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Definition of Terms Board of Registered Nursing Each state has a Board of Registered Nursing organized within the executive branch of the state government. Primary Responsibilities of the BRN include the administration of the Nurse Practice Act as applied to registered nurses. Authorization to Practice Nursing To legally engage in the practice of nursing, an individual must hold on an active license issued by the state in which he or she intends to work. Nurse Practice Act A series of statutes enacted by each state legislature to regulate the practice of nursing in that state. Topics that are included are the following a. scope of nursing, education, licensure, grounds for disciplinary actions & related topics. a. Provides legal authority for nursing practice including delegation of nursing tasks. b. Many boards of nursing also provide decision and delegation checklist. c. Set educational requirements for the nurse distinguishing Nursing Practice from Medical Practice & defines the Scope of Nursing. ANA (American Nurses Association) of 1980 Incorporates the following elements that demonstrate in a nurse: a. Human dignity & uniqueness of individual regardless of health problems & socio-economic status b. Maintain patients right for privacy & confidentiality c. Maintain competence through ongoing professional development & consultation. Ethical Principles of Bio-ethics A philosophical field that applies ethical reasoning process for achieving clear & convincing reasons to issues & dilemmas ( conflicting between two obligations) 1. Autonomy: the right of the patient to make ones own decision - Example: Religious Practices & Cultural Beliefs (Blood Transfusion & Organ Donation) 2. Veracity: the intention to tell the truth - Never give false reassurance to another person 3. Beneficence versus Non-malfeasance a. Beneficence : duty to do good b. Non-malfeasance: duty to avoid evil 4. Confidentiality: social contract in keeping ones privacy Standards of Care
Guidelines for determining whether nurses have performed duties in a appropriate manner & guidelines in which the nurse should practice Patients Bill of Rights Right for appropriate treatment that is most supportive & least restrictive Right to individualized treatment plan, subject to review & treatment Right to active participation in treatment with the risk and side effect of all medications and treatment
whereby one binds himself with respect to the other to give something or to render some service.
Exceptions to an Informed Consent (MEMO-S) M Married & Mature Minors E- Emancipated minors (to release a child from the control of his parents)
Emergency Cases M- Minors seeking birth control or pre-natal treatment O- Over specific age (ex. 12 years old & above) may give consent for STD, HIV testing, AIDS treatment, drugs & alcohol treatment WITHOUT parents consent. S- Sexually abused minors & adolescents Right to refuse Treatment 1. Advance Directives: Legal, written or oral statements made by a mentally competent person about treatment. In the event the person is unable to make these determinations, a surrogate decision-maker can do so, example: sudden serious illness. Characteristics of Advance Directives
1. 2. 3.
allows clients to participate in choosing health care providers (Choosing his / her own nurses & doctors) allows also in choosing the type of medical treatments the client desires. Allows clients to consent or refuse treatments
The Patient Determination Act of 1990 (PSDA) is a federal law that imposes on states and providers of health care certain requirements concerning Advanced Directives as well as clients right under law to to make decisions concerning medical care. The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1990 - Medical Screening of patients cannot be delayed until insurance coverage or the ability to pay has been determined. This is to assure that the patients are not denied care based on their ability to pay , patients must be medically screened & stabilized before their ability to pay is determined. Failure of a Hospital to comply may result in denial of Medicare funding. Example: All women patients having labor contractions must be medically screened & stabilized before transfer to another facility. Whether it is obvious that the patient is in labor or not, the patient must be medically screened & examined before the decision is made to transfer the patient to another facility. The emergency department does not have the right to refuse treatment to a patient before medically screening the patient. - It does not address payment for services as part of the admission procedure. It only addresses medical screening & stabilization of patients before transport or the determination of ability to pay for services rendered. a. Living Will: legal document stating person does not wish to have extra-ordinary life saving measures when not able to make decisions about his own care. -applicable FOR LIFE SAVING TREATMENT ONLY. Example: CPR, antibiotics & dialysis will be used or not b. Durable Power of Attorney: legal document giving designated person authority to make health care decisions on the clients behalf when the client is unable to do so. Right to obtain Advocacy Assistance Patient Advocate: is a person who pleads for a cause or who acts on the clients behalf. Example: nurse Goal of Advocacy: help client gain greater self-determination & Encourage freedom o choices, increase sensitivity
& responsiveness of the health care, social, political systems to the needs of the client. Example: advocates for HIV client rights for proper treatment & job opportunities
- Unintentional failure of an individual - any professional misconduct which person to perform an act or omission involves any conduct that exceeds to do something that a reasonable prudent the limits of ones professional stanperson would do or not do. dards means going beyond the context - Most common unintentional tort or scope of allowed nursing practice - Failure to observe the protection of ones resulting to injurious or non-injurious interest, the degree of care, and vigilance consequences. of circumstances. - stepping beyond ones authority Example: Example: a. Incorrect sponge counts a. prescribing drugs b. burns: heating pads ,solutions & steam b. giving anesthesia vaporizers c. doing surgery c. failure to take & observe appropriate actions forgetting to take vital signs to a newly post operative client. d. Falls: side rails left down, baby left unattended e. loss of or damage to a patients property f. failure or ignore to report to the superiors or clients family g. mistaken identity, wrong medicine, dose & route
ELEMENTS OF NEGLIGENCE LAWSUIT (B-R-O-D) e) B- breach of duty was the cause of the plaintiffs injury R- Real or actual proof injuries to the standards of care O- owed specific nursing duty D- defendant breach the duty
ELEMENTS OF MALPRACTICE(p
P- professional SPECIFIC standards of care is required R- required obedience E- exceeds the limits of the standards of care
Intentional Torts
Assault -Mental or physical threat Example a. threatening or attempting to do violence to another b. forcing a medication or treatment when the patient doesnt want it c. threatening children to take the medication Battery -physical harm through willful touching of person or clothing without consent. Example a. actually touching or wounding a person in offensive manner b. hitting or striking a client c. immediately injecting a surgical needle without informing the patient about the said procedure
False Imprisonment
- occurs when the person is not allowed to leave a health care facility when there is no legal justification to detain the client. - occurs when restraining devices are used without an appropriate clinical need. - The intentional confinement without authorization by a person who physically constricts another using force , the threat of force or confining structures and or clothing , even without force or malicious intent to detain another without consent in a specified area constitutes grounds or a charge of false person from harming self or others if it is necessary to confine to define one self , others or property or to effect a lawful arrest. Examples: a. A Hispanic American patient undergo TAHBSO and has no Medicare or HMO card nor nor any petty cash to pay hospital bills. The nurse put the patient in a room until the relatives of the former arrive to pay the bills. B. a Hong Kong OFW was suspected of having SARS. The ground duty nurse put the patient in a secluded room without doctors order and checked for other manifestations to confirm the presence of SARS. After 9 hours, it was just an ordinary cough and colds. c. A client was tested positive for HIV. Nurse Hamilton learned that this is highly contagious & communicable disease. The nurse locked the client inside a room.
ALTERNATIVES TO RESTRAINTS
1. Before restraints offer explanations, ask someone to stay with the client, use clocks, calendars, TV & radio ( to decrease disorientation) or any relaxation techniques. 2. Use LESS restrictive methods first. RESTRAINTS should always be the last. 3. Assign confuse and disoriented clients to rooms near the nurses station. 4. Maintain toileting routines & institute exercise and ambulation schedules as the client condition allows. QUESTION: Can I put restraints on a patient who is combative I there is no order for this? Only in an EMERGENCY, for a limited time (no longer than 24 hours) For the limited purpose of protecting the patient from injury NOT FOR CONVENIENCE OF Personnel. Notify the attending MD immediately, consult with another staff member, obtain patients consent if possible, and get a coworker to witness the record. RESTRAINTS OF ANY DEGREE MAY CONSTITUTE FALSE IMPRISONEMENT. Freedom from any UNLAWFUL restraint is a Basic human right protected by law. In July 1992 the FDA (Food and Drug Administration) issued a warning that the use of restraints is NO LONGER REPRESENTS RESPONSIBLE PRIMARY MANAGEMENT of a clients behavioral problem.
Question: Should I accept verbal phone orders from an MD? Generally, NO. Specifically, follow your hospitals by laws, regulations and policies regarding this. Failure to follow the hospitals rules could be considered NEGLIGENCE. In cases when verbal orders are deemed necessary the following outline may find helpful REGARDING TELEPHONE ORDERS: 1. date and time entry 2. repeat the order to the MD & record the order 3. sign the order, begin with t.o. ( telephone order), write the MDs name & then signature the order 4. if another nurse witnesses the order, that signature follows 5. The physician needs to countersign the order within the time frame according to hospital or agency policy. Question: Should I follow an MDs order if I know it is wrong? ] No. If you think a reasonable prudent nurse would not follow it; but first inform the MD and record your decision. Report it to your supervisor. Should I follow an MDs order if I disagree with his or her judgment?
Yes. Because the law does not allow you to substitute your nursing judgment for a doctors medical judgment. Do record that you questioned the order and that the doctor confirmed it before you carried it out. In order to be safe, check the agency policy manual of your work. Question: What can I do if the MD delegates a task to me for which I am not prepared? Inform the MD of your lack of medication and experience in performing the task. Refuse to do it. If you inform him or her and still carry out the task, both you and the MD could be considered NEGLIGENT if the patient is harmed by it. If you do not tell the MD and carry out the task, you are solely liable.
Requirements: a. Any person 18 years of age or older may become an organ donor by written consent. b. Informed choice to donate an organ can take place with the use of a written document signed by the client prior to death, a will, or a donor card or an advance directive. c. In the absence of appropriate documentation, a family member or legal guardian may authorize donation on the descendants organs. d. In case of newborns, they must be full term already ( more than 200 grams) Laws that Protect potential donors to Expedite acquisition: 1. National Organ Transplant Act: prohibit selling of organs 2. Uniform Anatomical Act: guidelines regarding who can donate, how donations are to Be made, and who can receive donated organs. 3. Uniform Determination Death Act: Legal determination of brain death ( absence of breathing movement, cranial nerve reflex, response to any painful stimuli and cerebral blood flow and flat EEG. Management of Donor 1. Maintain body temperature at GREATER than 96.8 F with room temperature at 70 -80 F warming blankets, warmer for IV fluids. 2. Maintain greater than 100% PaO2 and suction/ turn & use (PEEP) positive End expiratory pressure to prevent hypoxemia caused by airway obstruction & pulmonary edema.
Organ Donation
3. Maintain CVP (Central Venous Pressure) at 8 to 10 mm Hg and systolic blood pressure at greater than 90 mm Hg to prevent Hypotension. 4. Maintain Fluid & Electrolyte balance due to volume depletion 5. Prevent infections due to invasive procedures. Religions that have different views regarding organ donations 1. Russian Orthodox: permits all donations EXCEPT THE HEART. 2. Jehovahs Witness: DOES NOT ALLOW organ donation and all organ to be transplanted must be drained of blood first. 3. Judaism: They permit organ donation as long as with RABBINICAL CONSULTATION. 4. Islam: will NOT USE ORGAN STORED IN ORGAN BANKS.
consent.
Question: What is the meaning of Conditional Release? - usually requires outpatient treatment for a specified period of time to determine the clients compliance with medication protocol , ability to meet basic needs and ability to reintegrate to community.