1. CHAPTER 2 Legal and Ethical Aspects of Nursing

2. 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.

3. 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

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

5. 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.

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

7. Visit BVNPT website
Review State wide module

9. 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.

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

11. 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 .

12. 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.

13. 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)

14. 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)

15. 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)

16. Scope of practice

17. 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

18. 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.

19. 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

20. 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.

21. 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

22. 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.

23. 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.

24. 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

25. 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.

26. 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.

27. 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

28. What is the difference verses Law and Regulations
Ethics
Customs
Values

29. 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

30. 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

31. 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.

32. 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.

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

34. 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

35. 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.

36. 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

37. 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.

38. 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.

39. 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.