1. Legal and Ethical Concepts Nancy Pares RN, MSN Metro Community College

2.  http://www.youtube.com/watch?v=n5Zw4ZA RvNg http://www.youtube.com/watch?v=n5Zw4ZA RvNg

3.  Laws define and limit relationships  Sources of public law ◦ Constitutional ◦ Administrative ◦ Criminal  Civil Law ◦ Contract ◦ Tort ◦ Protective/reporting

4.  State ◦ Unintentional torts  Negligence  Duty  Breach of Duty  Injury  Causation  Malpractice

5.  Assault  Battery  False imprisonment  Restraints (OBRA)  Invasion of privacy  Defamation  fraud

6.  Defined by Practice Acts and Standards of Care  RN is legally responsible to ensure that the client receives competent, safe and holistic care.  Best Defense ◦ Actively participate in NNA ◦ Attend continuing ed on legal issues ◦ Call State Board with any questions about practice ◦ Stay current in hospital policies and procedures

7.  Unprofessional conduct  Impaired Nurse  Safety ◦ Understaffing ◦ Mandatory overtime ◦ Reassignment  Executing prescribed orders

8.  Whistle blowing  Nursing students  Professional liability insurance  Advance Directives

9.  DNR orders  Euthanasia  Wills  Pronouncement of Death  Care of the deceased  Organ donation  autopsies

10.  Ethics ◦ Study of rightness of conduct ◦ Vs. morality?  Relationship between ethics and legal ◦ Ethical opinions reflect individual differences ◦ Human behavior and motivation are too complex to be accurately reflected in law ◦ The legal system judges action rather than intention ◦ Laws change according to social and political influences

11.  Working in a clinic that performs abortions  Honoring a terminally ill client request for no heroic actions  d/c a comotose client life support at the request of the family  Diverting meds from a client for your own use

12.  Autonomy  Beneficience  Confidentiality  Double effect  Fidelity  Justice  Nonmaleficence  Paternalism  Sanctity of life  veracity

13.  Human caring should guide the practice  Confidentiality ◦ Privacy, misuse of information  Restraints  Trust  Refusing to provide care  Food and fluid

14.  Nancy Cruzan  Terri Shiavo

15.  Practice with compassion and respect  Nurses primary commitment is to the patient  Nurse advocates, protects the patient  Nurse is responsible and accountable for actions  Nurse must maintain competence and professional growth  Nurse participates in improving health  Nurse contributes to profession thru community, educational and social situations

16.  Dx: missed abortion—client hospitalized, D&C was scheduled—client discussed with MD  Nurse administered preop meds then noted that there was no consent signed. Surgery was postponed awaiting MD. MD arrived and had pt sign and husband also-witnessed by RN.  Procedure resulted in perforation, OB attempted to repair—called in general surgeon-- required removal of 1 ft of bowel  Result: likely to have higher incidence of SBO

17.  Was the hospital liable to obtain informed consent?

18.  1985- Nurse Midwife advertised ‘Family Birth’  Hospital Chief of Staff – OB wrote a letter to the administration of two hospitals stating that home deliveries were being done without qualified supervision.  Same MD confronted nurse midwife at L&D  Nurse midwife was prohibited from the hospital.

19.  Was the slander actionable?

20.  Client with fx leg—cast applied; orders to have nursing check hourly and call with concerns  Charting notes gap from 4am to 830 am.  MD examines at 830—compartment syndrome and identification of tissue death— leg amputated

21.  Was documentation considered substandard and cause for patient to suffer injury?

22.  Female patient admitted to LTC—noted large diamond ring and informed that she should not keep in her room. Pt kept the ring.  Ring disappeared—investigation proved fruitless—thru a ‘tip’ a nurse aid was implecated—arrested and pled guilty

23.  Was the nursing home responsible for the property damage sustained by the resident?

24. Male was admitted to psych unit on Nov 21due to being a threat to himself and others. Meeting held on Nov 23 determined that he was able to be released. (Thanksgiving holiday) Male entered house on Dec 5 and killed one individual and wounded two others, then shot himself.

25.  Was the institution liable for discharging the patient and the subsequent deaths?