chapter 23 legal accountability and responsibilities fundamentals of nursing: standards &...
TRANSCRIPT
Chapter 23
Legal Accountability and Responsibilities
Fundamentals of Nursing: Standards & Practices, 2E
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Legal Foundations of Nursing
The word law is derived from an Anglo-Saxon term meaning that which is laid down.
Public law deals with an individual’s relationship to the state.
Civil law deals with relations between individuals.
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Sources of Law
Public Law• Statutory law - laws enacted by
legislative bodies• Administrative law - governmental
administrative agencies who are entrusted with enforcing statutory laws
• Criminal law - acts or offenses against the welfare or safety of the public
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Civil Law• Contract law - the enforcement of
agreements among private individuals• Tort law - the enforcement of duties
and rights among individuals independent of contractual agreements: malpractice, negligence, assault, battery, false imprisonment, invasion of privacy, defamation, fraud
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Legal Liability in Nursing
When a nurse fails to meet the legal expectations of care, the client can initiate action if harm or injury is incurred by the client .
Liability is an obligation one has incurred or might incur through any act or failure to act.
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Negligence and Malpractice
Malpractice refers to the behavior of a professional person’s wrongful conduct, improper discharge of professional duties, or failure to meet the standards of acceptable care, which results in harm to another person.
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Negligence (breach of duty) is the failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance.• When a nurse commits a negligent act
that results in injury, it is known as malpractice.
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Assault and Battery
Assault is a stated intent to touch a person in an offensive, insulting, or physically intimidating manner.
Battery is the touching of another person without the person’s consent.
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Because assault and battery deal with acts of touching, the client’s cultural values, beliefs, and practices must be respected by the nurse.
Informed consent is essential to avoid assault and battery.
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Informed consent• A consent is a voluntary act by which
a person agrees to allow someone else to do something.
• Informed consent means that the client understands the reason for the proposed intervention and its benefits and risks, and agrees to the treatment by signing a consent form.
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• Consent forms must be signed for all invasive (accessing body tissues, organs, or cavities through some type of instrumentation) procedures.
• The health care provider can not coerce the client to sign the consent.
• Parental or guardian consent should be obtained before treatment of a minor.
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• The physician cannot delegate the responsibility for obtaining informed consent.
• The nurse could be held liable on a battery claim if the nurse knows the client has not given informed consent.
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• The nurse may witness a client’s signing of a consent form or may be responsible for making sure the signed form is in the chart.
• When the nurse discovers circumstances that render a signed consent form invalid, the nurse should notify the physician.
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False Imprisonment
False imprisonment occurs when clients are made to believe they cannot leave a place.
False imprisonment includes use of restraints (physical or chemical) and seclusion.
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• Restraints are legal only if they are necessary to protect the client or others from harm.
• If a competent client refuses to follow orders and the nurse uses restraints, the nurse can be charged with false imprisonment and/or assault and battery.
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• In an emergency situation when a client becomes violent and is in danger of harming him- or herself, the nurse may apply restraints and then immediately obtain an order from the physician.
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• The law mandates that the use of restraints or seclusion must have a physician order.
• The nurse is legally accountable for the client in restraints or seclusion.
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Invasion of Privacy and Confidentiality
State laws respect the privilege doctrine guaranteeing that no one will reveal confidential information without the client’s permission.
The client’s permission is needed before disclosing any information regarding the client, going through the client’s personal belongings, performing procedures, and photographing the client.
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Defamation
Defamation occurs when information is communicated to a third party that causes damage to someone else’s reputation, either in writing (libel) or verbally (slander).
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Fraud
Fraud results from a deliberate deception intended to produce unlawful gain.
Examples of fraud include obtaining and using false credentials, falsifying medical records, and illegal billing practices.
The Federal False Claims Act protects an employee who experiences any type of retaliation for reporting fraudulent practices.
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Safety
There are several areas regarding client safety in which nurses are at legal risk• Failure to monitor client status• Medication errors• Falls• Use of restraints• Use of medical equipment
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Understaffing
Understaffing refers to failure of a facility to provide a sufficient number of professional staff to meet client needs.
Reassignment (floating):• Floating is an acceptable, legal practice.• Legally, nurses cannot refuse to float.• Nurses who are required to float should
receive orientation before reassignment.
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Executing Prescribed Orders
In accordance with nurse practice acts, nurses are obligated to follow the orders of a licensed physician or other designated health care provider unless the orders would result in client harm.
The nurse has a legal responsibility to the client to ensure that the order is clear and appropriate to the client’s treatment.
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The Impaired Nurse
An impaired nurse is habitually intemperate or is addicted to the use of alcohol or habit-forming drugs.
If a nurse suspects a co-worker is abusing chemicals, the nurse has a duty to report the individual to nursing administration who, in turn, notifies the board of nursing.
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Legal Responsibilities and Roles of Professional Nurses
Provider of serviceExpert witnessForensic specialistReporting responsibilities
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Legal Responsibilities of Students
Nursing students must act as reasonably prudent persons, equivalent with education and experience, when performing nursing duties.
When employed as caregivers, nursing students must perform only those tasks that they are competent to perform, as stated in their job description.
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Legal Safeguards for Nursing Practice
Institutional policiesProfessional liability insuranceRisk management programsIncident reportsClient educationAdvance directives
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Legislation Affecting Nursing
AbortionThe Americans with Disabilities ActGood Samaritan actsNational Practitioner Data BankOccupational Safety and Health Act
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Do not resuscitate orders Euthanasia Wills Pronouncement of death Care of the deceased Organ donation Autopsies