Legal, Ethical Nursing
Legal
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Not the same as ethical - can go to harassment which then turns legal
Laws (NPA) vs. guidelines (code of ethics)
Duty
Breach of duty
Injury - emotional
Causation - is there a connection between breach of duty and injury
Duty, breach of duty and injury all have to be present in a lawsuit
NPA (legally binded) vs code of ethics - not legally binded
SOC - standard of care
Never tell a pt you have liability insurance
If there is an error made, never write in the chart
○ You chart the facts only, the explanation goes on the incidence report - not in pts
chart, follow hospital protocols, notify physician/take care of patient, notify
supervisor/manager - then hospital risk manager
● Liability - smart to get liability insurance (2 types)
● Civil law - person vs person
● Criminal - person vs sate
● Administrative - BON
● Megace or small dose of insulin can stimulate appetite
● Good samaritan law
○ Nurses role out of hospital is limited
○ When EMS arrives they are in charge, does not matter how much experience the
nurse has, if EMS says they have it covered- move out of the way
○ Nurses do not have to stop at a wreck, but once you stop you have to stay until
you turn patient care over to EMS
○ Provide care at the level within your scope of practice - covered
○ Without your scope of practice you are not covered
○ EMS cannot do anything in the ED unless asked or emergency
Most frequent problems
● Abandonment - refused to care for patient
● Floating - acceptable for hospitals, make sure they know what you don’t know
● Short of staff
● Respondeat superior - keep informed
○ Your superior also has to answer for your actions
● Failure to communicate
● Actions on license
○ Negligence - you omitted to do something you should have done
○ Malpractice - within the area of nursing and do something that is not correct
○ Informed consent - drs. Responsibility if surgery, all the nurse does is witness
signature
○ Failure to communicate
Ethical
● Reasoning
● Advocate - make sure patient voice is heard weather you agree or not
● right/wrong
● Not legally binding
● To prevent being in a lawsuit (can't prevent it)
● Before you can sue, you must have to attempted to settle with hospital lawyer first
Special populations
● People of color (racial and ethical minorities)
● Uninsured
● Living in poverty
● homeless/foster homes
● Those with chronic diseases
● Immigrants
● Refugees
● Limited english proficiency
● Persons incarcerated
● LGQBT
Influence for nurses
● Elicit client’s perspective based on cultural preferences
● Group share dominant characteristics
● Avoid stereotyping
● Minority will become majority in US
● More health care disparities in minorities
● Ethic minorities report hesitancy because of language barrier
● Lack of communication with HCP can affect safety and follow up
African Americans
● 50% have chronic conditions
● Obesity, diabetes
● Some without insurance or regular source of health care
● 35% hae chronic conditions
● Obesity, DM, end stage renal disease
LGQBT
● Wide variety of age, race, socioeconomic status and identity
● Stigma and discrimination is reason for being called special populations
● Lack of awareness and understanding among HCP causes less access to health care
compared to other populations
● Less likely to have family member support
● Less benefits such as spousal death benefits
● Use opened ended questions and do not judge
Homeless
● Non Judgemental, non-threatening approach
● Focus on symptoms first (will encourage follow up)
● Care to include management social problems, mental health as well as determining
emergency contact
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Risk of poor nutrition, sleep deprivation, violence, trauma (physical/emotional) and
exposure to toxic agents
● Poor hygiene, prolonged standing/working, sun exposure
Prisoners
● Environment predisposes to different health conditions such as TB, HIV, STIs, and other
conditions
● Rape is common
● Risks are asthma, DM, HTN, heart disease, mental disease
Verteras
● Mental health/ behavioral adjustment disorders
● Substance use disorders
● PTSD - may or may not be treated
● TBI
● Disfigurements and amputation
Religion
● 5 main ones
○ Christianity - no restrictions, personal preferences
■ Amish, catholic, mormons, protestent, baptist
○ Islam
■ Ramadan - fast during daytime (exempt in hospital if ordered by doctor)
■ Pork, birds of prey, alcohol and meats not religiously slaughtered is
prohibited
■ Can be forgiven if dr says to eat it
○ Judaism
■ Kosher laws (religiously slaughtered)
■ Don’t circumcised in hospital
■ Meats from animals that eat veg, cloven - hoofed animals and religiously
slaughtered
■ No combination of meat and milk
■ No fish and milk on same tray
○ Hinduism
○ Buddhism
Asians
● Increase BP
● Thalassemia
● Lactose imbalance
● Cancer
● Heart disease
Hispanics
● Parasites
● Obesity
● DM
● HTC
● Lactose imbalance
Nurse Interaction
● Treat with respect
● Be aware of different beliefs about health, illness, and treatment
● Ex - some believe illness is necessary in order to pay for sin and go to heaven
Unique practices r/t health
● AA may engage in PICA when pregnant
● Amish - don't usually have health insurance
● Asains - don’t touch others while talking and eye contact is disrespectful
● Hispanics - expressing negative feeling is disrespectful
● NA - massage on newborns to promote bonding and they honor elders
● White - man is usually dominant figure
Jehovah witness
● No blood products, will accept organ donation but has to be drained from all blood