1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 5Ethical and Legal Issues

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Along with the privilege of providing professional health care services to consumers, the professional nurse has a commensurate degree of responsibility and accountability to follow ethical principles and standards of care integral to the profession. Sheehy, 2006

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Explain the relationship between state Nurse Practice acts and the concepts of risk management and quality assurance Construct the six-step model of ethical nursing care designed by Chally and Loriz Articulate why nurses must become knowledgeable about genetics and the issues surrounding this topic Recognize five forms of nursing malpractice Discuss implications for psychiatric care related to the Tarasoff ruling of duty to warn Compare the criteria for voluntary and involuntary admission to a psychiatric facility Interpret the concept of competency

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Compare the legal rights of adults and minors admitted to psychiatric facilities Discuss the impact of the Omnibus Reconciliation Act (OBRA) on the placement of clients with psychiatric disorders in long-term care facilities Distinguish the legal phrases: diminished capacity, not guilty by reason of insanity, and guilty but mentally ill Explain forensic psychiatry and the role of the forensic nurse

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethics in Nursing Model of ethical nursing care Ethics in pain management Ethics in genetic testing and clinical research

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Decision-Making Model Clarify the ethical dilemma Gather additional data Identify options Make a decision Act or carry out the decision Evaluate the impact of the decision

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Ethical Dilemmas in Clinical Research Informed consent Documentation of research protocols The client’s right to full disclosure

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Legal Issues in Nursing Nurses, now more than ever, are subject to the scrutiny of federal and state regulations as well as the legal system.

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Bill of Rights for Registered Nurses Nurses have the right to A safe environment Practice in a manner that ensures the provision of safe care through adherence to professional standards and ethical practice Advocate freely on behalf of themselves and their clients

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Four Elements Required for Nursing Malpractice Failure to exercise reasonable care or act in an acceptable way when undertaking and providing care to a client Breach of duty or failure to conform to the required standard of care in treating the client’s condition Approximate cause, which requires that there be a reasonably close connection between the defendant’s conduct and the resultant injury (ie, the performance of the health care provider caused the injury to the client) The occurrence of actual damage to the client as a result of malpractice

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Forms of Malpractice Intentional torts Assault Battery Defamation False imprisonment Failure of duty to warn Breach of confidentiality and privacy

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Bill of Rights for Psychiatric–Mental Health Clients Receive treatment Refuse treatment Have a probable cause hearing Maintain client privacy and confidentiality Communicate freely with others Have personal privileges Maintain one’s civil rights Engage in religious freedom and education Maintain respect, dignity, and personal identity Maintain personal safety and assert grievances Be transferred and receive continuity of care Access own records Obtain an explanation of cost of services Obtain aftercare

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Hospitalization Involuntary admission or civil commitment Voluntary admission Hospitalization of minors Long-term care facilities Omnibus Reconciliation Act (OBRA) of 1987

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Forensic Psychiatry Evaluation of an individual’s competency Diminished capacity Not guilty by reason of insanity Guilty but mentally ill Role of the forensic nurse The forensic nurse as a legal nurse consultant and expert witness

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Advance psychiatric directives Assault Battery Bill of Rights for Registered Nurses Civil commitment Client confidentiality Client privacy Code of Ethics for Nurses Defamation Diminished capacity Doctrine of Charitable Immunity Ethics Failure of duty to warn False imprisonment Forensic psychiatry Genetic testing Guilty but mentally ill

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms (cont.) Incompetent Informed consent Intentional tort Involuntary admission Libel Malpractice Miranda warning Negligence Not guilty by reason of insanity Nurse Practice Act Omnibus Reconciliation Act Paternalism Quality assurance Risk management Sentinel event Slander Tarasoff decision Voluntariness hearing Writ of habeas corpus

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Imagine that you are providing care for a client undergoing a clinical research drug study. The client informs you that she suspects that she is pregnant but has not seen a doctor to confirm the pregnancy. ? What informed and effective care decisions do you need to make before taking action?