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Ethical and Legal Issues in Nursing

Oct 04, 2008 06:29 PM written by vadee | 2 Comments Print Email Follow

Just some stuff to refresh your memory on the ethical and legal issues in nursing. you may add on to this.

When to contact the Nursing Supervisor (NS)

1. A nurse questions an order but the Physician can not be located, the nurse should then

CONTACT the NURSING SUPERVISOR. Under no circumstances should the nurse carry out the order without clarification.
2. Under the Nurse Practice Acts, impaired nurses on the job should be reported to the

Nursing Supervisor. The NS will then report it to the Board of Nursing or Police as required. Security should only be called if a disturbance occur.
3. Nurses can not be a witness to a living will/advance directives (Patient Self-

Determination Act). Ask the NS to seek assistance for the client (usually a clinical social worker). 4. Report all sexual harassments to NS immediately. Examples of legal torts: 1. Invasion of Privacy example: a nursing student observing a procedure without the client's consent or taking photos of the client. 2. False imprisonment example is telling the client that he/she may not leave the hospital or the use of restraints. 3. Battery example: performing procedure without consent such as resuscitation. 4. Do not resuscitate (DNR) should be reviewed every 3 days for hosptialized clients and every 60 days for residential clients.
5. when the word threatens is in the question= it's assault 6. Defamation (Slander): something untrue was said to ruin the reputation of a person. 7. Defamation (Libel): something untrue was written to ruin the reputation of a person.

INFORMED CONSENT:
1. IN ONLY TWO INSTANCES where the INFORMED CONSENT is not needed:

emergency (where the client's life is endanger) and when the client waives the right to give informed consent. 2. A client under medications that affects their cognition, should not be asked to sign a consent. Legally the client must be emotionally and mentally competent to sign

consent. 3. a nurse can witness the client signing the informed consent.
4. Mentally or Emotionally INcompetent Clients: declared imcompetent, unconcious,

under the influence of alcohol/drugs, chronic dementia or other mental deficiency REPORTING 1. The nurse must report situations of child/elderly abuse, gunshot wounds, suicides, and infectious diseases to the proper personnel. OTHERS 1. Jehovah's Witness: may accept an organ transplant but the organ must be cleansed with a nonblood solution.
2. When giving medication to the client, think of the 5 rights C.T.D.M.R. right Client,

right Time, right Dosage, right Medication, right Route (i think of the mneumonic as Connecticut (CT) Dept of Mental Retardation (DMR)....formally known..now it is CT Dept of Social Services (DSS))

http://www.ehow.com/info_8245142_legal-issues-nurse-documentation.html

Legal Issues in Nurse Documentation

By Helen Messina, eHow Contributor

updated April 18, 2011

Print this article

Nursing documentation must be conscientious, professional, truthful and precise to avoid liability.

Nursing documentation frequently reflects the most crucial parts of the medical record. If it is meticulous, appropriate and truthful, it supports quality medical care. It can also contradict information found elsewhere in the chart when questions of malpractice or negligence arise. Nursing documentation, whether in a hospital, clinic or physician's office, symbolizes a continuous accounting of signs, symptoms, complaints and the patient's response to physician's orders, treatments and interventions.
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1. Nursing Documentation
Historically, the responsibility for medical care was strictly allotted to physicians. That is no longer the case as the public has become more aware of nursing's role in health care. Nurses are required to do more than simply follow physicians' orders. Nursing responsibilities include patient advocacy, even when the role is adversarial to the physician. Documentation begins the moment the patient arrives at the hospital, clinic or unit and continues until discharge. Documents include a complete nursing assessment, a nursing care plan, which outlines health care needs and goals, nursing interventions and responses and discharge instructions. Nursing documentation furnishes a vital aspect to the continuity of medical care given over a specific period of time.

Legal Issues
State and federal legislation and statutes set the foundations for legal nursing documentation. Each state's Department of Health and Board of Nursing also set standards. Nursing practice standards and guidelines help formulate the scope of nursing practice and the level of responsibility the nurse is held to in a legal action. Legal claims against a nurse require evidence of a nurse-patient relationship, which confirms a duty to the patient. Additionally, proof is required that the nurse deviated from accepted practice in her duties and that the patient was injured as a result of the deviation.

Documentation Guidelines
Whether documentation is computer-based or handwritten, the requirements remain the same. Clear and concise documentation, finished within an appropriate time frame and based on first-person observations, reflects responsible professional judgment. Nursing documentation includes the facility's choice of forms and adherence to procedures and policies set by the facility. When legal issues arise, the nursing documentation becomes a central part of proving whether standards of care were met or not.

Medication Errors
Legal issues in nursing documentation regarding medication records and medication errors are common. When the wrong drug is administered, the wrong dose is given or the wrong mode of administration is used, a medication error has

occurred that can have serious consequences for both the patient and the nurse. The failure of the nurse to monitor the patient for an appropriate response to medication, side effects or toxicity can result in harm to the patient. Following the physician's orders does not protect the nurse from legal action if or when the patient is harmed. It is the nurse's responsibility to provide a safe environment for her patient.
Read more: Legal Issues in Nurse Documentation | eHow.com http://www.ehow.com/info_8245142_legal-issues-nursedocumentation.html#ixzz1NSiKVnvg

Legal Issues in Psychiatric Nursing

By Jennifer Leigh, eHow Contributor Print this article Legal Legal Psychiatric Malpractice 1. Related Searches:

Psyciatric nurses benefit from understanding the law.

Psychiatric nurses provide a variety of services to mental health patients, according to the Bureau of Labor Statistics. Because of this, psychiatric nurses can face a number of legal concerns as well. To make sure they're legally protected, it is important for psychiatric nurses to stay up-to-date on legal and ethical issues in their field.

2. Patients' Rights
Psychiatric nurses must follow certain legal standards pertaining to patients' rights. Patients have the right to treatment in a public hospital, and they have the right to refuse treatment if they are deemed mentally competent by a judge in a court of law. Patients also have the right to informed consent, which means they must understand why they are being treated, understand their treatment options and sign an informed-consent agreement to be treated.

Confidentiality

 According to the American Nurses Association (ANA) 2001 Code of Ethics for Nurses, psychiatric nurses have a duty to protect the confidentiality of patients. Patient information cannot be released without the patient's consent, unless it is necessary to complete treatment or if the patient is threatening his life. Other exceptions include mandated reporting of child or elder abuse and a subpoena of mental health records.

Standard of Care
Psychiatric nurses have a standard of care established by the ANA, state licensing boards and hospital policies and procedures. This standard of care mandates that patients be treated a certain way or the nurse could face legal issues or loss of license. Examples of standards of care include treating the patient with dignity, honoring self-determination, and respecting the individuality of each patient.

Negligence and Malpractice

If a patient is injured while in a psychiatric nurse's care, the nurse may face legal issues related to negligence or malpractice, which indicate that the nurse did something that caused harm to the patient. To prove negligence or malpractice, it is necessary to explain the nurse's original duty, show how this duty was not met, and identify the cause of harm to the patient. The patient's physical harm is considered, along with mental pain or suffering she may have endured.
Read more: Legal Issues in Psychiatric Nursing | eHow.com http://www.ehow.com/list_6717618_legal-issues-psychiatricnursing.html#ixzz1NSnpw5Rl

The ethical implications and legal aspects of patient restraint

11 February, 2003 It is arguable that the association of restraint with people who have severe mental health difficulties may cloud appreciation of its widespread use in other areas of nursing. The focus of this article will be on the use of restraint within a care setting for older people. This is an area of

practice for which the RCN developed specific guidelines in 1999. The issues in the article are generic and the principles may apply to a variety of care settings. VOL: 99, ISSUE: 06, PAGE NO: 26 Dorothy Horsburgh, PhD, MEd, BA, DipCNE, RCNT, RNT, RGN, is lecturer, school of acute continuing care nursing, Napier University, Edinburgh Defining restraint The New Shorter Oxford English Dictionary (Brown, 1993) defines restraint as deprivation or restriction of liberty or freedom of action or movement. Restraint may occur in the following ways:
In a physical manner as in the manual restraint of one individual by others; By the use of apparatus such as cot-sides to keep a person within a defined area; By means of medication that may reduce an individuals capacity for freedom of movement (Brennan, 1999). In subtle ways, such as by reducing the heating in certain rooms within a care setting to discourage the use of these areas at specific times (Clarke and Bright, 2002). Similarly, if a patient requires a walking aid in order to be mobile, removal of the appliance from the patients reach would be form of restraint.

An attempt by an individual, or group of individuals, to restrain a person is legally justifiable in certain situations, for example to prevent someone committing a crime. In such instances the minimum means of restraint should be used (Clarke and Bright, 2002). The restraint of an individual outside such extenuating circumstances, or the use of excessive force, is unjustifiable. Therefore, it is important, from a legal and moral perspective, to ensure that nursing practice does not involve the unjustifiable restraint of patients. When might it be considered justifiable to restrain an adult within a health care setting? The right of individuals to freedom is based upon the principle of autonomy: people have the right to make their own decisions, which should be respected by others. Autonomy is often described as a prima facie principle; this means that, at first sight, the principle appears to be one that should be respected by others. However, further examination may reveal other ethical principles that have an equal, or greater, case for recognition. The ethics of restraint The following example illustrates the application of ethical principles in practice. Anne Martin (not her real name) is 87 years old and has senile dementia. She has been a resident in a care setting for older people for three years, after becoming unable to cope at home because of shortterm memory loss and confusion. Her state of mind had resulted in potentially dangerous behaviour, such as wandering from her home and becoming lost, being unaware of traffic hazards when crossing roads and forgetting to eat or drink for several days at a time. In the residential care setting she has attempted to wander outside and, for this reason, a baffle lock is in place at the end of the corridor that leads from her living area to the exit. Although Ms Martin continues to wander, she is unable to leave the premises. While this situation may not be viewed as constituting restraint in the same way that a nurse physically holding on to Ms Martin might be, the arrangement of the environment nonetheless ensures Ms Martins containment within a restricted area. We may question whether this is

justifiable and the following discussion provides one example of how the situation might be examined. The presence of a baffle lock appears to override Ms Martins autonomy. However, it may be argued that while autonomy constitutes a prima facie ethical principle, in certain circumstances it may be superseded by other principles. It can be argued that in order for an individual to be autonomous, they must possess insight into the potential or actual consequences of their actions. Ms Martins dementia interferes with her insight and it may be considered acceptable to override her autonomy by reference to the principle of non-maleficence - the requirement to prevent harm. If Ms Martin is allowed to wander out of the care setting she may encounter hazards such as traffic and suffer harm as a result. Interference with her autonomy may be seen as justifiable on this basis. Furthermore, it is arguable that in care settings, there is an ethical requirement not only to avoid harm, but also to create benefit for the client. This principle is beneficence and may also be used to justify restricting Ms Martins freedom of movement. It may be considered beneficial for Ms Martin to remain within the care environment, in order to maintain both her physical safety and her psychological well-being, because unfamiliar surroundings may cause her distress. The ethical principles of non-maleficence and beneficence might be used as justifications for overriding her autonomy. Legal aspects of restraint The fourth relevant ethical principle is that of justice. The purpose of justice is to ensure that individuals receive that to which they are entitled or deemed to deserve. It may be argued that the restriction of Ms Martins freedom is unjust. Older adults with senile dementia present problems that are not addressed fully by the UK mental health legislation. Unless Ms Martin is held as an involuntary patient under a section of the relevant act, she is legally entitled to leave the care setting if she so desires. Any attempt to impede her constitutes an illegal restriction of her liberty. In England, the Bournewood judgement (named after the hospital where the issue arose) by the Court of Appeal in 1998 ruled that patients who lacked the capacity to consent to admission could not be detained within a care setting unless sectioned under the Mental Health Act (HM Government, 1983). Before the Court of Appeal decision it was assumed that people lacking the mental capacity to make an informed choice (people with severe learning difficulties or dementia, for example) could be considered to be content with their admission - as long as they did not show signs of wanting to opt out of treatment. If they were not actively opting out, then it was acceptable for them to be detained in hospital and be treated without a formal detention under a section of the Mental Health Act. The Law Lords looked at two main questions: was the person involved actually detained and, if he or she was detained, was the detention lawful? However, this judgement was subsequently overturned by the House of Lords, on the basis of the common law principle of necessity, by which health care staff are able to act in the best interest of an individual who would otherwise experience significant pain and suffering. The ruling by the House of Lords restored the status quo. Background to the case, along with the full text letter from the carers of the patient at the centre of the Bournewood case can be found at the websites shown opposite (see Further information). There is a problem for the care team because, while restraint of Ms Martin may constitute an infringement of her legal right to freedom of movement, permitting her to wander - in the

knowledge that she may come to harm - could constitute negligence. In order for a charge of negligence to be upheld in law, the following three conditions must prevail:
A duty of care must exist. Within an officially designated care setting staff do owe a legal duty of care to patients/residents; The duty of care must have been breached. It is arguable that, since staff are aware that Ms Martin has a diminished sense of danger, they should ensure that she does not wander unattended. In the event of her coming to any harm the staff would be viewed as having neglected their duty of care to Ms Martin; Significant harm must have been sustained as a direct consequence of the neglect of the duty of care. For the care team Ms Martins situation presents a dilemma. On the one hand she is legally entitled to leave the premises and any effort to physically restrain her may be regarded as assault, while on the other hand if she leaves the premises and comes to any harm the staff may be guilty of negligence.

The best option is probably to justify the restriction of Ms Martins autonomy in the light of her diminished insight into the potential consequences of her actions. The care team may argue that the purpose of the baffle lock is to prevent harm and that they are acting in what they perceive to be Ms Martins best interests. Further issues There are other aspects of the situation which have to be taken into account:
The use of a baffle lock may be acceptable in order to ensure Ms Martins safety, but not if the purpose of its installation is to allow management to reduce staffing levels; Optimum staff-to-resident ratios would permit a member of staff to accompany Ms Martin in order to ensure that she does not come to any harm when she wishes to leave the premises; Another consideration is that Ms Martin is not the only resident whose freedom may be restricted by the presence of the baffle lock. The needs of other residents should also be taken into account before using this measure. Such an assessment may be carried out using the same ethical principles that helped to determine whether the restraint of Ms Martin was justifiable; In areas where baffle locks are justifiable, a written policy and procedure should be formulated by management to explain to staff, residents and their visitors the rationale for the use of the locks. This should also clearly identify the measures that should be taken to ensure that residents who do not need this form of protection are able to leave and enter the area as they please.

Conclusion This case study demonstrates that restricting a persons movements may not concur with commonly held perceptions of restraint as comprising dangerous behaviour on the part of the individual being restrained or those who are in a position to restrain It should also have highlighted the complex situations in which restraint may be required and the ethical principles that may be applied to support or discourage its use.

Reference:http://www.nursingtimes.net/nursing-practice/clinical-specialisms/olderpeople/the-ethical-implications-and-legal-aspects-of-patient-restraint/205611.article