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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 3

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Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 3 LEGAL RESPONSIBILITIES The Law Laws may be thought of as rules of conduct that guide interactions among ... – PowerPoint PPT presentation

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Title: Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 3


1
Medical-Surgical Nursing An Integrated Approach,
2E Chapter 3
  • LEGAL RESPONSIBILITIES

2
The Law
  • Laws may be thought of as rules of conduct that
    guide interactions among people.

3
Two Types of Law
  • Public Law Deals with an individuals
    relationship to the state.
  • Civil Law Deals with relationships among
    individuals.

4
Types of Public Law
  • Constitutional Law - defines and limits powers of
    government.
  • Statutory Law - enacted by legislative bodies.
  • Administrative Law - regulatory laws.
  • Criminal Law - deals with acts against safety and
    welfare of the public.

5
Types of Civil Law
  • Contract Law (the enforcement of agreements among
    private individuals).
  • Torts (civil wrongs committed by a person against
    another person or property).

6
Nursing Practice the Law
  • Nursing practice falls under both public and
    civil law.
  • Nurses are bound by rules and regulations
    stipulated by the nursing practice act as
    determined by the State legislature.

7
Standards of Practice
  • Guidelines developed under the auspices of the
    nursing practice acts to direct nursing care.
  • Liability is determined by whether the nurse
    adhered to the standards of practice.

8
Legal Issues in Practice
  • Physicians Orders - nurses are liable for
    carrying out erroneous orders.
  • Floating - nurses must be given orientation when
    floated to unfamiliar areas.
  • Inadequate Staffing - nurses leaving an
    inadequately staffed units may be liable.
  • Critical Care - nurses must constantly observe
    and assess.
  • Pediatric Care - nurses must report any suspected
    child abuse.

9
Legal Issues in Nurse-Client Relationships
  • Intentional Torts
  • Assault and Battery.
  • Defamation.
  • Fraud.
  • False Imprisonment.
  • Invasion of Privacy.

10
Legal Issues in Nurse-Client Relationships
  • Unintentional Torts
  • Negligence - A general term referring to
    negligent or careless acts on the part of an
    individual who is not exercising reasonable or
    prudent judgment.
  • Malpractice - Negligent acts on the part of a
    professional.

11
Documentation
  • A clients clinical history is the medical
    record, or chart, a legal document.
  • If it was not charted, it was not done.

12
Documentation Protocol
  • Documentation must be accurate and objective.
  • Entries must be neat, legible, spelled correctly,
    written clearly, and signed or initialed.

13
Informed Consent
  • Informed consent occurs when
  • The nurse discusses the surgical procedure with
    the client.
  • The client understands the risks, benefits, and
    alternatives to treatment.
  • The client signs the consent form.

14
Incident Report
  • A risk management tool used to describe and
    report any unusual event that occurs to a client,
    a visitor, or staff member.

15
Advance Directive
  • A written instruction for health care recognized
    under state law and related to the provision of
    such care when the individual is incapacitated.

16
Advance Directive Documents
  • Durable Power of Attorney - Designates who may
    make health care decisions for a client when that
    client is no longer capable of decision making.
  • Living Will - Allows a person to state
    preferences about use of life-sustaining measures
    when person is unable to make wishes known.

17
Malpractice Insurance
  • Many institutions provide insurance to nurses.
  • Personal insurance provides off the job coverage
    and individual legal counsel.

18
Impaired Nurses
  • A nurse who is habitually intemperate or is
    addicted to the use of alcohol or habit-forming
    drugs.

19
Impaired Nurses are Everyones Concern
  • Dates and times of inappropriate behavior should
    be documented and reported.

20
Impaired Nurses Rehabilitation
  • Some employers offer an employee assistance
    program for the impaired nurse.
  • Most states have peer assistance programs to aid
    in rehabilitation.

21
Medical-Surgical Nursing An Integrated Approach,
2E Chapter 4
  • ETHICAL RESPONSIBILITIES

22
Ethics
  • The branch of philosophy concerned with the
    distinction of right from wrong on the basis of a
    body of knowledge rather than on just opinions.
  • Ethics looks at human behavior - things people do
    under different types of circumstances.

23
Bioethics
  • The application of ethical principles of health
    care.

24
Why is Ethics an Increasing Issue for Health Care?
  • an increasingly technological society with
    complicated issues that never had to be
    considered before.
  • the changing fabric of society, particularly in
    terms of family structure.
  • health-care has become a consumer-driven system
    based on clients becoming more knowledgeable.

25
Ethical Principles
  • Codes that direct or govern actions.

26
Basic Ethical Principles
  • Autonomy - The respect for individual liberty
  • Justice - The equitable distribution of potential
    benefits and risks
  • Fidelity - The duty to do what one has promised
  • Nonmaleficence - The obligation to do or cause no
    harm to another
  • Beneficence - The duty to do good to others
  • Veracity - The obligation to tell the truth

27
Ethical Theories
  • Teleology - the value of a situation is
    determined by its consequences.
  • Deontology - the intrinsic significance of an act
    itself as the criterion for the determination of
    good.
  • Situational Theory - holds that there are no set
    rules or norms. Each situation must be considered
    individually.
  • Caring-Based Theory - focuses on emotions,
    feelings, and attitudes.

28
Values
  • Values are different from principles, in that
    they influence the development of beliefs and
    attitudes, rather than behaviors. They may,
    however, indirectly influence behaviors.

29
Value System
  • An individuals collection of inner beliefs that
    guides the way the person acts and helps
    determine the choices made in life.

30
Value Clarification
  • The process of analyzing ones own values to
    better understand those things that are truly
    important in life.

31
Value Clarification
  • The process of analyzing ones own values to
    better understand those things that are truly
    important in life.

32
Self-Reflection
  • Because ethics and values are so closely
    associated, nurses must explore their own values
    in order to acknowledge the value systems of
    their clients.

33
Ethical Codes
  • Codes are used to help nurses act ethically.
  • These have been developed by nursing
    organizations such as the NFLPN, the ICN and the
    ANA.

34
The Patients Bill of Rights
  • A document designed to guarantee ethical care of
    clients in terms of their decision making about
    treatment choices and other aspects of their care.

35
Ethical Dilemma
  • A conflict between two or more ethical
    principles.
  • In an ethical dilemma, there is no correct
    decision.

36
Major Types of Ethical Dilemma
  • Euthanasia.
  • Refusal of Treatment.
  • Scarcity of Resources.

37
Euthanasia
  • Intentional action or lack of action that causes
    the merciful death of someone suffering from a
    terminal illness or incurable condition.

38
Refusal of Treatment
  • Based on the principle of autonomy.
  • A clients rights to refuse treatment and to die
    often challenge the values of most health care
    providers.

39
Scarcity of Resources
  • The allocation of scarce resources (e.g. organs,
    specialists) is emerging as a major medical
    dilemma.

40
Ethical Decision Making
41
Ethics Committees
  • Many health care agencies now recognize the need
    for a systematic manner whereby to discuss
    ethical concerns.
  • Multidisciplinary committees offer dialogue
    regarding ethical dilemmas.
  • Ethics committees can lead to the establishment
    of policies and procedures for the prevention and
    resolution of dilemmas.

42
Nurse as Client Advocate
  • When acting as client advocate, the nurses first
    step is to develop a meaningful relationship with
    the client.
  • The nurse is then able to make decisions with the
    client based on the strength of the relationship.

43
Nurse as Whistleblower
  • Whistleblowing refers to calling attention to
    unethical, illegal, or incompetent actions of
    others.
  • Whistleblowing is based on the ethical principles
    of veracity and nonmaleficence.
  • Federal and state laws (to varying degrees)
    provide protection, such as privacy, to
    whistleblowers.

44
Questions for Whistleblowers
  • Whose problem is this?
  • Must I do anything about it?
  • Is it my fault?
  • Who am I to judge?
  • Do I have the facts straight?
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