NUR 134 Legal/Ethical Issues & Scopes of Practice

promote health, prevent illness, restore health, facilitate coping with disability or death

What are the 4 nursing aims?

to promote health

nursing aim motivated by desire to increase a person's well-being and health potential

to prevent illness

nursing aim that is anticipatory action taken to prevent the occurrence of an event or to minimize its effects after it has occurred.

to restore health

nursing aim that involves identifying & reporting abnormal findings, providing direct care, planning/teaching/evaluating treatments

to facilitate coping with disability or death

nursing aim that helps patient & family cope with altered function, life crisis, and death. helps maximize person's strengths & potential with disability, and provide & maintain comfort in end of life

cognitive, technical, interpersonal, ethical/legal

Competencies of Nursing (skills)

cognitive skills

critical thinking/ reasoning, analysis, evaluation, acquiring/comprehending knowledge

technical skills

"hands on" skills, equipment use

interpersonal skills

communication, listening, decision-making, ability to interact/get along with others

ethical/legal skills

values, respecting others, know your scope

patient-centered care, teamwork/collaboration, quality improvement, safety, EBP, informatics

QSEN competencies (6)

patient-centered care

focuses on including patients in all decisions and providing compassionate care that is based on patient's needs and values

teamwork & collaboration

focuses on interdisciplinary collaborations and shared decision-making among the healthcare team

quality improvement

data collection, evaluation, and improvement of patient outcomes

safety

preventing harm to patients and creating a "culture of ________"

EBP

utilization of current research/evidence in practices/providing care

informatics

utilization of technology to promote safety and quality

voluntary standards

developed and implemented by the nursing profession; not mandatory but used as guidelines for peer review

voluntary

The ANA standards of practice are examples of which type of standards?

legal standards

Developed by a legislature and are implemented by state authority; determine the minimum standards for nurse education, licensing requirements

legal

Nursing practice acts are examples of which type of standards?

nursing practice act

laws established in each state to regulate the practice of nursing; can vary among states but all have certain elements in common such as protecting the public by defining legal scope of nursing practice, creating a state board to make/enforce rules, etc

credentialing

refers to ways in which professional competence is ensured and maintained

Accreditation, licensure,

certification

What 3 processes are used for credentialing in nursing?

accreditation

the process by which a nursing program is evaluated and recognized as having met certain standards

licensure

process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants a license to do so

certification

process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area

legal, voluntary

What are the 2 types of accreditation for a nursing program?

legal

State approved accreditation done by the state boards of nursing--legally required

voluntary

Accreditation done by the National League for Nursing Accreditation Commission (AACN) or American Association of Colleges of Nursing (NLNAC)-- not a legal requirement

licensure

specialized form of credentialing based on laws passed by state legislature

license (licsensure)

Allows an individual to offer nursing skills to the public; allows one to act with basic competence and is NOT appealed without due process

licensure, certification

___________ measures entry-level competence and ________ validates specialty knowledge, experience, and clinical judgement

certification

confirms speciality knowledge, expertise, and clinical judgement; advanced knowledge and skill proficiency; requires additional testing

certification

credentialing acquired by advance practice nurses are which type of credential?

law

standard or rule of behavior established and enforced by the government to protect the rights of the public

litigation

process of taking legal action/bringing and trying a lawsuit

legal violations

wrongful acts committed against another person or his/her property

crime

an act or omission that violates the law

state/federal

crimes are punishable at what level?

tort

a wrongful act that injures/interferes with another's person or property

civil

tort is punishable at what level?

intentional, unintentional

what are the 2 types of torts?

intentional tort

invasion of privacy, false imprisonment, fraud, assault, battery, defamation

assault

a threat or attempt to make bodily contact with someone without consent

battery

assault that is carried out or acted upon; willful, angry, or violent touching of another person without consent

True

(T/F) Battery can include well-intentioned acts

defamation

occurs when an individual makes derogatory remarks about another person to negatively impact his/her reputation, without good reason to believe they are true

slander

oral defamation

libel

written defamation

invasion of privacy

breach of confidentiality

HIPAA

What protects patients' privacy rights?

True

(T/F) Patients have the right to be left alone and have information maintained confidential

false imprisonment

when a person is confined or restrained against their will

false inprisonment

unjustified custody or prevention of movement of another person without consent

fraud

purposeful misrepresentation that may cause loss or harm to an individual or property

fraud

lying by omission is an example of what?

standards of care

what a reasonable, practical, competent nurse would or would not do in a given situation; specific to areas of practice and facilities

negligence

unintentional tort; performing an act that a practical person WOULD NOT normally do in a similar situation or failing to act in a way that a reasonable person WOULD act in a similar situation

malpractice

failure to abide by the standard of care of one's profession; "professional negligence"

liability

the legal responsibility for one's actions (or failure to act)

duty, breach of duty, causation, damages

What are the 4 components of liability that must be established to prove malpractice/negligence has occurred?

duty

obligation to use due care (what someone would normally do)

breach of duty

failure to meet standard of care

causation

indicates that breach of duty can lead to/led to injury

damages

the actual harm or injury resulting to the patient

duty

nurse is responsible for accurate assessment on patients and alerting responsible health care professional of changes in condition

breach of duty

Ex: failure to note and report an older adult patient exhibiting periods of confusion, who was assessed as A + O on admission. did not perform fall risk assessment.

causation

ex: failure to use appropriate safety measures-causing patient to fall while attempting to get out of bed.

damages

ex: fractured left hip/pain/suffering/lengthened hospital stay/need for rehabilitation.

True

(T/F) Students in the clinical setting are held to the same standards of care as the RN.

physician

When obtaining informed consent, whose job is it to explain the procedure/treatment regimen & assess patient understanding of procedure?

values

beliefs that act as standards to direct one's behavior and decisions; formed throughout life based on environment, family, and cultural practices.

values

_______ in nursing set the foundation for practice & influence how nurses interact with patients and members of the healthcare team.

values clarification

understanding one's own values

altruism, autonomy, human dignity, integrity, social justice

What are the 5 values of the nursing profession?

altruism

concern for the well-being of others

autonomy

the right to self-determination

human dignity

respecting the worth of individuals & populations

integrity

acting in agreement with a code or accepted standards of practice

social justice

maintaining moral, legal, and humanistic principles

ethics

a conscious understanding about right & wrong behavior, or good vs. evil; gradually develops over time & may be a code of professional conduct

nursing code of ethics

set of principles that reflect the goals, values, and obligations of the nursing profession

nursing code of ethics

What sets the ethical standards/obligations for nursing, both in care provided and professional performance?

patient's bill of rights

rights and responsibilities while receiving care in the healthcare setting

bill of rights for registered nurses

enables nurses to provide safer patient care; empowerment of nurses

bioethics

discipline focusing on ethical concerns for bioethical research--science & medicine

nursing ethics

study of ethical concerns that arise during nursing practice; type of bioethics

utilitarian

theory of ethics in which the rightness/wrongness of an action depends on the consequences

deontological

theory of ethics in which an action is right or wrong based on a rule--regardless of the consequences

autonomy

principle of bioethics: respect patient's right to make decisions; self determination.

nonmaleficence

principle of bioethics: avoiding harm to patients... "shall do no harm"

beneficence

principle of bioethics: act of doing good, acts that benefit the patient

justice

principle of bioethics: being fair, giving each person his/her due

fidelity

principle of bioethics: keep promises

veracity

principle of bioethics: being truthful/honest

accountability

principle of bioethics: accepting responsibility

privacy

principle of bioethics: right to be left alone

confidentiality

principle of bioethics: protecting personal & healthcare information

ethical dilemma

when multiple moral principles apply but support inconsistent courses of action (2 or more conflicting principles)