Chapter 5 Ethical and Legal Issues Copyright 2012

Chapter 5 Ethical and Legal Issues Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Along with the privilege of providing professional health care services to consumers, the professional nurse has a commensurate degree of responsibility and accountability to follow ethical principles and standards of care integral to the profession. Sheehy, 2006 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Learning Objectives After studying this chapter, you should be able to • Explain the relationship between state Nurse Practice acts and the concepts of risk management and quality assurance • Construct the six-step model of ethical nursing care designed by Chally and Loriz • Articulate why nurses must become knowledgeable about genetics and the issues surrounding this topic • Recognize five forms of nursing malpractice • Discuss implications for psychiatric care related to the Tarasoff ruling of duty to warn • Compare the criteria for voluntary and involuntary admission to a psychiatric facility • Interpret the concept of competency Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Learning Objectives (cont. ) • Compare the legal rights of adults and minors admitted to psychiatric facilities • Discuss the impact of the Omnibus Reconciliation Act (OBRA) on the placement of clients with psychiatric disorders in long-term care facilities • Distinguish the legal phrases: diminished capacity, not guilty by reason of insanity, and guilty but mentally ill • Explain forensic psychiatry and the role of the forensic nurse Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ethics in Nursing • Model of ethical nursing care • Ethics in pain management • Ethics in genetic testing and clinical research Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ethical Decision-Making Model • Clarify the ethical dilemma • Gather additional data • Identify options • Make a decision • Act or carry out the decision • Evaluate the impact of the decision Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ethical Dilemmas in Clinical Research • Informed consent • Documentation of research protocols • The client’s right to full disclosure Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Legal Issues in Nursing • Nurses, now more than ever, are subject to the scrutiny of federal and state regulations as well as the legal system. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bill of Rights for Registered Nurses have the right to • A safe environment • Practice in a manner that ensures the provision of safe care through adherence to professional standards and ethical practice • Advocate freely on behalf of themselves and their clients Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Four Elements Required for Nursing Malpractice • Failure to exercise reasonable care or act in an acceptable way when undertaking and providing care to a client • Breach of duty or failure to conform to the required standard of care in treating the client’s condition • Approximate cause, which requires that there be a reasonably close connection between the defendant’s conduct and the resultant injury (ie, the performance of the health care provider caused the injury to the client) • The occurrence of actual damage to the client as a result of malpractice Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Other Forms of Malpractice • Intentional torts • Assault • Battery • Defamation • False imprisonment • Failure of duty to warn • Breach of confidentiality and privacy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Bill of Rights for Psychiatric–Mental Health Clients • Engage in religious freedom and education • Receive treatment • Refuse treatment • • Have a probable cause hearing Maintain respect, dignity, and personal identity • • Maintain client privacy and confidentiality Maintain personal safety and assert grievances • • Communicate freely with others Be transferred and receive continuity of care • Access own records • Have personal privileges • • Maintain one’s civil rights Obtain an explanation of cost of services • Obtain aftercare Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Psychiatric Hospitalization • Involuntary admission or civil commitment • Voluntary admission • Hospitalization of minors • Long-term care facilities Omnibus Reconciliation Act (OBRA) of 1987 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Forensic Psychiatry • Evaluation of an individual’s competency • Diminished capacity • Not guilty by reason of insanity • Guilty but mentally ill • Role of the forensic nurse • The forensic nurse as a legal nurse consultant and expert witness Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms • Advance psychiatric directives • Diminished capacity • Assault • Doctrine of Charitable Immunity • Battery • Bill of Rights for Registered Nurses • Ethics • Failure of duty to warn • Civil commitment • False imprisonment • Client confidentiality • Forensic psychiatry • Client privacy • Genetic testing • Code of Ethics for Nurses • Guilty but mentally ill • Defamation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Key Terms (cont. ) • Nurse Practice Act • Incompetent • Omnibus Reconciliation Act • Informed consent • Intentional tort • Involuntary admission • Libel • Paternalism • Quality assurance • Risk management • Sentinel event • Malpractice • Miranda warning • Negligence • Not guilty by reason of insanity • Slander • Tarasoff decision • Voluntariness hearing • Writ of habeas corpus Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Reflection Imagine that you are providing care for a client undergoing a clinical research drug study. The client informs you that she suspects that she is pregnant but has not seen a doctor to confirm the pregnancy. • What informed and effective care decisions do you need to make before taking action? Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins ?