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About Legal IssuesRights, responsibilities, scope of nursing
practiceAs defined by state nursing practice acts
Sources of lawsSum total of rules and regulations by which a
society is governedLaw made at federal, state, and local levels
Figure 47-1 Overview of the sources of law.
About Legal Issues, continuedCriminal and civil laws
Address conduct harmful to another individual or society
May be punishable by fines or imprisonmentCrime
Act prohibited by statute, common law principles
Civil law Deals with rights and duties of private persons
Tort LawTort civil wrong committed against a
person or person’s propertyUnintentional torts
NegligenceProfessional negligenceMalpractice
Professional Negligence or MalpracticeFive elements:
DutyBreach of dutyForseeabilityCausationInjury or harm
Professional Negligence or Malpractice, continued
Related doctrines:Respondeat superiorRes ipsa loquitur
Statute of limitations
Intentional TortsAssaultBattery False imprisonmentInvasion of privacy
Strategies to Prevent IncidentsMaintain client safetyFallsMistaken identity
Minimize risk of medication errorsApply the Five Rights
Right drug Right dose Right client Right route Right time
Strategies to Prevent Incidents, continuedUse effective communication
Helps decrease risk of bad outcomesAttentive listening Accurate documentation and reporting
Professional liability insuranceNurses should carry to manage personal
financial risk
Standards of CareBased on
Nurse Practice Act (NPA)Administrative rulesJob descriptionsPolicies and procedures
ANA
Selected LawsInformed consent
Client’s legal and ethical rights to be informed of, give permission for procedure, treatment
Client must not be coercedClient understanding essentialFollow agency’s specific protocolsCompetency for consentConsent in an emergencyChild participation in decision
Selected Laws, continuedControlled Substance Act
Federal lawGood Samaritan laws
Encourage health care providers to help victims in an emergency
Protects health care workers from potential liability
Nurse responsible for following through with emergency care
Nurse Practice ActsNurse Practice Acts (NPAs)
Defines: Scope of practice Standards for education programs Licensure requirements Grounds for disciplinary actions
Enforced by state boards of nursing (BON)
Figure 47-3 Relationship among the Nursing Practice Act, Administrative Rules, and position/advisory statements.
LicensureAllows nurses legal privilege to practice
nursing as defined by NPAEach BON oversees administration of a
licensure examinationNational Council of State Boards of Nursing
NCLEX-RN®
NCLEX-PN ®
BONsResponsibilitiesActions against nurses found guilty
Giving false informationNolo contendereConduct that endangers public healthUnfit or incompetent to practiceEngaging in conduct that deceives, defrauds,
or harms the public2009 NCSBN report www.NCSBN.org.
National Council of State Boards of NursingMembershipFunctionsNurse Licensure Compact
Mutual recognition model
NPAsCertificationFederal organizations
Joint CommissionCenters for Medicare and Medicaid Services
Nursing studentsStandards of Practice
Standards of Nursing PracticeANA Standards of Nursing PracticeStandards are authoritative statements by which the
nursing profession describes the responsibilities for which its practitioners are accountable. Standards reflect the values and priorities of the profession and provide direction for professional nursing practice and a framework for the evaluation of this practice. They also define the nursing profession’s accountability to the public and the outcomes for which registered nurses are responsible.
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NursingStandards.aspx
ANAStandards of Professional PerformanceQuality of practiceProfessional Practice EvaluationEducationCollegialityEthicsCollaborationResearchResource UtilizationLeadership
Professional Nursing PracticeNurse Practice Acts
Licensure and Certification
Science and Art of Nursing practice
Figure 47-4 Impact of laws and standards on the nurse.
Advance DirectivesLegal document Expresses an individual’s desires regarding
medical treatmentPatient Self-Determination ActTypes of advance directives
Living willDurable power of attorney for health care
Elements of Advance DirectivesSurrogate decision maker authority to:
Consent to or refuse medical treatment or diagnostic procedure
Hire or discharge medical providersAuthorize admission to medical and long-term
care facilitiesHave access to all medical recordsConsent to comfort care, pain relief measuresAny measures to carry out wishes
Role of NurseReassure clients and families that they have
option to change their decisionAssess whether clients, families have
accurate understanding of life-sustaining measures
Be supportive of clients’ decisions
Health Information and Portability and Accountability Act
HIPAAPurposes
Minimizes exclusion of preexisting conditionsDesignates special rights for those who lose other
health coverageEliminates medical underwriting in group plansIncludes Privacy Rule
Protected Health InformationProtected by Privacy Rule:
Individually identifiable health informationInformation that identifies individualAccess to medical recordsRequired notice of privacy practices and
opportunity for confidential communicationsLimits on use of medical informationProhibition of use of personal information for
marketing
Privacy vs. Confidentiality
Privacy right of individuals to keep their personal information from being disclosed
Confidentiality the assurance client has that private information will not be disclosed without client’s consent
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