Ethical Legal Precepts

Nota:

• Perry & Potter Chapter 23 Yoder-Wise Chapter 5

1. Criminal Law
   1. Drug Diversion & Theft
      1. TPAPN

         Nota:

         • Texas Peer Assistance Program for Nurses
         1. Nonpunitive & Confidential
      2. Nurse's Under Manadatory Reporting
   2. Abuse or Neglect
      1. Omnibus Budget Reconciliation Act of 1989

         Nota:

         • Resident has the right to be free from Verbal, sexual, Physical, mental, Corporal Punishment & Involuntary Seculsion (Abuse of Nursing Homes caused legislative strengthening)
      2. Nurse's Have Mandatory Reporting
      3. Patient Left in Urine Feces
      4. Restraint
      5. Overmedication
      6. Ignoring pt. Request
      7. Failure to Feed
   3. Disciplinary Sanctions
      1. Nurse Practice Act
   4. Healthcare Fraud
      1. Kickback
      2. Billing Fraud
      3. Coding
      4. Unbundling
      5. Federal False claim Act of 1986
      6. Medicare & Medicaide patient & Protection Act 1987 [Anti-kickbacks]
      7. HIPPA 1996
   5. Falsification of Records
      1. Fraudulent Billing
      2. failure to disclose any criminal activity
      3. Failure to disclose any relevant information [Injury]
      4. Prosecution (BON)
2. Civil Law

   Nota:

   • Governs Interactions of Individuals with One another. 
   1. Unintentional Torts
      1. Malpractice "Negligence within a profession"
         1. Requires EXPERTS to testify to the duty or standards breached and proximate Causes
      2. "Professional Actions and is the failure with professional education and skills to act in reasonably and Prudent Manner (Yoder-Wise, p. 73, 2015)."
         1. Omission or Commission
      3. "Since Nurse's have greater Autonomy, authority and accountability, issues of Malpracticed Increased (Yoder-Wise, p.73, 2015)
      4. Elements of Malpractice (Yoder-Wise, p. 73)
         1. Injury
         2. Damages

            Nota:

            • General, Special & Punitive
         3. Causation
            1. "But for"
            2. Direct relationship
         4. Foreseeability

            Nota:

            • Failure to see minimum standards of Care 
         5. Breach of the duty owed
         6. Duty Owed the patient

            Nota:

            • Nurse/patient Relationship Good samaritan status Volunteer services as a nurse
      5. How to Avoid Malpractice
         1. Critical Thinking

            Nota:

            • Adequately assess, monitor, attain assistance, RN responsibility includes assessment & Evaluation of Patient Care, Document & Communicate Patient Changes, Obtained needed Medical Assistance, Question/challenge an inappropriate Order. 
         2. Specifically Documenting to Avoid Malpractice

            Nota:

            • Patients physical & Mental Condition upon admission & discharge. The patient physical and mental condition after the incident, Action of Patient that demonstrates noncompliance w/ medical treatment directives, when pt. complains or does not complain or did you ask? what a patient states vs. what you think may of happened, The patient own statements & discharge instructions
         3. Report & Document Incidences & Occurences

            Nota:

            • Unprofessional Behavior, Child or Adult Abuse, Certain Communicable diseases, Certain deaths, injuries caused by violence, Evidence of medical Fraud, Emergency medical Treatment & Labor Act violations, Whistle Blower Statuses- Protects the nurse who reports a serious accident or occurance. 
         4. Provide Safe Environment

            Nota:

            • Exercise extra care when interruptions occur, Do NOT work fatigued, listen to your patients, Never Perform Procedures you do not know how to do, Never be afraid to admit you made a mistake, Keep current and up to date in practice knowledge, Do not rush when you are extra busy. 
         5. Make the Patient Feel Cared

            Nota:

            • Treat the patient and their families with respect and honesty, Remember that the first duty is to the patient, Use nursing Knowledge to Provide the Correct Care, Remain Current in your skills & Education, Document clearly and accurately, Respect the patients rights to education and participation in plan of Care. 
   2. Intentional Torts
      1. false Imprisonment

         Nota:

         • Closing or Locking the Door
         1. pt. Must be aware of confinement (unconscious pt. has not been falsely imprisioned)
      2. Battery
         1. Unconsented Touching of another that does not need to result in harm of a patient
      3. Assualt

         Nota:

         • intentional Threat toward another person that places the person in reasonable fear of harmful, imminent or unwelcome contact. 
         1. NO contact Required
      4. Conversion of Property

         Nota:

         • Removing clothing and personal effects when placing pt. in hospital gown. 
      5. Intentional confliction of Emotional DIstress
   3. Quasi-Intentional
      1. Invasion of Privacy

         Nota:

         • Sharing of confidential information without consent.
      2. Defamation of Character (Liable, slander)

         Nota:

         • False information about Another: Slander is verbal, Liable is written.
      3. Defense: Truth
   4. Defense: Consent
3. Informed Consent

   Nota:

   • Perry & Potter: Pg. 309 Yoder & Wise: Pg. 81-82
   1. Right to Refuse Treatment
      1. Right to Refuse Treatment Previously Agreed to.
      2. Nurse Must Notify Provider if Pt. Refuses Treatment
      3. Leaving Against Medical Advice (AMA): Notify & Clearly Articulate Dangers

         Nota:

         • Most insurance will not pay for hospitalization and the patient will be responsible for all the Cost. 
         1. AMA charting

            Nota:

            • aggravate current condition and complicate future care, Result in Permanent physical or mental impairment, Result in complication of Death. 
         2. Unlawful Detaining Patients
         3. Warn patient about Insurance Complications
   2. Mandated by the Federal and State Law
      1. Federal Patient Self Determination Act
   3. Duty of the Health Care Provider to DIsclose
   4. Nature of the Therapy, Benefits and outcomes and potential Risks must be disclosed
   5. Provider Cannot Delegate that duty to the Nurse
   6. RN generally a witness to the signing of the consent
   7. RN must Notify if the Informed Consent is Questioned
   8. Voluntary, Capacity & Sufficient Information

      Nota:

      • Understand the Language, Not under the influence * Emergency substituted Judgement is used
   9. Research: Gender, age & 3 digit zip code
4. Adherence
   1. TBON rules & Regulations
   2. ANA standards
   3. JCAHO standards
   4. Patient Saftey Goals
   5. INC code of Ethics
5. Incident Report
   1. Internal to facility