LEGAL AND ETHICAL ISSUES

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LEGAL AND ETHICAL ISSUES
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SOURCES OF LAW

• STATUTORY LAW
• COMMON LAW
• ADMINISTRATIVE LAW

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STATUTORY LAW

• CREATED BY VARIOUS LEGISLATIVE BODIES SUCH AS
  STATE LEGISLATURES OR THE CONGRESS

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COMMON LAW

• DEVELOPED WITHIN THE COURT SYSTEM AS JUDICIAL
  DECISIONS ARE MADE IN VARIOUS CASES AND
  PRECEDENTS FOR FUTURE CASES ARE SET

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ADMINISTRATIVE LAW

• ESTABLISHED THROUGH THE AUTHORITY GIVEN TO A
  GOVERNMENT AGENCY BY A LEGISLATIVE BODY, SUCH AS
  THE STATE BOARD OF NURSING

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TYPES OF LAW

• CRIMINAL LAW
• CIVIL LAW

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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)

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• A NURSE MAY BREAK A CRMINIAL LAW AND BE TRIED IN
  CRMINAL COURT!!!!!!!!!!!!
• EXAMPLES ILLEGALLY DISTRIBUTING CONTROLED
  SUBSTANCES OR ALTERING A PATIENTS RECORD

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CIVIL LAW

• LAW THAT IS ADMINISTERED BETWEEN CITIZEN AND
  CITIZEN
• USUALLY INVOLVE THE VIOLATION OF ONE INDIVIDUALS
  RIGHTS BY ANOTHER INDIVIDUAL
• TORT IS A TYPE OF CIVIL LAW

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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!)

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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!!

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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

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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

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SEXUAL HARASSMENT

• LAWS THAT PROHIBIT DISCRIMINATION IN THE
  WORKPLACE ARE BASED ON THE FIFTH AND FOURTEENTH
  AMENDMENTS TO THE CONSTITUTION!

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• 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)

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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)

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• 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!!!!!!!!!!!!!

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SEXUAL HARASSMENT

• DO NOT DISMISS ANY SEXUAL HARASSMENT AS JUST
  HAVING FUN!
• A RESPONSE LIKE THIS CAN HAVE SERIOUS
  CONSEQUENCES!!!!

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VIOLENCE IN THE WORKPLACE

• NURSES HAVE BEEN IDENTIFIED AS A GROUP AT RISK
  FOR VIOLENCE FROM PATIENTS, FAMILY MEMBERS, AND
  OTHER STAFF MEMBERS

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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)

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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 persons feelings, remain calm)
• IF THE SITUATION CANNOT BE DE-FUSED, QUICKLY
  LEAVE AND CALL SECURITY

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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!!

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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!!!

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DO NOT RESUSCITATE

• A DNR PERMITS HEALTH CARE PROVIDERS TO WITHHOLD
  ONLY TREATMENT RELATED TO RESUSCITATION. DOES NOT
  APPLY TO WITHHOLDING NOURISHMENT, HYDRATION, OR
  IVFS

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• NURSES MUST KNOW IF A PATIENT IS A CODE OR NO
  CODE!!

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ADVANCED DIRECTIVES

• A DOCUMENT THAT MAKES ONES WISHES KNOWN
  CONCERNING MEDICAL LIFE-SUPPORT MEASURES IN THE
  EVENT THAT ONE IS UNABLE TO SPEAK FOR ONESELF.

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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.

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ADVANCE DIRECTIVES

• THE TWO MOST COMMON FORMS (1) THE LIVING
  WILL (2)
  HEALTHCARE SURROGATE (Durable Power Of
  Attorney)

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LIVING WILL

• A LEGAL DOCUMENT STATING AN INDIVIDUALS WISHES
  REGARDING LIFE SUPPORT IN THE EVENT THAT THIS
  INDIVIDUAL BECOMES INCOMPETENT IN MAKING INFORMED
  TREATMENT DECISIONS AND IS SUFFERING FROM A
  TERMINAL CONDITION

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HEALTHCARE SURROGATE/PROXY (Durable Power OF
Attorney)

• A DOCUMENT AUTHORIZING ANOTHER PERSON TO ACT ON
  ONES BEHALF. THIS PERSON MAKES KNOWN THE
  PATIENTS WISHES TO MEDICAL PERSONNEL

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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!!!!

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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)

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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.

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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

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• 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!!!!

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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 PATIENTS RECORD
• (9) FAILURE TO REPORT A CO-WORKERS NEGLIGENCE
• (10)FAILURE TO PROVIDE PROPER EDUCATION
  (teaching) TO A PATIENT
• (11) DEFECTS IN EQUIPMENT

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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)

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EXAMPLES OF STATUTES INVOLVING A DUTY TO REPORT

• EVIDENCE OF CHILD OR ADULT ABUSE
• DEATHS UNDER SUSPICIOUS CIRCUMSTANCES
• INJURIES CAUSED BY VIOLENCE
• ILLEGAL, SUBSTANDARD, UNETHICAL,UNSAFE OR
  INCOMPETENT PRACTICE

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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.

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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 DRIVERS 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

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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!

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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!!!

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ABANDONMENT

• TO BE GUILTY OF ABANDONMENT IS A VIOLATION OF THE
  NURSE PRACTICE ACT!!!!

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ETHICAL PRINCIPLES

• AUTONOMY
• BENEFICENCE
• NONMALEFICENCE
• VERACITY
• JUSTICE
• PATERNALISM
• FIDELITY
• CONFIDENTIALITY
• ACCOUNTABILITY

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CODE OF ETHICS

• A FORMAL STATEMENT OF THE RULES OF ETHICAL
  BEHAVIOR FOR A PARTICULAR GROUP OF INNDIVIDUALS.
  

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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

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PATIENTS RIGHTS

• IN 1973, THE AMERICAN HOSPITAL ASSOCIATION
  PUBLISHED A STATEMENT KNOWN AS THE PATIENTS
  BILL OF RIGHTS
• IT IS NOW KNOWN AS YOUR RIGHTS AS A HOSPITAL
  PATIENT
• DERIVED FROM THE ETHICAL PRINCIPLE OF
  AUTONOMY

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YOUR RIGHTS AS A HOSPITAL PATIENT

• THIS DOCUMENT REFLECTS THE ACKNOWLEDG-
  MENT OF THE PATIENTS RIGHT TO ACTIVELY
  PARTICIPATE IN HIS/HER HEALTH CARE AND TO
  COMMUNICATE OPENLY WITH THE HEALTH CARE TEAM

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CURRENT ETHICAL ISSUES

• STEM CELL RESEARCH
• EUTHANASIA
• SURROGATE MOTHERHOOD
• PHYSICIAN-ASSISTED SUICIDE
• END OF LIFE CARE
• GENETIC SCREENING
• HEALTH CARE RATIONING

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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!!!!

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PROFESSIONAL ORGANIZATIONS

• AMERICAN NURSES ASSOCIATION
• NATIONAL LEAGUE FOR NURSING

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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

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NATIONAL LEAGUE FOR NURSING

• FOSTERS IMPROVEMENT IN NURSING SERVICES AND
  NURSING EDUCATION
• LOBBIES ACTIVELY FOR NURSING ISSUES

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LOBBYING

• AN ATTEMPT TO INFLUENCE OR SWAY A PUBLIC OFFICIAL
  TO TAKE A DESIRED ACTION!

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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

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HOW CAN NURSES LOBBY???

• JOIN A PROFESSIONAL GROUP THAT LOBBIES TO
  INFLUENCE LAWS THAT AFFECT THE PRACTICE OF
  NURSING!!!!!!!!!!!!

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POLITICAL ACTION COMMITTEES (PACs)

• THIS IS A MECHANISM WHEREBY INDIVIDUALS CAN POOL
  THEIR RESOURCES AND COLLECTIVELY SUPPORT A
  CANDIDATE. PACs MUST COMPLY WITH STATE AND/OR
  FEDERAL ELECTION CODES AND REPORT FINANCIAL
  SUPPORT GIVEN TO CANDIDATES.

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THE AMERICAN NURSES ASSOCIATIONS NATIONAL PAC IS
THE ANAPAC

• THIS ALLOWS NURSES TO ORGANIZE AS A GROUP TO
  ENDORSE CANDIDATES FOR NATIONAL OFFICES

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• THE ANA ALSO HAS STATE NURSES ASSOCIATIONS
  THAT HAVE PACs AT THE STATE LEVEL
• THIS ALLOWS NURSES TO ORGANIZE AS A GROUP TO
  ENDORSE CANDIDATES FOR STATE-WIDE OFFICES

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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!!!

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• THE END!!!!

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