Ch 22 Legal Implications

Front 1

Nurse Practice Act

Back 1

describe and define the legal boundaries of nursing practice within each state

Front 2

Regulatory law, or administrative law

Back 2

is created by administrative bodies such as State Boards of Nursing when they pass rules and regulations

Front 3

Common law

Back 3

is created by judicial decisions made in courts when individual legal cases are decided

Front 4

Criminal laws

Back 4

prevent harm to society and provide punishment from crimes

Front 5

Two classifications of crimes: Felony

Back 5

is a crime of a serious nature that has a penalty of imprisonment for greater than 1 year or even death

Front 6

Two classifications of crimes: Misdemeanor

Back 6

is a less serious crime that has a penalty of a fine or imprisonment for less than a year

Front 7

Civil laws

Back 7

protect the rights of individual persons within our society and encourage fair and equitable treatment among people

Front 8

The damages for civil laws involve

Back 8

the payment of money, unlike criminal laws, which are punished by imprisonment

Front 9

Standards of care

Back 9

are the legal guidelines for nursing practice.

Front 10

Nursing standards of care are defined in the

Back 10

Nurse Practice Acts and by the State Board of Nursing of each state, by the federal and state laws regulating hospitals and other health care institutions, and by the written policies and procedures of employing institutions

Front 11

In a malpractice lawsuit, nursing standards of care are used to

Back 11

measure nursing conduct and to determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances

Front 12

Nurse Practice Acts established

Back 12

educational requirements for nurses, distinguish between nursing and medical practice, and generally define the scope of nursing practice

Front 13

American Nurses Association

Back 13

has developed standards for nursing practice, policy statements, and similar resolutions

Front 14

Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Back 14

requires that accredited hospitals have written nursing policies and procedures

Front 15

Institutional policies and procedures must

Back 15

conform to state and federal laws, as well as community standards, and cannot conflict with legal guidelines that define acceptable standards of care

Front 16

In a lawsuit for malpractice or nursing negligence, a _ _ is called to testify to the jury about the standards of nursing care as applied to the facts of the case

Back 16

nursing expert

Front 17

Nurse experts must base their opinions on

Back 17

existing standards of practice established by Nurse Practice Acts, professional organizations, institutional policies and procedures, federal and state hospital licensing laws, and current nursing research literature

Front 18

The nurse is obligated to seek appropriate treatment for the client both

Back 18

ethically and legally

Front 19

fiduciary relationship

Back 19

is one in which a professional, the nurse, provides services which by nature cause the recipient, the client, to trust in the specialized knowledge, the integrity, and the fidelity of the professional

Front 20

Emergency Medical Treatment and Active Labor Act (EMTALA)

Back 20

This act provides that when a client comes to the emergency department or the hospital, an appropriate medical screening must be done within the hospital's capacity

Front 21

Under EMTALA a transfer to another hospital can be performed if

Back 21

1. Receiving facility agrees to the transfer, has space for the client, and has qualified personnel to receive the client; 2. the medical records must be forwarded to the receiving hospital; 3. the client must be transported by qualified personnel and transportation equipment

Front 22

Mental Health Parity Act of 1996

Back 22

forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benefits

Front 23

A petition for involuntary detention must be filed with the court within _ hours of the client's initial detention. A hearing must be conducted within _ days of the filing of the involuntary petition

Back 23

96 hours; 2 days

Front 24

If the judge determines that the client is a danger to self or others, the client can be detained for _ more days for psychiatric treatment

Back 24

21 days

Front 25

Two basic advance directives:

Back 25

living wills and durable powers of attorney

Front 26

Patient Self-Determination Act (PSDA)

Back 26

requires health care institutions to provide written information to clients concerning the clients' rights under state law to make decisions, including the right to refuse treatment and formulate advance directive

Front 27

Under PSDA, it must be documented in the client's _ whether the client has signed an advance directive

Back 27

chart

Front 28

In order for living wills or durable powers of attorney for health care to be enforceable, the client must

Back 28

be legally incompetent or lack decisional capacity to make decisions regarding health care treatment.

Front 29

The determination of legal competency is made by a

Back 29

judge

Front 30

The determination of decisional capacity is usually made by the

Back 30

physician and family

Front 31

Living wills

Back 31

are written documents that direct treatment in accordance with a client's wishes in the event of a terminal illness or condition

Front 32

Generally, _ witnesses, neither of whom can be a relative or physician, are needed when the client signs a living will

Back 32

two

Front 33

Durable power of attorney

Back 33

designates an agent, surrogate, or proxy to make health care decisions if and when the client is no longer able to make decisions on his/her own behalf

Front 34

Ethical doctrine of autonomy ensure the client

Back 34

the right to refuse medical treatment

Front 35

Every state now requires "_ and _" evidence of the client's choice, but individual states differ as to what standard satisfies the amount of evidence required

Back 35

"clear and convincing"

Front 36

A DNR order should be

Back 36

written, not given verbally

Front 37

"_ _" or "_ _" may be defined differently by various institutions and may be interpreted as not performing resuscitative procedures as a competent person would

Back 37

"slow codes" or "partial"

Front 38

_ is a procedure that is performed on an appropriate client unless a _ order is written in the client's chart

Back 38

CPR; DNR

Front 39

Legally competent adult clients may consent to a DNR order either

Back 39

verbally or in writing after being given the appropriate information by the physician.

Front 40

A verbal consent for a DNR requires

Back 40

two witnesses, one of whom must be a physician affiliated with the hospital.

Front 41

A written consent for a DNR requires

Back 41

two adult witnesses

Front 42

If no surrogate is available to give consent, the DNR order can still be written but

Back 42

only if the physician is reasonably medically certain that the resuscitation would be futile

Front 43

The statutes provide that the attending physician must review the DNR orders every

Back 43

3 days fro hospitalized clients or every 60 days for clients in residential health facilities

Front 44

An individual who is at least _ years of age may make an anatomical gift or organ donation

Back 44

18;
anatomical gift is defined as a "donation of all or part of a human body to take effect upon or after death"

Front 45

The anatomical gift must be made in

Back 45

writing and signed by the donor

Front 46

Uniform Anatomical Gift Act of 1987

Back 46

unless the gift is revoked by the donor before death, no further consent is required after the donor's death.

Front 47

In most states Required Request laws mandate that at the time of admission to a hospital,

Back 47

a qualified health care provider must ask each client over 18 whether they are an organ or tissue donor

Front 48

Required Request laws are also part of the _ _ _ _, which addresses many issues involving organ donation, including the rights and duties at death.

Back 48

Uniform Anatomical Gift Act

Front 49

The physician who certifies death

Back 49

shall not be involved in the removal or transplantation of organs

Front 50

National Organ Transplant Act of 1984

Back 50

prohibits the purchase or sale of organs. The act also provides civil and criminal immunity to the hospital and physician who acts in accordance with the act. The act also protects the donor's estate from liability for injury or damage that may result from the use of the gift.

Front 51

Health Insurance Portability and Accountability Act

Back 51

limits the extent to which health plans may impose preexisting condition limitations and prohibits discrimination in health plans against individuals participants and beneficiaries based on health status.

Front 52

One of the ways that insurance companies keep costs down is

Back 52

by not insuring certain preexisting conditions that clients have when they obtain group health insurance coverage.

Front 53

HIPPA requires insurers to only limit coverage for a preexisting condition for

Back 53

12 months in most cases

Front 54

The advantages of HIPPA are

Back 54

that employees can change jobs without losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage

Front 55

Privacy Standards

Back 55

these rules create client rights to consent to use and disclose protected health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information

Front 56

HIPPA requires that nurses and all health care providers avoid

Back 56

discussing clients in public hallways and should provide reasonable levels of privacy in communicating with and about clients in any manner

Front 57

FDA has set forth guidelines for the use of restraints

Back 57

1. only to ensure the physical safety of the resident or other residents 2. only on the written order of a physical that specifies the duration (usually 24 hours) and circumstances under which the restraints are to be used

Front 58

The most frequent indications for restraints are

Back 58

1. unanticipated risk of injury to self (falls) or others; 2. interference with treatment 3. clinically disruptive or disturbing behavior

Front 59

A license can be _ or _ by the State Board of Nursing if a nurse's conduct violates provisions in the licensing statue based on administrative law rules that implement and enforce the statue

Back 59

suspended or revoked

Front 60

Because a license is viewed as a _ right, due process must be followed before a license can be suspended or revoked.

Back 60

property

Front 61

Due process means

Back 61

that nurses must be notified of the charges brought against them and that the nurses have an opportunity to defend against the charges in a hearing

Front 62

Good Samaritan Law

Back 62

These laws limit liability and offer legal immunity for nurses who help at the scene of an accident. They also provide that a nurse can assist a minor in an emergency at the scene of an accident or competitive sports event before obtaining the parent's consent

Front 63

Nurses should check their own state's Good Samaritan statue because

Back 63

some states (Minnesota and Vermont) require nurses to stop and help in an emergency

Front 64

The purpose of public health laws are

Back 64

protection of the public's health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for the care provided

Front 65

Public Health Laws may include

Back 65

reporting suspected abuse and neglect, such as child abuse, elder abuse, or domestic violence, reporting communicable diseases, ensuring that required immunizations have been received by clients in the community, and reporting of other health-related issues enacted to protect the public's health

Front 66

Every state with child abuse legislation requires that

Back 66

suspected child abuse or neglect must be reported

Front 67

Health care professions who do not report suspected child abuse or neglect may be

Back 67

held liable for civil or criminal legal action

Front 68

There are two standards for the determination of death

Back 68

1. The cardiopulmonary standard requires irreversible cessation of circulatory and respiratory functions. 2. The whole-brain standard requires irreversible cessation of all functions of the entire brain, including the brain stem

Front 69

Uniform Determination of Death Act

Back 69

has been adopted in most states and provides that either the cardiopulmonary definition or the whole-brain definition may be used to determine death

Front 70

In many states there is an order of priority for the giving of consent for autopsies

Back 70

1. decedent, in writing; 2. durable power of attorney; 3. surviving spouse; 4. surviving child, parent, brother, or sister in the order named

Front 71

Oregon Death with Dignity Act

Back 71

the statute provided that a competent individual with a terminal disease defined as an "incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months" could make an oral and written request for medication to end his/her life in a humane and dignified manner

Front 72

There was a _-day waiting period between the initial oral request and the writing prescription and no less than a _-hour waiting period between the written request and the writing of the prescription

Back 72

15 day; 48 hour

Front 73

Tort

Back 73

is a civil wrong made against a person or property

Front 74

A tort can either be

Back 74

unintentional or intentional

Front 75

Malpractice

Back 75

is negligence committed by a professional such as a nurse or physician

Front 76

Intentional tort

Back 76

are willful acts that violate another's rights.

Front 77

Examples of Intentional torts

Back 77

1. Assault 2. Battery 3. Invasion of privacy 4. Defamation of character

Front 78

Assault

Back 78

is any intentional threat to bring about harmful or offensive contact
Example: a nurse threatening to give a client an injection without the client's consent

Front 79

Battery

Back 79

is any intentional touching without consent
Example: if the nurse actually gives the injection without consent

Front 80

A battery always includes an

Back 80

assault, which is why the terms assault and battery are commonly combined