Student Workbook and Resource Guide for Kozier & Erb's Fundamentals of Nursing, 10/E Chapter 04

breach of duty

a standard of care that is not observed

List four examples of external standards of care

a. Nurse practice acts b. Professional organizations c. Nursing specialty-practice organizations d. Federal organizations and federal guidelines

Explain the difference between a right and responsibility and give an example of each.

a right is a privilege or fundamental power to which an individual is entitled unless it is revoked by law or given up voluntarily. A responsibility is the obligation associated with a right. (See table 4-2 in chapter 4 of the text for examples of the responsibilities and rights associated with each role)

living will

provides specific instructions about what medical treatment the client chooses to omit or refuse in the event that the client is unable to make those decisions

liability

state of being legally responsible for one's obligations and actions, and to make financial restitution for wrongful acts

Define the terms and list any nursing responsibilities about the following legal issues surrounding death:

terms and responsibilities

euthanasia

the act of painlessly putting to death people suffering from an incurable or chronically painful disease

criminal law

the body of law that deals with disputes between an individual and the society as a whole.

public law

the body of law that deals with relationships between individuals and the government and/or governmental agencies.

contract law

the body of law that involves enforcement of agreements among individuals.

private law

the body of law that involves enforcement of agreements among individuals.

burden of proof

the duty of proving an assertion of wrong doing

interstate compact

the mechanism used to create mutual recognition among states

mandated reporters

the requirement that, by law, requires nurses to report abuse, neglect, or exploitation

false imprisonment

the unjustifiable detention of a person without legal warrant to confine the person

battery

the willful touching of a person that may or may not cause harm

injury

type of harm

Tort law is:

usually involved with nursing liability

Nurses are included as mandated reporters of violence, abuse, and/or neglect? a. True b. False

True

While reviewing the transfer papers of a client, the nurse notes that the client has both a living will and a durable power of attorney. A living will differs from a durable power of attorney in that a living will: 1. describes how the client wants his wishes carried out in the event of a terminal illness. 2. designates who should make decisions if the client is unable to make decisions. 3. determines which relative gets the house. 4. allows a health care provider to make decisions if the client is unable to make decisions.

(Answer 1) describes how the client wants his wishes carried out in the event of a terminal illness. (Rationale: A living will provides specific instructions about what medical treatment the client chooses to omit or refuse in the event that the client is unable to make those decisions. A durable power of attorney for health care is a notarized or witnessed statement that appoints someone to make health care decisions when the client is unable to do so, designates who should make medical decisions if the client is incapable of making independent decisions. Neither a living will nor a durable power of attorney describes determining real estate or health care provider's actions when the client is unable to make his or her own health care decisions. Nursing Process: Assessment Client Needs: Planning; Management of Care, Safety)

A client was discharged after having a 1-day surgery on her gallbladder. The nurse discharging the client failed to give the client oral or written discharge instructions. This failure to carry out the provision of discharge instructions could result in charges of: 1. malpractice 2. negligence 3. assault 4. battery

(Answer 1) malpractice (Rationale: Failing to provide discharge instructions is a form of malpractice. The nurse should document in the client's charge that discharge instructions were given verbally, the client expressed understanding of the discharge instructions, and/or a copy of the discharge instructions were given to the client or caregiver. Negligence is misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person. Assault can be described as an attempt or threat to touch another person unjustifiably. Assault precedes battery; it is the act that causes the person to believe a battery is about to occur. Battery is the willful touching of a person or the person's clothes or even something the person is carrying that may or may not cause harm. Nursing Process: Implementation client Need: Safe, Effective Care Environment)

A nurse documents in the client's chart that the health care provider is incompetent because the health care provider did not respond promptly to the nurses's call regarding the client. This is an example of: 1. defamation 2. slander 3. libel 4. battery 5. unprofessional conduct.

(Answer 1,3) defamation; libel (Rationale: The nurse defamed the health care provider's reputation by use of the word "incompetent" in the documentation. The nurse also committed libel because the defamation was by means of print, writing, or pictures. The nurse did not commit slander, defamation by spoken word. Unprofessional conduct includes incompetence or gross negligence, conviction for practicing without license, falsification of client records, illegally obtaining, using, or possessing controlled substances. Nursing Process: Implementation Client Need: Management of Care)

Most statutes include conscience clauses that are designed to protect hospitals and nurses in matters dealing with abortion services. These clauses allow the nurse to be protected from: 1. prejudicial statements. 2. discrimination or retaliation. 3. defamation or unjust prejudice. legal liability.

(Answer 2) discrimination or retaliation (Rationale: The conscience clauses give hospitals the right to deny admission to abortion clients and give health care personnel, including nurses, the right to refuse to participate in abortions. When these rights are exercised, the statutes also protect the agency and employee from discrimination or retaliation. Nursing Process: Implementation Client Need: Management of Care)

Which clients could make decisions regarding health care? (Select all that apply.) 1. A woman who arrives in the emergency department with an altered mental state and the aroma of ethyl alcohol 2. The parents of a 14-year old girl involved in a car collision 3. A middle-aged man who has the mental capacity of an 8-year-old 4. A 10-year old boy who arrived with friends and has a shallow laceration needing three sutures 5. A competent older adult who requires surgery on a prolapsed bladder

(Answer 2, 5) The parents of a 14-year old girl involved in a car collision; A competent older adult who requires surgery on a prolapsed bladder (Rationale: Of these options, the parents of the 14-year-old child and the competent older client would be the best persons to make health care decisions. The other responses are incorrect due to altered mental state and age of consent limitations. If the child with the laceration was hemorrhaging, implied consent would be adequate enough in order to save the child's life. Nursing Process: Assessment Client Need: Safe, Effective Care Environment)

Which statement indicates that the client understands informed consent of a surgical procedure? 1. The nurse discovers the signed informed consent form on the bedside table before the surgeon discusses the procedure with the client. 2. The client's oldest son stated that he explained the procedure to the client and the client told him that he wanted the surgery. 3. The client states that the surgeon explained the procedure to him, allowed him to ask questions, and explained the risks of not permitting the surgery. 4. The client has been declared legally incompetent; however, the client states understanding of the surgical procedure.

(Answer 3) The client states that the surgeon explained the procedure to him, allowed him to ask questions, and explained the risks of not permitting the surgery. (Rationale: In order for consent to be considered informed, the physician must describe the procedure, explain risks of the procedure, and alternative treatment options; the client must verbalize understanding of the explanation; and the informed consent form must be signed and witnessed. The client cannot sign the consent for before the procedure is explained by the surgeon , cannot have the son give express consent for surgery if the client is competent to give consent for himself, and consent would need to be obtained if the client has been declared incompetent. Nursing Process: Assessment Client Needs: Safe, Effective Care Environment.)

Conviction for practicing nursing without a license, incompetence or gross negligence, falsification of client records, and illegally obtaining, using, or possessing controlled substances is called: 1. libel 2. slander 3. unprofessional conduct 4. assualt

(Answer 3) unprofessional conduct (Rationale: Unprofessional conduct is defined by the Code of Ethics for Nurses. Unethical conduct may also be addressed in nurse practice acts. It includes violation of professional ethical codes, breach of confidentiality, fraud or refusing to care for clients of specific socioeconomic or cultural origins. Nursing Process: Assessment Client Needs: Safety, Safe Effective Care Environment)

A nurse threatens to give a loud, disruptive client an injection that will "knock the client out." The nurse follows through on the treat and gives the injection without the client's consent. What has the nurse committed? 1. Threat, assault 2. Battery, invasion of privacy 3. Assault, invasion of privacy 4. Assault, battery

(Answer 4) Assault, battery (Rationale: Assault is the attempt or threat to touch another person unjustifiably, It often precedes battery. Battery is the willful touching of a person that may or may not cause harm. Nursing Process: Assessment Client Needs: Planning, Management of Care; Safety)

Identify the element that is NOT one of the functions of the law in the nursing environment. 1. Accountability helps to maintain a minimum standard of nursing practice. 2. Law differentiates nurses' responsibilities from those of other health care professionals. 3. Law specifies which nursing actions are legal in caring for clients. 4. Law specifies which hospital policies are legal in caring for clients.

(Answer 4) Law specifies which hospital policies are legal in caring for clients. (Rationale: Hospital policies are not included in the laws of nursing. the other three items are functions of nursing laws. Nursing Process: Assessment Client Need: Management of Care)

Why is it important for nurses to know the basics of legal concepts?

It is important because nurses are accountable for their professional judgments and actions.

Review Questions

Legal and Ethical concepts and rational

Organize the five steps in the civil judicial process according to the procedural rules. (a. A document, called a complain is filed by an individual referred to as the plaintiff, who claims that his or her legal rights have been infringed on by one or more other individuals or entities referred to as defendants. b. In the trial of the case, all the relevant facts are presented to a jury or only to a judge. c. The judge renders a decision, or the jury renders a verdict. If the outcome is not acceptable to one of the parties, an appeal can be made for another trial. d. Both parties engage in pretrial activities, referred to as discovery, in an effort to obtain all the facts of the situation. e. A written response , called an answer, is made by the defendants. )

1. A document, called a complaint, is filed by an individual referred to as a the plaintiff, who claims that his or her legal rights have been infringed on by one or more other individuals or entities referred to as defendants. 2. A written response, called an answer, is made by the defendants. 3. Both parties engage in pretrial activities, referred to as discovery, in an effort to obtain all the facts of the situation. 4. In the trial of the case, all the relevant facts are presented to a jury or only to a judge. 5. The judge renders a decision, or the jury renders a verdict. If the outcome is not acceptable to one of the parties, an appeal can be made for another trial.

A client is scheduled for the surgical removal of the left ovary. During the surgery, the surgeon noticed that the appendix of the client was inflamed. He decides to remove it to prevent further problems. The client's consent for surgery only listed removal of the left ovary. 1. Did the surgeon adhere to the signed consent form that the client signed before the surgery? 2. Under the circumstances, what type of tort is the surgeon liable for? 3. What was the operating nurse's role in the this incident?

1. No, the surgeon did not adhere to the signed consent form because the appendix was not listed in the original signed consent form because the appendix was not listed in the original signed consent. 2. Battery is the type of tort because the surgeon has intentionally and wrongfully performed an act without the client's permission. 3. The operating nurse should have questioned the removal of the appendix since it is assumed that she reviewed the informed consent and is considered the patients advocate.

Inquests

Legal inquiries into the cause or manner of a death. An inquest is usually performed when the death is a result of an accident to determine any blame. Agency policy dictates who is responsible for reporting deaths to the coroner or medical examiner.

Describe the difference between an expressed contract and an implied contract. Given an example of each type.

A contract is considered to be expressed when the two parties discuss and agree, either orally or in writing, to terms and conditions during the creation of the contract. One example of an expressed contract is when a travel nurse works at a hospital for a stated length of time and under stated conditions. An implied contract is one that has not been explicitly agreed to by the parties, but that the law nevertheless considers existing. An example of an implied contract is when the hospital is expected to provide the necessary supplies and equipment needed to provide competent nursing care.

What is accountability, and what are two reasons it is needed in nursing?

Accountability is the ability and willingness to assume responsibility for one's actions and to accept the consequences of one's behavior. (Two examples: a. to ensure that the nurse's decisions and actions are consistent with current legal principles. b. To protect the nurse from liability. )

Advance directives

Allow individuals to specify aspects of care that he or she wishes to receive should that individual become unable to make or communicate his or her own preferences. Nurses need to assess whether clients and families have an accurate understanding of advance directives and give instructions as necessary. Also, nurses must know the laws in his or her practicing state regarding patient self-determination.

Which nurse would be considered to be the "best expert witness" for the defense in a case regarding an obstetric patient who died after delivery complications? 1. A nurse who holds a bachelor's degree in nursing and has been practicing for two years. 2. A nurse who holds a master's degree in nursing and has a certification in emergency nursing. 3. A nurse who holds a doctorate of nursing science in pediatric care. 4. A nurse who holds a master's degree in nursing and a state certification in maternal-infant nursing.

Answer 4: A nurse who holds a master's degree in nursing and a state certification in maternal-infant nursing. (Rationale: The nurse with a master's degree and a certificate in maternal-infant nursing is deemed an expert in that field because of the advanced preparation. The other chices do not address the needed expertise. Nursing Process: Assessment Client Needs: Safe, Effective Care Environment)

Autopsies

Are also called postmortem examinations. An autopsy is an examination of the body after death and is only performed in certain cases. It examines the organs and tissues to establish the exact cause of death. The nurse must understand the process to answer family's questions and to obtain a signed consent when the autopsy is performed voluntarily.

Organ donation

The donation of organs that an individual 18 years or older and of sound mind can endorse. Individuals can make a gift of any organs or his or her body for the following purposes medical or dental education and research, the advancement of medical or dental science, therapy, and/or transplantation. Nurses may serve as witnesses for individuals consenting to donate organs.

Certification of death

The formal determination of death or pronouncement that must be performed by a physician, a coroner, or a nurse. The granting of the authority of nurses to pronounce death is regulated by the state or province. It is necessary by law to complete this form.

right

a privilege or fundamental power to which an individual is entitled unless revoked by law or given up voluntarily

State laws regulate the distribution and use of controlled substances such as narcotics, depressants, stimulants, and hallucinogens. a. True b. False

False: federal laws regulate controlled substances

What is the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and why is it important? What are the four specific areas of HIPAA? (Refer to the HIPAA website found on the Companion Website)

HIPAA is the first nationwide legislation to protect the privacy of health information. The four specific areas of HIPAA include: a. The electronic transfer of information among organizations b. Standardized numbers for identifying providers, employers, and health plans c. Security rules providing for a uniform level of protection of all health care information. d. Privacy rules that set standards defining appropriate disclosure to protect health information.

What are four categories that nurses must question to protect themselves legally when carrying out health care provider's orders?

Nurses should question any order a client questions; any order if the client's condition has changed; any verbal orders to avoid miscommunication; and any orders that are illegible, unclear, or incomplete.

Case Study Scenario Q & A

Oophorectomy

Define standards of care and list the two classifications.

Standards of care are the skills and learning commonly possessed by members of a profession. The purpose is to protect the consumer. The two standards of care include: a. Internal standards b. External standards

_______is cited as one of the main reasons for chemical dependence in health care workers.

Stress

How is the nurse involved in the Americans with Disabilities Act? Explain your answer

The Americans with Disabilities Act prohibits discrimination on the basis of disability in employment, public services, and public accommodations. The nurse assists individuals with disabilities to comprehend the opportunities provided by law. Also, the nurse needs to be familiar with this law because nurses with disabilities may be refused employment opportunities inappropriately, and the nurse manger must know the laws in order to avoid discrimination of others.

Euthanasia

The act of painlessly putting to death persons suffering from incurable or chronically painful disease. (It is illegal in both Canada and the majority of the United States to perform any type of euthanasia. Some states have laws that allow clients to end their lives through voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. Some states have right to die statutes and honor living wills. These states legally recognize the right-to-die statutes as the client's right to refuse treatment. Nurses must know their state's policies and Nurse Practice Act in order to make an decisions regarding this matter.)

If a client refuses to sign the consent form, what actions does the nurse need to take?

The nurse must verify that the client is aware of the pros and cons of refusal and is making an informed decision. Documentation is essential and must include notification of the health care provider, the concerns of the client, the understanding of refusal of the client, and any witnesses to the refusal.

What are the two reasons for nurses to be knowledgeable regarding the Nurse Practice Act in their state of practice?

The nurse needs to know the state Nurse Practice Act because it will assist the nurse in delegation of duties among the various personnel, and also in the recognition of what is involved in the scope of nursing practice. Nurses are accountable and will be held responsible for following the Nurse Practice act in his or her practicing state.

Do not resuscitate orders (DNR's)

These are generally written by the provider when the client or proxy has expressed the wish for no resuscitation in the event of respiratory or cardiac arrest. It is written to indicate that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are not indicated. The nurse can request a change in assignment if a DNR is contrary to the nurse's personal beliefs. The responsibility of the nurse is to make sure that the health care team is aware of any DNR orders.

A written contract cannot be changed legally by an oral agreement a. True b. False

True

Each state has an obligation to define its scope of nursing practice and licensing requirements. a. True b. False

True

Regulation of nursing is a function of state law. a. True; b. False

True

The Constitution of the United States is the supreme law of the state. a. True ; b. False

True

What are the two types of informed consent?

a. Expressed consent (may take the form of either an oral or written agreement. Usually, the more invasive a procedure or the greater the potential for risk to the client, the greater the need for written permission.) b. Implied consent (is when the client's behavior indicates agreement or when a medical emergency occurs and the client cannot express consent.)

What three things does the nurse's signature confirm with the signed consent form?

a. The client has no further questions about the procedure and is ready to give consent. b. The individual signing the consent is the appropriate individual (either the client or the individual with legal responsibility for the client, such as a parent).

Name two functions of laws in nursing.

a. They provide a framework for establishing the nursing actions while caring for clients. b. They differentiate the nurse's responsibility from those of other members of the health care team. c. They help establish the boundaries of independent nursing action. d. They help to maintain a standard of nursing practice by making nurses accountable under the law.

What is the legal purpose for defining the scope of nursing, licensing requirements, and standards of care? (Select all that apply) a. for the protection of the nurse b. For the protection of the client c. For the protection of the public d. To maintain client confidentiality e. Fort the protection of the physician

a. for the protection of the nurse b. For the protection of the client c. For the protection of the public d. To maintain client confidentiality

List two types of laws and give the definition of each type.

a. public law b. criminal law c. private law d. contract law e. tort law

contract

agreement between competent persons, on sufficient consideration to do or not do a legal act

informed consent

agreement by a client to accept a course of treatment after being provided complete information

assault

an attempt or threat to touch a person unjustifiably

plaintiff

person who claims that his or her rights have been infringed on by one or more persons

Choose the correct definition of criminal action, the correct example of criminal action, and the potential results if a person is found guilty in a criminal trial. (Select all that apply) a. Deals with the relationship among individuals in society. b. Deals with disputes between an individual and the society as a whole. c. If found guilty, the defendant may have to pay a sum of money. d. If found guilty, the defendant may lose money, be jailed, be executed, and/or lose any professional licenses. e. One example of this type of legal action is a malpractice suit. f. One example of this type of legal infraction is a nurse who deliberately delivers a lethal dose of medication to a client.

b. Deals with disputes between an individual and the society as a whole. d. If found guilty, the defendant may lose money, be jailed, be executed, and/or lose any professional licenses. f. One example of this type of legal infraction is a nurse who deliberately delivers a lethal dose of medication to a client.

It is the nurse's responsibility to have the informed consent form signed prior to an invasive procedure. a. True b. False

b. False (it is the responsibility of the health care provider who is performing the procedure.)

Choose the types of invasion from which the client must be protected. (Select all that apply) a. Reporting the number of births that occurred in the hospital for statistical analysis b. Reporting of infections and communicable diseases c. Taking photographs or having nursing students observe the client's care without the client's consent d. Revealing the name of a client who was treated for domestic violence e. Reporting violent incidents to the local authorities

c. Taking photographs or having nursing students observe the client's care without the client's consent. d. Revealing the name of a client who was treated for domestic violence.

defamation

communication that is false, results in injury to the reputation of a person

civil law

deals with relationships among individuals

libel

defamation by means of print, writing, or pictures

tort law (defined)

defines and enforces duties and rights among individuals that are not based on contract law.

tort law

defines and enforces duties and rights among private individuals that are not based on contractual agreements

complaint

document filed by a person claiming that legal rights have been infringed upon

autopsy

examination of a body after death

causation

harm that occurred as a direct result of failure to follow standards of care

unprofessional conduct

includes incompetence or gross negligence, conviction for practicing without a license, falsification of client records, illegally obtaining, using, or possessing controlled substances

A strike

is an organized work stoppage by a group of employees to express grievance, enforce a demand for changes in conditions of employment, or solve a dispute with management. Usually, it is a result of failed collective bargaining between parties.

Certification

is the voluntary practice of validating that an individual nurse has met minimum standards of nursing competence in specialty areas such as maternal- child health, pediatrics, mental health, gerontology, and school nursing.

common law

laws evolving from court decisions

respondeat superior

legal relationship by which the employer assumes resonsibility for the conduct of the employee

The action f a lawsuit is called:

litigation

The name of newly developed regulatory model is the _______ model. It allows for multi-state licensure for nurses. Nurses can practice in states bordering their own state if both states have an ______ compact.

mutual recognition; interstate