Legal and Ethical
Issues to address when a patient is refusing care:
-establishing mental competence -identifying patient understanding -involving others -documenting
What is required before any medical treatment or procedure?
Informed consent
In incident reports nurses are required to report?
near misses as well as the actual event
Define patient autonomy
possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law
The Death with dignity act allows health care providers to?
prescribe life-ending medications to anyone who is mentally competent and diagnosed with an illness giving them less than 6 months to live.
Define standard of care:
set of guidelines based on various types of evidence as to what is reasonable and prudent for a health care professional in the same or similar circumstance
If the delegate is unable to perform the job appropriately who is held accountable?
the nurse that delegated the task
Bioethical Issues of Reproduction:
-Assisted reproductive technology -genetic screening -surrogacy
Do's and don'ts of documentation:
-Do not document personal notes about what others did or did not do. -Do not document a patient problem without documenting the action taken to address the problem. -Be objective and chart the specific details. -Document why something was not done if it is something the nurse would normally do. -Document at the time of the event. -Make sure to note "late entry" -Document health care provider rounds or visits and the nursing response to any health care provider prescriptions. -Document all phone conversations (with family, health care providers, and other medical providers) in the chart.
Match the type of law with the correct description Governs the professional practice of nursing Associated with civil lawsuits Laws associated with the Bill of Rights Patient Protection and Affordable Care Act -labor -constitutional -administrative -tort -federal statutory -corporate
-Governs the professional practice of nursing: ADMINISTRATIVE -Associated with civil lawsuits: TORT -Laws associated with the Bill of Rights: CONSTITUTIONAL -Patient Protection and Affordable Care Act: FEDERAL STATUTORY
Invasion of Privacy -define -example
-Health information is shared or images are obtained without patient consent -Posting a picture to social media that includes patient information in the background
Battery: -define -example
-Intentional offensive touching without consent -Placing restraints on a patient without reason
Assault: -define -examples
-Intentional threat toward another person -Threatening to restrain a patient without reason
Intentional Infliction of Emotional Distress -define -example
-The nurse's actions are so outrageous that it leads to emotional shock of the patient -In Roddy v Tanner Medical Center, 2003, the patient was discharged home after a spontaneous abortion at 10 weeks of gestation. At home, the patient discovered that the fetus was still in the bag of soiled clothes worn in the emergency department. The patient sued the hospital for emotional distress (Mahlmeister, 2017).
5 rights of safe delegation:
-right person -right direction/communication -right supervision/evaluation -right task -right circumstance
-What is constitutional law? -an example of a constitutional law affecting nursing?
-rights and privileges that are an inherent part of the US Constitution and Bill of Rights -patient autonomy or self-determination
-Federal and state health care statutory laws are: -violation of these laws is a
-written by a legislative body, such as Congress, and enacted by federal, state, or even local legislative bodies -criminal offense and is prosecuted by the government.
Delegation:
1) Only an RN can delegate a nursing task.. 2) The RN is accountable for any act that is delegated. 3) The RN is responsible for determining whether the delegated act is appropriate. 4) The RN must determine that the person is competent to perform the delegated nursing task. 5) The RN is accountable and responsible for interpreting and following up on any abnormal results. 6) The RN must follow the employer's policies and procedures on supervision for specific tasks and how to report problems with delegation. 7) The RN must remember that legal requirements will always take precedence over organizational policies.
The Death with Dignity Act allows health care providers to prescribe life-ending medication to anyone who is mentally competent and diagnosed with an illness giving them less than how many months to live?
6 months
The nurse is filling out an incident report after finding an older adult patient on the floor beside the bed. Which guidelines would the nurse follow when completing the report? Select all that apply. A) Describe objectively how the nurse found the patient. B) Notify management that a critical event occurred. C) Document in the medical record that an incident report was filed. D) Document in the medical record that the patient fell getting out of bed. E) Make a photocopy of the incident report to keep for personal records.
A, B
Which aspects of nursing care is the registered nurse (RN) responsible for when delegating actions to someone on his or her behalf? Select all that apply. A) Ensuring that the task is appropriate to delegate B) Ensuring that the delegatee is able to correctly perform the task C) Performing follow-up and evaluation after completing the task D) Correctly following hospital protocol E) Ensuring that the circumstance is appropriate to delegate the task
A, B, C, E
Which information should be included in patient documentation? Select all that apply. A) The specific treatment provided to the patient B) The patient's response to the treatment C) The nurse's opinion about the patient's mood/affect after the treatment D) The time the treatment was administered E) Documentation of the previous nurse failing to administer treatment
A, B, D
Which incidents are examples of never events and subject to nonreimbursement from the Centers for Medicare and Medicaid Services? Select all that apply. A) A patient falling out of bed B) An E. coli bacterial central venous line infection C) A candida urinary tract infection D) A retained surgical object after a surgery E) A staphylococcal surgical site infection
A, B, D, E
Which statements are correct regarding state nurse practice acts? a) State nurse practice acts delineate what a nurse can and cannot do. b) Nurse practice acts identify who can use the title of RN. c) They are consistent throughout the United States. d) Nurse practice acts are revised periodically to reflect a changing society. e) They define behaviors that are considered misconduct.
A, B, D, E
How did the 2010 Patient Protection and Affordable Care Act affect the ability for individuals to receive health care? A) It required insurance coverage for all US citizens and undocumented residents. B) It stipulated that there would be no out-of-pocket expenses for preventive services. C) It allowed insurance companies to screen for preexisting conditions. D) It allowed dependents to remain on a parent's insurance until 22 years of age.
B
When a patient is refusing medical treatment, which information should be included in the documentation? Select all that apply. A) Presence of hospital chaplain B) Patient being of sound mind C) Support system present for the patient D) Risks associated with refusal of care E) Patient signature on the document with all presented information
B, C, D, E
A patient diagnosed with terminal cancer has obtained a prescription for medications that will end his life. This is an example of which type of end-of-life treatment? A) Nonvoluntary euthanasia B) Suicide C) Assisted suicide D) Voluntary euthanasia
C
The nurse is caring for a patient for whom the health care provider has prescribed an injection to treat a sexually transmitted infection. The patient has requested oral antibiotics instead of an intramuscular injection. The nurse believes that the patient is acting childishly and is threatening to give the injection without the patient's consent. This action could lead to which type of lawsuit in nursing? A) Medication error B) Negligence C) Battery D) Assault
D
What can pose a significant legal risk if institution workplace policies and nursing standards of care are not followed?
Delegation, incident reports, documentation, and informed consent
Regardless of the outcome a patient has the right to?
Refuses medical care
Failure to properly assess the patient
The night shift nurse did not take vital signs or assess the patient from 11:30 p.m. (when a chest tube was inserted) until 3:30 a.m. The patient's condition significantly worsened, and the patient coded 10 minutes later.
Failure to document
The nurse did not document a dose of medication, so when a second phone call was made to the health care provider, a second dose of medication was prescribed because no documentation was noted of the first dose. The patient subsequently coded after the overdose.
Failure to use equipment appropriately
The nurse did not follow the manufacturer's recommendation about the appropriate safe use of medical equipment
Failure to act as a patient advocate
The nurse did not question the health care provider's prescription about an inappropriate dosage of medication.
Failure to communicate patient findings in a timely manner
The nurse did not report a critical laboratory value to the health care provider in timely manner. The nurse called the health care provider but did not receive a return phone call for 75 minutes. Because of the critical laboratory value, the nurse should have continued to call the health care provider every 5 to 10 minutes or called another health care provider if there was no response.
Failure to take appropriate action
The nurse did not use portable oxygen when moving a patient or did not appropriately administer medications.
Failure to preserve patient privacy
The nurse routinely discussed patients in the parking lot, elevators, and cafeteria, including discussions with patients' previously involved health care providers and others who were not currently involved with providing care to the patient.
What is the basis behind a tort lawsuit?
The standard of care
Which ethical principal supports the patient's right to refuse treatment or medical care? a) Autonomy b) Veracity c) Fidelity d) Justice
a
In the case study of Moon v St Thomas Hospital, which actions by the nurse contributed to the nursing malpractice award? a) Failure to notify the health care provider b) Failure to request a prescription for a bite block c) Failure to document the patient biting an endotracheal tube d) Failure to reposition the tube to prevent biting e) Failure to extubate the patient
a, b, d
Which conditions must be met for informed consent to be considered valid? Select all that apply. a) Consent must be given freely. b) The duration of the treatment must be defined. c) Alternatives to treatment must be clearly stated. d) The risks and benefits of the treatment must be clearly defined. e) Patients must be able to understand to what they are consenting.
a, c, d, e
What is the nurses best defense?
accurate and timely documentation of patient care, specifically the type of care administered, the time the care was administered, the overall status of the patient's condition, and, finally, evidence that the standard of care was met.
Deviation from the standard of care increases the nurses risk for?
malpractice and criminal negligence lawsuits
Which events would require an incident report to be filed? a) A patient death after failed chemotherapy b) An incident resulting in the unexpected death of a patient c) A patient who requires reintubation after extubation d) A patient who is not treated timely with antibiotics because of failure to report a positive culture e) A malfunction of medical equipment
b, d, e
A registered nurse (RN) is precepting a newly graduated RN. Which statement by the new RN indicates understanding of the newly acquired nursing license a) My employer can levy a fine against my license if I perform a task outside my scope of practice b) The state board of nursing is solely focused on protecting me as a registered nurse c) The state board of nursing has the authority to restrict me from practicing as a nurse. d) Nurse practice acts are the same in each state, which allows me to practice in any state in the United States
c
Which statement is correct regarding delegation? a) A registered nurse (RN) or a licensed vocational nurse/licensed practical nurse (LVN/LPN) can delegate a nursing task. b) If an RN delegates a task to a certified nursing assistant (CNA), the CNA is then accountable for the delegated task. c) An RN can delegate any task to another RN or LVN/LPN regardless of his or her ability. d) When making the decision to delegate, the RN is ultimately responsible.
d
Person without decision making capacity:
include those younger than 18 years of age and those without mental competence, either resulting from illness or injury or a cognitive disability that is present at birth.
Define assisted suicide
is a medically assisted death in which a qualified health care provider supplies the patient with the means of taking his or her own life but does not perform the actual actions required to cause the death
Define Euthanasia: -active euthanasia -passive euthanasia -voluntary euthanasia -nonvoluntary euthanasia
egally competent patient making an informed and voluntary choice to have a medically assisted death. -legal injection -medical support is withdrawn -patient gives consent -patient is unable to give consent but the act is justified on moral grounds
Person with decision making capacity:
has the right to refuse treatment, even if the treatment is considered lifesaving.
Never events are: -examples (10)
hospital-acquired conditions that are subject to nonpayment since they are easily preventable 1) Retained foreign object after surgery 2) Air embolism 3) Stage III and IV pressure ulcers 4) Blood incompatibility (blood transfusion error) 5) Falls 6) Poor outcomes associated with poor glycemic control 7) Catheter-associated urinary tract infections 8) Vascular catheter infections 9) Surgical site infections 10) Deep vein thrombosis or pulmonary embolism
