ch 2 legal and ethical aspects of nursing

What is the purpose of the legal system in nursing?

To establish rules, protect patients, and guide safe nursing practice.

What is the difference between law and ethics?

Law is the minimum standard of conduct; ethics are moral principles that guide higher standards of behavior.

What are the two categories of law?

Criminal law and civil law.

What is criminal law?

Laws dealing with crimes against society; penalties include fines or imprisonment.

What is civil law?

Laws involving disputes between individuals; penalties usually involve monetary damages.

What are the two main sources of law?

Statutory law and common law.

What is negligence?

Failure to provide reasonable care or acting carelessly.

What is malpractice?

Professional negligence by a licensed healthcare provider.

What are the four elements of malpractice?

Duty, breach of duty, harm, and causation.

How can nurses avoid malpractice?

Follow standards of care, policies, and practice within their scope.

Who is responsible for a nurse's actions?

The individual nurse.

What are supervisors liable for?

Poor supervision or improper delegation.

What is the employer responsible for?

Staff training, credentials, policies, and safe equipment.

Who files a lawsuit?

The plaintiff.

Who is being sued?

The defendant.

What are the steps in a civil lawsuit?

Complaint, summons, discovery, trial, and possible appeal.

What determines accountability in nursing?

Being legally responsible for one's own actions.

Why has litigation against nurses increased?

Expanded responsibilities, technology, staffing shortages, and higher patient acuity.

Which practice settings have the highest litigation rates?

Labor and delivery, emergency department, and surgery.

What is the most common cause of nursing lawsuits?

Poor communication.

When does the nurse-patient relationship begin?

When the nurse accepts the patient assignment.

What legal duty is created when accepting a patient assignment?

The duty to provide safe, professional nursing care.

What landmark case established nurses' legal responsibility?

Darling v. Charleston Community Memorial Hospital.

What are standards of care?

Expected nursing actions that define safe and competent practice.

Where do standards of care come from?

Laws, Nurse Practice Acts, professional organizations, and healthcare agencies.

How is a nurse's care judged legally?

Compared to what a reasonably prudent nurse would do.

What is the Nurse Practice Act (NPA)?

State law defining the legal scope of nursing practice.

Why should nurses know their state's Nurse Practice Act?

It defines what they are legally allowed to do.

What document replaced the Patient's Bill of Rights?

The Patient Care Partnership.

What does HIPAA protect?

Patient privacy and protected health information (PHI).

What is PHI?

Protected Health Information that can identify a patient.

Who may access PHI?

Only individuals directly involved in the patient's care.

What are examples of PHI?

Name, DOB, SSN, address, phone number, photos, and medical information.

Where should patient information never be discussed?

Public places like elevators or cafeterias.

What are patient rights?

Respect, dignity, privacy, safety, access to care, and informed decisions.

What are patient responsibilities?

Provide accurate information and participate in care.

What is informed consent?

The patient's voluntary agreement after receiving complete information.

What information must be included in informed consent?

Benefits, risks, alternatives, and consequences of refusing treatment.

Who explains a procedure for informed consent?

The provider performing the procedure.

What is the nurse's role in informed consent?

Witness the signature and refer questions to the provider.

What happens if informed consent is not obtained?

It may be considered battery.

Who can legally give informed consent?

A competent adult or legally authorized representative.

When can a minor give consent?

If married, emancipated, in the military, living independently, or seeking care for specific conditions.

What is implied consent?

Consent assumed by a patient's actions or in emergencies.

What is verbal consent?

Consent spoken by the patient.

What is written consent required for?

Invasive procedures.

What are common social media violations by nurses?

Posting patient information, photos, or negative workplace comments.

What can happen if nurses violate social media policies?

Termination, fines, or disciplinary action against their license.

What should nurses do before posting online?

Ensure patient confidentiality is never violated.

What should nurses do with shift notes?

Destroy them according to facility policy.

What information must nurses report by law?

Communicable diseases, gunshot wounds, and suspected abuse.

Who are mandatory reporters?

Healthcare professionals required by law to report abuse.

What law requires reporting child abuse?

Child Abuse Prevention and Treatment Act.

What is workplace violence?

Verbal, emotional, physical, or sexual abuse in the workplace.

How can nurses reduce the risk of lawsuits?

Provide competent care, communicate effectively, and follow standards.

What is the most important legal rule about documentation?

If it wasn't charted, it wasn't done.

Why is documentation important?

It serves as legal evidence of care provided.

What is professional liability insurance?

Insurance protecting a nurse's personal assets in lawsuits.

What is occurrence-based insurance?

Covers incidents that occurred while the policy was active, regardless of when the claim is filed.

What is claims-made insurance?

Covers claims filed while the policy is active.

What is tail coverage?

Extended coverage after a claims-made policy ends.

What is disciplinary defense insurance?

Insurance covering legal expenses during Board of Nursing investigations.

What actions can the Board of Nursing take?

Reprimand, probation, suspension, diversion, or license revocation.

What are ethics?

Moral principles that guide right and wrong behavior.

What is nursing ethics?

Ethical responsibilities to patients, coworkers, the profession, and society.

What is an advance directive?

A legal document stating healthcare wishes if the patient cannot decide.

What are the two main types of advance directives?

Living will and durable power of attorney for healthcare.

What is a living will?

A document stating desired medical treatments in terminal illness.

What is a durable power of attorney for healthcare?

A person chosen to make healthcare decisions for the patient.

What does the Patient Self-Determination Act require?

Healthcare facilities must inform patients about advance directives.

When is an advance directive used?

When the patient lacks decision-making capacity.

What ethical principle means respecting patient choices?

Autonomy.

What ethical principle means doing good?

Beneficence.

What ethical principle means do no harm?

Nonmaleficence.

What ethical principle means fairness?

Justice.

What ethical principle recognizes the worth of every person?

Respect for persons.

What is value clarification?

Examining and understanding one's own beliefs and values.

What is an ethical dilemma?

A situation with no clear right or wrong answer.

What are the steps in resolving an ethical dilemma?

Identify the problem, assess the situation, and apply ethical principles.

What does the ANA Code of Ethics provide?

Guidelines for ethical nursing practice.

When should nurses report unethical behavior?

When patient safety or professional standards are at risk.

What should nurses document when reporting unethical behavior?

Objective facts including what, when, where, and who.

What is physician-assisted suicide (PAS)?

A provider intentionally helping a patient end their life.

What is the ANA's position on PAS?

It opposes PAS because it conflicts with nursing ethics.

Can competent adults refuse treatment?

Yes, even if refusal may result in death.

What is a DNR order?

A physician's order not to perform CPR if the patient's heart or breathing stops.

What is the nurse's responsibility regarding a DNR?

Follow the order exactly as written.

Can nurses refuse patient assignments?

Only for conflicts such as moral or religious beliefs without abandoning the patient.

Can nurses refuse care based on HIV status or sexual orientation?

No.

What is the Good Samaritan Law?

A law protecting people who voluntarily provide emergency care in good faith.

What is the nurse's role as a patient advocate?

Protect the patient's rights, safety, and best interests.

What are the key ways to prevent legal problems?

Practice within scope, follow standards, communicate effectively, maintain confidentiality, and document accurately.