Presentation Transcript

1. Legal Implications in Nursing Practice

   Mr. Thilina Abeygunasekara B.Sc. Nursing (Hons)
2. Law “The sum total of rules & regulations by which a society is governed. As such, law is created by people & exists to regulate all persons” GUIDO, 2001
3. Functions of the Law in Nursing It provides a framework for establishing which nursing actions in the care of clients are legal. It differentiates the nurse’s responsibilities from those of other health professionals. It helps establish the boundaries of independent nursing action. It assist in maintaining a standard of nursing practice by making nurses accountable under the law.
4. Source of Law Laws are rules of conduct that are established by country’s government Three sources The Constitution and Bill of Rights Laws made by elected officials Regulations made by agencies created by elected officials
5. Sources of Law Constitutional law Legislation law (Statutory law) Administrative law Common law
6. Constitutional Law The supreme law of a country. Creates legal rights & responsibilities and a foundation of a system of justice. Constitutional law provide for basic rights and create legislative bodies.
7. Legislation law (Statutory law) Enacted by any legislative body The regulation of nursing is a function of state law
8. Administrative law It creates rules & regulations to enforce the statutory laws. comes from agencies created by the legislature.
9. Common Law Laws evolving from court decisions. Interpreting & applying the constitutional or statutory law.
10. Civil and Criminal Law Civil law Guarantees individual rights A tort is a violation of civil law Crime A wrong against society Imprisonment and/or fines may result if one is convicted of a crime
11. Judicial law results when a law or court decision is challenged and the judge affirms or reverses the decision
12. Nurse Practice Acts Define the scope of nursing practice Regulate the profession by a state’s board of nursing Include the definition of nursing for the RN and may include definitions for advanced practice nurses
13. Student Nurses Held to the same standards as a licensed nurse Legally responsible for their own actions or inaction Have responsibility to consult with instructor when unsure in a situation, or when patient's condition is changing rapidly Need to know their state’s nurse practice act
14. Professional Accountability Nurse’s responsibility to meet health care needs of patient in a safe and caring way Students must apply classroom learning and theory in the clinical setting Accountability entails a commitment to stay current and knowledgeable
15. Delegation The assignment of duties to another person LPN may supervise nursing assistants, technicians, or other LPNs Delegating nurse’s duty is to supervise and evaluate care that a licensed or unlicensed person provides
16. Standards of Care Provide a way of judging the quality and effectiveness of patient care In legal cases, determine whether a nurse acted correctly
17. Duty of Care Based on existence of the nurse-patient relationship A legal status created when the nurse is legally obligated to provide nursing care to a patient Law will demand that the nurse perform as a reasonably prudent nurse
18. Breach of Duty Nurse’s care fell below the acceptable Standard of Care Results: malpractice loss of nurse’s license loss of job / ability to work
19. Professional Discipline State boards of nursing are responsible for discipline within the profession Most common charges brought against nurses include substance abuse, incompetence, and negligence It is considered negligence not to report another professional’s misconduct
20. Continuing Education Many states have laws that require evidence of continuing education after a nurse has passed the licensing exam Nurses must continue their education to keep abreast of changes in health care practice, pharmacology, and technology in order to practice safely.

21. Licensure

22. Licensure Is a legal permit that a government agency grants to individuals to engage in the practice of a profession & to use a particular title. Nursing Licensure is mandatory
23. For a profession or occupation to obtain the right to license its members, it generally must meet 3 criteria: There is a need to protect the public’s safety or welfare The occupation is clearly delineated as a separate, distinct area of work. There is a proper authority to assume the obligations of the licensing process e.g. board of nursing
24. Grounds for Revocation of license Incompetent nursing practice Professional misconduct Conviction to a crime
25. Laws and Guidelines Affecting Nursing Practice Occupational Safety and Health Act Child Abuse Prevention and Treatment Act Discrimination Sexual harassment Good Samaritan laws Patients’ Rights National Patient Safety Goals Health Insurance Portability and Accountability Act Consents and releases
26. Occupational Safety and Health Administration (OSHA) Regulations on handling infectious/toxic materials, radiation safeguards, and electrical equipment Requires orientation and education in topics such as blood-borne pathogens, exposure, fire, bomb threats, lifting and evacuation procedures
27. Discrimination Making a decision or treating a person based on a class or group to which he belongs, such as race, religion, or sex, rather than on his individual qualities Illegal for employers to ask questions on an employment application that would indicate race or other protected categories, or health status
28. Sexual Harassment Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature Illegal when used as a condition of employment or promotion or when it interferes with job performance
29. Good Samaritan Laws Protect a health care professional from liability if he stops to provide aid in an emergency Liability is limited unless there is evidence of gross negligence or intentional misconduct
30. Patient’s Rights Seeks to preserve patient’s dignity, privacy, freedom of movement, and information needs State legislators have written laws that prohibit certain actions or guarantee particular rights
31. The Chart or Medical Record A legal document that includes records of all assessments, tests, and care provided Kept confidential Only people directly associated with the care of that patient have legal access to information in the chart Property of the hospital or agency or physician, not the patient
32. Consent Legal document that records the patient’s permission to perform a treatment or surgery, or to give information to insurance companies or other health care providers Informed consent Indicates patient’s participation in decision making Person signing must know what the consent allows and be able to make a knowledgeable decision
33. Release Legal form to excuse one party from liability Common release is a Leave Against Medical Advice (Leave AMA) May also refer to forms used to authorize an agency to send confidential health care information to another agency, school, or insurance company
34. Legal Liabilities in Nursing Practice Negligence Malpractice Tort Crimes
35. Negligence and Malpractice Negligence Failing to do something a reasonably prudent person would do, or doing something a reasonably prudent person would NOT do Malpractice Negligence by a professional person Not acting according to professional standards of care as a reasonably prudent professional would
36. Common Acts of Negligence Burns Objects left inside the patient’s body Falls of elderly Falls of children Failure to observe and take appropriate action as needed
37. Specific Examples Failure to report observations to attending physicians Failure to exercise the degree of diligence which the circumstances of the particular case demands Mistaken identity Wrong medicine, wrong concentration, wrong route, wrong dose
38. In order to prove that negligence or malpractice has occurred, circumstances must be present & must be proven in a court of law these are: Harm must have occurred to the individual One person must be in a situation where he had duty towards the person harmed The person must be found to have failed to fulfill his/her duties The harm must be shown to have been caused by the breach of duty.
39. Tort Definition A tort is a legal wrong, committed against a person or property independent of a contract which renders the person who commits it liable for damages in a civil action.
40. Examples Assault and Battery. The threat to harm another, or even to threaten to touch another without that person’s permission Battery is an intentional, unconsented touching of another person. False Imprisonment or Illegal Detention. Preventing a person from leaving, or restricting movements in the facility When involuntary admission is made against patient’s wishes, to protect him from self-harm or from harming others, he may be detained without consent for a short time
41. Defamation One person makes remarks about another person that are untrue, and the remarks damage that other person’s reputation Two types Slander (oral) Libel (written)
42. Crimes Crime defined It is an act committed or omitted in violation of the law.
43. Criminal Liability Nurse may incur criminal liability or subject herself to criminal prosecution either by committing a felony or by performing an act which would be an offense against person or property.
44. Common Legal Issues Nurses have access to private information and personal contact When legal boundaries are violated, and injury occurs, nurses may be subject to litigation
45. Invasion of Privacy A violation of the confidential and privileged nature of a professional relationship Unauthorized persons learn of the patient’s history, condition, or treatment from the professional caregiver Leaves patients in a position that might cause loss of dignity or embarrassment
46. Protective Devices The inappropriate use of devices that limit a person’s mobility can result in charges of false imprisonment Devices may be mechanical or chemical Physician order needed for any protective device
47. Telephone Orders Only in an extreme emergency and when no other resident or intern is available should a nurse receive telephone orders. The nurse should read back such order to the physician to make certain the order has been correctly written. Such order should be sign by the physician on his next visit within 24 hours.
48. Medical Records Supplies rich material for medical and nursing research Serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of the patient and his management. “if it was not charted, it was not observed or done”.
49. Continuation.. Nurses are expected to record fully, accurately, legibly and promptly their observations from admission to the time of the patient’s discharge. Nurses are legally and ethically bound to protect the patient’s chart from unauthorized person.
50. Charting done by Student Nurses When a nurse or clinical instructor counter signs the charting of the nursing student, he/she has personal knowledge of information and that such is accurate and authentic. Anyone who countersigns without verification commits herself to possible legal risks.
51. Restraint Policy Restraints are protective devices used to limit the physical activity of the client or part of the body. Purpose: is to prevent the client from injuring self or others.
52. Any order for Restraint & the Implementation of the Restraint order must be: In accordance with a written modification to the patient plan of care. Implemented in the least restrictive manner possible. In accordance with safe appropriate restraining techniques. Ended at the earliest possible time. documented.
53. Practice Guidelines for Restraint Application Obtain a consent Ensure the order is provided Assess the restraint every 30 minutes Release restraint at least 8 hours Never leave patient unattended if restraint is removed Provide emotional support
54. 5 Criteria before Selecting Restraint It restricts the client’s movement as little as possible It doesn’t interfere with the client’s treatment or health problems It is readily changeable It is safe for the particular client It the least obvious to others
55. Kinds of Restraints Jacket restraint Belt restraint Mitt or hand restraint Mummy restraint Elbow restraint Crib nets
56. Decreasing Legal Risk Nursing competence Incident or occurrence reports Liability insurance
57. Nursing Competence Possessing skill, knowledge, and experience necessary to provide adequate nursing care Documentation: key in proving nursing actions used were appropriate, protecting nurse from liability Lawsuits may be avoided by early identification of dissatisfied patients
58. Incident or Occurrence Reports Document occurrence that is out of the ordinary Document what happened, the facts about the incident, and who was involved or witnessed it Generally not filed as part of the patient’s chart; no reference to the incident report is made in the patient's chart
59. Liability Insurance Protects the livelihood and assets of a nurse should the nurse get sued Pays for lawyer to defend the nurse and any award won by plaintiff up to limits of the policy May also pay for attorney costs and related costs if the nurse is subjected to review by the state board of nursing

60. Risk Management

61. Patient Safety in Health Care “The degree to which the risk of an intervention & risk in the care environment are reduced for a patient & other persons, including health care practitioners” JCAHO 2003
62. Purposes of Risk Management The department focuses on identification & prevention of risk exposures within the organization that could: Cause injury to patient, visitors, & employees Jeopardize the safety & security of the environment Result in costly claims & lawsuits with subsequent financial loss to the organization
63. 2 main Areas of Risk Management Clinical Risk Management e.g. medical error Environmental Risk Management e.g. safety, security & preventive maintenance
64. Patient Safety Goals: Improve the process of Patient Identification Eliminate wrong-site, Wrong Patient & Wrong Procedure Surgery Improve the effectiveness of Communication among Caregiver Improve the Safety of High Alert Medications
65. 5. Improves Safety in Infusions Pumps 6. Reduce the risk of healthcare-acquired infections 7. Accurately & completely reconcile medications across the continuum of care 8. Reduce the risk of patient harm resulting from falls
66. Summery…..
67. Questions??
68. ThankYou !