Leadership- Legal and Legislative Issues
The minimal level of expertise that may be delivered to a patient; the conduct of a reasonably prudent nurse in similar circumstances
Standard of Care
Laws that govern; -Voted on and passed by legislative bodies -Compiled into codes, statues, or city ordinances -Ex- Nurse Practice Act
Statutes
True or False: Hospitals have a duty to detain person who are confused, disoriented, or mentally ill persons who are threat to society or themselves
TRUE
(outcome focus) -A person must take those actions that lead to good outcomes -Emphasis on results -The end justifies the means -Right consistent actions that have good consequences and wrong consistent actions that have bad consequences
Teleology
Four principal elements that are included in the international council of Nurses' Code of ethic for nursing:
o Nurses and people o Nurses and practice o Nurses in the profession o Nurses and coworkers
• Nurses have four fundamental responsibilities:
o Promote health o Prevent illness o Restore health o Alleviate suffering
RN licensure is a ______
privilege
The primary purpose of law and legislation is to
protect the patient and the nurse
Purpose- establish the basis of a governing system for the future and present
Constitution
System of fundamental laws that govern a nation, society, corporation, or another aggregate of individuals
Constitution
What are the different sources of law?
Constitutions, Statutes, Administrative, Judicial
Violation of criminal law and is prosecuted by the government
Criminal Law
What are the two types of law?
Criminal and Civil
Communicating to a third party false information that injures a person's reputation • Slander: spoken/oral • Liable: written
Defamation of character
(duty focused) -Actions are based on moral rules and unchanging principles -All persons are worthy of respect and thus should be treated the same -Right or wrong is determined on the persons duty to act, not on consequences of ones actions • Ex. Abortion and euthanasia are never acceptable because they violate the duty to respect the sanctity of life
Deontology
What are the five components necessary for malpractice to occur
Duty of care, breach of duty, foreseeability of harm must exist, causation, actual patient injury must occur
Making a choice between two or more equally undesirable alternatives EXAMPLE: Assisted suicide: Family might be opposed to seeing a love one suffering during last months of life but on the other head they are equally opposed to an earlier death
Ethical Dilemma
Deontology and teleology
Ethical Theories
Purpose is to→establish common ground between nurse, patient, family, other healthcare professionals & society to discuss ethical questions & make ethical decisions; permit people to take a consistent position on specific or related issues; provide an analytical framework by which moral problems can be evaluated
Ethical principles:
-The branch of philosophy that concerns the distinction of right from wrong on the basis of a body of knowledge -Provides a framework for determining the right course of action
Ethics
what is the FLAT charting acronym?
F- factual L- legible A- accurate and complete T- timely
Any unlawful confinement • Can be physical, emotional, or chemical • The use of physical restraints has led to claims of false imprisonment • Some circumstances do require detainment
False imprisonment
True or False: "Just following physician orders" IS a defense for malpractice
False- it is NOT
• The principle of promise keeping, faithful to commitments • Don't make promises when you cannot deliver • Ex. Something as simple as telling a patient you will be back in 30 minutes to reassess there pain medication would instill this principal of fidelity
Fidelity
Ex- the omission of an ordered insulin injection of a known diabetic will most likely result in an abnormally high serum glucose level • Med errors, patient falls
Foreseeability of harm must exist
The failure of a person with professional training to act in a reasonable and prudent manner--- also called?
Malpractice (also called professional negligence)
• The principle of doing no harm • Duty to prevent doing harm whether intentional or unintentional
Nonmaleficence
A legal instrument that defines what the functions of nursing shall be and sets standards for licensure
Nurse Practice Act
What are the two types of negligence?
Ordinary and Professional
-An unreasonable risk of harm exists -There is a concept of foreseeability that's included here (harm could be anticipated) -Includes both acts of commission (doing something you shouldn't be doing) and omission (not doing something you should be doing)
Ordinary negligence
Deviation from the standard of care that a reasonable person would use in a particular set of circumstances (plain old carelessness)
Ordinary negligence
-Beliefs chosen are cherished
Prizing
(aka malpractice) - the failure of a person with professional training to act in a reasonable and prudent (wise, judicious, sensible) manner
Professional negligence
-Involves the conduct of professionals that falls below a professional standard of care -Much more specific→ looks at a professional standard of care as well as the professional status of the care giver
Professional negligence
Four ways to prevent malpractice
o Follow a chain of command o Follow establish policies and procedures o Question improper provider orders o Safeguard patient legal interests
when an act is performed by a nonprofessional→ result is _______. When the same act is performed by a professional person→ the act is the basis for a ____________
negligence and malpractice suit
failure to meet the standard of care
"Breach of Duty"
a standard of care is in place
"Duty of care"
Regulates conduct between private individuals and businesses
Civil Law
•Formal statement that provides values standard and principals to help nursing function as a profession •Not a legal document but a guide for nurses •Stresses obligation to patient and include protecting patient from incompetent, unethical, or illegal practice
ANA Code of Ethics for Nurses
-The selected beliefs are demonstrated consistently through behavior
Acting
Physical, financial, or emotional injury resulted from the breach of duty
Actual patient injury must occur
(aka regulatory): gives authority to act by the state and legislative body, and creates rules and regulations that enforce statutory laws
Administrative
Ex- State Board of Nursing→ responsible for implementing and enforcing the Nurse Practice Act
Administrative
Conduct that makes a person fearful and produces a reasonable apprehension --- No touching is required
Assault
• Respect for a person's right to self-determination, the right to choose without interference • Not all cultures value autonomy to the same degree • Ex. Informed consent, respecting another choice even if you don't agree
Autonomy
Intentional or wrongful physical contact with a person that entails an injury or offensive touching
Battery
(caring in the truest sense) • The duty to do good to others and to maintain a balance between benefits and harms • Obtain from injuring others and remove conditions that could cause harm
Beneficence
-There must be a provable correlation between care and harm -Injury must have been incurred directly by the breach of duty owed to the patient
Causation
-Beliefs are chosen freely -Making an analysis of the consequences of various alternatives
Choosing
What is the process of valuing?
Choosing, Prizing, Acting
Tort- violation of a civil law in which another person is wronged Enforced through the courts as damages or monetary compensation The area of law that is normally involved in medical malpractice claims
Civil
Direct invasion of someone's legal rights -Assault and battery, false imprisonment, defamation of character
Intentional tort
(aka court decisions): to interpret legal issues that are in dispute
Judicial
• The principle of fairness • Have no regard to age, socioeconomic status, or any other variable • Involves the allocation of scares resources
Justice
Is not an exact science, but an organized and ongoing system of change in response to current conditions and public expectations
Law
• The right of people to make their own decisions (highest principal and incorporates all other principals)
Respect for others
-Designed to identify and correct system problems that contribute to errors in patient care or employee injury -Emphasis is on quality improvement and protection of the institution from financial liability
Risk Management
One of the most important tools for all providers in a malpractice claim is the medical record→ the _______ _______are most often the first part of the record to be examined*
nurses notes
A civil wrong committed against a person or the persons property
Tort
The accountable person failed to meet his/her responsibility or performed an action below the allowable standard of care
Tort
True or False: Nurses have an independent responsibility to take appropriate steps to safeguard patients
True
the question of whether a nurse acted with reasonable and prudent care is determined by the testimony of expert nursing witnesses
Under ordinary circumstances
Individual personal beliefs about the truth of ideals, standards, principles, objects, and behaviors that give meaning and direction to life
Values
The process of analyzing one's own values to better understand what is truly important
Values clarification
• The obligation to tell the truth • For trust to develop, there must be truthful communication • Ex. If a patient who suspects her diagnosis is cancer and asks do I have cancer, if you were abiding by the principal of veracity, especially if her family asked that she not be told the truth, what would you do?
Veracity
Statement of affirmation and acceptance of the personal and ethical responsibilities of being a member of the nursing profession
Written pledge for nurses:
Upon conviction, a crime might be punished by→
imprisonment, parole conditions, loss of privilege (for us, this would include loss of license), fine, or combo
Crimes are classified as→
misdemeanor or felony