funds. ch.3

Chapter 3: Legal and Ethical Aspects of Nursing

Introduction

  • Author: Patricia Ann Williams, MSN, RN, CCRN

  • Edition: 7th edition

Learning Objectives

Theory (Part 1 of 4)

  • Explain the legal requirements for the practice of nursing and their relevance to student nurses.

  • Identify the consequences of violating the nurse practice act.

  • Examine the issues of professional accountability, discipline, and continuing education for licensed nurses.

Theory (Part 2 of 4)

  • Compare and contrast negligence vs. malpractice.

  • Discuss measures to protect yourself from lawsuits and the impact of legal claims.

  • Differentiate a code of ethics from laws/regulations in nursing and explore similarities across various nursing organizations, including:

    • National Association of Licensed Practical/Licensed Vocational Nurses

    • National Association for Practical Nurse Education and Service, Inc.

    • American Nurses Association

Clinical Practice (Part 3 of 4)

  • Reflect on laws related to discrimination, workplace safety, child abuse, and sexual harassment in nursing practice.

  • Discuss National Patient Safety Goals and their accessibility.

  • Interpret the rights of patients in various settings, including hospitals, nursing homes, community settings, and psychiatric facilities.

Clinical Practice (Part 4 of 4)

  • Describe the four elements of informed consent.

  • Explain advance directives and benefits of having them documented.

  • Examine the relationship between HIPAA and social media use.

Legal Requirements and Terminology

Source of Law (Part 1 of 2)

  • Laws are rules of conduct established by government.

    • Three sources of law:

    • Constitution and Bill of Rights: Provide basic rights.

    • Laws made by elected officials: Legislative statutes.

    • Regulations made by agencies: Administrative regulations from legislative bodies.

Source of Law (Part 2 of 2)

  • Constitutional Law: Provides basic rights and creates legislative bodies.

  • Judicial Law: Emerges when a law/court decision is challenged, with judges affirming or reversing decisions.

  • Administrative Law: Derived from agencies established by the legislature.

Civil and Criminal Law

  • Civil Law: Ensures individual rights are guaranteed; a tort refers to a civil law violation.

  • Criminal Law: Involves wrongdoing against society with consequences that include imprisonment or fines for conviction.

Nurse Practice Acts and Scope of Practice

  • Define the scope of nursing practice.

  • Regulated by state boards of nursing.

  • Include definitions for Registered Nurses (RNs), Licensed Practical Nurses (LPNs), or Licensed Vocational Nurses (LVNs) and sometimes advanced-practice nurses.

Licensure

  • Eligibility determined by state boards of nursing.

  • NCLEX Examination: Developed by the National Council of State Boards of Nursing for licensure validation.

    • Passing score on NCLEX-PN® is generally accepted across all states for licensure.

  • Reciprocity: Current issues include nurse licensure compacts and recognition across states.

Student Nurses

  • Student nurses are held to the same standards as licensed nurses and are responsible for their actions or inactions.

  • Must consult with an instructor when uncertainties arise or when patient conditions change rapidly.

  • It is essential to be aware of the state’s nurse practice act.

Professional Accountability

  • Accountability involves the nurse's responsibility to meet patient health care needs safely and compassionately.

  • Students must apply theoretical knowledge in clinical practice.

  • Commitment to ongoing education and knowledge is emphasized.

Delegation

  • Refers to the assignment of duties to others.

  • LPNs may oversee nursing assistants, technicians, or other LPNs.

  • It is the delegating nurse's duty to supervise and evaluate care provided by licensed or unlicensed personnel.

Standards of Care

  • Sets a benchmark for evaluating the quality and effectiveness of patient care.

  • Determines whether nursing actions were appropriate in legal contexts.

Professional Discipline

  • State boards of nursing handle professional disciplinary actions.

    • Common charges involve substance abuse, incompetence, and negligence.

    • It is considered negligent not to report misconduct by other professionals.

Continuing Education

  • Many states require ongoing education after passing the licensing exam.

  • Continuous education is vital to stay current with health care practices, pharmacology, and technology to ensure safe practice.

Laws and Guidelines Affecting Nursing Practice (Part 1 of 2)

  • Occupational Safety and Health Act (OSHA)

  • Child Abuse Prevention and Treatment Act (CAPTA)

  • Discrimination Laws

  • Sexual Harassment Regulations

  • Good Samaritan Laws

Laws and Guidelines Affecting Nursing Practice (Part 2 of 2)

  • Patients' Rights

  • National Patient Safety Goals (NPSGs)

  • Health Insurance Portability and Accountability Act (HIPAA)

  • Consent Laws and Releases

Occupational Safety and Health Administration (OSHA)

  • Regulates handling of toxic materials, radiation safeguards, and electrical equipment.

  • Requires education on blood-borne pathogens, exposure protocols, fire safety, bomb threats, lifting techniques, and evacuation procedures.

  • Mandates facilities maintain records on hazardous substances and material safety data sheets (MSDS).

Child Abuse Prevention and Treatment Act (CAPTA)

  • Defines child abuse and neglect as:

    • Any recent act or failure to act resulting in serious harm, sexual abuse, or imminent risk of harm.

  • Licensed healthcare personnel are required to report child abuse incidents.

Discrimination

  • Involves making decisions based on class or group identity, such as race or sex, rather than individual merits.

  • It is illegal for employers to ask about protected categories or health status in applications.

Sexual Harassment

  • Includes unwelcome sexual advances, requests, or other distractions that interfere with job performance.

  • Deemed illegal when used as a condition for employment or promotion.

Good Samaritan Laws

  • Protect healthcare professionals from legal liability when providing aid in emergencies.

  • Liability remains only in cases of gross negligence or intentional misconduct.

Patient's Rights

  • Revised in 2003 as The Patient Care Partnership document.

  • An ethical guide, not legally binding, aiming to protect dignity, privacy, freedom of movement, and information needs.

  • State laws exist prohibiting specific actions or guaranteeing certain rights to patients.

National Patient Safety Goals (NPSGs)

  • Provide evidence-based solutions to improve patient safety.

  • Sentinel Event: An unexpected event resulting in death or serious injury; often caused by communication deficiencies among caregivers.

Protection from Lawsuits and Code of Ethics

Legal Documents: The Medical Record

  • Classified as a legal document that includes records of assessments, tests, and care provided.

  • Confidentiality is paramount; access is limited to individuals directly involved in patient care.

  • The ownership lies with the hospital, agency, or physician and not with the patient.

Health Insurance Portability and Accountability Act (HIPAA)

  • Establishes regulations regarding patient privacy and the management of electronic health records.

  • Failure to adhere to HIPAA rules may result in civil penalties, while intentional violations entail substantial fines and potential jail time.

Consent

  • The legal document captures the patient's authorization for treatment or surgery and sharing of information with other entities like insurance providers.

  • Informed Consent: Illustrates the patient's involvement in decision-making, requiring that the individual understands the consent's implications.

Release

  • A legal form that relieves one party from liability.

    • Example: Leave Against Medical Advice (Leave AMA)

    • May include authorization to share confidential health information with other agencies or parties.

Witnessing Wills or Other Legal Documents

  • Many institutions prohibit nurses from witnessing wills or legal documents.

  • If contested, nurses could be called to testify about the patient's condition or relationship with visitors.

Advance Directives

  • Permits individuals to outline their medical wishes in the event they become unable to do so themselves.

  • Durable Power of Attorney: Grants a chosen individual the authority to make medical decisions according to the patient’s advance directives.

Violations of Law: Negligence and Malpractice

  • Negligence: Failure to perform an action that a reasonably prudent person would or performing an action that a prudent person would not.

  • Malpractice: A subtype of negligence specifically related to professional practice standards.

Common Legal Issues

  • Nurses often handle sensitive information, elevating the risk of legal action if boundaries are exceeded and harm ensues.

Assault and Battery

  • Assault: Threatening to harm or implying unauthorized touching of another person.

  • Battery: Involves unwanted physical contact or actions taken against a person's will.

Defamation

  • Incorrect comments made by one individual about another that harm the latter's reputation.

    • Types:

    • Slander: Oral defamation

    • Libel: Written defamation

Invasion of Privacy

  • Breached confidentiality wherein unauthorized individuals learn private patient information, potentially causing embarrassment or loss of dignity.

False Imprisonment

  • Involves preventing a person from leaving or restricting their movement against their will.

  • Involuntary admission for protection against self-harm or harm to others may occur but requires consent.

Protective Devices

  • Misapplication of mechanisms that restrict mobility can lead to false imprisonment charges.

  • Both mechanical and chemical restraints require physician orders for use.

Decreasing Legal Risk

Nursing Competence

  • Essential skills, knowledge, and experience are vital for adequate patient care.

  • Documentation is crucial for defending nursing actions in court.

  • Early identification of dissatisfied patients can prevent lawsuits.

Incident or Occurrence Reports

  • Used to document any abnormal incidents occurring.

  • Require factual documentation concerning what happened and who was involved.

  • Typically not incorporated into the patient's chart, ensuring confidentiality.

Malpractice Insurance

  • Protects nurses' livelihoods and assets against lawsuits.

  • Covers legal defense costs and potential compensation awarded to plaintiffs.

  • May also cover related costs from reviews by state nursing boards.

Ethics in Nursing

  • Ethics: Agreed guidelines recognized by a group as morally right and acceptable.

  • Distinct from laws which are enforceable and mandatory.

Codes of Ethics

  • Respecting human dignity and providing equitable care regardless of race, religion, or personal circumstances.

  • Includes commitments to lifelong learning, maintaining professional competence, and ensuring confidentiality within nurse-patient relationships.

Ethics Committees

  • Composed of diverse departmental representatives working together to develop facility policies and address ethical dilemmas collaboratively.

Ethical Dilemmas

  • Examples include:

    • Decisions about life-prolonging treatment vs. refusing treatment.

    • Initiating or ceasing life support.

    • Issues surrounding assisted suicide and euthanasia.

Review Questions

  • Question 1: Universal guidelines for nursing interventions defined as:

    • Scope of practice.

    • Advocacy.

    • Standard of care.

    • Prudent practice.

  • Question 2: Reporting is necessary for unethical behavior, including:

    • A worker arriving late.

    • Favoritism.

    • Arguments among staff.

  • Question 3: In malpractice, the necessary elements are (excluding whose duty, breach of duty, and causation) and including defamation as an answer option.

  • Question 4: Suspected elder abuse should be reported to:

    • Supervisor.

    • Police.

    • Family.

    • Appropriate agency.