TEST 1 - UNIT A - CH 4 - LEGAL RESPONSIBILITIES (Fundamentals Book) Flashcards
1
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Question
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Answer
2
Q
Understanding laws governing nursing practice - helps nurses protect________and also reduces this
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clients rights
risk of nursing liability.
3
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Nurses who practice within the confines of the law shield thiemselves from what
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liability
4
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Nurses are accountable for practicing nursing within the (5)
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confines of law
advocate for clients rights
provide care w/in NURSE scope of practice
discern responsibilities of Nursing in relationship to responsibilities of other HCT members
provide safe, proficient care consistent w/ standards of care.
5
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SOURCES OF LAW
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FEDERAL REGULATIONS
CRIMINAL AND CIVIL LAWS
STATE LAWS
LICENSURE
6
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FEDERAL REGULATION - Federal laws affecting nursing practice
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Health Insurance Portability and Accountability Act (HIPAA)
Americans with Disabilities Act (ADA)
Mental Health Parity Act (MHPA)
Patient Self-Determination Act (PSDA)
one more mentioned by teacher???? what was it
7
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Criminal law is a subsection of______and relates to the relationshib between_______
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public lawan individual and the government
8
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A nurse who falsifies a record to cover up a serious mistake can be guilty of
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breaking a criminal law
9
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Civil laws protect
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individual rights
10
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One type of civil law that relates to the provision of nursing care is
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tort law
11
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Each state has enacted statutes that define
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parameters of nursing practice a
12
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Each state has given the authority to pract and regulate the practice of nursing to what organization
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state board of nursing
13
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State Boards of nursing have the authority to
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adopt rules and regulations that further regulate nursing practice
14
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Although the practice of nursing is similar among states, it is critical that nurses know
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laws and rules governing nursing in the state in which they practice
15
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State Boards of nursing have the authority to
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issue and revoke a nursing license
16
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State Boards set standards for
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nursing programs
outline scope of practice for
RNs,
practical nurses (PNs),
advanced practice nurses.
17
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Good Samaritan law - ALL STATES HAVE SOMETYPE
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protects health care workers from liability when they intervene at the scene of an emergency SOMETHING ABOUT PROVIDING REASONABLE CARE
18
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nurses must have a current license in
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every state in which they practice
19
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nurse licensure compact
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This model allows licensed nurses who reside in a compact state to practice in other compact states under a multistate license.
20
Q
Within the compact, nurses must practice in accordance with
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the statues and rules of the state in which they are currently providing care.
21
Q
(3) Types of torts
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Unintentional
Quasi intentional
Intentional
22
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Unintentional torts
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NEGLIGENCE
MALPRACTICE (PROFESSIONAL NEGLIGENCE):
23
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NEGLIGENCE: Example
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EX: fails to implement safety measures for client at risk for falls.
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MALPRACTICE (PROFESSIONAL NEGLIGENCE):
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admins large dose of meds due to calculation error.
client has cardiac arrest and dies.
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Quasi intentional torts
BREACH OF CONFIDENTIALITY
DEFAMATION OF CHARACTER:
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BREACH OF CONFIDENTIALITY:
releases clients medical diagnosis to member of press.
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DEFAMATION OF CHARACTER:
tells coworker you think client has been unfaithful to their partner.
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Intentional torts
ASSUALT
BATTERY
FALSE IMPRISONMENT
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ASSAULT
conduct of one person makes another person fearful / apprehensive
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Assualt EX:
nurse threatens to place NG tube in client refusing to eat.
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BATTERY
Intentional / wrongful physical contact w/ person that involves an injury / offensive contact
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Battery EX:
nurse restrains client and admins injection against their wishes.
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FALSE IMPRISONMENT
confined or restrained against your will
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False Improsonment EX:
uses restraints on competent client to prevent them leaving health care facility
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Professional negligence
failure of person (w/professional training) to act in reasonable / prudent manner.
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The terms reasonable prudent generally describe
person w/ average judgment / intelligence / foresight / skill that person w/ similar training / experience would have.
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Negligence issues prompt most malpractice suits include failure to:
Follow professional / facility-established standards of care
Use equipment in responsible / knowledgeable manner
Communicate effectively / thoroughly w/ clients
Document care nurse provided
Notify provider of change in clients condition
Complete a prescribed procedure
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Nursing students face liability if they
harm clients as result of their direct actions /inaction.
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Nursing students should not perform tasks for which
they are not prepared,
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Nursing students should have what
supervision as they learn new procedures.
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If a student harms a client - who shares in the liability for the wrong action or inaction (4)
student
instructor
educational institution
facility
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Nurses can avoid liability for negligence by: (6)
Following standards of care
Giving competent care
Communicating w/ other HCT members / clients
Developing a caring rapport w/ clients
Fully documenting assessments / interventions / evaluations
Being familiar w/ / following facility policies/ procedures.
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Nurses are accountable for protecting this for the client
rights of clients.
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Ex of protecting clients rights include
informed consent / refusal of treatment / advance directives / confidentiality / information security.
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clients rights are
legal privileges or powers clients have when they receive health care services
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Clients using services of health care institution retain their
rights as individuals AND citizens
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Nursing facilities that participate in Medicare programs also follow
Resident Rights statues
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Resident Rights statues govern what
nursing facilities operations
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The American Hospital Association (as part of Patient Care Partnership) identifies
clients rights in health care settings
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Nurses must ensure clients ◠Regardless of the client’s age, nursing needs, or health care setting, the basic tenets are
understand their rights
AND must protect their clientsrights
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client rights (4)
Understand their care
be active in decision-making process
Accept / refuse / request modification of POC (plan of care
Receive care from competent individuals who treat client w/ respect
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5 elements necessary to prove negligence
1. Duty to provide care (defined by standards)
2. Breach of duty (failure to meet standard)
3. Foreseeability of harm
4. Breach of duty has potential to cause harm (combines elements 2 / 3)
5. Harm occurs
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Duty to provide care as defined by a standard (1st element required to prove negligence)
Care given = what a reasonably prudent nurse would do
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Ex of duty to provide care as defined by a standard
EX: The nurse should complete a fall risk assessment for all clients during admission.
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Breach of duty by failure to meet standard (2nd element required to prove negligency
Failure to give the standard of care
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EX of: Breach of duty by failure to meet standard
The nurse does not perform a fall risk assessment during admission
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Foreseeability of harm (3rd element required to prove negligence)
Knowledge that failing to give the proper standard of care could harm the client
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EX of Foreseeability of harm
The nurse should know that failure to take fall risk precautions could endanger a client at risk for falls.
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Breach of duty has potential to cause harm (4th element required to prove negligence - combines elements 2 and 3))
Failure to meet the standard had potential to cause harm
relationship must be provable
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EX of Breach of duty
Without a fall risk assessment, the nurse does not know the client’s risk for falls and does not take the proper precautions.
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Harm occurs (5th element required to prove negligence)
Actual harm to the client occurs
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EX Harm occurs
The client falls out of bed and fractures their hip
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INFORMED CONSENT
legal process by which a client / clients legally appointed designee - given written permission for procedure / treatment.
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Consent is informed when a provider explains and the client understands….
reason for treatment / procedure
How treatment / procedure will benefit client
Risks involved if do not get treatment / procedure
Other options avail (including not treating).
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Who is repsonsible for getting informed consent
THE PROVIDER IS RESPONSIBLE
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The nurses role in informed consent process is to
witness client signature
ensure provider has obtained informed consent responsibly.
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INFORMED CONSENT GUIDELINES
Clients must consent to all care they receive in a health care facility.
A competent adult must sign the form for informed consent. ◠Individuals who can grant consent for another person include the following.◯ Parent of a minor◯ Legal guardian◯ Court‑specified representative◯ An individual who has durable power of attorney authority for health care◠Emancipated minors (minors who are independent from their parents [a married minor]) can consent for themselves.◠Include a mature adolescent in the informed consent process by allowing them to sign an assent as a part of the informed consent document. ◠The nurse must verify that consent is informed and witness the client signing the consent form.
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For most aspects of nursing care, implied consent is
adequate.
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Clients provide implied consent when they
adhere to instructions nurse provides.
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EX of Implied consent
nurse is preparing to perform a tuberculosis skin test, and the client holds out their arm for the nurse.
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For an invasive procedure / surgery, client must provide
written consent.
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State laws prescribe who is able to give
informed consent.
Laws vary regarding age limitations / emergencies.
Nurses responsible for knowing laws in state(s) they practice.
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What does it mean when we say "A competent adult must sign the form for informed consent.
person who signs form
must be capable of understanding info from health care professional who will perform service (surgical procedure)
person must be able to communicate w/ health care professional.
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When the person giving the informed consent is unable to communicate due to a language barrier or a hearing impairment, ....
trained medical interpreter must intervene.
Many health care facilities contract w/ professional interpreters (additional skills in medical terminology to assist w/ providing info)
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Individuals who can grant consent for another person include the following.
Parent of a minor
Legal guardian
Court specified representative
An individual who has durable power of attorney authority for health care
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Emancipated minors (minors who are independent from their parents [a married minor]) can provide consent how
for themselves.
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How is a mature adolescent involved in the informed consent process
signing an assent as part of the informed consent document.
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nurse must verify that consent is informed and
witness client signature
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Responsibilities for informed consent- PROVIDER- CLIENT- NURSE
PROVIDER - Obtains informed consent
CLIENT - Gives informed consent.
NURSE - Witnesses informed consent.
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Provider - Obtains informed consent. To do so, the provider must give the client
purpose of procedure.
complete description of procedure
description of professionals performing / participating in procedure
description of potential harm / pain / discomfort that might occur
Options for other treatment
option to refuse treatment and consequences
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Client Gives informed consent. To give informed consent, the client must
Give it voluntarily (no coercion involved)
competent and of legal age or emancipated minor.
When client is unable to provide consent - another authorized person must give consent
Receive enough infor - make decision based on understanding of what to expect
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Nurse Witnesses informed consent.This means the nurse must
Ensure provider gave the client the necessary information
Ensure client understood the info and is competent to give informed consent
Have client sign informed consent document
Notify provider if client has more questions / appears not to understand infor
provider then responsible for giving clarification
Document questions client has / notification of provider / reinforcement of teaching / use of an interpreter.
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The Patiest Self Determination Act (PSDA) stipulates that staff must inform clients they admit to a health care facility of their right to
accept or refuse care.
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Competent adults have the right to
refuse treatment, including the right to leave a facility without a discharge prescription from the provider.
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If client refuses treatment / procedure, client signs a document indicating
they understand risk involved w/ refusing treatment / procedure
they have chosen to refuse it.
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When a client decides to leave facility against medical advice (w/out discharge prescription), nurse does what
notifies provider
discusses w/ client risks to expect when leaving facility prior to discharge.
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IF A PATIENT REFUSES TREATMENTâ— The nurse asks the client to sign an
Against Medical Advice form and documents the incident
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STANDARDS OF CARE (PRACTICE) —Nurses base practice on
established standards of care or legal guidelines for care
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Established standards of care or legal guidelines for care include
nurse practice act of each state
Published standards of nursing practice from professional organizations / specialty groups,
Health care facilities policies / procedures,
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Published standards of nursing practice from professional organizations / specialty groups include (3)
American Nurses Association (ANA
American Association of Critical Care Nurses (AACN)
American Association of Occupational Health Nurses (AAOHN)
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Health care facilities policies / procedures establish the standard of
practice for employees of facility
provide detailed info about how nurse should respond to / provide care in specific situations / client care procedures.
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ANA
American Nurses Association (ANA),
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AACN
American Association of Critical Care Nurses (AACN),
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AAOHN
American Association of Occupational health Nurses (AAOHN)
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Standards of care define and direct the
level of care nurses should give
implicate nurses who did not follow standards in malpractice lawsuits.
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Nurses should refuse to practice beyond what
legal scope of practice / outside their areas of competence
regardless of reason (staffing shortage, lack of appropriate personnel).
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Nurses should use the formal chain of command to verbalize
concerns related to assignment in light of current - legal scope of practice / job description / area of competence.
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Impaired health care providers pose what
a significant risk to client safety
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A nurse who suspects a coworker of any behavior that jeopardizes client care or could indicate a substance use disorder has a
duty to report coworker to appropriate manager.
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Many facilities policies provide access to
assistance programs - facilitate entry into treatment programs.
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Each state has laws and regulations that govern the disposition of nurses who have what??
have substance use disorders.
Criminal charges could apply
102
Purpose of advance directives is to
communicate a clients wishes regarding end-of-life care should client become unable to do so.-
103
The PSDA requires asking all clients on admission to a health care facility ____â— Staff should give clients who do not have advance directives _____
whether they have advance directives
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Staff should give clients who do not have advance directives what
Who sould be available to help w/ this process
written infor - outlines their rights related to health care decisions
how to formulate advance directive
A health care representative
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Types of advance directives
Living will
Durable power of attorney for health care
Providers orders
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Living will
legal document that expresses the clients wishes regarding medical treatment in the event the client becomes incapacitated and is facing end-of-life issues.
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Most state laws include provisions that protect health care providers who follow
a living will from liability.
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Health care proxies can be whom
any competent adult the client chooses.
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Durable power of attorney for health care
document in which clients designate a health care proxy to make health care decisions for them if they are unable to do so.
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Unless a provider writes a "do not resuscitate" (DNR) or allow natural death (AND) prescription in clients medical record, Do what??
initiate cardiopulmonary resuscitation (CPR) when the client has no pulse or respirations.
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The provider consults who prior to adminsitering a DNR of AND
the client and the family
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DNR
do not resuscitate
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AND
allow natural death
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NURSING ROLE IN ADVANCE DIRECTIVESNursing responsibilities include the following
Provide written info about advance directives
Document clients advance directives status
Ensure advance directives reflect clients current decisions
Inform all members of health care team of clients advance directives.
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MANDATORY REPORTING - what is it
Health care providers legal obligation to report findings in accordance w/ state law when
abuse
communicable disease
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ABUSE
suspicion of abuse (child or elder abuse, adult violence)
follow facility policy.
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COMMUNICABLE DISEASES
report to local / state health department.
Each state mandates which diseases to report
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Reporting communicable diseases allows officials to
Ensure appropriate medical treatment of diseases (tuberculosis).
Monitor for common-source outbreaks (foodborne, hepatitis A)
Plan / evaluate control / prevention plans (immunizations).
Identify outbreaks / epidemics
Determine public health priorities based on trends.
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List the five elements necessary to prove negligence.
Duty to provide care as defined by a standard
Breach of duty by failure to meet standard
Foreseeability of harm
Breach of duty has potential to cause harm
Harm occurs
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List at least four ways nurses can avoid liability for negligence
Following standards of care
Giving competent care
Communicating with other health team members
Developing a caring rapport with clients
Fully documenting assessments, interventions, and evaluations
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1. A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells the client that diapers will be used next time the urinal is used improperly. Which of the following torts is the AP committing?
A. Assault
B. Battery
C. False imprisonment
D. Invasion of privacy
A1. A. CORRECT: By threatening the client, the AP is committing assault. The APs threats could make the client become fearful and apprehensive.
B. Battery is actual physical contact without the clients consent. Because the AP has only verbally threatened the client, battery has not occurred.
C. Unless the AP restrains the client, there is no false imprisonment involved.
D. Invasion of privacy involves disclosing information about a client to an unauthorized individual.
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assualt
threats or verbalizations that make someone else fearful / apprehensive
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BATTERY
Battery is actual physical contact without the clients consent.
124
If it is only a verbal threat, has battery occurred
no
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FALSE IMPRISONMENT INVOLVES
restraining the client,
126
INVASION OF PRIVACY
disclosing information about a client to an unauthorized individual.
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2. A nurse is caring for a competent adult client who tells the nurse, “I am leaving the hospital this morning whether the doctor discharges me or not. The nurse believes that this is not in the clients best interest, and prepares to administer a PRN sedative medication the client has not requested along with the scheduled morning medication. Which of the following types of tort is the nurse about to commit?
A. Assault
B. False imprisonment
C. Negligence
D. Breach of confidentiality
B2. A. Assault is an action that threatens harmful contact without the clients consent. The nurse has made no threats in this situation.
B. CORRECT: Administering a medication as a chemical restraint to keep the client from leaving the facility against medical advice is false imprisonment, because the client neither requested nor consented to receiving the sedative.
C. Negligence is a breach of duty that results in harm to the client. It is unlikely that the medication the nurse administered without his consent actually harmed the client.
D. The nurse has not disclosed any protected health information, so there is no breach of confidentiality involved in this situation.
128
Assault is an action that
threatens harmful contact without the clients consent.
129
Administering a medication as a chemical restraint - type of
FALSE IMPRISONMENT
130
Negligence
breach of duty results in harm toclient
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BREACH OF CONFIDENTIALITY
Disclosing protected health information
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3. A nurse in a surgeons office is providing preoperative teaching for a client who is scheduled for surgery the following week. The client tells the nurse that I plan to prepare my advance directives before I come to the hospital. Which of the following statements made by the client should indicate to the nurse an understanding of advance directives?
A. I'd rather have my brother make decisions for me, but I know it has to be my wife.
B."I know they won't go ahead with the surgery unless I prepare these forms."
C"I plan to write that I don't want them to keep me on a breathing machine."
D."I will get my regular doctor to approve my plan before I hand it in at the hospital".
A. The client can designate any competent adult to be his health care proxy. It does not have to be his spouse.
B. The hospital staff must ask the client whether he has prepared advance directives and provide written information about them if he has not. The nurse should document whether the client has signed the advance directives. The hospital staff cannot refuse care based on the lack of advance directives.
C. CORRECT: The client has the right to decide and specify which medical procedures he wants when a life‑threatening situation arises.
D. The client does not need his provider approval to submit his advance directives. However, he should give his primary care provider a copy of the document for his records.
133
4. A nurse is caring for a client who is about to undergo an elective surgical procedure. The nurse should take which of the following actions regarding informed consent? (Select all that apply.)
A. Make sure the surgeon obtained the clients consent.
B. Witness the clients signature on the consent form.
C. Explain the risks / benefits of procedure.
D. Describe the consequences of choosing not to have the surgery.
E. Tell the client about alternatives to having the surgery
A. CORRECT: It is the nurses responsibility to verify that the surgeon obtained the clients consent and that the client understands the information the surgeon gave them.
B. CORRECT: It is the nurses responsibility to witness the clients signing of the consent form, and to verify that they are consenting voluntarily and appear to be competent to do so. The nurse also should verify that the client understands the information the surgeon has provided.
C. It is the surgeons responsibility to explain the risks and benefits of the procedure.
D. It is the surgeons responsibility to describe the consequences of choosing not to have the surgery.
E. It is the surgeons responsibility to tell the client about any available alternatives to having the surgery.
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WITH REGARD TO INFORMED CONSENTWHAT ARE THE PROVIDERS RESPONSIBILITIES?
NURSE -
Responsible to verify surgeon obtained clients consent
client understands info surgeon gave them
witness client signature
verify voluntary consenting voluntarily
verify competent to do so.
135
WITH REGARD TO INFORMED CONSENTWHAT ARE THE NURSE'S RESPONSIBILITIES?WHAT ARE THE PROVIDERS RESPONSIBILITIES?
PROVIDER -
explain risks / benefits of procedure
describe the consequences of choosing not to have the surgery
describe available alternatives to having the surgery.
136
5. A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, the nurse was found asleep in a chair in the break room not during a break time. Which of the following actions should the nurse take?
A. Alert the American Nurses Association.
B. Fill out an incident report.
C. Report the observations to the nurse manager on the unit.
D. Leave the nurse alone to sleep.
A. Do not alert the American Nurses Association. The states board of nursing regulates disciplinary action and can revoke a nurses license for substance use.
B. Do not fill out an incident report. Incident reports are filed to document an accident or unusual occurrence.
C. CORRECT: Any nurse who notices behavior that could jeopardize client care or could indicate a substance use disorder has a duty to report the situation immediately to the nurse manager.
D. Do not leave the nurse alone to sleep. Although the nurse is not responsible for solving the problem, she does have a duty to take action because she has observed the problem.
