Nur Ch. 23

Restraints can be used (3)

(1) only to ensure the physical safety of the patient or other patients, (2) when less restrictive interventions are not successful, and (3) only on the written order of a health care provider

A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) 1. The nurse does not need any representation. 2. The patient must prove injury, damage, or loss occurred. 3. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4. The patient must prove that a breach in the prevailing standard of care caused an injury. 5. The burden of proof is always the responsibility of the nurse.

2. The patient must prove injury, damage, or loss occurred. 3. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4. The patient must prove that a breach in the prevailing standard of care caused an injury.

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

Minors

A. Ordinarily minors may not consent to medical treatment without a parent. However, emancipated minors may consent to medical treat-ment without a parent. Emancipated minors include: 1. Minors who are designated emancipated by a court order 2. Minors who are married, divorced, or widowed 3. Minors who are in active military service B. Unemancipated minors may consent to medical treatment if they have specific medical conditions 1. Pregnancy and pregnancy-related conditions (Various states differ in characterizing a pregnant minor as either emancipated or unemancipated. Know your state rules in this matter.) 2. A minor parent for his or her custodial child 3. Sexually transmitted infection (STI) information and treatment 4. Substance abuse treatment 5. Outpatient and/or temporary sheltered mental health treatment C. The issue of emancipated or unemancipated minors does not relieve the health care provider's duty to attempt to obtain meaningful informed consent

The civil law system is concerned with the

protection of a person's private rights, and the criminal law system deals with the rights of individuals and society as defined by legislative statutes.

Petition:

Elements of the claim. The plaintiff outlines what the defendant nurse did wrong and, as a result of that alleged negligence, how the plaintiff was injured.

As a result of patients being transferred from private to public hospitals without appropriate screening and stabilization (referred to as patient dumping), Congress enacted the ___________________________________ in 1986.

Emergency Medical Treatment and Active Labor Act (EMTALA)

A woman has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 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?

More information is needed about the wife's preference and if the husband has her medical power of attorney

___________________________ describe and define the legal boundaries of nursing practice within each state. The Nurse Practice Act of each state defines the scope of nursing practice and expanded nursing roles, sets education require-ments for nurses, and distinguishes between nursing and medical practice.

Nurse Practice Acts

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?

Surgeon

Medical records:

The defendant obtains all of the plaintiff's relevant medical records for treatment before and after the event. Everything written by the nurses and the health care provider in the medical record is open to examination by both the plaintiff and the defendants

Parties' depositions:

The plaintiff and defendants (health care provider, nurse, and hospital personnel) are almost always deposed.

Experts:

The plaintiff selects experts to establish the essential legal elements of the case against the defendant. The defendant selects experts to estab-lish the appropriateness of the nursing case. Nursing experts are asked to testify to the reasonableness or inappropriate actions of the health care staff once the patient's condition began to change. The expert is asked to compare the actions of the nursing staff to the standard of care

Occurrence reporting provides a

database for further investigation in an attempt to determine deviations from standards of care, to identify corrective measures needed to prevent recurrence, and to alert risk management to a potential claim situation. Examples of an occurrence include patient or visitor falls or injury; failure to follow health care provider orders; a significant complaint by patient, family, health care provider, or other hospital department; an error in technique or procedure; and a malfunctioning device or product.

Risk manage-ment

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

One tool used in risk management is the

occurrence report or incident report.

TJC (2016) and groups such as the Institute of Medicine have a focus on __________________ as major goals.

patient safety

Never events

preventable errors, which may include falls, urinary tract infections from improper use of catheters, and pressure ulcers. The federal government and health care insurance companies have developed policies to withhold reimbursement for preventable medical errors. Know your agency policies and procedures to help develop a system and culture of patient safety.

Defamation of character

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

The Patient Protection and Affordable Care Act (PPACA or ACA, 2010), is characterized by four themes embedded in nursing practice:

(1) consumer rights and protections; (2) affordable health care cover-age; (3) increased access to care; and (4) stronger Medicare to improve care for those most vulnerable in our society.

The three principles of protocol are:

(1) preoperative verification that relevant documents and studies are available before the start of the procedure and that these documents are consistent with the patient's expectations; (2) marking the operative site with indelible ink to mark left and right distinction, multiple structures (e.g., fingers), and levels of the spine; and (3) a time-out just before starting the pro-cedure for final verification of the correct patient, procedure, site, and any implants.

PPACA is also intended to reduce overall care costs to the consumer by (3)

(1) providing tax credits; (2) increasing insurance company account-ability for premiums and rate increases; and (3) increasing the number of choices patients have to select an insurer that best meets their needs. In addition, PPACA increased access to health

organ or tissue donation (National Organ Transplant Act, 1984). Individuals are approached in the following order:

(1) spouse, (2) adult son or daugh-ter, (3) parent, (4) adult brother or sister, (5) grandparent, and (6) guardian. The person in the highest class makes the donation unless they are aware of conflicting indications by the decedent (Uniform Anatomical Gift Act, 1987). The health care provider who certifies death is not involved in the removal or transplantation of organs

A nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow? 1. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. 2. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3. The patient cannot make changes in the advance directive once admitted to the hospital. 4. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

A homeless man 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. 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) without triage completed

Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed

Other witnesses:

Factual witnesses, both neutral and biased, are deposed to obtain information about their version of the case. They may include family members on the plaintiff's side and other medical personnel (e.g., nurses) on the defendant's side.

A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nurse manager because this action is a violation of which act?

Health Insurance Portability and Accountability Act (HIPAA)

________________ law or ________________ law, reflects decisions made by administrative bodies such as State Boards of Nursing when rules and regulations are passed. An example of a regulatory law is the require-ment to report incompetent or unethical nursing conduct to the State Board of Nursing

Regulatory -- administrative

A 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. What would probably cover the nurse in this situation?

The Good Samaritan law, which grants immunity from suit if there is no gross negligence

Discovery:

The process of discovering all the facts of the case involves using interrogatories, full access to the medical records in question, and the depositions. The patient and the health care staff are asked questions by counsel for the defense. They answer under oath, and their testimony is recorded and kept for reference.

Abandonment of a patient occurs when

a nurse refuses to provide care for a patient after having established a patient-nurse relation-ship. Before having established that relationship, a nurse may refuse an assignment when (1) the nurse lacks the 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; or (6) the nurse's clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the patient

Quasi-intentional torts

acts in which intent is lacking but voli-tional action and direct causation occur such as in invasion of privacy and defamation of character.

Nurses file incident/occurrence reports for

all errors even when someone is not injured.

The Centers for Medicare and Medicaid Services (CMS) (2008), ANA (2001), and TJC (2014) set standards to reduce the use of

all types of restraints in health care settings (i.e., that all patients have the right to be free from seclusion and physical or chemi-cal restraints, except to ensure the patient's safety in emergency situa-tions). They also describe the procedures to follow to restrain a patient, including who orders the restraints, when to write the order, and how often to renew the written order.

Emergency Medical Treatment and Active Labor Act (EMTALA) provides that, when a patient comes to the emergency department or the hospital,

an appropriate medical screening occurs within the capacity of the hospital. If an emergency condition exists, staff must evaluate the patient and may not discharge or transfer him or her until the patient's condition stabilizes. Exceptions to this provision include if a patient requests trans-fer or discharge in writing after receiving information about the benefits and risks or if a health care provider certifies that the benefits of transfer outweigh the risks.

Battery

any intentional offensive touching without consent or lawful justification (Shilling, 2011). The contact can be harmful to the patient and cause an injury, or it merely can be offensive to the patient's personal dignity.

Nurses follow health care providers' orders unless they

believe the order to be in error, that it violates agency policy, or that it can harm patients.

Depending on state laws, nurses are required to report possible criminal activities such as child abuse and ______________________________.

certain communicable diseases

The Omnibus Reconciliation Act (1987) includes _____________ restraint as a form of restraint

chemical

The Americans With Disabilities Act (ADA) of 1990 and as amended in 2008 is a

civil rights statute that protects the rights of people with physical or mental disabilities.

Torts

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

Nursing practice is also regulated by

common law or judicial case law of torts.

A health care proxy or durable power of attorney for health care (DPAHC)

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. This agent makes health care treatment decisions on the basis of the patient's wishes

Standards of care

legal requirements for nursing practice that describe minimum acceptable nursing care. Standards reflect the knowledge and skill ordinarily possessed and used by nurses actively practicing in the profession

Living wills

represent written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. With this document a patient is able to declare which medical procedures he or she wants or does not want when terminally ill or in a persistent vegetative state. Living wills are often difficult to interpret and not clinically specific in unforeseen circumstances. Thus you are required to know how your state inter-prets living wills and under which circumstances a nurse implements them

The Mental Health Parity Act of 1996 (MHPA) .

required insurance companies to offer the same level of coverage for mental health care that they provide for medical and surgical care

Common law

results from judicial decisions made by courts when individual legal cases are decided. An example of a common law includes informed consent, a patient's right to refuse treatment, negligence, and malpractice

Nurses are patient advocates and ensure quality of care through

risk management and lobbying for safe nursing practice standards

felony

serious offense that results in significant harm to another person or society in general. Felony crimes carry penalties of monetary restitution, imprisonment for greater than 1 year, or death. Examples of Nurse Practice Act violations that often carry criminal penalties include misuse of a controlled substance or practicing without a license

RNs and licensed practical nurses are licensed by the ______ in which they practice; licensing is based on _____________, ____________, and ___________

state -- educational requirements, the passing of an examination, and other criteria.

The legal guidelines that nurses follow originally were derived from constitutional law, statutory law, regulatory law, and common law. Elected legislative bodies such as state legislatures and the U.S. Con-gress create _______________________ . An example of state statutes are the Nurse Practice Acts found in all 50

statutory law

The American Association of Colleges of Nursing (AACN)

supports the International Council of Nurses' mandate to ensure an individual's peaceful end of life

The National Organ Transplant Act (1984) prohibits

the purchase or sale of organs. The act provides civil and criminal immunity to the hospital and health care provider who perform in accordance with the act. The act also protects the donor's estate from liability for injury or damage that results from the use of the gift.

Staffing standards determine

the ratio of nurses to patients; if the nurse has to care for more patients than is reasonable, he or she needs to make a formal protest to the nursing administration.

The third classification of tort is the

unintentional tort, which includes negligence or malpractice

The Health Information Technology for Economic and Clinical Health Act (HITECH Act, 2009)

was passed in conjunction with HIPPA in response to new technology and social media. In particular, HITECH expands the principles extended under the HIPAA, especially when a security breach of personal health information (PHI) occurs

Libel

written defamation of character

Key elements of informed consent include the following:

(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 pro-cedure 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

The priority for giving consent of an autopsy is (4)

(1) the patient, in writing before death; (2) durable power of attorney; (3) surviving spouse; and (4) surviving child, parent, or sibling in the order named. You also notify the medical examiner if a patient's death is unforeseen and sudden and a heath care provider has not seen the patient in over 36 hours.

A nurse is liable for malpractice if the nurse (____________) owed a duty to the patient (__________), the nurse did not carry out that duty, the patient was injured, and the nurse's failure to carry out the duty caused the patient's injury.

(defendant) --- (plaintiff)

Assault

intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact. No actual contact is required for an assault to occurs

Privacy

is the right of patients to keep personal information from being disclosed.

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 affect-ing 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." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affect-ing nursing."

A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. 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 follow the six rights of medication administration 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

Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Taking or selling controlled substances 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 physician's order 5. Completing an occurrence report on the unit

1. Taking or selling controlled substances 4. Applying physical restraints without a written physician's order

A nurse is caring for a patient who recently had coronary bypass surgery and now is on the postoperative unit. Which are legal sources of standards of care that the nurse uses to deliver safe health care? (Select all that apply.) 1. Information provided by the head nurse 2. Policies and procedures of the employing hospital 3. State Nurse Practice Act 4. Regulations identified in The Joint Commission manual 5. The American Nurses Association standards of nursing practice

2. Policies and procedures of the employing hospital 3. State Nurse Practice Act 4. Regulations identified in The Joint Commission manual 5. The American Nurses Association standards of nursing practice

You are the night shift nurse caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the priority nursing action? 1. Give the family the record 2. Discuss the issues that concern the family with them 3. Call the nursing supervisor 4. Determine from the medical record if the family has been granted permission by the patient to access his or her medical information

4. Determine from the medical record if the family has been granted permission by the patient to access his or her medical information

Adults

A. Any competent individual 18 years of age or older for himself or herself B. Any parent for his or her unemancipated minor C. Any guardian for his or her ward D. Any adult for the treatment of his or her minor brother or sister (if an emergency and parents are not present) E. Any grandparent for a minor grandchild (in an emergency and if parents are not present)

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

Call the nursing supervisor to discuss the situation

Requests for productions:

Opposing parties request relevant documents, pictures, or related materials such as medical records for treatment before and after the event.

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 patients 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 of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? 1. Discussing patient conditions in the nursing report room at the change of shift 2. Allowing nursing students to review patient charts before caring for patients to whom they are assigned 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

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

Depositions:

Questions are posed to opposing parties, witnesses, and experts under oath to obtain all relevant, nonprivileged information about the case. Experts establish the elements of the case and the applicable standard of care

Witnesses' deposition:

Questions are posed to the witnesses under oath to obtain all relevant, nonprivileged information about the case.

Most states have statutes similar to the Uniform Determination of Death Act (1980). It states that

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

Answer:

The nurse admits or denies each allegation in the petition. The plaintiff must prove anything that the nurse does not admit.

Proof of Negligence

The nurse owed a duty of care to the patient. • The nurse did not carry out the duty or breached it (failed to use that degree of skill and learning ordinarily used under the same or similar circum-stances by members of the profession). • The patient was physically injured. • The patient's injury resulted in compensable damages that can be qualified as medical bills, lost wages, and pain and suffering. • The patient's injury was caused by the nurse's failure to carry out that duty

Trial:

The trial usually occurs at least 1 to 3 years after the filing of the petition.

Interrogatories:

Written questions requiring answers under oath. Typically opposing counsel requests a list of possible witnesses, insur-ance experts, and which health care providers the plaintiff saw before and after the event.

Negligence

conduct that falls below the generally accepted standard of care of a reasonably prudent person. The law establishes the standard of care to protect others against an unreasonably great risk of harm. Negligent acts such as hanging the wrong intravenous solution for a patient often result in disciplinary action by the State Board of Nursing and a lawsuit for negligence against both the nurse and his or her employer.

Under the ADA employers are required to

construe the definition of a person's disability to the maximum intent allowed under the ADA. For example, as expanded under the ADA, an employer must consider the needs of a person with diabetes mellitus as a potential disability and reasonably accommodate that person's needs. A person with a disability makes the choice whether to tell others of his or her disability. By exception, several cases have held that a health care provider must disclose if he or she has human immunodeficiency virus (HIV). Despite these rulings and as enforced by the Office of Equal Employment Opportunity, the ADA protects health care workers in the workplace with disabilities such as HIV infection. Likewise, health care workers cannot discriminate against HIV-positive patients.

Malpractice or professional liability insurance

contract between a nurse and an insurance company. This insurance provides both malpractice and professional defense coverage for individual nurses. Malpractice insurance provides for a defense when a nurse is in a lawsuit.

All patients are entitled to

confidential health care and freedom from unauthorized release of information.

Nurses who witness consents are responsible for

confirming that patients have given informed consent for any surgery or other medical procedure voluntarily before the procedure is performed.

Misdemeanor

crime that causes injury but does not inflict serious harm. For example, parking in a no-parking zone is a misdemeanor violation of traffic laws. A misdemeanor usually has a penalty of a monetary fine, forfei-ture, or brief imprisonment.

Intentional torts

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

The American Nurses Association

develops standards for nursing practice, policy statements, and similar resolutions. These standards outline the scope, function, and role of the nurse in practice.

The ADA prohibits

discrimination and ensures equal opportunities for people with dis-abilities in employment, state and local government services, public accommodations, commercial facilities, and transportation. As defined by the statute and the U.S. Supreme Court, a disability is a mental or physical condition that substantially limits a major life activity, includ-ing seeing, hearing, speaking, walking, breathing, performing manual tasks, learning, caring for oneself, and/or working.

Legal issues involving death include

documenting all events sur-rounding the death and treating a deceased person with dignity.

Under the HITECH Act nurses must

ensure that patient PHI is not inadver-tently conveyed on social media and in particular that protected data are not disclosed other than as permitted by the patient . Civil and criminal sanctions may be brought against both the nurse and the organization should either or both violate either the HIPPA or the HITECH Act.

Nurses are sometimes required to "_________" from the area in which they normally practice to other nursing units on the basis of census load and patient acuities.

float --- Nurses who float must inform the supervisor of any lack of experience in caring for the type of patients on the nursing unit. They should request and receive an orientation to the unit. Supervisors are liable if they give a staff nurse an assignment that he or she cannot handle safely. Before accepting employment, learn the policies of the agency regarding floating and understand what is expected

Under the law, practicing nurses must

follow standards of care, the guidelines of professional organizations, and the written policies and procedures of the employing agency.

The ANA (2013) believes that

nurses' participation in assisted suicide violates the code of ethics for nurses.

Slander

occurs when one speaks falsely about another.

The tort of false imprisonment

occurs with unjustified restraint of a person without a legal reason. This occurs when nurses restrain a patient in a confined area to keep the person from freedom. False imprisonment requires that the patient be aware of the confinement. An unconscious patient has not been falsely imprisoned

Malpractice

one type of negligence and often referred to as professional negligence. When nursing care falls below a standard of care, nursing malpractice results. Certain criteria are neces-sary to establish nursing malpractice: (1) the nurse (defendant) owed a duty of care to the patient (plaintiff), (2) the nurse did not carry out or breached that duty, (3) the patient was injured, and (4) the nurse's failure to carry out the duty caused the injury

Informed consent

patient's agreement to have a medical procedure after receiving full disclosure of risks, ben-efits, alternatives, and consequences of refusal. Informed consent requires a health care provider to disclose informa-tion in terms a patient is able to understand to make an informed choice. Failure to obtain consent in situations other than emergencies can result in a claim of battery.

Nurses are responsible for

performing all procedures correctly and exercising professional judgment as they carry out health care pro-viders' orders.

PPACA created a new Patient's Bill of Rights that

prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick

Criminal laws

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

Civil laws

protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur. The consequences of civil law violations are fines or specific performance of good works such as public service. Nursing negligence or malpractice is an example of a civil law violation.

The tort of invasion of privacy

protects a patient's right to be free from unwanted intrusion into his or her private affairs. HIPAA and HITECH Act privacy standards have raised awareness of the need for health care professionals to provide confi-dentiality and privacy. Typically invasion of privacy is the release of a patient's medical information to an unauthorized person such as a member of the press, the patient's employer, or the patient's family or online.

Confidentiality

protects private patient information once it is disclosed in health care settings. Patient confidentiality is a sacred trust. Nurses help organizations protect patients' rights to confidentiality.

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 chang-ing jobs by providing portability. It allows individual employees to change jobs without losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage

Patient safety and improved care are the goals of

quality improvement and risk management.

Be aware of the common negligent acts that have resulted in lawsuits against hospitals and nurses.

• Failure to assess and/or monitor, including making a nursing diagnosis • Failure to observe, assess, correctly diagnose or treat in a timely manner • Failure to use, calibrate, or replace equipment required to safely care for the patient • Failure to document care and evaluation of care provided to the patient in a timely manner • Failure to notify the health care provider of significant changes in a patient's status • Failure to respond to or correctly implement new and existing orders • Failure to follow the six rights of medication administration • Failure to convey discharge instructions to the patient, his or her family, or providers who are assuming responsibility for the patient • Failure to ensure patient safety, especially patients who have a history of falling, are sedated or confused, are frail, are mentally impaired, get up in the night, or are uncooperative • Failure to follow policies and procedures • Failure to properly delegate and supervise