Sunday, June 12, 2022 ADN 151 Chapter 7 Subject - What is the de nition of law? • Standard or rule of conduct established and enforced by government designed to protect the rights of the public • Public law: regulates relationships between people and the government - Criminal law: a type of public law; de ne criminal actions such as murder, manslaughter, criminal negligence, illegal possession of drugs, etc. • Private law (civic law): regulates relationships among people; like contract, ownership, the practice of nursing, medicine, etc. - What are the 4 sources of laws? • Exist at both federal and state level • Constitutions law: relatively few constitutional laws, guides to legislative bodies • Statutory law: enacted by legislative body; in keeping with both federal and state constitution; nurse practice acts are an example of statutory laws. • Administrative law: empowered by executive o cers who administer facilities, they make the administrative rules and regulations that act as laws and are enforceable; boards of nursing are administrative facilities at the state level, and the rules and regulations they adopt are administrative laws. • Common law (court-made law): judiciary system reconciles controversies, creates a body of common law; most law involving malpractice is common law; based on stare decisis (“let the decision stand”); the case that rst sets down the rule by decision is called a precedent; court decision can be changed with strong justi cation. - Trial court ( rst-level court) —> appellate court (become common law) - What are the professional and legal regulations of nursing practice? (Table 7.1) fi ffi fi fi fi fi 1 • State’s Nurse Practice Acts: made by National Council of State Boards of Nursing (NCSBN); de nes practice limits with list of violations; intend to prevent untrained or unlicensed people from practicing nursing • Four sources of rules are Federal legislation, State legislation, Board of nursing, and Health care institution • Voluntary standards: developed and implemented by the nursing profession itself, used as guidelines for peer review • Legal Standards: developed by legislature and implemented by authority granted by the state; examples are State’s Nurse Practice Acts and Rules and Regulation of Nursing fi 2 • Three processes of credentialing: accreditation(programs), licensure (license candidates by states standards), and certi cation (by nongovernmental association) - What is a crime (罪⾏)? • A wrong against a person or the person’s property as well as the public; a violation punishable by the state • More serious o ense, with more legal implications, than a tort. • Criminal law is public law in most cases statutory law, less cases common law. - Example of common law are informed consent and the right to refuse treatment. • Misdemeanors (轻罪): less serious crime, commonly punishable with a ne, imprisonment for less than 1 year, or both, or with parole • Felonies (重罪): examples are rape, murder; imprisonment in state or federal penitentiary for more than 1 year. - What is a tort (侵权⾏为)? • A wrong committed by a person against another person or that person’s property; tried in civil court; subject to action in a civil court with damages usually being settled with money - Intentional torts or unintentional torts - What are intentional torts? • Have knowledge of the permitted legal limits but still act against it. • Some intentional torts for which nurses may be held liable includes: - Assault and battery • Assault is attempted violence; battery is the violence itself. • Assault is a threat or an attempt to make bodily contact with another person without the person’s consent. • Battery is an assault. Any willful and unlawful use of force or violence upon the person of another. fi fi ff 3 • An adult patients who are alert and orientated have the right to refuse any treatment • Can’t perform the treatment without the consent of the patient even though the treatment is desirable. - Defamation of character (诽谤) • Hurting someone's reputation or character by making fraudulent statements regarding that person. • Slander: spoken defamation • Libel: written defamation - Invasion of privacy • HIPPA is adopted to protect the patient’s privacy - What are unintentional torts? • Harm is not intended, but harm results. • Negligence: failing to perform an act that a reasonably prudent person under similar circumstances would do or would not do; omission or commission • Malpractice: Negligence by professional personnel - Failure to follow standards of care - Failure to use equipment in a responsible manner - Failure to assess and monitor - Failure to communicate - Failure to document - Failure to act as a patient advocate or to follow the chain of command - Proof of malpractice: duty, breach of duty, causation, and damages - What are the three outcomes of malpractice litigation? • All parties work toward fair settlement. • Case is presented to malpractice arbitration panel. • Case is brought to trial court. 4 - What are the patient’s rights under the HIPPA? • To see and copy their health record • To update their health record • To request correction of any mistakes • To get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations. • To request a restriction on certain uses or disclosures • To choose how to receive health information - When can we disclose a patient’s health information? (Box 19-2 in Chapter 19) • With the patient’s authorization for purposes other than treatment, payment, and routine health care operations. • Authorization is not required prior to releasing the patient’s health information(PHI) for public health activities, law enforcement and judicial proceedings, and deceased people. • Incidental Disclosure of PHI is de ned as a secondary disclosure that cannot reasonably be prevented, is limited in nature, and occurs as a byproduct of an otherwise permitted use or disclosure of PHI. Examples are sign-in sheets, calling out names in the waiting room, lacing patient charts outside exam rooms, etc. - What are three roles of nurses in legal proceedings? • Defendant, fact witness, or expert witness • Recommendations for Nurse Defendant: - Do not discuss the case with those involved in it. - Do not alter patient records. - Cooperate fully with your attorney. - Be courteous on witness stand. - Do not volunteer any information. - What are the legal safeguards in nursing practice? fi 5 • Competent practice: most important and best legal safeguards - Developing interpersonal communication skills - Respecting legal boundaries of practice - Following institutional procedures and policies - Owning personal strengths and weaknesses - Evaluating proposed assignments - Keeping current in nursing knowledge and skills - Respecting patient rights and developing rapport with patients - Keeping careful documentation - Working within agency for management policies • Informed consent or refusal - Needed for admission, each specialized diagnostic or treatment procedure, and for any experimental treatments or procedures - Must be written and signed (not needed in an emergency) - Use family member to translate is rarely acceptable - Elements of informed consent and obtaining the consent include: • Disclosure (nature of the procedure, risks, alternatives, and fact that no outcomes can be guaranteed), • Comprehension (patient/surrogate can correctly repeat in his or her own words that for which the patient.surrogate is giving consent) , • Competence (understands the information needed to make the decision), and • Voluntariness (choice being made of a person's free will) • Contracts - implied contract with the patient • Collective bargaining (like union) • Patient education - Document the teaching plan in care plan, also the patient’s response 6 • Executing physician orders - Verbal and telephone orders should be countersigned within 24 hours - Question any order that is ambiguous, contraindicated by normal practice, contraindicated by the patient’s present condition • Delegating nursing care • Documentation • Appropriate use of social media • Adequate sta ng • Whistle-blowing laws • Professional liability insurance • Risk management programs • Just culture - Encourages open reporting of errors, recognized that errors may be systemic rather than personal failures, and focuses on determining the root go the problem - Human error (unintentionally), at-risk behavior (cut-corner), and reckless behavior (disregard safety) • Incident, variance, or occurrence reports, Sentinel events, and Never events - Incident Reports (异常事件报告) • Information contained in incident reports - Complete name of person and names of witnesses - Factual account of incident - Date, time, and place of incident - Pertinent characteristics of person involved - Any equipment or resources being used - Any other important variables - Documentation by physician of medical examination of person involved ffi 7 - Sentinel event (医疗事故): an unexpected occurrence involving death or serious physiological or psychological injury, or the risk thereof - Never event: Medical error should never happen to a patient • Patients’ rights - The Patient Care Partnership: high-quality hospital care, a clean and safe environment, involvement in your care, protection of your privacy, help preparing you and your family for when you leave the hospital, help with your bill and ling insurance claims • Good Samaritan laws - Protect health care providers when they give aid to people in emergency situations • Student liability - Same as an RN - What are the laws a ecting nursing practice? • Occupational Safety and Health Act • National Practitioner Data Bank, Health Care Quality Improvement Act of 1986 • Reporting Obligations, mandated reporter of abuse • Controlled Substances • Discrimination and Sexual Harassment • Health Insurance Portability and Accountability Act (HIPPA) • Restraints, Nursing Home Reform Act of 1987, right to be free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat medical symptoms; attention to false imprisonment • 1990 Americans with Disabilities Act (ADA) • Wills • Legal Issues Related to Dying and Death - Advance directives - Do-not-resuscitate (DNR) fi ff 8 - Assisted suicide - Direct voluntary euthanasia - Organ donation - Autopsy - Inquest - What is voluntary consent? • The person decides whether to consent to treatment. • Example: I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost. - How do we obtain consent? - How to avoid legal con icts? • Document the actions clearly and carefully • Develop trusting nurse-patient relationships (satis ed patients rarely sued) • Nurses are less likely to be sued than other healthcare professional because we spend more time to take care of the patients and answer their questions • Practice within the scope of competence • Identify potential liability and work to prevent malpractice accusations. fi fl 9