Nurse Practice Acts and Tort Law

Hospital Policy and Nurse Practice Acts

• Hospital policies and state Nurse Practice Acts dictate the conditions of licensed nursing practice.
• Nurses are legally obligated to report suspected child abuse.
• Incident reports should not be documented in a patient's chart; instead, the filing of an incident report should be noted separately.
• Healthcare providers must inform clients of potential risks associated with their care decisions, including decisions to leave against medical advice (AMA).
• Advanced directives allow patients to control end-of-life healthcare decisions.

Tort Law

• Civil wrongs are known as torts.
• Intentional torts include assault, battery, defamation, false imprisonment, outrage, invasion of privacy, and wrongful disclosure of confidential information.
• Negligence is an unintentional tort, involving a failure to act as a reasonable person would in similar circumstances.

Negligence

• Intentional torts involve intentionally causing harm to another.
• Malpractice comprises professional misconduct involving a lack of skill or care in professional duties.
• Examples of malpractice include improper procedures (e.g., inserting a Foley catheter), failure to monitor a patient's condition, and failure to prevent falls.
• Other examples include failure to report worsening conditions to a physician or failure to prevent falls.
• Libel refers to written statements harming a person's reputation.
• Slander refers to oral statements harming a person's reputation.
• Assault is an attempt to injure someone physically or verbally.
• Battery is unlawful physical contact with another person.

Durable Power of Attorney

• A durable power of attorney enables a person to transfer healthcare decision-making authority to a designated agent.

Confidentiality

• Patient information should only be accessed by those directly involved in client care.
• Faxing or emailing patient information is permissible with written patient consent.
• Informed consent is not required in emergency situations.
• Specific situations for questioning orders include ambiguous orders, orders concerning client condition changes, orders inconsistent with the clinician's experience or licensure, and verbal physician orders requiring co-signing.

Legal Aspects of Nursing

• State regulations govern nursing practice and establish regulatory agencies for licensing.

Reporting Obligations

• Specific conditions, such as child or elder abuse, require reporting to the appropriate authorities. These conditions vary by state.

Informed Consent

• Capacity (e.g., age, competence) is crucial for valid consent.
• Voluntariness (absence of force, fraud, deceit, coercion) must be demonstrated.
• A healthcare professional witnesses consent, thereby validating voluntary consent, but it doesn't mean they explained the entire procedure.
• Health care providers need not inform patients about the procedure if asked.

Good Samaritan Laws

• Good Samaritan Laws encourage healthcare providers to help in emergencies.
• They generally ensure that care is provided in good faith.
• Care is usually gratuitous (no payment expected).
• Professional expertise is expected at the level of an ordinary nurse in similar situations, but a higher level of care may be expected due to the professional's expertise or experience.

Liability

• Healthcare professionals can be held liable individually or vicariously.
• Individual liability arises from their own actions.
• Vicarious liability can occur when a professional is held responsible for the actions of another individual or group.
• This group could include fellow doctors, fellow nurses or institution such as a hospital.

Criminal Law

• Criminal law involves wrongdoings against society.
• Examples include violation of the nursing practice act, murder, manslaughter, false imprisonment, and narcotic violations.

Civil Law

• Civil law involves wrongdoings against individuals or groups.
• Torts (e.g., negligence, malpractice) are common examples.

Nursing Implications

• Nurses are responsible for intervening if a patient's dignity or privacy is compromised.
• Nurses must be careful to ensure the client's belongings and medical records are protected and handled appropriately.
• Defamation involves harming a person's reputation through false statements, either written or spoken.
• Assault involves threatening or attempting to harm someone.
• Battery involves physically harming another.

Client Admission and Discharge

• Voluntary admission occurs when a patient chooses to seek admission.
• Involuntary admission occurs when admission is mandated by another person or authority.
• Hospital discharges can be final, absolute, conditional, or incomplete.
• Conditional or incomplete discharges may involve placement in a halfway house, nursing home, or other rehabilitation/monitoring facility.

Restraints

• Using restraints without proper justification can lead to false imprisonment.
• Restraints should be applied only when medically necessary and appropriate in response to a patient's harmful behaviors, and according to proper procedures and physician order.
• Restraints should be documented on a regular basis, noting the presence and duration of restraints and any client reaction.

Nursing Process

• Nurses use the nursing process (Assessment, Diagnosis, Planning, Implementation, and Evaluation) to systematically provide patient care.
• Assessment includes gathering data (both subjective and objective) on the patient's condition.
• Specific lab values are crucial to analyze the patient's condition (e.g., RBC, WBC, Hemoglobin, and Hematocrit)

Confidentiality in Nursing Care

• Patient confidentiality is vital.
• The right to confidentiality can only be violated in specific, necessary circumstances, such as potential suicide or harm.
• Nurses must protect patient information from unnecessary disclosure and unauthorized access.
• Specific conditions, like communication of communicable diseases, gunshot/knife wounds, elder or child abuse, psychiatric situations (e.g., suicidal tendencies) may necessitate disclosure of certain information.

Patient Rights in Nursing

• Nurses must actively protect patients' rights.
• Nurses should take appropriate steps to protect patients from harm, including preventing falls, avoiding inappropriate touching, and clearing and maintaining a safe environment.

Maslow's Hierarchy of Needs

• Maslow's hierarchy of needs is a framework that organizes human needs into a pyramid, starting from basic physiological needs to more complex needs such as self-actualization.

Nursing Procedures

• Standard precautions and hand hygiene are essential to prevent the transmission of infectious diseases.
• Nurses must follow evidence-based guidelines to perform specific procedures like blood transfusions, wound care, and administering medications.

Advance Care Directives

• Advance care directives such as living wills and durable power of attorney for healthcare are crucial legal documents that outline patient preferences regarding medical treatment.
• These documents outline the patient's desires regarding life-sustaining treatments, end-of-life care, and the appointment of someone to make healthcare decisions if they lose the capacity.

Euthanasia and Assisted Suicide

• Euthanasia involves actively ending a patient's life, while assisted suicide involves providing the means for a patient to end their own life.
• The legality and ethics of these practices vary by jurisdiction. Nurses must adhere to their professional code of conduct and relevant laws.