Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 3

1. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 3 LEGAL RESPONSIBILITIES

2. The Law Laws may be thought of as rules of conduct that guide interactions among people.

3. Two Types of Law • Public Law: Deals with an individual’s relationship to the state. • Civil Law: Deals with relationships among individuals.

4. Types of Public Law • Constitutional Law - defines and limits powers of government. • Statutory Law - enacted by legislative bodies. • Administrative Law - regulatory laws. • Criminal Law - deals with acts against safety and welfare of the public.

5. Types of Civil Law • Contract Law (the enforcement of agreements among private individuals). • Torts (civil wrongs committed by a person against another person or property).

6. Nursing Practice & the Law • Nursing practice falls under both public and civil law. • Nurses are bound by rules and regulations stipulated by the nursing practice act as determined by the State legislature.

7. Standards of Practice • Guidelines developed under the auspices of the nursing practice acts to direct nursing care. • Liability is determined by whether the nurse adhered to the standards of practice.

8. Legal Issues in Practice • Physician’s Orders - nurses are liable for carrying out erroneous orders. • Floating - nurses must be given orientation when “floated” to unfamiliar areas. • Inadequate Staffing - nurses leaving an inadequately staffed units may be liable. • Critical Care - nurses must constantly observe and assess. • Pediatric Care - nurses must report any suspected child abuse.

9. Legal Issues in Nurse-Client Relationships Intentional Torts: • Assault and Battery. • Defamation. • Fraud. • False Imprisonment. • Invasion of Privacy.

10. Legal Issues in Nurse-Client Relationships Unintentional Torts: • Negligence - A general term referring to negligent or careless acts on the part of an individual who is not exercising reasonable or prudent judgment. • Malpractice - Negligent acts on the part of a professional.

11. Documentation • A client’s clinical history is the medical record, or chart, a legal document. • “If it was not charted, it was not done.”

12. Documentation Protocol • Documentation must be accurate and objective. • Entries must be neat, legible, spelled correctly, written clearly, and signed or initialed.

13. Informed Consent Informed consent occurs when: • The nurse discusses the surgical procedure with the client. • The client understands the risks, benefits, and alternatives to treatment. • The client signs the consent form.

14. Incident Report • A risk management tool used to describe and report any unusual event that occurs to a client, a visitor, or staff member.

15. Advance Directive • A written instruction for health care recognized under state law and related to the provision of such care when the individual is incapacitated.

16. Advance Directive Documents • Durable Power of Attorney - Designates who may make health care decisions for a client when that client is no longer capable of decision making. • Living Will - Allows a person to state preferences about use of life-sustaining measures when person is unable to make wishes known.

17. Malpractice Insurance • Many institutions provide insurance to nurses. • Personal insurance provides off the job coverage and individual legal counsel.

18. Impaired Nurses • A nurse who is habitually intemperate or is addicted to the use of alcohol or habit-forming drugs.

19. Impaired Nurses are Everyone’s Concern • Dates and times of inappropriate behavior should be documented and reported.

20. Impaired Nurses: Rehabilitation • Some employers offer an employee assistance program for the impaired nurse. • Most states have peer assistance programs to aid in rehabilitation.

21. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 4 ETHICAL RESPONSIBILITIES

22. Ethics • The branch of philosophy concerned with the distinction of right from wrong on the basis of a body of knowledge rather than on just opinions. • Ethics looks at human behavior - things people do under different types of circumstances.

23. Bioethics • The application of ethical principles of health care.

24. Why is Ethics an Increasing Issue for Health Care? • an increasingly technological society with complicated issues that never had to be considered before. • the changing fabric of society, particularly in terms of family structure. • health-care has become a consumer-driven system based on clients becoming more knowledgeable.

25. Ethical Principles • Codes that direct or govern actions.

26. Basic Ethical Principles • Autonomy - The respect for individual liberty • Justice - The equitable distribution of potential benefits and risks • Fidelity - The duty to do what one has promised • Nonmaleficence - The obligation to do or cause no harm to another • Beneficence - The duty to do good to others • Veracity - The obligation to tell the truth

27. Ethical Theories • Teleology - the value of a situation is determined by its consequences. • Deontology - the intrinsic significance of an act itself as the criterion for the determination of good. • Situational Theory - holds that there are no set rules or norms. Each situation must be considered individually. • Caring-Based Theory - focuses on emotions, feelings, and attitudes.

28. Values • Values are different from principles, in that they influence the development of beliefs and attitudes, rather than behaviors. They may, however, indirectly influence behaviors.

29. Value System • An individual’s collection of inner beliefs that guides the way the person acts and helps determine the choices made in life.

30. Value Clarification • The process of analyzing one’s own values to better understand those things that are truly important in life.

31. Value Clarification • The process of analyzing one’s own values to better understand those things that are truly important in life.

32. Self-Reflection • Because ethics and values are so closely associated, nurses must explore their own values in order to acknowledge the value systems of their clients.

33. Ethical Codes • Codes are used to help nurses act ethically. • These have been developed by nursing organizations such as the NFLPN, the ICN and the ANA.

34. The Patient’s Bill of Rights • A document designed to guarantee ethical care of clients in terms of their decision making about treatment choices and other aspects of their care.

35. Ethical Dilemma • A conflict between two or more ethical principles. • In an ethical dilemma, there is no “correct” decision.

36. Major Types of Ethical Dilemma • Euthanasia. • Refusal of Treatment. • Scarcity of Resources.

37. Euthanasia • Intentional action or lack of action that causes the merciful death of someone suffering from a terminal illness or incurable condition.

38. Refusal of Treatment • Based on the principle of autonomy. • A client’s rights to refuse treatment and to die often challenge the values of most health care providers.

39. Scarcity of Resources • The allocation of scarce resources (e.g. organs, specialists) is emerging as a major medical dilemma.

40. Ethical Decision Making

41. Ethics Committees • Many health care agencies now recognize the need for a systematic manner whereby to discuss ethical concerns. • Multidisciplinary committees offer dialogue regarding ethical dilemmas. • Ethics committees can lead to the establishment of policies and procedures for the prevention and resolution of dilemmas.

42. Nurse as Client Advocate • When acting as client advocate, the nurse’s first step is to develop a meaningful relationship with the client. • The nurse is then able to make decisions with the client based on the strength of the relationship.

43. Nurse as Whistleblower • Whistleblowing refers to calling attention to unethical, illegal, or incompetent actions of others. • Whistleblowing is based on the ethical principles of veracity and nonmaleficence. • Federal and state laws (to varying degrees) provide protection, such as privacy, to whistleblowers.

44. Questions for Whistleblowers • Whose problem is this? • Must I do anything about it? • Is it my fault? • Who am I to judge? • Do I have the facts straight?