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138 Cards in this Set
- Front
- Back
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Legal Aspects Impacting Nursing Practice
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Civil and Criminal Laws
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Two types of laws affecting the nurse patient relationship
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Statutory Laws
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Responsible for nursing licensure
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Federal Laws
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create regulations to which nurses adhere in practice.
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Civil Laws
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Deal with crimes against a person in torts, contracts, legal documents, and consents.
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Tort
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Civil wrong committed against a person and includes infraction of a duty or violation of an obligation classified as either unintentional or intentional.
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Unintentional Tort
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Negligence and Malpractice.
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Intentional Tort
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Acts that the defendant committed with intention to harm others. Ex Assult, Battery, or Invasion of privacy and confidentiality.
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Fraud
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Act of deliberate deception with the purpose o generating unlawful gain.
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Defamation of Character
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occurs when information is communicated to a third party causing damage to an individuals reputation either in writting (libel) or verbally (slander)
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False Imprisonment
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occurs when patients are made to wrongfully believe they cannot leave a place by the use of physical or chemical restraints.
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Breach of Duty
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Can take place only when a nurse violates a standard of care found in a document or as stated by an expert witness.
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Abandonment
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Occurs when a nurse leaves a serious ill patient without first being sure that someone else will provide necessary care.
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Contracts
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-Agreements among individuals that can be either written or oral.
-Can be implied |
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4 Elements of a valid contract
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1 prmomise for the perfrmance of actions.
2 mutual understanding of the terms by all 3 legal purpose of activities 4 compensation |
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Legal Documents
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Legaldouments that can affect nurses are DNR orders, health care records, inident/irregular ocurances report, organ procurement prodcedures
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Advanced Directives
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Legal documents that state the wishes of the individual reguarding health care in the event theare no longer capable of giving information.
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Advanced Directive Types
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Living wills, health care proxies, and power of attorney.
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DNR Orders
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limits resuscitation in the event of a cardiac arrest.
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Incident/Unusual occurrence report
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Record of an accident in a health care setting
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Organ Donor
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Any person18 years or older can become an organ donor bywritten consent. In absence of documentation the family can authorize a donation.
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Organ Donation
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Nurses are expected to approah famiies for organ donation along with physicians, social workers, and clergy with the goal of timely removal of organs.
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Consent
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A voluntary act by which a person agrees to allow another to do something. PT consent for treatment can be expressed or implied.
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Informed Consent
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Patient has been provided and understands the reasons for treatment, risks and benefit, nnd indicates the understanding by signing a form.
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Informed Consent
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Nureses role in informed consent is to witness the signiture which indicates the patients consent was voluntar, authentic, and competent.
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Informed Consent
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Nurses are NOT responsible for explaininga medical or surgical procedure.
The right to refuse and change one's mind after signing the consent remains the patients domain. |
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Professional Liability
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Nurses are incouraged to carry professional liability insurance.
Most hospitals have liabilty insurance to cover nurses. Supervising nurse can be held liable for other nurses' actionsin cases where the nurse making assignments used poor judgment. |
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Criminal laws
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Deal with disbutes between an individual and the general welfare of the public.
In nursing can be applied with patient abuse, assisted suicide, substance abuse/use. |
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Criminal laws
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Nurses can often identify patient abuseand so are often included as a mandated reporter.
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Criminal law
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Some states have laws permitting assisted suicide for those severly ill or near death. If such assistance is not a legal action nurses can face criminal charges.
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Criminal Laws
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Misuse of controlled substances by nurses can lead to criminal charges.
It is estimated that 10-15% of nurses are chemically impaired. |
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Statutory Law
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Regulates nursing practice in reguardes to credentialing through licensure, nurse practice acts, reporting requirments, and other practice issues.
Includes both state and federal regulation. |
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License
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Is granted to an individual in order to practice a profession and use a title. It is the states responsibility to determining licensing requirments.
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State Board of Nursing
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Determine apprpriate examinations which measure minimum competency for practice as a registered nurse.
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National Council Licensure Examination for Registered Nurse (NCLEX-RN)
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Exam has been adopted by all 50 states.
Grads from foreign schools must provide proof of nursing education verification that meets state requirments before taking NCLEX. |
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Nursing Practice Acts
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Legally define the scope of nursing practice.
These Acts help to protect nurses against litigation. |
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Multistate Licensure
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Allows an individual recieving an RN liense in one state to become legally permitted to practice in additional states w/o obtaining additional licenses.
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Unlicensed Assistive Personnel
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States have laws regarding the use of delegation of nursing tasks to unlicensed assistive personnel.
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Mandatory Continuing Education
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Some states require CEU for the renewal of license.
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Good Samaritan Acts
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Designed to protect from lawsuit those healthcare workers who provide assistance at the scene of an emergency.
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Sunset Laws
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Provide that any regulatory act, such as the nurse practice act, if not reauthorized, will automatically be rescinded after a predetermined length of time.
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Reporting Requirments Related to Suspected Abse
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Set by state statutory laws.
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Grounds for Revocation of License
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State boards are responsible for deciding.
Can include violating the nurse practice act, chemical dependency, or professional misconduct. |
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Federal Statutory Laws
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Americans with Disability Acts
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Prohibits discrimination on the basis of disability in employment, public services, and accomodations.
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Patient Self Determination Act
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Required that upon admission to any health care service, patients be given an oppertunity to determie what life-saving/prolonging actions they want to be undertaken.
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Health InsurancePortability and Accountability Act (HIPPA)
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Federally legislated act to protect a patients privacy.
Forbids the release of information to anyone without the patient's consent. Patients are required to sign statements giving approval for release of info including to insurance companies. |
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Omnibus Budget Reconciliation Act (OBRA 1987)
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Federal budget bill that mandated quality care standards for nursing homes recieving reimbursment from medicare/medicaid. Positively affected care of residents.
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Family and Medical Leave Act (FMLA 1992)
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Balances the demands of family. Job security is provided when the individual is caring for a family member.
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Occupational Safety and Health Act (OSHA)
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Provides safety in the workplace.
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Legal Process of a Lawsuit
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Nurses should be fimiliar with the legal process of a lawsuit.
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Discovery
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A process of gathering information through documentation, as in a health care record.
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Plaintiff
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If a suit results in trial the plaintid becomes the individual bringing suit.
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Defendants
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People that are named in the suit. They may be asked to serve as expert witness.
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Expert Witness
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Defined as a witness qualified to be an expert through knowledge, skill, experience, and training. This witness is not directly involved in the case.
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Other Legal Concerns
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Enviromental Exposure.
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Examples are blood born pathogens such as HIV and hepatitis B. Occupational Safety and Health Administration (OSHA) mandates protective measures such as sharps containers and protective eyewear.
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Violence
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OSHA issued guidelines for facilities for use to est a safer workplace.
Training staff in the managment of hostile and violent behavior. Installing enviormental safeguards such as panic buttons and bullet proof glass. |
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Whistleblower
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Individual in the workplace who reports wrong doing of others to authorities.
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Harassment
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Can be committed by patients, co-workers, or physicians. sexual harassment. Exployers are legally responsible to have clear policies prohibiting harassment. Legal liability can result if employer fails to do so.
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Unionization
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Joining a union representing the nursing profession has been an accepted practice with the number of enrolled nurses increasing.
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Unionzation
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Nurses have the legal right to either join a union or not join.
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Values Clarification
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Process by which people identify and develop their personal convictions.
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Personal Values
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Judgments one internalizes from society.
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Professional Values
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Nurses professional values are acquired during socialization into nursing and are obtained through codes of nursing ethics nursing experiences, and from instructors and peers.
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American Association of Colleges of Nursing (AACN)
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Identified five essential values for the professional nurse.
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1. Alttruism
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Concern for the walfare of others.
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2. Autonomy
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The right to self-determination, reflects the nurses' respect for patients' rights in making health care decisions.
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3. Human Dignity
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Respect the worth and uniqueness of individuals and is seen when nurses value and respect all patients.
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4. Integrity
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Acting in accordance with an appropriate code of ethics and accepted standards. It is relected in nursing practice when the nurse provides care within an ethical framework as accepted w/i the profession.
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5. Social Justice
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Upholds moral principles, as when the nurse works to ensure equal treatment under the law and provide equal access to health care.
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Code of Ethics
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Formal statement of a groups ideals and values.
The profession of nursing developed a number of guidelines related to ethics. |
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ANA code of ethics for nursing.
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Stress the nurses' obligation to the patient in protecting the patient from incompetent, unethical, or illigal practice.
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International Council of Nurses(ICN) Code of Ethics
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Addresses the general responsibilities of nursing, followed by specific concerns of people, practice and the profession. It contains a pledge for nursing and coworkers as well as a statement of affirmation and acceptance of the personal and ethical responsibilities of the nursing profession.
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Nursing's Social Policy
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Provides a definition for nursing and descrbes a basis for practice. It provides significant ideals for all nurses, spcifically autonomy, self-regulation, and accountability.
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American Hospital Association(AHA)
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Published the Bill of Rights outlining the rights of hospitalized patients.
Serves as a basis for decision making. Now referred to as the Patient Care Partnership |
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Nurses responsibilities
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Identifying practice limitations and working within them. Nurse has an ethical duty to serve as a patient advocate. Important to maintain professionalcompetence by engaging in self-evaluation, identifying weakness, and working to improve.
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Ethical Theories
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Teleological/ Utilitarianism Therories
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Look to the consequences of an action in judging whether the behavior is right or wrong.
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Deontological Theories
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Emphasize individual rights, duties an obligations. The morality of an action is determined by a principle.
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Caring Theories
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Stress courage, generosity, commitment, and need to nurture and maintain relationships.
Caring theories judge actions according to a perspective of caring and responsibility in promoting the welfare or common good of the group. |
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Social Equity and Justice theories
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Support justice and equal rights for everyone.
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Components of Ethical Reasoning
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Moral Principles
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General conceptsthat provide the foundation for moral rules and specific regulations for practice.
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Principles that apply to nursing
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Veracity
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Refers to telling the truth and not misleading atients intentionally. Ex- tell the truth if it causes anxiety or lie in the interest of relieving fear.
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Fidelity
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Means faithful agreements and promises. Make sure promises made to patients promote a trusting relationship.
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Autonomy
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Involves the right to make ones own decisions. Nurses follow this ethical principle when theyaccept a patients decision reguarding heath care when such decisions do not seem to be in the patients best interest.
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Beneficence
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Refers to deeds that are helpful and appropriate. Nurses are obligated to implement actions that will aid and better their patients.
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Nonmaleficence
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A duty to do no harm, either intentional or unintentional.
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Justice
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Being fair to all people. Nurses make decisions regarding impartiality to all patients for whom they care. Confidentiality is where information is not shared.
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Privacy
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Is the right t be free from intrusion. It includes the right to have control over how sensitive information is shared.
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Ethical Decision Making
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Several models exsist to assist in making a decision and involve a series of steps.
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Ethical Decision Making
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Identify the problem, gather data, identify the options, consider the impact, finally carry out the decision and assess its outcome.
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Specific Ethical Issues
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Beginning of life issues
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Abortion outs the principles of autonomy against the sanctity of life. Nursing ethics supports the patients' right to information and counseling regarding making decisions.
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Sustaining quality of life
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Genetic screening makes it possible to determine if a person is genetically redisposed to certain diseases.
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Eugenics
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The study of methods to improve inherited human charateristics.
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Human Genome Project
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Research project designed to discover the entire human genome sequence. Knowledge about DNA variations can lead to new ways to diagnose and treat thousands if disorders
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End of Life Issues
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5. Social Justice
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Upholds moral principles, as when the nurse works to ensure equal treatment under the law and provide equal access to health care.
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Code of Ethics
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Formal statement of a groups ideals and values.
The profession of nursing developed a number of guidelines related to ethics. |
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ANA code of ethics for nursing.
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Stress the nurses' obligation to the patient in protecting the patient from incompetent, unethical, or illigal practice.
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International Council of Nurses(ICN) Code of Ethics
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Addresses the general responsibilities of nursing, followed by specific concerns of people, practice and the profession. It contains a pledge for nursing and coworkers as well as a statement of affirmation and acceptance of the personal and ethical responsibilities of the nursing profession.
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Nursing's Social Policy
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Provides a definition for nursing and descrbes a basis for practice. It provides significant ideals for all nurses, spcifically autonomy, self-regulation, and accountability.
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American Hospital Association(AHA)
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Published the Bill of Rights outlining the rights of hospitalized patients.
Serves as a basis for decision making. Now referred to as the Patient Care Partnership |
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Nurses responsibilities
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Identifying practice limitations and working within them. Nurse has an ethical duty to serve as a patient advocate. Important to maintain professionalcompetence by engaging in self-evaluation, identifying weakness, and working to improve.
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Ethical Theories
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Teleological/ Utilitarianism Therories
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Look to the consequences of an action in judging whether the behavior is right or wrong.
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Deontological Theories
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Emphasize individual rights, duties an obligations. The morality of an action is determined by a principle.
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Overview- Standards
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Standards
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Have been developed to provide the highest qulity care for patients. Accrediting agencies also set standards for nursing practice.
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American Nurses Association Scope and Standards of Practice
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Describes the who,what,when,where,why, and how of nursing practice and the responsibilities a nurse is accountable.
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State Nurse Practice Acts
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Legally define nursing and set standards for nursing practice in each state. The nurse practice acts are detailed in some states, whereas in others they are general in scope.
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Critical or Clinical Pathways
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Additional means of assuring quality and cost effective care. Institutions will often develop or utilized accepted guidelines for specific conditions, such as for a stroke or MI.
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Evidence-based Practice
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Uses clinical research outcomes in nursing procedures.
Various methods used are peer reviews, selfevaluation, and performance appraisal. |
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Research
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Quantitative
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Instruments are used to collect and statstical methods are used to analysis the data.
Quantatative research attempts to be objective, free of the researchers biases and values. |
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Qualitative
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The researcher is the primary instrment used for collecting the data. Findings are often reported in the form of verbal descriptions.
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Quality Managment/Quality Improvment
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Total quality managment is also known as continuous quality improvement.-Refers to a philosphy that defines a corporate culture emphasizing customer satisaction, innovationand employee involvment.
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Total Quality Managment
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Hospitals use total quality managment to attempt to prevent patient care problems by focusing on the process in which care is delivered.
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Total Quality Managment
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The overall goal is to improve the quality of care.
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Outcomes Management
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Involves setting goals for improvment by using a measurable standard.
Critical Pathways-Grid that outlines key events expected to happen each day a patient is hospitialized based on their diagnosis. |
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Process-Involves 6 steps
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1. Identify needs of the health care consumer
2.assemble a multidisciplinary tm to review the identified needs 3. Collect data |
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Process 6 steps
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4.Est measurable outcomes.
5. Develop a plan to meet the outcomes. 6. Evaluate the implementation of the plan. |
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Risk Managment
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Attempts to analyze problems and minimize loses after patient care errors occur.
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Nursing Theory Overview
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Theory is defined as a system of ideas to explain a phenomenon.
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Major Nursing Theories
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Peplau Interpersonal Relations Model-1952
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Focused on the nurse-atient relationship. Identifies 4 phases. Orientation, Identification, Exploitation, and resolution. Her model is used today when working with psychiatric patients.
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Henderson-1966
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Defined nursing as a seperate disipline from medicine and viewed the nurse as one who is concerned with both healthy and ill patients.
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Leininger's Cultural are Diversity and University-1970
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Describes transcultural nursing, in the degree to which nursingcare is impacted by an individuals culture.
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Orem's Theory of Self Care -1971
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Based on concept of responsibility assumed by the individual and explains how nurses can empower patients to attend to themselves. It is the one theory most closely identified with acute care nursing.
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Roger's 1970 Science of Unitary Human Beings
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Baseon multiple scientific disciplines and states that human beings are dynamic energy fields functioning in cont exchange with the enviroment.Theory is applied with noncontact therapeutic touch with patients.
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Roy's Adaptation Model-1977
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Focuses on increasing complexity of a person and enviroment and the relationship among people, the universe, and a supreme being.
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Roy -Cont
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Model is used by nurses to enhance life processes through adaptation in 4 models. physiological, self-concept, role function, and interdependence.
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Watson's Humn Caring Theory 1979
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describes the centrality of caring to nursing interventions and utilizes carratice factors.
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King's Goal Attainment Theory
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Shows the relationship between individuals, groups, and social systems and the nature of these relationshps to goal attainment.
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Neuman's System Model
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Based on the individuals relationship to stress, it causes, and corrective interventions. Her model is applicable to a variety of nursing pratice settings.
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