Nursing

practice is governed by many legal concepts. It is important for nurses to know the basics of legal concepts because nurses are accountable for their professional judgements and actions. Knowledge of laws that regulate and affect nursing practice is needed for 2 reasons:

To ensure that the nurses decisions are consistent with current legal principles. To protect the nurse from liability.

Law Can be defined as the sum total of rules and regulations by which a society is governed. As such, law is created by people and exist to regulate all persons. Functions of Law in Nursing:
It provides a framework for establishing which nursing actions in the care of clients are legal. It differentiates the nurses responsib ilities from those of other health professionals. It helps establish the boundaries of independent nursing action. It assists in maintaining a standard of nursing practice by making nurses accountable under the law.

Public law refers to the body of law that deals with relationships between individuals and the government and governmental agencies. Criminal law deals with actions against safety and welfare of the public. Private law or civil law is the body of law that deals with relationships among private individuals. It has 2 categories: 1. Contract law involves the enforcement of agreements among private individuals or the payment of compensation for failure to fulfill agreements. 2. Tort law defines and enforces duties and rights among private individuals that are not based on contractual agreements.

Civil actions deal with the relationships among individuals in society. Criminal actions deal with disputes between an individual and the society as a whole. Litigation the action of a lawsuit Litigators are referred to lawyers who participate in lawsuits

The judicial process primarily functions to settle disputes peacefully and in accordance with the law. A lawsuit has strict procedural rules. There are generally five steps:

1.

2.
3.

A document, called a complaint, is filed by a person referred to as the plaintiff, who claims that his or her legal rights have been infringed on by one or more other persons, referred to as defendants. A written reponse, called an answer, is made by the defendants. Both parties engage in pretrial activities, referred to as discovery, in an effort to obtain all the facts of the situation.

In the trial of the case, all relevant facts are presented to a jury or only to a judge. 5. The judge renders a decision, or a jury renders a verdict. If the outcome is not acceptable to one of the parties, an appeal can be made for another trial. During a trial, a plaintiff must offer evidence of the defendants wrongdoing. This duty of proving an assertion of wrongdoing is called the burden of proof.
4.

Informed consent is an agreement by a client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatment, alternatives to the treatment, and prognosis if not treated by health care provider. 3 Major Elements of Informed consent: 1. The consent must be given voluntarily 2. The consent must be given by a client with the capacity and competence to understand. 3. The client must be given enough information to be the ultimate decision maker. Exceptions: 1. Minors 2. Persons who are unconcious or injured in such a way that they are unable to give consent 3. Mentally ill persons who are incompetent.

2 Types of Consent 1. Expressed may either be oral or written agreement. 2. Implied exists when the individuals nonverbal behavior indicates agreement.

Advance Health Care Directives include a variety of legal and lay documents that allow persons to specify aspects of care they wish to receive should they become unable to make or communicate their preferences. Health Care Proxy also referred to as a durable power of attorney for health care, is a notarized or witnessed statement appointing someone else to manage health care treatment decisions when the client is unable to do so. Autopsy or postmortem examination is an examination of the body after death. DNR Orders physicians may order no code or do not resuscitate for clients who are in a stage of terminal, irreversible illness or expected death.

Euthanasia the act of painlessly putting to death persons suffering from incurable or distressing disease. It is sometimes referred to as mercy killing. Inquest is a legal inquiry into the cause or manner of a death. Medial examiner is a physician and usually has advanced education in pathology or forensic medicine.

Crime is an act committed in violation of public (criminal) law and punishable by a fine or imprisonment. A crime doesnt have to be intended in order to be a crime. 2 Classifications:
1.
1.

Felony is a crime of a serious nature, such as murder, punishable by a term in prison.

Manslaughter murder by the 2nd degree.

2.

Misdemenor is an offense of a less serious nature and is usually punishable by a fine or short-term jail sentence, or both.

Negligence is misconduct or practice that is below the standard expected of an ordinary reasonable and prudent person. Gross Negligence involves extreme lack of knowledge, skill or decision making that the person clearly should have known would put others at risk for harm. Malpractice is a professional negligence, that is negligence that occurred while the person was performing as a professional. 6 Elements of Negligence: 1. Duty a nurse should have had a relationship with the client that involves providing care and following acceptable standard of care. 2. Breech of duty there must be a standard of care that is expected in the specific situation that the nurse did not observe.

3.
4.

5.

6.

Forseeability a link must exist between the nurses act and the injury suffered. Causation it must be proved that the harm occured as a direct result of the nurses failure to follow the standard of care and the nurse should have known that failure to follow standard of care could result in such harm. Harm or injury the plaintiff must demonstrate some type of harm or injury (physical, financial, or emotional) as a result of the breach of duty. Damages if malpractice caused the injury, the nurse is held liable for damages that may be compensated.

Assult can be described as an attempt or threat to touch another person unjustifiably. Battery is the willful touching of a person (a persons clothes or even something the person is carrying) without the persons consent that may or may not cause harm. False Imprisonment is the injustifiable detention of a person without legal warrant to confine the person. Invasion of Privacy is a direct wrong of a personal nature. It injures the feelings of a person and does not take into account the effect of revealed information on the reputation of the person in the community. Defamation is communication that is false, or made with a careless disregard for the truth, and results in injury to the reputation of a person. 2 types of defamation: 1. Libel by means of print, writing, or pictures. 2. Slander by the spoken word, stating unpriviledged or false words by which a reputation is damaged.

Good Samaritan Acts are laws designed to protect health care providers who provide assitance at the scene of an emergency against claims of malpractice unless it can be shown that there wass a gross departure from the normal standard of care or willful wrongdoing on their part. Carrying Out a Physicians Order - it is the nurses responsibility to seek clarification of ambiguous or seemingly erroneous orders from the prescribing physician. Providing Competent Nursing Care nurses need to provide care that is within the legal boundaries of their practice and within the boundaries of agency policies and procedures. Documentation the clients medical chart is a legal document and can be produced in court as evidence. Nurses therefore need to provide accurate and complete documentation of nursing care provided to the clients.

The Incident Report aka unusual occurence report is an agency record of an accident or unusual occurence. The Nurse must include the ff. Information:

Clients name, initials and hospital or identification number. Date, time and place of the incident. Fact of the incident. (Avoid conclusions or blame; Describe the incident as you saw it.) Clients account of the incident (State clients comments by using direct quotes) All witnesses to the incident. Any equipment by number and any medication by name and dosage.