Unit 2: Issues in Nursing Chapter 7: Ethical and Legal Issues

Values

- Beliefs and attitudes that may influence behavior and the process of decision making

Disciplinary action ( Ky luat)

- Boards of nursing may deny, revoke (huy), or suspend any license to practice as a register nurse according to their statutory authority. - Causes for disciplinary action: 1. Unprofessional conduct. 2. Conduct that could affect the health and welfare of the public adversely. 3. Breach of client confidentiality 4. Failure to use sufficient knowledge, skills, or nursing judgment. 5. Physically or verbally abusing of client. 6. Assuming duties without sufficient preparation 7. Knowingly delegating to unlicensed personnel nursing care that places the client at risk for injury. 8. Failure to maintain an accurate record for each client. 9. Falsifying a client's record. 10. Leaving a nursing assignment without properly notifying appropriate personnel.

Safeguarding valuables ( tài sản của bệnh nhân)

- Clients' valuable should be given to a family member or secured for safekeeping in stored and locked designation locations. Location of the client's valuables should be documented per agency only. - Many health care agency requires client to sign a release to free the agency of the responsibility for lost values. - Client's wedding band can be taped in place unless a risk exists for swelling of the hands or fingers. - religious items such as medals or scapulars may be pinned to the client's gown if allowed by agency policy.

Do not resuscitate ( DNR) orders

- DNR is an order writen by a physician when a client has indicated a desire to be allowed to die if the client suffers cardiac or respiratory arrest. - Client or his legal representative must provide inform consent for the DNR status. - The DNR order must be defined clearly so that other treatment , not refused by the client , will be continued. - DNR order must be reviewed regularly according to agency policy. - All health care personnel must know whether a client has a DNR order - If client does not have a DNR order, health care personnel need to make every effort to revive the client. - DRN protocols may vary state to state, and it is important for the nurse to know his state's protocols.

The nurse's role

- Discussing advance directives with the client opens the communication channel to establish what is important to the client and what the client may view as promoting life versus prolonging dying. - The nurse needs to ensure that the client has been provided with info about the right to identify written directions about the care that the client wishes to receive. - On admission to a health care facility, the nurse determines whether an advance directive exists and ensures that it is art of the medical record. - All health care workers need to follow the directions of and advance directive to be safe from liability. - Some agencies have specific policies that prohibit a nurse from signing as a witness to a legal document, such as living will. - If allowed by the agent, when a nurse acts as a witness to a legal document, the nurse must document the event and the factual circumstances surrounding the signing in the medical record; documentation as a witness should include who was present, any significant comments by the client, and the nurse's observations of the client's conduct during this process.

Documentation

- Documentation is legally required by accrediting agencies, state licensing laws, and state nurse and medical practice act. - Nurse should follow agency guidelines and procedures.

What is HIPPA

- Health Insurance Portability and Accountability Act - It describes how personal health information (PHI) may be used to and how client can obtain access to the information.

Under the HIPPA, client's right includes

- Inspect a copy of PHI - If PHI is incorrect, ask the health care agency to amend - Request a list of disclosures made ( tiết lộ) regarding the PHI as specified by HIPPA. - Request to restrict how the health care agency uses or discloses PHI regarding treatment, payment, or service unless the information is needed to provide emergency treatment. - Request how and where health care agency can communicates with the client. - Request a paper copy of the HIPPA notice

Ethical dilemma

- Is a conflict occurs between two or more ethical principals. - No correct decision exists, and nurses must make a choice between two alternatives that are equally unsatisfactory - May occur as a result of differences in cultural or religious beliefs.

Collective bargaining

- Is a formalized decision-making process between representatives of management and representatives of labor to negotiate wages and conditions of employment. - Strike: is what employees are called when collective bargaining breaks down. - Striking represents moral dilemma to many nurses - The United American Nurses ( UAN), is an affiliate of the American Federation of Labor and Congress of Industrial Organizations ( AFL- CIO) and the American Nurse Association (ANA). It sets standard for RNs in organizing, collective bargaining, and contracts.

Floating

- Is an acceptable, legal practice used by health care facilities to alleviate understaffing and overstaffing. -Legally, a nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove lack of knowledge for the performance of assigned tasks. - Nurses in a floating situation must not assume responsibility beyond their level of experience or qualification. -Nurses who float should inform the supervisor of any lack of experience in caring for the type of clients of the new nursing unit. - The nurse should request and be given orientation to the new unit.

Malpractice

- Is negligence on the part of a nurse. - Malpractice is determined if the nurse owed a duty to the client and did not carry out the duty and the client was injured because the nurse failed to perform the duty.

Two basic types of advance directives

- Living will: list the medical treatment that a client chooses to omit or refuse if the client become unable to make decisions and is terminally ill. - Durable powers of attorney: appoints a person ( health care proxy) chosen by the client to make healthcare decision on the client's behalf when the client can no longer make decision.

Reporting responsibilities

- Nurses are required to report certain communicable diseases or criminal activities such as child or elder abuse or domestic violence, dog bite, gunshot, or stab wound, assault, and homicides, and suicides to the appropriate authorities.

Controlled substances:

- Nurses should adhere to facility policies and procedures concerning administration of controlled substances, which are governed by federal and state laws. Controlled substances must be kept ked securely and only authorized personnel should have access to them.

OSHA ( Occupational Safety and Health Act)

- OSHA requires that an employer provide a safe workplace for employees according to regulations. - Employee can confidentially report working condition that violates regulations, and he or she cannot be retaliated against by the employer.

assault ( hanh hung)

- Occurs when a person puts another person in fear of a harmful or offensive contact. - The victim fears and believes that harm will result because of the threat.

PHI

- Personal Health Information - includes individually identifiable information that relates to the client's past, present, or future health, treatment, payment for health care services. - HIPPA requires health care agencies to keep PHI private, provides information to the client about the legal responsibilities regarding privacy, and explain the client's rights with respect to PHI. - Client may file a complaint if client believes that privacy rights have been violated.

Nurse's responsibilities

- Protect client's confidentiality and from discriminate disclosure of health infor that may causes harms. - Liability for invasion of the client's privacy. - Not discussing client issues with other clients or staff uninvolved in the client's care. - Not sharing health care info with others without client's consent. - Discussing client info in a private and scheduling areas - Protecting medical record from all unauthorized readers.

Client and family teaching

- Provide complete instructions in a language that the client or family can understand - Document client and family teaching, what was taught, evaluation of understanding, and who was present during the teaching. - Inform the client of what could happen if information shared during teaching is not followed.

Physician's prescriptions

- The nurse is obligated to carry out a physician's prescription / ( orders) except when he nurse believes a prescription to be inappropriate or inaccurate. - A nurse carrying out an inaccurate prescription may be illegally responsible for any harm suffered by the client. - The nurse should clarify with the physician with unclear or inappropriate prescription. - If no resolution occurs regarding the prescription in question, the nurse should contact the nurse manager or supervisor. - The nurse should follow specific guidelines for telephone prescriptions. - The nurse should ensures that all components of a medication prescription are documented.

Minors consent

- Under 18 years old. - may not given legal consent and it should be given to parent or legal guardian - Except for the following cases: in an emergency, in situation in which the consent of the minor is insufficient, including treatment related to substance abuse, treatment of sexually transmitted infection, HIV and AIDS, birth control service, pregnancy, or psychiatric services.

organ donation and transplantation

- a client has the right to become an organ donor and a right to refuse organ transplant as a treatment option.

Nurse practice act

- a series of statutes that have been enacted by each state legislature to regulate the practice of nursing in that state. - It sets educational requirements for the nurse, distinguish between nursing practice and medical practice, and define the scopes of nursing practice. - Other issues covered by nurse practice act: licensure requirements for protection of the public, grounds for disciplinary action, rights of the nurse licensee if a disciplinary action is taken. - All nurses are responsible for knowing the provisions of the act of the state.

Medical records

- are confidential - only staff members directly involve in care have legitimate access to client's record - The medical record is sent to the records or the health information department after discharge of the client from the health care facility - The use of password or ID code is needed to enter and sign off a computer system. - Any info provided by the client when conducting a research is needed not to be reported in any manner that identify the client and not to be made accessible to anyone outside the research team.

consents/ releases

- are legal documents that indicate the client's permission to perform surgery, perform treatment or procedure, or give information to a third party. - patients must be informed in understandable terms, of the risks and benefits of the surgery or treatments. - Client's questions about the surgery or procedure must be answered before signing the consent. - client with sedating medications or has cognitive impairment should not be asked to sign a consent. - A consent must be signed freely by the client without threat or pressure and must be witnessed by an adult. - In most states, when a nurse is involved in the informed consent process, the nurse is witnessing only the signature of the client on the inform consent form.

over 18 years old adult donors

- can indicates it on DL or in an advance directive. - The Uniform Anatomical Gift Act provides a list of individuals who can provide informed consent for the donation of a deceased in individual's organs. - Some organs, such as the heart, lungs, and lier, can be obtained only from a person who is on mechanically ventilation and has suffered brain death, whereas other organs or tissues can be removed several hours after death. - Donor must be free of infectious disease and cancer. - Requests to the deceased family for organ donation usually are done by the physician or nurse specially trained for making such requests. - Donation of organs does not delay funeral arrangements, no obvious evidence that the organs were removed from the body shows when the body is dressed, and no cost for removal of the organ donated.

confidentiality

- client's right to the protection of privacy PHI - A special relationships exist between the client and nurse, in which the information discussed is not shared with a third party who is not directly involved in the client's care.

Standards of care

- guidelines that identify what the client can expect to receive in terms of nursing care. - The guidelines determine whether nurses have perform duties in an appropriate manner. - If nurse does not perform duties within accepted standards of care, the nurse places himself in jeopardy of legal action. - If a nurse is named as an defendant in a malpractice lawsuit and proceedings show that the nurse followed neither the accepted standards of care outlined by the state or province nurse practice act nor the policies of the employing institution, the nurse's legal liability is clear; he or she is liable.

impaired nurse

- if a nurse suspects that a co-worker is abusing chemicals and potentially jeopardizing a client's safety, the nurse must report the individual to the nursing administration in a confidential manner. ( client safety is always the first priority) - Nursing administration notifies the board of nursing regarding the nurse's behavior.

Patient Self- Determination Act

- is a law that indicates clients must be provided info abt their rights to identify written directions about the care that they wish to receive in the event that they become incapacitated to make health care decision. - On admission to a health care facility, the client is asked about the existence of an advance directive, and if one exists, it must be documented and included as part of the medical record. if the client signs an advance directive at the time of admission, it must be documented in the client's medical record.

An advocated

- is a person who speaks up for or acts on the behalf of the clients, protects that client's right to make his or her own decisions, and upholds the principle of fidelity. - advocate represents the client's viewpoints to others - support client's decision, avoid letting personal values influence advocacy for the client

Incident reports ( bệnh nhân té hay có rắc rối)

- is used as a means of identifying risk situations and improving client care. - following specific documentation guidelines. - fill out the report completely, accurately, and factually. - the report form should not be copied or placed in the client record. - Make no reference to the incident report form in the client's record. - The report is not a substitute ( thay the) for a complete entry in the client's record regarding the incident. - If a client injury or error in care occurred, assess the client frequently

Good Samaritan laws

- may vary from state to state - These laws encourage health care professionals to assist in emergency situations and limit liability and offer legal immunity for persons helping in an emergency, provided that they give reasonable care. - Immunity from suit applies only when all conditions of the state law are met, such as the health care provided and the care given is not intentionally negligent.

Value clarification

- process of analyzing one's own value to understand oneself more completely regarding what is truly important.

Health care agency use and disclosure of PHI for what purpose?

- providing or administering health insurance benefits. - Health care payment purposes. - Health care operation purposes. - Treatment purposes. - Providing information about health care services. - Data aggregation purposes to make health care benefits decisions.- - Administering health care benefits

Negligence

-Is conduct that falls below the standard of care. - Can include acts of commission and acts of omission ( chenh mang). - Nurse who does not meet appropriate standards of care may be held liable.

emancipated minor

-is someone who has established independence from his or her parents through marriage, pregnancy, service in the armed forces, or by a court order. - emancipated minor is consider legally capable of signing an informed consent.

Advance Directives issues

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Hospital staffing

1. Charges of abandonment maybe made against nurses who "walk out" when staffing is inadequate. 2. Nurses in short staffing situations are obligated to make a report to the nursing administration.

False imprisonment

1. Occurs when a client is not allowed to leave a health care facility when there is no legal justification to detain the client. 2. Occurs when restraining (reventive) devices are used without an appropriate clinical need. 3. A client can sign an Against Medical Advice form when the client refuses are and is competent to make decision. 4. The nurse should document circumstances in the medical record to avoid allegations (ly le) by the client that cannot be defended.

Ethical codes

1. Provide broad principles for determining and evaluating client care. 2. These codes are not legally biding, but the board of nursing has authority in most states to reprimand nurses for unprofessional conduct that results from violation of the ethical codes. 3. + Code for Nurses developed by the International Council of Nurses + American Nurses Association Code of Ethics.

Employee guideline

1. Respondent superior: the employer is liable for any negligent acts of an employee if the alleged negligent act occurred during the employment relationship and was within the scope of the employee's responsibility. 2. Contracts: Nurses are responsible for carrying out the terms of a contractual agreement with the employing agency and the client. The nurse-employee relationship is govern by established employee handbooks and client care policies and procedures. 3. Institutional policies: Written policies showing detail how nurses are to perform their duties. Policies and procedures are usually specific and describe the expected behaviors on the part of the nurse. These policies are not laws, but courts generally ruled against nurses who violate policies. The nurses minimize the potential for liability if the nurses practice nursing according to these polices.

Civil law

Concerned with relationships among persons and the protection of a person's rights. Violation may cause harm to an individual or property, but no grave threat to society exists.

Criminal law

Concerned with relationships between individuals and governments and with acts that threaten society and its order; a crime is an offense against society that violates a law and is defined as a misdemeanor ( less serious nature) or felony ( serious nature).

Types of laws ( legal liability)

Contract law, civil law, criminal law, tort law.

Contract law

Is concerned with enforcement of agreements among private individuals.

Professional liability insurance

Nurses need their own liability insurance for protection against malpractice lawsuits. Having their own insurance provides nurses protection as individuals; this allows a nurse to have an attorney present who has only the nurse's interests in mind.

Sexual harassment

Sexual harassment is prohibited by state and federal law. Sexual harassment includes unwelcome conduct of sexual nature. follow agency policies and procedure to handle reporting a concern or complaint

Ethics

The distinction between right and wrong based on a body of knowledge, not on opinions only.

Can a consent form be waived (tu choi) for urgent medical or surgical intervention as long as institutional policy so indicate?

Yes it can. Also, the client has the right to refuse information and waive the informed consent and undergo treatment, but this decision must be documented in the medical record. Client may withdraw consent at any time.

Proof of liability

a. Duty: at the time of injury, a duty existed between the plaintiff ( duong don) and the defendant. b. Breach of duty: The defendant breached (vi pham) duty of care to the plaintiff. c. Proximate cause: The breach of the duty was the legal cause of injury to the client. d. Damage or injury: the plaintiff experienced injury or damages or both can be compensated by law.

Battery ( bao hanh)

an intentional touching of another's body without the other's consent.

Morality

behavior in accordance with customs or tradition, usually reflecting personal or religious beliefs

ethical principles

codes that direct or govern nursing actions

Ethics committees

develop and establish policies and procedures to facilitate the prevention and resolution of dilemma.

Tort law

is a civil wrong, other than a breach ( failure) in contract, in which the law allows an injured person to seek damages from a person who cause the injury.

Defamation ( loi phi bang)

is a false document circumstances in the medical record that causes damage to someone's reputation, either in writing (libel) or verbally (slander)

Risk management

is a planned method to identify, analyze, and evaluate risks, followed by a plan for reducing the frequency of accidents and injuries. Programs are based on a systematic reporting system for incidents or unusual occurrences

informed consent

is the client's approval/ client's legal representative to has his or her body touched by a specific individual.

Client's rights

protect the client's ability to determine the level and type of care received; all health care agencies are required to have a Client's Bill of Rights posted in a visible area.

Rights for the mentally ill

psychiatric facilities are required to have a client's bill of rights posted in visible area.

Patient's Bill of Rights

reflects acknowledgment of a client's right to participate in her health care with an emphasis on client autonomy ( quyen tu tri)

fraud

results from a deliberate deception intended to produce unlawful gains.

Ethical reasoning

the process of thinking through what one should do in an orderly and systematic manner to provide justification for actions based on principles.

invasion of privacy

violating confidentiality, intruding (xam nhap) on private client or family matters, and sharing client information with unauthorized persons.