Legal and Ethical Concepts Nancy Pares RN, MSN Metro Community College
RvNg RvNg
Laws define and limit relationships Sources of public law ◦ Constitutional ◦ Administrative ◦ Criminal Civil Law ◦ Contract ◦ Tort ◦ Protective/reporting
State ◦ Unintentional torts Negligence Duty Breach of Duty Injury Causation Malpractice
Assault Battery False imprisonment Restraints (OBRA) Invasion of privacy Defamation fraud
Defined by Practice Acts and Standards of Care RN is legally responsible to ensure that the client receives competent, safe and holistic care. Best Defense ◦ Actively participate in NNA ◦ Attend continuing ed on legal issues ◦ Call State Board with any questions about practice ◦ Stay current in hospital policies and procedures
Unprofessional conduct Impaired Nurse Safety ◦ Understaffing ◦ Mandatory overtime ◦ Reassignment Executing prescribed orders
Whistle blowing Nursing students Professional liability insurance Advance Directives
DNR orders Euthanasia Wills Pronouncement of Death Care of the deceased Organ donation autopsies
Ethics ◦ Study of rightness of conduct ◦ Vs. morality? Relationship between ethics and legal ◦ Ethical opinions reflect individual differences ◦ Human behavior and motivation are too complex to be accurately reflected in law ◦ The legal system judges action rather than intention ◦ Laws change according to social and political influences
Working in a clinic that performs abortions Honoring a terminally ill client request for no heroic actions d/c a comotose client life support at the request of the family Diverting meds from a client for your own use
Autonomy Beneficience Confidentiality Double effect Fidelity Justice Nonmaleficence Paternalism Sanctity of life veracity
Human caring should guide the practice Confidentiality ◦ Privacy, misuse of information Restraints Trust Refusing to provide care Food and fluid
Nancy Cruzan Terri Shiavo
Practice with compassion and respect Nurses primary commitment is to the patient Nurse advocates, protects the patient Nurse is responsible and accountable for actions Nurse must maintain competence and professional growth Nurse participates in improving health Nurse contributes to profession thru community, educational and social situations
Dx: missed abortion—client hospitalized, D&C was scheduled—client discussed with MD Nurse administered preop meds then noted that there was no consent signed. Surgery was postponed awaiting MD. MD arrived and had pt sign and husband also-witnessed by RN. Procedure resulted in perforation, OB attempted to repair—called in general surgeon-- required removal of 1 ft of bowel Result: likely to have higher incidence of SBO
Was the hospital liable to obtain informed consent?
Nurse Midwife advertised ‘Family Birth’ Hospital Chief of Staff – OB wrote a letter to the administration of two hospitals stating that home deliveries were being done without qualified supervision. Same MD confronted nurse midwife at L&D Nurse midwife was prohibited from the hospital.
Was the slander actionable?
Client with fx leg—cast applied; orders to have nursing check hourly and call with concerns Charting notes gap from 4am to 830 am. MD examines at 830—compartment syndrome and identification of tissue death— leg amputated
Was documentation considered substandard and cause for patient to suffer injury?
Female patient admitted to LTC—noted large diamond ring and informed that she should not keep in her room. Pt kept the ring. Ring disappeared—investigation proved fruitless—thru a ‘tip’ a nurse aid was implecated—arrested and pled guilty
Was the nursing home responsible for the property damage sustained by the resident?
Male was admitted to psych unit on Nov 21due to being a threat to himself and others. Meeting held on Nov 23 determined that he was able to be released. (Thanksgiving holiday) Male entered house on Dec 5 and killed one individual and wounded two others, then shot himself.
Was the institution liable for discharging the patient and the subsequent deaths?