N112 Legal Issues in Nursing PDF

Legal Issues in Nursing 1 A: Examines legal controls for nursing practice B: Illustrates the legal responsibilities of a nurse C: Discusses clients’ rights and responsibilities For detailed objectives and content outline, please refer to your N112 syllabus 2 Required Reading: Taylor, C., Lynn, P., B...

Legal Issues in Nursing 1 A: Examines legal controls for nursing practice B: Illustrates the legal responsibilities of a nurse C: Discusses clients’ rights and responsibilities For detailed objectives and content outline, please refer to your N112 syllabus 2 Required Reading: Taylor, C., Lynn, P., Bartlett, J.L. (10th edition) Student Activities: Chapter 7, pp 143-171 Chapter 18, pp 475-478 Chapter 19, pp. 517-548 ANA’s Principles for Nursing Documentation: http://www.nursingworld.org/~4af4f2/globalassets /docs/ana/ethics/principles-of-nursingdocumentation.pdf Case studies 3 1 Legal Controls For Nursing Practice 4 Law A standard or rule of conduct established and enforced by the government that is intended chiefly to protect the rights of the public 5 5 Law Definitions Public Law Civil (Private) Law Criminal Law Direct government involvement Regulates people and government Describes powers of government Regulates people vs. people Contracts, property ownership, nursing practice A type of public law State and federal statutes Defines criminal actions (murder, criminal negligence, theft) 6 6 2 Sources of Law Constitution Legislation Nurse Practice Acts Administrative State BRN Common Stare decisis 7 Statutory Law Laws enacted by any legislative body Legislative body Federal (Congress) State (State Legislature) 8 Statutory laws affecting nurses Nurse Practice Act Good Samaritan Act Child & Adult abuse laws Living wills Sexual harassment laws Americans with Disabilities Act 9 3 Administrative Law Rules and regulations adopted by administrative facilities/agencies Administrative agencies executive officers develop specific rules and regulations that direct the implementation of statutory law. State Nursing Boards at the state level City board of health at the municipality (local) level 10 10 Common Law Stare decisis or “let the decision stand” Comes from court decisions The judge can apply the same rules and principles from a similar case 11 Nurse Practice Act LEGAL CONTROLS FOR NURSING PRACTICE BRN regulations Credentialing Voluntary Controls National League for Nursing Joint Commission 12 4 LEGAL CONTROLS FOR NURSING PRACTICE California Nurse Practice Act Laws regulating practice and licensure of nursing Protects the public Enforces rules and regulations concerning the nursing profession Defines important terms and activities in nursing Defines scope of practice and responsibilities of RNs 13 LEGAL CONTROLS FOR NURSING PRACTICE BRN Credentialing Ways to ensure professional competence is maintained For California: CEU: 30 CEU every 2 years 14 LEGAL CONTROLS FOR NURSING PRACTICE Voluntary Controls National League for Nursing Interprofessional Education Joint Commission National Patient Safety Goals 15 5 CRIMES AND TORTS A wrong committed against a person or property Criminal Violation punishable by the State or Federal Tort Violations subject to prosecution in civil court with damages settled by money 16 16 Criminal Actions Disputes between an individual and the society as a whole Examples: Homicide, manslaughter, theft, arson, active euthanasia, sexual assault, illegal possession of controlled drugs A nurse found guilty of a criminal action may lose their license 17 17 CIVIL LAWS TORT LAW Can be unintentional or intentional Defines and enforces duties & rights among private individuals that are not based on contractual agreements Tort law recognizes that individuals in their relationships with each other have a general duty not to harm each other (ethical principle of nonmaleficence) A legal or civil wrong carried out by one person against the person or property of another. 18 6 Intentional Tort Act was on purpose or with intent Grounds for prosecution Liability may still exist even if no harm occurs Intentional torts related to nursing: Assault and battery Defamation of character (Libel/ Slander) Invasion of privacy False imprisonment Fraud 19 19 Intentional Torts: Assault Assault “An attempt or threat to touch another person unjustifiably” A person who makes a gesture with a closed fist is guilty of assault Assault in Nursing A nurse who threatens a client with an injection after the client refuses to take the medication orally would be committing assault 20 20 Intentional Torts: Battery “The willful touching of a person (or the person’s clothes) that may or may not cause harm” If the nurse had given the injection without the client’s consent Liability applies even if there is a doctor’s order 21 7 22 Intentional Torts: Defamation of Character “Communication that is false, or made with a careless disregard for the truth, and results in injury to the reputation of a person” Includes both LIBEL & SLANDER 23 23 Intentional Torts: Defamation of Character “Communication that is false, or made with a careless disregard for the truth, and results in injury to the reputation of a person” Includes both LIBEL & SLANDER 24 24 8 Defamation: Libel 25 Defamation: Slander Defamation by the SPOKEN WORD by which a reputation is damaged The nurse tells the patient that Nurse Jones is incompetent. 26 26 Intentional Torts: Invasion of Privacy Invasion of Privacy “A direct wrong of a personal nature” The client has the right to privacy Nurse breaches confidentiality: HIPAA Confidential client information Intrudes on client’s privacy Never discuss client situations in the elevator, cafeteria, or other public areas 27 27 9 Intentional Torts: False Imprisonment “Unjustifiable detention of a person without legal warrant to confine the person” False imprisonment accompanied by forceful restraint or threat of restraint is battery 28 28 False Imprisonment Types of Restraints Physical Restraining limbs Moving a person to another location against their will Environmental Seclusion room Secure (Locked) units Mechanical Pharmacologic Four siderails up Chair with locking table Limb, waist, and trunk restraints Backfastening seat belts Sedatives Antipsychotic Antidepressant Benzodiazepine 29 30 10 Intentional Torts: Fraud Willful and purposeful misrepresentation that could cause loss or harm to a person or property Practicing nursing without a license 31 Unintentional Torts Malpractice Negligence by healthcare providers/ professionals Negligence Failure to act as a reasonably prudent person. 32 32 Two Forms of Malpractice Commission Doing something that should not have been done Omission Failing to do something that should have been done 33 33 11 Liability “The quality or state of being legally responsible for one’s obligations & actions and to make financial restitution for wrongful acts” Nurse’s obligation: Prevent harm or injury to client Maintain standards of care 34 34 Four Elements of Liability The nurse has assumed the duty of care The nurse breached the duty to care by failing to meet the standard of care The failure of the nurse to meet the standard of care was the proximate cause of the injury The injury is proved Taylor: Table 7-2, pp. 128 35 35 Treatment Causes for Liability Medication administration Communication/confidentiality Monitoring/observing/supervising Safety Taylor, Box 7-3, pp. 132 36 36 12 Legal Safeguards for Nursing Practice 37 Legal Safeguards for Nursing Practice Documentation Competent practice Informed Consent or Refusal Contracts Standards of clinical nursing practice Professional liability insurance Institutional policies & procedures Sentinel Events 38 38 Communication with the health care team Credentialing Why Document? Legal Reimbursement Quality process and improvement 39 13 Documentation examples “Pt states –CAN’T U C I’M DONE? Currently, pt kneeling at bedside with eyes closed. Non-skids socks on. Will continue to monitor.” “Patient turned off bed alarm, OOB by self.” “C/O SOB SPo2 82%, will continue to monitor” “No SS distress, VSS skin warm and dry. LSCTA. Bowel Sounds PAL. Ambulated.” “Pt. oob to chair, refused to go back to bed, unsteady. MD aware, Charge Nurse aware.” 40 Documentation Characteristics High Quality Documentation: Specific to the event, concise, clear and complete Timely, Sequential and complete Legible Reflective of the nursing process 41 Disclosure Patient/surrogate has been informed of the (1) nature of the procedure, (2) risks (nature of the risk, magnitude, probability that the risk will materialize) and benefits, (3) alternatives (including the option of nontreatment), and (4) fact that no outcomes can be guaranteed. Comprehension INFORMED CONSENT Patient/surrogate can correctly repeat in his or her own words that for which the patient/surrogate is giving consent. Competence The patient understands the information needed to make this decision, can reason in accord with a relatively consistent set of values and can communicate a preference. The surrogate (if needed) meets the above criteria, knows the patient’s wishes to the extent that this is possible, and is free from undue emotional stress and conflict of interests. Voluntariness The patient is voluntarily consenting or refusing. Care has been taken to avoid manipulative and coercive influences. 42 14 INFORMED CONSENT CHECKLIST Disclosure Comprehension Competence Voluntariness Informed of procedure’s nature Risks & benefits Alternatives No guaranteed outcomes Correctly verbalize satisfactory understanding of procedure Understands information Able to reason Can communicate preferences Freely consenting or refusing No coercion/manipulation 43 43 Consent Client must be competent to give consent If the nurse is concerned regarding client competency you must resource to your supervisor for guidance Consent is required before procedures are performed Battery exists if there is no consent Life-threatening emergencies Experts agree medically necessary Client unable to consent Legally authorized person unreachable to consent 44 44 Expressed Consent Oral or written agreement Two Types of Consent Implied Consent Exists with client’s non-verbal behavior Sit up to take meds Give arm for B/P Life-threatening medical emergencies 45 45 15 Three Groups Can Not Provide Consent Minors: parent or guardian must give consent Adult with mental capacity of a child (viewed as a minor) Appointed guardian must give consent Impaired judgment unconscious or injured Mentally ill patients, professionally deemed incompetent 46 46 Exceptions: Consenting minors Some minors are legally permitted to provide their own consent Married Pregnant Parents Members of the military Emancipated (living on their own) 47 Witness to having seen client sign consent form In all instances: Nurse’s Role - Consent Assess client’s understanding of procedure and voluntariness Answer client’s questions Notify provider of client’s need for further clarifications Ensure signed consent or refusal is in client’s chart 48 48 16 Right to considerate & respectful care Right to information (dx, tx, prognosis) Right to decide (plan of care) Right to advance directive (ex. Living will) Right to privacy (consultation, examination) Right to privacy (records, chart, labs) Right to request care/services/ referrals/ transfer to another facility Right to information Right to consent or decline services Right to be informed of hospital policies & procedure related to their care Clients’ Bill of Rights Patients’ Bill of Rights 49 Clients have the right to insist on leaving even though it may be detrimental to their health Client advocate role: Make sure the client is aware of all risks of leaving up to and including death Ask: Why do you want to leave? Exceptions: Active TB patients / Public Health Threats House Arrest 50 HIPAA 50 51 51 17 Do Not Resuscitate DNR orders “Do Not Resuscitate” Terminal ill clients, expected death Written when a client has expressed no resuscitation in the event of a respiratory or cardiac arrest Goal: dignified death, comfortable measures 52 52 53 53 Review Website: www.rn.ca.gov Nurse Practice Act Statutes & Regulations 54 54 18 Examined legal controls for nursing practice Conclusion Illustrated the legal responsibilities of a nurse managing individualized care Discussed clients’ rights and responsibilities 55 55 Questions??? 56 56 References Taylor, C., Lynn, P., Bartlett, J.L. (2023). Fundamentals of nursing: The art and science of person-centered nursing care (10th ed.). Philadelphia: Wolters Kluwer. 57 57 19