NRS 221 Legal-Ethical

Legal and Ethical Considerations in Chronic & End-Of-Life Care

Liability Definitions

• Liability: Legal responsibility for harm caused to another person or property due to one's actions.

• Negligence: Failure to act in a reasonable and prudent manner unintentionally, leading to harm.

• Malpractice: Failure of a professional to maintain the standard of conduct expected in similar circumstances, resulting in harm to the patient.

Personal Liability

• Nurses must assume personal responsibility for patient care.

• Cannot be reassigned responsibility regarding patient assignments.

• Familiarity with state statutes and case law is essential.

• Competency requirements extend to charge nurses and management staff.

Delegation in Nursing

• Team leaders and charge nurses must be clear about the legality of patient care assignments.

• Responsibility to determine the reasonableness and prudence of delegating tasks based on:

  • Knowledge of the worker's abilities.

  • Patient’s status and needs.

  • Current workplace conditions.

Employer Liability

• Doctrine of Vicarious Liability: Employers may be held liable for the actions of employees while they are acting within the scope of their employment.

• Principle of Respondeat Superior: Employers are responsible for the actions of their employees during the performance of their job duties.

Corporate Liability Duties

• Maintain safe and adequate facilities and equipment.

• Select and retain competent physicians.

• Oversee the conduct of all medical practitioners in the facility related to patient care.

• Formulate and enforce policies to ensure quality of care.

Frequent Allegations of Nursing Negligence

• Failure to communicate and report.

• Inadequate monitoring of patients and reporting of significant findings.

• Failure to maintain patient safety and timely interventions (failure to rescue).

• Errors in treatment or performance of procedures.

• Medication errors and non-adherence to policies.

• Neglecting the chain of command in patient care issues.

Determining Liability and Malpractice

1. The nurse owed a special duty of care to the patient.

2. Evidence shows that the nurse breached the standard of care.

3. Patient suffered actual harm or damage.

4. Establishing a connection between the breach of standard of care and the patient’s injury.

Proactive Risk Management Approaches

• Knowledge of the nurse practice act to avoid violations.

• Focus on reducing preventable adverse events.

• Develop and utilize high-reliability operating systems.

Oregon’s Nurse Practice Act

• The Oregon State Board of Nursing (OSBN) has the authority to take disciplinary actions against nurses violating the Nurse Practice Act.

Incident Reporting

• Document events objectively without mentioning in the medical record that an incident report exists.

• Avoid photocopying incident reports; they are confidential.

• Report any unusual occurrences or incidents, which include:

  • Patient injuries.

  • Unanticipated patient deaths.

  • Equipment malfunctions.

  • Significant adverse reactions to therapies.

  • Inabilities to meet patient care needs or ordered treatments.

  • Patient or family refusals of care.

  • Unresolved hospital issues or complaints.

  • Environmental emergencies such as toxic spills or fires.

  • Violent behavior from patients or families.

Preventive Initiatives

• Centers for Medicare and Medicaid Services - Partnership for Patients Initiative.

  • Goals include making care safer and improving transition of care.

  • Focus on core patient safety areas:

    • Adverse drug events (ADE).

    • Infections like CLABSI and CAUTI.

    • Prevention of surgical site infections (SSI).

    • Reducing instances of sepsis and pressure ulcers.

    • Prevention of readmissions due to inadequate care transitions.

Documentation Practices

• Good documentation is essential in defending oneself in legal contexts.

• Ensure documentation is complete, correct, and timely.

  • Follow recommended do’s and don’ts of documentation.

Ethical Issues in Nursing

• Discusses Quality of Life, Disabilities, End-of-Life Care, and Health Care Reform.

Quality of Life

• Quality of life is subjective and varies between individuals.

• Central to discussions about outcome measures and decisions around care at the end of life.

Disabilities Considerations

• Disabilities can include physical, mental, and communicative challenges.

• The Americans with Disabilities Act (ADA) of 1990 aims to eliminate discrimination against individuals with disabilities.

Advance Directives and POLST

• Advance Directives: Document outlining an individual's end-of-life care preferences, requiring signatures from two witnesses.

• POLST (Physician Orders for Life-Sustaining Treatment): A medical order for patients with advanced illness specifying preferences for medical care.

Key Differences: Advance Directive vs. POLST

• Advance Directive:

  • Voluntary legal document for all adults regardless of health status.

  • Appoints a legal decision-maker and memorializes patient values.

• POLST:

  • Specific medical order for those with advanced illness, signed by a healthcare professional.

  • Addresses likely medical scenarios that may arise.

Power of Attorney

• Appointed individual makes healthcare decisions for patients unable to do so themselves.

Guardianship of Incapacitated Individuals

• A guardian is court-appointed to make decisions for someone who is incapacitated.

Legally Mandated Care

• Civil Hold: Involves judicial processes determining whether individuals with mental illness should receive treatment.

• Responsibility includes ensuring patient safety during the legal process.

Physician-Assisted Death

• The Oregon Death with Dignity Act (1994): Allows a terminally ill patient to seek medication for assisted death, promoting a dignified end to life.

Conclusion

• This act remains controversial and highlights the ethical debates surrounding end-of-life care.