Legal issues in nursing Flashcards
Legislation, practice standards and legal responsibilities for nursing
Provincial legislation
- ex. RHPA. Nursing Act, HCCA
Federal legislation
- ex. Canada Health Act, MAID
CNO standards, Practice guidelines, and Jurisprudence exam
RNs and Nursing students professional accountability and responsibility
Provincial Statutes
- Health Care Consent Act (1996)
- Substitute Decisions Act (1992)
- Personal Health Information Protection Act (2004)
Consent
- Ethical and legal obligations
- Professional Standards, Revised 2002; “respecting client choice”
Legal requirements and ethical guidelines: CNA (2017)
- Promoting and respecting Informed Decision Making
- Maintaining Privacy and Confidentiality
Legal requirements and ethical guidelines: CNO (2019)
- Client choice
- Privacy & Confidentiality
Consent: CNO ETP Competencies
- Ensures that informed consent is provided as it applies to multiple contexts (e.g., consent for care; refusal of treatment; release of health information; consent for participation in research).
- Supports clients in making informed decisions about their health care.
- Reinforcing any kind of information that is shared ensuring they have clarification - Advocates for clients or their representatives, especially when they are unable to advocate for themselves. (CNO, 2014, p. 9)
- Being a patient advocate and focusing on what they patient wants
Health Care Consent Act (HCCA) 1996: Goals
Goals:
- Promoting individual autonomy and communication among patients/practitioners & families
- Includes decisions for
- Specific treatment/treatment plan
- Admission to a care facility
- Personal assistance services
- Health care providers do not have authority to make treatment decisions on behalf of clients except in an emergency when no authorized person is available
Main concern: to reach capacity to ensure the client has he capacity to make decisions; we don’t make the decision for that patient, we education and inform
Informed consent
- Protects and promotes patient autonomy
- Legally mandated
Principles of informed consent
- Patients have the right to refuse consent to treatment, regardless of whether that treatment is considered in their ‘best interests’
- Nurses should always explain to the client the treatment or procedure they are performing
- Consent is an ongoing process and can be withdrawn at any time
- Informed consent does not always need to be written
- Nurses should assume that a patient is capable unless there are reasonable grounds to believe otherwise
Conditions for informed consent
1) Patient must have capacity (ability) to make decisions
2) Medical provider offer disclosure of information (ex: benefits and risk)
3) Patient is able to comprehend information
4) Consent obtained voluntary (without coercion)
5) Consent must be specific to the proposed treatment or procedure. (A person may be capable to give consent to one treatment, but not capable with respect to another.)
6) Consent must specify who will perform the procedure or treatment.
Substitute decisions act (SDA)
If the person is incapable, consent (or refusal) is to be obtained from the highest ranked available substitute decision-maker from the HCCA hierarchy who is willing to make the decision.
Hierarchy of the SDA
- A court appointed guardian of personal care
- An attorney for personal care
- A representative appointed by the CCB
- The spouse, common law spouse or partner
- Parents and children
- Brothers and sisters
- Any other relative by blood, marriage or adoption
- The Public Guardian and Trustee if:
1) There is no one else to do this, OR
2) No one else wants to, OR
3) Two or more potential substitutes of the equal (and highest) ranking claim the role but disagree as to the decision
Autonomy
- A capable and competent individual is free to determine, and to act in accordance with, a self-chosen plan.
Key characteristics:
- choice, privacy, self-mastery, freedom, self-determination
Nursing implications: promoting patient autonomy
1) Explore the needs, interests, and concerns of patients at all stages of treatment
- informed consent is an interactive, ongoing process
- nurses play a highly important role in the informed consent process
2) Health care providers cannot presume to know what is best for their patients
- health care providers are not the experts on all health matters.
- must understand the meaning of the experience from the perspective of the patient.
- keep in mind the potentially oppressive cultural space in which care is provided and challenge unjust practices.
3) Develop awareness of personal biases and assumptions
- avoid denying their autonomy
4) Help foster the autonomy of group members who are potentially oppressed
- health promotion activities to enhance autonomy of oppressed persons such as those directed toward social change
- provide adequate time and counseling to ensure patient understanding
Legal liability in nursing
- Standards of Care are legal guidelines for nursing practice
- In negligence lawsuit, standards are use to determine if nurse acted as a reasonably prudent nurse in the same setting with the same credentials would act.
- “Ignorance of the law or standards of care is not a defense against negligence, nor is being asked by an employer to perform an out-of-scope procedure”
