LEGAL AND ETHICAL RESPONSIBILITIES

Faith Vaughn RN, MSN

LAWS AND JUDICIAL DECISIONS

U.S. Constitution Federal laws Federal administration law: OSHA, FDA State laws: nurse practice act Ominibus Budget Reconciliation act of 1987 (OBRA) State Administrative laws: Florida board of nursing Case laws Roe vs Wade- abortion issue

DELEGATION: RN RESPONSIBILITIES

Nurse practice act give nurses certain responsibilities the legal authority to perform nursing tasks Authorize another person to perform a task The delegating nurse is legally responsible for the task RN is responsible for all nursing care making the right decisions giving right directions and communication right task right supervision

RESPONSIBILITIES OF ASSISTIVE PERSONNEL

Help patients maintain or regain activities of daily living (ADL).

Provide physical and emotional support to patients

Take direction from RNs & LPNs to carry out the care plan
Make observations and report them according to the facility policy All duties has to be within your scope of practice, that you are legally permitted to perform

ETHICAL ASPECTS

Ethics is knowledge of what is right conduct and wrong conduct Morals are involved An ethical persons behaves and acts in the right way He or she does not cause person harm Ethical behavior involves not being ethical or biased Make judgments and have opinions before knowing the facts Ethical problems involved making choices Professional groups have codes of ethics American nurses association (ANA) for RNs National federation of licensed practical nurses (LPNs)

LEGAL ASPECTS

Standards of care: a set of guidelines for good nursing assistant care. Liable: legally responsible for your own actions Negligence: an important law that applies to health care professionals Malpractice: negligence committed by a professional, such as a physician, nurse or pharmacist As a health care worker you are negligent if you cause a patient harm by: a) disregarding a supervisors instructions b) performing a task incorrectly or without proper training d) performing a task that is beyond your scope of practice, even if authorized by a nurse/professional

LEGAL ASPECTS CONTD

Civil laws are concerned with relationships between people Torts are part of civil law. A wrong committed against a person or the persons property. All 4 elements must be present: Duty to act one person owes a legal duty to another Breach of duty to act person accused fail to act Damage or harm to plaintiff the person making the accusation was/is hurt, injured, or harmed in some way Proximate cause breach of duty directly caused the damage or harm

LEGAL ASPECTS CONTD

Unintentional torts: Negligence is an unintentional wrong the negligent person failed to act in a reasonable and careful manner Malpractice is negligence by professionals a person has professional status because of training, education, and the service provided What you do or do not do can lead to a lawsuit if harm results Standard of care refers to the: skills, care and judgment required by the health team under similar conditions

LEGAL ASPECTS CONTD

Intentional torts are acts meant to be harmful defamation (libel and slander) is injuring a persons name or reputation by making false statements to a third person False imprisonment is the unlawful restraint or restriction of a persons freedom of movement Threatening to restrain a person or preventing a person from leaving the agency Invasion of privacy is violating a persons right not to have his or her name, picture, or private affairs exposed or made public without giving consent Fraud is saying or doing something to trick, fool, or deceive a person

LEGAL ASPECTS CONTD

Assault and battery may result in both civil and criminal charges assault is intentionally attempting or threatening to touch a persons body without consent Battery is touching a persons body without his or her consent the person must consent to any procedure, treatment, or other act that involves touching the body Protect yourself from being accused of assault and battery explain to the person what is to be done and get the persons consent may be verbal or it can be a gesture

LEGAL ASPECTS CONTD

Consent is informed when the person understands the reason for treatment what will be done Persons under legal age and mentally incompetent persons cannot give consent informed consent is giving by a responsible party Consent is given when the person enters the agency Special consent forms are required for surgery and other complex and invasive procedures You are never responsible for obtaining written consent you can witness the signing of a consent

PATIENT ABUSE

Abuse is any intentional act that causes harm to a patient Abuse has one or more elements: willful causing of injury unreasonable confinement, intimidation, punishment, and depriving the person of goods or services needed Physical abuse: occurs when a nursing assistant causes physical harm by injuring or neglecting a patient False imprisonment: a form of physical abuse. No restraining of a patient without an MDs order Psychological abuse: occurs when a nursing assistant threatens a patient or causes a patient to be afraid. Neglect: the person is deprived of needed health care or treatment

PATIENT ABUSE CONTD

Verbal abuse using oral or written words or statements that speak badly of, sneer at, criticize, or condemn the person unkind gestures Involuntary seclusion confining the person to a certain area Financial abuse: the persons money is stolen or used by another person Mental abuse: humiliation, harassment, ridicule, and threats of punishment Sexual abuse the person is harassed about sex or is attacked sexually

ABUSE FEDERAL AND STATE LAWS

Federal and state laws require the reporting of elder abuse where and how to report varies among state suspected abuse discuss the matter and your observations to the RN or supervisor RN contacts health team members and community agencies as needed OBRA does not allow nursing centers to employ persons who were convicted of abuse, neglect, or mistreatment of persons in any health care agency

PATIENT ABUSE CONTD

The incident is reported at once to the administrator and other officials required by law
All claims of abuse are thoroughly investigated Investigation results are reported to the center administrator and to other officials as required by federal and state laws within 5 days of the incident

CHILD ABUSE

Child abuse occurs at every social level Risk factors for child abuse Stress family crisis drug and alcohol abuse abuser history of being abused as a child discipline beliefs that include physical punishment lack of emotional attachment unrealistic expectations for the childs behavior or performance

TYPES OF CHILD ABUSE

Abuse differs from neglect physical neglect means to deprive the child of food, clothing, shelter emotional neglect is not meeting the childs need for affection and attention Physical abuse: injuring the child on purpose frequent ER visits Sexual abuse persuading or forcing a child to engage in sexual act rape, molestation, incest, child pornography, child prostitution

DOMESTIC ABUSE

Domestic abuse: occurs in relationships Usually more than one type physical abuse, punching, slapping, grabbing, twisting arms Victim often hides the abuse or protects the abusive partner Health team provide emotional support give information about safety and community resources

Medical records

All medical record documentation must be: Accurate Complete Up-to-date Readable

Medical records

Documentation must also reflect: The History Physical examination Assessment Treatment Plan This is necessary to: Provide the best medical care Justify services billed to insurance company Defend physician in the event of a lawsuit

Subpoena

Definition: under penalty Court order for a witness to give testimony Expert testimony Subpoena duces tecum Under penalty you shall bring with you Court order for the witness (physician) to bring the medical record

Advance Directives

Legal form detailing the desires for procedures to be either performed or withheld when death is imminent Living Will Not legally binding But can be used as evidence of intent

Advance Directives

Health Care Power of Attorney Legally binding Can be used by those not terminally ill Can be used to appoint another person to make decisions
Medical Directive Forty-eight questions detailing what the patient would or would not want done Values History Form Uncover the patients value system

Advance Directives

Health Care Proxy Appoints a surrogate to make decisions Do Not Resuscitate Form No resuscitation if patients heart stops
Uniform Anatomical Gift Act Uniform donor card Advanced Directive Guidelines Signed by the individual Signed by two witnesses Copy should be kept in the medical record

Advance Directives

STOP AND THINK

Ethics Review the scenario Should the physician supply enough medication to provide relief or only enough pills for the patient to take when she is experiencing pain? Why?

STOP AND THINK

Bioethics Review the scenario Would you want your child to benefit from this method of treatment if this research proves successful? Would you advocate cloning research for other scientific breakthroughs?

STOP AND THINK

Stem cell research Review the scenario Stem cell research is fighting for its life Think through this complex scenario You may want to do additional research on your own Take a stance and be ready to debate

incident reports

Incidents are unusual events, such as accidents, errors, or thefts, that occur in a healthy care facility Any incident that affects a patient, visitor, or employee must be reported immediately to the nurse An Incident report gives a complete description of what occurred incidents reports are important for ensuring that steps are taken to correct the problem and to prevent future problems incident reports prepare the facility administrators for any claims that might result

A PATIENTS BILL OF RIGHTS

American Hospital Association (AHA) has written the policy for the Patients Bill of Rights. These rights include the right of patients to: receive considerate and respectful care obtain information regarding their diagnosis & treatment refuse treatment or leave the health care facility expect privacy and confidentiality in their medical care

GETTING A JOB
There are many ways to find out about jobs: Newspaper classified ads

Local state employment service Phone book yellow pages Internet Your clinical experience site: staff looks at students as future employees

EMPLOYERS SEARCH
Employers want employees who: > dependable and well groomed, > have the needed job skills and training > have values and attitudes that fit with the agency b) You need to care about others c) Good work ethics involves certain traits, attitudes, and manners d) Being dependable is important e) Applicants who look good communicate many things to the employer f) Proof of training (certificate, high school, college, or technical school transcript) g) Nursing home facilities cannot hire persons who were convicted of abusing, neglecting, or mistreating a person

ON THE JOB

Your attitude: a) Show that you enjoy your work

b) listen to others

c) be willing to learn d) stay busy, and use your time well e) you must believe that you and your work have value; always think before you speak

ON THE JOB

Gossip means: to spread rumors or talk about the private matters of others. Confidentiality: to trust others with personal and private information a) persons information is shared only among health care team members involved in his or her care b) agency and co-worker information also is confidential d) avoid eavesdropping (it invades a persons privacy) c) many agencies have intercom systems (be careful what you say over the intercom Speech and language must be professional Courtesy is a polite, considerate, or helpful comment or act

ON THE JOB

Personal matters cannot interfere with the job: a) you could lose your job Meals and breaks are scheduled so that some staff is always on the unit Job safety: everyone is responsible understand the roles, functions, and responsibilities in your job description know what is right and wrong; know what you can and cannot do follow the nurses directions and instructions question unclear instructions and things you do not understand accept responsibility for your actions; always try to learn from your mistakes

MANAGING STRESS

Stress is the response or change in the body caused by any emotional, physical, social or economic factor. It is normal A stressor is the event or factor that causes stress Stress affects the whole person Prolonged or frequent stress can threaten your health Guidelines to help deal with stress: exercise regularly get enough rest and sleep do one thing at a time give yourself praise have a sense of humor talk to the nurse if your work or a person is causing you too much stress

HARASSMENT

Harassment can: a) be sexual b) involve age, race, ethnic background, religion, or disability Do not offend others: a) by your gestures, remarks, or use of touch b) with jokes or pictures Harassment is not legal in the workplace Sexual harassment behavior may be: a) a sexual advance b) a request for a sexual favor; a comment or touch If you feel harassed, report the matter to your supervisor and the human resource officer

RESIGNING FROM A JOB

Whatever the reason for resigning, you need to tell your employer a) give a written notice b) giving 2 weeks notice is a good practice 1) do not leave a job without notice Include the following in your written notice: a) reason for leaving b) the last date you will work c) comments thanking the employer for the opportunity to work in the agency An exit interview is common practice

LOSING A JOB

Poor attendance: not showing up for work or excessive tardiness (being late) Abandonment: leaving the job during your shift Falsifying a record job application or a persons record Violent behavior in the workplace Having weapons in the work setting guns, knives, explosives, or other dangerous items Use and distribution of alcohol, or drugs (excludes taking drugs ordered by an MD) Taking a persons drug or giving it to others Stealing or destroying the agencys or a persons property

LOSING A JOB

Showing disrespect to patients, residents, visitors, coworkers, or supervisors Abusing or neglecting a person Invading a persons privacy Failing to maintain confidentiality (patient, agency, coworker confidentiality, access to computer information) Using agencys supplies and equipment for your own use Abusing meal breaks and break periods Sleeping on the job Violating agency dress code; and any agency policy Failing to follow agency procedures for providing care Tending to personal matters while on duty