3:1 LAP Ethical & Legal Implecations
Terms
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- Assault
- Intentional tort, a threat or attempt to make bodily contact withanother person or without that person's consent
- Credentialling
- the process of determining and maintaining competence in practice; includes licensure, registration, certification, and accreditation
- Defamation
- Intentional Tort, which one party makes derogatory remarks about another that diminish the other parties reputation/ Slander
- Ethics
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study of good conduct, character, and motives
right and wrong
system for deciding what should be done
Governs conduct - Ethical Dilemma
- approaches Priciple Based which is combing of two, and Care Based looks at pt
- DNR
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Do not resuscitate
an order - Felony
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a crime of a serious nature, such as murder, punishable by a term in prison
criminal law ( crime) - Good Samaritan Act
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Act as laws to health care providers that act in the event of an emergency, covers nurses. You cannot diagnose.
(protect)covers nursing student - Informed Consent
- a client's agreement to accept a course of treatment or a procedure after receiving complete information, including the risks
- Libel
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Intentional Tort
defamation by means of print, writing, or pictures ( Libel) - Malpractice
- the negligent acts of health care persons, very hard to prove
- Misdemeanor
- a legal offense usually punishable by a fine or a short-term jail sentence, or both, criminal law (crime)
- Morality
- A doctrine or system denoting what is right or wrong in conduct, character,or attitude
- Negligence
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failure to behave in a reasonable and prudent manner; an unintentional tort
ex. medication error, malpractice - Slander
- defamation by the spoken word, stating unprivileged (not legally protected) or false words by which a reputation is damaged
- Standards of Care
- detailed guidelines describing the minimal nursing care that can reasonably be expected to ensure high quality care in a defined situation (eg, a medical diagnosis or a diagnostic test)
- Civil Tort
- wrong committed against a person or a person's property, a tort is subject to action in a civil court, invasion
- Value
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values differ, beliefs or attitudes about the worth of person object, idea, or action
freely chosen, personal belief, often taken for granted - Value Clarification
- Process by which people identify, examine,and develop their own individual values.
- Identify 4 professional values for a nurse
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1. strong commitment to service
2.Belief in dignity and worth of each person
3.Commitment to Education
4.Professional autonomy - Discuss how values calrification promotes personal growth:
- Values clarification promotes personal health by fostering awareness , empathy, and insight. Therefore it is an important step for the nurse to take in dealing with ethical problems
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Function of the laws in Nursing:
Constitutional law - Federal and state constitutions indicate hoe the federal and state governments are created and given authority and state principles and provisions for establishing laws, serves guidelines for legislative bodies
- Statuatory Law
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-nurse practice acts
-Good Sama. Act
Child and adult abuse laws
living wills
Sexual Harrass.
must be in keeping with both federal consti. and state consti.
American Disability Act - Administrative laws
- Executive officers (Ex. The President Of the United States, governors, or mayors of the city) administer agencies that are responsible for law enforcement ( Board of Nursing are admin. at a state level)
- Commom laws
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laws evolving from court decisions
blue laws ( court made law) Most law involving malpractices are common made law - Purpose of Nurse Practice Act
- Each state has a nurse practice act which protects the public by legally defining and describing the scope of nursing practice. They also act legally to control nursing practice through licensing requirements, is the most important law affecting your nursing practice
- Purpose of a license
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legal permit the gov. agency grants to an indidvidual to practice of a profession or to use a particular title. Must meet criteria
1. protect the publics safety and wealfare
2.occupation is clearly defined as a seperate or distinct area of work
3. Proper authority to assume the obligations of the licensing process" Nursing State Boards" - Internal Standards of Care
- includes nurse description, education, and expertise as well as an individuals policies and procedures
- External Standards of Care
- Nurse Practice Acts, professional organizations, nursing specialty practice organizations, federal organizations, and federal guidelines
- 3 Independant legal roles of the nurse
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1.provider of service
2.Employee or contractor for service
3.Citizen - Nurses role in obtaining informwd consent
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the nurse is not responsible for explaining the procedure, but for witnessing the clients signature on the form
"sullivan 98 states the nurse's signature confirms 3 things
clients gave consent voluntarily
Signature is authentic
Client appears competent to give cnsent - Nurses role in reporting crime
- nurse can identify acess cases of violence against others. As a result they are often included in mandated reportes
- 6 elements that must be present for a case of nursing negligence or malpractice to be proven:
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1.Duty
2.Breach of Duty
3. Foreseability
4.Caucasion
5.Harmor
6. Injury - Identify basic nursing errors that may result in a malpractice.
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Assessment Errors
Planning Errors
Intervention Errors - Unintential torts
- do not require intent but do reqiure the element of harm
- Intential torts
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the act on purpose with no intent
-no harm need by caused by intential torts for liability to exist - Good Smaritan Act
- laws designed to protect health care providers on scene of emergency
- Incident Report and information it may contain
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record of the accident or unusual occurrence
Identify:
client name, date, time, palce of accident, facts,witnesses... - Legal responsibilities of a student nurse
- responsible for own actions and liable for their own actions of neglience committed during the couse of clinical experiences ( Same as RN)
- Pateint Bill of rights
- "knock on door" (AHA"
- Health Care Proxy
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See handout
for someone who is uncable of speaking forthemselves the person makes the decisions for the client who cannot
-living will for someone who does not want extreme measures to be taken - HIPPA
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-If pt stated going to sue, get risk management involved immed.
-have 2yrs from time of discovery to prove can sue forever (statue of limitations) if it is not written NOT done
No personal opinion, no blaming write what you see - Advanced Directives
- Health Care Proxy
- Restraints
- can not restrain against own will
- Nurses Role In Reporting
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-write description -Be accurate
-Be creditable -get support
Report-sign Assume responsibility
follow through -
Importance of Incident Report
(variance, occurrence report) - Uncured event, document the occurrence of anything out of the ordinary that results in or has potential to harm a pt, employee, or visitor
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Basic Nursing Errors resulting in
negligence - liable for own actions
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Mode of value transmission
Modeling - parents, teachers, clergy, co-workers
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Mode of value transmission
Moralizing - are taught a complete value system by parents or a institution ex. church or school that allows little opportunity for them to weigh different values.
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Mode of value transmission
Laissez- fare - whatever goes, lazy
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Mode of value transmission
Rewarding + Punishing - children are rewarded for demonstrating values held by parents and punished for demonstrating unacceptable values
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Mode of value transmission
Responsible Choice - encourage children to explore competing values and to way their consequences . Support and guidance are offered as children develop a personal value system
- 1. Valuing Process
- Theorists say to have 7 steps focusing on three main activities 1. choosing, 2. Prizing, 3. Acting
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Valuing Process
Choosing - 1. Freely to believe in the worth and uniqueness of each indiv. to realize you have other options, belive in respecting their dignity 2. Alternatives ex. comply, refuse 3. After consideration of consequences
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Valuing Process
Prizing -
You will also prize your choice
4. with pride and happiness 5. with public affirmation -
Valuing Process
Acting - 6. With Incooperation of the choice into one's behavior 7. with Consistence, and regularity
- Clarification strategies
- Clarifying this value of respect for human dignity will motivate you in corporate this value into your practice
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Value clarifiaction
(Look at own values) -
Process of identity , examine, +develop own individuals values
-promotes growth fostering awareness, empathy, and insight
Acts as your standard guide behavior - Principle care bases Approach
- are doing ethics combined elements combines both utilitarian and deontology are acting specific guides for practice, combining of 2
- Care Based
- looks at pt. , Directs attention to the specific situations of the indiv. patients viewed as within the context of their life narrative
- Utilitarian
- The end justifies mean (Ex. sex ed in school)
- Deontology
- The act itself is wright or wrong in your belief (Ex. abortion)
- Code of ethics
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Formalized guidelines, Accountability, Responsibility
Advocacy, Confidentially, Veracity - Bill of Rights for Nurses
- Advocacy of behalf of nurses and the profession has resulted in a tangible tool, Bill of Rights for nurses , to aid in providing workplaces and ensuring nurses ability to provide safe quality pt care
- Examples of Ethical Problems
- Paternalism, Deception, Confidentiality, Allocation of Scarce Nursing Resources, Advocay in market Driven Environment,Valid consent or refusal
- Ethical Decision Making
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Ethical Committees- for ethical dilemmas
Example of ethical Problems -
Nurses who value pt advocacy
1. - Make sure that their loyalty to an employee or institution or colleague does not compromise their primary commitment to the pt
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Nurses who value pt advocacy
2. - Give priority to the good of the indiv.pt rather than the good of the society in general
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Nurses who value pt advocacy
3. - Carefully evaluate the claims of the pt.'s autonomy ( self determination) and pt well being
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Professional Values
Altrusim - is a concern for the welfare and well being others, demonstrating cultures of theirs, advocates for pt, take risk on behalf f pt, mentors other professionals
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Professional Values
Autonomy - freedom, right to self determination, make own choices
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Professional Values
Human Dignity - Respect for the inherit worth and uniqueness of individuals and populations, provide culturally competent and sensitive care, pts privacy, Design care with sensitivity to indii. pt needs
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Professional Values
Integrity - is acting in accordance with an appropriate code of ethics and accepted standards of practice, provides honest info to pts and public
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Professional Values
Social Justice - Fairness, is upholding moral, legal, and humanistic principles, supports non discrimination, promotes universal access to healthcare
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Moral Principles
Nonmaleficence - To do know harm
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Moral Principles
Autonomy - pt freedom, Respect the rights of patients or their surrogates to make health care decisions
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Moral Principles
Beneficence - Benefit the pt, and balance benefits against risks and harms
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Moral Principles
Justice - fairness, act fairly
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Moral Principles
Fidelity / Veracity -
faithfulness, commitment (be careful what you tell pts, keep promises
truth -
ANA code of ethics
Standards of Practice - Governed by ANA
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ANA code of ethics
Pts Bill of Rights - AHA
- Bill of Rights for RN
- AHA
- Law
- Is a standard of rule or conduct established and enforced by the government. Laws are intended chiefly protect the rights of the public
- Functions of Law
- 1. provide framework for legal nursing actions 2. Differentiate nurse responsibilities 3. Establish boundaries 4. Maintains standards
- Law and it's 4 sources
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constitution
statute
administrative law
common law - Accreditation
- process by which an educational program is evaluated and recognized as having met certain standards
- Liscensure
- process by which a state determines that a candidate meets certain minimal requirements to practice in the professional and grants a license to do so
- certification
- process by which a person who has met certain criteria established by a nongovernmental associations is granted recognition in a specified area of practice
- Invasion of Privacy
- 4th amendment right of privacy and right to be left alone ( HIPPA)
- False Imprisonment (Freud)
- A person cannot be legally be forced to remain in a health care agency such as hospital if he or she is of sound mind even if health care providers think they should be treated.
- Negligence ( UNINTENTIONAL TORTS)
- Unintentional tort performing an act that a reasonably prudent person under similar circumstances would do. Ex. malpractice very hard to prove!
- Personal areas of possible liability
- Incomplete data, significant errors, omissions, no indication of nursing care plan, wrongful documentation, no notes, wrongful d/c, failure to respond as RN
- Nurse as Defendant
- should work closely with the attorney while preparing the defense
- Nurse as a fact witness
- may be called to go under oath, and must base their testimony only on first hand knowledge of the incident and not on assumptions
- Nurse as a expert Witness
- solid educational background, strong clinical experience comparable to the nurse defendant
- Legal Safeguards in Nursing
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Informed consent or Refusal
Contracts
Collective Bargaining
Competent Practice
(most import) - Components of Law suit
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Litigation - whole process
Plaintiff- accusing, brings complaint
Defendant Defends himself against plaintiff
Burden of Proof- enough evidence to be found guilty beyond a reasonable doubt - Malice
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intentional or published
willfull - Battery
- actually touching
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Elements Essential to prove negligence/ malpractice
ALL must be present! -
1. Duty to the pt ( responsible for pt)
2. Negligence
3. Damage- harm to pt
4.Causation -cause of demise or injury
(If one is missing NO case) - Students and the Law
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student nurse accountable for their actions
work/liable under their own actions - Basic Care Nursing errors resulting in Negligence
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Assessment errors-didn't gather enough info
Planning Error- didn't identify info or accurate info
Intervention Error - Advance Directives
- Health Care Proxy, power of attorney