Nursing Laws

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Natasha Renaud Professional Dimension Professor Yolanda Torres

Questions: Unit 2 1. About laws that regulate the nursing practice in PR: a. Law #9- This law will ensure that the one who is receiving care will receive the best quality care. Law 9 regulates the practice of nursing in Puerto Rico. According to this law, the definition of Nursing is the art and science of caring for the health of the individual, the family, a group or a community. Its field of action is the promotion and maintenance of health, disease, prevention and the participation in treatment, including person in rehabilitation, independently of the stage of growth and development in which he/she is in. 1) What is the objective and reach of nursing according to this law for the professional nurse? b. Law # 82 1) What is the purpose of this law? The purpose is to establish the College of Nursing Professionals of Puerto Rico, to determine its organization, to specify their duties and functions, and establish penalties and appropriate funds. c) Law #11 1) What is the purpose of this law? Ley #11: "Charter of Patient Rights and Responsibilities” (A) Right to high quality health service. (B) Right to the collection and dissemination of information. (C) Right in the selection of plans and providers. (D) The right to continuation of healthcare services. (E) Right of access to emergency services and facilities. (F) Right to participate in making treatment decisions. (G) The right to confidentiality of information and medical records. (H) The right to respect and give equal treatment.

2. Provide an example of the following illegal conducts and the prudent way to prevent it: a. Defamation of character- Any intentional false communication, either written or spoken, that harms a person's reputation; decreases the respect, regard, or confidence in which a person is held; or induces disparaging, hostile, or disagreeable opinions or feelings against a person. An example would be saying stuff like” oh the patient is lying”… “The patient is rude and domineering”. b. Assault- An unlawful act that places another person, without that person's consent, in fear of immediate bodily harm or battery. Example: In a medical setting, the touching of the body without permission would be an assault and battery. To prevent this, always use professional guidelines. Ask patient permission. Inform patient of the procedure before performing it. Document the procedure. Ask a family member to be present. c. False imprisonment- An intentional tort; the intentional unjustified, nonconsensual detention or confinement of a person within fixed boundaries for any length of time. Example: Restraining a patient. Always involve your supervisor when making a decision to restraint a patient. Follow the Doctor‟s orders in all medications. Do not deviate. d. Criminal negligence- Recklessly acting without reasonable caution and putting another person at risk of injury or death (or failing to do something with the same consequences) Example: giving the wrong patient the wrong medication. Follow the 5 “rights” of nursing. . This is the best way to prevent this. e. Malpractice- Improper or negligent treatment of a patient, as by a physician or nurse, resulting in injury, damage, or loss. Example would be to perform a surgery on the wrong side of the body. To prevent, Follow the 5 “rights” of nursing. Always make sure you check the site in which the procedure will be performed. Document all procedures with time. Do not leave blank spaces on your nursing notes. If you have any questions about treatment or Doctors orders, always ask. Repeat when taking medication orders from the dr. Again, each procedure must be documented. f. Involuntary Homicide- Usually refers to an unintentional killing that results from recklessness or criminal negligence, Example: Giving a child a higher dose of medication than ordered and killing him/her. Always check to make sure that you are reading the Doctor‟s orders correctly. If you ever have doubt, always ask. As an RN you should be fully aware of any mistakes made by the Dr and you should notice the doses immediately. 3. Explain- “Patient Self-Determination Right” as intended by federal laws. Mention 3 examples of ways in which you could violate the patient‟s right to privacy in a nurse-patient relationship.

On admission to any health care facility, patients be given an opportunity to determine what life-saving or life-prolonging actions they want carried out. The nurse„s job to educate the patient on this is very important so that there are no misunderstandings. The nurse obtains the signature. This information is confidential. She must respect the patient‟s wishes for privacy. 4. Define: a. Negligence is failure to provide the prevailing standard of care to a patient, which results in injury, damage, or loss to the patient. b. Malpractice. .. Improper or negligent treatment of a patient, as by a physician or nurse, resulting in injury, c. Ethics- The rules or standards governing the conduct of a person or the conduct of the members of a profession. d. Informed consent- Consent by a patient to a surgical or medical procedure or participation in a clinical study after achieving an understanding of the relevant medical facts and the risks involved. e. Standard of care- A written statement describing the rules, actions, or conditions that direct patient care. Standards of care guide practice and can be used to evaluate performance. f. Criminal negligence- Recklessly acting without reasonable caution and putting another person at risk of injury or death (or failing to do something with the same consequences) g. Prudent professional- A person who was educated in a specialized area, such as a nurse, who shows skill and good judgment in the use of resources and the ability to govern and discipline oneself by the use of reason h. Misdemeanor- An offense that is considered less serious than a felony and carries a lesser penalty, usually a fine or imprisonment for less than 1 year. Conviction for a misdemeanor does not prohibit the person from holding public office or practicing a licensed occupation. I. Reckless endangerment- A crime consisting of acts that create a substantial risk of serious physical injury to another person j. Intentional tort. A tort is a wrongful act that results in injury to one person by another. Examples of intentional torts include assault, battery, false imprisonment, invasion of privacy, and slander. Intentional torts are deliberate acts of violation of another's rights. The key word is intentional and a plaintiff must prove that the wrong doing was intentional. k. Unintentional tort- A wrongful act that results in injury to one person by another. Negligent torts are not deliberate and are the result of omission and

commission of an act. Malpractice is the unintentional tort of professional negligence; that is, a professional either failed to act in a reasonable and prudent manner and caused harm to the patient or did what a reasonable and prudent person would not have done and caused harm to a patient. 5. What are the required elements to prove professional malpractice? The duty of a professional towards an individual and breach of duty/ negligence by the professional 6. What is the importance of knowing the standards of care? Standards of care are guidelines used to determine what a nurse should or should not do. Standards of care (SOC‟s) measure the degree of excellence in nursing care and describe a competent level of nursing care. All standards of care provide a guide to the knowledge, skills, judgment and attitudes that are needed to practice safely. You keep your patient and yourself safe from legal problems and meet the nursing standard of care in your daily practice. 7. Describe the 3 sources of law. 1. Statutory Law- Is a rule or formal regulation established by government legislative authority, such as the Congress, the state legislature, or the city council, that appears in writing. 2. Regulatory (administrative) law- Includes the rules and regulations established by government agencies to carry out enacted law. Federal level= Medicare. State = board of Nursing. The rules and regulations protect the safety of the public by defining standards for nursing education and practice. 3. Common Law- Derives from common usage, custom and judicial law. It is based in the English common law. It is fluid and changes over time. In general, statutory and regulatory law carries more weight in court than does common law. 8. Describe the malpractice trends impacting today’s nursing practice:. There are a number of legal issues that occur in nursing today. Nurses can be involved in cases related to intentional torts, negligence, or malpractice. Nurses can also be involved in many criminal cases such as fraud, assault and battery, and false imprisonment. Nurses can also be witnesses of trials, so it is important for us to know our legal rights and our obligations. 9. Define: Liability- Liability is an obligation or debt that can be enforced by law. It could be that you verified a medication you knew that the dose would cause complications to the patient and yet you still administered it because you were told to. The nurse is then held liable for whatever happened to the patient. 10. Explain the following concepts and their legal implications for the nursing practice: a) Brain death - Irreversible brain damage and loss of brain function, as evidenced by cessation of breathing and other vital reflexes, unresponsiveness

to stimuli, absence of muscle activity, and a flat electroencephalogram for a specific length of time. If a nurse suspects a brain death in a patient she or he cannot talk to the patient‟s family about the diagnoses; this responsibility belongs to the physician in charge after performing various tests. If for some reason the nurse talks about this matter with patient or other healthcare workers he or she could be accused of disclosure of personal information. b) Withdrawing life support – The withdrawing of life support is a determination of the doctor in charge after different diagnostic tests in conjunction with family members. Once the decision is made nurses responsibility is to assist in the withdrawing of life support device. c) Assisted suicide - Used of pharmacological agents to hasten the death of a terminally ill patient. Assisted suicide is an illegal practice in most states, if a nurse contributes in any manner with this practice cold be process by law and lose it license permanently. d) Terminal sedation - Known in healthcare setting as palliative sedation is the use of pharmacologic agents, at the request of the terminally ill patient, to induce sedation when symptoms have not respond to other management measures; the purpose is to hasten the patient death but to relieve intractable symptoms. e) Advance directives – Written document recognized by state law that provides directions concerning the provision of care when a client is unable to make his or her own treatment choices. The two basic types are living wills and durable power of attorney. The nurse cannot perform any treatment that is rejecting in the advance directive it does not matter that the patient is at risk of death. Doing so is a violation of the patient‟s right and the nurse can confront legal problems. f) Resuscitation- triage category signifying life threatening injuries or illnesses requiring immediate intervention. In case of resuscitation to a patient the nurse can only perform CPR. The use of a defibrillator is a privilege of a doctor. The patient could suit the nurse t for using a defibrillator on him, it doesn‟t matter he or she save his life. g) Euthanasia – The intentional killing by act or omission of dependent human being for his or her alleged benefit. Euthanasia is illegal in most states of US except for the state of Oregon. Nurses cannot suggest by any reason euthanasia in an advance directive concern, doing so is a violation to the existing laws and can result in imprisonment and the lost of nurse license h) Organ donation - The process of removal and transplantation of viable organs from donor to recipient. Recipients have to be matched with the donor organ in order to reduce the recipient's rejection of the new organ. The suggestion of organ donation to family members does not belong to the nurse; this is a responsibility of the organ donation entity like for example, Life link. The responsibility of the nurse is to include the decision of the client to donate his organs in case of death in an advance directive.

I) Autopsy - Assessment or examination of a body to determine the cause of death. A physician trained in pathology performs an autopsy. The nurse has to make sure that a special consent is signed by family members to prevent any legal problems. j) Will – List of medical treatment that a client chooses to omit or refuse if the client becomes unable to make decisions and is terminally ill. A nurse could be accused of negligent if she or he does not explain to the client about the consent. Also they always need to be sure that the client is mentally competent.

“Ladies of the jury, I present... the nursing documentation” & gentlemen
Questions 1- 17 1) D 2) A 3) C 4) C 5) D 6) B 7) B 8) C 9) D 10) C 11) A 12) B 13) D 14) C 15) B 16) A 17) C

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