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NP2 - Legal Ethical

NP2 Unit 2 Legal/Ethical

Responsibility A state of obligation for something within one's power or control
Accountability A state in which one is subject to the obligation to report, explain, or justify something or some action
T or F - If a nurse isn't accountable if he or she does something wrong/illegal and didn't know it was wrong/illegal. False. Ignorance is not a defense.
Nurse's legal responsibilities 1. Practice so that harm or injury to the client is prevented and standards of care are maintained. 2. Direct the practice of those under the RN's supervision so that harm or injury to client is prevented and standards of care are maintained.
Intentional torts Assault and battery Defamation of character Invasion of privacy False imprisonment Fraud
Assault Threat or attempt to make bodily contact with another person without that person's consent.
Battery Any willful, angry, violent or negligent touching of another person's body or anything attached to that person.
What tort has been committed if a patient refuses treatment and the RN performs that treatment anyway? Battery
Slander Making derogatory remarks about someone, thereby diminishing his or her character. Verbal.
Libel Written derogatory marks about another person. Written.
Slander or libel? A person writes into a newspaper making derogatory remarks about another person. Libel.
Slander or libel? An RN says derogatory things about another RN to their coworkers. Slander.
Invasion of privacy Intrusion into the personal affairs of someone else.
Examples of invasion of privacy Eavesdropping on a private conversation Unauthorized intrusion on childbirth Taking pictures without consent Displaying x-rays/papers with the client's name on them.
False imprisonment Unjustified retention or prevention of the movement of another person without proper consent
A confused patient who has a foley and IV has been trying to get up and walk around. The nurse puts up all the bed rails to prevent this rather than getting an order for restraints. This is an example of... False imprisonment. At least one bedrail must be left down unless there is an order for restraints.
T or F - If leaving the hospital will likely cause serious injury or death to the patient, you can prevent him from leaving. False. The patient has a right to leave.
If a patient wants to leave against medical advice, what should you do? Explain the consequences, ask if you can remove the IV, call the doctor immediately.
Fraud Willful misrepresentation that could cause harm or has caused loss or harm to a person or property.
Examples of fraud A CNA who claims to be a nurse. An ASN RN who claims to have a BSN.
Unintentional torts Negligence and malpractice
Negligence Performing an act that a reasonable prudent person under similar circumstances would not do. Failing to perform an act that a reasonable prudent person under similar circumstances would do.
Malpractice Specialized kind of negligence - violation of professional duty, failure to meet standards of care, failure to use skills and knowledge of other professionals in same situation.
Standards of Care Expectations/standards the RN is held to. Defines professional accountability to the public Establishes general and specific guidelines for practice
Who develops standards of care? Professional organizations and institution policies
Nurse Practice Act - purposes? To guarantee minimum standards for licensure and credentialing. Distinguishes between medical and nursing practice by defining legal scope of nursing practice
What tasks can an RN delegate? Tasks such as V/S, bathing, comfort care Sometimes dressing changes, depending on facility.
A nurse delegates vital signs to the CNA for a patient. What should the nurse do? Monitor the information gathered by the CNA and interpret the information. Verify results and take action if necessary.
T or F - The RN can have the CNA do assessments so long as the CNA knows what he or she is doing. False. An RN cannot delegate the nursing process, and must complete assessments.
If the hospital allows CNAs to perform dressing changes, what must the RN do? The RN must assess the wound after the old dressing is removed and before the new dressing is applied.
State Board of Nursing has the power to ______ 1. Examine and license 2. Regulate and define nursing practice 3. Approve nursing educational programs. 4. Investigate and discipline nurses
Legal considerations for student nurses 1. Perform as a professional nurse would to the point of your experience. 2. Liable for your own actions 3. Supervision required for new procedures 4. Must notify instructor if you receive a "U" on a check-off.
T or F - If the student nurse causes in injury to a client, only the student nurse is liable for that action. False. Liability is shared by the student, the instructor, and the school of nursing.
T or F - The student nurse in NP2 must have another nurse present when giving meds. This can be either a staff nurse or the instructor. False. For NP2, you must give meds with the instructor ONLY.
Self-Determination Act Permits clients to make own health care choices. 1. Living Wills, Health Care Surrogates.
What impact does the Patient Self-Determination Act have on the initial assessment? When taking history, the hospital staff should ask if the patient already has advance directives, and should make a note of this in the medical record.
Under Self-Determination Act, what should the patient be told upon admission? Written notification upon admission of their decision-making rights, and policies regarding advance health care directives in their state and in the institution to which they have been admitted.
What decision-making rights does the patient have under the Self-Determination Act? 1. The right to facilitate their own health care decisions 2. The right to accept or refuse medical treatment 3. The right to make an advance health care directive
Self-Determination Act - What must the facility do to ensure employees comply? Educate both staff an affiliates about advance health care directives
T or F - A hospital may refuse to admit or treat a patient if the patient has an advance health care directive. False. Health care providers are not allowed to discriminately admit or treat patients based on whether or not they have an advance health care directive.
Informed Consent The pt's consent for treatment given after having discussed with the MD the patient's condition/diagnosis (if known), the treatment proposed, risks and benefits of the treatment and of not getting the treatment, and any alternatives their may be.
Under what circumstances is consent not required? Emergency situations.
If the patient is confused or otherwise unable to give consent, what must be done? Make sure the guardian, health care surrogate, next of kin, etc. has given consent - whoever is legally able to give consent for that person.
What are some forms of negligence that can result in malpractice lawsuits? Improper technique Untimely response to s/s Fail to act as pt. advocate Fail to use equipment responsibly Fail to follow standards of care Fail to communicate (with MD especially) Med errors Fail to assess/monitor Fail to document
Legal Safeguards - What you do at work Cont. education Follow Nurse Practice Act Follow policies Evidence-based practice Evaluate assignments (do you have necessary training?) Develop rapport w/coworkers, esp. MDs. Sensitive to client issues Limits on hours worked Incident reports
What is the cut-off point for refusing an assignment? You can refuse before you take report. Once you have taken report, you are responsible for that patient.
Legal Safeguards - further protections Malpractice insurance Good Samaritan Act
T or F - If another nurse is involved in an incident and doesn't fill out an incident report, you should fill one out anyway. True.
T or F - Though most hospitals will cover you while you're at work, you need malpractice insurance to cover incidents outside of work and BON hearings, etc. True. The hospital won't cover your expenses for BON hearings or practice outside of work (such as if you help someone who has been in a car accident).
Good Samaritan Act Defense for those who volunteer their services in emergency situations.
T or F - The Good Samaritan Act protects you from getting sued. False. It provides a defense if you are sued, but cannot prevent a lawsuit from being filed.
T or F - Nurses must stop at the scene of a car accident if EMS has not yet arrived. False.
What can the nurse do for a person who has been in an accident? (Outside of the facility) BLS only.
T or F - the nurse has a legal responsibility to carry out the physician's orders unless he or she anticipates injury if orders are carried out. True.
How should telephone orders be verified? A second RN should verify a telephone order.
What sort of orders should be questioned? Ambiguous orders, orders that contradict normal practice, orders that are contradicted by client's present condition, or orders that the client questions.
T or F - An RN can give normal saline without a doctor's order. True.
T or F - You are legally required to follow Dr's orders. True.
How should you go about refusing to follow an order? You must have a good reason, and you must notify the MD and explain your concerns.
What is the importance of the initial assessment? It allows you to recognize a change in the client's condition.
What should be done for each client at the beginning of a shift? A thorough assessment.
At what times (other than admission and beginning of a shift) is assessment especially important? Before and after medication administration or procedures.
What steps should be taken for assessment follow-up? Nurse should know findings, communicate them when needed, and document them properly. Reassess periodically, especially if findings are changing or are abnormal.
You question an order. The Dr. doesn't address your concerns to your satisfaction, but assures you that you should proceed. What should you do? Keep pressing until you are comfortable giving the order, or until you determine that you cannot responsibly follow the order.
Ethics Systematic (philosophical) inquiry into the principles of right and wrong conduct, and of virtue and evil as they relate to conduct.
Morals Personal standards of right and wrong
Values Personal beliefs about worth that guide one's behavior
Attitude Feeling or emotion toward people, objects, or ideas.
Belief Intellectual attitude based primarily on faith as opposed to fact
Who establishes the code of ethics for nurses? The ANA
What ethical principles are included in the nursing code of ethics? Respect for persons Respect for autonomy Beneficence Value neutrality Non-maleficence Veracity Justice Fidelity
What is value neutrality? Remaining neutral when another person's values clash with your own.
What is non-maleficence? Avoiding harm
What is beneficence? Doing good
What is veracity? Truthfulness
What is fidelity? Being faithful to agreements and promises
What functions does the nurse perform as a client advocate? Informing, supporting, mediation
Code of Ethics List of written statements describing ideal behavior for a group of individuals. Not necessarily "right and wrong".
Ethical decision-making steps Identify problem Gather data Collaborate with healthcare team members Discuss options Make decision Re-assess
Ethics Committee Group of people from different disciplines who respond to ethical dilemmas. Provides a safe place to discuss ethical dilemma between providers and family/patient.
If you find yourself in an ethical dilemma, how should you go about addressing the ethical committee? First speak with the nurse manager to inform him/her of the situation, then request access to the committee.
Created by: christyness