Transcript Document

Chapter 3
Nursing Practice
and the Law
OBJECTIVES
• Describe the principles of ethics
• Examine the relationship of critical thinking
to the ethical decision-making process
• Discuss how the Code of Ethics serves as a
guideline to ethical decision making
• Identify areas that are subject to frequent
ethical dilemmas in the clinical setting
OBJECTIVES
• Discuss common areas of difficulty involved
in making ethical decisions.
• Differentiate between personal ethics and
Professional ethics.
• Differentiate between values and
personal/professional ethics.
• Discuss methods in which values are
formed.
• Describe the process of values clarification
OBJECTIVES
• Differentiate between morals and ethics.
• Compare and contrast principles and rules
of ethics.
• Apply the eight basic ethical principles to
an ethical issue.
• Compare and contrast different types of
ethics.
• Utilize the Code of Ethics for Nurses to
critically think when making decisions in
professional practice.
OBJECTIVES
• Utilize strategies to enhance ethical
decisions in nursing practice.
• Discuss the influence organizational ethics have
on nursing practice
• Examine the steps to ethical dilemma resolution.
• Examine ethical dilemmas that the nurse may
encounter in professional practice and in health
care.
• Apply critical thinking to client scenarios and
NCLEX-style questions.
Meaning of Law
• Statutory law
• Common law
• Administrative law
Sources of Law
• The Constitution
• Statutes
• Administrative
Types of Law
• Criminal law
• Civil law
Criminal Law
• Criminal acts are considered offenses against
the state
• Three categories of criminal law
– Felony
– Misdemeanor
– Juvenile
Civil Law
• Usually involve the violation of one person’s
rights against another’s rights
• Tort
• Quasi-intentional tort
• Negligence
• Malpractice
Other Laws Relevant to Nursing
• Good Samaritan laws
• Confidentiality
• Slander and libel
• False imprisonment
• Assault and battery
Nursing Standards
• Established as guidelines for the profession to
ensure quality of care
• Also used as criteria to determine whether
appropriate care has been delivered
Types of Standards
• Internal standards
• Organizational standards
• Accepted state and national standards
• Nurse Practice Acts
• Patient Care Partnership
Internal Standards
• Developed by institutions
• Institutional policies
• Maintained in policy and procedure manuals
Boards of Nursing
• Develop the Nurse Practice Acts
• The courts have upheld the authority of the
boards of nursing to regulate standards
• With the expanded role of nursing, it is
important to clarify the distinction between
nursing and medicine
Uses of Standards in Nursing
Negligence or Malpractice
• Standards are used as a guide
• State, local, or national standards
• Institutional policies that alter or adhere to the
nursing standards of care
• Expert opinions on appropriate standards of care
• Available literature substantiating current standards
Informed Consent
• Without informed consent many medical
procedures could be considered battery
• Consent to treatment by the client gives the
health care personnel the right to deliver care
without fear of prosecution
Informed Consent
• The physician obtains the consent
– Gives the client the information
– States the risks and advantages
• The nurse may be involved in the process by
gaining signatures on the appropriate forms
Helpful Hints
• A mentally competent adult has voluntarily
given consent
• The client understands exactly what he or she is
consenting to
• The consent includes the risks, alternative
treatments, and outcomes
• The consent is written
Prevention
• Keep yourself informed about new information
related to your area of practice
• Insist that the health care institution keep
personnel informed of all changes in policies
and procedures and in the management of new
technological advances
Prevention
• Follow the standards of care or practice for your
institution
• Delegate tasks and procedures to appropriate
personnel
• Identify clients at risk for problems
Prevention
• Establish and maintain a safe environment
• Document precisely and carefully
• Write detailed incident reports
• File incident reports with appropriate personnel
and departments
• Recognize client behaviors that may cause
problems
Common Causes of Negligence
• Client falls
• Equipment injuries
• Failure to monitor
• Failure to communicate
• Medication errors
• Medical errors
Medication Errors
• Right drug
• Right dose
• Right route
• Right time
• Right client
• Right reason
• Right documentation
Tips for Credible Documentation
• Contemporaneous
• Accurate
• Truthful
• Appropriate
The 6 Fs
• Failure to appropriately assess a client
• Failure to report changes in client status
• Failure to document in the client record
• Failure to obtain informed consent
• Failure to report a coworker’s negligence
• Failure to provide adequate education
The 2 Big Bad Ones
• Altering or falsifying a record
• Violation of an internal or external standard of
practice
If a Problem Arises
• When served with a complaint, immediately
contact legal counsel
• Never sign any documents without legal
counsel
• Notify your malpractice carrier if covered;
notify your institution immediately
• Keep all correspondence: written and verbal
End-of-Life Decisions
• DNR orders
• Advance directives
• The “living will”
• Durable power of attorney
• Health care surrogate
Mandatory Overtime
• Increased demand due to nursing shortages
• Physical and mental fatigue
• Increased physical and emotional stress
• Decreased concentration
Licensure
• In the United States, granted through the
state government via state boards of nursing
(NCLEX-RN)
Qualifications for Licensure
• Graduation from an approved nursing program
• English proficiency
• Disclosure of criminal conviction
NCLEX-RN Examination
• Computerized Adaptive Testing (CAT)
• Minimum and maximum number of questions
• Regulated length of time to complete the
examination
NCLEX-RN Examination
• Based on client needs and the nursing process
• Multiple choice and alternative item formats
– Fill in the blank
– Drag and drop
Preparing for the NCLEX-RN
• Review courses
• Review books
• Videos
• DVDs
• Practice tests
Moving?
• Endorsement
• Multistate licensure
Disciplinary Action
• State boards of nursing
• Major issues
–
–
–
–
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Falsifying documents
Felony
Drugs or alcohol
Functioning outside the scope of practice
Abuse
Conclusion
• Nurses need to be aware of the Nurse Practice Act in
their states
• Nurses need to familiarize themselves with their
institutions’ standards of care
• Nurses need to understand the most common causes
of negligence
• Nurses need to document accurately and
appropriately