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78 Cards in this Set
- Front
- Back
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Meaning of Law
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protects the public, protects the nurse as long as the law is followed.
Sets scope of practice. Nurse Practice Act is the law of Nursing. National Council of State Boards has oversight over state boards. |
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Statutory law
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made by legislative bodies such as congress or state legislatures. Laws governing nursing practice are statutory in nature. Ie. State Nurse Practice Acts.
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Administrative law
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Rules & regulations made by an appointed government agency from the statutory law.
Federal : Dept. of Health & Human Services, Dept. of Labor, Dept. of Education State: Licensing Boards (Mo. State Board of Nursing) |
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Explain Administrative Cases.
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State or federal charges are brought against an individual for not following the administrative laws set (ie. by the Mo. State Board of Nursing). The Board becomes the Court of Law & determines the penalty. Ie. Newsletter w/ naughty list or decides that you can't be a nurse anymore.
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Sources of Law
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a. Constitution: The Bill of Rights, comprising the first 10 amendments to the Constitution, is the basis for protection of individual rights.
b. Statutes: Localities, state legislatures, and the U.S. Congress create statutes. These can be found in multivolume sets of books and databases. Nurses have an opportunity to influence the development of statutory law both as citizens and as health-care providers. c. Administrative law: The Dept. of Health and Human Services, the Dept. of Labor, and the Dept. of Education are the federal agencies that administer health-care-related laws. At the state level are dept.’s of health and mental health and licensing boards. [specific statutory laws give state nursing boards the authority to issue and revoke licenses, which means that each board of nursing has the responsibility to oversee the professional nurse’s competence] |
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What is criminal law?
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State or Federal charges.
Crime against an individual or society. Perpetrator punished, victim gets nothing. Punishments: Fine, incarceration, combo or death. Can be charged as felony, misdemeanor or juvenile. Nursing acts don't fall under criminal law (they fall under civil/tort law). |
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Civil Law
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usually involves the violation of one person’s rights by another person.
One sues another for financial compensation of perceived loss. Money paid to wronged individual & to court for court costs. |
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Give some examples of Quasi-Intentional Civil Cases.
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Invasion of Privacy
Breach of Confidentiality |
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Negligence
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to act or fail to act as an ordinary, reasonable, prudent person would, resulting in harm to the person to whom the duty of care is owed.
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What are some common causes of negligence?
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Falls
Equipment Injuries Failure to monitor Failure to communicate Med Errors Altering or falsifying records Violation of standards of practice (internal & external) |
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What are the 6 F's?
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More causes of negligence:
Failure to Assess the client appropriately Failure to report client status changes to personnel Failure to document in the patient record Failure to obtain informed consent Failure to report coworkers negligence or poor practice Failure to provide education to client/family members |
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Malpractice
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(professional negligence). When fulfillment of duties requires specialized education, the term malpractice is used. The defendant named is usually the facility employing the nurse.
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Good Samaritan Laws
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Protect the nurse if they behave in the same manner as they would in professional practice under similar circumstances. However, protection is nullified if they accept payment for care given. These laws do vary from state to state.
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HIPAA
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Preserves confidentiality and protects the privacy of health information of individuals.
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Slander
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the spoken word; A quasi-intentional tort. Making a verbal false statement about a client’s condition that may result in an injury to that client.
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Libel
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written word; A quasi-intentional tort. Making a written false statement. Ex: stating that a client who had blood drawn for drug testing has a substance abuse problem, when the client does not carry that diagnosis, could be considered a slanderous statement.
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False Imprisonment
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confining an individual against their will by either physical (restraining) or verbal (detaining) means. Examples:
o Using restraints on individuals without the appropriate written consent o Restraining mentally handicapped individuals who do not represent a threat to themselves or others o Detaining unwilling clients in an institution when they desire to leave o Keeping persons who are medically cleared for discharge for an unreasonable amount of time o Removing clothing of clients to prevent them from leaving o Threatening clients with some form of physical, emotional, or legal action if they insist on leaving. |
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Assault
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threatening to do harm
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Battery
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touching a person without their consent.... Holding a violent client down against their will and injecting a sedative IS battery. Most medical treatments, particularly surgery, would be battery if it weren’t for informed consent from the client.
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Nurse Practice Acts
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define the boundaries within that state
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Informed Consent
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gives health-care personnel the right to deliver care and perform specific treatments without fear of prosecution. It is the physician’s responsibility to give information to a client about a specific treatment or medical intervention however nurses frequently obtain the signatures on the forms.
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Who can give informed consent?
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Competent adults
Legal guardians or durable power of attorney's Minors if emancipated or married Mature minors (varies by state) Parent of a minor child Court ordered |
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What are the various roles a nurse can play when obtaining informed consent?
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Witness
Ensuring the patient is informed in all aspects Remedy the situation if the patient doesn't have all info Clarify presented info - but cannot present new info Determine the patients level of understanding |
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What must the patient comprehend when signing informed consent?
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The procedure to be performed
The risks involved Expected/desired outcome Expected complications Alternative treatments available |
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When is expressed consent given? How does it differ from informed consent?
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Expressed consent is given when the patient signs themselves into the hospital/facility.
Further consents such as informed consent is required when invasive actions are needed. |
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Can a minor walk into an urgent care facility and request testing/treatment for an STD without the facility calling the parent?
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Yes. If a minor comes in and wants services for anything sexually related, we have to provide such care without getting consent of the parent.
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What are the 7 rights of medication administration?
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* Right patient
* Right drug * Right dose * Right route * Right time * Right reason * RIght documentation |
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Documentation is credible when it is:
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o Contemporaneous: documenting at the time care was provided
o Accurate: documenting exactly what was done o Truthful: documenting only what was done o Appropriate: documenting only what could be discussed comfortably in a public setting |
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Do Not Resuscitate Orders
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only a physician can write this order. The ANA advocates that every facility have a written policy regarding the initiation of such orders. The client, or if the client is unable to speak for him/herself, a family member or guardian should make clear the client’s preference for either having as much possible done or withholding treatment.
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living will
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A legally executed document that states wishes regarding the use of life-prolonging treatments if he/she is no longer competent to make such decisions and is suffering from a terminal condition.
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What are standards of practice used for?
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Standards of practice & expert witnesses are used to determine negligence/malpractice in court cases.
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Who sets the standards of practice?
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Professional organizations
Job descriptions Agency policies Textbooks Nurse Practice Acts |
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What are standards of practice?
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The minimum acceptable levels of care
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What are some tips to avoid legal problems?
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Care
Document - if undocumented, it didn't happen Practice within scope of NPA & agency policies Patient rights & welfare first Stay informed of new research in your area of practice Insist institution keep personnel apprised of policy changes & mgmt of new equipment Delegate only to appropriate personnel Identify clients at risk such as falls or decubs Establish/maintain safe environment Write detailed incident reports & file appropriately Recognize client behaviors that may indicate possibility of lawsuits |
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Explain mandatory overtime.
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Once a nurse accepts an assignment for a client, they are required to provide care even in the event of overtime. This puts their ability to delivery quality care at risk & errors can occur causing the risk of loss of license. Not providing that care in an OT situation is abandonment. States are working to create legislation restricting mandatory overtime for nurses.
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What are the two most common forms of advance directives?
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Living Wills
Durable Power of Attorneys |
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What is a Durable Power of Attorney?
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It is a document that states who the client wishes to be their health care surrogate. This person is to make the client's wishes known to medical & nursing personnel & must have a clear understanding of that client's wishes.
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What is the Patient Self-Determination Act?
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It provides guidelines for developing advance directives concerning what will be done if they are no longer able to actively participate in making decisions about their own care.
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Who determines guilt/innocence if a violation of the nurse practice act occurs?
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The state board of nursing
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What are some common reasons for disciplining a license?
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Unlawful use of controlled substances
Criminal prosecution Obtaining license by fraud/deception Incompetence Disciplinary action in another state Being found insane or mentally incompetent Enabling a person to practice w/o a license Violation of professional trust or fact Misleading advertising or solicitation Violation of drug laws of any state/federal government Placement on employee disqualification list Failure to complete the impaired nurse program |
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How are tort or common laws set? What types of cases are determined by tort law?
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Previous court decisions set precedent for future similar cases.
Most malpractice cases are addressed in civil cases under tort law. |
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How do you obtain liability insurance?
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Your institution will carry it for itself & its workers
*Remember who they really support on the bottom line, also how long is back coverage if you change facilities Carry your own personal liability insurance *Can be a rider on another personal type of insurance or through an individual company or through professional organization |
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What are the 3 things that most states require in order to be licensed
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1 - graduate from approved school of nursing
2 - pass nclex-rn 3 - pass a criminal background check |
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How long can new grads practice in Missouri without a license? What if you fail the NCLEX exam prior to the expiration of the time period?
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90 days
If you fail the exam, you must stop practicing and cannot practice as a graduate nurse |
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How often must you renew your license?
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Q 2 years
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What should you do if you get sued?
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Get legal representation (various ways)
* through your institution * personally hiring an attorney * through liability insurance company Inform your employer Maintain files of all papers & correspondence |
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Values
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Something that someone deems of worth or desirable. They guide our behaviors and decision making. We learn them from others (parents), by being taught directly (school), or by social norms. They change w/ experience & maturity.
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Value systems:
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a set of related values.
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Intrinsic values:
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those related to sustaining life, such as food and water
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Extrinsic values:
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not essential to life; things, people, and ideas, such as kindness, understanding, and material items, are extrinsically valuable
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Personal values:
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qualities that people consider valuable in their private lives; concepts such as strong family ties and acceptance by others
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Professional values:
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qualities considered important by a professional group; autonomy, integrity, and commitment
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Belief
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an organized way of thinking that help us explain issues such as life and death, good and evil, and health and illness. People may have a personal belief system, may participate in a religion that provides such a system, or both.
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Morals
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one’s own code for acceptable behavior; arising from an individual’s conscience. Morals act as a guide for individual behavior and are learned through instruction and socialization.
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Ethics
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A standardized code that deals with the rightness or wrongness of a situation. Identifies right & wrong in specific situations. Not law but gives guidance in a situation/decision making process. Ethical principles are usually based on that persons morals.
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Autonomy
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Self determination. The freedom to make decisions for oneself. This requires that nurses respect patients’ rights to make their own choices about treatment. Ex. Informed consent.
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Nonmaleficence
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No harm. either deliberately or unintentionally. This requires that nurses protect from danger individuals who are unable to protect themselves because of their physical or mental condition. .
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Beneficence
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Benefit. demands that good be done for the benefit of others. It requires helping patients meet all their needs, whether physical, social, or emotional. It is caring in the truest sense, and caring fuses thought, feeling, and action
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Justice
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Treating every person equally without discrimination.
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distributive justice
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Fair allocation of responsibilities and advantages. Organ transplants are a good example. Age & ability to pay are often controversial issues.
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Fidelity
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Keeping promises. Taking responsibility for your own actions.
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Confidentiality
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Both a legal & ethical issue. Patient/nurse confidentiality. Exceptions only exist when patients give permission for the release of information or when the law requires the release of specific information.
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Veracity
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Being truthful. Never deceive or mislead. Truth is fundamental to building trust.
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Accountability
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Linked to fidelity. Admitting your mistakes and doing what is necessary to correct it.
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Code of Ethics
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The hallmark of a profession; a formal statement of the rules of behavior; makes clear the behavior expected. Ethical codes are subject to change, as society and technology evolve.
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ANA Code of Ethics:
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provides values, standards, and principles for Professional Nursing.
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Ethical Dilemmas (analysis of case studies):
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an ethical dilemma occurs when a problem exists that forces a choice between two or more ethical principles. Deciding in favor of one principle will violate another, bringing the added burden of emotions; feelings of anger, frustration, and fear often override rationality in the decision-making process.
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What is the acronym for the ethical problem solving process?
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MORAL
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What does MORAL stand for?
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M - Massage the dilemma. Talk/think about it. Identify pertinent facts. Make sure you understand the real issue.
O - Outline all possible options available in the situation. R - Review criteria & resolve. Choose the best option to resolve the situation. A - Affirm position & act. Once decision has been made, don't go back on it. L - Look back. Evaluate last. Look at what happened from the decision that was made & determine again if it was right or wrong. Learn from the situation. |
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What questions should you think about when faced with an ethical dilemma?
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What are the medical facts?
What are the psychosocial facts? What are the patient's wishes? What values are in conflict? |
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What are the 9 provisions of the ANA Code of Ethics?
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1 - Practices w/ compassion & respect regardless of social/economic status, personal attributes, or the nature of health problems.
2 - Primary commitment is to the patient (can be individual, family, group or community) 3 - Promotes & advocates for the health, safety & rights of the patient. 4 - Responsible & accountable for optimum patient care. 5 - Preserve integrity/safety, maintain competence & continue personal/professional growth. 6 - Establishing, maintaining & improving health care environments. 7 - Advancement of the profession 8 - Promotes community, national & international efforts to meet health needs. 9 - Articulating values, maintaining integrity, & shaping social policy. |
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What are the 5 elements that must be proven in negligence cases?
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* Duty to provide care based on standards of care
* Breach of duty to provide that care * Foreseeability of harm (failure to provide care causes harm) * Direct relationship between breach & the injury * Injury for which compensation is due |
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How do you reduce the risk of a client falling?
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* Identify at risk clients
* Place notices about fall precautions * Follow policies on use of restraints * Beds low * Use side rails appropriately |
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How do you avoid equipment injuries?
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* Check thermostats & temperatures on equipment used in heat/cold applications.
* Check wiring on all electrical equipment. |
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How do you avoid problems related to monitoring patients?
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* Observe IV infusion sites
* Obtain & record V/Ss, Urinary Output, Cardiac Status, etc. by policy & more often if patient situation dictates * Check pertinent lab values |
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How do you avoid communication problems?
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* Report pertinent changes in client status
* Document changes accurately * Document communication with appropriate source |
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How do you avoid medication errors?
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* Follow the 7 rights
* Monitor client response to meds * Check medications for multiple drugs for the same actions. |
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What is the 1st priority of Law?
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Protect the public
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