1. LEGAL ISSUES COMMON IN NURSING PRACTICE PRESENT BY: DR. AMIRA YAHIA

2. Introduction Some legal issues recur frequently in nursing practice. It is important for the nurse to understand these particular issues as they relate to individual practice

3. 1. Duty to Report or Seek Medical Care for a Patient A nurse who cares for a patient has a legal duty to ensure that the patient receives safe and competent care. This duty requires that the nurse maintains an appropriate standard of care and take action to obtain an appropriate standard of care from other professionals when necessary If a nurse identifies that a patient needs the attention of a physician and fails to make every effort to obtain that attention, the nurse has breached a duty of care to the patient. Refer to Example Case Five Failure to Seek Medical Care for a Patient

4. 2. Nursing Responsibility for Medical Orders The nurse has a responsibility to critically examine medical orders that are written for a patient. Although the nurse is not responsible for the medical order itself, the nurse's education provides a background to identify obvious discrepancies or problems. For example in one reported case two doctors left conflicting orders, which the charge nurse then transcribed. The court ruled that the nurse had a duty to understand the patient's plan of care and to communicate with the doctors who had written the conflicting orders.

5. Cont…. Another area of important nursing responsibility is in relationship to telephone orders. Although written orders are better, there are situations when telephone orders are essential to timely care. In these instances, there should be clear guidelines as to how orders are documented and verified. The preferred method is for the nurse to speak directly to the prescriber, write down the order as received, and then read it back to the prescriber for verification. The prescriber must then review and sign the order as soon as practical. Refer to Example Case Six: Obtaining Telephone Order

6. 3. Confidentiality and Right to Privacy Confidentiality and the right to privacy with respect to one's personal life are basic rights, All information regarding a patient belongs to that patient. The law demands major efforts of all health care providers in regard to protecting patient privacy. A nurse who gives out information without authorization from the patient or from the legally responsible guardian can be held liable for any harm that results. Only those professional persons involved in the patient's care who have a need to know about the patient are allowed routine access to the record.

7. Cont…. A physician who is not involved in the patient's care or who does not have an administrative responsibility relative to that care is not allowed routine access. Persons not involved in care may be allowed access to the record only by specific written authorization of the patient or by court order. The nurse must be very careful about what information you share verbally and with whom. Lawyers, family members, media representatives, or the police sometimes have the right to request access to patient records or specific patient information without having consent from the patient or a legal court order to view the records or be given information. If you are ever approached for patient information by someone who claim to have authority, your best course of action is to refer that individual to appropriate administrative personnel, who can determine the validity of the request. Refer to Example Case seven Breach of Confidentiality

8. 4. Defamation of Character Defamation of Character occurs when information about a person’s reputation is shared with another person about a third party, the person sharing the information may be liable for defamation of character. There are two types of Defamation of Character: Libel: is a written defamation Slander: is a verbal defamation which is also called Smearing

9. Cont… Defamation of character involves communication that is malicious and false. Sometimes such comments are made in the heat of anger.. Statements written in a patient's chart which has severe and critical opinion can be considered as Libel, Severely critical opinions may be stated as fact. An example of such a statement might be, “The patient is lying,” or “The patient is rude and domineering.” Patients may charge that comments in the chart adversely affected their care by prejudicing other staff against them.

10. Cont… Libel and slander may also be charged when written comments or verbal statements are made regarding another health care provider. Thoughtless or angry comments that undermine the abilities of a physician or that might cause a patient to lose trust in a physician can be slander. Defamation of character also may be charged by a health care provider who believes that statements made by another professional are false, malicious, and have caused harm.

11. Critical points for nurses to consider 1.The careful nurse avoids discussing patients personal issues with others 2.The careful nurse considers any comments about other health care providers before making them. 3.The smart nurse will chart only objective information regarding patients and give opinion in professional terms and well documented with fact. 4.The smart nurse must make sure to use accepted mechanisms for confidentially reporting inappropriate care or errors and do not make critical statements to uninvolved third parties. 5.Criticism reported without malice and in good faith, through the appropriate channels, is protected from legal action for defamation.  Refer to Example Case Eight Accurate and Responsible Documentation

12. 5. Privileged Communication Privileged communication refers to information that is shared by a client with certain professionals such as doctors and nurses but that does not need to be revealed, even in a court of law. This professional is said to possess “privilege”, that is, he has the privilege of not revealing information. Certain types of communication (between client and lawyers, between patient and doctor, or between an individual and a member of the clergy) are considered privileged. Not all nurse–patient relationship communications are privileged. But some are potentially privileged. Privilege is a limited concept that only a court can determine whether privilege exists in any specific case.

13. 6. Informed Consent Every person has the right either to consent or to refuse health care treatment. The law requires that a person give voluntary & informed consent. Voluntary means that no coercion exists Informed means that a person clearly understands the choices being offered. Consent for Medical Treatment Consent for medical treatment is the responsibility of the medical provider (i.e. physician, dentist, nurse practitioner).

14. Cont… Information to be shared with the client includes: 1.A description of the procedure 2.Any alternatives for treatment 3.The risks involved in the procedure 4.The probable results, including problems of recovery 5.Anything else generally disclosed to patients This consent may be either verbal or written and indicates a patient has decided to go ahead with the procedure based on a clear understanding of the options.

15. Cont… Written consent usually is preferred in health care to ensure that a record of consent exists, although a signature alone does not prove that the consent was informed. A blanket consent for “any procedures deemed necessary” usually is not considered adequate consent for specific procedures. The form should state the specific proposed medical procedure or test. The courts do not accept the patient's medical condition alone as a valid reason for withholding complete and accurate information when seeking consent. Currently, there are no clear guidelines as to what constitutes complete information. What constitutes adequate information about various alternative approaches to treatment is often unclear.

16. Cont… Is it always necessary to discuss a treatment the physician does not believe is a good choice? Must all risks be discussed? Courts have generally supported the idea that commonly accepted alternatives and usual risks need to be disclosed, but that marginal or unusual treatments and rare or unexpected risks do not have to be discussed. The law places the responsibility for obtaining consent for medical treatment on the provider who will perform the procedure. It is that person's responsibility to provide appropriate information, and he or she is liable if the patient charges that appropriate information was not given.

17. Cont… A nurse may present a form for a patient to sign, and the nurse may sign the form as a witness to the signature. This does not transfer the legal responsibility for informed consent for medical care to the nurse. If the patient does not seem well informed, the nurse should notify the provider so that further information can be provided to the patient. Although the nurse would not be liable legally for the lack of informed consent, the nurse has ethical obligations to assist the patient in exercising his or her rights and to assist the provider in providing appropriate care.