Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing: A Concept-Based Approach to Learning VOLUME TWO | SECOND EDITION MODULE 49 Legal Issues

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Definition Understanding the legal implications of nursing practice demands critical reasoning skills to protect the patient’s rights and the nurse from liability.

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition The Concept of Legal Issues Rights, responsibilities, scope of nursing practice  As defined by state nurse practice acts Malpractice  Conduct deviating from standard of practice dictated by the profession

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Legal Limits of Nursing Sources of legal guidelines come from:  Statutory law (Nurse Practice Act) Criminal law (felonies or misdemeanors): controlled substance misuse Civil law: Malpractice  Regulatory law (administrative law): State Board of Nursing  Common law (judicial decisions): based on legal cases; patient’s rights

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Standards of Care Legal requirements for nursing practice that describe minimum acceptable nursing care. American Nurses Association and State Nurse Practice Acts set these standards

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Civil and Common Law Issues in Nursing Practice Torts: a civil wrong Intentional  Assault  Battery  False imprisonment  Invasion of Privacy

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Civil and Common Law Issues in Nursing Practice (cont’d) Quasi-intentional  Invasion of privacy  Malice  Slander  Libel Unintentional  Negligence: Conduct that deviates from what a responsible person would do in a particular circumstance  Malpractice

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Common Negligent Acts Failure to assess and/or monitor, including making a nursing diagnosis  Failure to monitor in timely fashion  Failure to use proper equipment to monitor the patient  Failure to document the monitoring  Failure to notify the health care provider of problems  Failure to follow orders  Failure to follow the six rights of medication administration

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Common Negligent Acts (cont’d) Failure to convey discharge instructions Failure to ensure patient safety, especially for patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative Failure to follow policies and procedures Failure to properly delegate and supervise

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Proof of Negligence The nurse owed a duty to the patient. The nurse did not carry out the duty or breached it. The patient was injured. The patient’s injury was caused by the nurse’s failure to carry out that duty.

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Informed Consent Client's legal and ethical rights to be informed of, give permission for procedure, treatment Client must not be coerced Client understanding essential Client's cultural, spiritual preferences Follow employing agency's specific protocols

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Informed Consent, continued Competency for consent  Adult assumed to be competent if over 18, not declared legally incompetent, rendered temporarily incompetent Consent in an emergency  Assumes participation of client in situations where consent impossible, impractical to obtain Child participation in healthcare decisions  Parent, guardian unless mature minor

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Statutory Guidelines for Legal Consent for Medical Treatment  Adults  Any competent individual 18 years of age or older for himself or herself  Minors A. For his or her child and any child in his or her legal custody B. For himself or herself in the following situations: 1. Lawfully married or a parent (emancipated) 2. Pregnancy (excluding abortions) 3. Venereal disease 4. Drug or substance abuse

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Controlled Substances Act Federal law Drugs classified  Schedules numbered from I to V  Schedules I, II highest potential for abuse

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Good Samaritan Laws Encourage healthcare providers to help victims in an emergency Protect healthcare workers from potential liability Nurse responsible for following through with emergency care

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Exemplar 49.1 Nurse Practice Acts

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Overview Nurse Practice Act (NPA)  Defines Scope of practice Standards for education programs Licensure requirements Grounds for disciplinary actions  Enforced by state boards of nursing (BONs)

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Licensure Allows nurses legal privilege to practice nursing as defined by each state's NPA Each BON oversees administration of a licensure examination.

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Licensure National Council of State Boards of Nursing (NCSBN)  NCLEX-RN ®  NCLEX-PN ® Nurse required to meet responsibilities to clients, healthcare system

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition National Council of State Boards of Nursing Membership  50 states, DC, four U.S. territories Functions  Services to member BONs  Central repository of data  Initial competency licensure examinations

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nurse Licensure Compact Mutual recognition model  Single license that confers privilege to practice in other states  Nurse held accountable for following laws, rules of state  Similar to driver's license

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Credentialing Certification Federal organizations  Joint Commission  Centers for Medicare and Medicaid Services

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Nursing Students Guidelines for clinical performance  Ensure client safety  Know facility's policies, procedures before undertaking any clinical assignment  Ensure knowledge about client's condition, interventions, medications, treatments  Never perform care if unprepared  Seek help before beginning procedure if unsure

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Standards of Practice Established by ANA Address nursing care, professional performance Available for specialties  Pediatric nursing  Nurse anesthesia practice  Critical care nursing  Psychiatric nursing

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Exemplar 49.2 Advance Directives

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Overview Healthcare advance directive  Legal document  Expresses an individual's desires regarding medical treatment Patient Self-Determination Act Types of advance directives  Living will  Durable power of attorney for health care

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Elements of Advance Directives Gives agent or surrogate decision maker authority to:  Consent to or refuse medical treatment or diagnostic procedure  Hire or discharge medical providers  Authorize admission to medical and long-term care facilities  Have access to all medical records  Take any measures to carry out wishes

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Role of the Nurse Reassure clients and families that they have option to change their decision when competent Assess whether clients, families have accurate understanding of life-sustaining measures Be supportive of clients' decisions

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Exemplar 49.3 Health Insurance Portability and Accountability Act (HIPAA)

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Overview HIPAA Purposes  Minimizes exclusion of preexisting conditions  Designates special rights for those who lose other health coverage  Eliminates medical underwriting in group plans  Includes Privacy Rule

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Protected Health Information Protected by Privacy Rule:  Information that identifies individual  Access to medical records  Required notice of privacy practices and opportunity for confidential communications  Limits on use of medical information  Prohibition of use of personal information for marketing

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Exemplar 49.4 Just Culture

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Just Culture A just culture:  Supports employee involvement in decision making  Supports learning  Examines system failure when error, adverse event  Encourages members to learn from each other's mistakes, near-misses

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Exemplar 49.5 Mandatory Reporting

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Overview Mandatory reporting  Legal requirement to report act, event, or situation that is designated as reportable by state or local law Certain types of health information Certain vital statistics Communicable diseases

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Abuse or Neglect of Minors and Older Adults Mandated in most states Reports through administrative chain  Immediate supervisor, Primary healthcare Required only to have a good faith suspicion  Information disclosed by client  Physical symptoms manifested by client Reporter not required to investigate or otherwise confirm

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Good Faith Immunity Healthcare workers protected when child abuse reported out of suspicion  Even if investigation does not make determination of abuse

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Mandatory Reporting of Nurses Who Are in Violation of the Nurse Practice Act BONs take these reports seriously.  Reporting forms easily available  Respect each nurse's right to due process Nature of alleged violations varies widely. Immunity clause Legal obligation to report conduct that is incompetent, unethical, illegal

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Mandatory Reporting of Certain Injuries and Illnesses Caused or appearing to be caused by:  Bullet, gunshot wounds, powder burns  Poisoning  Knife or other sharp, pointed instrument  Suspected criminal act or act of violence  Infectious diseases Tuberculosis, HIV/AIDS, Escherichia coli Data managed, maintained by state's department of health

Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved Nursing: A Concept-Based Approach to Learning Volume Two, Second Edition Other Examples of Mandatory Reporting Child care workers, teachers, other school personnel mandated to report suspicions of child abuse, neglect Principals required to report known crimes  Assault  Sexual assault  Rape  Indecent liberties with a minor  Possession of firearm on school property