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LEGAL AND ETHICAL ISSUES

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LEGAL AND ETHICAL ISSUES Powered By Docstoc
					LEGAL AND ETHICAL
     ISSUES
       SOURCES OF LAW
• STATUTORY LAW

• COMMON LAW

• ADMINISTRATIVE
  LAW
      STATUTORY LAW
• CREATED BY VARIOUS LEGISLATIVE
  BODIES SUCH AS STATE
  LEGISLATURES OR THE CONGRESS
        COMMON LAW
• DEVELOPED WITHIN THE COURT
  SYSTEM AS JUDICIAL DECISIONS ARE
  MADE IN VARIOUS CASES AND
  PRECEDENTS FOR FUTURE CASES
  ARE SET
    ADMINISTRATIVE LAW
• ESTABLISHED THROUGH THE
  AUTHORITY GIVEN TO A
  GOVERNMENT AGENCY BY A
  LEGISLATIVE BODY, SUCH AS THE
  STATE BOARD OF NURSING
TYPES OF LAW
      • CRIMINAL LAW



      • CIVIL LAW
          CRMINIAL LAW
• DEVELOPED TO PROTECT SOCIETY
• THERE ARE THREE (3) CATEGORIES:
  (1) FELONY (most serious! Includes
  violating the Nurse Practice Act)
• (2) MISDEMEANOR (lesser offenses,
  such as a traffic violation)
• (3) JUVENILE (crimes committed by those
  under the age of eighteen)
• A NURSE MAY BREAK
  A CRMINIAL LAW AND
  BE TRIED IN CRMINAL
  COURT!!!!!!!!!!!!
• EXAMPLES: ILLEGALLY
  DISTRIBUTING
  CONTROLED
  SUBSTANCES OR
  ALTERING A PATIENT’S
  RECORD
           CIVIL LAW
• LAW THAT IS ADMINISTERED
  BETWEEN CITIZEN AND CITIZEN
• USUALLY INVOLVE THE VIOLATION OF
  ONE INDIVIDUAL’S RIGHTS BY
  ANOTHER INDIVIDUAL
• TORT IS A TYPE OF CIVIL LAW
                  TORT
• A CIVIL/LEGAL WRONG COMMITTED
  AGAINST A PERSON OR PROPERTY
  AND IS PUNISHABLE BY DAMAGES
  (monetary) NOT IMPRISONMENT
• NEGLIGENCE IS A TYPE OF TORT
  (Malpractice is the term for professional
  negligence!)
    FOUR LEGAL ELEMENTS OF
          NEGLIGENCE
•   (1) DUTY
•   (2) BREACH OF DUTY
•   (3) CAUSATION
•   (4) HARM
    ALL FOUR OF THESE
    COMPONENTS MUST
    BE INVOLVED TO
    PROVE NEGLIGENCE!!
WHAT IS THE NURSE PRACTICE
         ACT???????
• THE NURSE PRACTICE ACT IS THE
  LAW!
• THE ADMINISTRATIVE RULES ARE
  HOW THE BOARD OF NURSING
  ENFORCES THE LAW
• KNOW YOUR PRACTICE ACT AND
  RULES IN ANY STATE THAT YOU ARE
  LICENSED AND PRACTICING NURSING
APPLICATION OF THE NURSE
     PRACTICE ACT
           • SEXUAL HARASSMENT
           • WORKPLACE VIOLENCE
           • END OF LIFE DECISIONS
           • ADVANCED DIRECTIVES
           • CONFIDENTIALITY
           • INFORMED CONSENT
           • MALPRACTICE ISSUES
           • WHISTLEBLOWER
             PROTECTION
           • ORGAN DONATION
           • ABANDONMENT
   SEXUAL HARASSMENT
• LAWS THAT PROHIBIT
  DISCRIMINATION IN THE WORKPLACE
  ARE BASED ON THE FIFTH AND
  FOURTEENTH AMENDMENTS TO THE
  CONSTITUTION!
• TITLE VII OF THE CIVIL RIGHTS ACT OF 1964
  IDENTIFIED TWO FORMS OF SEXUAL
  HARASSMENT
• (1) QUID PRO QUO (sexual favors are given in
  exchange for job security/benefits)
• (2) HOSTILE ENVIRONMENT (harassment is
  based on gender and creates an offensive
  workplace causing the employee not to be able
  to effectively discharge the responsibilities of the
  job)
 IF THE NURSE IS A VICTIM OF
     SEXUAL HARASSMENT
• THE ANA SUGGESTS FOUR TACTICS:
• (1) CONFRONT THE HARASSER
• (2) REPORT TO THE SUPERVISOR (file
  a formal complaint)
• (3) DOCUMENT THE INCIDENT (name
  any witnesses)
• (4) SEEK SUPPORT FROM
  FRIENDS,FAMILY, AND
  ORGANIZATIONS (such as the ANA)
• NURSES WHO ENGAGE IN SEXUAL
  HARASSMENT OF OTHERS ARE
  GUILTY OF INTENTIONAL TORTS AND
  CIVIL RIGHTS CLAIMS. THEY ARE
  GUILTY OF INTENTIONAL INFLICTION
  OF EMOTIONAL DISTRESS. FURTHER,
  THEY HAVE VIOLATED THE NURSE
  PRACTICE ACT!!!!!!!!!!!!!
    SEXUAL HARASSMENT
• DO NOT DISMISS
  ANY SEXUAL
  HARASSMENT AS
  “JUST HAVING
  FUN”!
• A RESPONSE LIKE
  THIS CAN HAVE
  SERIOUS
  CONSEQUENCES!!!!
VIOLENCE IN THE WORKPLACE
• NURSES HAVE BEEN IDENTIFIED AS A
  GROUP AT RISK FOR VIOLENCE FROM
  PATIENTS, FAMILY MEMBERS, AND
  OTHER STAFF MEMBERS
VIOLENCE IN THE WORKPLACE
MAY INCLUDE THE FOLLOWING:

• (1) THREATS (making expressions of
  intent to harm others) (This may include
  verbal threats, written threats, or
  threatening body language)
• (2) PHYSICAL ASSAULTS (slapping,
  beating, rape, using weapons)
• (3) MUGGINGS ( assaults with the intent
  to rob)
SUGGESTIONS FOR NURSES TO
IMPROVE WORKPLACE SAFETY
• PARTICIPATE IN WORKPLACE
  ASSESSMENTS (identify unsafe areas as well
  as factors that might contribute to violent
  behaviors)
• ALWAYS BE ALERT FOR SUSPICIOUS
  BEHAVIOR (threatening body language,
  drug/alcohol use, a weapon)
• MAINTAIN BEHAVIOR THAT DE-FUSES
  ANGER (acknowledge the person’s feelings,
  remain calm)
• IF THE SITUATION CANNOT BE DE-FUSED,
  QUICKLY LEAVE AND CALL SECURITY
   IF THE NURSE IS THE VICTIM OF
   WORKPLACE VIOLENCE, HE/SHE
    SHOULD DO THE FOLLOWING:

• REPORT THE INCIDENT TO THE
  SUPERVISOR
• CALL THE POLICE
• GET MEDICAL ATTENTION
• CONTACT YOUR STATE NURSES
  ASSOCIATION
• BE PROACTIVE!!
   END OF LIFE DECISIONS
• DNR (DO NOT RESUSCITATE) ORDERS
  OR NO CODE ORDERS ARE A FORM
  OF WITHHOLDING TREATMENT
• ONLY PHYSICIANS CAN WRITE A DNR,
  USUALLY AFTER CONSULTING WITH
  THE PATIENT (when possible) AND THE
  FAMILY. ALL MEMBERS OF THE
  HEALTH CARE TEAM ARE EXPECTED
  TO COMPLY WITH THE ORDER!!!
     DO NOT RESUSCITATE
• A DNR PERMITS
  HEALTH CARE
  PROVIDERS TO
  WITHHOLD ONLY
  TREATMENT RELATED
  TO RESUSCITATION.
  DOES NOT APPLY TO
  WITHHOLDING
  NOURISHMENT,
  HYDRATION, OR IVF’S
• NURSES MUST
  KNOW IF A PATIENT
  IS A CODE OR NO
  CODE!!
   ADVANCED DIRECTIVES
• A DOCUMENT THAT MAKES ONE’S
  WISHES KNOWN CONCERNING
  MEDICAL LIFE-SUPPORT MEASURES
  IN THE EVENT THAT ONE IS UNABLE
  TO SPEAK FOR ONESELF.
     THE PATIENT SELF-
 DETERMINATION ACT OF 1990
• THIS LAW WAS PASSED TO PROVIDE
  GUIDELINES FOR DEVELOPING
  ADVANCED DIRECTIVES.
  HEALTHCARE FACILITIES/AGENCIES
  ARE REQUIRED TO ASK PATIENTS
  ABOUT ADVANCE DIRECTIVES. MOST
  FACILITIES/AGENCIES WILL PROVIDE
  THE NECESSARY FORMS FOR
  PATIENTS TO FILL OUT IF THEY WISH
  TO SET UP ADVANCED DIRECTIVES.
   ADVANCE DIRECTIVES
• THE TWO MOST COMMON FORMS:
  (1) THE LIVING WILL
  (2) HEALTHCARE SURROGATE
  (Durable Power Of Attorney)
             LIVING WILL
• A LEGAL DOCUMENT
  STATING AN
  INDIVIDUAL’S WISHES
  REGARDING “LIFE
  SUPPORT” IN THE
  EVENT THAT THIS
  INDIVIDUAL BECOMES
  INCOMPETENT IN
  MAKING INFORMED
  TREATMENT
  DECISIONS AND IS
  SUFFERING FROM A
  TERMINAL CONDITION
      HEALTHCARE
SURROGATE/PROXY (Durable
    Power OF Attorney)
            • A DOCUMENT
              AUTHORIZING
              ANOTHER PERSON
              TO ACT ON ONE’S
              BEHALF. THIS
              PERSON MAKES
              KNOWN THE
              PATIENT’S WISHES
              TO MEDICAL
              PERSONNEL
      CONFIDENTIALITY
• THE ACT OF HOLDING INFORMATION
  IN CONFIDENCE. IT IS NOT TO BE
  RELEASED TO UNAUTHORIZED
  INDIVIDUALS!!!!!!!!
• ALL INFORMATION CONCERNING
  PATIENTS SHOULD BE GIVEN ONLY IN
  PRIVATE, SECLUDED AREAS!!!!
CONFIDENTIALITY
        • NURSES WHO FAIL
          TO MAINTAIN
          CONFIDENTIALITY,
          ARE GUILTY OF
          VIOLATING THE
          NURSE PRACTICE
          ACT AS WELL AS
          HIPAA (Health
          Insurance Portability
          and Accountability Act
          of 1996)
     INFORMED CONSENT
• THE PATIENT HAS GIVEN PERMISSION
  EITHER EXPRESSED (orally or written)
  OR IMPLIED FOR THE PHYSICIAN TO
  EXAMINE HIM/HER, TO PERFORM
  TESTS THAT AID IN DIAGNOSIS,
  AND/OR TO TREAT FOR A MEDICAL
  CONDITION.
   INFORMED CONSENT IMPLIES
THAT THE PATIENT UNDERSTANDS
     THE FOLLOWING: (it is the
responsibility of the MD to explain this)
• PROPOSED MODE OF
  TREATMENT
• REASON TREATMENT IS
  NECESSARY
• RISKS INVOLVED
• ALTERNATIVE MODES OF
  TREATMENT
• RISKS OF ALTERNATIVE
  MODES OF TREATMENT
• RISKS INVOLVED IF
  TREATMENT IS REFUSED
• NURSES ARE OFTEN REPONSIBLE FOR
  GETTING CONSENT FORMS SIGNED!
• NURSES MUST BE SURE THAT A PATIENT IS
  CONSIDERED ABLE OR COMPETENT TO
  MAKE INFORMED DECISIONS (competency is
  defined differently from state to state)
• IF THE PATIENT DOES NOT UNDERSTAND
  THE PROCEDURE AND/OR TREATMENT OR
  EXPRESSES UNCERTAINTY, CONTACT THE
  PHYSICIAN!!!!
         MALPRACTICE ISSUES
          (COMMON ACTS OF
            NEGLIGENCE)
• (1) MEDICATION ERRORS
• (2) FAILURE TO MONITOR (OBSERVE) AND TAKE
  APPROPRIATE ACTION
• (3) FAILURE TO COMMUNICATE
• (4) FALLS
• (5) FOREIGN OBJECTS LEFT IN PATIENTS (post-surgery)
• (6) BURNS
• (7) BLOOD ADMINISTRATION (failing to follow proper
  policies/procedures)
• (8)ALTERING A PATIENT’S RECORD
• (9) FAILURE TO REPORT A CO-WORKER’S NEGLIGENCE
• (10)FAILURE TO PROVIDE PROPER EDUCATION (teaching) TO
  A PATIENT
• (11) DEFECTS IN EQUIPMENT
WHISTLEBLOWER STATUTES
• THIS PROVIDES PROTECTION FOR
  NURSES FROM RETALIATORY ACTION
  WHO REPORT THEIR EMPLOYERS,
  OTHER HEALTH CARE
  PROFESSIONALS, OR OTHER
  AGENCIES.
  (These statutes differ from state to state)
   EXAMPLES OF STATUTES
INVOLVING A DUTY TO REPORT:
(1) EVIDENCE OF CHILD OR ADULT ABUSE
(2) DEATHS UNDER SUSPICIOUS
    CIRCUMSTANCES
(3) INJURIES CAUSED BY VIOLENCE
(4) ILLEGAL, SUBSTANDARD,
    UNETHICAL,UNSAFE OR INCOMPETENT
    PRACTICE
        ORGAN DONATION
• THE UNIFORM
  ANATOMICAL GIFT ACT
  (1968, 1987) ALLOWS
  PEOPLE 18 YEARS OF
  AGE OR OLDER AND
  OF SOUND MIND TO
  MAKE A GIFT OF ALL
  OR ANY PART OF
  THEIR OWN BODIES
  FOR MEDICAL
  EDUCATION,
  RESEARCH, OR
  TRANSPLANTATION.
            ORGAN DONATION
•   SOME PATIENTS CARRY A
    CARD THEY HAVE SIGNED
    STATING THEY WISH TO BE AN
    ORGAN DONOR
•   SOME HAVE INDICIATED THEY
    WISH TO BE AN ORGAN
    DONOR ON THEIR DRIVER’S
    LICENSE
•   NURSES MAY SERVE AS A
    WITNESS FOR PATIENTS
    CONSENTING TO DONATE
    ORGANS
•   PATIENTS MAY REVOKE THEIR
    DECISION BY (1)DESTROYING
    THE CARD OR (2)ORALLY
    RETRACTING THEIR DESIRE
    TO BE A DONOR IN THE
    PRESENCE OF TWO
    WITNESSES
              ORGAN DONATION
•   NURSES ARE REQUIRED BY
    LAW TO CONTACT THE
    ALABAMA ORGAN CENTER
    AND THE EYE BANK WHEN A
    PATIENT EXPIRES. THESE
    ORGANIZATIONS DETERMINE
    (based on pre-determined criteria)
    IF THE INDIVIDUAL IS A
    CANDIDATE FOR ORGAN
    DONATION. IF THESE
    ORGANIZATIONS DETERMINE
    THAT THE INDIVIDUAL MEETS
    THE CRITERIA, THEN THE
    NURSE APPROACHES THE
    FAMILY TO DISCUSS THE
    POSSIBILITY OF ORGAN
    DONATION!
       ABANDONMENT
• ACCEPTANCE OF A PATIENT
  ASSIGNMENT, THUS ESTABLISHING A
  NURSE-PATIENT RELATIONSHIP, AND
  THEN ENDING THE RELATIONSHIP
  WITHOUT GIVING REASONABLE
  NOTICE TO SUPERVISORY
  PERSONNEL, SO THAT OTHERS CAN
  MAKE ARRANGEMENTS FOR
  CONTINUATION OF NURSING CARE!!!
         ABANDONMENT

• TO BE GUILTY OF
  ABANDONMENT IS
  A VIOLATION OF
  THE NURSE
  PRACTICE ACT!!!!
       ETHICAL PRINCIPLES
•   AUTONOMY
•   BENEFICENCE
•   NONMALEFICENCE
•   VERACITY
•   JUSTICE
•   PATERNALISM
•   FIDELITY
•   CONFIDENTIALITY
•   ACCOUNTABILITY
      CODE OF ETHICS
• A FORMAL STATEMENT OF THE
  RULES OF ETHICAL BEHAVIOR FOR A
  PARTICULAR GROUP OF
  INNDIVIDUALS.
 NURSING CODE OF ETHICS
• PROVIDES VALUES,
  STANDARDS, AND
  PRINCIPLES TO HELP
  NURSING FUNCTION
  AS A PROFESSION
• THE ORIGINAL CODE
  WAS DEVELOPED IN
  1985 BY THE ANA
  BOARD OF DIRECTORS
  AND THE CONGRESS
  ON NURSING
  PRACTICE
      PATIENT’S RIGHTS
• IN 1973, THE AMERICAN HOSPITAL
  ASSOCIATION PUBLISHED A
  STATEMENT KNOWN AS THE
  “PATIENT’S BILL OF RIGHTS”
• IT IS NOW KNOWN AS “YOUR RIGHTS
  AS A HOSPITAL PATIENT”
   ***DERIVED FROM THE ETHICAL
  PRINCIPLE OF AUTONOMY
“YOUR RIGHTS AS A HOSPITAL
         PATIENT”
             • THIS DOCUMENT
               REFLECTS THE
               ACKNOWLEDG-
               MENT OF THE
               PATIENT’S RIGHT TO
               ACTIVELY
               PARTICIPATE IN
               HIS/HER HEALTH CARE
               AND TO
               COMMUNICATE
               OPENLY WITH THE
               HEALTH CARE TEAM
    CURRENT ETHICAL ISSUES
•   STEM CELL RESEARCH
•   EUTHANASIA
•   SURROGATE MOTHERHOOD
•   PHYSICIAN-ASSISTED SUICIDE
•   END OF LIFE CARE
•   GENETIC SCREENING
•   HEALTH CARE RATIONING
POLITICAL ACTION IN NURSING
• NURSES MUST REALIZE THAT
  INVOLVEMENT IN THE POLITICAL
  PROCESS IS A NECESSITY IF THEY
  ARE TO CARRY OUT THEIR MISSION ---
  PROVIDING QUALITY PATIENT CARE!!!!
       PROFESSIONAL
       ORGANIZATIONS

• AMERICAN NURSES ASSOCIATION



• NATIONAL LEAGUE FOR NURSING
       AMERICAN NURSES
         ASSOCIATION
• FUNCTIONS AS THE MAJOR VOICE OF
  NURSING
• ONE OF THE PRIMARY FUNCTIONS IS TO
  LOBBY CONGRESS AND REGULATORY
  AGENCIES ABOUT HEALTH CARE ISSUES
  AFFECTING NURSING AND THE PUBLIC
• NOT ONLY LOBBIES AT THE NATIONAL
  LEVEL BUT AT THE STATE LEVEL AS WELL
  TO INFLUENCE LAWS THAT AFFECT THE
  PRACTICE OF NURSING AND THE SAFETY
  OF THE CONSUMER
    NATIONAL LEAGUE FOR
          NURSING
• FOSTERS IMPROVEMENT IN NURSING
  SERVICES AND NURSING EDUCATION
• LOBBIES ACTIVELY FOR NURSING
  ISSUES
            LOBBYING
• AN ATTEMPT TO
  INFLUENCE OR
  SWAY A PUBLIC
  OFFICIAL TO TAKE
  A DESIRED ACTION!
HOW CAN NURSES LOBBY??
• MEET THE CANDIDATE AND EVALUATE HIM/HER AS
  A POTENTIAL OFFICE-HOLDER (Assess their
  knowledge of health care issues)
• CONTACT THE ELECTED OFFICIAL WHEN THEY
  NEED INFORMATION ON HOW TO VOTE ON AN
  ISSUE (May be accomplished by a visit, writing a letter,
  sending an e-mail, or making a telephone call)
• CONTACT THE ELECTED OFFICIAL WHEN A BILL IS
  COMING UP THE FIRST TIME IN COMMITTEE
• PARTICIPATE IN A STATEWIDE NETWORK TO
  BOMBARDE ELECTED OFFICIALS WITH LETTERS,
  PHONE CALLS, AND E-MAILS WHEN A
  CONTROVERSIAL BILL IS COMING UP FOR A VOTE
HOW CAN NURSES LOBBY???
            • JOIN A
              PROFESSIONAL
              GROUP THAT
              LOBBIES TO
              INFLUENCE LAWS
              THAT AFFECT THE
              PRACTICE OF
              NURSING!!!!!!!!!!!!
      POLITICAL ACTION
     COMMITTEES (PAC’s)
• THIS IS A MECHANISM WHEREBY
  INDIVIDUALS CAN POOL THEIR
  RESOURCES AND COLLECTIVELY
  SUPPORT A CANDIDATE. PAC’s MUST
  COMPLY WITH STATE AND/OR
  FEDERAL ELECTION CODES AND
  REPORT FINANCIAL SUPPORT GIVEN
  TO CANDIDATES.
   THE AMERICAN NURSES
ASSOCIATION’S NATIONAL PAC
       IS THE ANAPAC
• THIS ALLOWS
  NURSES TO
  ORGANIZE AS A
  GROUP TO
  ENDORSE
  CANDIDATES FOR
  NATIONAL OFFICES
THE ANA ALSO HAS STATE NURSES
ASSOCIATIONS THAT HAVE PAC’s AT
THE STATE LEVEL

THIS ALLOWS NURSES TO ORGANIZE
AS A GROUP TO ENDORSE
CANDIDATES FOR STATE-WIDE
OFFICES
         THE ANAPAC
• PROVIDES FINANCIAL AND CAMPAIGN
  SUPPORT TO CANDIDATES
• DOES NOT LOBBY ELECTED
  OFFICIALS
• DOES NOT “BUY” CANDIDATES
• EVALUATES CANDIDATES BASED ON
  NURSING AND HEALTH CARE
  CONCERNS ONLY!!!
•THE
 END!!!!

				
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posted:10/12/2011
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