CHAPTER 2 Legal and Ethical Aspects of Nursing

Overview of the Legal System Laws Prescribe how a person should act in society Criminal Law Conduct in issue is offensive to society in general Is to punish for the crime and deter and prevent further crimes.

Overview of the Legal System Civil Law Conduct violates a person’s rights Conduct is detrimental to that individual Law’s purpose: Is to make the aggrieved person whole again, to restore them to where they were

You are at risk IF YOU ARE A STUDENT OR A LICENSED PT CAN YOU BE CHARGED WITH CIVIL LITIGATION?

Overview of the Legal Process Liability Legal responsibility A health care worker can be charged with civil or criminal liability depending on the particular circumstances surrounding the case.

LEGAL ISSUES R/T Psych Tech’s Patient rights Informed consent Confidentiality Medical records Invasion of privacy Reporting abuse Negligence and or malpractice

Visit BVNPT website Review State wide module

Very important to your field of practice Legal Relationship Nurse/PT-patient relationship When the nurse/PT assumes responsibility for the patient’s care Failure to provide care to the expected level of expertise gives rise to legal liability.

Very Important to Remember! The best defense against a lawsuit is to provide compassionate, competent nursing care

Your major role Legal Relationships Advocate One who will defend or plead a cause or issue on behalf of another. The PT accepts the role of an advocate for the patient even as a student .

You need to remember this point Regulation of Practice Standards of Care Acts that are permitted to be performed or are prohibited from being performed.

Overview of the Legal Process Regulation of Practice The PT CANNOT use ignorance as an excuse. Every PT needs to know what she or he can and cannot do while providing nursing care. (Standards of care)

This is your goal: Licensure Regulation of Practice Licensure All licensed PT’s must apply for licensure in the state in which they wish to practice. Applicants are carefully screened. Upon approval by the board, the applicant is eligible to take the computerized licensing examination at a testing center. (handout from board listing requirements)

Overview of the Legal Process Regulation of Practice Licensure It can be suspended or revoked (taken away) for unprofessional, unethical, immoral, and/or criminal conduct. (online BVNPT board website for psychiatric technician’s that have been convicted)

Scope of practice

Know this well Malpractice (this will be what you are charged with) Legal Issues Malpractice (this will be what you are charged with) Commission Doing an act Omission Not doing an act

Overview of the Legal Process Malpractice Elements that must be present: Breach of the duty: The PT fails to perform the duty in a reasonable, prudent manner. Harm occurs: This does not have to be physical injury.

Overview of the Legal Process Patients’ Rights The Patient’s Bill of Rights (pg. 24 in book) The major purpose of this regulation The right to an informed decision The right to have a procedure done or the right to refuse it

Overview of the Legal Process Informed Consent (PG. 26 IN BOOK) A particular treatment decision is based on full disclosure of the facts needed to make an intelligent (informed) decision. Informed Consent must be obtained before any invasive treatment or procedure. Patient needs to be aware of the consequences of refusing the treatment.

Failure to secure informed consent may result in a charge of civil battery. You can be charged with Civil Battery Unlawful touching of a person

CONFIDENTIALITY: extremely important!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! The PT has a duty to protect information about a patient Failure to maintain confidentiality gives rise to legal liability Health Insurance Portability and Accountability Act of 1996 (HIPAA) set rules and limits on who can look at and receive health care information.

Overview of the Legal Process Medical Records Medical records are NOT public documents. The information they contain must be guarded. Records may be used by both parties in a lawsuit to argue facts of the case. All entries in the medical record must be permanent, accurate, complete, and legible.

Overview of the Legal Process Invasion of Privacy The right to be left alone and go unnoticed if the patient chooses Legal liability may occur in Exposing the patient’s body parts unnecessarily Discussing the patient inappropriately Disclosing information about the patient Using any unauthorized patient information

You are a Mandatory Reporter Reporting Abuse Mandatory reporter The health care professional is protected from liability when acting in good faith. Child Abuse Prevention Treatment Act of 1973 Act made reporting of child abuse mandatory. Health care professionals may face fines and/or imprisonment if they fail to report suspected cases of child abuse.

Remember How to Avoid a Lawsuit Provide compassionate, competent nursing care PT-patient relationship must be one based on trust and respect. Use open and honest communication. Follow the standards of care and adhere to the scope of practice for a licensed PT.

Good Samaritan Law: need to know Provides immunity from liability in certain circumstances Encourages assistance in emergencies occurring outside of a medical facility by providing protection against liability

What is the difference verses Law and Regulations Ethics Customs Values

Can you provide examples? Ethics Values that influence a person’s behavior An individual’s feelings and beliefs about what is right and wrong Customs Habits, ways of acting Members of a family expected to behave in a certain way Influenced by religious teachings

VALUES Values Personal beliefs about the worth of an object, idea, a custom, or an attitude Develop over time and change as necessary Influences behavior behavior and decisions Learned through experience, observation, and reasoning

Ethical Aspects Development of Ethical Principles Ethical Dilemmas Situations that do not have a clear right or wrong answer Identify the problem. Assess the situation completely. Consider any ethical principles that might apply.

Ethical Aspects Ethical Principles Respect for Persons All human life is sacred. No one person is more important than another. Each patient has the same worth as another and is always entitled to respect. Autonomy Personal freedom of choice A right to be independent and make decisions PT does not have the right to make decisions for the patient.

Ethical Aspects Beneficence Doing what is good Nonmaleficence Ethical Principles Beneficence Doing what is good Nonmaleficence To do no harm

CODE OF ETHICS PT Code of Ethics (PT code of ethics, student syllabus) Serves as a way to regulate the actions of PT’s and gives guidelines for ethical behavior Promote competent, trustworthy, and accountable health care practitioners in order to safeguard society Makes the PT a better person/caregiver

Ethical Aspects Reporting Unethical Behavior Unethical behavior Failing to perform the duties of a competent, caring PT Each member of the nursing profession has a duty to report behavior that does not meet the established standards.

Ethical Aspects Ethical Issues Right to Refuse Treatment Durable power of attorney A person to make decisions regarding medical treatment if the patient is unable to make them

Ethical Aspects Do Not Resuscitate Orders The patient is usually incapacitated with little hope of recovery. Physician will consult with the family before writing a DNR order. PT has a duty to follow the order.

Ethical Aspects Refusal to Treat The PT cannot refuse to care for a patient because she disagrees with the decisions the patient makes. PT does not have to participate in the procedure but cannot refuse to provide care after procedure. Do not abandon the patient, but ask for another assignment.

Ethical Aspects Refusal to Treat The PT cannot refuse to care for a person with an infectious disease. Standard precautions should be applied to every patient and therefore the PT is at no greater risk. The patient has the right to receive care and the PT has the responsibility to provide care.