Ch 23 Flashcards
Constitutional Law
-derived from federal and state constitutions.
-For example, in the United States a constitutional right afforded to every citizen is the right to refuse treatment
-As a nurse, you must understand the rights of your patients to refuse treatment even when you may not agree with their decisions.
Statutory law
-derived from statutes passed by the U.S. Congress and state legislatures. These laws are either civil or criminal.
Civil laws
-protect the rights of individuals and provide for fair and equitable treatment when civil wrongs or violations occur.
Nurse practice acts
-civil state laws that define nursing and the standards nurses must meet within individual states.
-Your state’s nurse prac- tice act defines a nurse’s scope of practice, the educational requirements you must have to be a nurse, and how to obtain licensure as a nurse in your state.
-Nurse practice acts also distin- guish nursing from other health professions (e.g., medicine, therapists, and alternative medicine providers).
Criminal laws
-protect society and provide punishment for crimes, which are defined by municipal, state, and federal legislation
-Criminal mistreatment of adults who are vulnerable is an example of criminal statutory law.
-Criminal mistreatment is classified as either a misdemeanor or a felony offense depending on the severity of harm done to a patient who is vulnerable.
Administrative law
Or
Regulatory law
-more clearly defines expectations of civil and criminal laws.
-For example, a nurse practice act, as a civil statutory law, states that you have a duty to care for your patients.
-Regulations typically state that duty means you will observe, assess, diagnose, plan, intervene, and evaluate patient care. Providing current, evidence-based care is essential to meeting nursing statutory duty and regulations.
-Regulatory law also describes the process to report incompetent or unethical nursing conduct to the State Board of Nursing or Nursing Commission.
-A nurse who does not report unethical or incompetent conduct violates regulatory law. Nurses can appeal violations to the State Board of Nursing or the Nursing Commission.
Common law
-originates from decisions that were made in the absence of law.
-For example, the right to privacy is implied in the U.S. Constitution. Thus patient confidentiality originated as common law.
Case law
-describes decisions made in legal cases that were resolved in courts. After a case is presented to a judge or jury, there is a report of the issue, facts, findings, and subsequent decision that was made to resolve the issue.
scope of nursing practice
-defines nursing and reflects the values of the nursing profession.
Standards of nursing care
reflect the knowledge and skill ordinarily possessed and used by nurses to perform within the scope of practice
durable power of attorney for health care (DPAHC)
- Instructions regarding care before or during cardiac or respiratory arrest should be signed by either a physician or a nurse practitioner. -Unless otherwise specified by state law, the document should be treated as an order; it may direct whether to provide lifesaving measures such as cardiopulmonary resuscitation (CPR) or to provide comfort care only.
REFLECT NOW
You are caring for a patient who is terminally ill and has a “do not resuscitate” order, but the medical record does not have an entry regarding the physician’s discussion with the patient prior to writing the order. How would you respond if the patient has a cardiac arrest? How would your response differ if the patient were 8 versus 80 years old?
Restraints can be used when:
(1) only to ensure the physical safety of the patient or other patients, (2) when less restrictive interventions are unsuccessful, and (3) only on the written order of a health care provider
Nurse Practice Acts
Professional licensure defense
-expensive when nurses do not have insurance that covers the costs of keeping their licenses to practice
- Nurses often presume that either their personal or their employer’s malpractice insurance will include costs of defending and retaining their nursing license. In most instances this is not true.
-Pro- fessional licensure defense insurance is a contract between a nurse and an insurance company. When a complaint is made to a state board of nursing, an action is initiated that could result in a restriction, suspension, or revocation of the nurse’s license to practice.
-When a nurse specifically has professional licensure defense insurance, the nurse notifies the company.
Informed consent
- a patient’s agreement to have a medical procedure after receiving full disclosure of risks, benefits, alternatives, and consequences of refusal
-Key elements of informed consent include the following:
- The patient receives an explanation of the procedure or treatment.
- The patient receives the names and qualifications of people performing and assisting in the procedure.
- The patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort.
- The patient receives an explanation of alternative therapies to the proposed procedure or treatment and the risks of doing nothing.
- The patient knows of the right to refuse the procedure or treatment
without discontinuing other supportive care. - The patient knows of the right to refuse the procedure or treatment even after the procedure has begun.
neglect
-a pattern of conduct by a person with a duty of care to provide services that maintain the physical and/or mental health of a child or vulnerable adult
-may also be a one-time act that is a clear and present danger to another’s health, welfare, or safety.
-Neglect does not usually require that a nurse inten- tionally acts to harm a patient; rather, the nurse knew or should have known that neglect would occur under the circumstances.
Patient Abandonment
-occurs when a nurse refuses to provide care for a patient after having established a patient-nurse relationship.
- Before having established that relationship, a nurse may refuse an assignment when (1) the nurse lacks the knowledge or skill to provide competent care; (2) care exceeding the nurse practice act is expected; (3) health of the nurse or the nurse’s unborn child is directly threatened by the type of assignment; (4) orientation to the unit has not been completed and safety is at risk; (5) the nurse clearly states and documents a conscien- tious objection on the basis of moral, ethical, or religious grounds; or (6) the nurse’s clinical judgment is impaired as a result of fatigue, resulting in a safety risk for the patient
nurse delegation
- nurse delegation means that an RN educates, observes, and verifies that a nonregistered nurse (e.g., LPN, nurse assistant, or assistive personnel) can do a specific task that is usu- ally completed by an RN
- The RN retains responsibility to communicate clearly and supervise care received by a patient and to periodically reassess whether nurse delegation continues to be appropriate
- Delegated tasks may include hygiene care, ambulation assistance, vital signs, or blood glucose monitoring. RNs can usually delegate administration of medications to LPNs.
Consider your role as a nursing student as it is defined in your state’s Nurse Practice Act. What are you required to do when working in a hospital? In your state, is it different if you are working in a skilled nursing facility or nursing home? What about if you are in a retirement center? What can you do in one place that you cannot do in another?
Torts
-civil wrongful acts or omissions of care made against a person or property.
-They are classified as intentional, quasi-intentional, or unintentional.
Intentional torts
-deliberate acts against a person or property that may result in both civil and criminal actions.
-Assault is an intentional threat toward another person that places the person in reasonable fear of harmful, imminent, or unwelcome contact.
-No actual contact is required for an assault to occur. For ex- ample, if a nurse threatens to give a patient an injection or to restrain a patient while having an x-ray taken when the patient has refused consent, the nurse’s action is considered an assault. Likewise, assault occurs when a patient threatens a nurse.
Battery
- any intentional offensive touching without consent or lawful justification
-The contact can be harmful to the patient and cause an injury, or it merely can be offensive to the patient’s personal dignity. In the example of a nurse threatening to give a patient an injection with- out the patient’s consent, if the nurse gives the injection, it is battery.
Quasi-intentional torts
-acts in which a person may not intend to cause harm to another but does.
-Typically, the person invades another’s privacy or in some way defames another’s character. Quasi-intentional torts are alleged when a person should have known that harm to another person could occur.