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Legal and Ethical Issues

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Tammi Elford

on 22 August 2016

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Transcript of Legal and Ethical Issues

Ethical Decision-Making
Nurses use problem solving to provide care
“Failure to perform duties or activities with due diligence and attention or to meet the standards of regular care.”
Intentional Torts
assault-act that involves a threat or attempt to do bodily harm. Includes physical intimidation, verbal, or gestures that lead someone to believe that injury may be forthcoming.
Legal and Ethical


Legal/Ethical Dilemma
Laws are rules of conduct enacted and enforced by governments. Laws help protect people. Legal responsibilities are based on laws. All people have legal responsibilities, such as following traffic rules and paying taxes. Health care workers have specific legal responsibilities that help protect their patients, themselves, and their employers.

Overview of Legal & Ethical Issues
Laws are written rules for conduct and actions.
Ethics are moral principles and values that guide the behavior of honorable people.
Professional Status of nurses
Privacy and Confidentiality
Principles and concepts of ethics
Morals vs. Ethics
Human Rights vs. Code of Conduct
Ethics and Law
Laws versus Ethics
Privacy and Confidentiality
Basic Rights
Related to
"A Judge made a finding of unprofessional conduct against member XXX who submitted a fraudulent sick note to her employer who on night shift left on a break at around 0515 and failed to check on her patients after that time; failed to report on her patients to the charge nurse or the oncoming shift before leaving at the end of her shift; and failed to chart adequately on her patients for that shift..."
"A Judge made a finding of unprofessional conduct against member XXXXX who on one occasion took photographs of the patient without her consent or consent on her behalf, took inappropriate photographs of the patient and had the photographs sent to her personal Hotmail address so they could be printed. The photos were taken to place on the patient's chart for the information of the physician..."
Statutory Law
local, state, or federal legislative body enacts

1. Respect for Autonomy
client's right to self-determination or the freedom to make choices without opposition.

2. Beneficence
obligation to not cause harm to another; To do "good" towards others.
foundation of nursing and medical ethics

3. Justice
treatment that is fair, due or owed; idea that everyone has certain rights.

4. Fidelity-duty to maintain commitments of professional obligations and responsibilities.

5. Veracity-duty to tell the truth.
Principles of Deontology
The tradition and principles of Deontology allow us to take consistent positions on issues...
Battery-actual physical contact with another person without that person's consent.
(Ross-Kerr & Wood, 2011b)
Is there a situation that justifies limiting a prson's autonomy "for their own good"?
1. Informed Consent
2. Right to make decisions related to death referred to as Self-determination
3. DNR Orders

Code of Ethics
defined by the profession through the association and serves to inform members of that profession and society, about the professions expectations in ethical matters
CNA Code of Ethics
serve as rules of conduct
guide actions and interactions within a society
are regulated by authorized organizations and law officers
Deal with right and wrong
consider beliefs about morals and values
do not have a formal enforcements system
1-defendant must owe the plaintiff a duty of care
2-duty of care was breached
3-breach caused injury
4-breach of duty resulted in damages5-defendant must not be able to raise any defense to plaintiffs’ claim
Elements of a claim...
Nurse practice act regulate the practice of nursing to protect the health and safety of citizens.
define the scope of practice
establish requirements for licensure and licensure and entry into practice.
create a board of nursing to oversee nursing practice
identify legal titles for nurses, such as registered nurse and licensed practical nurse
determine what constitutes grounds for disiplinary action

primary responsibility is to protect the public
approving nursing education programs in the state, forming criteria for granting licensure, overseeing procedures for licensure exams, issuing or transferring licenses, and implementing disciplinary procedures.
State Board of Nursing
-A fundamental right
-Basic requirements for consent:
must related to the treatment
must be informed
must be given voluntarily
patient must have the capacity to consent to the proposed treatment
primary purpose of creating health records is to facilitate communication among the HCPs in treating a patient
a legal document
if it wasn't charted, it wasn't done!
Write legibly
record what you PERFORMED, SAW & HEARD, Promptly!
Use only standard abbrev.
Do not leave vacant lines
Sign every entry
Keep charting free of criticism or complaints
Make no mention of an incident report (separate form)
Do not destroy or attempt to obliterate documentation
Part of our Code of Ethics
By not upholding this, a nurse may be subject to allegations of professional misconduct
Questions to ask yourself
How do you know who really needs to know the patient information?
Who are you legally allowed to share it with?
Is consent required when sharing with other HCPs?
Federal Patient Self-Determination Act of 1990 mandates that all federally funded medical facilities inform patients of their right to have Advanced Directives.
provides opportunity for client to determine wishes in regards to life sustaining treatment, so family will know what to do.
2 types: 1. Living will-states clients wishes regarding health care if terminally ill. 2. Medical Durable Power of Attorney- the person you appoint has the authority to make decisions for you if you are incapable.
DNR- means do not resuscitate....
Advanced Directives
*Lines are a little fuzzy on what is right and wrong in todays world. But one thing stands true. It will remain constant in the medical field.
*Ethical standards dictate the rightness or wrongness of human behavior.
*Issues related to competence, safety, optimal care, protecting clients' rights, and practicing according to professional standards of care are of most concern to nurses.

Criminal Law
One type of law that affects health care workers is criminal law. Criminal law protects all citizens from people who pose a threat to society.

When a criminal law is broken, the government, or plaintiff, brings charges against the alleged offender, or defendant. Criminal law includes minor to serious offenses. These offenses may result in the following punishments:
Community service
Fines paid to the government
Loss of license
Examples of criminal offenses committed by health care workers may include falsifying medical records, insurance fraud, practicing without the required license, misuse of drugs, stealing of drugs, abuse, and murder.

Civil Law

*Tort-injury that occured because of another person's intentional or unintentional action or failure to act. Can be physical, emotional, or financial. May have to pay restitution for damages.
False imprisonment-healthcare workers physically or chemically restrain an individual from leaving a healthcare institution.
AMA-Against Medical Advice-if a client wishes to leave the facility against medical advice.
Invasion of Privacy-persons have the right to expect that they and their property will be left alone. Examples?
Defamation-act that harms a person's reputation and good name. Slander- oral. Libel- written and read by others.
professional negligence. Referring to harm that results from a licensed person's actions or lack of action. Example?
Good Samaritan Laws
Statue of limitations
designated time in which a person can file a lawsuit.
Risk Management IS
responsible for reviewing all the problems that occur at the workplace, identifying common elements and developing methods to reduce risk of occurrence.
Incident report is a primary tool - document when an incident occurs that result in harm. Id's who, what, when, where, and when. Records witnesses and what action were taken and clients condition. Its a means to collect data.
1. obtain as much info as possible. Id the problem and describe. Determine what values are involved.
2. List all possible options for solving the dilemma; Brainstorming
3. Examine the pros and cons
4. Make the decision and follow through on it.
5. Evaluate the outcome in terms of effects and results.
Ethics Committees
Patient Self Determination
Knock, knock...
who's there?...
HIPAA who?
...sorry, I can't tell you!
Ombudsman-purpose of the program is to protect the rights of frail, elderly, and disabled citizens who may not be able to speak for themselves.
its a person with legal training who supports the health, welfare, safety and rights of residents in term car facilities.
5 Tips to Avoid HIPAA Violations
1. Avoid unauthorized access to patient information. As a health care professional, snooping into medical records is easy to do whether the records are stored electronically or in a paper format. Unauthorized access and use of Protected Health Information (PHI) is a serious offense, and these cases are often caught.

2. Avoid the improper use of the internet. Do not post anything with patient information on social-media sites. No matter how innocuously uploaded, it is a violation of privacy that is prohibited and subject to prosecution. Avoid posting pictures of a patient performing breathing treatments, or posting surgery schedules, or even selfies with a patient.

3. Avoid conversations about patients. This is most commonly done in the break room or in the elevator. However done, it is subject to criminal punishment. Not all members of the healthcare team need information regarding a patient. Being overheard discussing PHI is a grave offense. Train yourself and your staff not to discuss PHI within earshot of other patients or non-staff members.

4. Avoid leaving patient information unattended. Often times, as healthcare professionals, walking around with pertinent patient information is necessary. However, never leave this information unattended. Do not ‘temporarily’ set the information on a table, cart, workstation, etc.

5. Avoid throwing records in a public trash bin. If you need to discard patient records, do so by shredding the document and not just simply throw it away in a trash bin. Facilities have been equipped with designated protected bins that will shred all records.
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