“ “WHAT LIES BEHIND US AND WHAT LIES BEFORE US ARE TINY MATTERS COMPARED TO WHAT LIES WITHIN US.”

1. SEMINAR PRESENTATION ON PATIENT CARE ISSUES, MANAGEMENT ISSUES, EMPLOYMENT ISSUES AND MEDICO LEGAL ISSUES

2. “ “WHAT LIES BEHIND US AND WHAT LIES BEFORE US ARE TINY MATTERS COMPARED TO WHAT LIES WITHIN US.” Oliver Wendell Holmes

3. TERMINOLOGY • Issue: An issue is a topic of interest which leads into a discussion and requiring a decision. • Mandatory: Conveying a command. • Fraud: Willful and purposeful interpretation or misinterpreting the outcome of procedure or a treatment. • False Imprisonment: A person cannot be legally forced to remain in health Centers or hospital. • Act: Act is a written law. When law is passed in the assembly and is approved by Government it is called as an Act.

4. TERMINOLOGY • Legislation: Legislation as ‘the process of making laws’. Legislation is a method of improving public services. To control and maintain standard in nursing education and nursing practice. • Legal Responsibility: Legal responsibility refers to the ways in which a nurse is expected to follow the rules andregulations prescribed for nursing practice. These responsibilities are described by State,Central Government through service conduct rules based on standards developed by StateNursing Council and National Nursing Council.

5. TERMINOLOGY • Quacks: An unqualified practiser of medicine. • Malpractice: Professional misconduct; negligence performed in professional practice; any unreasonablelack of skill in professional duties or illegal or immoral conduct that results in injury ordeath to the client/consumer. • Negligence: Negligence is described as lack of proper care and attention; carelessness.

6. TERMINOLOGY • Crime: It refers a wrong committed by a person against another person or his or her property. • Torts: It is gross negligence. • Intentional Torts: Intentional torts are, when others interfere in individual’s privacy, mobility, property orpersonal interests. • Defamation: Publication of a false statement about an individual made either verbally or in some other form to the third person, which damages his/her reputation.

7. TERMINOLOGY • Causation: Failure to use appropriate safety measures. • Liability: The state of being liable, a person or thing that is troublesome as an unwelcome responsibility, a handicap. •  Assault: It is a threat or an attempt to make bodily contact with another person without that person’s consent. • Battery: It is an assault that is carried out with willful angry and violent or negligent touching of another person’s body or clothes.

8. MEANING OF LEGAL ISSUES It is a standard or rules of conduct established and enforced by the government. These are intended to protect the public.

9. ISSUES B. Management Issues A. Patient care Issues C. Employment Issues D. Medico legal Issues

10. PATIENT CARE ISSUES • Nursing Shortage • Health-Care Reform • Low salaries • Standard of care

11. Nursing Shortage • The nursing shortage is a major issue facing the biggest licensed profession in the health-care system. • This shortage will affect health care more each day. • Many emergency rooms have longer wait times due to less nursing staff. • This shortage is being felt in hospitals, nursing homes and home-health agencies.

12. Health-Care Reform • Nurses have always been involved with health-care reform as advocates for patients. • The American Nursing Association (ANA) has been working to have the voice of nurses heard. • LOW SALARIES

13. Standard of care • State Nurse Practice Act • ANA-Standards of Clinical Nursing Practice • National Association of School Nurses (NASN) • School policy and protocols

14. MANAGEMENT ISSUES • Turnover • Funding • Workload • Issues regarding malpractice in nursing management • Ethics • Effect • Issues in Nursing Curriculum Development • Collaboration Issues

15. Turnover • Representatives working in nurse management and leadership are often faced with the responsibility of controlling turnover rates. • Nurses faced with long work hours for relatively little pay have few motivations to remain in one position and often seek employment opportunities at competing hospitals and neighboring clinics.

16. Funding • Lack of funding is an issue for many nurse managers who seek to provide sufficient compensation to existing nurses as well as offer suitable compensation in an attempt to recruit new nursing professionals for hire. • An underfunded institution cannot attract and provide for the right professionals. • And funding inadequacies can also become a detriment to the level of training provided to medical staff, in addition to the needs for medical equipment and supplies.

17. Workload • Individual nurse manager workload and overall medical workload are issues in leadership. • Many nurses are unwilling to enter into the nurse management field because of the added stress and responsibility.

18. Issues regarding malpractice in nursing management a. Issues of delegation and supervision • The failure to delegate and supervise within acceptable standards of professional practice. b. Issues related to staffing • Inadequate accreditation standards. • Inadequate staffing, i.e. short staffing. • Floating staff from unit to unit.

19. Ethics • A major ethical goal is to keep patients' information confidential, and this includes not discussing patients in public places. • Another ethical issue is protecting patients from negligent co-workers who may endanger them. • The individual nurse must not endanger the patient and has to be accountable to the standards of the field.

20. Effect • Effects of reform, shortages, ethics and salaries are issues that keep nurses constantly thinking, growing and changing.

21. Issues in Nursing Curriculum Development • Where are we now? • Academic validation • Professional validation • Economic validation • Institutional validation • Performance validation • Where we want to go? • What we want to achieve? • Domain of attitudes (communication skills) • Domain of practical skills • Domain of intellectual skills(knowledge and recall of facts) • How can we achieve?

22. EMPLOYMENT ISSUES a. Issues related to Nursing Shortage b. Issues in Nurse Migration c. The Right to Work and the Right to Practice d. Exploitation and Discrimination e. Essential Terms and Conditions in an Employment contract f. Unsatisfactory work performance and termination of employment g. Misconduct and imposition of punishment

23. EMPLOYMENT ISSUES CONT…. • Sexual harassment at the workplace • Renewal of nursing registration • Diploma vs degree in nursing for registration to practice nursing • Specialization in clinical area • Nursing care standards

24. a. Issues related to Nursing Shortage • The nurse shortage itself is a contributing factor because the shortage creates staffing problems, mandatory overtime, and constant calls for additional shift work. • National nursing organizations are making strong efforts at stopping the shortage by mandating better nurse- to-patient ratios, eliminating mandatory overtime, and increasing salaries and benefits for nurses.

25. b. Issues in Nurse Migration • Nurse migration has attracted a great deal of political as well as media attention in recent years. • In this section a discussion on the right to work and the right to practice is, by necessity, followed by a warning that cases of exploitation and discrimination often occur when dealing with a vulnerable migrant population.

26. c. The Right to Work and the Right to Practice • Professionally active nurses are important players in an increasingly competitive and global labor market. • For nurses to practice their profession internationally, they need to meet both professional standards and migration criteria. • The right to practice, e.g., to hold a license or registration, a professional criteria, and the right to work, e.g. to hold a work permit, a migration criteria, are sometimes linked. Yet they often require a different set of procedures with a distinct set of competent authorities.

27. d. Exploitation and Discrimination • One of the most serious problems migrant nurses encounter in their new community and workplace is that discrimination. • Migrant nurses are frequent victims of poorly enforced equal opportunity policies . • Some migrant nurses are experiencing dramatic situations on the job where colleagues purposefully misunderstand, undermine their professional skills, refuse to help.

28. f. Unsatisfactory work performance and termination of employment • However, when an employee has an attitude problem or whose work performance is not up to the expectations he cannot be terminated by the employer . • The employer has to follow certain rules and procedures and only at the end of it can he terminate the services of a non-performing employee.

29. g. Misconduct and imposition of punishment • The Courts will interfere if, among others, the action taken by the management was perverse, baseless or unnecessarily harsh or was not just or fair.

30. h. Sexual harassment at the workplace • The employers have a legal responsibility to safeguard their employees from sexual harassment at the workplace.

31. Medico legal Issues a. Legal Issues Specific to Nursing • Duty to seek Medical Care for the patient • Confidentiality • Permission to treat • Informed consent • Advance Directives • Negligence • Malpractice • Fraud • Assault and Battery • False Imprisonment • Invasion of privacy • Nurse Practice Act • Patient's Advocate • Administering Medication • Report It or Tort It • Rights to Privacy • Document, Document, Document

32. Medico legal Issues b. Legal Issues in specialty and practice area • Maternal and infant Nursing • Pediatric Nursing • Medical Surgical Nursing • Psychiatric Nursing • Community Health Nursing c. Legal, Ethical, Professional Issues in Nursing. • The Nursing and Midwifery Council • Respecting Confidentiality • Respecting Autonomy

33. Legal Issues Specific to Nursing It is the legal duty of the nurse to ensure that every patient receives safe and competent care. • Duty to seek Medical Care for the patient The law requires you to treat all such information with strict confidentiality. This is also an ethical issue. • Confidentiality When people are admitted to hospitals, nursing homes, and home health services, they sign a document that gives the personnel in the organization permission to treat them. Every time the nurse provides nursing care to person, however, permission must be obtained. • Permission • to treat

34. Legal Issues Specific to Nursing • The concept of permission to treat is closely tied to the concept of informed consent. The law states the persons receiving health care must give permission to treat based on informed consent. • Informed consent The purpose of advanced directives is to give the person an opportunity to make decisions regarding healthcare before an illness or a need for treatment that would prohibit making such critical decisions. • Advance Directives

35. Legal Issues Specific to Nursing • The law requires nurses to provide safe and competent care. • The measure of safe and competent care is the standards of care. • Negligence occurs when a person fails to perform according to the standards of care . Negligence • Malpractice is a term used for negligence. • Malpractice specifically refers to negligence by a professional person with a license. • Malpractice

36. Fraud Legal Issues Specific to Nursing Fraud is a deliberate deception for the purpose of personal gain and usually is prosecuted as a crime. • Fraud • Assault is the threat of unlawful touching of another, the willful attempt to harm someone. • Battery is the unlawful touching of another without consent, justification, or exercise. • In legal medicine battery occurs if a medical or surgical procedure is performed without patient consent. • Assault and Battery

37. Legal Issues Specific to Nursing • Preventing movement or making a person stay in a place without obtaining consent is false imprisonment. • This can be done through physical or non physical means. • Physical means include using restraints or locking a person in a room. • False Imprisonment • Clients are entitled to confidential health care. • All aspects of care should be free from unwanted publicity or exposure to public. • Invasion of privacy

38. Legal Issues Specific to Nursing • Each nurse has a limitation on what he is allowed and trained to do. • He must follow the chain of command, especially with the care of a patient. • Nurse Practice Act • Nurses are responsible for administering the correct doses and medications to patients. • If the nurse gives a fatal dosage amount, she may face legal malpractice suits. • Administer • ing Medication

39. Legal Issues Specific to Nursing • Allegations of abuse are serious matters. • It is the duty of the nurse to report to the proper authority when any allegations are made in regards to abuse (emotional, sexual, physical, and mental) towards a vulnerable population (children, elderly, or domestic). • If no report is made, the nurse is liable for negligence or wrongdoing towards the victimized patient. • Report It or Tort It

40. Legal Issues Specific to Nursing The nurse is responsible for keeping all patient records and personal information private and only accessible to the immediate care providers. • Rights to Privacy It is the nurse's responsibility to make sure everything that is done in regards to a patient's care (vital signs, specimen collections, noting what the patient is seen doing in the room, medication administration, etc.), is documented in the chart. • Document, Document, Document

41. Legal Issues in specialty and practice area a. Maternal and infant Nursing • Problems of medication • Failure in adequate client monitoring. • Failure to adequately assess the client. • Failure to report changes in the patient • Abortions • Nursing care of new born.

42. a. Maternal and infant Nursing • Informed Consent • Prenatal Screening • In vitro fertilization (IVF) • Surrogacy • Preterm and high risk neonate treatment

43. Legal Issues in specialty and practice area b. Pediatric Nursing • As in all areas of nursing practice, negligence involving pediatric clients is possible. • Paediatric nurses are responsible for preventing children, in their care, from accidentally harming themselves. • All poisonous substances and sharp objects should be kept out of the reach of children.

44. Medical Surgical Nursing • Over looked sponges, instruments needles • Burns • Falls • Injury due to the use of defective apparatus or supplies • Injury due to administration of wrong medicine, wrong dosage and wrong concentration. • Assault and battery • Failure to report accidents • Maintenance of records and reports.

45. Psychiatric Nursing A psychiatric nurse should be sufficiently acquainted with the legal aspects of psychiatry so that she/he can be aware of the patient’s rights and can avoid giving poor advice or innocently involving herself/himself in a legal entanglement. • Informal Admission • Restraints • Discharge

46. Community Health Nursing

47. Nurses Responsibilities • Practice within the scope of nurse practice act. • Observe agency policies and procedures. • Establish standards by using evidence based practice. • Always prefer patient’s welfare. • Be aware of relevant law and understand the limits. • Practice within the area of individual competence. • Upgrade technical skills by attending continuing nursing education (CNE) and seeking certification.

48. Nurses Responsibilities Conti……... • Following the standards of care and referral services. • Ensure patient safety. • Proper action for needs and problems and appropriate treatment. • Monitor the programme and proper reporting. • Verify the medication errors and reactions.

49. Legal Safe Guards of Community Health Nurses • Informed consent: Granted freedom, written or oral form (procedures, expected outcome, complication, side effects, and alternative treatment. • Contracts: Exchange of promises between two parties. • Collective bargaining: Policies, legal procedures, up to date knowledge. • Competent practice: It is most important and best legal safeguard.

50. List of do’s as guidelines for safe practice • Documentation of all unusual incidences. • Report all unusual incidences. • Know your job description. • Follow policies and procedures as established by your employing agency. • Keep your registration updated. • Perform procedures that you have been taught and that are within the standard scope of your practice.