LEGAL AND ETHICAL RESPONSIBILITIES

1. SECTION I BASIC NURSING UNIT1FOUNDATIONS CHAPTER 4 LEGAL AND ETHICAL RESPONSIBILITIES White Edited by: Leslie Lehmkuhl, RN

2. LAWS are decisions about conduct that guide the interactions of people. PUBLIC LAW deals with the individual’s (person) relationship to the state. CIVIL LAW deals with relationships among individuals (people). BASIC LEGAL CONCEPTS

3. CONSTITUTIONAL–defines and limits government powers. STATUTORY LAW–enacted by legislative bodies. (Nurse Practice Act) ADMINISTRATIVE LAW–regulatory. Appointed by government agency (e.g. State Board rules and regulations set in NPA) CRIMINAL LAW–deals with acts against safety and welfare of the public. Felonies >1yr prison, lose lic Misdemeners less serious than felony, <1yr, local jail PUBLIC LAW

4. CIVIL LAW (relationships among individuals or people) CONTRACT LAW–the enforcement of agreements among private individuals. (Employment contract between the nurse and employer) TORTS–civil wrongs committed by a person against another person or property. PROTECTIVE REPORTING LAW- action to provide certain individuals or groups protection (e.g. disabled, elderly, children)

5. Protect off-duty health care providers when care during emergency situations. Protects care-giver from civil liability. Usually outside the hospital setting. Vary in coverage from state to state. Individuals are responsible for knowing the law in their own jurisdictions. GOOD SAMARITAN LAWS

6. Nursing practice falls under both public and civil law. Nurses bound by rules and regulations stipulated by the nursing practice act as determined by the legislature. Nursing practice act states those things that the nurse can and cannot do. These laws are created and governed by statutory law. NURSING PRACTICE AND THE LAW

7. Developed from the nursing practice acts to direct nursing care. Also derived from professional organizations (e.g. ANA, Nt’l federation of Lic Practical nurses) and policy and procedure manuals. Liability determined by whether standards of practice have been adhered to. STANDARDS OF PRACTICE

8. Physician’s orders- need to clarify, recognize errors Floating- need orientation Inadequate staffing-Joint Commission sets ratios. Pt abandonment if you leave. Critical care-1:1 or 1:2 Pediatric care- mandated to report LEGAL ISSUES IN PRACTICE

9. INTENTIONAL TORTS violate the civil rights of another individual knowingly and willingly (e.g. assault, battery, defamation, libel, slander, fraud, false imprisonment, invasion of privacy,) UNINTENTIONAL TORTS are those actions that cause harm to the client resulting from carelessness or negligence on the part of nurse. (negligence, malpractice) LEGAL ISSUES IN NURSE-CLIENT RELATIONSHIPS

10. ASSAULT–threat to cause harm. BATTERY–unauthorized or unwanted touching of one person by another. DEFAMATION–using words to harm or injure another. FRAUD–wrong resulting from deliberate deception to produce unlawful gain. INTENTIONAL TORTS

11. FALSE IMPRISONMENT–making the client wrongfully believe that she cannot leave or restricting movement. INVASION OF PRIVACY–rights to be left alone, to choose care, to govern body integrity, to choose when and how sensitive information is shared. INTENTIONAL TORTS (continued)

12. INTENTIONAL TORTS (continued)

13. NEGLIGENCE–general term for careless acts on the part of an individual who is not exercising reasonable or prudent judgment. MALPRACTICE–conduct of a person while acting in a professional capacity. UNINTENTIONAL TORTS

14. DOCUMENTATION • The source of information regarding the client’s clinical history. • All client care, including medication and treatments, is documented after being provided. • Must be neat, legible, spelled correctly, written clearly, and signed or initialed.

15. Refers to a competent client’s ability to make health care decisions based on full disclosure of the benefits, risks, and potential consequences. It is the physicians responsibility to obtain consent. Nurse, health care provider or hospital representative can witness.. INFORMED CONSENT

16. INFORMED CONSENT (continued) • Individuals who are incompetent are assigned a guardian or someone who has power of attorney to make health care decisions and give consent for treatment.

17. INFORMED CONSENT (continued)

18. ADVANCE DIRECTIVES • Written instruction for health care, recognized under state law, related to the provision of care when the individual is incapacitated.

19. ADVANCE DIRECTIVE DOCUMENTS • DURABLE POWER OF ATTORNEY–legal document designating who may make health care decisions for a client when that client is no longer capable of decision making.

20. ADVANCE DIRECTIVE DOCUMENTS(continued) • LIVING WILL–legal document that allows a person to state preferences about the use of life-sustaining measures should person be unable to make wishes known.

21. INCIDENT REPORT • Risk management tool used to describe and report any unusual event that occurs to a client, visitor, or staff member.

22. MALPRACTICE INSURANCE • Provides the nurse with an attorney who will represent that nurse in court. • Many institutions provide insurance to nurses. • Personal insurance provides coverage off the job and individual legal counsel.

23. IMPAIRED NURSES • Nurses who are habitually intemperate or addicted to the use of alcohol or habit-forming drugs. • Substance abuse does eventually interfere with clinical judgment and performance.

24. IMPAIRED NURSES ARE EVERYONE’S CONCERN • Dates, times of inappropriate behavior should be documented and reported. • Some employers offer an employee assistance program for impaired nurses. • Most states have peer assistance programs to aid in rehabilitation.

25. HEALTH CARE AND ETHICS • ETHICS–concerned with determining right from wrong on basis of knowledge rather than opinions. • BIOETHICS–application of general ethical principles to health care. • ETHICAL PRINCIPLES–codes that direct or govern actions.

26. ETHICAL PRINCIPLES • AUTONOMY–respect the individual’s right to self-determination. • NONMALEFICENCE–cause or do no harm to another. • BENEFICENCE–do good to others.

27. ETHICAL PRINCIPLES (continued) • JUSTICE–equitable distribution of potential benefits and risks. • VERACITY–tell the truth. • FIDELITY–do what one has promised.

28. ETHICAL THEORIES • TELEOLOGY–the value of a situation is determined by its consequences. • DEONTOLOGY–consider the motives of individual performing the act instead of the consequences of that act.

29. ETHICAL THEORIES (continued) • SITUATIONAL–consider each situation individually. • CARING-BASED–focus on emotions, feelings, and attitudes.

30. ETHICS AND VALUES • VALUES–influence the development of beliefs and attitudes. • VALUE SYSTEM–an individual’s collection of inner beliefs that guide each person’s behaviors and choices.

31. ETHICS AND VALUES (continued) • VALUES CLARIFICATION–the process of analyzing one’s own values to better understand those things that are truly important.

32. CODES OF ETHICS Professions determine ethical behavior for members: • National Federation of Licensed Practical Nurses code of ethics for LP/VNs • International Council of Nurses • American Nurses Association

33. CLIENT RIGHTS Clients have rights that include, but are not limited to, the right to: • Make decisions regarding their care. • Be actively involved in the treatment process. • Be treated with dignity and respect.

34. ETHICAL DILEMMAS • Occur when two or more ideals or values are in conflict and include: • EUTHANASIA–action or inaction that causes merciful death. • REFUSAL OF TREATMENT–client’s right to refuse treatment. • SCARCITY OF RESOURCES–limited availability of health care.

35. ETHICS AND NURSING • Nursing practice involves making ethical decisions. • Each practice setting has its own set of ethical concerns. • Ethics committees establish policies and procedures for preventing and resolving dilemmas.

36. Answers to the Review Questions 1. Standards of practice are: b. guidelines. 2. The situation that violates client privacy is: d. talking in the cafeteria about an interesting client. 3. Informed consent occurs when the: c. client understands the risks, benefits, and alternatives to treatment. 4. Nurses would use the Code for Licensed Practical/Vocational Nurses to: d. understand the professional expectations required of them. 5. An ethical dilemma is a: b. problem with two equally unsatisfactory solutions.