Legal & Ethical Issues Pt 1 – Flashcards
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Legal & Ethical Aspects of Nursing
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Individuals are accountable to laws & regulations... and legal consequences if violated Nurses governed by these civil & criminal laws: professionally, privately, as health care employee
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Basically:
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laws prescribe how person should act in society Often obligatory minimal standard in given situation laws ID & sanction acceptable behavior ethical principles frequently impose higher duty legal standards + ethical principles help Protect all members of society Support members of health care
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Legal Aspects of Nursing
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Is legal relationship between the nurse & client The "nurse-client relationship" Relationship influenced by existing laws, rules & regulations governing nursing practice Nurse is held responsible (liable) if client harm caused by his/her negligent acts (acts of commission) failure to act (acts of omission)
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Legal Aspects of Nursing
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Nurse can be charged with civil or criminal liability, depending on circumstances Each nurse has legal obligation to provide a standard of care expected of a "reasonably competent", professional, licensed nurse" Nurse can be charged, depending on circumstances, with Civil liability Criminal liability
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Legal Aspects of Nursing cont
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Again... Each nurse then can be held responsible (liable) for harm resulting from their negligent acts or failure to act Nurse then becomes involved in legal system
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Overview of Legal System
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Complex set of rules & regulations in response to the needs of society Laws prescribe proper behavior Sanction acceptable behavior Prohibit unacceptable behavior There is a balance in legal system: System both mandates & protects ID basic legal duties Protect members of society
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Overview Legal System cont
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2 basic categories of law: Criminal Civil Laws of both types are established in one of two ways: Statutory Law: established by federal, state & local governments Common Law (case law): response to legal questions that come before the court Precedent (previous rulings on an issue)
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Criminal & Civil Law Characteristics
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Criminal law: Conduct offensive to society in general Conduct detrimental to society as a whole Law involves public offenses (robbery, murder, assault) Law's purpose is to punish for the crime and deter and prevent further crimes Civil law: Conduct violates a person's rights Conduct is detrimental to that individual Law involves an offense that is against an individual Law's purpose is to make aggrieved person whole again; restore to where s/he was
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Legal Process Terms
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Civil litigation = lawsuit in civil court Plaintiff = the complaining party Defendant = person alleged to be liable Complaint = the alleged wrong Damages = compensation Summons = court order announcing the action and "legal notice" Answer = detailed response to charges in complaint
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Legal Process Terms cont
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Discovery = pretrial examination of documents Request for production of documents & things = to obtain P&Ps, standards of care, med records, assignment sheets, personnel files, equipment maintenance records, med bills Deposition = Q & A session under oath Interrogatory = written questionnaire Verdict = a decision Appeal = request for legal review of decision
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Criminal Law Terms
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Criminal law: legal action between individual & society Felony = crime of serious nature punishable by term in prison Murder Manslaughter Ns removes life support before pt pronounced dead/MD Ns injects pt with lethal dose to hasten death Misdemeanor = less serious crime, usually punishable by fine &/or short jail term (<1yr) Falsifying documents to avoid liability Guilt- proof beyond a reasonable doubt
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Civil Law Terms
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Civil law (tort law): wrongs against a person or property; damages can be sought by injured party Unintentional tort- did not mean to harm Negligence Malpractice Intentional tort- intended to do harm Assault Battery False imprisonment Invasion of privacy Defamation Libel Slander
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Types of Torts: Nursing Focus
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Assault: Intentional threat to cause bodily harm, pt in fear; bodily contact not necessary; unjustified attempt to touch or threaten Battery: Intentional touching of pt without consent; treatments without consent False Imprisonment: keeping a pt against his/her will; physical/chemical restraints without an order; meds used on pt to assist Ns' needs Defamation: Spoken or written statements made maliciously & intentionally that damages a pt's reputation Libel- written defamation Slander - verbal defamation
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Unintential Torts
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Negligence: commission or omission of act that a reasonable prudent person would have done in a similar situation, causing harm Malpractice: failure to meet a legal duty, thus causing harm to another Legal name for "professional " negligence Conduct or pt care that falls below the accepted standard of care
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Malpractice
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4 elements MUST be present and proven for a case to be decided against defendant (nurse, hospital, physician): Duty Breach of Duty Harm Proximate Cause To defend against a malpractice suit, It must be proven that one or more of the elements is not met Contributary/comparative negligence: clients at least partly responsible for own injuries: choose not to follow health care worker's advice
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4 elements of Malpractice
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Duty exists- nurse-patient relationship establishes a duty, defined by standards of care Breach of the duty- failure to perform the duty in a reasonable, prudent manner Harm has occurred- this does not have to be physical injury Proximate cause- the occurrence of harm depended directly upon the occurrence of the breach
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Examples of Nsg errors
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Assessment Errors Failing to gather & chart client info adequately Failing to recognize the significance of certain info (V.S) Planning Errors Failing to chart each identified problem Failing to use language in the care plan that other care givers can understand Failing to assure continuity of care by ignoring care plan Intervention Errors Failing to administer & document meds correctly Failing to interpret & carry out MD orders Failing to perform nursing tasks correctly Failing to give discharge instructions pt understands Failing to pursue MD/chain of command if no response to calls to MD
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Malpractice Issues
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"Neighborhood nurse"- watch giving advice to neighbors, friends & family. Possible to be held libel if something happens
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Medical errors:
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Most common: medication 1 of 5 doses of meds observed at one facility US: 7,000 deaths/yr 770,000 injuries/yr d/t med errors Malpractice Insurance: Institution policies cover liability only if Ns on duty & acting within proper capacity Personal malpractice insurance provides protection for nurse on & off duty
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Accountability & responsibility
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Legal relationships: Accountability: Being responsible for one's own actions As student nurse, you are answerable to yourself, assigned pt(s), Team Leader, Physician, Instructor Responsibility: Reliable & trustworthy when assuming care of a pt Arrive to work on time, focus is on "assignments", pt care is your focus You need to accept responsibility for what you do- same legal expectation as for LPN
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Additional Considerations
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Advocate One who defends/pleads an issue on behalf of a pt The nurse accepts the role of advocate for the pt Nurse advocate has a legal & ethical obligation to safeguard the patient's interests Represents the patient's viewpoints to others Nurses should avoid letting his/her personal values/beliefs influence advocating for the pt We have a duty to advocate for each & every pt
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Regulation of Practice
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State Board of Nursing www.nursing.ohio.gov Nurse Practice Act "Scope of nursing practice" defined and described Laws regulate nsg practice to safeguard the public Contains: Definition of nursing Definition of RN, LPN, advanced practice nurses Scope of practice Elements of unprofessional conduct Functions of State Board of Nursing State Board & Ns Practice Act are final authority over nurses & licensure
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Regulation of Practice cont
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Standards of Care Give direction to nsg practice, defining what should or should not be done for patients Every nurse is obligated to know and follow established standards of care Failure to follow standards can give rise to legal liability Legal test is known as the "reasonable, prudent nurse" standard What a reasonably prudent (wise) nurse of similar education and experience would have done in a similar circumstance
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Nursing Standards
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Where find? Practice protocols, contracts, employment agreements, personnel manuals Policy & procedure manuals ANA Code for Nurses Accreditation criteria, The Joint Commission(TJC) State/federal licensing laws Nursing specialty standards of care Nursing literature, textbooks, journals Orientation, continuing ed, staff development Expert nurse witness
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Regulation of Practice cont
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Licensure Graduates of approved schools of nursing can apply to state board to take the licenses NCLEX-PN NCLEX-RN When approved by the board, applicant can take the computerized licensing exam at a designated exam center When passes, license is granted to practice in that state License can be: Suspended or revoked for conduct deemed unprofessional, unethical, immoral, and criminal
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Patients' Rights
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The Patient's Bill of Rights Developed by AMA in 1972 Revised 2003 to include pt responsibilities Renamed "The Patient Care Partnership: Understanding expectations, Rights and Responsibilities" Is an ethical, not legal document Intended to guarantee patient rights Goal to educate public re their rights & responsibilities as health care consumers All patients receive a copy
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Patients' Rights cont
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Informed Consent A full disclosure of the facts the patient needs to make an intelligent ("informed") decision before any invasive treatment or procedure is performed Benefits of treatment and Risks involved Done in non-technical language pt can understand Failure to secure informed consent can result in civil liability for battery Civil battery: unlawful touching of a person; intent to harm not necessary Pt must indicate understanding of info given/MD + sign form consenting to care planned Often WITNESSED by nurse (not explained/nurse!)
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Patients' Rights cont
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Confidentiality Ns has a duty to protect pt information Restrict access to only health care personnel who have a legitimate need to know Failure to maintain pt confidentiality (on duty or off duty; during or after hospitalization) can lead to legal liability Legal remedies used to address breaching pt's confidence
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Patients' Rights cont
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HIPAA Health Insurance Portability & Accountability Act Federal regulation impacting health care r/t health care providers' duty to protect confidentiality of all health information Protected health information Fines for non-compliance: Civil penalty: $25,000/calendar year Criminal penalty: $50,000 + 1 year prison False pretenses: $100,000 &/or up to 5 yrs in prison Non- compliance for commercial advantage: $250,000 &/or imprisonment up to 10 years
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Patients' Rights COnt
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Invasion of privacy Legal concept involving person's right to be left alone, remain anonymous if s/he wishes Consent for care does not waive this right Legal liability results r/t: Exposing pt's body parts unnecessarily Discussing pt inappropriately Disclosing information about the pt Using any pt info without authorization Name Photos- traditional camera or cell Specific facts regarding an illness
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Patients' Rights Cont
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Exceptions to right of privacy exist Law requires health care professional MUST report certain info to authorities: Certain communicable diseases Gunshot wounds Suspected child abuse Withholding med tx to newborn with life-threatening condition Often spousal & elder abuse (in most states) Duty exists to report abuse and suspected abuse To know signs of abuse & how to report ( follow facility procedures) May face fines &/or prison time if fail to report
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How to Avoid a Lawsuit
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Best defense: Provide compassionate, competent nursing care Nurse-patient relationship: based on trust & respect Use open & honest communication Follow standards of care Adhere to scope of practice Proper documentation "Care was not given if it was not charted"
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Good Samaritan Act
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Law designed to protect those (including health care workers) who give first aid in emergency situations Protect care professionals from legal liability when giving emergency first aid Follow reasonable & prudent course of action: small risk of legal problems Obtain verbal permission to treat (help) If refuses help, must honor Unconscious: law assumes consent given After initiate first aid, obligated to continue until: Someone with comparable or better training is able to care for victim
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Americans with Disabilities act (ADA)
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As of 1994, ADA: Purpose: To eliminate discrimination against individuals with disabilities Prohibits: discrimination on basis of disability in employment, public services, public accommodations Provides hiring of nurses with disabilities if can fulfill duties of work role Will see evidence of ADA in health care facilities: building access; room access; bathroom fixtures; showers
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Chemically Impaired Nurses
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Numbers of nurses illegally using drugs/ abusing alcohol continues to increase ~10-15% (even 20% )"Impaired nursing": under influence of drugs/alcohol Is unsafe & unprofessional; a violation Nurse Practice Act State Boards are using Disciplinary Diversion Act Includes: voluntary treatment & rehab License suspension; permanent license loss Chemical dependence excuses r/t stress; easy access Nurses are legally liable for their practice Seek immediate help: Refer self or another to SBN
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Disciplinary Process
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Receipt of letter from SBN alleging breaches of the standard of care or infractions of pt safety practices Licensure issues fall under administrative law Variations by state but generally: Investigation of allegations Meeting with investigators Hearings with the SBN Appeal process What happens to Nursing License after process done? Charge dismissed Investigations agreement Letter of reprimand (formal or informal) Probation with stipulations (education, fines, monitoring, tx) Mandated diversion treatment program Suspension of license; Revocation of license
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Sexual Harassment
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Is a violation of an individual's right; form of discrimination Fed law prohibits sexual discrimination in schools & places of business Definition: "unwelcomed sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature" In healthcare, both medical personnel and clients may experience sexual harassment Speak up: use facility P&P; use chain of command
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Summary re Student Nurses
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Student nurses are responsible for their own actions Student nurses can be held liable for their actions Student nurses must operate under Scope of Practice Will be assigned activities within their capabilities Will be given guidance & supervision Will be prepared for clinical experiences Should seek help/supervision for situations unprepared for Will comply with policies of clinical site Will comply with policies of the school of nursing Accompanied throughout med administration by instructor, never facility RN
