legal aspect of nursing
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Legal Aspect of Nursing
Objectives By the end of the lectures students should
be able to explain and discuss:
1. Standards that govern nursing care
2. The Law and how it governs nursing/midwifery
3. Conduct of students
Standards of Care Guidelines for nursing/midwifery practice Average degree of skill, care and diligence
exercised by members of the same profession under the same or similar circumstances
If standards does not met this level is negligence-incompetence or gross negligence
Yard stick by which the legal system measures the actions of a nurse in a malpractice suit
Protects patients from inferior care
Standards CONT’D If nurse /midwives do not perform their
duties within accepted standards of care they place themselves in jeopardy of legal action and also place their client’s at risk for harm or injury
Definitions Standards of professional performance-
activities such as continuous quality improvement, education, research,ethics and peer review
Standard is an authoritative statement Guidelines suggest or recommend
practices by which standards of care can be met-do not mandate compliance
Definitions CONT’D By laws are rules that are adopted to
regulate practice and privileges-med/surg nursing
Policy-overall plan to accomplish general goals
Procedures –tools used to implement the policies
Sources of Standards Joint Commission on Accreditation of Healthcare
Organizations State laws and regulations American Nurses association Bylaws, Facility proceduresGhana NMC Constitution GRNA/GRMA MOH/GHS Facility procedures and protocols
Developing Standards State board of nursing Nursing associations Specialty nursing associations Standards vary-general or specific
Legal Implications Standard serves as evidence- prove 4 elements1. Duty2. Breech of duty3. Proximate cause4. Damages
Expert-relevanceHearsay evidence
Standards in disciplinary Proceedings
Standard of Care Defenses Nurses in Training
Error-in-Judgement- standard met even though error occurred
Two-schools- of Thought Doctrine-more than one method of doing a procedure
Legal Responsibilities Law is the body of rules and regulations that
governs people’s behaviour and their relationships with others in the society and with the state
Rules made by a society for the purpose of preserving orders and promoting the safety of that society
Standard of human conduct established and enforced by authority of an organized society through its government
Responsibilities CONT’D Law promote order by resolving conflicts
and disputes non-violently
Nurses/midwives must understand the legal aspect of the profession
Protect the rights of the client's and reduce the risk of liability
Responsibilities CONT’D When we practice within the confines of
the law, we are able to Shield yourself from liability Advocate for clients rights Provide care that is within the scope of
practice Discern the responsibilities of nursing in
relationship to the responsibilities of other members of the health team
Responsibilities CONT’D Provide safe competent care that is
consistent with standards of care
Types of law Coded or written- laws formally enacted
or approved by parliament
Uncoded or unwritten – un-enacted i.e. judicial precedents
Categories of Law2 Main Categories1. Public laws- Constitutional Law-regulate functions of
government and the relationship of individuals to them
Criminal laws- prevent and punish people who do wrong in the state
Categories CONT’D2. Private and Civil Laws- rights and duties of individuals
BillActDecree
Nurse/Midwife and the Law-Laws have dual purpose in nursing/midwifery:1. To regulate practice2. To protect client/patient-All professions are subject to legal control-Each state has it s own laws pertaining to nursing called ’’ Nurses Practice Act”Administration is by NMC in Ghana
Nurse/Midwife and the Law CONT’D
The midwives ordinance was established in 1931 which gave way to the formulation of their board
The nurses ordinance empowered the formulation of the nurses board of the Gold coast in 1948
Regulation on education, examination and registration of nurses
It was merged with the Midwives board on 27th September 1972 to form the NMC
Proclaim under NRC Decree 117
Tort Law Is a wrongful act committed by one
part against another part or property Purpose is to make the injured party
whole again usually through monetary compensation
Tort is divided into two main parts Negligence or unintentional tort Intentional tort
Unintentional Tort Negligence- occurs when an
unreasonable or careless act or ommission of an act causes injury to another
Ordinary-failure to exercise the care that an ordinary prudent party exercises under similar circumstances- aid fails to clean a spill and patient falls
Unintentional CONT’D Malpractice- specific type of professional
negligence that occurs when the standard of care that can be reasonably expected from such professional is not met
Only professionals can be sue for malpractice
Breaching standard of care The nurse is responsible for her actions-
know the consequences off your actions
Unintentional CONT’D Personal liability-you are responsible for
your own conscious conduct Respondent superior-employer may be
responsible for the legal consequences of the employee’s action within the scope of his or her employment
Right to control, direct and supervise-employer
Unintentional CONT’D Gross negligence- if the nurse/midwife is
careless in her duties to the extent that human life is jorpardized then is viewed as a crime rather than a tort
Examples of Acts of Negligence Leaving side rails down-patient fall out Burning patient from hot water bottle,
enemas, heating pads, sitz baths Giving wrong medication Using faulty apparatus Misuse of patient personal belongings Failure to count sponges accurately Patient abandonment in urgent situations
Intentional Torts Willfully or intentional act or wrong doing that
violates another person’s rights or property; e.g. Assault Battery False imprisonment Trespass Defamation Infliction of emotional distressCivil/criminal law
Assault Treat or an attempt to contact the body
of another person without the privilege of doing so and without consent
Treat to use force E.g. shaking a stick at a person close
enough to be hit
Battery Act of making an unauthorized contact Actual employment of force or merely
touching someone against their will No treatment can be done without the
patient’s consent or relative’s In rear cases- mentally ill or in
emergencies Nurse is responsible for reporting cases
of child abuse
False Imprisonment Unwarranted restriction of the freedom
of another. It includes:
Unlawful detention of a patient- for failure to pay bills
Misuse of restraints by hospital personnel-need an order to use restriants
Defamation Wrongful act meaning to injured the
reputation of another person Very careful in personal remarks in daily
activities If defamation is oral- slander Written defamation –libel Statement is considered libel or slander
when another person either hears or sees it
Crime Any offence perpetuated against the
public interestTwo categories Misdemeanors- misbehaviors Felony- more serious crimes carrying
penalties ranging from imprisonment to death
Nursing/Midwives Activities that Borders on the LawPatient Consent- patient or parent (minor) or significant signs for it Its to protect the hospital or physician Do not obtain consent after the patient is
medicated or If patient is physically or mentally
challenged Its your responsibility to let them know
the procedure -witness
Consent CONT’D If the patient refused to sign a consent
form its your responsibility to inform the surgeon so that unauthorized procedure is not performed
In emergency situation the consent may be obtain from the next of king
When underage (below 21) the parent signs the consent
Invasion of Privacy Every patient has the right to privacy
Do not make unauthorized disclosures about the patient
If patient is unconscious next of kin should be consulted to grant permission
Privacy CONT’DIn police and accident cases the only facts that can be released without patient consent are: Name, Address, Sex, Marital Status, Approximate age, Occupation, Employer, Name and address of nearest relative
Privacy CONT’D The condition of the patient may be
stated as good, fair, serious, critical or dead on arrival
The name of the physician can be disclosed with permission
Photographs must not be taken-permission
No shop talk-gossip
Privacy CONT’DCertain cases that nurses can give information Communicable disease, child abuse, criminal abortions, gunshot wounds, attempted suicide drug abuse
AbortionIf you are called to take care of a critically ill patient with criminal abortion; Stay with the patient till legal or medical
aid is obtain Give your best and refrain from making
moral judgments
Narcotics and other drugs Drug abuse prevention and control act-
prescription storage, administration of poisons and dangerous drugs
Poison and dangerous drug act- prescription, sales, storage and administration of narcotics-opium and cocaine. E.g.
Morphine sulphate,pethidine,barbiturates Kept in a double lock cupboard( box-in a
box)
Narcotics CONT’D Nurse may give narcotics if supplied by
the institutions License to dispense it Carefully record on legal records which
indicates patients name, physician, name of drug, dosage and the time give as well as the nurses signature
These records are checked and a narcotic count done on each shift
Euthanasia(Mercy Killing) From a Greek word- easy death Practice of painless putting to death
persons who have incurable, painful or distressing handicaps or diseases
Opposed by various religious bodies It could be called suicide or murder
Unlawful Death Homicide- to cause the death of another
person unlawfully If death is due to negligence-
involuntary manslaughter E.g. nurse involved in illegal abortion
and the person dies- will be charge with the above
Wills Legal declaration of a person’s wishes as to the
deposition of his property after death Patience may ask the nurse/midwife to help in making a
will - You have help the patience in securing the services of
a lawyer by referring the patient to a list of lawyer in your locality
You can serve as a witness The patient should be of a sound mind too Not under the influence of drugs or persons Nurse should record this as a fact in the patient’s record
Living Wills Documents instructing physicians to
withhold or withdraw life sustaining procedures when death is imminent
Prolonging the dying process and nor promoting health
Needs two witness neither should be a doctor or relative
Living Wills CONT’D Advance directives- gives directions to
healthcare providers on client’s desires in specific critical situations
Durable power of attorney- health care surrogate –client appoint someone to make health care decisions if and when they are no longer able to make decisions on their own behalf
Patient’s Chart Is considered a legal document Patient is safe guarded through the chart It can also protect the doctor,nurse and
hospital in cases of law suits Provides a written account of patient
hospitalization- it should be up to date and accurate to the last minute
Patients physical condition from admission to discharge
Chart CONT’D All recorded information must be legible,
complete, spelt correctly and standard abbreviations used
Pertinent observations should be recorded and signed, dated and patients name must appear on every chart, page on which notation is being made.
Effective Documentation Careful, complete and objective
documentation should be done Timely and truthful Keeps other health care providers p to
date Institutions has a duty to maintain nursing
records If records are incomplete it can be term
negligent
Documentation CONT’D If errors are made in documentation,
follow the facility’s protocol to correct it- don’t erase
Suit Prone Patient Patient who is usually unhappy,
resentful and dissatisfied with all phases of his life
Because of his psychological make is more likely to sue for malpractice when something goes wrong
Health Care Fraud and Abuse Intentional misrepresentation that one
knows is false and makes anyway, knowing that the deception could result in an unauthorised or illegal benefit to self or others such as monetary gain
The most common forms of fraud involve insurance or payment
It includes: Receiving ,offering or soliciting kick back
Fraud CONT’D Billing for services not rendered Misrepresenting a patient’s diagnosis to
justify payment Falsification of documents to justify
payments “Upcoding” -billing for a service not provided Billing for patients visits not done Billing for medical unnecessary testing Inflating bills
Student Nurses/Midwifes Practice nursing and midwifery in
reasonable and safe manner Liability of a student is usually shared
by the student, instructor, hospital and educational institution
Never accept a procedure you are not familiar with- ask for supervision
Questions
Summary
Thank you.
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