Lecture 2 - Legal aspects of Nursing (1).pdf

Legal aspects of Nursing Dr. Enas Mohamed lofty Associate Professor in hospital and nursing administration PNU Intended 1 2 3 leaning Outcomes (ILOs) Identify the different legal terms in Nu...

Legal aspects of Nursing Dr. Enas Mohamed lofty Associate Professor in hospital and nursing administration PNU Intended 1 2 3 leaning Outcomes (ILOs) Identify the different legal terms in Nursing Recognize the different types of law Describe the Patient Bill of Rights and Responsibilities  Law in Nursing Law: "the sum total of rules and regulations by which a society is governed. As such, law is created by people and exists to regulate all persons"  Law in Nursing "Nursing practice is governed by many legal concepts. Knowledge of laws that affect nursing practice is needed to ensure nurse’s decisions and action's in work area and also it will protect the nurse from liability Source of Law 1.Statutory law Created by various government legislative authority such as the congress,or city ‫إنشاؤها من قبل مختلف السلطات ر‬ council.‫التشيعية الحكومية‬  Source of Law 2. Administrative/ regulatory law Established through the authority given to a government agency by a legislative body, such as the state board of Nursing. ‫خالل السلطة‬ ،‫تشيعية‬‫الممنوحة لوكالة حكومية من قبل هيئة ر‬  Types of Law Public law: it refers to the \body of law that deals with relationship between individuals and the government and the governmental agencies. It has 2 Types: Criminal law: Which deals with safety and welfare of the public. (protect society) Civil law: it is the body of the law that deals with relationship among private individuals. (enforces rights of individuals) Examples: 1. Criminal Law (1)Felony ‫(الجناية‬most serious! Includes serious nature (e.g., murder) punishable by term in prison (2)Misdemeanor ‫ الجنحة‬less serious punishable by a fine or short- term jail sentence, or both (e.g., a nurse who slaps a client’s face could be charged with a misdemeanor) Fraud – Robbery- Death due to lack of or incorrect nursing care  Examples of crimes A Nurse may break a criminal law and be tried in criminal court. Examples: Illegally distributing controlled substancesor altering a patient’s record ‫توزيع المواد الخاضعة للرقابة بشكل غير قانوني أو تغيير سجل المريض‬ A nurse who administers an additional and lethal dose of a narcotic may be charged with second-degree murder or man slaughter ‫جريمة قتل من الدرجة‬ ‫الثانية‬  2- Civil Law Civil law : It is the body of the law that deals with relationship among private individuals. law that is administered between citizen and citizen usualy involve the violation of one individual’s rights by another individual ‫عادة ً ما تنطوي على انتهاك حقوق فرد ما من قبل فرد آخر‬  2- Civil Law Civil law is classified into contract law and tort law ‫نقسم القانون المدني إلى قانون‬ ‫العقود وقانون الضرر‬ Contract law ‫انتهاك اتفاقيات‬: is the enforcement of agreements among private individuals. Tort law ‫الضرر‬: it defines and enforces duties and rights among private individuals that are not based on the contractual agreement. e.g.: invasion of privacy, assault and battery ‫انتهاك الخصوصية واالعتداء والضرب‬  Tort Tort: a civil wrong committed against a person or property 1. Intentional torts : injuries caused by willful/ harmful, forceful and aggressive behavior The outcome is planned Assault Battery Client abandonment False imprisonment  1.Intentional torts a)Assault ‫ االعتداء‬: threat or attempt to make bodily contact without another person’s consent; causes fear that battery about to occur Example: a nurse who threatens a client with an injection for refusing an oral medication b) Battery : assault carried out, impermissible touching; actual harm may or may not occur Example: Give patient vitamin injection against their will  1.Intentionaltorts–contd… C ) Client abandonment: ‫التخلي عن العميل‬ Abandonment occurs when the treatment relationship ends, but this necessary process does not occur, Examples: leaving the ward without a notice Being unavailable to other care providers because you are distracted by playing computers, face book, making calls or text..  Intentional torts –contd… d) False Imprisonment: Refers to restraining or restricting an individual’s freedom Examples: Applying physical restraints without doctor’s permission or with no justification Keeping a patient in the hospital against their will  Tort: 2. Unintentional torts: wrong committed against another person or property that was not intended to happen Malpractice Negligence  2 - Unintentional torts A) MALPRACTICE: “bad practice”: providing improper or unprofessional treatment or care that results in injury to a person closely related to negligence Example: Medications administered by a health care worker who has no training/knowledge of medications(like nursing assistant giving medications instead of nurse) Elements of Malpractice There are 6 elements that must be present for a case of nursing malpractice to be proven. 1. Duty: the nurse must have a relationship with the client that involves providing care and following an acceptable standard 2. Breach of duty‫اإلخالل بالواجب‬: standard of care that is expected in the specific situation but that the nurse did not observe. 3. Foreseeability: a link mustexist between the nurse’s act and the injury occurred. Elements of Malpractice – contd.. 4.Causation: it must be proved that harm occurred as a direct result of nurse’s failure to follow the standard of care. 5.Harm or injury: the client mustdemonstrate sometype of harm or injury ( physical, financial, or emotional) 6.Damages: if malpractice caused the injury, the nurse is held liable for damages that may be compensated.  2 - Unintentionaltorts–contd.. B) NEGLIGENCE: failure to give care that is normally expected of a person in a particular position, resulting in injury of another person Commission ‫ =ارتكاب‬doing something that should not have been done Omission ‫ = اإلغفال‬failing to do things that should have been done Examples: fallsandinjuries that occur when side rails are left down or wheel chairs wheels not locked using defective equipment infections caused by use of non-sterile instruments  CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTICE 1.Failure to follow standards of care 2.Failure to use equipment in a responsible manner 3.Failure to communicate 4.Failure to document 5.Failure to assess and monitor 6.Failure to act as a patient advocate  CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTI contd… 1-Failure to follow standards of care Perform a complete admission assessmentor design a plan of care Adhere to standardized protocol e.g.. using improper site of injection Folow physician's order or written orders. 1-Failure to follow standards of care. Standards such as hospital policies have evolved to protect consumers from substandard care. Standards of care are derived from sources such as state boards of nursing, professional nursing associations (for example, the ANA and the National League for Nursing), hospital policies and procedures, and the guidelines of federal organizations (for example, JCAHO and the Centers for Medicare and Medicaid Services). Introduction to Professional Ethics Page 05 1- Failure to follow standards of care. Sarah” is a nursing professional. She was assigned to care for “Mr. Mohamed ”. “Mr. Mohamed ” was required to receive the medications order for him in a timely manner…. Introduction to Professional Ethics Page 05 1- Failure to follow standards of care. SHE stopped by his room and found he was not in his bed. The bathroom door was closed and you heard moaning..‫أنين‬ SHE decided to give him his privacy. SHE continued to provide care for the other patients you are assigned to. Introduction to Professional Ethics Page 05 Failure to follow standards of care. SHE came back to “Mr. Mohamed ” room about one hour later and SHE finds him in cardiac arrest on the bathroom floor. You failed to properly follow your facility’s standard of care and reasonable nursing judgment by not making sure your patient was “OK” when you checked on him. Page 05 1- Failure to follow standards of care. Example situations demonstrate where a nursing professional may have a claim made against him or her include: Failure to follow proper “fall” or other safety protocols established by the health care institution. Failure to administer certain medications in a timely and reasonable way. Introduction to Professional Ethics Page 05  CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTI contd… 2-Failure to use equipment in a responsible manner Folow the manufacturer's recommendation for operating equipment Learn how equipment functions Check equipment for safety before use Place equipment properly during treatment  2-Failure to use equipment in a responsible manner. Some sample situations that could cause malpractice allegations ‫ادعاءات‬ against you may include: If you move the equipment before it is fully charged and the battery goes dead during critical transport. CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTICE- 3-Failure to communicate notify a physician in timely manner when condition warrant it Listen to a patient’s complaints and act on them Communicate effectively with a patient e.g. discharge instructions CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTICE- contd. 5-Failure to assess and monitor Complete a shift assessment Implement a plan of care Observe a patient ongoing progress Interpret patient’s signs and symptoms 3-Failure to assess and monitor and failure to communicate. Vital aspects of communication besides timeliness in reporting the change include persistence in notifying the physician of the change Page 09  Mr. Ahmed died from injuries sustained in a fall from his third-floor window; the nurse assigned to care for Mr. AHMED testified that during her last evening visit with him, he had experienced an episode of tachycardia and hypertension. Page 09  He had also behaved atypically, desiring isolation and refusing all nursing care and his prescribed medication, known to have adverse effects, including confusion, anxiety, and psychosis Page 09 The nurse did not report the symptoms and the change in behavior to the physician. She also testified that when she observed the patient at midnight, he appeared to be sleeping; she did not reassess his vital signs. Introduction to Professional Ethics Page 09 Mr. AHMED's surgeon testified that, because of the mind-altering adverse effects of the patient's medication, he would have reassessed his patient if he had been notified of the changing signs and symptoms. Expert testimony opined that the nurse was negligent , failing to adequately monitor Mr. AHMED on the evening and night before he died, Introduction to Professional Ethics Page 09 and that the hospital was negligent ,failing to maintain a safe environment (evidence presented at trial showed that the hospital had not acted on a JCAHO directive to restrict the opening of windows in patients' rooms). CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTICE- 4-Failure to document A patient progress and response to treatment Patient injuries Patient nursing assessment e.g. drug allergy Verbal orders from physicians and action taken Failure to document. Documentation showing evidence of nursing assessment and diagnosis, planning for nursing intervention, implementation and evaluation of planned interventions, and patient response. Introduction to Professional Ethics Page 32  4-Failure to document. A couple years ago you had a patient whose condition worsened on your shift. You remember contacting the physician when you noticed the change in condition and you reported to the oncoming shift to continue to monitor the situation.. 4-Failure to document. Later that morning the patient died. Now, you are specifically named in a lawsuit, there is no written or electronic documentation of your conversation with the physician or the other health care professional. 4- Failure to document. Examples of when a nursing professional may be sued include: 1. Failure to document the final status of your patient at the end of your shift; this may lead to lack of continuous care by the oncoming shift. 2. Failure to document a phone call or other communication with a health care provider who has the authority to give you orders and the patient becomes more ill. Without the entry of your communication it becomes a “he said” / “she said” situation.  Failure to document. Examples of when a nursing professional may be sued include: 3. Failure to document your medication dosage, which results in an overdose when another nursing professional administers the dosage. (The patient was double dosed). CATEGORIES OF NEGLIGENCE THAT RESULT IN MALPRACTICE- contd. 6-Failure to act as a patient advocate Question discharge orders when patient's condition warrants it Question incomplete or illegal medical order provide a safe environment  Tort: 2. 3. Quasi-intentional torts: it usually involves situations of communication and often violate a persona's reputation, personal privacy or civil rights. Invasion of Privacy‫نتهاك الخصوصية‬ Defamation of character‫التشهير بالشخصية‬  3. Quasi Intentional torts a) Invasion of privacy: unnecessaryexposure of an individual or revealing personal information about an individual without consent Examples: Improper draping or covering of a patient during a procedure Sending information to an insurance company without the patient’s written permission Telling the newsmedia about patient  3-Quasi Intentional torts –contd.. b) Defamation of character: it is a communication that is false, or made with a careless disregard for the truth. Example: a nurse writes in her nurse’s notes that a physician is incompetent or telling a client that her colleague is incompetent Occurs when false statements cause one of the following: a.leads to a person being ridiculed b.damage to a person’sreputation Spoken Information is called Slander..‫لمعلومات المنطوقة تسمى القذف‬ Written Information is called Libel..‫المعلومات المكتوبة تسمى التشهير‬  Patient Bill of Rights and Responsibilities 1. The Right to Be Treated with Respect. 2. The Right to Obtain Your Medical Records. 3. The Right to Privacy of Your Medical Records. 4. The Right to Make a Treatment Choice. 5. The Right to Informed Consent. 6. The Right to Refuse Treatment. 7. The Right to Make Decisions About End-of-Life Care.  Saudi - Patient Bill of Rights The Saudi PBR defines patients' rights as “accessible health care that meets their needs, to be treated with respect, to receive understandable information, to be involved in treatment options and plans, to file a complaint and to the inviolability of personal privacy.”  Patient Bill of Rights and Responsibilities Reference: www.moh.gov.sa 1. Patients and their families have the right to health care 2. Knowledge of Rights and Responsibilities of Patients and their Families 3. Providing Health Care and Services Based on Respect and appreciation 4. Privacy and Confidentiality 5.Providing Protection and Safety 6.Healthcare Plan Engagement  Patient Bill of Rights and Responsibilities-contd… Reference: www.moh.gov.sa 7. Refusal of Treatment 8.Availability of Material Costs and Health Insurance Policy 9. Clarity and Comprehensiveness of Forms and Reports 10.Availability of Policies and Procedures for Complaints and suggestions 11.Availability of Policies and Procedures for Organ and Tissue donation 12. Participation in Research and Study Programs REFERENCES Patricia Stauton &Mary Chiarella (2020). Law for Nurses and Midwives,(9th ed).Elsevier Black, B. (2016) Professional Nursing: Concept & Challenges. 8th ed. USA: SaundersPublishing.