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Out-of-court statements made under oath.

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What is a deposition?

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When the nurse assumes responsibility for the patient's care.

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What is a nurse patient relationship?

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• Personal beliefs about the worth of an object, idea, a custom, or an attitude. • They develop over time and change as necessary. • They influence your behavior and decisions. • They are learned through experience, observation, and reasoning.

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What are values?

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• Acts that are permitted to be performed or are prohibited from being performed. • Give direction to the practicing nurse, defining what should or should not be done for patients. • Every nurse is obligated to know and follow the established standards of care. • Failure to adhere to these standards gives rise to legal liability.

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What are standards of care?

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Define and limit the scope of nursing practice.

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What is the Nurse Practice Act?

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• *Commission* --- Doing an act • *Omission* --- Not doing an act • Legal action that a nurse may be charged with for failing to meet the standards of care

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*Malpractice (professional negligence):* Improper, illegal, or negligent professional activity or treatment.

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• *Duty exists:* The nurse-patient relationship establishes a duty. • *Breach of the duty:* The nurse fails to perform the duty in a reasonable, prudent manner. • *Harm occurs:* This does not have to be physical injury. • *Proximate cause:* The breach of duty was the proximate cause of the harm.

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*Malpractice* - Elements that must be present:

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• Developed by the American Hospital Association in 1972 • Goal is to promote the public's understanding of their rights and responsibilities as consumers of health care • Health Insurance Portability and Accountability Act of 1996 (HIPAA)

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What is the Patient's bill of right?

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• A person agrees to allow a particular treatment based on full disclosure of the facts needed to make an intelligent (informed) decision • Consent must be obtained before any invasive treatment or procedure • Patient needs to be aware of the benefits of the treatment, the risks involved, any alternative treatments, and the consequences of refusing the treatment

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What is informed consent?

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• The nurse has a duty to protect information about a patient no matter how that information is received • Failure to maintain confidentiality gives rise to legal liability, and legal remedies exist to address confidentiality breaches • Health Insurance Portability and Accountability Act of 1996 (HIPAA) set rules and limits on who can look at and receive health care information

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What is confidentiality?

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• The law prescribes when a health care professional must report certain information to authorities (certain communicable diseases, gunshot wounds, signs of abuse) • The health care professional is protected from liability when acting in good faith • Child Abuse Prevention Treatment Act of 1973 • Act made reporting of child abuse mandatory • Health care professionals may face fines and/or imprisonment if they fail to report suspected cases of child abuse

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Discuss reporting abuse. (report to charge nurse first)

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• Nurse-patient relationship must be one based on trust and respect • Use open and honest communication • Follow the standards of care and adhere to the scope of practice for a licensed practical nurse • Proper documentation

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How to avoid a lawsuit? Provide compassionate, competent nursing care.

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• A competent adult has the right to determine what does or does not happen to him or her

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The patient has the right to refuse treatment.

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• The patient is usually incapacitated with little hope of recovery • Physician will consult with the family before writing a DNR order • Nurse has a duty to follow the order

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Do not resuscitate orders

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• The nurse cannot refuse to care for a patient because she disagrees with the decisions the patient makes • Nurse does not have to participate in the procedure but cannot refuse to provide care after procedure • Do not abandon the patient, but ask for another assignment

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Refusal to treat

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• As an LPN, you might be asked by an RN or physician to perform nursing duties beyond your scope of practice or experience • It is up to you to speak up

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Functioning beyond the scope of practice and experience of the LPN.

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The process of self-evaluation that helps a person gain insight into individually held values.

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What is value clarification ?

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Respect for others

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The first and most fundamental principle of ethics is?

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Each member of the nursing profession has a duty to report behavior that does not meet the established standards.

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Reporting unethical behavior.

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While on duty

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Malpractice insurance carried by an institution only covers the nurse when ?

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Divulging patient information

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Identify an example of a HIPAA violation.

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Unlawful touching of a person; an intent to do harm is not necessary

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What is civil battery?

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An unjustified attempt or threat to touch someone

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What is assault ?

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Records may be used by both parties in a lawsuit to argue facts of the case.

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How can a medical record be used in a litigation?

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Breaking confidentiality and invasion of privacy.

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There are two things you are guilty of when talking about a patient to other nurses, what are they?

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A system of standards or moral principles that directs actions as being right or wrong.

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What are ethics?

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Involve the worth you assign to an idea or an action

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What are values?

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Ethics are behaviors we ought to observe and laws are behaviors we must to observe.

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The difference between ethics and laws is?

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You are answerable to yourself, to your assigned patient, to the team leader, to the physician, and to your instructor who evaluates your work.

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What does accountability mean?

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(Do No Harm): the principle of doing the least amount of harm possible to a patient (ex. Returning the bed to lowest position).

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What is nonmaleficence? Identify an example.

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Individuals have the capacity to think, and based on these thoughts, make a decision freely whether or not to seek health care (the freedom to choose) ex. The patient's right to refuse treatment.

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What is Autonomy and identify an example.

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Acting in patients' best interests when they are unable to make free choices

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How do nurses practice fidelity?

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Give patients their due and treat each patient fairly and equally (i.e., with dignity and respect).

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Identify how a nurse provides justice to patients.

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A disrespectful attitude toward the patient and what the patient has to contribute to personal care and recovery. An, "I know what is best for you" attitude.

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Be able to identify an example of beneficent paternalism.

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1. *Patient advocacy* • The patient needs to be informed of what you will be doing with him or her (e.g., steps of a procedure) 2. *Accountability* • You are answerable to yourself, to your assigned patient, to the team leader, to the physician, and to your instructor who evaluates your work 3. *Peer reporting* • Report peers for behaviors that are potentially harmful to patients

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Name the three ethical responsibilities of nurses.

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• Checking temperature • Returning bed to lowest position • Raising side rails • Giving medications

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Be able to identify actions that nurses take to increase the possibility of doing no harm while caring for their patients.

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a. Put patient interests first b. Place the good of patients before one's own needs • Includes organizational and other work-related needs

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Identify examples of the use of beneficence.

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Defines nursing practice and establishes standards for nurses in your state.

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The Nurse Practice Act

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Involves people and society as a whole and relationships between individuals and government. a. Misdemeanor b. Felony

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Identify an example of a criminal action.

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• *Interstate endorsements* - Makes it possible to work in another state without repeating the NCLEX-PN® examination, after you meet that state's criteria for licensure by endorsement • *Multi-state licensure* - Allows a nurse to have one license in his or her state of residency and practice in other states, depending on each state's Nurse Practice Act and legislation • Nurse Licensure Compact

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Know how to work in other states.

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• This is your guideline for good nursing care • The phrase "you are held to the nursing standard of care" has important legal implications • Based on what an ordinary, prudent nurse with similar education and nursing experience would do in similar circumstances

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Nursing Standard of Care

question

You are guilty of causing physical harm to someone

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What does it mean to be liable for battery?

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Keeping someone detained against their will

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Identify an example of false imprisonment.

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Taking unwanted photos showing a patient's wound

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Identify an example of libel.

question

LPN

answer

Legally, student practical/vocational nurses are held to the same level of performance of...

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Anything that the nurse didn't do correctly (commission) or what was expected of the nurse was not done (omission).

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Identify an example of breach of duty.

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It means that you are answerable to yourself, to your assigned patient, and to your assigned instructor, to the team leader, to the physician, and to your instructor who evaluates your work.

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What does accountability mean?

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Generally an RN or physician must be present to translate medical terminology and to answer questions.

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When access medical records, who is responsible for reviewing the records with the patient?

question

A legal document that names a health care proxy (anyone at least 18 years old) to make medical decisions if that person is no longer able to speak for themselves.

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What is a durable power of attorney?

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• *Implied consent* - general consent for treatment obtained on admission • *Informed consent* - must be obtained for invasive procedures ordered for therapeutic or diagnostic purposes (e.g., surgery). • *Authorized consent* - parents must give consent for the treatment of their children up to a certain age.

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Know the difference between implied consent, informed consent, and authorized consent.

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Disclosing information regarding patients.

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Identify breach of confidentiality.

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The best defense is to provide compassionate, competent nursing care.

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What is the best way to avoid a lawsuit as a nurse?

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A legal document that describes the kind of medical treatments or life-sustaining treatments the person would want if seriously or terminally ill.

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What is a living will?

question

An advanced directive based on the Patient Self-Determination Act that gives the physician legal permission to write such an order.

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What is a do-not-resuscitate order?

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A law developed by the legislative branch of the state and the U.S. Congress of the federal government (e.g., The Nurse Practice Act)

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What is statutory law and provide an example.

question

Forcing a patient to take medications

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Identify an example of battery.

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Gossip

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Identify an example of slander.

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Right or Wrong

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Ethics is a system of standards that refer to ideas and actions in terms of being ....

question

• *Slander* - defamation by verbalizing untrue or private information (gossip) to a third party. • *Libel* - defamation through written communication or pictures. • *Defamation* - Damage to someone's reputation through false communication or communication without permission. • *Invasion of Privacy* - Privacy in health care means the right to be left alone and free from intrusion, including the right to choose care based on personal beliefs, feelings, or attitudes. • *HIPAA Violation* - The main focus of HIPAA is protection of patient privacy, including access to medical records and confidential communications.

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Define: Slander, Libel, Defamation, Invasion of privacy, HIPAA violation

question

Medication and treatment errors, lack of observation and timely reporting about the patient, defective technologies or equipment, infections caused or worsened by poor nursing care, poor communication of important information (including change of condition), failure to intervene to protect the patient from poor medical care.

answer

Identify the instances of possible malpractice.

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A coworker who is impaired at work because of alcohol and/or other drug use. A coworker who stole a patient's medication. A coworker who gave a patient a cold shower.

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Identify an example of illegal and unethical behavior.

question

An agency might carry a policy that covers you only while you are employed by that institution. A suit may come up years after you have stopped working for the employer. A nurse should obtain occurrence coverage because it protects him/her for each incidence regardless of employer.

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What is true about malpractice insurance provided by the hospital?

question

It is the nurse's responsibility to maintain patient safety and make it a priority, he/she needs to double check all medications and their orders and if unsure of what it says they need to contact the physician.

answer

What is the nurse's responsibility regarding an improper medical order that, if carried out, may harm a patient?

question

Some states have arrangements for interstate endorsements which means that for nurses who choose to work in other states can do it without repeating the NCLEX-PN examination. Another is the multistate licensure which allows a nurse to have a license for the state that they live in among other states depending on the other states Nurse Practice Act and legislation.

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How do you become licensed in another state?

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The physician is the one who is responsible for obtaining the patient's signature, it is only the nurse's responsibility to witness signing the form.

answer

Know what is true about informed consent

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Letting the patient sit in their own urine or feces; not giving them their medication

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Which situations can be identified as abandonment of patients by the nurse?

question

Privacy

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By protecting the information in a patient's record, the nurse fulfills the ethical responsibility of:

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Maleficence

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A nurse who failed to irrigate a feeding tube as ordered resulting in harm to the patient could be found guilty of

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• *Durable medical power of attorney* - is a legal document that is valid in all 50 states. It names a healthcare proxy (anyone at least 18 years old) to make medical decisions if that person is no longer able to speak for himself or herself. It becomes active anytime the person is unconscious or unable to make a medical decision. • *Living will* - is a legal document that describes the kind of medical treatments or life-sustaining treatments the person would want if seriously or terminally ill. Does not let the person select someone to make decisions for them. This lets the person make their own decisions, no one else can make a decision for them.

answer

Know the difference between a durable medical power of attorney and a living will.

question

Defines nursing practices and establishes standards for nurses in your state. Ignorance of your state's Nurse Practice Act is never a valid defense against any legal proceeding regarding your license.

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Know the truths about nurse practice acts.

question

Inform the patient that the Nurse Practice Act prohibits the LPN from giving professional advice. That is beyond our level of education and they need to consult a physician.

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If the patient asks you the LPN to view their chart what do you do...?

question

The Nurse Practice Act is an example of a statutory law.

answer

What is an example of statutory law?

question

Values are freely chosen and are affected by age, experience, and maturity.

answer

Identify an example of Values.

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Ignorance of your state's Nurse Practice Act is never a valid defense against any legal proceeding regarding your license.

answer

Remember it is the nurse's responsibility to know the nurse practice act in his or her state.

question

The rights of the individual

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A major change in medical ethics that affected nursing occurred when the Western secular belief system shifted emphasis from duties to...?

question

• Thinking through the facts • Deciding on the basis of an independent thinking process • Acting based on a personal decision • Undertaking a decision voluntarily without pressure, direct or subtle, from anyone else.

answer

Know what Autonomy is

question

A complaint

answer

When a nurse becomes involved in a legal action, the first step to occur is that a document is filed in an appropriate court. This document is called a(n):

question

The guideline for good nursing care. The standard is based on what an ordinary, prudent nurse with similar education and nursing experience would do in similar circumstances.

answer

What is meant by the practical/vocational nurses standard of care.

question

The state's Nurse Practice Act.

answer

The legal duties and functions of the nurse in a given state are determined by what/whom?

question

Inform the RN asking you to do the task that you have never performed that task before and request they assist you and teach you how to do it.

answer

When asked to perform a procedure that the nurse has never done before, what should the nurse do to legally protect himself or herself?

question

Beneficence

answer

When a student nurse prepares diligently for a clinical assignment, the ethical principle being observed is

question

Protecting individual rights and results in payment of money to the injured person.

answer

What is Civil law is concerned with ?

question

The nurse must give the patient their due and treat each patient fairly. Treat all patients the same.

answer

How does a nurse provide justice to their patients ?

question

Ethics are concerned with ways people decide the following: • What actions are right or wrong • If one *ought* to do something • If one has the *right* to do something • If one has the *duty* to do something A law is thought of as a minimum ethic that is written and enforced

answer

What's the difference between laws and ethics ?

question

*Assault* - an unjustified attempt or threat to touch someone *Battery* - means to cause physical harm to someone

answer

What is the difference between assault and battery?

question

Taking a narcotic intended for the patient's pain relief and giving the patient another substance in its place.

answer

Identify an example of criminal action committed by a nurse.

question

The best defense is to provide compassionate, competent nursing care.

answer

What is the best way to avoid a lawsuit as a nurse?

question

*False imprisonment* - keeping someone detained against his or her will *Intentional tort* - is intended to cause harm to the patient (threat or actual harm)

answer

Identify an example of false imprisonment, an intentional tort.

question

A disrespectful attitude toward the patient and what the patient has to contribute to personal care and recovery. "I know what's best for you."

answer

Identify an example of beneficent paternalism.

question

No

answer

Can a LPN/LVN administer blood products?

question

Defamation through written communication or pictures.

answer

Know what libel is?

question

Defamation by verbalizing untrue or private information (gossip) to a third party.

answer

Know what slander is?

question

Standing/ speaking up for your patient (ex. The physician or other health care workers didn't really listen to your patient.)

answer

Know what it means for a nurse to be an advocate.

question

It means that you are answerable to yourself, to your assigned patient, and to your assigned instructor, to the team leader, to the physician, and to your instructor who evaluates your work.

answer

What does accountability mean?

question

Intentional acts to cause harm to the patient.

answer

Identify an example of a civil assault.

question

Respect for others.

answer

What is the first fundamental principle?

question

LPN

answer

Legally, student practical/vocational nurses are held to the level of performance of .....

question

The nurse-patient relationship

answer

Assuming responsibility for a patient's care forms a legally binding situation described as ...

question

Anything that the nurse didn't do correctly (commission) or what was expected of the nurse was not done (omission).

answer

Identify an example of breach of duty.

question

Anything that doesn't protect the patients' confidentiality

answer

Identify a nursing care error that violates the Health Insurance Portability and Accountability Act.

question

The physician

answer

Who should the nurse should seek the advice of if a patient is refusing to comply with a written order?

PN LPN 138 Exam 1 Study Guide 3rd semester – Flashcards

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