Legal, Ethical, and Professional Accountability – Flashcards

The nursing profession is accountable for establishing and maintaining standards that promote safe, effective care. The professional nurse is accountable in several domains: -Professional -Legal -Ethical

-Nursing Practice Act: states legal scope of practice and standards of care (state specific) -Nursing Scope and Standards of Practice/Standards of Professional Performance (ANA 2010): guidelines for nursing care -Code of Ethics (ANA 2015): just revised, provides ethical foundation for practice -Nurses obtain the right to practice and then must maintain the right to practice

-Organizational regulation --Accreditation bodies (JACHO) --Center for Disease Control and Prevention (CDC) --Employer Policies and procedures (make sure to pull policies for things) -Federal legislation: ADA, EMTALA, Mental Health parity Act, HIPPA, PSDA, Uniform Anatomical Gift Act -Other state legislation: Good Samaritan Act, Uniform Determination of Death Act, Public Health laws, Criminal laws

Most important law affecting nursing practice Nurse practice acts are statues created by the legislature of each state to ensure public safety. Rules and regulations are then created by SBON to regulate nursing practice The nurse practice act defines: -scope of nursing practice and the standard of care -educational requirements/criteria -professional governance and make up of SBON -licensure requirements -tasks that can be delegated to assistive personnel

-Oversees adherence to the nurse practice act -Approve educational programs that prepare individuals for licensure -Grants licensure, renew licensure -Establishes legal standards of practice -Disciplines licensure -Administrates law: create rules and regulations which impose regulatory law on nursing practice -Continuing education record

Standards of Care: -assessment -diagnosis -outcome identification -planning -implementation -evaluation -Coordination of care -Health teaching and promotion -Prescriptive authority/treatment

-Quality of practice -Education -Professional practice evaluation *Environmental health *Communication -Ethics -Resources -Leadership *Evidenced based practice -Collaboration *indicates new

-Tort: is a civil wrong committed by one person against another person or that person's property. Tort actions compensate for damages -Intentional Tort: willful acts that violate another's rights (assault, battery, false imprisonment) -Quasi Intentional Tort: intent is lacking but volitional and direct causation occur: invasion of privacy, defamation of character -Unintentional Tort: intent is lacking: negligence, malpractice -Patient consent -Treats count

-Negligence is conduct that falls below a standard of care are established to product others from harm -Nursing malpractice: is professional negligence where nursing care has fallen below the standard of care -To establish nursing malpractice there are 4 criteria: --the nurse owed a duty to the client --the duty was breached --the client was injured --the nurses breach caused the injury -Malpractice errors can be errors of commission or omission -The standard of care is derived from nurse practice act, hospital policy/procedure and other professional and legal regulations of nursing practice

Relationship between the plaintiff and the defendant Hospital staff nurses are responsible for: -accurate assessment of patients assigned to their care -alerting responsible healthcare professionals to changes in a patient's condition -competent execution of safety measures for patients

Failure to conform to standard of care -failure to note & report that an elderly patient assessed as alert on admission is exhibiting periods of confusion -failure to execute & document use of appropriate safety measures: side rails, assist with ambulation -failure to follow hospital policy -failure to notify providers of problems -failure to utilize 6 rights of med administration -failure to follow MD orders

Results in harm to client -failure to assist patient out of bed, patient falls & fractures hip -failure to perform 6 rights of med admin: client receives wrong med dosage -failure to perform discharge education, client develops complications at home -failure to monitor delegated duties, abnormal vital signs are overlooked

Proof of harm required. Liability denotes legal responsibility to pay damages -pain & suffering -lengthened hospital stay -disability -need for rehabilitation -death

-Failure to ensure patient safety -Improper treatment or performance of treatment -Failure to monitor and report -Medication errors -Failure to follow agency procedures -Documentation

-A criminal offense is an act against society which generally violates a statutory law (felony or misdemeanor -Misuse of a controlled substance is an example of criminal conduct that a nurse could be involved in

-Negligence: substandard care -Incompetence: unqualified -Physical/mental impairment -Violation of Patient Bill of Rights -Abusive behavior -Drug/alcohol abuse -Fraud -Criminal behavior

Informed consent: the legal right of clients to receive adequate and accurate information about a medical conduction and treatment. Written document followed by and oral description -physician responsibility -nurses responsibility is to protect the client and to ensure that the client is informed -the nurses signature witnessing the consent means that the client voluntarily gave consent, the clients signature is authentic and the client appears to be competent to give consent

-The client's current medical status and the general course of the illness -The proposed treatment, surgery, and its rationale -Risk and benefits to the proposed treatment -Risk of not consenting to the treatment -The providers must describe facts in terms the client is able to understand -The client must understand and sign to indicate consent

-General consent upon hospital admission -Consent is implied in a medical emergency -Patient may refuse treatment, however the principle of informed consents still applies, tell patient risks associated with refusal -AMA: nurses responsibility is patient education and advocacy --documentation, disclosure, comprehension, competency

-Considerate and respectful care -Complete information -Informed consent -Access to treatment -Confidentiality -Continuity of care -Information regarding financial liabilities

-Abandonment & Assignment -Risk Management --incident/occurrence reports

-Ethics: attempts to determine what constitutes good, bad, right, and wrong in human behavior -Morals: standards of conduct that represent the ideal in human behavior -Values: ideals, beliefs, and patterns of behavior that are prized and choosen

Autonomy: accept another right to decision Beneficence: perform actions that benefit Nonmaleficence: do no harm Justice: fairness Fidelity: faithful to commitment

Deontology: right or wrong Feminist ethics: nature of relationships Utilitarianism: determined by usefulness Ethics of care: through personal narratives

The nurse: -Acts with patients best interest at heart -Promotes advocates for health, safety, rights of the patient -Responsible & accountable for individual practice -Owes same duties to self as others: preserve integrity, safety, competence, personal professional growth -Establishes maintains improves healthcare environments to provide quality healthcare -Participates int eh advancement of the profession in education, practice and knowledge development -Collaborates with others to meet heath needs

-Quality of life -Genetics -Allocation of resources/access to care -Care at end of life

How to identify that you have ethical dilemma: -Two or more choices are available -It cannot be solved simply by looking at scientific data -It is difficult to determine which decision is best; it is perplexing -The needs of all involved cannot be met by available alternatives -The option chosen will have a profound effect on the client

1. Ask "is this an ethical dilemma" 2. Review all pertinent information (get all perspectives) 3. Examine and determine facts: opinions, personal values related to the issue 4. Verbalize the problems: produce a clear, simple statement describing the dilemma 5. List possible options 6. Negotiate a plan while demonstrating respect for the opinions of others 7. Evaluate the plan over time

-The best defense is a good offense! -Practice exemplary nursing -Build a good rapport with clients -Head off complaints: --defuse anger instead of ignoring it --take problems seriously: listen intently --anticipate needs -Practice within scope of practice -Remain up-to-date (continued education) -Know and follow facility policies and procedures -Document completely, accurately, & objectively. It is as important as the care given -Know and follow the provisions of the Nurse Practice Act -Be familiar with the Patient's Bill of Rights -Remember that your primary obligation is to protect the patient, and let that principle be your guide