Legal and Ethical Nursing Considerations PDF
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This document presents legal and ethical considerations in nursing practice. It covers topics such as controlled acts, drug standards, and the nursing process. The material includes practice questions related to ethical and legal situations nurses may face.
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LEGAL AND ETHICAL CONSIDERATIONS Chapter 3 1 Regulated Health Professions Act (RHPA) and Nursing Act Legislationthat governs Ontario's regulated health professions' Colleges. College of Nurses of Ontario Scope of practice Controlled acts authorized to nursing...
LEGAL AND ETHICAL CONSIDERATIONS Chapter 3 1 Regulated Health Professions Act (RHPA) and Nursing Act Legislationthat governs Ontario's regulated health professions' Colleges. College of Nurses of Ontario Scope of practice Controlled acts authorized to nursing 2 Controlled Acts Acts considered harmful if performed by unqualified persons 5 of 14 authorized to nursing when ordered 3 Controlled Acts for Nursing 1. Perform a prescribed procedure below the dermis/mucous membrane 2. Administer a substance by injection or inhalation 3. Put an instrument, hand or finger beyond a body orifice or artificial opening in the body. 4. Dispensing a drug. (NEW for RPNs) 5. Treating by means of Psychotherapy 4 Authorizing Mechanisms Order written, client-specific Directive written, pre-existing orders, a group of clients Havingthe authority to administer a medication does not necessarily mean it is appropriate to do so! 5 When is an order required? Controlled act Injection or inhalation Below the dermis Instrument or hand/finger beyond body orifice Dispensing a drug Part of medical POC Lab tests Not included within RHPA but included in other legislation (eg. X-Ray) 6 Canadian Food and Drug Act Primary piece of legislation governing foods, drugs, cosmetics, and medical devices According to the Act, drugs must comply with official prescribed standards Recognized formularies Various schedules Health Products and Food Branch federal regulator 7 Non-Prescription Drugs/OTC Open Access/Unscheduled – pharmacist not required, sold in any store, used to Tx minor discomforts i.e. Tylenol Open Access/Scheduled- pharmacist must be available to answer questions, used for self-limiting problems i.e. suppositories, ulcer medications, antihistamines Restricted Access/Scheduled - “BTC”, dispensed by pharmacist i.e. low dose codeine Tylenol #1 8 Non-Narcotic Prescription Drugs [Schedule F] may be prescribed and refilled only by qualified practitioners: MD, dentist etc. i.e. antibiotics, corticosteroids etc. 9 Controlled Drugs and Substances Act (CDSA) Replaced the Narcotic Control Act in 1997. Provides requirements for the control and sale of narcotics, controlled drugs, and substances of misuse The letter N and the symbol are printed on the label of every narcotic drug. RCMP is responsible for enforcement of the CDSA 10 Restrictions for Narcotics Restricted possession Persons in possession of these drugs must ensure their security, promptly report any loss/theft and maintain complete records of the disposition of the drugs Canonly be dispensed by prescription, for a specified amount of time before reassessment 11 Legal Possession of Narcotics by a Nurse When administering to a client with a Dr.’s order When acting as the custodian of narcotics in a health care facility …”carrying the keys” Whenthe narcotic has been prescribed for medical treatment for the nurse 12 Managing Narcotics Narcotics are kept locked Strict Documentation (NAR) Narcotic Count Q shift Count must be correct Co-sign waste Set timeframe for review of the prescription 13 Drug Standards Purity: outline type and concentration of allowable impurities i.e. dyes, flavorings, buffers, fillers etc. Potency: the strength of the drug is standardized Bioavailability: degree to which the drug can be absorbed and transported by the body to its site of action Efficacy: the effectiveness of the drug Safety: measured by the incidence and severity of reported adverse reactions 14 Sources of Drugs Plants Animal Products Inorganic Compounds Synthetic Sources 15 New Drug Development Ongoing process Our system of drug research and development is one of the most stringent in the world Developed out of concern for patient safety and drug efficacy Natural Health Products Regulation (2004) Health Canada drug approval process Once approved, drug is assigned a Drug Identification Number (DIN). 16 Four Clinical Phases of Inves tigational Drug Studies Phase I: small number of health subjects (usually fewer than 100) Phase II: larger numbers of volunteers who have the disease or ailment (usually 100 to 300) Phase III: larger number of patients who are followed by medical research centres (1 000 to 3 000) Phase IV: postmarketing studies voluntarily conducted by drug companies to obtain information of the therapeutic and adverse effects of the new drug 17 Special Access Programme Allows health care providers compassionate access to drugs unavailable for sale in Canada Limited to those with serious or life- threatening conditions, where other treatments: have failed are unsuitable or are not available in Canada 18 Patient Access to and Costs of Prescription Drugs High drug expense significant barrier for access to prescription drugs as they are not covered under the Canada Health Act. People specifically affected include low income, those with no drug benefits, and those in poor health. Marginalized, Lower SES 19 Legal Nursing Considerations Nursing practice standards of care Scope of practice Case law or common law consisting of prior court rulings also affect professional nursing practice. Canadian Nurses Association (CNA) is the national voice for nurses. CNO Accreditation Canada requires accredited hospitals to fulfill certain standards in regard to nursing practice. 20 Areas of Potential Liability Liablefor negligence and malpractice Failure to assess or re-evaluate Failure to ensure safety Medication errors 21 Ethical Considerations Ethical principles are useful strategies for health care providers and include standards or truths on which ethical actions are made. Autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity CNA Code of Ethics for registered nurses (RNs) International Council of Nurses (ICN) Code of Ethics for Nurses 22 Legal and Ethical Nursing Consideration s Providing safe, compassionate, competent, ethical care Promoting health and well-being Promoting and respecting informed decision making Honouring dignity Maintaining privacy and confidentiality Promoting justice 23 Right of Nurse to Refuse Care Violates the nurse’s personal ethical principles Nurse speaks to supervisor or manager to request unit transfer, but must not abandon the patient. Nurse is responsible for providing nonjudgemental nursing care. Nurse always acts in the best interest of the patient while remaining an objective patient advocate. 24 Practice Question A nurse has been asked to participate in an elective procedure that violates the nurse’s personal ethical principles. The nurse should A. refuse to participate. B. ask to switch assignments with another nurse. C. speak to the manager or supervisor. D. perform the procedure. 25 Practice Question A research group is conducting an investigational drug study on a promising new drug. It has been difficult to find research participants who meet the criteria. Just before the conclusion of the study, four participants approach the researchers and express their desire to withdraw from the study. The researcher should first: A. inform them that they waited too long to withdraw from the study. B. explore with them the reasons for withdrawing from the study. 26 C. acknowledge that they can withdraw at any time from Practice Question A nurse does not notice that a patient’s IV site is swollen, red, painful, and warm to touch, nor that the IV is not infusing properly. This is an example of failure to: A. Assess B. Evaluate C. Ensure safety D. Obtain informed consent 27 A research-based organizational framework for professional nursing practice Flexible, adaptable, and considered the major The systematic framework for professional nursing practice Nursing Ensures the delivery of Process thorough, individualized, and quality nursing care to patients Requires critical thinking (clinical reasoning and clinical judgement) Ongoing and constantly evolving process 28 Five Steps of the Nursing Process Assessment Nursing diagnosis Planning Goals Outcome criteria Implementation, including patient education Evaluation 29 Assessment Data collection, review, and analysis Medication profile Any and all drug use Home or folk remedies; natural heath products or homeopathic treatments Alcohol, tobacco, caffeine intake Current or past illicit drug use Prescriptions and over-the-counter medications Past or present health history and associated drug regimen Family history; growth and developmental stage Issues related to age and medication regimen 30 Nursing Diagnoses Three-step process: PART I: Human response to illness, injury, or significant change PART II: Factors related to the response (“related to”) PART III: Listing of cues, clues, evidence, or other data that support the nurse’s claim for the diagnosis (“as evidenced by”) 31 Nursing Diagnosis Nursing diagnoses are used to communicate and share information about the patient and the patient’s experience. Common nursing diagnoses related to drug therapy develop from data associated with: Deficient knowledge Risk of injury Nonadherence Various disturbances, deficits, excesses, or impairments in bodily function Other problems or concerns related to drug therapy 32 Planning Identification of goals and outcome criteria Goals Objective,measurable, and realistic, with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria Outcome criteria Concrete descriptions of patient goals 33 Implementation Implementation is guided by the preceding phases of the nursing process. Initiation and completion of specific nursing actions as defined by nursing diagnoses, goals, and outcome criteria Independent, collaborative, dependent Statements of interventions include frequency, specific instructions, and any other pertinent information. 34 Evaluation Systematic, ongoing, and dynamic part of the nursing process Determining the status of the goals and outcomes of care Monitoring the patient’s response to drug therapy Therapeutic, expected, and toxic responses Clear, concise documentation 35