Nursing Law and Ethics Quiz

Hospital Policy and Legal Mandates

• Licensed nursing practice is governed by hospital policy and state Nurses Practice Acts.
• Nurses are legally obligated to report suspected child abuse.
• Incident reports are not documented in patient charts. Do not document that an incident report was filed.
• Healthcare providers must inform clients of potential risks related to refusing treatment, particularly in cases of leaving the facility against medical advice (AMA).
• Advanced directives facilitate patient control over end-of-life healthcare decisions.
• Common advanced directives are living wills and durable powers of attorney.

Torts and Negligence

• Civil wrongs are called torts.
• Intentional torts include assault, battery, defamation, false imprisonment, outrage, invasion of privacy, and wrongful disclosure of confidential information.
• Negligence is an unintentional tort, resulting from a failure to act as a reasonable person would in similar circumstances (action or omission).
• Malpractice is professional misconduct, a significant lack of skill or care in professional duties. Examples include incorrect procedures, neglecting to address worsening conditions, and failing to prevent falls.
• Libel involves written statements damaging a person's reputation.
• Slander involves oral statements damaging a person's reputation.
• Assault is an attempt to harm or touch another.
• Battery is unlawful touching or carrying out a threatened physical action.

Confidentiality and Informed Consent

• Patient confidentiality is essential, limiting access to information to those directly involved in care.
• Faxing or emailing patient information requires written consent.
• Informed consent is not required in emergencies.
• Questionable orders include ambiguous orders, orders questionable to the nurse, orders necessitated by changed patient conditions, orders inconsistent with experience/licensure, and verbal orders requiring physician co-signature.

Cultural Considerations in Nursing

• When a client's behavior appears culturally-based, assess interactions with family and friends to understand the behavior's context.

Reporting Requirements

• Reporting requirements vary by state.
• Examples of reportable conditions include child abuse, elder abuse, gunshot wounds, communicable diseases, certain ophthalmic neonatal conditions, phenylketonuria, and criminal acts.

Informed Consent Requirements

• Informed consent requires capacity (age of majority, competence to make choices/understand consequences) and voluntariness (free choice, without coercion).
• Medications (e.g., alcohol, pre-medications) can affect a client’s capacity to consent.
• A nurse's signature on a consent form indicates witnessing the signature and the client's or designated representative's voluntary action but does not constitute informing the client about medical procedures. The physician is responsible for giving the patient information.

Good Samaritan Laws

• Good Samaritan laws encourage healthcare providers to assist in accidents or emergencies.
• Key elements include care provided in good faith, gratuitously (no compensation), and meeting a standard of care expected of similar professionals in similar situations.

Liability (Individual and Vicarious)

• Individual liability: Individuals are accountable for their actions.
• Vicarious liability: Nurses are liable under the Nurse Practice Act for a standard of care they are expected to meet.

Criminal and Civil Law

• Criminal law involves wrongdoings against society (e.g., murder, manslaughter, nursing practice violations, narcotics violations).
• Civil law involves wrongdoings against individuals/groups that can result in compensation. Examples include malpractice and negligence (inappropriate action or omission).

Malpractice Elements

• Professional duty: Established nurse-client relationship.
• Breach of duty: Failure to meet the standard of care.
• Harm: Occurrence of injury.
• Causation: Direct link between breach and harm.
• Foreseeability: Injury could reasonably be anticipated given the breach.

Invasion of Privacy

• Nursing implication: Protect client dignity and privacy, covering the body during procedures, respecting information release, and protecting belongings.

Defamation

• Defamation involves written or oral communication damaging a person's reputation, communicated to a third party.

Assault and Battery

• Assault: Threat of physical harm or contact without consent.
• Battery: Actual physical contact or the carrying out of an assault.
• Nursing actions include identifying potential assaults, reporting them appropriately, and prioritizing client safety.

Admission (Voluntary and Involuntary)

• Voluntary: Patient initiates admission.
• Involuntary: Admission is initiated by a third party, without patient consent, when a client poses a danger to self or others or is a minor. (Parent)

Discharge (Types)

• Discharge can be absolute (final), conditional (leaving for halfway house, rehabilitation services, etc.), or incomplete.

False Imprisonment

• False imprisonment involves unlawful restraint of freedom.

Restraints (Physical and Chemical)

• Physical restraints require physician orders, except in emergencies. Ensure appropriate types and duration.
• Monitor restrained clients frequently.
• Chemical restraints (e.g. psychotropic drugs) should only be used for diagnosed medical conditions, not for behavior control.

Nursing Process (ADPIE)

• The nursing process systematically assesses patient data and strengths, and diagnoses concerns.
• This systematized nursing practice improves quality and enhances client participation.
• The five phases are Assessment, Diagnosis/Analysis, Planning, Implementation, and Evaluation.

Assessment

• Begins on patient arrival.
• Establishes a patient database, collecting physical and psychosocial data.
• Validates and questions data to confirm.
• Question orders (doctor, other providers), considering diagnoses, patient condition, and lab work, before implementation.
• Assess pain level before pain medications.

Data Types(Subjective and Objective)

• Subjective data (symptoms): Patient perceived feelings (nausea, chills, pain).
• Objective data: Clinician observed data (body temperature, blood pressure, cyanosis).

Nursing Diagnosis

• Identifies actual or potential problems, causes, immediate needs, strengths, and weaknesses based on NANDA-approved categories.

Analysis and Data Interpretation

• Analyze patient data (physical findings, lab values, diagnostic tests) leading to a diagnosis. Interpret lab results.
• Reference ranges for common laboratory values (RBC, WBC, Hb, Hct, platelets, PTT, PT, aPTT, INR, bleeding time, Na, K, Mg, Ca, BUN, creatinine, lithium, digoxin, Cholesterol, CKP, AST, PSA, Glucose, HbA1c, ABG's).

This quiz covers key aspects of hospital policy and legal mandates relevant to nursing practice, including reporting obligations and incident documentation. Additionally, it delves into torts and negligence, highlighting intentional and unintentional torts in the healthcare context.