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Legal Aspects of Nursing


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Title: Legal Aspects of Nursing

Legal Aspects of Nursing
  • Dr. Belal Hijji, RN, PhD
  • October 31 November 01, 2010

Learning Outcomes
  • At the end of this lecture, students will be able
  • Define law and identify the its functions in
  • Discuss selected legal aspects of nursing practice

Definition of Law
  • Law is the sum total of rules and regulations by
    which the society is governed. The law exists to
    regulate all persons.

Functions of the Law in Nursing
  • It tells us about which nursing actions in the
    care of clients are legal
  • It distinguishes the responsibilities of the
    nurse from those of other healthcare providers
  • It helps establish the boundaries of independent
    nursing action
  • It assists in maintaining a standard of nursing
    practice by making nurses accountable to their

Selected Legal Aspects of Nursing Practice
  • Nurses need to know and apply legal aspects in
    their various roles. As client advocates, nurses
    should ensure the clients right to informed
    consent identify and report violent behaviour
    and neglect of vulnerable clients. Also nurses
    are required to report a nurse who is an
    chemically impaired, and should be aware of
    issues related to delegation.

Informed Consent
  • Informed consent is an agreement by a client to
    accept a course of treatment or a procedure after
    being fully informed of it.
  • Consents are either express or implied. Express
    consent could be oral or written. If the
    procedure is more invasive and/ or the potential
    for risk to the client is great, a written
    permission is needed.
  • Implied consent exists when the clients
    nonverbal behaviour indicates agreement such as
    in positioning their bodies for an injection or
    when their vital signs are recorded.
  • Obtaining an informed consent for specific
    medical or surgical procedure is the
    responsibility of the person who performs the

Information to be Given to a Client to Make an
Informed Decision
  • Diagnosis or condition that requires treatment
  • Purpose of treatment
  • What the client can expect to feel or experience
  • The intended benefits of the procedure
  • Possible risks
  • Advantages and disadvantages of alternatives to
    treatment (including no treatment)

What are the Major Elements and Exceptions of
Informed Consent?
  • The consent must be voluntary
  • The consent must be given by a client who is
    capable and competent to understand. This means
    that certain population groups cannot provide
    consent such as children, whose appointed
    guardians must give consent before minors are
    treated. A second group is persons who are
    unconscious or severely injured. A third group
    is persons who are mentally ill.
  • The client must be given enough information to be
    the ultimate decision maker.

The Nurses Role in Obtaining A Clients Informed
  • The nurse is not responsible for explaining the
    medical or surgical procedure but for witnessing
    the clients signature on the consent form. The
    nurses signature means
  • The client gave voluntary consent after receiving
    enough information
  • The clients signature is authentic
  • The client appears competent to give consent
  • In the United States, nurses could be liable for
    interfering with the client-provider relationship

  • Delegation is the transfer of responsibility for
    the performance of an activity from person to
    another while retaining accountability for the
  • In the us, the process of delegation is governed
    by laws and regulations such as the Nurse
    Practice Act (NPA), the Unlicensed Assistive
    Personnel (UAP) job description and skill level.
    The NPA defines and describes the scope of
    nursing practice.
  • When delegation is to occur, the nurse needs to
    determine the answers to the following questions
  • Does the NPA permit delegation
  • Is there a list of procedure a nurse can
  • Are there guidelines explaining the nurses
    responsibilities when delegating?

  • In Palestine, we know that staff nurses delegate
    the responsibility of performing certain tasks to
    practical nurses. However, it remains imperative
    to know whether this process is regulated or not.

Violence, Abuse, and Neglect
  • Violent behaviour can include domestic violence,
    human abuse, and sexual abuse.
  • Neglect is the absence of care necessary to
    maintain the health and safety of a client
  • Nurses are in position to identify and assess
    cases of violence.
  • When an injury appears to be present resulting
    from abuse, neglect, or exploitation, the nurse
    must report the situation to the appropriate

Controlled Substances
  • Laws regulate the distribution of controlled
    drugs such as narcotics, depressants drugs that
    temporarily reduce the function or activity of a
    specific part of the body or mind, such as
    alcohol and morphine, and stimulants.

The Impaired Nurse
  • This term (impaired nurse) refers to a nurse
    whose ability to perform nursing functions is
    diminished by chemical dependency on drugs,
    alcohol, or mental illness.
  • Chemical dependence is a real problem caused by
    high levels of stress in health care settings,
    increased workloads, decreased staffing, fatigue,
    isolation, and access to addictive drugs.
  • In the US, more than 50 of impaired nurses
    started abusing drugs including alcohol before
    they finished their nursing education. In the US,
    these nurses and student nurses receive treatment
    and support, not discipline.

Sexual Harassment
  • Sexual harassment is defined as unwelcome sexual
    advances, requests for sexual favors, and other
    verbal of physical conduct of a sexual nature
    it is a violation of the individuals rights and
    a form of discrimination.
  • Sexual harassment occurs when submission to such
    conduct is considered a condition of an
    employment, when submission or rejection of such
    conduct is used as the basis for employment
    decisions affecting the person, and when such a
    conduct interferes with a persons work
  • Nurses must develop skills to deter sexual
    harassment in workplace and must be familiar with
    existing policies and procedures related to
    sexual harassment that must be enacted in every

  • Abortion laws in the US provide specific
    guidelines for nurses about what is legally
    permissible. Women have the right to abort her
    fetus in the early stages of pregnancy

Do-Not-Resuscitate Orders (DNR)
  • Clients who are terminally sick with irreversible
    illness may be ordered DNR. This order is
    generally written when the client or relatives
    express the wish for no resuscitation in case of
    respiratory or cardiac arrest.

Areas of Potential Liability in Nursing
  • Nurses need to know the differences between
    malpractice (unintentional tort) and intentional
    tort. Nurses must also recognise nursing
    situations in which negligent actions are most
    likely to occur and take measures to prevent them.

Crimes and Torts
  • A crime is an act committed in violation of
    public (criminal) law and punishable by a fine or
    jail (US).
  • Crimes could be felonies ????? or misdemeanors
    ????. A felony is a crime of serious nature,
    such as murder. A misdemeanor is an offence of a
    less serous nature usually punishable by a fine
    or short-term jail, or both.
  • A tort is a civil wrong committed against a
    person or persons property. The persons
    responsible for the tort are sued for damages.

Privacy of Clients Health Information
  • It is a nursing responsibility to protect
    clients confidentiality. By this, we mean health
    and identifying information including diagnosis,
    social security number, name, address, phone
    number, and website address.
  • The American Health Insurance Portability and
    Accountability Act of 1996 (HIPPA) protects the
    privacy of clients information.

Examples of HIPPA Compliance and Nursing Practice
  • A clients name cannot appear near or on the room
  • Clients medical records should be kept in safe,
    secure, and non-public location to prevent
    unauthorised access.
  • Printed copies of protected health information
    should not be left unattended near fax machines
    or printers
  • Access to protected information is permitted for
    authorised personnel
  • Voice levels should be lowered, and a notice
    informing clients of their rights about privacy,
    should be provided

Loss of Clients Property
  • Loss of client property is a concern to hospital
  • However, institutions nowadays assume less
    responsibility for clients property, and request
    clients to sign a waiver relieving a hospital
    and its employees form any responsibility.
  • Nurses can take the responsibility of
    safeguarding the clients property when s(h)e
    cant sign a waiver.

Unprofessional Conduct
  • Unprofessional conduct is one of the grounds for
    action against the nurses license
  • Unprofessional conduct includes incompetence,
    gross negligence, conviction of practicing
    without license, falsification of clients
    records, and illegally obtaining controlled
  • Having personal relationship with a vulnerable
    client may be considered unprofessional conduct,
    because nurses are responsible for retaining
    professional boundaries.
  • Unethical conduct includes violation of ethical
    codes, breach of confidentiality, or
    discrimination in the provision of care.

Reporting Crimes, Torts, and Unsafe Practices
  • Nurses may report colleagues or other
    professionals if for practices that endanger the
    health and safety of clients. This may include
    alcoholism, drug use, theft and unsafe nursing
  • Reporting a colleague is not easy, as the
    reporting person may feel disloyal, disapproved
    by others, or risks promotion.