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Legal Aspects
Legal Aspects
With autonomy comes accountability for decisions and actions As autonomy and responsibility increase, so does the level of accountability and liability Nurse Managers have the major responsibility for upholding the standards of care for the staff
Legal Aspects
TYPES OF LAWS Constitutional Law Statutory Law Enacted by government bodies Administrative Law Regulations adopted by agencies to implement Statutory Law Common Law Decisions of courts setting precedents
Legal Aspects
:
Two classes of wrongful acts
Criminal Acts Conduct that is harmful or offensive to society Civil Acts Wrongs that violate rights of individuals
Civil Acts
Judicial Risk Torts Negligence Malpractice Intentional Torts Strict Liability Torts Breach of Contracts Contd..
Civil Acts
Judicial Risk Uncontrollable variables that increase risk (judge / jury having a bad day; suing another without real justification) Contd..
Civil Acts
Tort wrongful act committed against another person, organization, or property that causes harm Personal (Direct) Liability imposed on the person who committed the wrongful act.
Vicarious (Indirect) Liability imposed on a person or organization that did not commit an act, but is associated with the liable person. Contd..
Civil Acts
Negligence (unintentional tort) Negligence (failure to do what a prudent person would do) Malpractice (failure to do what a prudent professional would do) (professional negligence) Intentional Tort Wrongful act intended to cause harm Strict Liability Tort Others endangered unintentionally Faulty equipment, potential dangers Contd
Civil Acts
Breach of Contracts
Legal Concerns
Nurse Managers are responsible for: Upholding policies of their healthcare organization.
Ensuring that laws of society at local, state and national levels. (including anti-discrimination laws, employee-related laws, etc.) Ensuring that management and employees follow policies and laws. Contd
Legal Concerns
Three Main Areas of Legal Concerns
Personal negligence in clinical practice Liability for delegation and supervision Liability of health care organizations Contd.
Four Elements of Professional Liability To establish legal liability injured party (plaintiff) must prove:
1) 2) 3) 4)
Duty of care was owed to injured party There was breach of that duty The breach of duty caused injury Plaintiff suffered actual harm or damages
Patient falls Use of restraints Medication errors Burns Equipment injuries Retained foreign objects Failure to monitor Failure to take action Failure to ensure safety
Failure to confirm accuracy of orders Improper techniques used with treatments Failure to respond to a patient Failure to follow hospital procedure Failure to supervise treatment
The nurse is responsible for tasks that she delegates to others. The nurse must monitor and supervise staff who are performing delegated tasks.
If a staff member delegated to perform the task makes an error, the delegating nurse is also liable.
CLINICAL SCENARIO
You enter the medication room and see a nurse swallow a pill. After she leaves the room you note that she had just signed out for a pain pill for her patient. What would you do?
Face extensive liability from several sources Have deep pockets Are almost always named as defendants in liability cases Must also have policies and follow laws regarding discrimination, hiring, performance appraisals, management of problem.
Nurse Practice Act Scope of practice of other staff Standards of Care Code of Ethics and Interpretive Statements Hospital policies and procedures
Contd.
Documentation Truthful / accurate / Complete Objective / non-judgmental Legible Utilize appropriate abbreviations Maintain honest, caring, respectful relationship with patients. Report unsafe, unethical practices of self and others thru proper channels. Follow proper delegation and supervision guidelines.
Talk to the appropriate person in private Clarify problem Observe professional courtesies Provide facts and supportive evidence File complaints of unsafe acts within the facility Communicate through chain of command If problem, urgent may need to speak with manager or supervisor immediately. May need to notify risk manager Follow hospital / Institution policy May remain anonymous
Witnessing consumption of alcohol or other substances Changes in dress, appearance, posture, or gesture Slurred speech or abusive / incoherent language
Reports of impairment Witnessed unprofessional conduct Lack of attention to detail Witnessed theft of controlled substances
Impaired Nurse
May be a candidate for:
Self-referral or board referral Monitoring system with guidelines Cease practice, agree to assistance & seek evaluation & treatment Disciplinary action
When you have to judge what is right or wrong Choosing between options Deciding whether to do something or do nothing Should I or shouldnt I ?
Conflicts can be between: Professional ethics and organization ethics Two ethical duties to the patient Professional ethics and personal or religious ethics Duties to family / self and duties to patient
Right to decide
Informed consent Alternative treatment issues
Illnesses once leading to mortality are now classified as chronic illnesses Cost is a consequence of prolonging life with technology
Autonomy (self-detemination)
Beneficience (doing good) Non maleficence (doing no harm)
2)
3)
4)
Establish common ground between nurse, patient, family and other health care professionals and society to discuss ethical questions and make ethical decisions. Permit people to take a consistent position on specific or related issues. Provide an analytical framework by which moral problems can be evaluated.
Ethical rules
Veracity truth telling, informed consent, respect for autonomy. Privacy a persons right to remain private, to not disclose information . Confidentiality only sharing private information on a need to know basis. Fidelity loyalty, maintaining the duty to care for all no matter who they are or what they may have done.
2.
3.
4.
Contd
What are the reasonable possibilities for action? How do different parties want to resolve the problem? What ethical principles are required for each alternative? What assumptions are required, and what are their implications for future actions? What additional ethical problems do alternatives raise? Contd..
Integration of multiple factors Blend ethical theory, principles and values Contd
Specify reasons for action Clearly present ethical basis for these reasons Understand the shortcomings of the justification Anticipate objections to the justification Contd
Ethical Dilemmas
Common Ethical Dilemmas in nursing care practice:
Conflict of professional ethics with organizational / business ethics (nursing shortage, cost cutting measures, refusal of treatments / care, floating nurses. End of life issues (withholding treatments, administering unproductive life prolonging treatments, honouring family wishes over patients, right to die, euthanasia)
Ethical Challenges
Veracity
Paternalism Autonomy Accountability
CLINICAL SCENARIO
There has been a protest and violence in your town. Your Nurse Manager calls and tells you that the staff is on emergency alert. She says that even though your arent scheduled to work that you need to come in now or you will lose your job. At the same time your child is sick. What would you do?
CLINICAL SCENARIO
You are in a hospital elevator that is packed with people. Two of the nurses from your floor are talking about a patient they have been caring for. What would you do?
CLINICAL SCENARIOS
A patient and his family offer you money/ material for giving such good care to the patient. What would you do? You discover that you are HIV+ve .Should you tell your employer or coworkers?
CLINICAL SCENARIO
You have given medication to the wrong patient and have to fill out an incident report. Should you tell the patient? If you think the medication may have caused injury to the patient would you make a different decision?
CLINICAL SCENARIO
Your 55 year-old patient is in pain from terminal cancer. You know that giving him morphine will slow his respirations that might lead to death. What would you do?
Conclusion
As nurses, we need to maintain high standards of patient care through updates in nursing Scholarly work must be conducted responsibly and ethically to improve the standard of nursing care.
Contd
Any Questions
References
Beauchamp T and Childress J (2001) Principles of Biomedical Ethics 5th Edition Oxford University Press Hunt G (1994) Ethical Issues in Nursing Routledge. London Seedhouse D (1998) Ethics the heart of Health Care Wiley. Winchester. Watt H (2000) Life and Death in Health Care Ethics Routledge. London
http://www.iep.utm.edu/e/ethics.htm#SH2a http://www.nursingethics.ca/articles.html http://www.freedomtocare.org/iane.htm http://www.lib.flinders.edu.au/resources/sub/healthsci/a-zlist/ethics.html