Legal And Ethical Aspects Of Nursing Chapter 2

Chapter 2 (legal), Chapter 33 (elder abuse) - May 1 Legal and ethical aspects of nursing chapter 2 Nursing practice of LPN/LVN is guided by: (3) - Combined legal principles and established laws - Moral standards - Ethical principles Morals in nursing is objective (3) - Concerned with the principles of right and wrong behavior and goodness or badness of human character - Good vs. bad principles Ethics - Refers to values that influences a person’s behavior -and the individuals feelings -and beliefs about what is right and wrong NPA (nursing practice act) - Each state has laws that govern the scope and practice of nursing that are referred to as nurse practice acts Law (SATA?) (3) - Prescribe how a person should act in society - Sanction acceptable behavior and prohibit unacceptable behavior - Provide protection for all members of the health care system Overview of the legal system (types of law) - Criminal law: needs of the public - (finding guilty) - Civil law: between individuals; involve civil matter - (accountability) - 2 ways laws are established 1. Statutory law 2. Common law Criminal Civil conduct at issues offensive to conduct at issues violate a person’s right society in general conduct at issues is determental to society as a whole the law involves public offenses (such as robbery, murder, assult) purpose: - punish for the crime and deter - prevent futher crimes conduct at issue is detrimental to that individual involve offenses that against an individual purpose: -make aggrieved person whole again, -restore the person to where he or she was Negligence - Refers to the absence of due care - It is more of a general action that often can be attributed to being careless - Nurses and unlicensed assistive personnel may be charged with negligence Malpractice Refers to professional negligence Nursing responsibilities include actions taken as well as omitted Must contain four key elements - Duty: the established relationship betwen the patient and the nurse (provide professional care) - Breach of duty: failure to perform the duty in a reasonable, prudent manner - Harm: occured; does not have to be physical injury - (the breach of duty was )Proximate cause of harm: occurance of harm depended directly on the occurance of the breach -if court finds malpractice has occured, the nurse is subject to legal punishment or restitution as the court determines. -Best way to avoid: practice within the rules and regulations, the standards pf care, and the employing agency’s policies and procedures. -establish positive nurse-patient relationship: -poor nurse-patient relationship--> leading factor patient seeks legal action Four options for establishing the levels of responsibility: - the individual may be personally responsible for the act of negligence or malpractice committed -manager or supervisor may be implicted if there was inappropriate supervision or delegation by another member of health care team -employer may be responsible for employee’s action if there are deficits in education or inappropriate credentials for the role -employer also responsible for ensuring the staff members have the needed supplies and equipment. Overview of legal process -Civil litigation: -involve the legal exchange between individuals as opposed to legal concerns that involve a criminal natterm which would involve the state or federal government bringing charges. -most legal suits in health care involve civil litigation -complaint: defendant or respondent (person alleged to be liable (legal responsible), state the facts involved in the case, defines the legal issues he case riases, and outlines the damage (compensation seeking) - deposition: witness under oath. both side of case review documents and interview witnesses; witness are reqruiedto undergo questioning by the attorneys -verdict: decision based on the facts of the case, the evidence and testimon presented, the credibility of the witness, and the laws that pertain to the issue. Legal relationships Accountability - Responsible for one’s own actions -give rise to a legal duty, and thus liability (legal responsibility), in nursing Liability - Legal responsibility -falls into several areas: practice, monitor and communication - (p26 commoin breaches of standard of care) Legal relationship - Nurse-patient relationship - When the nurse assumes responsibility for the patient’s care - Failure to provide care to the expected level of expertise gives rise to legal liability - has a legal basis: the duty to provide professional care (book) - nurse accept the role of advocate for the patient - Advocate - One who defends or pleads a cause or issue on behalf of another - The nurse accepts the role of advocate for the patient - A nurse advocate has a legal and ethical obligation to safeguard the pt’s interests REGULATION OF PRACTICE -Standards of care (4 +2) - Acts that are or are not permitted to be performed -define acts whose performance is required, permitted, or prohibited (book) -drive from federal and state laws, rules, regulations and codes that govern other professional agencies such cas the American Nurse Association (ANA) and CNA. (book) - (coupled with scope of nursing practice) Give directions to the practicing nurse, -->defines what can or cannot be done to pts /define obligations of the nurse (including activities are obligatory or prohibited) (book) - Every nurse is obligated to know and follow the established standards of care - Failure to adhere to the standards gives rise to legal liability (responsiblity) - Scope of nursing practice coupled with standards of care (5) - Give direction to the practicing nurse - Follow the laws of individual states - Defines the obligations of the nurse including prohibited standards - It is the nurse’s responsibility to know the specific nurse practice act(s) in the states or states he/she practices in - Institution has the right to establish policies and procedures for nursing within the nurse practice act -Reality: -nurses feel presssure to take expanded duties--> increase risk for liability -orientation program often fail to adquetely cover all skills needed to be competent practitioner--> nurse responsibility to seek additional instruction and supervision Legal issues -affect LPN/LVN and influence the level of care delivered to the pt. - Statutory and common law can both play important roles defining the rights and responsbilities of patients and the nursing professionals. - Patient’s bill of rights - Patient rights (to expect the nurse to act in the pt’s best interest by providing care that meets and is consistent with the established legal standards and principles.) - Informed consent: -doctrine of informed consent: full disclosure of the facts the pt needs to make an intelligent (informed decision before any invasive treatment or procedure is performed. -pt has right to accept or reject the proposed care but only after understanding fullly what is being proposed: benefits of treatment, risk involved, any alternative treatments, consequences of refusing the treatment or procedure. -explanation must be nontechnical terms and in language pt can understand -civil battery: unlawful touching a person; intent to harm not necessary - pt can verbalize the consent, invasive treatment--> written consent - nurse often has the responsibility to witness the pt’s signing in consent -nurse does not discuss elements of procedure that the physician or practitioner are required to make: involving provide these info place nurse in position of liability--> answers to unanswered questions about the procedure that pt has--> responsibility of health care provider who will perform the procedure. -consent must provided by appropriate person: -18 or above, minor under 18 may consent if meet certain criteria: -marriage, court-approved emancipation, living aprt from parent or gardient >60 days, service in arm force -can’t obtain from imparied or under influence of alcohol or drugs. -many cases, consent provided by spouse - Confidentiality: nurse have duty to protect info about a pt regardless how info is kept -info should be accessed only on a need-to- know basis. -ex: only health care personnel directly involved in an individual’s care able to access. - Medical records: -law govern collection,maintenance, and disclosure of information in medical records. -not public documents, info must be kept secure -any breach in the confidentiaility of inforamtion kept in a patient's medical record risks legal liability -both parties are permitted to use the patient’s medical record to argue facts of case - all entereis in medical record must be permanent, accurate, complete and legible. -take HIPPA privacy standatds in consideration and prevent unauthorized disclosure of medical records and patients info. - Invasion of privacy: -legal concept: involve a person’s right to be left alone and remain anonymous if pt’s choose to - consent of treament doesn’t waive the right to privacy. -privacy concerns: physical exposure or disclosure of patient info to others -protect pt from unnecesssary exposure with use of drape and close door and restrict admission to rooms during procedures. -provide info to callers-->breach in confidentiality; refer call the charge nurse or available family members -destroy report sheets and communication tools at the end of shift before leaving. -use of pt’s info without authorization--> violation of pt’s legal rights; safeguard pt’s right to privacy at all times. - Reporting abuse: (4) -health care professionals is required to report certain infor to appripriate authorities: report should given to a supervisor or directly to police, accoirding to agency policy -acting in good faith and report mandated info (certain communicable diesase or gunshot wounds) the health care professional is protected from liability -child abuse prevention treatment act 1973: reporting of childe abuse is mandatory -witholding medical treatment to an infant born with serious lifetheratenting handicaps--> form of child abuse; -withholding lifesaving treatment and care is a form of passive euthanasia (letting people die) and medical neglect--> carries risk of professional neglect (medical malpractice) charge HIPAA (5 RIGHT+health institution/insurance portability) - Health insurance portability and accountability act of 1996 - Patient’s right: - Health care institution is obligated to uphold certain provisions to the patient - Right to have care without prejudice - Right to be treated with respect and dignity - Right to confidentiality - Right to personal safety - Right to complete information about one’s own conditions and treatment How to avoid a lawsuit (7) - best way: Provide compassionate, competent nursing care - Nurse-patient relationship must be one based on trust and respect - Use of open and honest communication (key to building a therapeutic relationship and often helps resolve patient dissatisfaction before the pt resorts to legal action. ) - Maintain and adhere to the standards of care and scope of practice -remain current practice developments and take advantage of continuing education oportunities to help ensure competance. - Good samaritan law provides immunity from lawsuits in certain circumstances --> if nurse choose to offer help, liability may be limited under good samritan law. --> goal of this protection: encourage assistanc e in emergencies occur outside of facility. - Proper documentation - if it isn’t charted, it wasn’t done Insurance (3) - Professional liability insurance -employer carry insurnace for their facilities, coverage provides insurance to employee (book) - Policies (2): 1. Claims-made policy :provides protection when claim for nursing or negligence is made while the policy is in forced ( during policy period or extended coverage). 2. Occurrence-basis policy :protects against claims made about events that occured during the policy period or extended coverage period - Disciplinary defense insurance - The disciplinary process: seek legal representation -provides following if brought before the LPN/LVN board of nursing for disciplinary actions and problems with the license -qualified nurse attorney or attorney to represent the nurse -wage loss reimbursement -travel, food, lodgin reimbursement -legal fees paid or reimbursement for payment - Potential sanctions against a nursing license (7) -dismissed charge -investigation agreement -letter of reprimand, formal or informal -probation with stipulation -mandated div ersion program for drug or alcohol-related charge or health mental -supervision with stipulation -revocation of license Ethical aspects of nursing - Define ethics：refers to value that influence a person’s behavior and the individual’s feeling and beliefs about what is right or wrong. - Advanced directives (2) : signed and witnessed documents that provide specific instructions for health care if a person is unable to make decisions personally at the time they are needed. 1. Living wills: written document that directs treatmemnt in accordance with pt’s wishes in the vevnt of a terminal illness or condition. 2. Durable power of attorney :designates an agent, surrogate, or proxy to make health care decisions on the pt’s behalf based on the pt’s wishes. - Patient self determination act (PSDA) of 1991 requires all healthcare institutions to provide written information to patients regarding their right to make decisions about their health care under the state law, including the right to refuse treatment and fomulate advance directives.: must document whether pt signed the advance directive. Development of ethical principles - Define values: personal beliefs about the worth of an object, an idea, a custom, or an attitude. - Define value clarification:the proces of self-evaluation that helps gain insight into personal values. do the following to clarify value: 1. select the belief or behavior and consiously ecamin it 2. decide its value 3. incorporate the value into everyday responses and behaviors. - Define ethical dilemma: situations that do not have a clear right or wrong answer. -are complex, confusing and often frustrating situations that call for careful rational analysis.questions presented can’t be answered by applying external laws, ruls, policies and procedures. Ethical principles in nursing practice (5) - Most fundamental principle is respect for people - Autonomy: freedom of personal choice, right to be independent and make decision freely (ensure pt the right to refuse medical treament, upheld in Bouvia v superior court case -1986) - Beneficence:doing good or acting for someone's good - Nonmaleficence: means to do no harm - Justice: concept of what is fair; all pt have the same right to nursing intervemtion Reporting unethical behavior - Nurses have a duty to report behavior witnessed that does not meet the established standards - Always follow the proper chain of command and explain the facts as clrearly as possible Ethical issues - Change as society changes Current ethical issue: - Practitioner-assisted suicide (PAS) - right to refuse treatment - Refusal to treat - DNR orders -genetic research Questions will be about applying morality clarification Chapter 33 - elder abuse Types of elder abuse Domestic mistreatment - Takes place in the home of the older adult and usually carried out by family member or significant other; include physical maltreatment, neglect, or abandonment Institutional mistreatment - Takes place when an older adult experiences abuse when hospitalized or living somewhere other than home (e.g. long-term care facility) - Self-neglect is the choice by a mentally competent individual to avoid medical care or other services that could improve optimal function, not to care for oneself, and engage in actions that negatively affect his or her personal safety; unless declared legally incompetent, an individual has the right to refuse care - Individuals at most risk include those who are dependent because of their immobility or altered mental status Identification and treatment of abuse in 5 classifications: - Physical or sexual - Neglect - Medical abuse - Psychological - Misuse of assets Signs of neglect: - The refusal or failure to fulfill any part of a person’s previously agreed obligation or duties to an elder dependent on the person for care of assistance 1. Failure to assist in personal hygiene 2. Unkept appearance 不整洁的外表 3. Prolonged deprivation of food or water 长时间缺乏食物和水 4. Dressed inadequately 着装不当 Elder abuse indication: bruises in various stages of healing Signs of emotional abuse (SATA?) (3) - Fear - Agitation - Confusion Physical abuse (3) - Bruises - Lacerations - Burns BOX 33.5 P1115 Physical abuse: use of physical force, bodily injury, physical pain or impairment Sexual abuse: nonconsensual sexual contact 非自愿的性接触，including individuals unable to give consent Emotional or psychological abuse:infliction of anguish, pain or distress through verbal or nonverbal acts, including intimidation or enforced social isolation Medical or mateiral abuse or exploitation: Neglect: the refusal or failure to fulfill any part of a person’s previously agreed obligation or duties to an elder dependent on the person for care or assistance Abandonment: the desertion of an elder by an individual who had assumed the responsibility of providng care or assistance Common reasons for abuse and neglect (4) - Exhaustion of caregiver i Abandonment ii Caregiver role strain: family member complains of being tired; Ex: dementia patient awake day and night - Alcoholism, - Turbulent lifestyles - Lack of financial, emotions, family, and community resources ） Caregiver role （2） - Caregiver’s needs may need reminders to attend to own physical and emotional needs - It is important that the caregiver has the opportunity to relax and reenergize emotionally throughout the day to assume care responsibilities increased chance of elder abuse if caregiver (3) - Suffers from low self esteem - Perceives he or she is not receiving adequate help or support from others - Experiences emotional and mental “burn out”, anxiety, or severe depression The national center on elder abuse identifies the two most important indicators of abuse as 1. An older person’s frequent unexplained crying 2. An other person’s unexplained fear or suspicion of a particular person(s) in the home - LVN/Registered nurse are amount the health practitioners who must report known or observed instances of abuse (suspected abuse) to the appropriate authorities - Must report suspicion in 24 hours California law nurse’s responsibility - Report suspected abuse to authorities: 1. Police 2. Ombudsman 3. Adult protective service