Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 05: Legal and Ethical Issues

Legal Issues in Nursing Practice Introduction System of laws and ethical beliefs: Help establish and maintain order and harmony Laws: Written rules for conduct and actions; binding; ensure protection of rights Ethics: Moral principles and values Ethical standards: Determine rightness or wrongness of human behavior Healthcare delivery system: Societal beliefs; values; laws; accountability; basic understanding of laws

Question Is the following statement true or false? Laws are binding, written rules to govern conduct and actions.

Answer True. Laws are binding, written rules to govern conduct and actions.

Legal Issues in Nursing Practice Sources of Law Constitutional law Protects basic rights of nurses and clients Statutory law Enacted by local, state, or federal legislative body Affects healthcare providers; “DRG law” Nurse practice acts Define nursing practice; protect health and safety of citizens Components: Licensure, board of nursing, disciplinary actions

Legal Issues in Nursing Practice Sources of Law Statutory Law: State board of nursing Protect public; Reviewing and approving nursing education program Forming criteria-granting licensure Issuing or transferring licenses Disciplinary procedures Common Law Judicial: Based on earlier court decisions Precedents for interpretation of laws

Legal Issues in Nursing Practice Sources of Law Administrative law Practiced by federal and regulatory agencies Enforces rules and regulations for health, welfare, safety Occupational Safety and Health Administration (OSHA) State board of nursing regulates the nurse practice act

Legal Issues in Nursing Practice Sources of Law Criminal law Offenses: Violate public’s welfare Crime: Violation of criminal law Two categories: Misdemeanors and felonies Civil law Applies to disputes arising between individual citizens Protects personal freedoms, property rights; individual plaintiffs

Legal Issues in Nursing Practice Sources of Law Civil law (cont’d) Complaint: Formal written dispute Defendant: Individual or party against whom complaint is filed Liability: Legal responsibility Tort law: Governs breaches of duty owed by one person to another Duty: Expected moral or legal actions Tort: Injury occurred due to another person’s actions or failure to act

Legal Issues in Nursing Practice Sources of Law Intentional torts: Deliberate, willful acts that infringe on another person’s rights Assault: Threat or attempt at bodily harm Battery: Physical contact without consent; clients sign general permission for care and treatment to protect healthcare workers from being charged Parent or guardian consent for minor or mentally retarded Nonconsensual physical contact may be justified; document situation

Legal Issues in Nursing Practice Figure 5-1 Consent for treatment , pg 37

Question Is the following statement true or false? Generally, healthcare personnel are not legally allowed to touch clients without direct verbal permission.

Answer False. When clients sign the consent for treatment form, they are granting general permission for healthcare workers to touch them.

Legal Issues in Nursing Practice Sources of Law Intentional torts (cont’d) False imprisonment: Restraining person without consent Confinement: Restraining with medical orders and court-ordered commitments; sign release form to leave facility against medical advice Unnecessary application of physical or chemical restraints: Potential liability for battery and false imprisonment Show just cause through accurate documentation

Legal Issues in Nursing Practice Sources of Law Figure 5-2 Release form for leaving against medical advice, pg 38

Legal Issues in Nursing Practice Sources of Law Intentional torts: Invasion of privacy Failure to leave person or property alone Nonmedical torts: Trespassing, illegal search and seizure, wiretapping Revealing private information Medical torts: Photographing without consent; revealing client’s name in public report or research papers; unauthorized people observing clients

Legal Issues in Nursing Practice Sources of Law Intentional torts: Invasion of privacy Protect client’s privacy Signed release for recognizable photographs; initials; code numbers Close bedside curtains during personal care Obtain client’s permission for observers during treatment

Legal Issues in Nursing Practice Sources of Law Intentional torts: Defamation Harms person’s reputation: Slander, libel Avoid: Negative opinions may mar a person’s public image or keep potential clients from seeking services Nurses at risk for defamation: Negative comments in public areas; assert opinions regarding client’s character in medical record

Legal Issues in Nursing Practice Sources of Law Unintentional torts Situations: Unintentional injuries Negligence: Failure to act reasonably; harm resulting from action; client may sue individual for negligence Malpractice: Professional negligence; harm caused by licensed person’s actions or lack of action

Legal Issues in Nursing Practice Sources of Law Unintentional torts (cont’d) Professional standards of care: Published standards Testimony: Expert witnesses; written agency policies and procedures Patient’s Bill of Rights Standardized care plans

Legal Issues in Nursing Practice Sources of Law Figure 5-3 How the court establishes professional standards of care, pg 41

Legal Issues in Nursing Practice Limiting Liability Good Samaritan Laws: Legal immunity for rescuers providing first aid in emergency; no absolute exemption from prosecution; gross negligence is a criminal offense Statute of limitations: Designated time to file lawsuit; for injury of a minor, commences in adulthood Assumption of risk: Warn clients; client responsible if warning is disregarded; document warnings

Legal Issues in Nursing Practice Limiting Liability Documentation Major component: Limiting liability Medical record: Legal document REVIEW: Box 5-5, pg 40 & Box 5-6 pg 41 Risk management Identifying and reducing anticipated loss Risk manager reviews problems at workplace; develops new methods Incident report documents nature of incident, witnesses, actions taken, & client’s condition

Legal Issues in Nursing Practice Limiting Liability Risk management (cont’d) Nurse: Records incident only in client’s record; not included in medical record Steps: To reduce harm to clients and avoid litigation Anecdotal records Handwritten and personal account of incident Helps refresh nurse’s memory May be presented as evidence in court

Legal Issues in Nursing Practice Limiting Liability Liability insurance Provides funds for attorneys’ fees and damages awarded in malpractice lawsuits Nurses should have personal malpractice insurance: Increasing malpractice lawsuits

Legal Issues in Nursing Practice Other Legal Issues Informed consent Permission granted by client or medical proxy to perform procedures or surgery Information provided to the client by physicians Emergency: Document facts in medical record; verification Consent signed by adult or guardian Nurses: Witness client’s signature; ensure client has necessary information; clarify; provide client teaching

Legal Issues in Nursing Practice Other Legal Issues Advance directives Clients: Determine wishes in advance Living will: Document stating client’s wishes regarding healthcare, Figure 5-4, pg 43 Medical durable power of attorney: Designating another person; desirable to consult a lawyer Do-not-resuscitate orders Written medical order for end-of-life instructions; policy regarding DNR orders

Ethical Issues in Nursing Practice Introduction Ethical issues: No absolute answers; possibility of conflicts Theories of Ethics Nursing ethics Utilitarianism: Teleologic theory; outcome- oriented approach for decision making; principles; compels to evaluate consequences of actions and make decisions

Question Is the following statement true or false? Ethical issues typically present a clear-cut right-or-wrong option.

Answer False. Ethical issues can present conflicting options.

Ethical Issues in Nursing Practice Theories of Ethics Deontology Duty equally important: Ethical dilemmas Rights: Actions having moral or legal claim Nurses: Professional duty to clients Advantages: Considers rights of each person, obligation to duty, and moral thinking Disadvantage: Consequence of harmful decision

Ethical Issues in Nursing Practice Factors That Influence Ethical Decision-Making Professional values Ethical values: Principles to make decisions about right and wrong Characteristics: Professional values support ethical conduct of profession Beneficence: Duty to do good for clients Technical competence; humanistic approach; supports client advocacy; advocacy includes safeguarding client rights and supporting interests

Ethical Issues in Nursing Practice Factors That Influence Ethical Decision-Making Professional values (cont’d) Nonmaleficence: Do no harm to client; treatment may cause harm; outcome potentially good Autonomy: Client’s right to self-determination; freedom to make choices Justice: Fairness to all Fidelity: Professional obligations; responsibilities; nurse practice acts Veracity: Tell the truth; factual information

Ethical Issues in Nursing Practice Factors That Influence Ethical Decision-Making Legislative and judicial influences Result of society’s struggles with ethical issues Nurse’s role: Preserve life; nurse practice acts prohibit assisting clients to die Influence of technology Developments: Impregnation of women past menopause; genetic engineering; cloning; nurse’s role and decisions involved

Ethical Issues in Nursing Practice Factors That Influence Ethical Decision-Making Healthcare reform Affecting factors: Cost control Decreased hospital stays; increased client acuity; alternative healthcare Nurse: Examine own values; provide high- quality care to clients

Ethical Issues in Nursing Practice Ethical Decision-Making Nurses: Use problem-solving method to provide care to clients Steps involved in making ethical decisions Ethics Committees Resolve ethical dilemmas Decisions: Per case basis People from diverse backgrounds Guidelines; policies; careful and unbiased decisions

Ethical Issues in Nursing Practice Gerontologic Considerations Informed consent: May be an issue with older adults Fluctuating cognitive status: Retain ability to make decisions Dependency on healthcare provider Federal and state governments: Regulate treatment given by licensed healthcare facilities

NO sleeping… it’s NCLEX Q & A and Workbook time!