In-Depth Notes on Legal Aspects of Gerontological Nursing

Legal Aspects of Gerontological Nursing

Chapter Learning Objectives
  • Discuss laws governing gerontological nursing practice.
  • Describe legal issues in gerontological nursing practice and ways to minimize risks.
  • List legal safeguards for nurses.
Key Terms

  • Consent: Granting permission for an action or procedure.

  • Durable Power of Attorney: Allows competent individuals to appoint someone for decision-making if they become incompetent.

  • Duty: Responsibility in a relationship to provide service to another.

  • HIPAA: Health Insurance Portability and Accountability Act (1996) ensuring confidentiality in health information and patient access to records.

  • Injury: Physical or mental harm due to negligent acts.

  • Malpractice: Deviation from the standard of care.

  • Negligence: Failure to meet the standard of care.

  • Private Law: Governs individual relationships.

  • Public Law: Governs relationships between individuals and the government.

  • Standard of Care: Norm of what a reasonable person would do in similar circumstances.

Introduction to Legal Aspects
  • Nurses must understand and comply with legal boundaries in their practice.
  • Gerontological nurses operate autonomously, supervising others and are accountable for their actions.
  • Issues faced by older adults may lead to legal challenges.
  • Nurses play a crucial role in advocating for older adults' rights.
Laws Governing Gerontological Nursing Practice
  • Variation Among States: Legal standards differ in practice regulations.
  • Public Laws: Include scope of nursing practice and licensure requirements.
  • Private Laws: Involve individual rights, torts, and conduct standards.
  • Voluntary Standards: Defined by the American Nurses Association (ANA) for gerontological nursing.
Legal Risks in Gerontological Nursing
  • Risks may be increased by working with insufficient resources, not following policies, taking shortcuts, and working while physically/emotionally exhausted.
Legal Liability Risks
  • Potential acts leading to liability include:
    • Assault
    • Battery
    • Defamation of Character
    • False Imprisonment
    • Fraud
    • Invasion of Privacy
    • Larceny
    • Negligence
Understanding Malpractice
  • Malpractice involves failure to provide competent care according to standards.
  • Key components leading to malpractice claims:
    • Duty: Nurse has a responsibility to provide care.
    • Negligence: Failure to act as a reasonable nurse would.
    • Injury: Patient suffers harm due to negligence.
Managing Malpractice Risks
  • Increased responsibilities entail a greater risk of malpractice.
  • Nurses should:
    • Be knowledgeable about legal risks.
    • Carry personal malpractice insurance.
Situations Leading to Negligence
  • Common negligence scenarios include:
    • Failing to take appropriate action.
    • Contributing to patient injury.
    • Not following reporting protocols.
    • Mismanaging patient possessions.
Confidentiality in Nursing
  • HIPAA allows patients access to their medical records and control over their information. Nurses must protect patient privacy by adhering to policies and procedures.
Patient Consent
  • Patients must be informed of consent implications and their ability to make decisions.
  • Informed consent includes:
    • Description of procedure.
    • Explanation by the professional.
    • Alternatives and risks.
    • The patient's right to refuse must be documented.
Patient Competency
  • Mentally incompetent individuals cannot provide legal consent. Legal guardianship may differ from powers of attorney.
Supervision Responsibilities
  • Nurses supervise staff, ensuring competent care delivery and follow-up on tasks.
Medication Administration
  • Nurses are responsible for safe medication administration and must not engage in activities outside their scope, such as compounding or dispensing.
Use of Restraints
  • The Omnibus Budget Reconciliation Act (OBRA) mandates strict standards for using restraints, requiring physician orders and emphasizing less restrictive alternatives.
Telephone Orders Management
  • To minimize risk in communication:
    • Document orders accurately and confirm understanding with the physician.
Do Not Resuscitate (DNR) Orders
  • DNR orders require consent and must be incorporated into facility policies.
Advance Directives
  • Advance directives express patient preferences for end-of-life care. The Patient Self-Determination Act requires discussion of these directives with patients.
Elder Abuse
  • Types of abuse: physical, emotional, sexual, exploitation, neglect, and self-neglect.
  • Nurses must be aware of signs of abuse and their reporting obligations.
Legal Safeguards for Nurses
  • Common Sense: Remain vigilant and informed.
  • Know Agency Policies: Adhere to legal and regulatory guidelines.
  • Practice Safely: Refuse to work under conditions of unsafe patient care.
  • Documentation: Report and document unusual occurrences.
  • Insurance: Carry liability insurance for added protection.
Summary of Legal Questions
  1. True/False: Following accepted standards protects nurses from malpractice liability.
    • Answer: True; deviations can result in malpractice claims.
  2. Informed Consent: All elements must be present aside from time needed for procedures.
  3. Restraints: Alternatives must always be tried before resorting to restraints, requiring physician orders.
  4. True/False: Knowledge of agency policies helps prevent malpractice.
    • Answer: True; understanding policies is crucial for legal compliance.