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Unit 2

Unit 2. The Nursing Process. An orderly way of developing a plan of care for the individual patient. The Nursing Process. Five-Step RN Nursing Process. Assessment (Data Collection)‏ Diagnosis Planning Intervention Evaluation. Four-Step LPN Nursing Process. Assessment (Data Collection)‏

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Unit 2

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  1. Unit 2 • The Nursing Process

  2. An orderly way of developing a plan of care for the individual patient. The Nursing Process

  3. Five-Step RN Nursing Process • Assessment (Data Collection)‏ • Diagnosis • Planning • Intervention • Evaluation

  4. Four-Step LPN Nursing Process • Assessment (Data Collection)‏ • Planning • Intervention • Evaluation

  5. Role Differences Between RNs and LPN/LVNs • RN’s Role • Nursing diagnosis • Independent role in all process areas • LPN/LVN’s Role • No nursing diagnosis • Dependent role in some process areas • Independent role in some process areas

  6. LPN Nursing ProcessPhase 1: Data Collection • Systematic information gathering • Information verification • Information communication • Continuing data collection • Measuring and collecting data accurately

  7. LPN Nursing ProcessPhase 2: Planning • Assist RN in developing nursing diagnosis • Assist RN in developing outcomes • Assist RN in developing nursing interventions

  8. LPN Nursing ProcessPhase 3: Implementation • Nursing action • Maintaining patient safety • Teaching in support of RN’s teaching • Reporting and documenting

  9. LPN Nursing ProcessPhase 4: Evaluation • Assisting in determining patient progress toward meeting desired goals and outcomes • Communicating findings

  10. CHAPTER 2Legal and Ethical Aspects of Nursing

  11. Overview of the Legal System • Laws • Prescribe how a person should act in society • Sanction acceptable behavior and prohibit unacceptable behavior • Provide protection for all members of the health care system

  12. Overview of the Legal System • Criminal Law • Conduct in issue is offensive to society in general • Conduct is detrimental to society as a whole • Involves public offenses (ie, robbery, murder, assault)‏ • Law’s purpose is to punish for the crime and deter and prevent further crimes.

  13. Overview of the Legal System • Civil Law • Conduct violates a person’s rights • Conduct is detrimental to that individual • Involves an offense that is against an individual • Law’s purpose is to make the aggrieved person whole again, to restore them to where they were

  14. Overview of the Legal System • Two Ways Laws Are Established • Statutory Law • Developed by federal, state, and local governments • Common Law • Developed in response to specific legal questions brought before the court and usually follow precedent (previous rulings on an issue)‏

  15. Overview of the Legal Process • Civil Litigation • Lawsuit in a civil court • Begins when the plaintiff contacts an attorney • Plaintiff • The complaining party • Complaint • Statement by the plaintiff • Written and filed in the appropriate court • States the facts involved in the legal issues raised and outlines the damages

  16. Overview of the Legal Process • Defendant • States the facts involved in the legal issues raised and outlines the damages • The alleged person liable • Damages • Compensation sought by the plaintiff • Summons • Court order that notifies the defendant of the legal action

  17. Overview of the Legal Process • Answer • Detailed response to the charges outlined in the complaint • Usually prepared and filed by an attorney hired by the defendant • Will either admit or deny any or all of the allegations made in the complaint • Discovery • Pretrial process allowing both sides to interview witnesses and/or look at documents

  18. Depositions

  19. Overview of the Legal Process • Depositions • Out-of-court statements made by a witness under oath • Interrogatories • Written questions that must be answered in writing • Verdict • Decision made after the evidence has been presented • Based on the facts of the case, the evidence and testimony presented, the credibility of the witnesses, and the laws that pertain to the issue

  20. Overview of the Legal Process • Appeal • Request a review of the decision • May be filed by either party if they disagree with the outcome of the lawsuit • Criminal Trial • Defendant is arrested for a crime against the people. • People’s attorney and the defendant’s attorney present their cases in court. • The judge or jury then deliberates.

  21. Overview of the Legal Process • Deliberation • Decide the guilt or innocence of the defendant • Not Guilty Verdict • Defendant will be released from custody • Guilty Verdict • Sentence (penalty) will be decided based on the severity of the crime, the defendant’s past criminal record, and the applicable laws.

  22. Overview of the Legal Process • Liability • Legal responsibility • A nurse can be charged with civil or criminal liability depending on the particular circumstances surrounding the case.

  23. Negligence Slander Tort Common Legal Terminology (Review Box 2-2 p. 22)‏ • Abandonment of care • Assault • Battery • Competency • Defamation • Harm • Libel • malpractice

  24. Overview of the Legal Process • Legal Relationships • Accountability • Being responsible for one’s own actions • Legal Relationship • Nurse-patient relationship • When the nurse assumes responsibility for the patient’s care • Failure to provide care to the expected level of expertise gives rise to legal liability.

  25. Overview of the Legal Process • Legal Relationships • Advocate • One who will defend or plead a cause or issue on behalf of another. • The nurse accepts the role of an advocate for the patient. • A nurse advocate has a legal and ethical obligation to safeguard the patient’s interests.

  26. Overview of the Legal Process • Regulation of Practice • Standards of Care • Acts that are permitted to be performed or are prohibited from being performed. • Give direction to the practicing nurse, defining what should or should not be done for patients. • Every nurse is obligated to know and follow the established standards of care. • Failure to adhere to these standards gives rise to legal liability.

  27. Overview of the Legal Process • Regulation of Practice • Standards of Care • The legal test is what a reasonably prudent (wise) nurse of similar education and experience would have done under similar circumstances.

  28. Overview of the Legal Process • Regulation of Practice • Scope of Nursing Practice • Each licensed practical/vocational nurse must be familiar with his or her scope of practice. • The nurse CANNOT use ignorance as an excuse. • Every nurse needs to know what she or he can and cannot do while providing nursing care. • Nurse Practice Acts • Define and limit the scope of nursing practice

  29. Overview of the Legal Process • Regulation of Practice • Licensure • All licensed practical/vocational nurses must apply for licensure in the state in which they wish to practice. • Applicants are carefully screened. • Upon approval by the board, the applicant is eligible to take the computerized licensing examination at a testing center.

  30. Overview of the Legal Process • Regulation of Practice • Licensure • Once a license is granted, it can be suspended or revoked (taken away) for unprofessional, unethical, immoral, and/or criminal conduct. • Interstate Compact • Allows multistate practice of nursing • The nurse must be licensed in her or his home state, and privileges are then granted to practice in other states that have signed the interstate compact.

  31. Overview of the Legal Process • Legal Issues • Malpractice (Professional Negligence)‏ • Commission • Doing an act • Omission • Not doing an act • Legal action that a nurse may be charged with for failing to meet the standards of care

  32. Overview of the Legal Process • Legal Issues • Malpractice (Professional Negligence)‏ • Elements that must be present: • Duty exist: The nurse-patient relationship establishes a duty. • Breach of the duty: The nurse fails to perform the duty in a reasonable, prudent manner. • Harm occurs: This does not have to be physical injury. • Proximate cause: The breach of duty was the proximate cause of the harm.

  33. Overview of the Legal Process • Legal Issues • Malpractice (Professional Negligence)‏ • Malpractice insurance • The nurse may want to purchase individual coverage even if the employing institution carries insurance. • Personal malpractice insurance provides more protection for the nurse while off and on duty. • Most institutions’ policies cover only liability if the nurse is on duty and acting within the proper capacity.

  34. Overview of the Legal Process • Patients’ Rights • The Patient’s Bill of Rights • Developed by the American Hospital Association in 1972 • Goal is to promote the public’s understanding of their rights and responsibilities as consumers of health care.

  35. Overview of the Legal Process • Informed Consent • A person agrees to allow a particular treatment based on full disclosure of the facts needed to make an intelligent (informed) decision. • Consent must be obtained before any invasive treatment or procedure. • Patient needs to be aware of the benefits of the treatment, the risks involved, any alternative treatments, and the consequences of refusing the treatment.

  36. Overview of the Legal Process • Informed Consent • The patient has the right to accept or reject the proposed care. • Failure to secure informed consent may result in civil liability for battery. • Civil battery • Unlawful touching of a person; an intent to harm is NOT necessary.

  37. Overview of the Legal Process • Confidentiality • The nurse has a duty to protect information about a patient no matter how that information is received. • Failure to maintain confidentiality gives rise to legal liability, and legal remedies exist to address confidentiality breaches. • Health Insurance Portability and Accountability Act of 1996 (HIPAA) set rules and limits on who can look at and receive health care information.

  38. Overview of the Legal Process • Medical Records • Medical records are NOT public documents. • The information they contain must be guarded. • Records may be used by both parties in a lawsuit to argue facts of the case. • All entries in the medical record must be permanent, accurate, complete, and legible.

  39. Overview of the Legal Process • Invasion of Privacy • The right to be left alone and go unnoticed if the patient chooses • Legal liability may occur in • Exposing the patient’s body parts unnecessarily • Discussing the patient inappropriately • Disclosing information about the patient • Using any unauthorized patient information

  40. Overview of the Legal Process • Reporting Abuse • The law prescribes when a health care professional must report certain information to authorities (certain communicable diseases, gunshot wounds, signs of abuse). • The health care professional is protected from liability when acting in good faith. • Child Abuse Prevention Treatment Act of 1973 • Act made reporting of child abuse mandatory. • Health care professionals may face fines and/or imprisonment if they fail to report suspected cases of child abuse.

  41. Overview of the Legal Process • Practitioner-Assisted Suicide • Form of active euthanasia • The practitioner taking an active role in helping to end a patient’s life

  42. Overview of the Legal Process • How to Avoid a Lawsuit • Provide compassionate, competent nursing care • Nurse-patient relationship must be one based on trust and respect. • Use open and honest communication. • Follow the standards of care and adhere to the scope of practice for a licensed practical/vocational nurse.

  43. Overview of the Legal Process • How to Avoid a Lawsuit • Good Samaritan Law • Provides immunity from liability in certain circumstances • Encourages assistance in emergencies occurring outside of a medical facility by providing protection against liability • Proper documentation • Medical record is used to prove that the standards of care were met (or were not met). • “IF IT ISN’T CHARTED, IT WASN’T DONE.”

  44. Ethical Aspects • Development of Ethical Principles • Ethics • Values that influence a person’s behavior • An individual’s feelings and beliefs about what is right and wrong • Customs • Habits, ways of acting • Members of a family expected to behave in a certain way • Influenced by religious teachings

  45. Ethical Aspects • Development of Ethical Principles • Values • Personal beliefs about the worth of an object, idea, a custom, or an attitude • Develop over time and change as necessary • Influences behavior behavior and decisions • Learned through experience, observation, and reasoning • Values Clarification • The process of self-evaluation that helps a person gain insight into individually held values

  46. Ethical Aspects • Development of Ethical Principles • Ethical Dilemmas • Situations that do not have a clear right or wrong answer • Identify the problem. • Assess the situation completely. • Consider any ethical principles that might apply.

  47. Ethical Aspects • Ethical Principles • Respect for Persons • All human life is sacred. • No one person is more important than another. • Each patient has the same worth as another and is always entitled to respect. • Autonomy • Personal freedom of choice • A right to be independent and make decisions • Nurse does not have the right to make decisions for the patient.

  48. Ethical Aspects • Code of Ethics • Serves as a way to regulate the actions of nurses and gives guidelines for ethical behavior • Promote competent, trustworthy, and accountable health care practitioners in order to safeguard society

  49. Ethical Aspects • National Federation of Licensed Practical/Vocational Nurses Code of Ethics • Know and function within the scope of practice for an LPN/LVN • Maintain patient confidences • Provide health care without discrimination • Maintain a high degree of professional and personal behavior • Take an active role in the development of the LPN/LVN profession

  50. Ethical Aspects • Reporting Unethical Behavior • Unethical behavior • Failing to perform the duties of a competent, caring nurse • Each member of the nursing profession has a duty to report behavior that does not meet the established standards. • Follow the proper chain of command • Explain the facts as clearly as possible • Documentation of the incident: objective, accurate, when and where, other pertinent facts

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