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53 Cards in this Set
- Front
- Back
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What are some legal principles that are important to nurses?
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1. Unintentional Torts = negligence
2. Intentional Torts and quasi-intentional torts = assault, battery, false imprisonment, intentional infliction of emotional distress, defamation of character (slander, libel), invasion of privacy, breach of confidentiality |
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Define negligence
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failure to act in a reasonably prudent manner as would anyone with the same education, experience; you don't need an intent to act; there must be proof of damage, there must be a duty of care / standard of care, consent is NOT a defense
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Define intentional tort
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willful action; outcome was not the intention, it is the action that was intentional; not required to have damage, duty to the patient is not required; patient consent CAN ALWAYS be used as a defense.
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Define assault
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apprehension of immediate harmful or offensive contact. Example: If you don't eat, I will stick an NG tube in you!
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Define battery
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Harmful/offensive touching; defenses = patient gave consent (blood draws); there was no harm involved
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Define invasion of privacy
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Looking at something there is no need for you to look at (medical records); example, Hilary Clinton is in the hospital, but you work in peds and want to peek.
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Define breach of confidentiality
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Taking private information and disseminating it to the world; example, your peeking at someone's record is sold to the National Enquirer.
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Define false imprisonment
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confining or restraining; e.g. restraints are a form of this
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Define intentional infliction of emotional distress
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using words or actions to cause heightened concern / anxiety
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Define the two types of defamation of character
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Slander -- verbal defamation
Libel -- written defamation |
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Identify 4 elements of negligence which must be present to prove liability for malpractice
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1. Duty of care
2. Breach of standard of care a. Res ipsa loquitor -- "the thing speaks itself"; common sense b. Negligence per se -- not due to lack of professional knowledge, but a layperson would not know. 3. Causation 4. Damage |
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What can a nurse do to reduce the risk of malpractice?
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1. practice in a safe setting (good nurse/patient ratios)
2. communicate 3. delegate wisely 4. meet/exceed standards of care 5. carry professional liability insurance 6. promote positive relationships |
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What are some different types of liability?
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1. personal liability -- 3rd part is injured or property damaged
2. corporate liability - extent to which corporation is liable for acts of their employees--used in criminal law 3. vicarious liability -- in criminal law it applied to holding one personal liable for the actions of another; in civil cases it is the secondary liability which holds superiors liable for the actions of their subordinates (those who could control that violator) |
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Define res ipsa loquitor
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"the thing speaks for itself"; in order to prove negligence in this case you must prove that:
1. harm would not have occurred without someone's negligence 2. the thing which caused the harm was under exclusive control of the defendant 3. there must be an absence of a reasonable explanation as to how the harm occurred |
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Define respondeat superior
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"let the master answer"; employer who is responsible for the actions of the employees performing in capacity of employment. "Master Servant Rule"; used in both common and civil law. 3 considerations are necessary:
1. Was act committed in time/ space of the agency? 2. Was offense incidental to the responsibilities of the agent authorized to perform? 3. Was agent motivated to any degree to benefit the principal by committing the act? |
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What are 3 elements of informed consent?
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1. Understanding -- information has been conveyed and understood
2. Capacity -- pt has capacity to understand 3. Voluntary -- pt has freely consented to give consent |
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What is capacity?
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Capacity is dependent on many factors, including maturity level and state of mind. A certain level of maturity is needed for decision making. The patient must also have the cognitive abilities to make decisions.
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Describe two possible exceptions to informed consent
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1. Therapeutic -- opinion of the healthcare provider that informed consent would do more harm than good; old idea; rarely used now.
2. Emergency--delay of tx would be life threatening and there is no surrogate available. |
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Describe different roles the nurse would play in a legal case
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1. plaintiff -- nurse is suing someone
2. defendant - nurse is being sued 3. factual witness - nurse saw something and needs to testify; good documentation needed for recall 4. expert witness -- what would nurse have done in similar situation? |
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Discuss 5 approaches to defense of malpractice case
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1. contributory vs. comparative negligence - the extent to which the patient's own actions contributed to the harm; what % of blame can be attributed to each of the parties concerned
2. Assumption of risk - pt knowingly assumed risk 3. Good Samaritan statute - varies from state to state; you are not required to give assistance, but if you do and adverse consequences arise you are not at fault (unless you do something that is beyond your professional scope such as a nurse trying to perform surgery) 4. Unavoidable accident- you could not reasonably forsee 5. Defense of fact - pt must prove there was an injury and injury was directly caused by your actions |
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What is a tort?
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a wrong against an individual alleging negligence
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What is the Patient Self-Determination Act?
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1991 - enacted to promote knowledge and usage of advance directives in patient care; healthcare providers must ask the patient if they have one in place and if they do not, provide information on how they can set one up if they like.
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What is the history of advanced directives?
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In the 1960's, living wills were established to provide direction regarding a person's medical care under specific circumstances (very vague). Advanced directives grew from this to include instructions on what types of care the patient would like should they become incapacitated. Durable power of attorney is the strongest legal document in which the patient designates a family member or friend to make healthcare decisions in the event of incapacitation.
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Differentiated between pure and applied science
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Pure - research; basic; expands knowledge base or builds theory; not specific.
Applied - practice oriented; real life situations; generates knowledge which allows direction of practice; problem solving and controlling outcomes. |
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Differentiate between inductive and deductive reasoning
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Inductive - makes generalizations based on specific set of circumstances
Deductive - premise exists - > argument - > conclusive statement (logic based). |
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Why is scientific method limited when applied to nursing?
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Humans are not lab rats. We are more complex. We are more than just our physiology; there are many more processes involved in the process of health and illness. In addition, the situations in which we find ourselves (hospitals) are not labs which means that the "experiments" are not controllable.
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Differentiate between problem solving and research
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Problem solving is based on specific set of circumstances but research is an attempt to solve problems that are widely experienced.
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At the different levels of nursing, define what role nurses play in research
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1. Student nurse - consumer of research
2. RN/BSN - data collection and problem id 3. Advanced Practice Nurse (APN) - set up studies; lit reviews to see what studies are out there 4. Doctorate - independent research |
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Identify the elements of research
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1. Identify topic of interest
2. Develop methodology for studying 3. Collect data 4. Analyze data 5. Describe findings 6. Disseminate findings to scientific community |
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Compare qualitative and quantitative research
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Qualitative - subjective data; narrative; natural setting; multiple answers.
Quantitative - objective data; numerical; lab setting; one answer. |
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List factors affecting communication
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1. Listen (receive, understand, remember, evaluate, respond)
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List the communication styles
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1. Non-Assertive (passive)- your rights are not as important as others; "I don't matter"
2. Assertive - rights are equal to others; "We both matter" 3. Aggressive - your rights are more important that others rights; "You don't matter". |
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List some conflict management strategies
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1. Collaborative
2. Compromise 3. Accomodate 4. Compete 5. Avoid |
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Define the different types of justices
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1. Ethical justice -- not always the same as legal justice
2. Social justice - treat people fairly 3. Distributive justice - equitable distribution of goods/services |
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What is justice?
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Giving what is due
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What is distributive justice?
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The disbursement of a finite supply of something; several approaches help determine who gets what:
1. To each equally 2, 3, 4, 5, 6, 7: To each according to need/merit/social contribution/person's rights/individual effort/to the greatest good 8. As you would have done by you |
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What is autonomy?
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ability to self rule; four elements to this:
1. respect for person 2. person has ability to determine personal goals 3. person has capacity to decide on plan 4. person has freedom to act on plan |
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What is fidelity?
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Faithfulness, promise-keeping
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What is beneficence?
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"mercy, kindness, charity" = do good, prevent harm. Do not put yourself in harms way.
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What is nonmaleficence?
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Do no harm; includes the doctrine of double effect which states:
1. action is not in of itself immoral 2. objective is to achieve good 3. cannot do good by doing bad 4. grave reason. |
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What are some threats to autonomy?
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interfere too much / too little
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When can people lose the right of autonomy?
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When there are cases of endangering or harming others through acts of violence or communicable disease.
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How can one recognize violations of autonomy?
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1. Assume same values/goals
2. Fail to recognize different thought processes 3. Faulty assumptions regarding knowledge base 4. Tasks are the focus and not the patient |
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What is Veracity?
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duty to tell the truth and not lie/deceive.
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What is pateralism?
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The healthcare worker crosses the line between 1) doing what is good / giving the patient a voice (being an advocate) and 2) doing what THEY think is the best and not considering what the patient wants (like the parent who says "because I said so!").
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Define and discuss the following: utilitarianism, deontology, virtue ethics
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1. utilitarianism - focus is on the outcome; ends justify the means
2. deontology - focus on the process; moral laws are absolutes 3. virtue ethics - humans are intrinsically moral; a virtuous person can be created; the morality of an act is due to the morality of the person rather than the rightness or wrongness of the act; Golden mean (Aristotle), ethics of hope, focal virtues (compassion, discernment, trustworthiness, integrity) |
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How does culture/lifestyle affect healthcare?
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1. Understand life processes differently
2. Define life, health and wellness differently 3. Do different things to maintain wellness Cultural background of the nurse will also influence the care that is given; need for self reflection and cultural awareness/knowledge/sensitivity. |
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List some potential cultural conflicts
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1. Internal vs. external LOC
2. Time - polychronic vs. monochronic 3. Health definition 4. Expected relationship with provider 5. Pain, suffering 6. Birth, death 7. Medicines 8. Causation 9. Decision making/ communication |
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What are some strategies for the culturally sensitive nurse to employ?
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1. Do not stereotype
2. Do not be ethnocentric 3. Use a cultural broker 4. Communicate/ask questions 5. Educate yourself on the culture; find out individual differences |
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What are the following:
1. Culture care preservation 2. Culture care negotiation 3. Culture care restructuring |
1. preservation - when a patient's ideas/actions are not harmful to their health or a barrier to healthcare; keep it.
2. negotiation - when a patient's ideas/actions are potentially harmful and need some form of compromise in order for attainment/maintaining of health to occur; lessen it. 3. restructure - when a patient's actions/beliefs are obviously harmful to their health and/or detrimental to healthcare delivery; get rid of it. |
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Discuss cultural competency and sensitivity
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Cultural competency - provide culturally congruent care; knowledge and skills needed.
Cultural sensitivity - differences and similarities exist in all cultures; knowledge of this; acceptance that different is just different not better or worse. |
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What is the ADA?
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The Americans with Disabilities Act was enacted to ensure that the rights of individuals with disabilities were recognized and acted upon. It guaranteed that in employment, the provision of state and local government activities, public domain accomodations and transportation, and communication be made accessible and equal to those without disabilities. No discrimination should occur just because of someone's impairments.
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Why should nurses be involved in politics?
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Nurses have the ability to have their voices heard and exert their expert power in order to influence change in policy and programs. Agenda setting is not possible without practical nurses' input. Nurses can influence policy for the patients and themselves: nursing education, the healthcare environment, financing, and scope of practice. As lobbyists workign to exert influence, government response can be directly achieved. Nurses can implement and evaluate all the policies and programs that affect nursing care and research.
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