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.