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what is the American w/ Disabiltiy Act?
- protects rights of disabled people
- most extensive law on how employers must tx health care workers and clients infected w/ HIV
- gives individuals the opportunity to decide whether to disclose their disability
Emergency MEdical Treatmeant & Active LAbor Act does what?
- provides that when a client comes to the ED or the hospital, an appropriate medical screening occurs w/in the hospital's capacity
- The hospital is not to discharge or transfer the client until the condition stabilizes in emergency situations
- Enacted as result of clients' being transferred from private hospitals to public hospitals w/o appropriate screening & stabilization (pt dumping)
Mental Health Act
- Forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benifits
- people w/ mental health issues need to have same coverage as you or I would have w/ surgical procedures
patient self determination act:
requires health care insitutions to provide written info to clients concerning the clients rights under state law to make decisions, including the right to reufse tx and formulate advance directives; the clients record must contain doc. whether the client has signed an advance directive
a part of advance directives you need to know is decisional capacity. what is it?
ability to make right choices for oneself as it relates to medical care
You are required by law to ask if your pt has any direct directives. Is it ok if its not in the chart?
If they do you must have a copy for the medical record.
what are the different types of advance directives?
- Living wills
- Durable power of Attorney for health care
What is a living will?
represents written doc. that direct tx in accordance w/ a client's ishes in the event of a terminal illness or condition; they are often difficult to interpert and not clinically specific in unforseen cirucumstances
Durable power of attorney for health, what is it?
Legal doc. that designates a person or persons of one's choosing to make helath care decisions when the client is no longer able to make decisons on his or her own behalf; the agent makes health care tx decisions based on the client's wishes
DNR orders should be written or verbal orders?
what is the Uniform Anatomical Gift Act?
- an individual who is at least 18 years of age ahs the right to make an organ donation
- Gift must be in writing w/ their signature
- qualified health care provider has to ask each client over age of 18 whether client is a organ/tissue donor
- adhere to the cleint's wishes if they wan ttheir body donated for science
HIPPA.... oh HIPPA
- provides rights to clients & protects employees
- protects idnividuals from losing their health insureance when changing jobs by providing portability
- clients have rights to use and disclose health info, inspect and copy their medical records, amend mistaken or incomplete info
- limits who is able to access clients records
- privacy: the right of clients to keep info about themselves from being disclosed
- confidentiality: how health care providerstx client's private info once it has been disclosed to others
when can restraints be used?
- only to ensure physical safety of the resident or other residents
- when less restirctive interventions are not successful
- only on the written order of a pysician or health care provider (specific start/end tiems)
- state board of nursing license are registerd nurses in the state in which they practice
- all states use NCLEX
what are the good samaritan laws?
- providing emergency assistance at the site of an accident
- limit liability and offer legal immunity to nurses who help at the scene of an accident
- some state requires nurses to stop at accidens to help
what are public health laws?
- State legislatures enact statutes under the health code, which describes the reporting laws for communicable diseases, school immunizations, and laws intended to promote health and reduce health risks in communities
- Purpuses of public health laws are protection of the public’s health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for the care
- Laws include reporting suspected abuse and neglect, reporting communicable diseases, ensuring that clients in the community have received required immunizations and reporting of other health-related issues enacted to protect the public’s health
what is the uniform determination of death act? and the whole brain standard?
- Health care providers can use either the cardiopulmonary definition or the whole-brain definition to determine death
- Cardiopulmonary standard: requires irreversible cessation of circulatory and respiratory functions
- Whole-brain standard: requires irreversible cessation of all functions of the entire brain, including the brain stem
- To facilitate the recovery of organs for transplantation If a physician is not present on the floor, to RNs are required to verify and the name of the second RN needs to be charted in the notes of the primary nurse
- There are certain things that have to be charted, so look through your hospital policies to determine what is required
what is a physician assissted suicide?
- Oregon Death With Dignity Act: a competent individual with a terminal disease could make an oral and written request for medication to end his or her
- life in a humane and dignified manner
- Terminal disease: incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death
- within 6 months
- Supreme Court holds that there is no fundamental constitutional right to assisted suicide but it does not prevent the states from passing legislation to legalize assisted suicide
- Feeding tubes and assisted suicide: courts have hesitated to authorize withdrawals of feeding tubes unless there is very clear evidence that the client previously expressed a preference against a feeding tube
define common law.
judicial decisions made in courts when individual legal cases are decided (informed consent, right to refuse treatment) - where most court cases come from
- conduct that falls below a standard of care
- Nurse can be held liable
- Not doing something you should have done
define malpractice. how does one avoid?
- the failure to use that degree of skill or learning ordinarily used under the same or similar circumstances by members of the nursing profession
- (court definition)
- Physicians are usually held to professional negligence
- To establish nursing malpractice
- -The nurse (defendant) owed a duty to the client (plaintiff)
- -The nurse did not carry out that duty
- -The client was injured
- -The nurse’s failure to carry out the duty caused the injury
- To avoid nursing malpractice: follow standards of care, give competent health care, communicate with other health care providers, develop caring rapport with the client and document assessment, interventions and evaluations fully
- A signed consent form is required for all routine treatment, hazardous procedures, some treatment programs and research involving clients
- If a client is deaf, illiterate, or speaks a foreign language, there needs to be an official interpreter to explain the terms of consent - don’t use a family member or another nurse (unless the nurse has been
- Physician’s responsibility to explain the procedure, witness the signing of the consent
- You can get consent for giving blood because you will be the one giving the blood
Nursing students and the law.
- If a student harms a client as a direct result of his or her actions or lack of action, the student, instructor, hospital or health care facility, and university or educational institution generally share the
- liability for the incorrect action
- Nursing students should never be assigned tasks for which they are unprepared
- When nursing students work as nursing assistants or nurse’s aides when not attending classes, they should not perform tasks that do not appear in a job description for a nurse’s aide or assistant
what is malpractice insurance?
- A contract between the nurse and the insurance company
- Provides for a defense when a nurse is in a lawsuit involving professional negligence or medical malpractice
- Nurses employed by health care institutions generally are covered by that institution’s insurance and do not need to purchase any supplemental insurance unless the nurse plans to practice nursing outside of the
- employing institution
- Sara recommends having your own
what are things to be aware of when floating?
- Based on census load and client acuities
- Nurses who float need to inform the supervisor of an lack of experience in caring for the type of clients on the nursing unit
- They need to request and receive an orientation to the unit
- Supervisors are liable if they give a staff nurse an assignment he or she cannot safely handle
wahts a physician order?
- Nurses follow orders unless they believe an order is in error or harmful
- You can take telephone orders but the physician needs to write the order if they are right there on your floor giving a verbal order
- Telephone order: Dr.’s name, repeat back and order verification by the physician within 24 hours
- Date, time, and sticker
- The physician is responsible for directing medical treatment
- If an order is found to be erroneous or harmful, clarify with the physician; if the physician confirms the order and you still find it questionable, take it to your supervisor or follow the chain of command
- Inform the physician of any changes in the client’s condition and document the notification, the physician’s response, the follow-up and the client’s response
define risk management.
- system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs
- -Identification of possible risks
- -Analyzing possible risks
- -Acting to reduce the risks
- -Evaluating the steps taken
- -Incident or occurrence repor
- Provides a database for further investigation in an attempt to determine deviations from standards of care and corrective measures needed to prevent recurrence and to alert risk management to a potential claim situation
- Never document in the client’s medical record that an occurrence report was completed because the report is confidential and separate from the medical record Professional involvement: nurses need to be involved in their professional organizations and on committees that define the standards of care for nursing practice
standard 1: Assessment
The RN collects comprehensive data pertinent to the healthcare consumer’s health and/or the situation
standrard 2: Diagnosis
The RN analyzes the assessment data to determine the diagnoses or issues
standard 3: outcome identification
The RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation
standard 4: Planning
The RN develops a plan that prescribes strategies and alternatives to attain expected outcomes
standard 5: implementation
The RN implements the identified planStandard 5A Coordination of careStandard 5B Health teaching and health promotionThe RN employs strategies to promote health and a safe environment
standard 6: evaluation
The RN evaluates progress toward attainment of outcomes