Legal Principles in Nursing Chapter_05 - 1

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Chapter 5 Legal Principles in Nursing

Objectives:

Objectives Describe the legal obligations and role of nurses regarding federal and state laws that affect health care. Explain the legal concepts of standard of care and informed consent. List sources for standards of care for nurses. Explain the concept of negligence and identify the elements of professional negligence. Define the legal relationships of nurse-patient, nurse–health care provider, nurse-nurse, and nurse-employer. Identify nursing interventions to improve patient safety. 2

Legal Limits of Nursing :

Legal Limits of Nursing Sources of law Common law (decisions made by judges) Statutory law (statutes made by government) Nurse Practice Acts S tatutes enacted by state legislatures E stablish a regulatory agency

Federal Statutory Issues in Nursing Practice:

Federal Statutory Issues in Nursing Practice Health Insurance Portability and Accountability Act Americans With Disabilities Act Emergency Medical Treatment and Active Labor Act Patient Self-Determination Act

Federal Statutory Issues in Nursing Practice (Cont.):

Federal Statutory Issues in Nursing Practice (Cont.) Federal Nursing Home Reform Act National Organ Transplant Act Mental Health Parity Act

Legal Limits of Nursing (Cont.) :

Legal Limits of Nursing (Cont.) Criminal law Misdemeanor Felony Torts Intentional (e.g., assault and battery) Unintentional (e.g., negligence)

Legal Limits of Nursing (Cont.) :

Legal Limits of Nursing (Cont.) To establish malpractice, the plaintiff must prove: The nurse owed a duty to the patient T he nurse breached that duty The patient was injured because of the breach of duty The patient has accrued damages as a result of the injury

Standards of Care:

Standards of Care State Nurse Practice Acts S tate and federal laws and accreditation rules P rofessional and specialty organizations Written policies and procedures

Malpractice Insurance:

Malpractice Insurance A contract between the nurse and the insurance company Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance Nurses are covered by the institution’s insurance while working

Documentation:

Documentation Documentation includes: Patient assessments Interventions E valuations Occurrence report/incident report Documents a deviation from the standard of care Do not document in the nurses’ notes that an occurrence report was completed. Follow agency policy

Risk Management and Quality Assurance:

Risk Management and Quality Assurance A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs Steps involved: Identify possible risks Analyze risks Act to reduce risks Evaluate steps taken Never events

Good Samaritan Laws:

Good Samaritan Laws E ncourage nurses to assist in emergency situations L imit liability and offer legal immunity Allow nurses to treat minors in an emergency without parental consent Require nurses to act within accepted standards for their level of training

Consent:

Consent When consent is necessary: On admission to the hospital or health care facility Before specialized procedures Special considerations Communication issues Cultural issues Informed consent Right to refuse care

Statutory Guidelines for Legal Consent for Medical Treatment:

Statutory Guidelines for Legal Consent for Medical Treatment Adults A. Any competent individual 18 years of age or older for himself or herself B. Any parent for his or her unemancipated minor C. Any guardian for his or her ward D. Any adult for the treatment of his or her minor brother or sister (if an emergency, and parents are not present) E. Any grandparent for a minor grandchild (if an emergency, and parents are not present)

Statutory Guidelines for Legal Consent for Medical Treatment (Cont.):

Statutory Guidelines for Legal Consent for Medical Treatment (Cont.) Minors A. For his or her child and any child in his or her legal custody B. For himself or herself in the following situations: 1. Lawfully married or a parent (emancipated) 2. Pregnancy (excluding abortions) 3. Venereal disease 4. Drug or substance abuse

Statutory Guidelines for Legal Consent for Medical Treatment (Cont.):

Statutory Guidelines for Legal Consent for Medical Treatment (Cont.) Minors (Cont.) C. Unemancipated minors may not consent to abortion without one of the following: 1. Consent of one parent 2. Self-consent granted by court order 3. Consent specifically given by a court

Restraints:

Restraints Two types of restraints Physical Chemical The Joint Commission guidelines Patient rights Procedures Documentation Follow-up assessments Liability

Death and Dying:

Death and Dying Standards for the determination of death Cardiopulmonary Whole brain Advance directives DNR orders Organ and tissue donation Autopsies Confidentiality Social media

Health Care Provider Orders:

Health Care Provider Orders Assess physician or health care provider orders Obtain clarification as needed Orders should be in writing with the correct date and time

Nursing Students:

Nursing Students You are liable if your actions cause harm to patients , as is your instructor, hospital, and college/university. You are expected to perform as a professional when rendering care. You must separate your student nurse role from your work as a certified nursing assistant (CNA).

Patient Abandonment and Delegation Issues:

Patient Abandonment and Delegation Issues Short staffing Legal problems occur if inadequate number of nurses will provide care Floating Based on census load and patient acuities

Controlled Substances:

Controlled Substances Administer controlled substances only under the direction of a licensed physician Keep controlled substances secured Maintain careful documentation Report illegally prescribed and dispensed controlled substances

Reporting Obligations:

Reporting Obligations It is mandatory for health care providers to report: A buse Rape Gunshot wounds Attempted suicide Certain communicable diseases Unsafe or impaired professionals

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