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

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 3
LEGAL
RESPONSIBILITIES
The Law
Laws may be thought of as rules of
conduct that guide interactions among
people.
Two Types of Law
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Public Law: Deals with an individual’s
relationship to the state.
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Civil Law: Deals with relationships
among individuals.
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.
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Types of Civil Law
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Contract Law (the enforcement of
agreements among private individuals).
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Torts (civil wrongs committed by a
person against another person or
property).
Nursing Practice & the Law
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Nursing practice falls under both public
and civil law.
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Nurses are bound by rules and
regulations stipulated by the nursing
practice act as determined by the State
legislature.
Standards of Practice
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Guidelines developed under the
auspices of the nursing practice acts to
direct nursing care.
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Liability is determined by whether the
nurse adhered to the standards of
practice.
Legal Issues in Practice
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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.
Legal Issues in Nurse-Client
Relationships
Intentional Torts:
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Assault and Battery.
Defamation.
Fraud.
False Imprisonment.
Invasion of Privacy.
Legal Issues in Nurse-Client
Relationships
Unintentional Torts:
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Negligence - A general term referring to negligent or
careless acts on the part of an individual who is not
exercising reasonable or prudent judgment.
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Malpractice - Negligent acts on the part of a
professional.
Documentation
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A client’s clinical history is the medical
record, or chart, a legal document.
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“If it was not charted, it was not done.”
Documentation Protocol
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Documentation must be accurate and
objective.
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Entries must be neat, legible, spelled
correctly, written clearly, and signed or
initialed.
Informed Consent
Informed consent occurs when:
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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.
Incident Report
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A risk management tool used to
describe and report any unusual event
that occurs to a client, a visitor, or staff
member.
Advance Directive
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A written instruction for health care
recognized under state law and related
to the provision of such care when the
individual is incapacitated.
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.
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Malpractice Insurance
Many institutions provide insurance to
nurses.
 Personal insurance provides off the job
coverage and individual legal counsel.
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Impaired Nurses
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A nurse who is habitually intemperate or
is addicted to the use of alcohol or
habit-forming drugs.
Impaired Nurses are Everyone’s
Concern
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Dates and times of inappropriate
behavior should be documented and
reported.
Impaired Nurses: Rehabilitation
Some employers offer an employee
assistance program for the impaired
nurse.
 Most states have peer assistance
programs to aid in rehabilitation.
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Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 4
ETHICAL
RESPONSIBILITIES
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.
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Ethics looks at human behavior - things
people do under different types of
circumstances.
Bioethics
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The application of ethical principles of
health care.
Why is Ethics an Increasing
Issue for Health Care?
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an increasingly technological society with
complicated issues that never had to be considered
before.
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the changing fabric of society, particularly in terms of
family structure.
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health-care has become a consumer-driven system
based on clients becoming more knowledgeable.
Ethical Principles
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Codes that direct or govern actions.
Basic Ethical Principles
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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
Ethical Theories
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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.
Values
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Values are different from principles, in
that they influence the development of
beliefs and attitudes, rather than
behaviors. They may, however,
indirectly influence behaviors.
Value System
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An individual’s collection of inner beliefs
that guides the way the person acts and
helps determine the choices made in
life.
Value Clarification
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The process of analyzing one’s own
values to better understand those
things that are truly important in life.
Value Clarification
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The process of analyzing one’s own
values to better understand those
things that are truly important in life.
Self-Reflection
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Because ethics and values are so
closely associated, nurses must explore
their own values in order to
acknowledge the value systems of their
clients.
Ethical Codes
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Codes are used to help nurses act
ethically.
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These have been developed by
nursing organizations such as the
NFLPN, the ICN and the ANA.
The Patient’s Bill of Rights
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A document designed to guarantee
ethical care of clients in terms of their
decision making about treatment
choices and other aspects of their care.
Ethical Dilemma
A conflict between two or more ethical
principles.
 In an ethical dilemma, there is no
“correct” decision.
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Major Types of Ethical Dilemma
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Euthanasia.
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Refusal of Treatment.
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Scarcity of Resources.
Euthanasia
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Intentional action or lack of action that
causes the merciful death of someone
suffering from a terminal illness or
incurable condition.
Refusal of Treatment
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Based on the principle of autonomy.
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A client’s rights to refuse treatment and
to die often challenge the values of
most health care providers.
Scarcity of Resources
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The allocation of scarce resources (e.g.
organs, specialists) is emerging as a
major medical dilemma.
Ethical Decision Making
ASSESSMENT
Determination of claims and parties
ANALYSIS & DIAGNOSIS
Identification of problem: Statement of ethical dilemma
PLANNING
Consideration of priorities of claims
Consideration of consequences of alternatives
IMPLEMENTATION
Carrying out selected moral actions
EVALUATION
Evaluation of outcome of moral actions
"Were the actions ethical?" "What were the consequences?"
Ethics Committees
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Many health care agencies now recognize the need
for a systematic manner whereby to discuss ethical
concerns.
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Multidisciplinary committees offer dialogue regarding
ethical dilemmas.
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Ethics committees can lead to the establishment of
policies and procedures for the prevention and
resolution of dilemmas.
Nurse as Client Advocate
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When acting as client advocate, the
nurse’s first step is to develop a
meaningful relationship with the client.
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The nurse is then able to make
decisions with the client based on the
strength of the relationship.
Nurse as Whistleblower
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Whistleblowing refers to calling attention to unethical,
illegal, or incompetent actions of others.
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Whistleblowing is based on the ethical principles of
veracity and nonmaleficence.
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Federal and state laws (to varying degrees) provide
protection, such as privacy, to whistleblowers.
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?
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