1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7  Legal Responsibilities for Practice

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Understanding the Scope of the Law Law: The principles and regulations established in a community by some authority and applicable to its people, whether in the form of legislation or of custom and policies recognized and enforced by judicial decision. Ethics deal with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question What type of law includes all written laws and government codes? A. Statutory law B. Constitutional law C. Enacted law D. Regulatory law

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Statutory law Rationale: Statutory law includes all written laws and government codes. Constitutional law, which has the greatest authority in any jurisdiction, is found in the U.S. constitution and in state constitutions. Enacted law includes those laws passed by legislative bodies. Regulatory law, also referred to as administrative or executive law, includes those rules and regulations established by administrative bodies within the government.

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sources of Law Statutory law –Constitutional law –Enacted law Regulatory law Common law –Judicial law –Common usage and custom

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Statutory Law All written laws and governmental codes –Constitutional law—greatest authority in any jurisdiction  U.S. constitution  State constitution –Enacted law—laws passed by legislative bodies

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Regulatory Law Administrative or Executive law Rules and regulations established by administrative bodies within the government

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Factors Affecting Legal Decision Administrative rulings Rights and responsibilities in healthcare Institutional policies, protocols, and procedures

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Institutional Policies and Protocols Policies –Provide guidance in proper actions to be taken in specific situations –Identify individuals responsible for taking action –Set standards of practice Protocols –List actions for managing a specific problem that may involve more than one procedure

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Institutional Procedures Outline the steps in a particular task Purpose of protocols and procedures—ensure consistent sound practice in an institution

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Violations of Criminal law are considered torts, whereas violations of Civil law are considered crimes.

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Violations of Criminal law are considered crimes, whereas violations of Civil law are considered torts.

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Classification of Laws Criminal law –Regulates actions having to do with the safety of the community as a whole –Violations considered crimes Civil law –Encompasses those laws regulating private conduct between individuals –Violations considered torts

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Criminal Law and Nursing Performance outside the nurse practice act Administering medication without an order Inappropriate care and distribution of controlled substances Committing crimes while in the role of caregiver –Reckless endangerment –Criminal negligence Felonies

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Civil Law and Nursing Torts: civil wrong committed against a person or the person’s property Negligence: conduct lacking in due care Malpractice: professional negligence—liability resulting from improper practice based on standards of care required by the profession for which the person has been educated

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Essential Elements of Negligence Harm Duty Breach of duty Causation

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Malpractice actions brought against healthcare workers involve Criminal law.

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: Malpractice actions brought against healthcare workers involve Civil law.

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Liability Liability is an obligation or debt that can be enforced by law Personal liability—legally responsible or liable for your own actions Employer liability Supervisory liability Limits on patient’s claim to negligence

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Employer Liability Torts committed by an employee called respondeat superior Employer responsible for: –Hiring qualified individuals –Establishing an appropriate environment for correct functioning –Maintaining correct policies and procedures –Providing supervision or direction as needed

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Supervisory Liability Role that involves delegation, supervision, or direction of other individuals can be potentially liable for the actions of others

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Charitable Immunity Institutional charitable immunity Charitable immunity for volunteers in health settings Good Samaritan laws

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Liability Insurance Transfers cost of being sued and cost of any settlement from the individual to an insurance company, which spreads the risks to a large group Institutional and individual insurance Analyzing liability insurance coverage

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Issues Common in Nursing Duty to report or seek medical care for a patient Nursing responsibility for medical orders Confidentiality and right to privacy Defamation of character Privileged communication

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Informed Consent Consent for medical treatment Consent for nursing measures Competence to give consent Withdrawing consent Consent and minors

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Advance Directives Living will Durable power of attorney for healthcare Physician orders for life sustaining treatments Patient Self-Determination Act

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Emergency Care Consent in emergencies Standards of practice and emergencies Protocols and emergencies Noninstitutional emergency care

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Issues in Nursing Fraud Assault and battery False imprisonment

29. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors that Contribute to Malpractice Claims Consequences of errors Social factors Suit prone patients Suit prone nurses

30. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Preventing Malpractice Claims Maintaining excellent standards of care Self-awareness Adapting proposed assignments Following policies, procedures, and protocols Changing policies, procedures, and protocols Effective documentation

31. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Elements of a Legal Action Discovery Settlement out of court Trials

32. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse as Witness The nurse as witness to fact The nurse as expert witness

33. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 8Ethical Concerns in Nursing Practice

34. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Ethics is a branch of philosophy referred to as moral philosophy.

35. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Ethics is a branch of philosophy referred to as moral philosophy. It seeks to provide answers to some of the questions of human conduct that arise in our life, and attempts to determine what is right or good.

36. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Understanding Concepts of Ethics Morals—basic standards for what is considered right and wrong Ethics—specific area of study of morality that concentrates on human conduct and human values Ethical dilemma—occurs when an individual must choose between two unfavorable alternatives Values conflict—occurs when we must choose between two things, both of which are important to us

37. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Values Clarification Choosing the values that feels right Prizing the value or cherishing it Acting on the value

38. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Ethical Concepts Autonomy—right of self-determination or choice, independence, and freedom Beneficence—obligation to do good, not harm, to other people Nonmaleficence—prohibition of intentional harm Justice—fairness, obligation to treat like cases similarly

39. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Basic Ethical Concepts (cont.) Fidelity –Obligation to be faithful to the agreements, commitments, and responsibilities that one has made to oneself and others –Foundation of the concept of accountability Veracity –Telling the truth –Not intentionally deceiving or misleading patients

40. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? The problems associated with the allocation of scarce resources are expected to decrease in the near future with the implementation of healthcare reform.

41. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: The concept of justice has been expanded to include distributive justice that is applied in situations requiring the allocation of scarce resources. The problems associated with the allocation of scarce resources are expected to increase in the near future.

42. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Theories Utilitarianism Deontology Theory of social justice

43. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Utilitarianism An act is right when it is useful in bringing about a desirable or good end Allows the end to justify the means Fits well into western society’s values regarding work ethic and the behavioristic approach to education, philosophy, and life

44. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Deontology Based on moral rules and unchanging principles considered separately from the consequences Unconditional commands that must be applied in all situations without exception

45. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Social Equity and Justice Allows social and economic positions to be to everyone’s advantage and open to all Introduces a “veil of ignorance” whereby persons making choices would not have any specific information regarding those involved, thus choosing the alternative that supported the most disadvantaged person Supports justice and equal rights for everyone

46. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Applying Basic Concepts Rights –Right to self-determination –Rights and cultural relativism –Rights of the unborn –Right to privacy and right to confidentiality Standard of best interest Ethics and financial compensation

47. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Ethical decision-making may be based on personal religious and philosophic viewpoints.

48. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Ethical decision-making may be based on personal religious and philosophic viewpoints, but must always be grounded in professional standards seen in the codes for nurses and the statements of patient rights.

49. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors that Influence Ethical Decision- Making Codes for nurses Patient’s rights Social and cultural factors Science and technology Legislation Judicial decisions Funding Personal religious and philosophic viewpoints

50. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Personal Values and the Work Environment Seeking employment Workplace influences –Status as an employee –Collective bargaining contracts –Collegial relationships –Authoritarian and paternalistic backgrounds –Institutional supports for ethical behavior –Consumer involvement in healthcare

51. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Framework for Ethical Decision-Making Identify and clarify the ethical problem Gather factual data Identify and evaluate options Make a decision Act and assess

52. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Nurses have ethical obligations to the patient and to the employer, and must maintain an objective stance regarding other healthcare providers, and when confronting substandard care.

53. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Nurses have ethical obligations to the patient and to the employer, and must maintain an objective stance regarding other healthcare providers, and when confronting substandard care. Commitment to the personal excellence and to the profession of nursing are also desired characteristics of the professional nurse.

54. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Specific Ethical Issues Related to the Profession of Nursing Commitment to the patient Commitment to the employer –Responsible work ethic –Responsible use of supplies Commitment to the colleagues Commitment to the personal excellence Commitment to the nursing profession

55. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Commitment to the Nursing Profession Formal evaluation Informal evaluation Addressing substandard care –Basic pattern for action –Alternative approaches for action –Personal risks in reporting –Whistleblowing Recommending a care provider

56. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chemically Impaired Professional Chemical impairment in healthcare professionals Recognizing the chemically impaired nurse Reporting the chemically impaired colleague

57. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Chemically Impaired Professional Mood swings Inappropriate behavior Frequent days off Noncompliance with policies and procedures Deteriorating appearance Inadequate documentation

58. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Chemically Impaired Professional (cont.) Unusual prescribing patterns Alcohol on breath Poor judgment and concentration Dishonesty Missed appointments Boundary violations

59. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Boundary violations, a situation in which the nurse moves beyond a professional relationship and becomes involved with patients and their families, has become a concern in nursing.

60. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Boundary violations, a situation in which the nurse moves beyond a professional relationship and becomes involved with patients and their families, has become a concern in nursing. Educational programs to increase understanding of this problem and to help avoid its occurrence are being conducted.

61. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Boundary Violations Situation in which the nurse moves beyond a professional relationship and becomes involved with patients and their families Represents a violation of the trust relationship that exists between the patient and the nurse