Major Issues/Liability in Nursing Practice PDF

MAJOR ISSUES/LIABILITY IN NURSING PRACTICE PRESENTED BY: GROUP 7 Topics to be discussed: 01 Electronic Documentation 02 Informed Consent Facility Liabilty: Employment 03 Issues 04 Liability Of The Nurse Managers Pr...

MAJOR ISSUES/LIABILITY IN NURSING PRACTICE PRESENTED BY: GROUP 7 Topics to be discussed: 01 Electronic Documentation 02 Informed Consent Facility Liabilty: Employment 03 Issues 04 Liability Of The Nurse Managers Professional Issues: The 05 Nurse and the Contract 06 Incident Reports Conflict Management And 07 The Nurse  0 1 ELECTRONIC DOCUMENTATION  ELECTRONIC DOCUMENTATION Electronic documentation refers to the process of recording, storing, and managing patient information digitally rather than on paper. It typically involves the use of electronic health records (EHR) or electronic medical records (EMR) systems, which enable healthcare providers to input, access, and update patient data through computers, tablets, or other digital devices. ADVANTAGES OF USING ELECTRONIC DOCUMENTATION 1. Enhanced Security and Privacy Electronic documentation systems require healthcare professionals to log in with unique usernames and passwords, ensuring that only authorized personnel can access patient records. This security feature helps track who enters or modifies data, preventing unauthorized access and safeguarding patient privacy. 2. Efficient Documentation and Data Retrieval Electronic systems allow healthcare providers to directly input and retrieve patient data, making it quickly accessible to everyone involved in the patient’s care. This reduces the time spent searching for paper records and enhances workflow. ADVANTAGES OF USING ELECTRONIC DOCUMENTATION 3. Minimization of Errors and Patient Safety Features HER systems are designed with automated alerts to notify healthcare providers about potential drug interactions, allergies, or missed treatments, reducing the risk of errors that could harm patients. 4. Streamlined Workflows and Reduced Redundancy By eliminating repetitive data entry, electronic documentation reduces redundancy, allowing patients to provide information once and have it available for all providers. This saves time for both healthcare professionals and patients. HARMFUL EFFECTS OF USING ELECTRONIC DOCUMENTATION 1. Technical Glitches Electronic documentation systems can experience malfunctions, such as system crashes or server failures, that may prevent healthcare providers from accessing patient records. This could lead to delays in diagnosis and treatment, as physicians would need to rely on verbal patient history or manual records, which can cause errors or missed information. 2. Vulnerability to Cyber-Attacks Electronic medical records are susceptible to cyber-attacks such as ransomware, where attackers lock access to patient records and demand a ransom. These breaches can result in lost or stolen data, putting patient privacy at risk and HARMFUL EFFECTS OF USING ELECTRONIC DOCUMENTATION 3. Risk of Violating Privacy Laws Healthcare facilities must comply with strict data protection laws like HIPAA when managing electronic records. Failing to secure these records or mishandling them can result in legal violations and hefty penalties, compromising patient trust. 4. Dependence on Technology Over-reliance on electronic systems can be problematic during system downtimes, power outages, or equipment failures. Healthcare providers may be unable to access vital patient data, disrupting care and causing delays.  INFORMED 0 CONSENT 2  INFORMED CONSENT Informed consent refers to the process of providing patients with sufficient information that allows them to make a voluntary and informed decision whether to undergo or forego a procedure or treatment, provided that the information given is capable of being understood by the patient.  Legality of Informed Consent Autonomy – is the right of the patient to make decisions according to their beliefs or preferences. Competence – ability or capacity to make a specific decision for oneself. Battery – application of force to a person’s body without consent. Negligence – failure in the duty of care. Components of Informed Consent 1.Competence 2.Disclosure 3.Understanding 4.Voluntariness 5.Consent  Capacity to Consent To give informed consent, a person must have the capacity to understand and communicate what they are agreeing to. 1.Children 2.Mentally Incapable 3.Living Will 4.Pregnant Mother (baby) 5.Emergency Situations Checklist 1.Name of operation 2.Nature of proposed treatment 3.What the operation involves 4.Other treatment options or alternatives 5.Potential complications 6.Risks of operation 7.Risks of no treatment  Modes of Consent 1.Implied Consent The patient is presumed to minor operations (e.g. X-ray) 2.Express Written Consent Whenever possible, this should be obtained for all patients undergoing procedures involving an anesthetic complex treatments with significant risks or side effects, or as part of research. Written consent is not legal proof that adequate consent was obtained at the time the document was signed. 3.Express Verbal Consent Should be obtained it is not possible to get written consent and witnessed by an independent health care professional, and documented in the notes accordingly, for simple procedures with minimal risk of harm.  Special Consideration 1.Emergencies Treatment can be provided without consent where a patient is experiencing a severe suffering, or where delay in treatment would lead to serious harm or death or consent can not be obtained from their patient or their substitute decision maker. NB: However, you must report respect any valid advance refusals that you know about or are drawn to your attention. 2.Mentally Incapable Patients Assess patient’s competence to make an informed decision. If unable to decide, and provided they comply, treatment may be instigated that is judges to be in their best interest.  Special Consideration CONT’D: 3.Advanced Statements/Living Will A/S made by patients before loosing their capacity of informed consent must be respected. Provided: Decision is applicable to current situation No reason to believe that they may have changed their decision. The known wishes of the patient should be take into consideration if an A/S is unavailable.  Special Consideration CONT’D: 4.Children Under 16 – Parents or guardians would see at the best of interest of the child. However, may give their own consent, if they are judged to understand what is involved. Over 16 – Regarded as young adults and have capacity to decide. Age 6 – 15 can give assent. If child refuses that parent cannot force participation. Unlike adults, if competent child refuses treatment, a person with parental responsibility or a court may authorize treatment deemed in the child’s best of interest. Emergencies applicable in same manner as an adult.  Special Consideration CONT’D: 5.Pregnancy The right to autonomy applies equally to pregnant women. It includes the right refuse treatment that is intended to benefit the unborn child. Consequences of Failure to Obtain Valid Consent Treatment without consent = BATTERY including NO consent or WRONG procedure. Treatment with poor or invalid consent = NEGLIGENCE Including misinformation about diagnosis or surgery  Faculty 0 Liability: 3 Employment Issues Faculty Liability: Employment Issues Facility liability in health care practice encompasses the legal responsibilities of institutions regarding the actions of their staff and the care provided to patients. By adhering to standards of care, ensuring informed consent, maintaining thorough documentation, and participating in risk management, nurses and healthcare facilities can work together to minimize legal risks and enhance patient safety. Faculty Liability: Employment Issues Facility liability in health care practice encompasses the legal responsibilities of institutions regarding the actions of their staff and the care provided to patients. By adhering to standards of care, ensuring informed consent, maintaining thorough documentation, and participating in risk management, nurses and healthcare facilities can work together to minimize legal risks and enhance patient safety.  Issues Related to Nursing Shortage This shortage is more noticeable, however and it is lasting longer. The nurse shortage itself is a contributing factor because the shortage creates staffing problems, mandatory overtime, and constant calls for additional shift work. National nursing organizations are making strong efforts at stopping the shortage by mandating better nurse-to- patient ratios, eliminating mandatory overtime, and increasing salaries and benefits for nurses.  Issues in Nurse Migration Nurse migration has attracted a great deal of political as well as media attention in recent years. The rights to healthcare as well as workers’ rights are paramount to understanding the interests of health sector stakeholders, including the consumer or patient, the government or employer, and the worker or health professional. In this section a discussion on the right to work and the right to practice is, by necessity, followed by a warning that cases of exploitation and discrimination often occur when dealing with a vulnerable migrant population.  The Right to Work and The Right to Practice Nurse for nurses to practice their profession internationally, they need to meet both professional standards and migration criteria. The right to practice, e.g., to hold a license or registration, a professional criteria, and the right to work, e.g. to hold a work permit, a migration criteria, are sometimes linked. Yet they often require a different set of procedures with a distinct set of competent authorities.  Exploitation and Discrimination One of the most serious problems migrant nurses encounter in their new community and workplace is that of racism and its resulting discrimination Incidents are, however, often hidden by a blanket of silence and therefore difficult to quantify. Migrant nurses are frequent victims of poorly enforced equal opportunity policies and pervasive double standards.  Essential Terms and Conditions in an Employment Contract An employment relationship has traditionally been governed by terms and conditions of the employment contract. Previously, the employer retained sole control in respect of the terms and conditions of employment to be incorporated into the employment contract. however, over the years there has been an increase in the implied terms and conditions which are also read into the contract. Additionally, then there are statutory terms and conditions which also apply. Unsatisfactory Work Performance and Termination of Employment When an employee has an attitude problem or whose work performance is not up to the expectations, he cannot be terminated by the employer simply by invoking the termination clause in the employment contract. The employer has to follow certain rules and procedures and only at the end of it can he terminate the services of a non-performing employee. Misconduct and Imposition of Punishment It has long been held that the employer has the inherent right to discipline his workers. Should misconduct be committed, the employer after a proper inquiry has been instituted can impose a suitable punishment, including dismissal if the offence committed was of a serious nature. The decision on the type of punishment to be imposed is under all circumstances a subjective one. The Courts will interfere if, among others, the cation taken by the management was perverse, baseless or unnecessarily harsh or was not just or fair.  Sexual Harassment at the Workplace Sometime ago, this subject matter received a great deal of attention especially with the launching of the Code of Practice on the Prevention and Eradication of Sexual Harassment at the Workplace by Ministry of Human Resources. However, the response to the adoption of the Code by employers was not encouraging. Some NGO’s have called for the introduction of statutory measures to deal with the problem. Some recent judicial pronouncements appear to make it difficult to prove sexual harassment had indeed taken place.  Renewal of Nursing Registration Renewal of nursing registration so that the registration office is updated with nurses in practice. Of course re- registration may qualify its periodicity and qualifications of nurses e.g. clinical experiences, attendance at continuing education etc.  Diploma VS Degree in Nursing for Registration to Practice Nursing This issue need in-depth study of merits and demerits as well as its feasibility before it could come on the surface.  Specialization in Clinical Area It could be either through clinical experience or education. Specialization in cure and specialized care required for patients demand that nurses be highly skilled in the unit. Generalization of care seems remoter and unacceptable for patients under specialized treatment.  Liability of the 0 Nurse 4 Managers  Liability of the Nurse Managers I. What is nurse managers? A nurse manager is an individual in a medical setting with the decision-making power to influence daily operations. They can advocate for improved patient care by optimizing certain processes that a hospital or healthcare organization fulfills every day. As a specialized career option, nurse managers are required to complete several stages of schooling, registration, and experience. Nursing managers first operate as nurses in a medical setting before assuming roles that add administrative responsibilities.  Liability of the Nurse Managers II. Responsibilities of the Nurse Managers Nurse managers fulfill a wide range of responsibilities. At the same time that nurse managers provide patient care, they also maintain responsibilities that involve the oversight of healthcare processes. Fulfilling both administrative and personal care roles, nurse managers can influence how and why hospitals and healthcare organizations use certain processes.  Liability of the Nurse Managers 1. Negligence and malpractice Nurse managers can be held liable for any negligence or malpractice that occurs under their supervision. 2. Staff training Nurse managers are responsible for ensuring that their staff is adequately trained and competent to perform their duties. They should also ensure that staff members know how to operate equipment safely. 3. Standards of care Nurse managers must ensure that standards of care are being met. They should also take appropriate action when a problem is detected.  Liability of the Nurse Managers 4. Staffing Nurse managers are responsible for meeting staffing requirements, including minimum nurse-to-patient ratios. They should also consider how to accommodate for short staffing. 5. Patient care Nurse managers are responsible for ensuring that patients receive safe and efficient care. They should also facilitate underperforming staff members.  Liability of the Nurse Managers 6. Patient condition Nurse managers may be held liable if they are aware of a patient's declining condition and the provider fails to respond. In this case, the nurse manager should go through the chain of command to get the treatment needed for the patient. 7. Fatigue Errors due to fatigue can have serious consequences for nurses, their employers, and their managers. Healthcare organizations can implement strategies to reduce healthcare worker fatigue to help prevent these tragedies.  Professional 0 Issues: The 5 Nurse and The Contract Professional Issues: The Nurse and The Contract An agreement between two or more competent persons upon sufficient consideration to do or not do some lawful act Can be written or oral The Elements of Contract Offer is an invitation to a contract. It’s the promise to do or not do something. Acceptance occurs when the parties mutually negotiate to reach an agreement. Consideration may be to make a financial payment or provide a  7 Key Ingredients of Contract Who – in the case of contracts are the parties involved. What – is the scope of work. Where – is the location of the work. When – is the timeline of work. How Much – is the terms of payment. The Date – is simply the date the contract becomes effective. Signatures – it close the deal and the contract is complete. Contract in Nursing It refers to the nurses duty to render care established by the presence of an expressed or implied contact.  Breach of Contract Breach of a contract occurs when one or more parties to contract fail to meet up with obligations/ responsibilities It also means a violation of contract through failure to perform contractual obligations whether partially or wholly or as described in the contract. In breach of contract cases, the plaintiff may be able to recover as damages, the cost of the procedure, nursing care and other monetary expenses that may result from the breach of contract. Where there is breach of contract, the resulting damages will have to be paid by the party breaching the contract to the aggrieved party.  Ways of Breaching a Contract  Fails to perform their obligations under the contract in whole or in part  Behaves in manner that shows an intention not to perform their obligations.  The contract becomes impossible to perform as a result of defaulting party’s own act. Types of Breach of Contract  Actual Breach – it occurs when one party fails or refuses to perform his promises his promise under the contract.  Anticipatory Breach – it is also known as repudiator breach. This occurs when a party demonstrates his intention to breach a contract 0 Incident Report 6  Incidents are related to physical injuries, medical errors, equipment failure, administration, patient care, or others. anything that endangers a patient or staff's safety is called an incident in the medical system. INCIDENT REPORT IN HEALTHCARE - with incident reporting, an emerging problem is highlighted in a non-blaming way to root out the cause of the error or the contributing factors. designated staff with authority to file a report or staff who has witnessed an incident firsthand, usually file the incident report in the hospital. When To Write? when an events result in an injury to a person or damage to a property, incident reporting becomes a must.  Incident Report Purpose IR provide valuable information to hospital administration facilities: 1. ROOT CAUSE IDENTIFICATION – all incidents have a cause. mishaps are pretty uncommon in hospitals settings and most accidents can be root caused by a potential reason. 2. POLICY AND PROCESS IMPROVEMENTS – some incident are part of a larger pattern that can only be identified by looking at them together. 3. CLINICAL RISK MANAGEMENT – a subset healthcare risk management, uses incident report as essential data point. 4. CONTINOUS QUALITY IMPROVEMENT – All hospitals have continuous improvement plans that help them stay updated with all the latest developments in patient safety and quality by assessing, evaluating, and improving their processes and methods over time. 5. BETTER TRAINING AND CONTINUOUS LEARNING – Incident data are essential sources of knowledge and on-the-job training material. Types of Incident Report in Healthcare and Hospitals 1. CLINICAL INCIDENTS: A clinical incident is an unpleasant and unplanned event that causes or can cause physical harm to a patient. These incidents are harmful in nature; they can severely harm a person or damage the property. 2. NEAR MISS INCIDENTS: Sometimes an error/unsafe condition is caught before it reaches the patient. Such incidents are called “near-miss” incidents. However, the problem might have diffused before the severe harm, but it is still essential to report near-miss incidents. Nearly 50 near-miss incidents occur for each injury reported. 3. NON CLINICAL INCIDENTS: Non-clinical incidents include events, incidents, and near-misses related to a failure or breach of EH&S, regardless of who is injured or involved. 4. WORKPLACE INCIDENTS: A work accident, occupational incident, or accident at work is a discrete occurrence that can lead to physical or mental occupational injury. The workplace incidents are related to mental as well as physical hurts. According to the BLS’s Workplace Injuries and Illness News, nursing assistant jobs have the highest incidence rates.  Conflict 0 Management and The Nurse 7  Conflict Conflict is generally defined as the internal or external discord that results from difference in ideas. Values, or feeling between two or more people. Conflict is also created when there are differences in the economic and professional among professionals. Scarce resources, restructuring and poorly defined role expectations also are frequent sources of conflict in organizations. Conflict – Definition Conflict is a clash between hostile or opposing parties. Conflict can be defined an expressed struggle between at least two interdependent parties, who perceive that others are preventing them from achieving their goals.  Conflict Management – Definition Conflict management is the process of planning to avoid conflict where possible and organizing to resolve conflict it does happen. As rapidly and smoothly as possible. Remember…. Conflict is neither good nor bad, and it can produce growth or destruction, depending on how it Sources of Conflict Informational Factors – decreased knowledge and information leading to conflict. Perceptual Factors – when persons have different images of the same stimulus. Role Factors – ie; each individual occupies a certain position or status in the society or in the organization, when disruption, conflict development.  Sources of Conflict Skill Differences Competition for Scarce Resources. EG.: Money and Skilled Man Power Role Ambiguity Inter Group Rivalry for Rewards Shift in Organizational Power Base Unworkable Organizational Structure Pressure to Avoid Failures Unhealthy Competitions Sources of Conflict Psychological Factors – feeling of insecurity is a patent cause of tension and conflict. It is generally the case that fear of security is 20% financial and 80% emotional. Self knowledge and recognition will probably ensure better security. Conflicts may also arise due to lack of consideration, lack of appreciation, misunderstanding or bad handling of situations  Effects of Conflict Win-Lose Outcome Lose-Lose Outcome Win-Win Outcome Stress Absenteeism Staff Turnover Demotivation Non-productivity