for Nurses, which defines the nurse's responsibility for upholding client's rights

Informed consent

Indicates the client's participation in the decision regarding health care. It is the client's approval (or that of the client's legal representative) to have their body touched by a specific individual. Can be waived for urgent medical or surgical intervention as long as institutional policy so indicates. In most states, when the nurse is involved in the informed consent process, the nurse is witnessing only the signature of the client on the informed consent form.

American Hospital Association (AHA)

Issued Patient's Bill of Rights

Advance Directives Instructional Directives

Lists the medical treatment that a client chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill.

Minor legal consent (usually younger than 18 years).

Must be obtained from a parent or the legal guardian except in the following cases: In an emergency In situations in which the consent of the minor is sufficient, Treatment related to substance abuse Treatment of a sexually transmitted infection Human immunodeficiency virus (HIV) Testing and acquired immunodeficiency syndrome (AIDS) treatment, Birth control services, Pregnancy Psychiatric services The minor is an emancipated minor; or a court order or other legal authorization has been obtained.

Reporting Responsibilities

Nurses are required to report certain communicable diseases or criminal activities such as child or elder abuse or domestic violence; dog bite or other animal bite, gunshot or stab wounds, assaults, and homicides; and suicides to the appropriate authorities.

Religious beliefs: Organ donation and transplantation Catholic Church

Organ donation and transplants are acceptable.

Americans With Disabilities Act (ADA)

Prohibits discrimination against an individual with disabilities in all areas of public life

Autonomy

Respect for an individual's right to self-determination

Do not resuscitate (DNR) prescriptions

The PHCP writes a DNR prescription if the client and PHCP have made the decision that the client's health is deteriorating and the client chooses not to undergo cardiopulmonary resuscitation if needed. Some states offer DNR Comfort Care and DNR Comfort Care Arrest protocols; these protocols list specific actions that HCPs will take when providing cardiopulmonary resuscitation (CPR).

Patient Self-Determination Act (PSDA)

The Patient Self-Determination Act is a law that requires clients be provided with information about their right to have written directions about the care that they wish to receive in the event that they become incapacitated and are unable to make health care decisions.

Ethics

The branch of philosophy concerned with the distinction between right and wrong on the basis of a body of knowledge, not only on the basis of opinions

(Patient's) Bill of Rights

The document provides a list of the rights of the client and responsibilities that the hospital cannot violate. ▪ Right to considerate and respectful care ▪ Right to be informed about diagnosis, possible treatments, and likely outcome, and to discuss this information with the health care provider ▪ Right to know the names and roles of the persons who are involved in care ▪ Right to consent or refuse a treatment ▪ Right to have an advance directive ▪ Right to privacy ▪ Right to expect that medical records are confidential ▪ Right to review the medical record and to have information explained ▪ Right to expect that the hospital will provide necessary health services

Beneficence

The duty to do good to others and to maintain a balance between benefits and harms. Paternalism is an undesirable outcome of beneficence, in which the health care provider decides what is best for the client and encourages the client to act against his or her own choices.

Fidelity

The duty to do what one has promised

Justice

The equitable distribution of potential benefits and tasks determining the order in which clients should be cared for

Nonmaleficence

The obligation to do or cause no harm to another

Veracity

The obligation to tell the truth

Religious beliefs: Organ donation and transplantation Orthodox Judaism

a. All body parts removed during autopsy must be buried with the body because it is believed that the entire body must be returned to the earth; organ donation may not be considered by family members. b. Organ transplantation may be allowed with the rabbi's approval.

Uses or Disclosures of Personal Health Information (PHI)

▪ Compliance with legal proceedings or for limited law enforcement purposes ▪ To a family member or significant other in a medical emergency ▪ To a personal representative appointed by the client or designated by law ▪ For research purposes in limited circumstances ▪ To a coroner, medical examiner, or funeral director about a deceased person ▪ To an organ procurement organization in limited circumstances ▪ To avert a serious threat to the client's health or safety or the health or safety of others ▪ To a governmental agency authorized to oversee the health care system or government programs ▪ To the Department of Health and Human Services for the investigation of compliance with the Health Insurance Portability and Accountability Act or to fulfill another lawful request ▪ To federal officials for lawful intelligence or national security purposes ▪ To protect health authorities for public health purposes ▪ To appropriate military authorities if a client is a member of the armed forces ▪ In accordance with a valid authorization signed by the client

Do's and Don'ts Documentation Guidelines: Narrative and Information Technology

▪ Date and time entries. ▪ Provide objective, factual, and complete documentation. ▪ Document care, medications, treatments, and procedures as soon as possible after completion. ▪ Document client responses to interventions. ▪ Document consent for or refusal of treatments. ▪ Document calls made to other primary health care providers. ▪ Use quotes as appropriate for subjective data. ▪ Use correct spelling, grammar, and punctuation. ▪ Sign and title each entry. ▪ Follow agency policies when an error is made. ▪ Follow agency guidelines regarding late entries. ▪ Use only the user identification code, name, or password for computerized documentation. ▪ Maintain privacy and confidentiality of documented information printed from the computer. ▪ Do not document for others or change documentation for other individuals. ▪ Do not use unacceptable abbreviations. (3. Refer to The Joint Commission Web site for acceptable abbreviations and documentation guidelines) ▪ Do not use judgmental or evaluative statements, such as "uncooperative client." ▪ Do not leave blank spaces on documentation forms. ▪ Do not lend access identification computer codes to another person; change password at regular intervals.

Components of a Medication Prescription

▪ Date and time prescription was written ▪ Medication name ▪ Medication dosage ▪ Route of administration ▪ Frequency of administration ▪ Primary health care provider's signature

Telephone Prescription Guidelines

▪ Date and time the entry. ▪ Repeat the prescription to the primary health care provider (PHCP), and record the prescription. ▪ Sign the prescription; begin with "t.o." (telephone order), write the PHCP's name, and sign the prescription. ▪ If another nurse witnessed the prescription, that nurse's signature follows. ▪ The PHCP needs to countersign the prescription within a time frame according

Mentally or Emotionally Incompetent Clients

▪ Declared incompetent ▪ Unconscious ▪ Under the influence of chemical agents such as alcohol or drugs ▪ Chronic dementia or other mental deficiency that impairs thought processes and ability to make decisions

Examples of Negligent Acts

▪ Medication errors that result in injury to the client ▪ Intravenous administration errors, such as incorrect flow rates, failure to monitor a flow rate that results in injury to the client, infiltration, or phlebitis ▪ Falls that occur as a result of failure to provide safety to the client ▪ Failure to use aseptic technique when indicated ▪ Failure to check equipment for proper functioning ▪ Burns sustained by the client as a result of failure to monitor bath temperature or equipment, protect the client from spills of hot liquids or foods ▪ Errors in sponge, instrument, or needle counts in surgical cases, meaning that an item was left in a client ▪ Failure to adequately monitor a client's condition ▪ Failure to report changes in the client's condition to the primary health care provider ▪ Failure to give a report or giving an incomplete report to the oncoming shift personnel

Maintenance of Confidentiality

▪ Not discussing client issues with other clients or staff uninvolved in the client's care ▪ Not sharing health care information with others without the client's consent (includes family members or friends of the client and social networking sites) ▪ Keeping all information about a client private, and not revealing it to someone not directly involved in care ▪ Discussing client information only in private and secluded areas ▪ Protecting the medical record from all unauthorized readers

Social Networking and Health Care

▪ Specific social networking sites can be beneficial to health care providers (HCPs) and clients; misuse of social networking sites by the HCP can lead to Health Insurance Portability and Accountability Act (HIPAA) violations and subsequent termination of the employee. ▪ Nurses need to adhere to the code of ethics, confidentiality rules, and social media rules. Additional information about these codes and rules can be located at the American Nurses Association Web site at https://www.nursingworld.org/practice-policy/nursing-excellence/social- networking-Principles/ ▪ Standards of professionalism need to be maintained, and any information obtained through any nurse-client relationship cannot be shared in any way. ▪ The nurse is responsible for reporting any identified breach of privacy or confidentiality.

Violations and Invasion of Client Privacy

▪ Taking photographs of the client ▪ Release of medical information to an unauthorized person, such as a member of the press, family, friend, or neighbor of the client, without the client's permission ▪ Use of the client's name or picture for the health care agency's sole advantage ▪ Intrusion by the health care agency regarding the client's affairs ▪ Publication of information about the client or photographs of the client, including on a social networking site ▪ Publication of embarrassing facts ▪ Public disclosure of private information ▪ Leaving the curtains or room door open while a treatment or procedure is being performed ▪ Allowing individuals to observe a treatment or procedure without the client's consent ▪ Leaving a confused or agitated client sitting in the nursing unit hallway ▪ Interviewing a client in a room with only a curtain between clients or where conversation can be overheard ▪ Accessing medical records when unauthorized to do so