Fundamentals

slander

spoken defamation

Beginning and End of Life Nursing Issues

termination of pregnancy death with dignity or physician-assisted suicide

patient abandonment

when a nurse refuses to provide care for a patient after having established a patient-nurse relationship

libel

written defamation

scope of nursing practice

defines nursing and reflects the values of the nursing profession

Americans with Disabilities Act (ADA)

Protects rights of people with physical or mental disabilities Prohibits discrimination and ensures equal opportunities for people with disabilities in employment, state, and local government services, public accommodations, commercial facilities, and transportation.

Defamation of Character

The publication of false statements that result in damage to a person's reputation.

Privacy

The right of patients to keep personal information from being disclosed

Key point

The scope of nursing practice defines nursing and reflects the values of the nursing profession. Standards of nursing care reflect the knowledge and skill ordinarily possessed and used by nurses.

Public Health Laws

Protection of the public's health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for the health care provided. Laws include reporting suspected abuse and neglect, such as child abuse or domestic violence, reporting communicable diseases, and ensuring clients have received required immunizations.

before establishing a patient-nurse relationship, a nurse may refuse an assignment when

1. The nurse lacks knowledge or skill to provide competent care. 2. Care exceeding the Nurse Practice Act is expected. 3. Health of the nurse or her unborn child is directly threatened by the type of assignment. 4. Orientation to the unit has not been completed and safety is at risk. 5. The nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds. 6. The nurse's clinical judgement is impaired as a result of fatigue, resulting in a safety risk for the patient.

Confidentiality

Protects private patient information once it is disclosed in health care settings.

The driver of the car who struck Mr. Barber is guilty of which unintentional tort? A. Homicide B. Manslaughter C. Negligence D. Assault E. Battery

C. Negligence The driver of the car that struck Mr. Barber is guilty of negligence since running the stop sign is conduct that falls below a standard of care.

Nurse Practice Act

Describe and define the legal boundries of nursing practice within each state State Board of Nursing Nursing Commission

nursing assignments

Floating Based on census load and patient acuities. Nurses follow orders unless they believe an order is given in error or is harmful. If you do not have the education or experience to care for patients assigned to you, notify your supervisor

Malpractice

One type of negligence and often referred to as professional negligence 1) nurse owed a duty 2) nurse did not carry out or breached that duty 3) the patient was injured due to breach 4) damages caused by negligence

Federal statutory issues in nursing practice

Patient Protection and Affordable Care Act (PPACA) Americans with Disabilities Act (ADA) Emergency Medical Treatment and Active Labor Act Mental Health Parity Act as Enacted Under PPACA Advance directives Uniform Anatomical Gift Act Health Insurance Portability and Accountability Act (HIPAA) Health Information Technology Act (HITECH) Restraints

Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? (Select all that apply.) 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."

1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 83. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." Nurses need to be actively involved in their communities and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees to be involved in decision making. Nurses have a powerful voice in the legislature.

You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first? 1. Call the nursing supervisor to discuss the situation. 2. Discuss the problem with a colleague. 3. Leave the nursing unit and go home. 4. Say nothing and begin your work.

1. Call the nursing supervisor to discuss the situation. 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 staf

The Patient Protection and Affordable Care Act (PPACA) is characterized by four themes embedded in nursing practice:

1. Consumer rights and protections 2. Affordable health care coverage 3. Increased access to care 4. Stronger Medicare to improve care for those most vulnerable in our society

A patient is in skeletal traction and has a plaster cast due to a fractured femur. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? (Select all that apply.) 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to provide patient education about cast care. 4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition

1. Failure to document a change in assessment data 5. Failure to notify a health care provider about a change in the patient's condition The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.

Which of the following actions, if performed by a registered nurse, could result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Reviewing the electronic health record of a family member who is a patient in the same hospital on a different unit 2. Refusing to provide health care information to a patient's child 3. Reporting suspected abuse and neglect of children 4. Applying physical restraints without a written order 5. Completing an occurrence report on the unit

1. Reviewing the electronic health record of a family member who is a patient in the same hospital on a different unit 4. Applying physical restraints without a written order Viewing a family member's electronic health record violates the patient's rights provided by HIPAA. A physical restraint can be applied only on the written order of a health care provider based on The Joint Commission and Medicare guidelines

1. Mr. Barber has a durable power of attorney for health care (DPAHC). This document means that Mr. Barber has expressed in written form that he does not wish to be sustained on life support. A. True B. False

B. False The DPAHC is a legal document that designates a person or person of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf. A living will is a written document of the patient's wishes in which the patient declares what he or she wants in the event of a terminal illness or condition.

Key elements of informed consent

1. The patient receives an explanation of the procedure or treatment. 2. The patient receives the names and qualifications of people performing and assisting in the procedure. 3. The patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort. 4. The patient receives an explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing. 5. The patient knows that he or she has the right to refuse the procedure/treatment without discontinuing other supportive care. 6. The patient knows that he or she may refuse the procedure/treatment even after the procedure has begun.

Termination of pregnancy or abortion issues

1973 Roe v. Wade U.S. Supreme Court ruled that there is a fundamental right to privacy, which includes a woman's right to have an abortion. 1989 Webster v. Reproductive Health Services Some states require viability tests if the fetus is more than 28 weeks' gestational age.

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

2. Surgeon The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.

A nurse sends a text message to the oncoming nurse to report that a patient refuses to take medication as ordered. What should the oncoming nurse do? (Select all that apply). 1. Add this information to the board hanging at the patient's bedside. 2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Inform the nursing supervisor. 4. Forward the text to the charge nurse. 5. Thank the nurse for sending the information

2. Tell the nurse who sent the text that the text is a HIPAA violation. 3. Inform the nursing supervisor. The Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology Act provide rules about how and with whom nurses can share patient health information. Sending a text message to another nurse about a patient is a violation of these acts. Report violations of the privacy of patient health information to your supervisor or manager.

A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Document her findings and treat the patient. 2. Instruct the mother on safe handling of a 2-year-old child. 3. Contact a child abuse hotline. 4. Discuss this story with a colleague.

3. Contact a child abuse hotline. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.

A nurse received bedside report at the change of shift with the night-shift nurse and the patient. The nursing student assigned to the patient asks to review the patient's medical record. The nurse lists patients' medical diagnoses on the message boards in the patients' rooms. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? 1. Discussing patient conditions at the bedside at the change of shift 2. Allowing the nursing student to review the assigned patient's chart before providing care during the clinical experience 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

3. Posting medical information about the patient on a message board in the patient's room 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.

Risk management and performance/quality improvement

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Steps involved: Identify possible risks Analyze risks Act to reduce risks Evaluate steps taken One tool used in risk management is the incident report or occurrence report

A man who is homeless enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the city hospital for care before assessing the patient. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPAA) 2. Americans with Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA)

4. Emergency Medical Treatment and Active Labor Act (EMTALA) The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.

A woman has severe life-threatening injuries, is unresponsive, and is hemorrhaging following a car accident. The health care 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 for religious reasons. What is the nurse's responsibility? 1. Obtain a court order to give the blood. 2. Convince the husband to allow the nurse to give the blood. 3. Call security and have the husband removed from the hospital. 4. Gather more information about the wife's preferences and determine whether the husband is her power of attorney for health care

4. Gather more information about the wife's preferences and determine whether the husband is her power of attorney for health care Adult patients such as those with specific religious objections are able to refuse treatment for personal religious reasons. Because this patient is unresponsive, it is important for the nurse to better understand the patient's preferences and know if the woman has a power of attorney for health care before following the husband's wishes. However, there needs to be clear directions on who can make the decision

Malpractice insurance

A contract between the nurse and the insurance company Provides a defense when a nurse is in a lawsuit involving negligence or malpractice Nurses covered by institution's insurance while working

Durable Power of Attorney for Health Care

A legal document that designates a person or people of one's choosing to make health care decisions when a patient is no longer able to make decisions on his or her own behalf.

Key point

A nurse has a duty of care. When a nurse's performance is questioned, the standard of proof in nursing is typically what a reasonably prudent nurse would do under similar circumstances in the geographic area in which the alleged breach occurred

Key point

A nurse's witness to a patient's informed consent indicates that the patient appeared to voluntarily give consent, that he or she appeared capable to give consent, and that the patient signed the consent in the nurse's presence

Key point

Physical or chemical restraints are used only as a last resort to ensure the physical safety of the patient or other patients when less restrictive interventions are unsuccessful and require a written order from a health care provider

staffing and nurse-to-patient ratios

Adequate staffing is required to assure patient safety and satisfaction with care Legal problems occur if an inadequate number of nurses will provide care.

Assault

An intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact.

torts

Civil wrongful acts or omissions made against a person or property. They are classified an intentional, quasi-intentional, or unintentional.

Negligence

Conduct that falls below the generally accepted standard of care of a reasonably prudent person.

Brad carries Mr. Barber's laboratory requisition slip to the laboratory in the basement of the hospital. He folds the paper so Mr. Barber's information is not visible to others in the halls and elevators. Brad is protecting Mr. Barber's _______________.

Confidentiality Confidentiality protects private patient information once it has been disclosed in health care settings. Privacy is the right of patients to keep personal information from being disclosed.

Key Point

Constitutional law refers to rights granted to citizens in the US Constitution and state constitutions. Civil laws are passed by Congress and state legislatures to protect the rights of individuals. Criminal laws are passed by Congress and state legislatures to protect society and provide punishment for crimes.

intentional torts

Deliberate acts that violate another's rights such as assault, battery, and false imprisonment.

Emergency Medical Treatment and Active Labor Act (1986)

Intended to prevent "patient dumping" When a patient presents to an emergency department, they must be treated

Key point

It is important to know your Nurse Practice Act, to implement and follow agency policies and procedures, to delegate care appropriately, and to participate in risk-management and quality improvement activities to reduce your legal risk when practicing nursing.

Criminal laws

Law that protect society as a whole and provide punishment for crimes, which are defined by municipal, state, and federal legislation. These are separated into misdemeanors or felonies.

Civil laws

Laws that protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur. Consequences include fines or public service. Example: Nursing negligence or malpractice.

Key point

Negligence occurs when a nurse had a duty of care that is breached, a patient is physically harmed, and damages are provided to "make the person whole"; a reasonably prudent nurse under similar circumstances would have done care differently

State statutory issues in nursing practice

Nurse Practice Act Informed Consent and Health Care Acts Good Samaritan Laws Public Health Laws Uniform Determination of Death Act

Nursing Workforce Issues

Nursing students staffing and nurse-to-patient ratios nursing assignments patient abandonment nurse delegation

occurrence report or incident report

Occurrence reporting Serves as a database for further investigation Alerts risk management to a potential claim situation Documentation TJC's Universal Protocols Professional involvement

The Health Insurance Portability and Accountability Act (HIPAA, 1996)

Provides rights to patients and protects employees. It protects individual employees from losing their health insurance when changing jobs by providing portability. taken very seriously if you are not taking care of that patient, you cannot look into their chart

Living Wills

Represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition.

Patient Self-Determination Act (1991) PSDA

Requires health care institutions to provide written information to patients concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives. ex. durable power of attorney for health care (DPAHC) saying DNR it may direct whether to provide lifesaving measures or comfort care only

The Whole-Brain Standard

Requires irreversible cessation of all functions of the entire brain, including the brainstem.

The Cardiopulmonary Standard

Requires irreversible cessation of circulatory and respiratory functions.

The Uniform Determination of Death Act

States that health care providers can use either cardiopulmonary definition or the whole-brain definition to determine death.

Key point

Statutory law is civil or criminal. Civil laws protect the rights of individuals as in the case of a Nurse Practice Act, which defines the scope of nursing practice and the standards you must meet within individual states to ensure safe evidence-based and competent nursing practice.

The Mental Health Parity and Addiction Equity Act (MHPAEA) 2008

Strengthens mental health services requires health insurance companies to provide coverage for mental health and substance use disorder (SUD) treatment

Key point

The Health Insurance Portability and Accountability Act, Health Information Technology Act, and Americans with Disabilities Act are examples of federal statutes that affect nursing practice.

Key point

The Patient Self-Determination Act is a federal statute that requires health care institutions to provide information to patients regarding their rights to make informed decisions about their care, including the right to create an advanced directive. When a patient has an advanced directive that includes a "do not resuscitate" (DNR) order, you need to ensure that the patient and provider have discussed end-of-life choices and that the discussion is documented in the patient's medical record.

Nurse Practice Acts

These acts describe and define the legal boundaries of nursing practice within each state.

Good Samaritan Laws

These encourage health care professionals to assist in emergencies. These laws limit liability and offer legal immunity if a nurse helps at the scene of an accident.

Key point

Worsening pressure injuries, failure to contact the provider as conditions change, and medication errors often trigger complaints of negligence or malpractice against nurses

nursing students

You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. You are expected to perform as a professional when rendering care. You must separate your student nurse role from your work as a certified nursing assistant (CNA).

Death with Dignity or Physician-Assisted Suicide

a competent individual with a terminal disease could make an oral and written request for medication to end his or her life in a humane and dignified manner

informed consent

a patient's agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal The nurse's signature as a witness to the consent means that the patient voluntarily gave consent, the patient's signature is authentic, and the patient appears to be competent to give consent

Informed Consent and Health Care Acts

a patients signed consent is necessary for admission to a health care agency, invasive procedures such as intravenous central line insertion, surgery, some treatment programs

neglect

a pattern of conduct by a person with a duty to care to provide services that maintain the physical and/or mental health of a child or vulnerable adult

Unintentional Torts

a person is harmed and the person inflicting the harm knew, or should have known, that their actions were less than the accepted scoped and standard of practice ex. negligence, malpractice

Quasi-Intentional Torts

acts in which a person may not intend to cause harm to another but does. ex. invasion of privacy, defamation of character, slander

The Omnibus Budget Reconciliation Act (1987)

altered the way in which health care is provided to older adults. focused on patients rights, quality of life, quality of care, physical environment, use of restraints

battery

any intentional offensive touching without consent or lawful justification

Constitutional law

derived from federal and state constitutions. ex. every citizen has the right to refuse treatment

Statutory law

derived from statutes passed by congress and state they can be civil or criminal

Case law

describes decisions made in legal cases that were resolved in courts. After a case is presented to a judge or jury, there is a report of the issue, facts, findings, and subsequent decision that was mad to resolve the issue

risk management

involves several components, including identifying possible risks, analyzing them, acting to reduce the risks, and evaluating the steps taken to reduce them

nurse delegation

means that an RN educates, observes, and verifies that a non-nurse can do specific task that is usually completed by a nurse

Regulatory Law/Administrative Law

more clearly defines expectations of civil and criminal laws Laws that reflect decisions made by administrative bodies such as State Boards of Nursing when rules and regulations are passed. Example: The requirement to report incompetent or unethical nursing conduct to the State Board of Nursing

Common Law

originates from decisions that were made in the absence of law. Example: Informed consent, confidentiality, a patient's right to refuse treatment, negligence, and malpractice.

Health Information Technology Act (HITECH Act, 2009)

passed with HIPAA, passed in response to new technology and social media

Uniform Anatomical Gift Act (UAGA)

provides that foundation for the national organ donation system

standards of nursing care

reflect the knowledge and skill ordinarily possessed and used by nurses derived from health care laws, best practice guidelines, professional organization white papers, evidence-bases nursing knowledge, and citizen advocacy groups Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care Best known comes from the American Nurses Association (ANA) Set by state and federal laws that govern where nurses work The Joint Commission (TJC) requires policies and procedures (P&Ps).

Case Study Mr. Nick Barber, a 47-year-old professor, is a trauma patient who sustained injuries when he was crossing the street on campus. He was struck by a fast-moving car that failed to stop at a stop sign. He was rushed to the emergency department and then to surgery to repair his injuries. After surgery he was transferred to the medical-surgical unit for postsurgical management. Brad is the nursing student assigned to Mr. Barber. Currently Mr. Barber is resting quietly in his room with his wife present.

see questions