Answers to Study Guide: Chap 4 Legal/Ethical Concepts

1. Civic Law-deals with the relationships among individuals Contract Law- enforcement of agreements among private individuals Public Law- deals with the individuals relationship to the state Tort-civil wrong committed by a person against another person or property Administrative Law- (regulatory law) developed by those appointed to governmental administrative agencies Constitutional Law- defines and limits the powers of government (US & state constitutions) Criminal Law- (most common example of public law) addresses acts or offenses against the safety or welfare of the public Statutory Law- enacted by legislative bodies 2. Public Law *Constitutional Law- e.g. US constitution/civil rights act/state constitutions *Statutory Law- e.g. various state boards and professional practice acts * Administrative Law- e.g. Social Security Act/National Labor Relations Act/rules of state boards and regulations *criminal Law- e.g. Felonies and misdemeanor / controlled substance act/ homicide/ criminal codes(murder, rape, fraud, theft, assault, battery) Civil Law *Contract Law- e.g. business contracts with clients/employment contracts *Torts- e.g. federal torts/claims act/ state torts claims act, defamation(libel and slander) false imprisonment, invasion of privacy, negligence, malpractice *Protective/Reporting Laws- e.g. child abuse prevention and treatment act/privacy act of 1974/ Good Samaritan laws, abuse, age of consent, living will legislation, disabilities act, abortion 3. Nursing practice acts state those things that the nurse can and cannot do. The nurse is responsible to know the state practice act for any state that she practices in. This act falls under both public and civil law. 4. A formal contract is written and cannot be changed legally by an oral agreement. 5. Good Samaritan Law protects health care providers by ensuring immunity from civil liability. Good Samaritan laws vary in coverage from state to state and may be amended periodically by legislation. It is the responsibility of caregivers to know the law for their respective jurisdictions. It only applies in emergency situations, usually those outside the hospital setting. For example, health care professionals are not required to stop at the scene of accidents. If they do stop, however, they are held to higher standards than is a layperson. Health care professionals are expected to use their specialize body of knowledge when providing care.

6. Felony- a crime of a serious nature that is usually punishable by imprisonment at a state penitentiary or by death or crime violating a federal statute that involves punishment of more than 1 year incarceration. Misdemeanor- offense less serious than a felony that may be punishable by a fine or a sentence to a local prison for less than 1 year. Libel-if the words are written Slander- if the information is communicated verbally to a third party Negligence- (applies to anyone) general term referring to negligent or careless acts on the part of an individual who is no exercising reasonable or prudent judgment Malpractice- negligent acts on the part of a professional 7. Disciplinary actions by the ARSBN can result in penalties such as fines, probation, suspension of license, taking classes related to the violation of the nurse practice act, revocation of license. 8. NEGLIGENCE *side rails should not be left down on a confused clients bed *puddles and spill should be cleaned up immediately to prevent falls rather than waiting for housekeeping Malpractice differs from negligence in that anyone can be accused of negligence; only professionals can be accused of malpractice. MALPRACTICE *The nurse owed a special duty to the client; that is, a nurse-client relationship existed. *The nurse failed to meet the standards of care. *The injury occurred as a direct result of the nurse s action or inaction. *Damage such as physical or emotional pain, suffering, monetary losses, or medical expenses must be proved. If there is not damage, the plaintiff is not entitled to an award. 9. Assault- the threat to do something that may cause harm or be unpleasant to another person. Key elements are fear and intimidation. e.g.: A client confined to a wheelchair is told, If you do not finish your meal, you are going to sit there all night. The client complies because he believes the health care worker will leave him to sit there. The client knows the worker is in a position to carry out this threat. Battery- unauthorized or unwanted touching of one person by another. Key element is consent. e.g.: Striking a client, performing a procedure without the client s consent, and forcing a person to take medication he does not want. Invasion of privacy- when a person s private affairs become public knowledge without the person s permission. e.g.: Photographing a client without his consent, failure to pull curtains to shield the client when performing personal or intimate care.

False Imprisonment- refers to making the client wrongfully believe that she cannot leave a place. Any means used to confine a client or to restrict movement can be considered a restraint and a form or false imprisonment. e.g.: threats, physical restraints such as wrist or vest restraints, locked doors, side rails, geriatric chairs, and psychotropic drugs. 11. Informed consent-refers to a competent client s ability to make health care decisions based on full disclosure of the benefits, risks, potential consequences of a recommended treatment plan, and alternate treatments, including no treatment, and the client s agreement to the treatment as indicated by the client s signing a consent form. who obtains the informed consent? who obtains the signature? who can sign? 12. Advance Directives- A written instruction for health care, recognized under state law, related to the provision of care when the individual is incapacitated. 2 types: Durable Power of Attorney for Health Care (DPAHC) and living wills Purpose: to indicate who is to make health care decisions for the client if they become unable to do so for themselves. Durable Power of Attorney for Heath Care (DPAHC) is a legal document designating who may make health care decisions for a client when that client is no longer capable of decision making. For Durable power of attorney anyone who stands to benefit from the estate cannot be appointed health care representative. 13. Living Will-a legal document that allows a person to state preferences about the use of life-sustaining measures in case they are unable to make their wishes known. *They can be used when those life-sustaining measures are to be done or not done. E.g.: food, fluids, and comfort measures are generally continued, and the person is not abandoned; however, artificial means of sustain life, such as ventilators or feeding tubes, are not to be used. 14. Life-Prolonging Procedure Declaration- states that the person wants all possible procedures done to delay the dying process, including the use of ventilators. *They can be used when those life-sustaining measures are to be done or not done. 15. Incident reports are used by the facility to identify or tract problem areas and to alert the legal department to possible lawsuits. Incident reports- a risk management tool used to describe and report any unusual event that occurs to a client, visitor, or staff member. Incident reports can also be called variance report or occurrence report !

16. Impaired Nurse-a nurse who is habitually intemperate or is addicted to the use of alcohol or habit-forming drugs. **Actions you should take if you think someone is impaired: *document the dates, times, and observed behavior very specifically & descriptive *report concerns to the supervisor and provide a copy of the documentation about the incidents *do not approach or confront the coworker yourself 17. Ethics-branch of philosophy concerned with determining right from wrong on the basis of knowledge rather than on opinions. Bioethics- the application of general ethical principles to health care. Values- influence the development of beliefs and attitudes rather than behaviors, although they often indirectly influence behaviors. **Values are an ethical theory. MoralsAutonomy-refers to the individual s right to choose and the individual s ability to act on that choice. **an ethical principle. The ethical principle of autonomy respects the individual s right to self-determination for a competent person, even if their decisions may result in self-harm. *Probably one of the most difficult things for nurses to accept is that clients are ultimately responsible for themselves; they will do what they want to do. e.g.: smoking after a diagnosis of emphysema or lung cancer refusing to receive a blood transfusion because of religious beliefs Beneficence- the duty to promote good and to prevent harm **an ethical principle. e.g.: a client who has had a serious stroke may resist performing range-of-motion exercises and become angry at the nurse for insisting. The nurse knows the long-term value of these exercises yet perceives the client s physical and psychological pain. Fidelity- ethical foundation of nurse-client relationships **an ethical principle e.g.: ^share the client s wishes with other members of the health care team ^keep their own personal values from influencing their advocacy for clients ^support the client s decision, even if it conflicts with their own preferences Veracity- means truthfulness (neither lying nor deceiving others) **an ethical principle

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Nonmaleficence- the obligation to cause no harm to others, which can be physiological, psychological, financial, social and/or spiritual **an ethical principle e.g.: ^preventing medication errors (including drug interactions) ^being aware of potential risks of treatment modalities ^removing hazards( obstructions or water on the floor that might cause a fall) Justice- based on the concept of fairness extended to each individual **an ethical principle Deontology- an ethical theory that considers the intrinsic significance of an act itself as the criterion for determination of good. **an ethical theory e.g.: health care researchers might risk the well-being of a person participating in an experimental procedure for the sake of finding a drug that will save many people from suffering. Teleology-an ethical theory that states that the value of a situation is determined by its consequences. **an ethical theory e.g.: immunizations----receiving an injection is not good, but preventing the illness is Utility-states that an act must result in the greatest positive benefit for the greatest number of people involved. **a basic concept of teleology Situational Theory-holds that there are no set norms, rules, or majority-focused results. **an ethical theory Caring-Based Theory- founded on the idea that ethical decisions are not made based on principles but are made with respect to relationships, communication, caring, responsiveness, and a desire not to hurt others. **an ethical theory Confidentiality- nondisclosure of information *HIPPA(Health Information Portability and Accountability Act) The rules now protect how client health care information is stored and transferred and prescribe to whom it can be revealed. Also, clients are given the right to access their health care records, amend health care information, and obtain a list of who has seen their health care records. Values clarification- process of analyzing one s own values to better understand those things that are truly important Ethical Dilemma-when 2 or more ideals or values are in conflict *3 areas where this occurs: ^Euthanasia ^Refusal of treatment ^scarcity of resources Euthanasia- refers to intentional action or lack of action that causes the merciful death of someone suffering from a terminal illness or incurable condition

Active Euthanasia- refers to taking specific action to hasten a client s death, such as removing a client who is in a vegetative state from a respirator Passive Euthanasia- working with the client s dying process Assisted Suicide- a form of active euthanasia where another person provides a client with the means to end their own life. Refusal of Treatment-the principle of autonomy is the basis of a client s right to refuse treatment. Only after treatment methods and their consequences have been explained can the client refuse treatment. 22. Ethical Reasoning-the process of examining the issue in a methodical manner *Ethical decision making is used in situations where conflicts of rights and duties exist. 23. Ethical Principles- widely accepted codes generally based on the humane aspects of society that direct or govern actions. Overview of Ethical Principles Principle Autonomy Nonmaleficence Beneficence Justice Veracity Fidelity Explanation Respect individual s right to selfdetermination; respect individual liberty Cause or do no harm to another Do good to others and maintain a balance between benefits and harms Distribute equitable potential benefits and risks Tell the truth Do what one has promised