Week 6; Legal and Ethical Considerations

Question 1

Federal laws impacting nursing practice

Answer 1

Bill of Rights (first 10 amendments)
Emergency Medical Treatment and Active
Labor Act (EMTALA)
Patient Self-determination Act of 1991
Americans With Disabilities Act (1990)
HIPAA

Question 2

EMTALA

Answer 2

Requires healthcare facilities to provide emergency medical treatment to patients who seek healthcare in the emergency department, regardless of their ability to pay, legal status, or citizenship status. Medical facility must provide medical screening to determine if an emergency exists and to stabilize the patient before transferring him or her to another healthcare facility.

Question 3

Americans with Disabilities Act Amendments Act of 2008

Answer 3

Protection against discrimination of individuals with disabilities. A person has a disability if he or she has a physical or mental impairment that substantially limits one or more major life activities (EEOC, updated 2012). In general, the ADA provides that employers must provide reasonable accommodations in the work setting.

Question 4

Patient Self-Determination Act

Answer 4

Recognizes the patient’s right to make
decisions regarding his or her own healthcare. Based on the information provided to him or
her by the healthcare provider, regarding
the medical or surgical treatment options
availablE. Includes the benefits, risks, and alternatives. Relates to ethical principle of Autonomy. Living Wills, health care surrogate, durable Power of attorney, POLST, legal documents and vary from state to state

Question 5

Rights that come with patient self determination act

Answer 5

Right to appropriate treatment
Right to individualized treatment plan
Right to exercise decisions without reprisal
Right to file grievances
Right to referral after discharge

Question 6

Health Information Portability and
Accountability Act – HIPAA 1996

Answer 6

Passed by Congress in 1996 to:
Protect health insurance benefits for workers who lose or change their jobs, protect coverage to persons with preexisting medical conditions, establish standards to protect the privacy of personal health information. Prior to HIPAA, client confidentiality in medical records was not protected by Federal law, but right of PRIVACY was covered under various state laws.

Question 7

What does HIPAA encompass?

Answer 7

Protected Health Information (PHI)
Protection of various identifiers including but not limited to: name, address, phone numbers, email, SSN, MRNs, health plan numbers, account numbers, vehicle numbers, photographic images

Question 8

Additional HIPAA components

Answer 8

Hospitals must keep a record of all information
released. Patients have a right to a copy of their medical records – Medical Records Departments have Policies and Procedures for this. U.S. Department of Health and Human Services
(HHS) Office for Civil Rights (OCR) is responsible for enforcing the HIPAA Privacy and Security Rules.

Question 9

Forms of HIPAA breaches

Answer 9

Social Media, talking in Public, speaking with friends, neighbors, taking documents out of the facility, computer Security

Question 10

Mandatory reporting laws

Answer 10

Communicable disease
Abuse- physical, sexual, or emotional
abuse or neglect of children, older adults,
or the mentally ill whether suspected or have actual evidence

Question 11

Good Samaritan laws

Answer 11

Differ by state, designed to protect from liability those who provide emergency care to someone
who has been injured. Encourage people to help without fear. Call 911 – activate EMS at onset

Question 12

Key elements for protection with Good Samaritan laws

Answer 12

Key elements
1. Permission of ill/injured person when possible.
2. Care given in appropriate (non-reckless) manner.
3. Care was being given because it was an emergency situation and
trained help had yet to arrive. Activate 911

Questions arise when person covered by good Samaritan laws was the
one who caused an accident. (example physical altercation, purposeful
act of aggression)

Question 13

Nurse practice acts

Answer 13

Statutory laws passed by each state’s
legislative body that define the practice
of nursing. Nurse practice acts are designed to protect patients or society and define the scope of nursing practice. Identify the minimum level of nursing care that must be provided to clients
Nurse practice acts address: credentialing, licensing, discipline

Question 14

BON

Answer 14

Each state regulates its own practice of
nursing; therefore, the scope of nursing
practice varies from state to state. It is your legal and professional responsibility to understand your legal scope of practice. Ignorance of the law is not an excuse for
violating the practice act.

Question 15

Standards of practice

Answer 15

What a reasonable and prudent nurse would do in the same or a similar scenario. Derived from nurse practice acts, professional organizations, the Joint Commission. In malpractice, attorneys look to several sources to identify the standards of care, determine what a reasonable and prudent (careful) nurse would have done in the same or a similar situation.

Question 16

Fourth Degree Assault

Answer 16

In most situations, this offense is a Class A misdemeanor. The offense could be elevated to a Class C felony. Class C felonies can carry up to 5 years in prison and fines reaching $125,000. You could be accused of fourth degree assault if it’s believed that you intentionally, knowingly, or recklessly caused physical injury to someone or caused injury with a deadly weapon through negligence.

Question 17

Intentional torts

Answer 17

An assault and battery occurs when there is the
intent to cause a person fear, combined with an
offensive or harmful contact.
Example: Performing a procedure
without consent or false imprisonment (restraining a client against his or her will)

Question 18

Second Degree Assault

Answer 18

Simply defined, assault in the 2nd degree is when you are believed to have intentionally or knowingly caused serious physical injury to
someone or caused serious physical injury with a deadly or dangerous weapon.

Question 19

First Degree Assault

Answer 19

First degree assault charges could apply when it’s believed that you: intentionally caused serious physical injury to someone with a deadly
or dangerous weapon

Question 20

Physical restraints

Answer 20

You may restrain patients who pose a threat or
harm to themselves or others for safety. Alternative less restrictive methods must be
attempted first. An RN may direct placement in an emergency situation and get order from MD immediately – check hospital policy. RN must immediately obtain the proper authorization to continue the restraint at required intervals.

Question 21

Additional facts about restraints

Answer 21

KNOW and Follow Hospital Policy and Procedure including documentation. Policy must have procedures for assessment and frequency of
checks, length of time permitted in restraints. Cannot use as punishment or to keep a patient in bed. This is a HIGH RISK intervention. Question chest/vest restraints to keep patients in bed or chairs. Many states have regulations regarding the use of these.

Question 22

Fraud

Answer 22

Failing to provide essential information for
informed consent

Question 23

Invasion of privacy

Answer 23

Breach of confidentiality, violates a person’ right to be left alone (unwanted interference in private affairs)

Question 24

Negligence

Answer 24

is the failure to use ordinary
or reasonable care or the failure to act in
a reasonable and prudent (careful)
manner. In many cases, an expert witness
is used to determine the nurse’s
adherence to or deviation from standards
of practice.

Question 25

Standard to Compare

Answer 25

What would a reasonably prudent nurse do?

Question 26

Malpractice -

Answer 26

Professional form of negligence to win and recover damages (money) in a malpractice lawsuit, the plaintiff must prove four elements:
Duty, breach of duty, causation, injury/damages

Question 27

DUTY

Answer 27

Existence of a duty . The nurse-patient relationship creates this legal
obligation. A duty forms when the patient is assigned to the nurse or seeks treatment from the nurse, or when the nurse observes another person doing something that could harm the patient.

Question 28

Creation of a Relationship

Answer 28

By assignment
By providing care
By giving advice
A word of caution – did you create a special relationship?

Question 29

Breach of Duty

Answer 29

Nurse fails to meet standards of care. Attorneys look to several sources of information to identify the standards of care and to determine what a reasonable and prudent (careful) nurse would have done in the situation.

Question 30

Causation

Answer 30

The breach of duty or deviation from acceptable standards of care by the nurse must be the direct and proximate cause of the injury suffered by the patient. Causation is usually established based on the testimony of experts, such as physicians, advanced practice nurses, or other healthcare professionals, who can clearly show the connection between the nurse’s action or omission and the resulting injury to the patient.

Question 31

Injury/damages

Answer 31

In civil cases, the remedy for the harm the patient suffered is money. The judge or jury will award the plaintiff money to compensate him or her for pain and suffering, lost wages, additional medical bills, and other losses. In some cases, the plaintiff may be awarded punitive damages for grossly negligent or wrongful behavior by the
healthcare provider.

Question 32

Common Malpractice Claims

Answer 32

Failure to assess and diagnose
Failure to plan
Failure to implement a plan of care
Failure to evaluate – observe for changes,
recognize significance of change, document
or report symptoms

Question 33

Potential Boundary Violations

Answer 33

Excessive self disclosure, flirtation, secretive behavior, “Super Nurse” attitude, excessive attention to client, unclear communication – only part of story is told, client seeks out one particular nurse

Question 34

Minimizing Malpractice Risk

Answer 34

PROPER DOCUMENTATION, observe standards of practice, use nursing process; follow professional standards, avoid medication and treatment errors, report and document accurately, obtain informed consent, attend to client safety.

Question 35

Guidelines for Documentation

Answer 35

Document immediately, or ASAP, never chart ahead, chart Chronologically, designate late entries, interventions – make sure you document symptom AND what you did about it, teaching, attempts to contact MD, discharge or AMA, document refusal of treatment or medications, use of restraints, complete medication documentation – 6 rights, accurate, objective, non-judgmental, avoid vague, subjective terms, approved Abbreviations only, if information is critical and it is what someone
else said, “USE quotes”

Question 36

FACTUAL –

Answer 36

mnemonic for charting, a third person should be able to read your documentation and form a mental picture of your client and the care provided
F – Factual and objective
A – Accurate
C – complete
T – Timely
U – always document unusual occurrences
L – Legal record