Foundations exam 4 - Legal and ethical issues

Health Insurance Portability and Accountability Act (HIPAA)

protects private health information (PHI) and guides appropriate disclosure

Americans with Disabilities Act (ADA)

protects individuals with disabilities from discrimination

Mental Health Parity Act (MHPA)

supports mental health/substance use coverage parity

PSDA

supports advance directives and healthcare decision-making

EMTALA

requires emergency screening and stabilizing care

Criminal Law

offenses against the government/public

Civil Law

disputes involving individual rights; nursing care often relates to torts

EMTALA: EMERGENCY CARE REGARDLESS OF ABILITY TO PAY

Applies to clients who present to the emergency department seeking care
• Requires a medical screening exam
• Emergency conditions must be stabilized
• If the facility cannot provide needed care, the client must be appropriately transferred
• Care cannot be delayed or denied based on insurance, financial status, or ability to pay

What does HIPAA protect?

• Identifiable private information

• Protected Health Information (PHI)

• Patient privacy and confidentiality

When is it appropriate to access a patient's EHR?

• Only when needed for your role in patient care

• Never access records out of curiosity

• EHR access is monitored and audited

What are HIPAA confidentiality rules?

• Do not discuss patient information with uninvolved staff, family, friends, or the public

• Access your own medical record through the patient portal or medical records process—not through your employee access

Whare are torts?

• civil (non-criminal) wrongs that cause harm to another person.

• A person who commits a tort may be sued for damages

Intentional torts

• Assault
• Battery
• False imprisonment

Unintentional torts

• Negligence
• Malpractice

Quasi-intentional torts

Acts in which a person may not intend to cause harm to another but does

Common sources of negligence and malpractice

• failure to follow standards of care

• misuse of equipment

• ineffective or incomplete communication

• failure to document

• failure to assess and monitor

• failure to advocate for patient

What does To Err Is Human teach about healthcare errors?

• Most healthcare errors are caused by system failures, not just individual mistakes.

• The focus should be on improving systems to prevent future errors

What are common causes of healthcare errors?

• Communication breakdowns

• Poor processes

• Fatigue

• Interruptions

• Unsafe workarounds

What is a just culture?

• Encourages reporting of errors and near misses

• Balances accountability with learning and prevention

• Goal: Improve patient safety, not just assign blame

What are the 5 elements proving negligence / malpractice

• Duty to provide care as established by standards of care

• Breach of duty owed to the patient

• Forseeable harm

• Causation

• Injury or damages

How can nurses help prevent negligence and malpractice?

• Identify and eliminate potential hazards before harm occurs.

• Use risk assessment tools (e.g., Braden Scale for pressure injuries, Morse Fall Scale for fall risk)

• DOCUMENT!!!!

Why is documentation important?

• Document accurately and thoroughly.

• Good documentation provides evidence of the care given and helps prevent legal issues

What should you know about incident reports?

• Report actual harm, near misses, and potential safety risks.

• Reports should be factual and help with quality improvement.

• Never chart "incident report completed" in the patient's medical record because it may become discoverable in litigation

Can nursing students be held liable?

Yes. Students can be held liable if their actions meet the 5 elements of negligence/malpractice

How can nursing students avoid liability?

• Perform only skills within your knowledge and level of training.

• Do not perform procedures you have not been taught (e.g., IV insertion in Foundations)

What role should a student perform during clinicals?

Function as a student nurse, not as a CNA or UAP, even if you are certified in those roles

What is a nurse's legal responsibility?

• Nurses are accountable for both their actions and inactions.

• They are expected to use critical thinking and clinical judgment when providing care

What does it mean to be a patient advocate?

• Protect the patient from physical and emotional harm.

• Question orders that seem unsafe or inappropriate.

• Speak up to ensure safe patient care

How can nurses reduce liability?

• Use clinical judgment.

• Communicate clearly with the healthcare team.

• Document care accurately and completely.

• Always prioritize patient safety

What is liability?

• legal responsibility for your actions or inactions.

• A nurse may be held liable if their negligence or malpractice causes patient harm.

What if I think an order is questionable?

• Contact provider and document

• Continue to follow up and use chain of command

What is Malpractice insurance?

• Provides monetary protection for covered claims
• Finances defense when a nurse is named in a suit involving negligence or malpractice
• Nurses are covered by institution’s insurance while working – may be discouraged from obtaining individual coverage

What is Mandatory reporting?

• Suspected abuse or neglect
• Reasonable belief
• Child or elder
• Communicable diseases

What is malpractice?

• professional negligence.

• Occurs when a healthcare provider fails to meet the standard of care, resulting in patient harm

What is client abandonment?

• Nurse disengages relationship without reasonable notice to supervisor
• Nurse leaves floor/unit without reporting off to another nurse and having another nurse assume care

What is standard of care?

• Legal guidelines for care
• Published standards by professional organizations, specialty groups and institutions
• Used in malpractice lawsuits to define level of care
• Nurses should refuse to practice outside scope of practice

What is informed consent?

• Permission obtained for a procedure or treatment
• Provider explains
- Procedure
- Indications & benefits
- Risks & alternatives
- Prognosis if not done

What is the nurse's role in informed consent?

• Witness the patient's signature.

• Verify the patient is signing voluntarily.

• Confirm the provider has explained the procedure and the patient's questions have been answered.

Provider explains → Patient understands → Nurse witnesses

What is NOT the nurse's role in informed consent?

• The nurse does not explain the procedure, risks, benefits, or alternatives.

• Those explanations are the provider's responsibility.

Who can sign informed consent if the patient cannot?

A Power of Attorney (POA) or next of kin may sign if the patient cannot because they are:

• Under the influence of sedatives/pain medications

• Not competent (e.g., dementia)

• Unconscious or have decreased level of consciousness (LOC)

When can a minor legally give informed consent?

• Age of consent varies by state (16 in South Carolina).

• Exceptions include if the minor is:

  • Married

  • Pregnant

  • A parent

  • Legally emancipated

MPPE = Married, Pregnant, Parent, Emancipated (common exceptions to parental consent

What influences a nurse's personal values?

• Family

• Culture

• Education

• Community

• Life experiences

Why is recognizing personal values important in nursing?

• Nurses should recognize their own beliefs while respecting the patient's values.

• This helps provide respectful, client-centered care

What is value clarification?

• The process of identifying your own beliefs and values.

• Helps nurses practice ethically and avoid letting personal beliefs interfere with patient care

Professional values in nursing: Altruism

selfless concern for the well-being of others

Professional values in nursing: Human dignity

respect for the inherent worth of every person

Professional values in nursing: Integrity

honesty and accountability, even in difficult situations

Professional values in nursing: Autonomy

respect for the client’s right to make health care decisions

Professional values in nursing: social justice

fair, equitable care for all clients

Ethics in patient care• Autonomy

• Autonomy
• Beneficence
• Fidelity
• Justice
• Nonmaleficence
• Veracity

What is an ethical dilemma?

• A situation with more than one possible choice.

• Different values or beliefs make the decision difficult

When do ethical dilemmas occur?

• Not enough scientific evidence to support one choice.

• Conflict between two moral principles.

• The decision will have a significant impact on the patient or others.

What is moral distress?

occurs when a nurse is forced to take an action they believe is ethically wrong or unsound.

What is the first step in ethical decision-making?

• Determine whether an ethical dilemma exists.

• Clearly identify the dilemma and who is affected

What should you do when considering solutions to an ethical dilemma?

• List possible solutions without judging them right away.

• Apply ethical principles to each option

What else should be included in ethical decision-making?

• Include relevant individuals, policies, and legal considerations.

• Choose a solution, review it, and then carry it out.

Why are some healthcare cases ethical dilemmas?

• Family wishes, laws, policies, prognosis, and patient rights may conflict.

• There may not be one clearly "right" answer.

How should nurses handle ethical dilemmas?

• Use the ethical decision-making process.

• Base decisions on ethical principles, not personal opinions.

• Nurses may experience moral distress when the best action is unclear.

What ethical principles should nurses consider?

• Autonomy – Respect the patient's choices.

• Beneficence – Do good.

• Nonmaleficence – Do no harm.

• Justice – Treat patients fairly.

• Dignity – Respect every person's worth.

• Advocacy – Protect the patient's rights

Nursing Advocacy:

• advanced directives

• patient rights

• preventing harm

• health disparities

What does delegate mean in nursing?

• Assign a task to another qualified healthcare worker.

• The RN remains accountable for the patient's care and the outcome.

• Only delegate tasks that are appropriate for the person's training and scope of practice

Scope of practice: RN

• Clinical assessment

• Initial client education

• Discharge education

• Clinical judgment

• Initiating blood transfusion

Scope of practice: LPN/LVN

• Monitoring RN findings

• Reinforcing education

• Routing procedures (catheterization)

• Most medication administrations

• Ostomy care

• Tube patency and enteral feeding

• Specific assessments

Scope of practice: UAP

• Activities of daily living

• Hygiene

• Linen change

• Routine, stable vitals

• Documenting input/output

• Positioning

Delegate when:

• patient is stable

• task is within worker’s job description

• you’re able to teach and supervise

• you’ve planned how to monitor

DON’T delegate when:

• Thinking, complex assessment, and judgment are required

• There is an unpredictable outcome

• Increased risk of harm

• Creativity and problem solving are required

Do not delegate what you can EAT

Evaluate

Assess

Teach