Legal Aspects of Nursing
Legal Aspects of Nursing
Definition of Terms
Standards of Care
Guidelines for determining whether nurses have performed duties in a appropriate manner & guidelines in which
the nurse should practice
- is a federal law that imposes on states and providers of health care certain requirements concerning Advanced
Directives as well as client’s right under law to to make decisions concerning medical care.
Example: All women patients having labor contractions must be medically screened & stabilized before transfer to
another facility. Whether it is obvious that the patient is in labor or not, the patient must be medically screened &
examined before the decision is made to transfer the patient to another facility.
The emergency department does not have the right to refuse treatment to a patient before medically screening the
patient.
- It does not address payment for services as part of the admission procedure. It
only addresses medical screening & stabilization of patients before transport
or the determination of ability to pay for services rendered.
1. Fraud – misrepresentation of fact with intentions for it to be acted on by another person ( such as falsifying
graduate nursing programs)
2. Negligence
3. Malpractice
Definition: Definition:
Example: Example:
a. Incorrect sponge counts a. prescribing drugs
b. burns: heating pads ,solutions & steam b. giving anesthesia
vaporizers c. doing surgery
c. failure to take & observe appropriate
actions – forgetting to take vital signs to
a newly post –operative client.
d. Falls: side rails left down, baby left
unattended
e. loss of or damage to a patient’s property
f. failure or ignore to report to the superiors or
client’s family
g. mistaken identity, wrong medicine, dose & route
B- breach of duty was the cause of the P- professional SPECIFIC standards of care
plaintiff’s injury is required
R- Real or actual proof injuries R- required obedience
to the standards of care
O- owed specific nursing duty E- exceeds the limits of the standards of care
D- defendant breach the duty
Intentional Torts
Assault Battery
-Mental or physical threat -physical harm through willful touching of
person or clothing without consent.
Example Example
a. threatening or attempting to do a. actually touching or wounding a person in
violence to another offensive manner
b. forcing a medication or treatment b. hitting or striking a client
when the patient doesn’t want it c. immediately injecting a surgical needle
c. threatening children to take the medication without informing the patient about
the said procedure
False Imprisonment
- occurs when the person is not allowed to leave a health care facility when there is no legal
justification to detain the client.
- occurs when restraining devices are used without an appropriate clinical need.
- The intentional confinement without authorization by a person who physically constricts
another using force , the threat of force or confining structures and or clothing , even without
force or malicious intent to detain another without consent in a specified area constitutes
grounds or a charge of false person from harming self or others if it is necessary to confine to
define one self , others or property or to effect a lawful arrest.
Examples:
a. A Hispanic American patient undergo TAHBSO and has no Medicare or HMO card nor
nor any petty cash to pay hospital bills. The nurse put the patient in a room until the
relatives of the former arrive to pay the bills.
B. a Hong Kong OFW was suspected of having SARS. The ground duty nurse put the patient
in a secluded room without doctors order and checked for other manifestations to confirm
the presence of SARS. After 9 hours, it was just an ordinary cough and colds.
c. A client was tested positive for HIV. Nurse Hamilton learned that this is highly contagious
& communicable disease. The nurse locked the client inside a room.
Restraints are protective devices used to limit the physical activity of a client or to immobilize a client or an extremity.
Physical restraints: restrict client movement through the application of a device.
Chemical restraints: Medications given to inhibit a specific behavior or movement.
Under Omnibus Budget Reconciliation Act: any client or patient has the right to be free from Physical (such as restraint
jackets) and chemical (sedation, psychotropic drugs) restraints
Imposed for the purpose o discipline or convenience and should not be required to treat medical
or psychiatric symptoms.
ALTERNATIVES TO RESTRAINTS
1. Before restraints offer explanations, ask someone to stay with the client, use clocks, calendars, TV & radio ( to
decrease disorientation) or any relaxation techniques.
2. Use LESS restrictive methods first. RESTRAINTS should always be the last.
3. Assign confuse and disoriented clients to rooms near the nurse’s station.
4. Maintain toileting routines & institute exercise and ambulation schedules as the client
condition allows.
QUESTION: Can I put restraints on a patient who is combative I there is no order for this?
Only in an EMERGENCY, for a limited time (no longer than 24 hours)
For the limited purpose of protecting the patient from injury – NOT FOR
CONVENIENCE OF Personnel. Notify the attending MD immediately, consult
with another staff member, obtain patients consent if possible, and get a co-
worker to witness the record. RESTRAINTS OF ANY DEGREE MAY CONSTI-
TUTE FALSE IMPRISONEMENT. Freedom from any UNLAWFUL restraint is a
Basic human right protected by law. In July 1992 the FDA (Food and Drug Admi-
nistration) issued a warning that the use of restraints is – NO LONGER
REPRESENTS RESPONSIBLE PRIMARY MANAGEMENT of a client’s
behavioral problem.
- A tool used as a means of identifying and improving client care. They are usually made
immediately after its occurrence and validated immediately by co-workers.
- the real purpose is to provide accurate documentation of occurrences affecting the client as
to have basis for its intervention.
- it is usually made as a comprehensive & accurate report on any unexpected or unplanned
occurrence that affects or potentially affects his family or other members of the health team.
Documentation
- Legally required by accrediting agencies, state licensing laws and state nurse and medical
practice acts.
-required for insurers reimbursement
- legal documentation that signifies proper communication about the patients condition
Question: For what would I be liable if I voluntarily stopped to give care at the scene of an accident? The GOOD
SAMARITAN ACT – protects health practitioners against malpractice claims resulting from assistance provided at the
scene of an emergency ( UNLESS THERE WAS WILLFUL DOING) as long as the level of care provided is the same
way as any other reasonably prudent person would give under similar circumstances. It also encouraged health care
professionals to assist in emergency situations without fear of being sued for the care provided. These laws limit liability
and offer legal immunity for people helping in an emergency, providing they give reasonable care.
Organ Donation
Requirements:
a. Any person 18 years of age or older may become an organ donor by written consent.
b. Informed choice to donate an organ can take place with the use of a written document signed by the client prior
to death, a will, or a donor card or an advance directive.
c. In the absence of appropriate documentation, a family member or legal guardian may authorize donation on the
descendant’s organs.
d. In case of newborns, they must be full term already ( more than 200 grams)
Laws that Protect potential donors to Expedite acquisition:
1. National Organ Transplant Act: prohibit selling of organs
2. Uniform Anatomical Act: guidelines regarding who can donate, how donations are to
Be made, and who can receive donated organs.
3. Uniform Determination Death Act: Legal determination of brain death ( absence of
breathing movement, cranial nerve reflex, response to any painful stimuli and cerebral
blood flow and flat EEG.
Management of Donor
1. Maintain body temperature at GREATER than 96.8 F with room temperature at 70 -80 F warming blankets, warmer
for IV fluids.
2. Maintain greater than 100% PaO2 and suction/ turn & use (PEEP) positive End expiratory pressure to prevent
hypoxemia caused by airway obstruction & pulmonary edema.
3. Maintain CVP (Central Venous Pressure) at 8 to 10 mm Hg and systolic blood pressure at greater than 90 mm Hg
to prevent Hypotension.
4. Maintain Fluid & Electrolyte balance due to volume depletion
5. Prevent infections due to invasive procedures.
Religions that have different views regarding organ donations
1. Russian Orthodox: permits all donations EXCEPT THE HEART.
2. Jehovah’s Witness: DOES NOT ALLOW organ donation and all organ to be
transplanted must be drained of blood first.
3. Judaism: They permit organ donation as long as with RABBINICAL CONSULTATION.
4. Islam: will NOT USE ORGAN STORED IN ORGAN BANKS.
Voluntary Admissions:
Requirements & By Laws
a. Lawful or of legal age
b. If the client is too ill, a guardian is possible
c. Client agrees to accept the treatment
d. The client is free to sign him or herself out of the hospital- Has the right to demand & receive RELEASE.
Involuntary Admissions
Requirements & By Laws
a. Deemed necessary for the following reasons & criteria:
1. Danger to self & others
2. need psychiatric or physical care
3. State laws have been determined legally by the state
b. The client who is involuntarily admitted does not lose his or her right of informed
consent.
Occupational Safety & Health Act- requires that an employer provide a safe work place for employees according to
regulations. Employees can confidentially report UNSAFE WORKING CONDITIONS that violate regulations. A
PERSON WHO DOES NOT REPORT UNSAFE WORKING CONDITIONS CAN BE RETALIATED AGAINST BY THE
EMPLOYER.
Irresistible Impulse Test (used together with M,Naghten Rule) – person knows right from wrong, but:
a. Driven by impulse to commit criminal acts regardless of consequences.
b. Lack premeditation in sudden violent behavior.