Legal Issues in Nursing

Question 1

According to Professional Standards, what is ethical nursing care?

Answer 1

”..promoting the values of client well-being, respecting client choice, assuring privacy and confidentiality, respecting the sanctity and quality of life, maintaining commitments, respecting truthfulness and ensuring fairness in the use of resources”

Question 2

Legal requirements and ethical guidelines regarding CONSENT

Answer 2

CNA:
- promote and respect informed decision making
- maintain privacy and confidentiality
CNO:
- client choice
- privacy and confidentiality

Question 3

ETP Competencies surrounding CONSENT

Answer 3

81: ensures that informed consent is provided as it applies to multiple contexts (consent for care, refusal, release of info, participation in research)
82: supports clients in making informed decisions about their health care
83: advocates for clients or their representatives, especially when they are unable to advocate for themselves

Question 4

Health Care Consent Act (HCCA) 1996

Answer 4

• promoting individual autonomy and communication among patients/practitioners and families
• includes decisions for specific treatment, admission to care facility, personal assistance services

Question 5

Principles of Informed Consent

Answer 5

• patients have the right to refuse consent to treatment, regardless of whether the 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• consent is an ongoing process and can be withdrawn at any time
• does not always need to be written (i.e. taking bp)
• nurses should assume that a patient is capable unless are reasonable grounds to believe otherwise

Question 6

Conditions for Informed consent

Answer 6

a. patient must have capacity (ability) to make decisions
[16 or older assumes ability, although there are no minimum age]

b. medical provider offer disclosure of information (i.e. benefits and risks)
c. patient is able to comprehend information
d. consent obtained voluntarily (without coercion)
e. consent must be specific to proposed tx or procedure
f. consent must specify (all) who will perform procedure or tx

Question 7

Substitute Decisions Act (SDA)

Answer 7

If the person is incapable, consent (or refusal) is to be obtained from the highest ranked available substitution decision-maker from the HCCA hierarchy who is willing to make the decision

Question 8

HCCA Hierarchy

Answer 8

a. court appointed guardian of personal care
b. attorney for personal care
c. representative appointed by CCB
d. spouse, common law or partner
e. parent and children
f. brothers and sisters
g. any relatives (blood, marriage or adoption

Question 9

Autonomy

Answer 9

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

Question 10

Nursing implications on promoting patient autonomy

Answer 10

1. Explore the needs, interests and concerns of clients at all stage of assessment
2. HCP cannot presume to know what is best for their client (understand meaning, keep in mind potentially oppressive cultural space, challenge unjust behaviour)
3. Develop awareness of personal biases and assumptions
4. Help foster the autonomy of the group members who are oppressed (health promotion activities, provide adequate time and understanding)

Question 11

In a negligence lawsuit, standards of care..

Answer 11

..determine if nurse acted as a reasonably prudent nurse in the same setting with the same credential would act

Question 12

Assault

Answer 12

Verbal or physical act that creates fear of imminent harmful contact (does not require actual contact, threat is considered assault)

Question 13

Battery

Answer 13

Intentional physical contact without the person’s consent

Question 14

Invasion of Privacy

Answer 14

Free from unwanted intrusion into private life - breaching confidentiality

Question 15

False Imprisonment

Answer 15

Held involuntarily (inappropriate/unjustified use of restraints)

Patient Restraints Minimization Act (2001) methods to minimize the use of restraints

Question 16

Common reasons to be sued

Answer 16

a. conduct that does not meet standard of care

b. negligence
- unintentional, committed by inattention, thoughtlessness or carelessness
- performing procedure for which nurse is not educated

Question 17

Common Negligent Acts

Answer 17

a. med error (not checking ID)
b. IV therapy errors (infiltration, phlebitis)
c. burns (spills)
d. failure to use aseptic technique
e. failure to give report or incomplete report
f. failure to monitor a pt’s condition adequately

Question 18

Ways to prevent negligence

Answer 18

• Ensure nursing actions follow standards of care
• Appropriate orientation
• Continuing education
• Adequate staffing
• Maintain good communication
• Documentation (timely, truthful, accurate)

Question 19

Personal Health Information Protection Act (PHIPA), 2004

Answer 19

Protects any identifying information about clients in verbal, written or electronic form

Balance client’s rights and HCP’s need for information in order to provide effective care

Question 20

When can a nurse collect PHI from someone other than client without client’s consent?

Answer 20

1. The client cannot provide it (unconscious)
2. Obtaining consent would affect timeliness of care (in emergency)
3. The accuracy of the information is questionable

Question 21

CNO’s Standard Statement on PHI

Answer 21

Nurses share relevant information with healthcare team whose members are obliged to maintain confidentiality

Explain to client that information will be shared with health care team and if identify who they are

Question 22

Behavioural indicators for protecting PHI

Answer 22

• maintain confidentiality after the professional relationship has ended
• collect only info needed for care
• not discussing client info in public space
• access info for your client only
• deny access to people not a part of the health care team

Question 23

PLP

Answer 23

Professional Liability Protection

- employers may have coverage that cover its staff