1113 Exam Flashcards
Explain the relationship between law and ethics
Law must be followed by nurses and midwives, with consequences if not. Ethics is what is considered morally right or wrong by an individual or society
Explain the fundamental aspects of the Australian Legal system
- Generated and influenced by the history and values of society
- Regulates peoples actions and apply sanctions for those who do not
Identify the key features of the Australian Law
- Legalisation (parliamentary law)
- Common Law (Judge made law)
Define legalisation (parliamentary law)
Passed at a state and federal level, by parliament as acts or statutes. (Primary source of law) e.g.. Mental Health Act 2014
Define an ACT
Elected by the people and passed by parliament e.g.. Mental Health Act 2014
Define common law (judge made law)
Judges decide on cases brought to the court and develop common law principles called precedents
Distinguish between where you would use Legalisation over Common Law
Common law applies when there is no specific statutory law according to the application of Doctrine of Precedent
Define the Doctrine of Precedent
“Like cases are treated similarly” Outcomes from similar cases in the past are applied
Define the Adversarial system
Where disputes are resolved in court only. Both parties present their case, and the outcome is decided by the judge/judge and jury purely based on the information provided
Define the Inquisitorial system
Where the court is able to gain additional information externally outside of the court as part of coming to a decision. eg. Coroner’s Court
Define bioethics
The study of ethical/moral dilemmas in the medical environment eg. organ donation
Define the deontology theory
Where ‘duty/obligation’ is the basis of all moral action. Concerned with the rightness/wrongness of all actions e.g.. stealing food
Define the teleology theory
Concerned with the rightness/wrongness of the consequences of actions. Actions/motives are not considered wrong. eg. Poor person stealing food for their family would be considered right
Define Virtue Ethics (theory)
Concerned with the role of an individual and their specific characteristics which inform their actions e.g.. nurse’s empathy
Identify the 4 ethical principles
Autonomy
Beneficence
Non-maleficence
Justice
Define autonomy
Autonomy is concerned with the rights of people to have an opinion and a choice with decisions that concern them
Define beneficence
“Above all do good” eg. providing appropriate intervention ensuring that it will produce greater benefit than harm
Define non-maleficence
“Above all do no harm” eg. Avoiding unnecessary and and unreasonable harm in the process of treatment and management
Define justice
Concerned with fair and equitable distribution of resources and access to care
Define natural justice
Applies to all courts and tribunals to ensure that proceedings against a person are fair, impartial and without bias
Explain the importance of nursing documentation
- High quality documentation contributes to high quality care
- Communication of important information to other health professionals for coordinated care
- Patients can request access to medical records, therefore quality of your care will be provided to them
- Documentation is your only defence in a claim of negligence against you if things go wrong
Identify the 5 requirements of documentation
- Handwriting must be legible, dated, signed with designation
- Must contain specific, accurate and objective information
- Subjective information from family members etc. include statements, feelings expectations
- Must be contemporaneous (real time) reflecting the patients current state written as closely to occurrence as possible
- Must include everything done to/with the patient eg. assessments, care provided
Explain the purpose of the mental health legalisation
It promotes voluntary treatment over compulsory treatment and establishes robust safeguards and oversight mechanisms. Protects the rights, dignity and autonomy of people living with a mental illness
Outline what information the mental health legalisation includes
Outlines the purpose, provides definitions and the requirements under the Act, and stipulates how assessment should occur
Identify the (4) common features of a profession
- requires specific skills and training
- higher education
- ongoing education and training
- scope of practice
Define a regulated HCW
They are registered and require a licence/ongoing education to practice
Define a unregulated HCW
They are not registered and do not require a practicing licence
Identify the (4) functions of APHRA
- provides professional standards
- registration of HCW
- manage notifications (complaints)
- accreditation of graduating students
Identify the (4) functions of NMBA
- registration of nurses, midwives, N&M students
- development of standards and codes
- manage notifications and investigations
- assessment of internationally trained N & M
Define notifiable conduct
Is valid when a HCW has:
- worked under the influence (alcohol or drugs)
- engaged in sexual misconduct that is unlawful
- placed the public at risk of substantial harm
Outline the relationship between NMBA and the Health Complaints Commissioner
The relationship that exists is due to when a N or M breaches the code of conduct created by NMBA, this is classified as notifiable conduct and is passed on to the HCC
Identify the national code for nurses/midwives
Code of Conduct for Nurses (NMBA, 2018)
Identify the (4) actions that may give rise to disciplinary action of a HCW
- under involvement/negligence
- bullying/harassment
- breach of professional boundaries
- confidentiality/privacy
Explain the concept of mandatory reporting of child abuse
Any person who believes a child is in need of protection must report it. Evidence is not required, just reasonable grounds to believe
Identify the (4) types of child abuse that may be reported upon
- Neglect
- Abuse
- Emotional maltreatment
- Exposure to family violence`
Identify the three types of consent relevant for clinical practice
Verbal
Implied
Written
Define verbal consent
When a patient says yes or no
Define implied consent
When a patient holds out their arm when you ask to take their blood pressure
Define written consent
When a patient signs a consent form e.g. before surgery
Identify the four elements required for consent to be valid
- Freely and voluntarily given (no misinterpretation/pressure)
- Must cover procedure (Must gain consent for everything you do)
- Must be informed (patient must be aware of risks, benefits, side effects)
- Must have legal capacity (Must be of sounds mind and legally competent)
Identify three exceptions for when consent is not required
- Emergency treatment
- Parental authority is not absolute
- In necessity
Define emergency treatment (exception to consent rule)
Emergency treatment is conducted in order to save a patients life, prevent a patient from serious damage or prevent a patient from suffering in some way
Define ‘parental authority is not absolute’ (exception to consent rule)
When parental consent is not required (e.g. in lifesaving situations such as blood transfusion for a child)
Define necessity (exception to consent rule)
(Not in a clinical environment) e.g. touching someone to prevent them from being hit by a car)
Define assault
Acting with specific intent to cause harm. Can be as simple as instilling fear in a patient e.g. threatening to/pretending to hit a patient
Define battery
Acting upon the intent (Acting upon assault) such as touching/striking someone without their permission e.g. pushing/slapping a patient
Define false imprisonment
Unlawful, intentional and complete application of restraint restricting a patients freedom to move
Identify the three elements of false imprisonment
- Can be done without actually touching the patient
- Must be total (Patient has no means to move)
- Person must be unaware at the time that they are unable to move
Explain when it is okay to restrain a patient
- Specific to each hospital
- Specific guidelines on who can order restraints
- Must be ongoing review, planning and managing of the restraint order
Identify the two types of restraint
Physical : eg. isolated room
Chemical : eg. medication
Outline what occurs if a person is unable to give consent
- A competent person may appoint a subsist decision maker before they loose capacity to do so under the ‘Medical Treatment Planning and Decisions Act 2016’
Identify the three ways in which a substitute decision maker can be appointed
- Medical power if attorney (appointed before 12/3/2018)
- Guardianship and Administration Act 2019 (if the person has a disability that creates incapacity
- Under the Mental health act 2014
Define medical power of attorney
A medical power of attorney allows someone to give and withhold consent to medical treatment on behalf of another person
Identify the (3) requirements for a medical power of attorney
- Patient must have decision making capacity at the time of appointing
- Patient should choose someone they trust and who respects their values and preferences
- Patient can appoint more than one person, but only one person may act at one time
Explain the new law for medical power of attorney as of 12 March 2018
A person can appoint a ‘Medical Treatment Decision Maker’ without making an enduring power of attorney
Define a guardian
A person appointed in a guardianship order as a guardian in relation to one or more specified matters
Identify the law that allows a ‘guardian’ to be appointed for medical decisions
Guardianship and Administration Act 2019 (Vic)
Outline the purpose of the Guardianship and Administration Act 2019 (Vic)
Is to protect and promote the human rights and dignity of persons with a disability
Explain the role of guardianship in relation to patient decisions for treatment
This Act means for someone who has a disability contributing to incapacity to make decisions, a guardian is appointed to make these decisions for them in order to protect their rights and dignity
Define refusal of treatment
Occurs when a patient chooses (when competent) to refuse treatment, which could ultimately lead to palliative care
Define withdrawal of treatment
Occurs when the health team decide in consultation with a patient’s family to withdraw the patient from treatment, where they are not competent and treatment is futile
Define futile treatment
Treatment which is not in the patients best interest, cannot achieve it’s purpose or is not clinically indicated
Explain (3) factors which may affect treatment becoming futile
- Patient’s diagnosis/prognosis
- Treatment goals (whether they can be achieved)
- Treatment alternatives (Are they worth it? risks? benefits?)
Define advanced care planning
The process of thinking about/documenting your preferences for future healthcare. It is based on your individual values, beliefs, traditions and culture
Define an advanced care directive
Is a legally binding document made under the Medical Treatment Planning and Decisions Act 2016 by a legally competent person and may contain a values directive, instructional directive or both
Define instructional directive (ACD)
Contains legally binding instructions about future medical treatment you consent/refuse to (used as if the patient is there making the decisions)
Define values directive (ACD)
Documents your values/preferences for your appointed Medical Treatment Decision Maker to consider when making decisions for you
Define Voluntary Assisted Dying
Is the means of administering a medication for the purpose of causing death in accordance with the relevant steps/law
Identify when the voluntary assisted dying law was passed in Victoria
19th of June 2019 (19/06/19)
Outline the requirements for Voluntary assisted dying
- Must be voluntary and initiated by the patient (often self administering medication)
- Only for those who face inevitable, imminent death due to incurable disease, condition or illness
Define NFR order
NFR orders prevent the use of cardiopulmonary resuscitation in situations where it is deemed futile/unwanted by the patient.
Explain who decides on NFR orders
NFR orders are decided on by a competent patient themselves, or an appointed Medical Decision Maker
Identify the (4) requirements for a NFR order
- Further treatment must be futile
- Decision must be made by a group of people consisting of a doctor, nurse and a family representative
- Order must conform with law of consent and it’s requirements
- Order must be clearly documented in the patient notes and reviewed regularly in case of the patients condition improving
Define negligence in healthcare
Failure to provide a patient with proper professional care, resulting in injury
Identify when a claim of negligence can be made
If the patient has suffered physical or psychological harm, or suffered a financial loss as a result of he care provided
Outline the two types of negligence in healthcare
- Criminal negligence: Where there is intent to cause harm
- Civil negligence: Act or omission which is casually linked to the injury
Explain the (4) requirements for a claim of negligence to be valid
- Patient was owed a duty of care by the death professional
- Patient suffered harm, damage and loss as a result
- There was a breach of duty of care (care fell below the standard)
- The harm, damage and loss was a consequence of the health professionals actions
Identify the possible defences to a general claim of negligence
- To deny that a duty of care was owed
- Defendants actions were reasonable at the time and widely accepted by colleagues
- To establish that no harm was caused
- To establish that their is no relationship between the duty of care and damage caused
- The alleged harm/damage is too remote
Define the doctrine of vicarious liability
When the employer is made liable when an employee has been proven to be negligent
Outline the two effects caused as a result of vicarious liability
- Financial responsibility is shifted to the employer
- Employer most likely to have the means to compensate the injured patient
Explain the concept of the “egg shell principle”
The unexpected frailty of the person is not a valid defence to the seriousness of the injury e.g. some people will be more vulnerable to injury, but this doesn’t matter under this principle
Identify the (3) requirements for Doctrine of vicarious liability
- Person was an employee
- Negligent act arose in conduct/scope of employment
- Personal liability for the actions remains with the employee
Explain the concept of a “Good Samaritan”
Someone who potentially saves a persons life, by taking a risk in an emergency situation that they would otherwise not do
Outline the legal provisions which now stand for Good Samaritans
If your provide assistance/advice/care to an individual at risk of death/injury who no expectation of financial reward, you will not be liable for anything done or omitted to be in good faith at the scene
Define an apology within healthcare
Is an expression of sorrow, regret or sympathy (including the word sorry) but does not include acknowledgement of fault
Define an open disclosure
Open disclosure is a discussion within a document about an incident which resulted in harm whilst the patient was receiving healthcare
Outline the (4) elements within an open disclosure
- Apology/expression of regret
- Factual explanation of what happened
- Opportunity for patient to relate their experience
- Explanation of steps taken to manage the situation and prevent recurrence
Define privacy
Focuses on the collection, storage and handling of patient information
Define confidentiality
Is concerned with inappropriate disclosure or communication of a patient’s information
Identify when a patients information can be disclosed
- When a patient consents
- When the information does not identify the patient
- To other HCW who are responsible for the patient’s treatment
- When required by legalisation
Identify the three Acts concerned with confidentiality and privacy
- Privacy Act 1988
- My Health Records Act 2012
- Health Records Act 2001 (Vic)
Explain the function of the Privacy Act 1988
Regulates the handling of personal information by private and public sector organisations and individuals
Explain the function of My Health Records Act 2012
Limits how and when health information can be collected, used and disclosed
Explain the function of Health Records Act 2001 (Vic)
Framework which enables patients to access their health information
Identify what the Health Records Act 2001 consists of
Consists of 11 guiding principles relating to health information (Health Privacy Principles) (HPP)
Outline the purpose of the Health Records Act 2001
To promote fair and responsible handling of health information by protecting the privacy and rights of patients to access their information
Explain the requirements of transparency of health information
- Providers must have a document explaining how they handle their health information
- Document must be available to patients when they ask
- Consumers have a general right of access to their own health records
Identify some of the outcomes that could arise as a result of a breach
- Possible termination
- Complaints made to the HCC
- Negligence (Possible defamation if the patients reputation has been damaged
Identify the purpose of documentation
- Communication between HCW
- Accountability of HCW if something goes wrong
- Legislative requirement
- Professional responsibility
- Quality research
Outline the times in which a patients information can be disclosed due to legalisation
- Child abuse
- Reportable deaths to the Coroner
- Infectious diseases
- Blood/Drug test results
Identify the 9 principles of documentation
- contemporaneous
- accurate and complete
- objective
- legible and clear
- avoid total oliberation
- late entries (cross reference)
- signing/countersigning
- avoid transcription (write once)
- don’t rewrite reports
Outline the possible outcomes of poor documentation
- Often a deciding factor in a legal case
- First thing they look at when things go wrong
- If it isn’t in the notes, it didn’t happen
Explain (3) elements of good practice regarding documentation
- Health/medical information is highly sensitive
- Keep track of records and files at all times
- Don’t leave records open on desks
- Shred documents
Define the coroners court
Investigates deaths that are unexpected, unnatural, accidental or violent. Inquisitorial system actively investigates
Define criminal law
Protecting society as a whole, where the crime is against the state. They are public wrongs initiated by the state
Identify the common penalties for criminal law
Incarceration or Fine
Identify the two components of criminal law that must be proven
Mens Rea
Actus Reus
Define Mens Rea
The mental intention carry out the offence, through intent, negligence or recklessness
Define Actus Reus
Proves that the activity or conduct constitutes the offence and physical act of crime
Explain the principle of double effect
Refers to when a patient is terminally ill and requires a large amount of analgesia, which may hasten death or bring it on at a quicker rate than normal
Explain when homicide/manslaughter can be associated with healthcare delivery
Where someone dies as a result of negligence e.g. unlawful administration of medication
Explain when suicide can be associated with healthcare delivery
If a nurse discusses Voluntary assisted dying with a patient, this may be considered incitation of suicide
Explain when rape can be associated with healthcare delivery
E.g. No consent before inserting a suppository. Must be free agreement before the medical treatment
Explain when abortion can be associated with healthcare delivery
An abortion after 24 weeks with no approval from doctors is considered a crime
Explain when female mutilation can be associated with healthcare delivery
Prohibits the removal of the clitorial hood (female girl or baby) or any genital area (e.g. for cultural or non therapeutic reasons). Therefore, not abiding this rule is considered a crime
Identify the (2) relevant legalisations associated with criminal law and coronal jurisdiction
Crimes Act 1958 (Vic)
Coroner’s Act 2008 (Vic)
Identify the (3) actions of the Coroner’s Court
- Investigates deaths and fires
- Reduce preventable deaths
- Promote public health/safety and administration of justice
Identify the distinguishing features of Coroners Court
- Preliminary Exams (Visual exam, collection/review of personal and health information, collect bodily fluids/fingerprints
- Autopsies (Post mortem) by a pathologist, examination of a body/body parts
Define reportable deaths
Where a persons death was unexpected, unnatural, violent or a result of a medical procedure.
Also occur in deaths that occur in prison, when a HCW doesn’t sign and death certificate or when the identify is unknown
Define reviewable deaths
Occur when the death of a child is the second or subsequent child of either parents to have died
Define an inquest
Is a court hearing into a single death, multiple deaths or a fire led by the coroner to understand why it occurred
Identify what the coroners findings usually compromises
- Identity of the person who died
- Cause of death
May also include: - Circumstance in which the death occurred
- Comments or recommendations
What is the role of the nurse/midwife in a coroners case
- Minimal interference when the death occurs e.g. Not touching the body before the coroner’s review)
- Leave nasogastric NGT, IV, IDC. drain tubes etc in situ
- May also need to act as witnesses, or providing evidence to a medico legal investigation
Identify the national act that regulates health practitioners
Health Practitioner Regulation National Law Act 2009
Identify the purpose of the Health Practitioner National Law Act 2009
To provide a national registration and accreditation scheme for registered health practitioners
