Legal Aspects of Nursing

 

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Nursing practice is governed by many legal concepts.

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It is important for nurses to know the basics of legal concepts because nurses are accountable for their professional judgements and actions.

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Knowledge Know ledge of laws that regulate and affect nursing practice is needed for 2 reasons: 

To ensure that the nurse’s decisions are consistent with current legal principles.

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To prot protect ect th the e nurse nurs e from liabil liability ity..

 

Law – Can be defined as “the sum total of rules and regulations by which a society is governed. As such, law is created by people and exist to regulate all persons.”  persons.”  Functions of Law in Nursing: 

It provides a framework for establishing which nursing actions in the care of clients are legal.

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It differentiates the nurse’ nurse’ss responsib ilities from those of other health professionals.

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It helps establish the boundaries of independent nursing action.

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It assists in maintaining a standard of nursing nurs ing practice by making nurses accountable under the law law..

 

Public law – refers to the body of law that deals with relationships between individuals and the government and governmental agencies. Criminal law – deals with actions against safety and welfare of the public. Private law or civil law – is the body of law that deals with relationships among private individuals. It has 2 categories: 1. Contract law – involves the enforcement of  agreements among private individuals or the payment of compensation for failure to fulfill agreements. 2. Tort law – defines and enforces duties and rights among private individuals that are not based on contractual contractual agreements.

 

Civil actions – deal with the relationships among individuals in society. Criminal actions – deal with disputes between an individual and the society as a whole. Litigation – the action of a lawsuit Litigators – are referred to lawyers who participate in lawsuits

 

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The judicial process primarily functions to settle disputes peacefully and in accordance with the law. A lawsuit has generally fivestrict steps:procedural rules. There are 1.

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A document document,, called a complaint, is filed by a person referred to as the plaintiff , who claims that his or her legal rights have been infringed on by one or more other persons, referred to as defendants. A written reponse, called an answer, is made by the defendants. Both parties engage in pretrial activities, referred to as discovery, in an effort to obtain all the facts of the situation.

 

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In the trial of the case, all relevant facts are presented to a jury or only to a judge. The judge renders a decision, or a jury renders a verdict. If the outcome is not acceptable to one of the parties, an appeal can be made for another trial.

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During a trial, a plaintiff must offer evidence of  the defendant’s wrongdoing. This duty of proving an assertion of wrongdoing is called the burden of proof .

 

Informed consent – is an agreement by a client to accept a course of treatment or a procedure after being provided complete information, including the benefits and risks of treatment, alternatives to the treatment, and prognosis if not treated by health care provider. 3 Major Elements of Informed consent: 1. The consent must be given voluntarily 2. The consent must be given by a client with the capacity and competence to understand. The client must be given enough information to be the ultimate decision maker.   Exceptions: Minors 1. 2. Persons who are unconcious or injured in such a way that they are unable to give consent 3. Mentally ill persons who are incompetent. 3.

 

  2 Types Types o off Cons Consent ent 1.

Expressed – may either be oral or written Expressed  agreement.

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Implied – exists when the individual’s nonverbal Implied  behavior indicates agreement.

 

Advance Health Care Directives – include a variety of  legal and lay documents that allow persons to specify aspects of care they wish to receive should they become unable to make or communicate their preferences. Health Care Proxy – also referred to as a durable power of attorney for health care, is a notarized or witnessed statement appointing someone else to manage health care treatment decisions when the client is unable to do so. Autopsy or postmortem examination – is an examination of the body after death. DNR Orders – physicians may order “no code” or “do for clients are in a stage not resuscitate” terminal, irreversible illness who or expected death.of   

 

Euthanasia – the act of painlessly putting to death persons suffering from incurable or distressing disease. It is sometimes referred to as “mercy killing”.  killing”.  Inquest – is a legal inquiry into the cause or manner of a death. – is a physician and usually Medial examiner has advanced education in pathology or forensic medicine.

 

Crime – is an act committed in violation of  public (criminal) law and punishable by a fine or imprisonment. imprisonm ent. A crime doesn’t have to be intended in order to be a crime. 2 Classifications: Felony – is a crime of a serious nature, such as murder, punishable by a term in prison.

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Manslaughter – murder by the 2nd degree.

Misdemenor – is an offense of a less serious nature and is usually punishable by a fine or short-term jail sentence, or both.

 

Negligence – is misconduct or practice that is below the standard expected of an ordinary reasonable and prudent person. Gross Negligence – involves extreme lack of knowledge, skill or decision making that the person clearly should have known would put others at risk for harm. Malpractice – is a “professional “prof essional negligence”, that is negligence that occurred while the person was performing as a professional. 6 Elements of Negligence: 1.

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with the Duty – a nurse should have had a relationship client that involves providing care and following follo wing acceptable standard of care. Breech of duty – there must be a standard of care that is expected in the specific situation that the nurse did not observe.

 

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Forseeability – a link must exist between the nurse’s act and the injury suffered.  suffered.  Causation  – it must be proved that the harm Causation occured as a direct result of the nurse’s failure to follow the standard of care and the nurse should have known that failure to follow standard of care could result in such harm. Harm or injury  injury – the plaintiff must demonstrate some type of harm or injury (physical, or emotional) as a result of the breach financial, of duty. Damages  – if malpractice caused the injury, the Damages nurse is held liable for damages that may be compensated.

 

Assult  – can be described as an attempt or threat to touch Assult another person unjustifiably. Battery  – is the willful touching of a person (a person’s Battery clothes or even something the person is carrying) without the person’s consent that may or may not cause harm.  – iswarrant the injustifiable of a False Imprison Imprisonment ment  person without legal to confinedetention the person.

Invasion of Privacy – is a direct wrong of a personal nature. It injures the feelings of a person and does not take into account the effect of revealed information on the reputation of the person in the community. Defamation  – is communication that is false, or made with Defamation a careless disregard for the truth, and results in injury to the reputation of a person. 2 types of defamation: 1. 2.

 – by means of print, writing, or pictures. Libel Libel  Slander  Slander  – by the spoken word, stating unpriviledged or false words by which a reputation is damaged.

 

Good Samaritan Acts – are laws designed to protect health care providers who provide assitance at the scene of an emergency against claims of malpractice unless it can be shown that there wass a gross departure from the normal standard of care or willful wrongdoing on their part. Carrying Out a Physician’s Order - it is the nurse’s responsibility to seek clarification of ambiguous or seemingly erroneous orders from the prescribing physician.  Providing Competent Nursing Care – nurses need to provide care that is within the legal boundaries of their practice and within the boundaries of agency policies and procedures.  Documentation – the client’s client’s medical chart is a legal document and can be produced in court co urt as evidence. Nurses therefore therefore need to to provide accurate and complete documentation of nursing care provided to the clients.  

 

The Incident Report – aka unusual occurence report is an agency record of an accident or unusual occurence. The Nurse must include ff. Information: Client’s s name, initials and the hospital or identification  Client’  

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number. Date, time and place of the incident. Fact of the incident. (Avoid (Avoid conclusions or blame; Describe the incident as you saw it.) Client’ss account of the incident (State client’s Client’ comments by using direct quotes) All witnesses to the incident. Any equipment by number and any medication by name and dosage.