Legal & Ethical Issues in Perioperative Nursing PDF

LEGAL, REGULATORY AND ETHICAL ISSUES IN PERIOPERATIVE PRACTICE Learning Outcome: 1. State legal issues in perioperative nursing 2. Contrast patient consents 3. Describe ethical issues in perioperative nursing The learning outcome addresses the Nursing Council Competency units 1,...

LEGAL, REGULATORY AND ETHICAL ISSUES IN PERIOPERATIVE PRACTICE Learning Outcome: 1. State legal issues in perioperative nursing 2. Contrast patient consents 3. Describe ethical issues in perioperative nursing The learning outcome addresses the Nursing Council Competency units 1, 2, 3, 4  Introduction to Legal Issues  HCW have the duty to safeguard the safety and rights of patients  Patient is at risk for harm during any surgical procedure  These factors may provide HCW with ethical dilemma's complicated by legal issues.  Respect for the patients autonomy & the patients right to make informed decisions about his/ her own health care should be considered & balanced by the professional obligations of beneficence ( the duty to benefit) & non- maleficence (not to harm)  LIABILITY  To be liable is to, be legally bound and responsible for personal actions that adversely affect another person  Every patient care provider should always perform duties in accordance with standards and practice guidelines established by the government, institution and the regulatory bodies.  Deviation from these standards and practices that cause injury to the patient can result in Liability for Negligence or Malpractice.  For this type of civil suit to be successful, the plaintiff has to prove that negligent care or malpractice caused the injury Negligence  Negligence is the failure to use the care or skills that any care giver in the same or similar situation would be expected to use.  These acts of omission or commission that cause damage to a patient may give rise to tort (any civil wrong or injury) action, which is a civil lawsuit Civil - applying to ordinary citizen Civil suit – a lawsuit alleging violations of civil law by the defendant Civil law – a body of law established by a state or nation for its own regulation Malpractice: is any professional misconduct, unreasonable lack of skill, judgement, illegal or immoral judgement  Medical care & professional liability have become institutional problems.  The primary cause of Professional liability cause is: Iatrogenic medical injury – an injury or other adverse outcome sustained by a patient because of treatment or care  Many incidents in the perioperative environment have been causes for a lawsuit IATROGENICC MEDICAL INJURY - LAW SUITS 1. Borrowed Servant Rule 2. Extension Doctrine 3. Assault And Battery 4. Invasion Of Privacy 5. Abandonment  1. Borrowed Servant Rule  In the past surgeons were considered the captain of the ship in the perioperative environment and was liable for the negligence act of the servants.  But courts now recognize that the surgeon does not have complete control over the acts of perioperative team at all times  Each member of the team has significant performance autonomy  A good example: The counting of sponges, sharps and instruments. Facility establishes the mechanism by which employee accounts for items used during an open procedure. The surgeon does share some liability if he/she prevents the team from accomplishing this task.  2. Extension Doctrine  If surgeon goes beyond the limit to which the patient consented.  Liability for assault & battery may be charged  This doctrine implies that the patient explicit consent for a surgical procedure serves as an implicit consent for any or all procedures deemed necessary to cope with unpredictable situations that puts patients health at risk By medical necessity and sound judgement , the surgeon may perform a different or an additional surgical procedure. The surgeon may extend the surgical procedure to correct or remove any abnormal or pathologic conditions under the extension doctrine The court will decide whether patient consented to a specific procedure or generally to the surgical treatment of a health problem. 3. Assault and Battery in legal terms  Assault: is an unlawful threat to harm another physically  Battery: is the carrying out of bodily harm as by touching without authorization or consent  Lack of informed consent to perform a procedure is an important aspect of an assault – and –battery charge  Inform consent must be obtained by the physician and consent to perform a procedure must be given voluntarily with full understanding of implications by the patients  The purpose of a written, signed and witness consent are to protect the surgeon, anesthesia provider, perioperative team members and facility from claims of unauthorized procedures and to protect the patient from unsanctioned procedures.  4. Invasion of Privacy  The patients right to privacy exists by the common law, The patients charts, medical record, video tapes, x-rays are considered confidential information for use by physicians and other HCP directly concerned with patients care  The patient should give written consent for video taping or photographing his/ her surgical procedure for medical education or research  The patient has the right to refuse photographic consent  Patient has the right to expect that all communications and records pertaining to individualized care will be treated as confidential & will not be misused  This includes the right to privacy during interview, examination & treatment  The surgery schedule bearing the names of the patient should not be posted in a location where the public or other patients can read it  Every HCW has a moral obligation to hold in confidence any personal / family affairs learned from patients  5. Abandonment:  Consist of leaving the patient for any reason, when the patient's condition is contingent (dependent) on the presence of care giver  If the care giver leaves the room knowing there is a potential need for care during his/ her absence, even under the order of a physician , the care giver is liable for his/ her own actions  If an event necessitates leaving a patient, it is important to transfer care to another caregiver of equal status and function  The circulating nurse may be considered negligent by reason of abandonment for failure to monitor a patient within the OR  The circulating nurse should be in attendance during induction, of & emergence from anaesthesia & through out the surgical procedure to assist as needed. CONSE NT 1. General 2. Informed General Consent: Most facilities requires patient or his/ her legal guardian to sign a general consent form on admission. This form authorizes the attending physician and the staff to render standard day to day treatment or to perform generalized treatments and care as the physician deems advisable Each facility should have policies & procedures in place about the authorization of general consent. Many require that GC is done on admission before admitting to the ward & is done by the admissions clerk, who is a nonmedical person This in no way equals Informed consent Informed Consent:  The physician's duty to inform the patient of the risks, benefits & alternatives of a procedure and to obtain consent before treatment.  Failure to do so may be considered a breach (the act of breaking) of duty  Informed consent is a process -not just a paper document that is signed  Explanation of the procedure, risks, benefits & alternative therapy are made verbally to the patient's level of understanding  Informed consent is a Protective Act for the patient & the treating physician & should be documented appropriately  The Anesthesia provider also has the responsibility to inform patient of any potential for unfavorable reactions to any anesthetic agent or medication  Other items relating to informed consent 1. Informed consent for a surgical procedure 2. Responsibility for informed consent before surgical procedure 3. Validation of consent 4. Witnessing a consent 5. Consent in emergency situation 6. Right to refuse surgical procedure & 7. Second opinion Documentation of Perioperative care Verbal communication between patients & HCP does not constitute legal documentation of care Entries in the record provide a history of patient's clinical course & responses to treatment Record serves to identify what was done The broad assumption is that if something is not documented, it was not done The record serves as a means of communication amoung providers for continuity of care ETHICAL ISSUES ETHICAL ISSUES: o Professions have code of conduct and documents that include value statements derived from moral concepts. o Nurses have international Code of Ethics. Nationally, we have our PNG Nurses Code of Ethics o The ethics of a profession establish the role & scope of professional behavior and the nature of relationship with patients & colleagues o Universal moral principles guide ethical decision making & activities in clinical practice Bioethical Situations:  An ethical dilemma arises in the work situation when the choice between two or more alternatives create a conflict between an individual's value system & moral obligation to the patient, to the family or SO, to the physician, workers or coworkers.  Conflicts can be between rights, duties & responsibilities  Both legal & ethical considerations can cause conflict  The rights to refuse to participate maybe covered by a law but not at the expense of a patient's safety & welfare Bioethical situations that present ethical dilemma’s  Reproductive sterilization  Abortion  Euthanasia (an act of killing someone painlessly –especially someone suffering from an incurable disease)  Right to die o Organ Donation and Transplantation