Healthcare Systems/Legal & Ethical Issues (FON) 1

Example of the Preventive level of health care

· Vaccines

· Healthy diet

· Exercise

Primary Care

• First point of contact

• Health Promotion

• Early Detection

• Routine Care

• Generalists

Secondary Care

• Usually requires a referral

• Specialist

• Specific body system

• May be in office, clinic, hospital

• Examples:

o Orthopedics

o Emergency department for chest pain

o Cardiologist

Tertiary Care

"Acute care"

• Hospitals

• Intensive Care

• Surgeons

• Psychiatric facility

Restorative Care

Restoring

• Rehabilitation

• Home Health Care

• Extended care

Continuing Care

• Long-term care

• Assisted living

• Adult day care

• Hospice

An example of Statutory law (Federal/State; Criminal/Civil)

Nursing practicing act - legal boundaries of nursing

An example of Regulatory law (administrative law)

Requirement to report incompetent or unethical nursing conduct to BON

An example of Common law

· Negligence

· Malpractice

· Informed consent

What is the American Nurses Association (ANA)?

Experts that advise state legislator.

Advocates for nurses.

What is the Nurse Practice Act (NPA)?

Actual law.

Set by state legislator

What is the Internal standards of care-regulated by TJC?

Regulates the medical facilities.

Quality control.

What do the Hospitals' Policy & Procedure manuals regulate?

Regulate what we can and can't do in the hospital.

What is the number one violations of Florida Nurse Practice Act?

Being impaired by drugs or alcohol while working.

What are common violations of the Florida Nurse Practice Act?

· Stealing from a patient/client, including medications.

· Providing treatment or care that should be provided only by a physician or APRN.

· Falsifying records.

· Boundary issues, including abusing a patient physically or sexually.

· Involvement in criminal conduct.

Living wills

A legal document stating a person's desires on what measures should or should not be taken to prolong life when his or her condition is terminal.

Durable Power of Attorney

a legal agreement that allows an agent or representative of the patient to act on behalf of the patient

Health Care Proxy

a person chosen by another person to make medical decisions if the second person becomes unable to do so

Do Not Resuscitate (DNR)/Allow Natural Death (AND)

is an order to not attempt resuscitation of the patient in the event of a cardiac or respiratory failure. The ANA recommends "allow natural death" (AND).

How is a DNR/AND acquired?

An adult with "capacity" with a physician can authorize this order.

Characteristics of DNR/AND

· Must be documented that provider met with individual and family then attached to chart.

· Provider must review routinely for change in patient condition.

· No DNR/AND order=full code.

Licensure

Varies among states

Good Samaritan Laws

Protects nurses providing care outside work

Public Health Laws

Some diseases have to be reported to the CDC

Intentional Torts

· Deliberate acts that violate another’s rights

· Battery, Assault

· False imprisonment

Quasi-intentional Torts

• Intent is lacking, but volitional action and direct causations occur

• Slander (Oral), Libel (Written)

• Invasion of privacy

Unintentional Torts

• An act that is unintended but causes injury

• Negligence

• Malpractice

What all 4 elements must be true for Proof of Negligence?

• The nurse owed a duty to the patient.

• The nurse did not carry out the duty or broke it.

• The patient was injured.

• The patient's injury was caused by the nurse's failure to carry out that duty.

Are nurses responsible for explaining a procedure to a patient?

No

What should a nurse observe when witnessing a signature?

• Patient voluntarily gave consent

• Comprehends what is to be done

• Signature authentic

• Patient appears to be competent

What are a nurse's responsibility with informed consent?

• Must notify physician or supervisor if concerned

• If patient unconscious, consent must be obtained from a person legally authorized to give it on their behalf.

• In emergencies, procedure may be performed without consent to benefit patient or save a life.

Malpractice Insurance

• A contract between the nurse & the insurance company.

• Provides a defense when a nurse is in a lawsuit involving negligence or malpractice insurance.

• Nurses covered by institution's insurance while working.

Abandonment & Assignment Issues:

Short staffing

Legal problems occur if inadequate number of nurses will provide care.

Abandonment & Assignment Issues:

Floating

Based on census load and patient acuities

Abandonment & Assignment Issues:

Physician's orders

Nurses follow orders unless they believe an order is given in error or is harmful.

Abandonment & Assignment Issues:

Patient abandonment

Refusing to care for assignment after care has been established.

Risk Management

A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs.

Incident (Occurrence) reporting

• Serves as a database for further investigation.

• Alerts risk management to a potential claim situation.

• Confidential

• Agencies have specific guidelines on how to complete.

• NOT a part of the patient’s chart.

• Completed by the person who witnessed the event.

Ethics

The study of conduct and character. It is concerned with determining what is good or valuable for individuals and society at large.

Values

Personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behavior.

Autonomy (health ethics)

Commitment to include patients in decisions

Beneficence (health ethics)

To do good

Nonmalficence (health ethics)

duty to do no harm

Justice (health ethics)

fair and equitable distribution of health resources

Fidelity (health ethics)

keep promises

Veracity

be truthful

Professional Nursing Code of Ethics

-A set of guiding principles that all members of a profession accept

-Helps professional groups settle questions about practice or behavior

-Includes advocacy, responsibility, accountability, and confidentiality

Code of Ethics

• Advocacy

• Responsibility

• Accountability

• Confidentiality

Issues in Health Care Ethics

• Quality of Life

• Genetic Screening

• Care at the End-of-Life

• Access to Care

Ethics Committees

• Multidisciplinary and serve several purposes: education, policy recommendation, and case consultation.

• Any person involved in an ethical dilemma can request access to an ethics committee.