Legal Issues in Nursing Flashcards
According to Professional Standards, what is ethical nursing care?
”..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”
Legal requirements and ethical guidelines regarding CONSENT
CNA: - promote and respect informed decision making - maintain privacy and confidentiality CNO: - client choice - privacy and confidentiality
ETP Competencies surrounding CONSENT
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
Health Care Consent Act (HCCA) 1996
- promoting individual autonomy and communication among patients/practitioners and families
- includes decisions for specific treatment, admission to care facility, personal assistance services
Principles of Informed Consent
- 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- consent is an ongoing process and can be withdrawn at any time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
Conditions for Informed consent
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
Substitute Decisions Act (SDA)
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
HCCA Hierarchy
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
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 on promoting patient autonomy
- Explore the needs, interests and concerns of clients at all stage of assessment
- HCP cannot presume to know what is best for their client (understand meaning, keep in mind potentially oppressive cultural space, challenge unjust behaviour)
- Develop awareness of personal biases and assumptions
- Help foster the autonomy of the group members who are oppressed (health promotion activities, provide adequate time and understanding)
In a negligence lawsuit, standards of care..
..determine if nurse acted as a reasonably prudent nurse in the same setting with the same credential would act
Assault
Verbal or physical act that creates fear of imminent harmful contact (does not require actual contact, threat is considered assault)
Battery
Intentional physical contact without the person’s consent
Invasion of Privacy
Free from unwanted intrusion into private life - breaching confidentiality
False Imprisonment
Held involuntarily (inappropriate/unjustified use of restraints)
Patient Restraints Minimization Act (2001) methods to minimize the use of restraints
Common reasons to be sued
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
Common Negligent Acts
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
Ways to prevent negligence
- Ensure nursing actions follow standards of care
- Appropriate orientation
- Continuing education
- Adequate staffing
- Maintain good communication
- Documentation (timely, truthful, accurate)
Personal Health Information Protection Act (PHIPA), 2004
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
When can a nurse collect PHI from someone other than client without client’s consent?
- The client cannot provide it (unconscious)
- Obtaining consent would affect timeliness of care (in emergency)
- The accuracy of the information is questionable
CNO’s Standard Statement on PHI
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
Behavioural indicators for protecting PHI
- 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
PLP
Professional Liability Protection
- employers may have coverage that cover its staff
