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NURS 2210 Roles II: Unit II

NURS 2210 Roles II: Unit II. Legal and Ethical Concepts Nancy Pares RN, MSN Metro Community College. http://www.youtube.com/watch?v=n5Zw4ZARvNg. Obj 1: Review legal standards. Laws define and limit relationships Sources of public law Constitutional Administrative Criminal Civil Law

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NURS 2210 Roles II: Unit II

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  1. NURS 2210 Roles II: Unit II Legal and Ethical Concepts Nancy Pares RN, MSN Metro Community College

  2. http://www.youtube.com/watch?v=n5Zw4ZARvNg

  3. Obj 1: Review legal standards • Laws define and limit relationships • Sources of public law • Constitutional • Administrative • Criminal • Civil Law • Contract • Tort • Protective/reporting

  4. Tort law • State • Unintentional torts • Negligence • Duty • Breach of Duty • Injury • Causation • Malpractice

  5. Intentional Torts • Assault • Battery • False imprisonment • Restraints (OBRA) • Invasion of privacy • Defamation • fraud

  6. Legal responsibilities of RN • Defined by Practice Acts and Standards of Care • RN is legally responsible to ensure that the client receives competent, safe and holistic care. • Best Defense • Actively participate in NNA • Attend continuing ed on legal issues • Call State Board with any questions about practice • Stay current in hospital policies and procedures

  7. Responsibilities • Unprofessional conduct • Impaired Nurse • Safety • Understaffing • Mandatory overtime • Reassignment • Executing prescribed orders

  8. Other legal issues • Whistle blowing • Nursing students • Professional liability insurance • Advance Directives

  9. Legal issues related to death • DNR orders • Euthanasia • Wills • Pronouncement of Death • Care of the deceased • Organ donation • autopsies

  10. Obj 2 Review ethical principles • Ethics • Study of rightness of conduct • Vs. morality? • Relationship between ethics and legal • Ethical opinions reflect individual differences • Human behavior and motivation are too complex to be accurately reflected in law • The legal system judges action rather than intention • Laws change according to social and political influences

  11. Ethical vs. Legal…or both • Working in a clinic that performs abortions • Honoring a terminally ill client request for no heroic actions • d/c a comotose client life support at the request of the family • Diverting meds from a client for your own use

  12. Ethical Principles • Autonomy • Beneficience • Confidentiality • Double effect • Fidelity • Justice • Nonmaleficence • Paternalism • Sanctity of life • veracity

  13. Basics of nursing ethics • Human caring should guide the practice • Confidentiality • Privacy, misuse of information • Restraints • Trust • Refusing to provide care • Food and fluid

  14. Preventative ethics • Nancy Cruzan • Terri Shiavo

  15. Code of Ethics (pg 31 Brunner) • Practice with compassion and respect • Nurses primary commitment is to the patient • Nurse advocates, protects the patient • Nurse is responsible and accountable for actions • Nurse must maintain competence and professional growth • Nurse participates in improving health • Nurse contributes to profession thru community, educational and social situations

  16. Case 1 • Dx: missed abortion—client hospitalized, D&C was scheduled—client discussed with MD • Nurse administered preop meds then noted that there was no consent signed. Surgery was postponed awaiting MD. MD arrived and had pt sign and husband also-witnessed by RN. • Procedure resulted in perforation, OB attempted to repair—called in general surgeon-- required removal of 1 ft of bowel • Result: likely to have higher incidence of SBO

  17. Issue: • Was the hospital liable to obtain informed consent?

  18. Case 2 • 1985- Nurse Midwife advertised ‘Family Birth’ • Hospital Chief of Staff – OB wrote a letter to the administration of two hospitals stating that home deliveries were being done without qualified supervision. • Same MD confronted nurse midwife at L&D • Nurse midwife was prohibited from the hospital.

  19. Issue • Was the slander actionable?

  20. Case 3 • Client with fx leg—cast applied; orders to have nursing check hourly and call with concerns • Charting notes gap from 4am to 830 am. • MD examines at 830—compartment syndrome and identification of tissue death—leg amputated

  21. Issue • Was documentation considered substandard and cause for patient to suffer injury?

  22. Case 4 • Female patient admitted to LTC—noted large diamond ring and informed that she should not keep in her room. Pt kept the ring. • Ring disappeared—investigation proved fruitless—thru a ‘tip’ a nurse aid was implecated—arrested and pled guilty

  23. Issue: • Was the nursing home responsible for the property damage sustained by the resident?

  24. Case 5 Male was admitted to psych unit on Nov 21due to being a threat to himself and others. Meeting held on Nov 23 determined that he was able to be released. (Thanksgiving holiday) Male entered house on Dec 5 and killed one individual and wounded two others, then shot himself.

  25. Issue • Was the institution liable for discharging the patient and the subsequent deaths?

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