NURS 2210 Roles II: Unit II

1. NURS 2210 Roles II: Unit II Legal and Ethical Concepts Nancy Pares RN, MSN Metro Community College

2. Obj 1: Review legal standards • Laws define and limit relationships • Sources of public law • Constitutional • Administrative • Criminal • Felony vs misdemeanor

3. Civil Law • Contract • Involves compensation, mutual understanding • Implied contract • Employer policies, fulfill terms, respect others • Tort • Wrongful act against another • Protective/reporting • HIPPA • Good Samaritan

4. Nurses also have rights • Adequate assistance • Reasonable conduct from clients • Compensation • Reasonable treatment by co workers

5. Tort law • State • Unintentional torts • Negligence • Duty • Breach of Duty • Injury • Causation • Malpractice

6. Intentional Torts • Assault • Battery • False imprisonment • Restraints (OBRA) • Invasion of privacy • Right to be left alone; consent for no treatment • Defamation • fraud

7. Quasi intentional • Intent is lacking, but a willfull action is evident • Defamation of character • Invasion of privacy • Breech of confidentiality

8. Legal responsibilities of RN • Defined by Practice Acts and Standards of Care • RN is legally responsible to ensure that the client receives competent, safe and holistic care. • Best Defense • Actively participate in NNA • Attend continuing ed on legal issues • Call State Board with any questions about practice • Stay current in hospital policies and procedures

9. Responsibilities • Unprofessional conduct • Delegation, HIPPA, lack of knowledge; abuse, false documentation, leaving assignment • Impaired Nurse • Duty to report • Safety • Understaffing • Mandatory overtime • Reassignment • Executing prescribed orders

10. Other legal issues • Whistle blowing • Nursing students • Professional liability insurance • Advance Directives

11. Legal issues related to death • DNR orders • Euthanasia • Wills • Pronouncement of Death • Care of the deceased • Organ donation • autopsies

12. Obj 2 Review ethical principles • Ethics • Study of rightness of conduct • Vs. morality? • Relationship between ethics and legal • Ethical opinions reflect individual differences • Human behavior and motivation are too complex to be accurately reflected in law • The legal system judges action rather than intention • Laws change according to social and political influences

13. Ethical vs. Legal…or both • Working in a clinic that performs abortions • Honoring a terminally ill client request for no heroic actions • d/c a comotose client life support at the request of the family • Diverting meds from a client for your own use

14. Ethical Principles • Autonomy • Beneficience • Confidentiality • Double effect • Fidelity • Justice • Nonmaleficence • Paternalism • Sanctity of life • veracity

15. MORAL model • M ….. Massage the dilemma • O…outline options • R…resolve • A…act by applying options • L…look back and evaluate

16. Nurse obligations in ethical decisions • Maximize client well being • Balance client needs with family responsibilities • Support family and enhance support system • Carry out hospital policies • Protect other client well being • Protect nursing standards

17. Critical thinking • Is the action good or neutral? • Is the intent good? • Good effect cannot be achieved by bad action • Balance of good/bad

18. Basics of nursing ethics • Human caring should guide the practice • Confidentiality • Privacy, misuse of information • Restraints • Trust • Refusing to provide care • Food and fluid

19. Preventative ethics • Nancy Cruzan • Terri Shiavo

20. Code of Ethics • Practice with compassion and respect • Nurses primary commitment is to the patient • Nurse advocates, protects the patient • Nurse is responsible and accountable for actions • Nurse must maintain competence and professional growth • Nurse participates in improving health • Nurse contributes to profession thru community, educational and social situations

21. Case 1 • Dx: missed abortion—client hospitalized, D&C was scheduled—client discussed with MD • Nurse administered preop meds then noted that there was no consent signed. Surgery was postponed awaiting MD. MD arrived and had pt sign and husband also-witnessed by RN. • Procedure resulted in perforation, OB attempted to repair—called in general surgeon-- required removal of 1 ft of bowel • Result: likely to have higher incidence of SBO

22. Issue: • Was the hospital liable to obtain informed consent?

23. Case 2 • 1985- Nurse Midwife advertised ‘Family Birth’ • Hospital Chief of Staff – OB wrote a letter to the administration of two hospitals stating that home deliveries were being done without qualified supervision. • Same MD confronted nurse midwife at L&D • Nurse midwife was prohibited from the hospital.

24. Issue • Was the slander actionable?

25. Case 3 • Client with fx leg—cast applied; orders to have nursing check hourly and call with concerns • Charting notes gap from 4am to 830 am. • MD examines at 830—compartment syndrome and identification of tissue death—leg amputated

26. Issue • Was documentation considered substandard and cause for patient to suffer injury?

27. Case 4 • Female patient admitted to LTC—noted large diamond ring and informed that she should not keep in her room. Pt kept the ring. • Ring disappeared—investigation proved fruitless—thru a ‘tip’ a nurse aid was implecated—arrested and pled guilty

28. Issue: • Was the nursing home responsible for the property damage sustained by the resident?

29. Case 5 Male was admitted to psych unit on Nov 21due to being a threat to himself and others. Meeting held on Nov 23 determined that he was able to be released. (Thanksgiving holiday) Male entered house on Dec 5 and killed one individual and wounded two others, then shot himself.

30. Issue • Was the institution liable for discharging the patient and the subsequent deaths?

31. Ethical Behaviors in Professional Nursing • What are they? • What about gossip amongst peers? • What about behaviors of student nurses?

32. Legal and ethical standards in the classroom • How do we apply these standards in the classroom? • What should be done if • student cheats? • Lies to instructor? • Copies from other’s work • Instructor or student ‘bullies’