Class 2 - Legislation Governing Practical Nursing Practice

Question 1

What does the law serve in respect to nursing?

there are 3 points to remember

Answer 1

1. Provides a framework for establishing which nursing actions in the care of clients are legal.
2. Outlines the responsibilities that govern nursing practice & nurses’ relationships with physicians, other health care practitioners, and the health care system.
3. Assists nurses in ensuring they are consistent, competent, & safe in providing quality care that serves society while preserving individual rights & human dignity.

Question 2

What does common law tradition mean?

there are 3 points to remember

Answer 2

1. Legal principles & rules evolve through the courts.
2. Judges interpret & apply principles from similar decisions in previous cases (precedents) to the case before them to make a decision.
3. No two cases are identical & common law develpos through judges making distinctions between cases. Provides consistency & predictability.

Question 3

What does civil law tradition mean?

there are 2 points to remember

Answer 3

1. Laws are written down in a “code.”
2. This code provides all citizens with an accessible & written collection of the laws that apply to them & that judges must follow.

Question 4

What does statutory law mean?

there are 4 points to remember

Answer 4

1. Parliament has the power to pass laws for all of Canada.
2. Legislatures of each province & territory pass laws of a more local nature.
3. Laws enacted by these legislative bodies are called statutes, legislation or acts.
4. When Parliament or one of the legislatures enacts legislation, that legislation then supersedes any case law dealing with the same subject.

Question 5

What does criminal law mean?

Answer 5

1. Laws that affect the public welfare.
2. Breaking the law is a crime punishable by imprisonment, probation, loss of license, fines or a combination.
3. Designed to preserve society.
   Punishments designed to deter people from committing crimes.
4. Any violation of the law that governs the practice of nursing is considered a crime. (ex. LPN representing self as an RN)

Question 6

Who is responsible for the Canadian health care system?

Answer 6

Federal and provincial/territorial governments are responsible for the Canadian health care system.

Question 7

Who is responsible for regulating health care professionals?

Answer 7

it is the responsibility of the provinces & territories and delegated to the provincial/territorial professional organizations, like CLPNBC etc.

Question 8

What is tort law?

Answer 8

it is the body of law through which a person who suffers injury caused by another person is able to claim compensation for that injury. The goal is to put the person who suffered the harm back in the position he/she would have been in had the injury not happened.
Two categories: 1. Intentional torts
2. Negligence

Question 9

Define negligence

Answer 9

failure to behave in a reasonable and prudent manner

Ex. failing to follow proper procedure in moving a patient

Question 10

Define assault

Answer 10

an attempt or threat to touch someone with out consent

Question 11

Define battery

Answer 11

willful or negligent touching of a person which may or may not cause harm

Question 12

Define false imprisonment

Answer 12

the unlawful restraint or detention of another person against their wishes.

Question 13

What is disclosure

Answer 13

refers to the provision of information as it pertains to the risks of treatment, alternative treatments and any associated risk and the affects of no treatment

Question 14

What is meant by capacity

Answer 14

refers to the patients ability to understand relevant information and the consequences of the decisions

Question 15

Define informed consent

Answer 15

patient is advised of all of the information and has the ability to make a decision

Question 16

Define expressed consent

Answer 16

a clear statement by the patient and can be oral or written.
Ex: a nod by a patient to go ahead with intervention

Question 17

Define implied consent

Answer 17

non verbal behaviour indicating willingness to proceed with intervention

Question 18

Define confidentiality

Answer 18

the right of anyone that any information about that individual will not be made public or available to others

Question 19

Define privacy

Answer 19

a degree of of social retreat that provides a feeling of comfort

Question 20

Define problematic substance use (drug abuse)

Answer 20

a disruption in any area of a persons life caused by excessive intake of a substance either continually or periodically

Question 21

Define chemical dependancy

Answer 21

addiction to a mood or mind altering drug

Ex: alcohol or cocaine

Question 22

What is it about confidentiality and social media that nurses neeed to be aware of

Answer 22

that nurses are held to a certain level of professionalism and that putting anything on Facebook, twitter etc… about collegues or clients can have serious legal consequences.

Question 23

What is advanced care planning

Answer 23

Allows older adults to have a say in what they would choose for health care/interventions if/when they become unable to make those decisions (i.e. dementia, strokes, etc.)

Question 24

What information is in an advanced care plan

Answer 24

1. Who do you want to make your health care decisions for you?
2. What health care treatment(s) do you agree to, or refuse, if a health care provider recommends them?
3. Would you accept or refuse life support and life-prolonging medical interventions for certain conditions?
4. What are your preferences should you need residential care and not be able to be cared for at home?

Question 25

Advanced care planning has several options what are they

there are 5

Answer 25

1. Standard representation:
   allows the person to name a someone that they want to make personal care decisions. This not allow the named person to refuse life support or life-prolonging medical interventions for you
2. Advanced representation agreement:
   allow a person to name someone to make personal care decisions, some health care decisions (including decisions to refuse life support or life-prolonging medical interventions)
3. Advanced directives:
   allows you to state your decisions about accepting or refusing health care treatments, including life support or life-prolonging medical interventions, directly to a health care provider. The advance directive must be followed when it addresses the health care decision needed at the time. No one will be asked to make a decision for you.
4. Enduring Power of Attorney:
   allows you to appoint someone to make financial and legal decisions on your behalf if you become incapable.

5. Temporary Substitute Decision Maker (TSDM):
a temporary substitute decision maker is chosen if you have not legally named an individual (representative) to make health care decisions for you when you are incapable of making them
yourself.
  *Must be 19 or over
  *Must have no dispute with the  
        older person 
  *Must have had contact in the
        past 12 months
  *As per the list of people who 
        will be contacted – the order 
        cannot be change

Question 26

For a Temporary Substitute Decision Maker (TSDM) what is the list of people that will be contacted and in what order
(there are 9)

Answer 26

1. Your spouse
2. A son or daughter (19+)
3. A parent
4. A brother or sister
5. A grandparent
6. A grandchild
7. Anyone else related to you by
   birth or adoption
8. A close friend
9. A person immediately related
   to you by marriage (in-laws,
   step-parents, step-children,
   etc.)

Question 27

Explain the Health Care Consent and Care Facility Act

Answer 27

• Does not apply to anyone admitted to a care facility under the Mental Health Act
• Under the act every adult is presumed to be capable of given consent for:
  *Giving, refusing, revoking
  consent to health care
  *Deciding to apply, accept
  offer, or move out of a
  residential care facility

Question 28

What are the consent rights

there are 6

Answer 28

(a) the right to give consent or to refuse consent on any grounds
(b) the right to select a particular form of available health care
(c) the right to revoke consent
(d) the right to expect that a decision to give, refuse or revoke consent will be respected
(e) the right to be involved to the greatest degree possible in all planning and decision making.
(f) Incapacity is determined

Question 29

When is consent required

Answer 29

A health care provider must not provide any health care to an adult without the adult’s consent except under sections 11 to 15.

A health care provider must not seek a decision about whether to give or refuse substitute consent to health care under section 11, 14 or 15 unless he or she has made every reasonable effort to obtain a decision from the adult.

Question 30

What are the parts of a consent (what is a consent made up of)

Answer 30

- Relates to the proposed health 
      care
- Is given voluntarily
- Not obtained by fraudulent 
      means
- The adult is deemed capable of 
      giving consent
- The health care provider gives 
      the appropriate information – 
      “informed consent”
- The adult has had the 
      opportunity to ask questions – 
      role of nurse or doctor?
- Consent must be expressed 
      orally, in writing, or inferred by
      conduct
- Consent is only for what the 
      adult has agreed to except 
      when: 
         *The adult is unconscious or 
           semi-conscious
         *Medically necessary to 
          provide additional or 
          related care that was 
          unforeseen

Question 31

Section 11 -A health care provider may provide health care to an adult without the adult’s consent if

Answer 31

(a) the health care provider is of the opinion that the adult needs the health care and is incapable of giving or refusing consent, and
(b) the adult’s personal guardian or representative

   (i)  has authority to consent to 
        the health care,

  (ii)  is capable of giving 
        consent, and

  (iii)  gives substitute consent.

Question 32

Section 14 – Major Health Care

what are the 2 points

Answer 32

The ability to give major health care (i.e. surgery) without consent of adult but in consultation with primary relative (if possible) if it is life/death, or if the adult is deemed incapable of consenting or refusing care

Or if the adult has a legally appointed substitute decision maker and is incapable of consenting/refusing

Question 33

Section 15 – Minor Health Care

- A health care provider may provide minor health care to an adult without the adult’s consent if

Answer 33

(a) the health care provider is of the opinion that the adult is incapable of giving or refusing consent to the minor health care,
(b) the adult does not have a personal guardian or representative or the personal guardian or representative is incapable of giving or refusing consent, and
(c) someone chosen under section 16 gives substitute consent to the minor health care.

Question 34

How is Incapability Determined?

Answer 34

a health care provider must base the decision on whether or not the adult demonstrates that he or she understands

(a) the information given by the health care provider
(b) that the information applies to the situation of the adult for whom the health care is proposed.

Question 35

What are the nurse’s responsibilities

Answer 35

• assessing capacity in order to obtain consent (verbally, written, or indicated)
• there is no algorithm for assessing capacity and capacity cannot be globally applied
• know the laws in your province

Question 36

What are the expectations regarding reporting elder abuse

Answer 36

• Mandatory reporting of suspected abuse or neglect of residents in residential care
• However, if an adult is determined competent then he/she has the right to make decisions about their personal care and can refuse assessment and interventions