I) Denial: individuals act as though nothing has happened and may refuse to believe that a loss has occurred. The court held that the husband and wife stated a claim for invasion of privacy and that, even though the in vitro fertilization program was of public interest, the identity of the plaintiffs was a private matter (YG v Jewish Hospital, 1990). Child fantasizes about parent as first love. The man’s toes became swollen and discolored, and he developed decreased sensation. 2) The right dose. f) Submit the report as soon as possible to the appropriate administrator. Select all that apply. g) Keep a written account of the incident report for personal files. They have also upheld the right of a legally competent patient to refuse medical treatment for religious reasons. In Quasi intentional torts the accusation is lacking but there is still a volitional act and direct allegations. 16) Outline Federal Drug Administration Legislation. Intentional tort requires the person who committed the act to do so deliberately. Each state providing for living wills has its own requirements for executing them. Describe the nurse’s role regarding a “do not resuscitate” (DNR) order. 10) What are Erickson’s Stages of Development and how they compare to Freud’s? Licensure protects the consuming public and insures that the nurse has completed a state approved nursing school, has successfully passed their licensure examination and has also continuously met the requirement(s) for relicensure each biennium without any suspensions or revocations of their license. Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action. The defendant. 3. explain a recent case involtional or quasi-intentional torts? This occurs when nurses restrain a patient in a confined area to keep the person from freedom. Nursing standards of care are described in the Nurse Practice Act of every state, in the federal and state laws regulating hospitals and other health care institutions, by professional and specialty nursing organizations, and by the policies and procedures established by the health care facility where nurses work (Guido, 2010). Does the failure to document an admission nursing assessment equate with the fact that this nurse did no admission nursing … The whole-brain standard requires irreversible cessation of all functions of the entire brain, including the brainstem. Institutional policies and procedures need to conform to state and federal laws and community standards and cannot conflict with legal guidelines that define acceptable standards of care (Guido, 2010). * The defendant owed the plaintiff a specific duty (in nursing malpractice cases, the standard of care). The statute stated that 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. Nursing care of the grieving family begins with establishing the significance of the loss. Due process means that nurses must be notified of the charges brought against them and have an opportunity to defend against them in a hearing. Some states such as Ohio offer DNR Comfort Care and DNR Comfort Care Arrest protocols. Patients in end-stage renal disease are eligible for Medicare coverage for a kidney transplant, but private insurance pays for other transplants. 19) Outline the legal responsibilities for nurses when giving drugs. Prizing and cherishing the choice. d) STAT order: signifies that a single dose of a medication is to be given immediately and only once. Be familiar with the policies of your institution complying with the act. Organ transplantation is extremely expensive. John does not know that Adam suffers a disability, but he does know that kicking someone will cause discomfort. This agent makes health care treatment decisions based on the patient’s wishes (Blais et al., 2006). Although the HIPAA does not require such measures as soundproof rooms in hospitals, it does mean that nurses and all health care providers need to avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any manner. The Supreme Court ruled in 1998 in Bragdon v Abbott that even asymptomatic HIV constitutes a disability within the meaning of the ADA. * Initiative vs. CPR is an emergency treatment provided without patient consent. Written orders include a specific episode with start and end times. Measures to counteract the effects of the error may be necessary. A felony is a crime of a serious nature that has a penalty of imprisonment for longer than 1 year or even death. The U.S. Supreme Court stated in the Cruzan v Director of Missouri Department of Health case in 1990 that “we assume that the U.S. Constitution would grant a constitutionally protected competent person the right to refuse lifesaving hydration and nutrition.” In cases involving the patient’s right to refuse or withdraw medical treatment, the courts balance the patient’s interest with the interest of the state in protecting life, preserving medical ethics, preventing suicide, and protecting innocent third parties. 11) What are the physiological signs and symptoms of death? Many states, through their respective public health departments, require that hospitals report certain infectious or communicable diseases. * Phallic or Oedipal complex (3 to 6 yrs) -sexual organ gains prominence. What is a quasi-intentional tort? The Federal Nursing Home Reform Act (1987) gave residents in certified nursing homes the right to be free of unnecessary and inappropriate restraints. Examples are assault, battery, invasion of privacy and defamation of character. The Americans with Disabilities Act (ADA) (1990) is a broad civil rights statute that protects the rights of people with physical or mental disabilities (Grohar-Murray and Langan, 2011). The complexity of the healthcare delivery system today is such that the roles and responsibilities of the nurse are constantly expanding. This means that the ADA protects a person who is HIV positive but does not have acquired immunodeficiency syndrome (AIDS). Intentional Torts Intentional torts, on the other hand, occur when a person intentionally acts in a certain way that leads to another person's injury. What does it mean to be liable for an action? a) Store all narcotics in a locked, secure cabinet or container (Computerized, locked cabinets are now available). If a patient does not have a DNR order, health care providers need to make every effort to revive the patient. False imprisonment requires that the patient be aware of the confinement. Is coming to terms with the situation, rather than submitting to resignation or hopelessness. 6) Define and give patient examples for the ethical principles discussed in class. For example, taking the height and weight of a pediatric client and comparing the measurements to the standardized charts. Guilt (3 to 6yrs) If a client is affected, the physician documents the examination and findings in the client’s medical record. It is not a set of rules designed to interfere with conscientious decision making, and it does not suggest that a specific set of values should be accepted by all persons. Interrogatories: Written questions requiring answers under oath. Durable power of attorney for health care (DPAHC), p. 299. Specialized nurses such as nurse anesthetists, operating room (OR) nurses, intensive care nurses, or certified nurse-midwives have specially defined standards of care and skills. What is the Nursing Practice Act, and what is its purpose? Nurses who apply restraints in violation of state and federal regulations may be charged with abuse, battery, or false imprisonment. A nursing student is listing examples of quasi-intentional torts. (issues in nursing) How would the student nurse describe a quasi-intentional tort occurring during the practice of nursing a- it is a willful act violating a client's rights b- it is a civil wrong made against a person or property c- it is an act that lacks intent but involves volitional action The requirements for licensure vary among states, but most states have minimum education requirements and require a licensure examination. It is not the nurse’s responsibility to decide independently the legality of disclosing information. Parties’ depositions: The plaintiff and defendants (physician, nurse, hospital personnel) are almost always deposed. The nurse documents only and objective description of what was actually observed, and follow up care that occurred, and does not specify in the medical record that an incident report was prepared. Read the case study presented at the end of Chapter 5 (Guido p. 67). In addition to patient refusals of treatment, the nurse frequently encounters a DNR order. As a result of patients being transferred from private to public hospitals without appropriate screening and stabilization (referred to as patient dumping), Congress enacted the Emergency Medical Treatment and Active Labor Act (EMTALA) (1986). Under the act the patient’s record needs to document whether or not the patient has signed an advance directive. b) Describe specifically what happened in concise, objective terms. A hospice program emphasizes palliative treatment to control symptoms rather than curative treatment, which treat disease. The tort of nuisance, for example, involves strict liability for a neighbor who interferes with another's enjoyment of his real property. Even though the nurses attempted to contact the physician, this case holds that, when the physician fails to respond, the nurse must go over the health care provider’s head to make sure that he or she is appropriately treated. Quasi-intentional tort has to do with something you SAY that causes harm to someone or their reputation. Libel is the written defamation of character (e.g., charting false entries in a medical record). Erickson defined 8 stages of life, first five coinciding with Freud’s stages. Research and summarize a case that involves an unintentional tort in a healthcare setting in United States and identify the following information: The plaintiff. When nursing care falls below a standard of care, nursing malpractice results. Considering all consequences. The coroner should be also contacted if a client’s death is unforeseen and sudden and the client has not been seen by a physician in over 36 hours. Which examples mentioned by the nursing student need correction? When a family asks to see a patient’s medical record, you must instead establish a relationship that allows for open communication so you can discuss the family’s concerns. There are many alternatives to the use of restraints, and you should try all of them before using restraints. 15) What are the legal responsibilities after death? e) Do not interpret or attempt to explain the cause of the incident or blame anyone. Describe the nursing implications associated with legal issues that occur in nursing practice. IV) Depression: the individual realizes the loss and the full impact of its significance is apparent. Knowledge of the law of tort is important for all because most of the civil cases that resulted from nursing activities belong to the category of tort. This article explores the potential application of intentional torts claims in a medical context in light of recent case law. Because a license is a property right, the State Board has to follow due process before revoking or suspending a license. If the patient subsequently develops complications as a result of your actions, you are immune from liability as long as you acted without gross negligence (Good Samaritan Act, 1997). b) Nurses in charge carry a set of keys (or a special computer entry code) for narcotics cabinet. This sets it apart from other torts, including negligence. The American Nurses Association (ANA) (2008) has held that nurses’ participation in assisted suicide violates the code of ethics for nurses. * Defamation of Character -publication of false statements that result on damage to a person’s reputation. Infant: cries for death of mother or significant other. The couple filed a lawsuit. Publicly affirming the choice. For example, respect the wish not to inform the patient’s family of a terminal illness. Malpractice sometimes involves failing to check a patient’s identification correctly before administering blood and then giving the blood to the wrong patient. Living wills are often difficult to interpret and not clinically specific in unforeseen circumstances. It establishes the basis for privacy and confidentiality concerns, viewed as two basic rights within the U.S. health care setting. Examples of common law include informed consent, the patient’s right to refuse treatment, negligence, and malpractice. Most states have adopted the, An individual’s right to privacy sometimes conflicts with the public’s right to know. Witnesses’ depositions: Questions are posed to the witness under oath to obtain all relevant, nonprivileged information about the case. What would be a crime committed by a nurse? A tort is a wrongful act that injures or interferes with another’s person or property. c) During institutions change of shift the nurse going off duty counts all the narcotics with the nurse coming on duty. Development: implies a progressive and continuous process of change leading to a state of organized and specialized functional capacity, for example, a child’s progressions from rolling over to crawling to walking and developmental changes (Haywood, 1993) It identifies advantages for plaintiffs who plead intentional tort claims, including onus of proof, causation, remoteness, the quantum of compensatory damages and the availability of aggravated and exemplary damages. • Describe the nurse’s role regarding a “do not resuscitate” (DNR) order. Nurses should not fear the law but instead practice nursing armed with the judgment skills that are the outcomes of informed critical thinking. Living wills are often difficult to interpret and not clinically specific in unforeseen circumstances. • Failure to assess and/or monitor, including making a nursing diagnosis, • Failure to use proper equipment to monitor the patient, • Failure to notify the health care provider of problems, • Failure to follow the six rights of medication administration, • Failure to convey discharge instructions, • Failure to ensure patient safety, especially patients who have a history of falling, are heavily sedated, have disequilibrium problems, are frail, are mentally impaired, get up in the night, and are uncooperative, • Failure to follow policies and procedures, • Failure to properly delegate and supervise, Only gold members can continue reading. The Florence Nightingale Pledge A restraint-free environment is the first goal of care for all patients. Privacy is the right of patients to keep personal information from being disclosed. 4. analyze the ethical implications of committing an intentioal or quasi- intentional tort? For example, nurses who perform illegal acts such as selling or taking controlled substances jeopardize their license status. * Must have a License In general, courts define negligence in car accident cases and other negligence cases as that degree of care that an ordinarily careful and prudent person would use under the same or similar circumstances. Intentional Tort Example. The U.S. Orphan Drug Act of 1983 offers federal financial incentives to commercial and nonprofit organizations to develop and market the drugs previously unavailable in the USA. A crime committed by a nurse will be considered a malpractice. A terminal disease is an “incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death within 6 months.”. There are essentially two standards for the determination of death. So defamation of character or sharing private information that causes harm to the person or their reputation. Certain criteria are necessary to establish nursing malpractice: (1) the nurse (defendant) owed a duty to the patient (plaintiff), (2) the nurse did not carry out that duty, (3) the patient was injured, and (4) the nurse’s failure to carry out the duty caused the injury. The patient’s injury was caused by the nurse’s failure to carry out that duty (“but for” the breach of duty, the patient would not have been injured). a) Protocol/Standing orders or routine medication orders: a standing order is carried out until the prescriber cancels it by another order or until a prescribed number of days elapse. Nurses act as Good Samaritans by providing emergency assistance at an accident scene (Good Samaritan Act, 1997). Medical records: The defendant obtains all of the plaintiff’s relevant medical records for treatment before and after the incident. Erroneous: call Dr if illegible handwriting. Define legal aspects of nurse-patient, nurse–health care provider, nurse-nurse, and nurse-employer relationships. Sexual urges reemerge. Typically invasion of privacy is the release of a patient’s medical information to an unauthorized person such as a member of the press, the patient’s employer, or the patient’s family. Ms. McGuire's specialty became critical care and also has extensive experience in intensive surgical, medical, coronary, emergency, and telemetry care units for the past several years. In most states Required Request laws mandate that, at the time of admission to a hospital, a qualified health care provider has to ask each patient over age 18 whether he or she is an organ or tissue donor. When the patient’s death is not subject to a medical examiner review, consent must be obtained. * Generativity vs. Self-Absorption and Stagnation (Middle Age) They are based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over the dying process. Lawsuits result from patients’ attempts at suicide within the hospital. He believed that the maturation of bodily functions was linked with expectations of society and culture in which the person live. Wrongful handling of a deceased person’s remains causes emotional harm to the surviving family. Example: “Why is God doing this to me?” It limits who is able to access a patient’s record. Statutory law is either civil or criminal. c) Single (one time) orders: a prescriber will often order a medication to be given only once at specific time. f) The record is used to document the client’s name, date, time of medication administration, name of medication, dose, and signature of nurse dispensing the medication. The American Association of Colleges of Nursing (AACN) supports the International Council of Nurses’ mandate to ensure an individual’s peaceful end of life (Guido, 2010). Gangrene developed, and the man’s leg was amputated. Society expects safe health care delivery, especially from nurses who are typically perceived as the most trusted profession. Exceptions to the ability to access medical records apply to psychotherapy notes or when the health care provider has determined that access would result in harm to the patient or another party (Privacy Rights Clearinghouse, 2011). Toddler: think that death is reversible. The tort of invasion of privacy protects the patient’s right to be free from unwanted intrusion into his or her private affairs. If John had not kicked Adam, the “actual cause” of the injury would not have occurred. It identifies advantages for plaintiffs who plead intentional tort claims, including onus of proof, causation, remoteness, the quantum of compensatory damages and the availability of aggravated and exemplary damages. Value clarification is a process of self-discovery that helps a person gain insight into values. An example of a regulatory law is the requirement to report incompetent or unethical nursing conduct to the State Board of Nursing. * Publicly placing one in a false light It is also the most extensive law on how employers must treat health care workers and patients infected with the human immunodeficiency virus (HIV). The nursing code of ethics sets forth ideals of conduct. Health care providers perform CPR on an appropriate patient unless there is a DNR order in the patient’s chart. Malpractice is one type of negligence and often referred to as professional negligence. II) Prizing one’s beliefs and behaviors. Unintentional tort is negligence or malpractice. As a professional nurse you need to understand the legal limits influencing your practice. The positions of these two national organizations are not contradictory and require nurses to approach a patient’s end of life with openness to listening to the patient’s expressions of fear and to attempt to control the patient’s pain. The act also protects the donor’s estate from liability for injury or damage that results from the use of the gift. Standards reflect the knowledge and skill ordinarily possessed and used by nurses actively practicing in the profession (Guido, 2010) (see Chapter 1). 1) What are intentional and unintentional torts? * Autonomy vs. Shame and Doubt (1 to 3yrs) The nurse uses objective and subjective assessment and discretion in determining whether or not the client needs the medication. For example, if a patient gets into a wheelchair or transfers to a stretcher after receiving advice that it is time to be taken for an x-ray procedure, the patient has given implied consent to the procedure. Id- primitive part, basic instinctual impulses driven to achieve pleasure. Other witnesses: Factual witnesses, both neutral and biased, including family members on the plaintiff’s side and other medical personnel (e.g., nurses) on the defendant’s side, are deposed to obtain information and their version of the case. • Discuss the nurse’s role in witnessing the informed consent process. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling. Any pharmaceutical product that may be available to physicians and patients in countries other than the United   States but that has not been “adopted” by a domestic pharmaceutical manufacturer or distributor. • Define legal aspects of nurse-patient, nurse–health care provider, nurse-nurse, and nurse-employer relationships. * Refuse a medication regardless of consequences Litigation from improper restraint use is a common nursing legal issue (Evans and Cotter, 2008). After the newscast they received phone calls and embarrassing questions. reflects decisions made by administrative bodies such as State Boards of Nursing when they pass rules and regulations. The contact can be harmful to the patient and cause an injury, or it can be merely offensive to the patient’s personal dignity. Learning Outcome For example, if someone swings a baseball bat at you, you see it coming and duck, and the baseball bat continues to travel and hits the person standing next to you, then the person hit is the victim of a tort even if the person swinging the bat had no intention of hitting the victim. Unintentional Tort: A type of unintended accident that leads to injury, property damage or financial loss. An intentional tort is when an individual or entity purposely engages in conduct that causes injury or damage to another. Torts can either be intentional (performed purposefully) or negligent (caused by a lack of reasonable care). Quasi-intentional torts are acts in which intent is lacking but volitional action and direct causation occur such as in invasion of privacy and defamation of character. Four factors must be verified for a consent to be valid: I) The person giving consent must be mentally and physically competent and be legally an adult (over 18 yrs of age or emancipated). For example, if a nurse tells people erroneously that a patient has gonorrhea and the disclosure affects the patient’s business, the nurse is liable for slander. It protects individuals from losing their health insurance when changing jobs by providing portability. Practicing without a current and valid license is illegal and it amounts to pra… When supporting the grieving family, the nurse must acknowledge their grief, understand the value of the client to the family, and assist them through the dying process. This act provides that, when a patient comes to the emergency department or the hospital, an appropriate medical screening occurs within the capacity of the hospital. The use of physical restraints is a safety strategy that has been used in hospitals and long-term care settings to protect patients from injury. A State Board of Nursing licenses all registered nurses in the state in which they practice. • List sources for standards of care for nurses. IV) Justice: refers to fairness. The United Network for Organ Sharing (UNOS) has a contract with the federal government and sets policies and guidelines for the procurement of organs. In some situations consent is implied. For example a new bone marrow transplant procedure may promise a chance at cure. In addition, many state laws allow patients to access their medical records. Defamation of character is the publication of false statements that result in damage to a person’s reputation. The emergency department physician applied a cast with insufficient padding. Standards are those actions that ensure safe nursing practice. ). The tort of false imprisonment occurs with unjustified restraint of a person without legal warrant. This constitutes intentional tort since John “intended” to kick Adam knowing the “act” could cause harm. With this legal document the patient is able to declare which medical procedures he or she wants or does not want when terminally ill or in a persistent vegetative state. Despair (Old Age). A patient must authorize the release of information and designate to whom the health care information may be released. d) Report any measures taken by oneself, other nurses, or physicians at the time of the incident. Nurses help organizations protect patients’ rights to confidentiality. III) The person giving the consent must thoroughly understand the procedure, its risks and benefits, and alternative procedures. * Must demonstrate accountability and responsibility, Make sure it’s the RIGHT medication, dose, client, route, and time. Definition. 4) The right route. Intentional Torts. The jury uses the standards of care to determine whether the nurse acted appropriately. Good Samaritan laws have been enacted in almost every state to encourage health care professionals to assist in emergency situations. School age (9-10): Understand that death in permanent. Describe the legal responsibilities and obligations of nurses regarding the following federal statutes: Americans with Disabilities Act (ADA), Emergency Medical Treatment and Active Labor Act (EMTALA), Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Patient Self-Determination Act (PSDA). Those laws limit liability and offer legal immunity for nurses who help at the scene of an accident. Assault Battery Malpractice Invasion of privacy Defamation of character 3) The right client. III) Acting on one’s beliefs. 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