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. What would you like to do?
to have the freedom and the right to make decisions for yourself.
to do good for others, promoting goodness, kindness and charity
help heal, dont hurt
the duty not to inflict harm.....dont do it if it will hurt somebody
the principle of truth telling
Abortion law in CA...cuz it is state spefific
cant have abortion after 26 weeks
States that allow assisted suicide/euthanasia
What act allows 2 Dr.'s to make the choice of sustaining a persons life or letting them die when they cant speak and dont have family present
Natural Death Act
Laws that are written and enacted by legislative bodies, where violations are criminal offenses and are punishable by fines or improsonment
What statutes mandate a minimum standard of care in all settings that receive federal funds....(Medicare, Medicaid)
Federal statutes related to nursing and health care
Emergency Medical Treatment and Active Labor Law (EMTALA)
- prohibits the refusal of care to indigent/uninsured in the ED
- prohibits the transfer of unstable patients, including women in active labor from one facility to another
Americans with Disabilities Act of 1990
prohibits discrimination against persons with disabilities by removing barriers that might prevent the same opportunities available to persons without disabilities....language/wheelchairs
This requires all federally funded hospitals (Medicare, Medicaid) to inform their adult patients in writing about their right to make treatment choices
ask patients whether they have a living will or a durable power of attorney for health care
Patient Self Determination Act
Durable Power of Attorney
- all patients have the right to choose care or end of life decisions
- assignment of a person to make these decisions for them should they become incapacitated
**they have the knowledge and legal right
What supercedes all hospital policies?
Board of nursing for the state I am licensed/practicing in
3 things to know about the Nursing Practice Act
- it is revised every year
- my responsibility to look at and know changes
- can be found on www.rn.ca.gov.regulations
6 Standards of competence for nursing
- how to form a plan of care
- how to perform and teach skills
- delegation of tasks
- evaluation effectiveness of care plan
- act as an advocate
Why are nurse patient ratios important?
research indicates that improved nurse-patient ratios are associated with lower "failure to rescue" rates and lower inpatient mortality rates
These things can only be done by an RN...cant be delegated to LPN or CNA
Under Child Abuse Prevention and Treatment Act we are obligated to....
report the following or be fined or imprisoned
- infant/child/elder abuse
- specified communicable diseases
Details of dependent elder abuse
Neglect...physical or financial should be reported to social services
must be reported within 36 hours
dont report....$1000 fine or 6 mo. in jail
If I am not comfy with a patient I have been assigned to or a circumstance...what do I do?
report it up the chain of command and decrease my liability
How do you become a preceptor?
one year of experience on that unit
What are standards of care?
- policies and procedures for the population I am taking care of
- would any reasonable nurse have acted in the same matter for this patient
Nursing case law
body of written opinions about nursing practice
An important nursing case law is Affirmative Duty...what is this?
the duty that nurses will exercise independent judgment to prevent harm to her patients
What 2 laws provide precedence and guidelines for deciding future cases
failure to act in a reasonable and prudent manner
the failure of a PROFESSIONAL, or a person with a specialized education and training, to act in a reasonable and prudent manner
4 elements essential to prove negligence or malpractice
- breached duty of care
- breached standard of care
- suffering of harm/damage
- connection established between the standard of care given by the nurse and the patients injury
Example of breached duty of care
didnt give/get report
How do you make sure you dont breach the standard of care to your patients?
document the time you received report from the previous shift....that is when you are liable
Most frequent allegations of nursing negligence
- patient safety...meds, side rails, skills
- improper treatment/negligent perfromance of treatment
- failure to monitor/report significant findings
- medication errors
Res Ipsa Loquitur
- a doctrine that applies when the negligent act clearly lies within the range of a jury's common knowledge and experience to determine the standard of care ....
- "the thing speaks for itself"
doesnt take an expert witness to determine that an error happened....2x2 left in patients body after surgery
Why are incident reports important to file?
shows the hospitals flaws in the system....so they can be improved upon
reckless act that reflects a CONSCIOUS disregard for the patient s welfare
damages awarded to the injured patient from a grossly negligent nurse
Who's the 2nd victim?
the person that made the error
a negligent act that also constitutes a crime...the act is deemed so reckless that the action also results in serious injury or death to the patient
3 defenses again claims of negligence for nurses and 1 that will never work
- Emergency situation
- Governmental immunity-VA/Jail employees
- Good samaritan....even as a nurse as long as care you provided wasnt negligent
"I was following physicians orders" will never work!!
What is the statute of limitations for filing a malpractice claim
until they are 18 years old
Transparency and disclosure of Error
- best to tell the patient about our error
- if they like you they are less likely to sue
- institutions must have a process in place to disclose these unanticipated outcomes to the patients/family
Why nurses need malpractice insurance
- can be named in civil suits
- floating/cross training is more common
- some employers dont initiate an adequate defense for nurses....so need extra council provided thru my malpractice insurance
every person is responsible for the wrong or injury done to another as the result of carelessness
a nurse cant be relieved of liability by another professional, such as a physician or nurse manage
Personal liability with floating and cross training
- in no case is a nurse permitted to render services if the requisite knowledge to act competently is lacking
- nurses have a legal duty to refuse specific tasks they cant perform safely and completently
- no hospital shall assign a licensed nurse to a unit or area unless they are determined competent in that area
Personal liability for team leaders/managers
duty assignments are given to competent nurses who can provide quality care
triage of patients and allocation of staff and equipment
What type of nurses allow the proper ratios to be maintained during breaks/meals?
Nurse managers and administrators may be held liable for the following:
- inadequate training
- failure to periodically reevaluate staff competencies
- failure to terminate/discipline unsafe workers
- failure to uphold institutional licensing laws and state and federal statutes
- negligence in developing appropriate policies and procedures
an unexpected occurrence involving death or serious physical or psychological injury....specifically including loss of limb or function
requires immediate investigation or response
the analysis of the sentinel event.... and examples
- root cause
- what happened
- how do we make sure it doesnt happen again
threat of harm....causing a person to fear that he or she will be touched without consent
the unauthorized touching or the actual harmful or offensive touching of a person and may rise to the level of a crime
What is the simple way to prevent battery?
always ask the patients permission before initiating any procedure and should document permission was granted
defamation caused by written word
defamation caused by spoken word
unlawful restrain or detention of another person against his or her wishes...nurses has no authority to detain a patient even with the likelihood of harm or injury
rules of leather vs. regular restraints
- leather evaluate q 15min
- regulpar q 2 hr
Define misdemeanor offense....and give examples
minor criminal offenses
- illegal practice of medicine
- failing to report child/elder abuse
- falsification of the patients medical records
- assault and battery
Main 4 student learning objectives
- nursing process
- taking on the professional role
Define felony offense and give examples
major criminal offenses
- drug trafficking
- fraud in billing services for Medicare patients
- theft, rape, murder
Advance Directives legality details
- signed by 2
- 1 is a witness not related by blood.
1 is a notary
written by the physician on the basis of the directives by the patient
What gives a person, other than the ill person, to make decisions for them?
Durable power of Attorney for healthcare
Physician or advanced practice nurse has a duty to disclose information so the patient can make intelligent choices
What must be explained by the doctor when getting an informed consent
- nature of the therapy or procedure
- expected benefits and outcomes
- potential risks....and alternative procedures, and what will happen if they dont do it
RN's job when getting an informed consent
getting the signature and making sure they dont have any questions
The right to refuse diagnostic testing, treatment and care
an adult of sound mind has a right to refuse any treatment that has previously been agreed to.
nurse must notify the MD of the change
What do I do if a patient is leaving against medical advice
- tell them insurance wont pay for any treatments rendered
- tell the doctor
- clearly articulate the dangers of them leaving
- TRY to get them to sign AMA papers
Charges that can be filed when restraints are used immproperly
- assault and battery
- false imprisonment
When can a nurse apply restraints without an order?
when it is an emergency and in their independent judgment, no other strategies are effective in protecting the patient from harm
**careful and detailed documentation is crucial
What would you like to do?
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