Legal Aspect of Nursing

1. Legal Aspect of Nursing

2. Objectives • By the end of the lectures students should be able to explain and discuss: • Standards that govern nursing care 2. The Law and how it governs nursing/midwifery 3. Conduct of students

3. Standards of Care • Guidelines for nursing/midwifery practice • Average degree of skill, care and diligence exercised by members of the same profession under the same or similar circumstances • If standards does not met this level is negligence-incompetence or gross negligence • Yard stick by which the legal system measures the actions of a nurse in a malpractice suit • Protects patients from inferior care

4. Standards CONT’D • If nurse /midwives do not perform their duties within accepted standards of care they place themselves in jeopardy of legal action and also place their client’s at risk for harm or injury

5. Definitions • Standards of professional performance-activities such as continuous quality improvement, education, research,ethics and peer review • Standard is an authoritative statement • Guidelines suggest or recommend practices by which standards of care can be met-do not mandate compliance

6. Definitions CONT’D • By laws are rules that are adopted to regulate practice and privileges-med/surg nursing • Policy-overall plan to accomplish general goals • Procedures –tools used to implement the policies

7. Sources of Standards • Joint Commission on Accreditation of Healthcare Organizations • State laws and regulations • American Nurses association • Bylaws, Facility procedures Ghana • NMC • Constitution • GRNA/GRMA • MOH/GHS • Facility procedures and protocols

8. Developing Standards • State board of nursing • Nursing associations • Specialty nursing associations • Standards vary-general or specific

9. Legal Implications • Standard serves as evidence- prove 4 elements 1. Duty 2. Breech of duty 3. Proximate cause 4. Damages Expert-relevance Hearsay evidence • Standards in disciplinary Proceedings

10. Standard of Care Defenses • Nurses in Training • Error-in-Judgement- standard met even though error occurred • Two-schools- of Thought Doctrine-more than one method of doing a procedure

11. Legal Responsibilities • Law is the body of rules and regulations that governs people’s behaviour and their relationships with others in the society and with the state • Rules made by a society for the purpose of preserving orders and promoting the safety of that society • Standard of human conduct established and enforced by authority of an organized society through its government

12. Responsibilities CONT’D • Law promote order by resolving conflicts and disputes non-violently • Nurses/midwives must understand the legal aspect of the profession • Protect the rights of the client's and reduce the risk of liability

13. Responsibilities CONT’D • When we practice within the confines of the law, we are able to • Shield yourself from liability • Advocate for clients rights • Provide care that is within the scope of practice • Discern the responsibilities of nursing in relationship to the responsibilities of other members of the health team

14. Responsibilities CONT’D • Provide safe competent care that is consistent with standards of care

15. Types of law • Coded or written- laws formally enacted or approved by parliament • Uncoded or unwritten – un-enacted i.e. judicial precedents

16. Categories of Law2 Main Categories 1. Public laws- • Constitutional Law-regulate functions of government and the relationship of individuals to them • Criminal laws- prevent and punish people who do wrong in the state

17. Categories CONT’D 2. Private and Civil Laws- rights and duties of individuals Bill Act Decree

18. Nurse/Midwife and the Law -Laws have dual purpose in nursing/midwifery: • To regulate practice • To protect client/patient -All professions are subject to legal control -Each state has it s own laws pertaining to nursing called ’’ Nurses Practice Act” Administration is by NMC in Ghana

19. Nurse/Midwife and the Law CONT’D • The midwives ordinance was established in 1931 which gave way to the formulation of their board • The nurses ordinance empowered the formulation of the nurses board of the Gold coast in 1948 • Regulation on education, examination and registration of nurses • It was merged with the Midwives board on 27th September 1972 to form the NMC • Proclaim under NRC Decree 117

20. Tort Law • Is a wrongful act committed by one part against another part or property • Purpose is to make the injured party whole again usually through monetary compensation • Tort is divided into two main parts • Negligence or unintentional tort • Intentional tort

21. Unintentional Tort • Negligence- occurs when an unreasonable or careless act or ommission of an act causes injury to another • Ordinary-failure to exercise the care that an ordinary prudent party exercises under similar circumstances- aid fails to clean a spill and patient falls

22. Unintentional CONT’D • Malpractice- specific type of professional negligence that occurs when the standard of care that can be reasonably expected from such professional is not met • Only professionals can be sue for malpractice • Breaching standard of care • The nurse is responsible for her actions-know the consequences off your actions

23. Unintentional CONT’D • Personal liability-you are responsible for your own conscious conduct • Respondent superior-employer may be responsible for the legal consequences of the employee’s action within the scope of his or her employment • Right to control, direct and supervise-employer

24. Unintentional CONT’D • Gross negligence- if the nurse/midwife is careless in her duties to the extent that human life is jorpardized then is viewed as a crime rather than a tort

25. Examples of Acts of Negligence • Leaving side rails down-patient fall out • Burning patient from hot water bottle, enemas, heating pads, sitz baths • Giving wrong medication • Using faulty apparatus • Misuse of patient personal belongings • Failure to count sponges accurately • Patient abandonment in urgent situations

26. Intentional Torts • Willfully or intentional act or wrong doing that violates another person’s rights or property; e.g. • Assault • Battery • False imprisonment • Trespass • Defamation • Infliction of emotional distress Civil/criminal law

27. Assault • Treat or an attempt to contact the body of another person without the privilege of doing so and without consent • Treat to use force • E.g. shaking a stick at a person close enough to be hit

28. Battery • Act of making an unauthorized contact • Actual employment of force or merely touching someone against their will • No treatment can be done without the patient’s consent or relative’s • In rear cases- mentally ill or in emergencies • Nurse is responsible for reporting cases of child abuse

29. False Imprisonment • Unwarranted restriction of the freedom of another. It includes: • Unlawful detention of a patient- for failure to pay bills • Misuse of restraints by hospital personnel-need an order to use restriants

30. Defamation • Wrongful act meaning to injured the reputation of another person • Very careful in personal remarks in daily activities • If defamation is oral- slander • Written defamation –libel • Statement is considered libel or slander when another person either hears or sees it

31. Crime • Any offence perpetuated against the public interest Two categories • Misdemeanors- misbehaviors • Felony- more serious crimes carrying penalties ranging from imprisonment to death

32. Nursing/Midwives Activities that Borders on the Law Patient Consent- patient or parent (minor) or significant signs for it • Its to protect the hospital or physician • Do not obtain consent after the patient is medicated or • If patient is physically or mentally challenged • Its your responsibility to let them know the procedure -witness

33. Consent CONT’D • If the patient refused to sign a consent form its your responsibility to inform the surgeon so that unauthorized procedure is not performed • In emergency situation the consent may be obtain from the next of king • When underage (below 21) the parent signs the consent

34. Invasion of Privacy • Every patient has the right to privacy • Do not make unauthorized disclosures about the patient • If patient is unconscious next of kin should be consulted to grant permission

35. Privacy CONT’D In police and accident cases the only facts that can be released without patient consent are: • Name, • Address, • Sex, • Marital Status, • Approximate age, • Occupation, • Employer, • Name and address of nearest relative

36. Privacy CONT’D • The condition of the patient may be stated as good, fair, serious, critical or dead on arrival • The name of the physician can be disclosed with permission • Photographs must not be taken-permission • No shop talk-gossip

37. Privacy CONT’D Certain cases that nurses can give information • Communicable disease, • child abuse, • criminal abortions, • gunshot wounds, • attempted suicide • drug abuse

38. Abortion If you are called to take care of a critically ill patient with criminal abortion; • Stay with the patient till legal or medical aid is obtain • Give your best and refrain from making moral judgments

39. Narcotics and other drugs • Drug abuse prevention and control act- prescription storage, administration of poisons and dangerous drugs • Poison and dangerous drug act- prescription, sales, storage and administration of narcotics-opium and cocaine. E.g. • Morphine sulphate,pethidine,barbiturates • Kept in a double lock cupboard( box-in a box)

40. Narcotics CONT’D • Nurse may give narcotics if supplied by the institutions • License to dispense it • Carefully record on legal records which indicates patients name, physician, name of drug, dosage and the time give as well as the nurses signature • These records are checked and a narcotic count done on each shift

41. Euthanasia(Mercy Killing) • From a Greek word- easy death • Practice of painless putting to death persons who have incurable, painful or distressing handicaps or diseases • Opposed by various religious bodies • It could be called suicide or murder

42. Unlawful Death • Homicide- to cause the death of another person unlawfully • If death is due to negligence- involuntary manslaughter • E.g. nurse involved in illegal abortion and the person dies- will be charge with the above

43. Wills • Legal declaration of a person’s wishes as to the deposition of his property after death • Patience may ask the nurse/midwife to help in making a will - • You have help the patience in securing the services of a lawyer by referring the patient to a list of lawyer in your locality • You can serve as a witness • The patient should be of a sound mind too • Not under the influence of drugs or persons • Nurse should record this as a fact in the patient’s record

44. Living Wills • Documents instructing physicians to withhold or withdraw life sustaining procedures when death is imminent • Prolonging the dying process and nor promoting health • Needs two witness neither should be a doctor or relative

45. Living Wills CONT’D • Advance directives- gives directions to healthcare providers on client’s desires in specific critical situations • Durable power of attorney- health care surrogate –client appoint someone to make health care decisions if and when they are no longer able to make decisions on their own behalf

46. Patient’s Chart • Is considered a legal document • Patient is safe guarded through the chart • It can also protect the doctor,nurse and hospital in cases of law suits • Provides a written account of patient hospitalization- it should be up to date and accurate to the last minute • Patients physical condition from admission to discharge

47. Chart CONT’D • All recorded information must be legible, complete, spelt correctly and standard abbreviations used • Pertinent observations should be recorded and signed, dated and patients name must appear on every chart, page on which notation is being made.

48. Effective Documentation • Careful, complete and objective documentation should be done • Timely and truthful • Keeps other health care providers p to date • Institutions has a duty to maintain nursing records • If records are incomplete it can be term negligent

49. Documentation CONT’D • If errors are made in documentation, follow the facility’s protocol to correct it- don’t erase

50. Suit Prone Patient • Patient who is usually unhappy, resentful and dissatisfied with all phases of his life • Because of his psychological make is more likely to sue for malpractice when something goes wrong