Ethical and Legal Issues By Dr Ali Saleh

Ethical and Legal Issues By Dr. Ali Saleh

Basic Legal Concepts • Torts: a private wrong against the person or property of another (compensated with money ). e. g. fraud, invasion of privacy , and defamation. • Nsg negligence: Is the omission ( failure to do something) or commission (doing something) that violates the standard of care of an occupational & environmental health nursing. • Standard of care: the average, reasonable, and prudent occupational health nurse do in same or similar circumstances.

Basic Legal Concepts • Duty: Is the obligation that an occupational and environmental health nurse has to workers in a specific work setting to prevent foreseeable harm. • Breach of duty occurs when an OEH nurse fails to provide care according to the reasonable OHN standard. • Examples of Negligence include the following: • • Failure to assess& make proper nursing diagnosis Failure to observe& monitor Failure to take action Failure to communicate danger Delay in obtaining assistance Medication error Failure to obtain informed consent

Basic Legal Concepts • Informed consent: means that a worker's decision about a treatment or action plan is made with a clear understanding, including material risks, benefits, and alternative treatments. a. Nature & purpose of proposed treatment b. Diagnosis c. Material risks of proposed treatment d. Alternative treatments e. Consequences of lack of treatment

Informed Consent • Purposes of informed consent: a. allows the worker to make a decision based upon all known information b. Ensures accountability of health professionals • In order to be valid, informed consent must have the following characteristics: - Given freely , without coercion - Given with full understanding • The person giving informed consent must be mentally, physically , & legally competent.

Basic Legal Concepts • Malpractice: Is negligence that involves professional misconduct or unreasonable lack of skill.

Legal responsibilities of the occupational health nurse • Maintaining a current knowledge of the laws affecting occupational health practice in the jurisdiction where they practice. – Rules affecting nursing practice – Rules affecting the practice of occupational health nursing. • There may be inconsistencies between actual practice and legal guidelines of practice.

Documentation • Is the written communication of information. Purposes: • Provide information to improve quality and to assist in planning. • Communication among health professionals. • To audit the quality of care and adherence established policies and procedures. • Establish a baseline to evaluate improvement, worsening, or comparison. • Basis for retrospective, current, or prospective research • Provide information that can be used for worker education and counseling

Documentation Basics 1. Complete • • • Worker’s name and unique identifier Date and time Signature of person who wrote the note Original signature on computer generated notes. Safeguards so documentation cannot be changed. Legible Permanent entries. Should include normal and abnormal findings Include worker questions or comments.

Documentation Basics 2. Concise, descriptive manner, using accepted abbreviations and terminology. 3. Errors or changes should be corrected using SLIDE method. – – Single Line through the error Initial and write “error” above the correction Date when the correction was made Explain why the correction made 4. Correction should be made as soon as possible.

Documentation Basics 5. Stereotypes, generalizations, and judgmental statements should be avoided. 6. Documentation should be contemporaneous with the assessment. – Information that was inadvertently omitted should be documented as soon as possible. – Late entries should be preceded by notation “late entry” – For late entry include date of entry and date of data being documented.

Recordkeeping • Maintaining records of work-related injuries and illness. • Must record each work-related fatality, injury, or illness: – – – Results in death Results in days a way from work Results in restricted work activity Involves medical treatment beyond first aids Results in loss of consciousness Results in a significant injury or illness diagnosed by a physician.

Recordkeeping • Injuries/illnesses that must recorded as “privacy cases”: – An injury or illness to reproductive system – An injury or illness resulting from sexual assault. – Mental illnesses – HIV infection, hepatitis, or tuberculosis – Needlestick injuries and cuts from contaminated sharp objects – Other illnesses if worker requests.

Recordkeeping • Worker medical record: is a record concerning the health status of a worker. • Worker’s exposure records

Best Practices related to Recordkeeping • May consist both occupational and nonoccupational health data. • Desirable to separate nonoccupational data from occupational data. • The record may include Pre-placement examination, surveillance evaluations, job hazard analysis, job physical and occupational requirements, work injury/illness and follow up care, diagnostic procedures, functional capacity evaluations, medications, consent forms, progress notes, and recommendations, treatment of injuries and illnesses.

Best Practices related to Recordkeeping • A written policy for the management, access, and retention of individual health records: – Where and how records are stored and secured. – Managing records when a worker resigns, transfers, or is terminated. – Mechanism for worker access and consent for disclosure. – Mechanism for release of information on a need-toknow basis. • Records should be maintained in a secure place. • Administrative records may be retained or discarded.

Access to Employee Records • Workers should have access to their medical records. • Worker should sign a written consent before health information released. Authorization should include: – – – – What records are to be released Purpose of release To whom the records are to be released. Period of time for which authorization is valid. Date of authorization. Authority by which a person is requesting records. Identifying data of worker. Signature of person requesting records.

Access to Employee Records • For a special diagnosis of a terminal illness or a psychiatric condition: – Need for special informed consent – Can be only accessed by the worker

Workers’ Compensation • Compensation benefits include: – – Income replacement Support for dependents in the event of occupation death. Hospital, medical, and funeral expenses. Incidental expenses such as travel and parking. • Compensation laws hold that employers must assume costs of work related injuries and illnesses without regard to fault. (no further legal action). • Illnesses that are “ordinary diseases of life” can not be compensated.

Workers’ Compensation • Identifying work related illnesses can be complex and difficult because: – Time elapsed between exposure and onset of illness – Insidious onset of illness – Multifactorial nature of the illness – Obscurity of exposure because of the inability to detect low levels of toxic substances.

Workers’ Compensation • Income benefits can be provided based on: – A percentage of injured worker’s average weekly wage – A schedule for specific losses (e. g. loss of a limb) – Percent of impairment that results from injury or illness. – Whether the disability is temporary or permanent

Workers’ Compensation • Disability from occupational injury or illness can be: – Temporary total disability: worker is unable to return to any type of continuous gainful employment. – Temporary partial disability : the worker is not medically fixed and stable but can return to “light” at a lower wage than before injury. – Permanent total disability: a condition that permanently and completely incapacitates a worker, preventing the worker from ever performing gainful employment. – Permanent partial disability: results in permanent loss of a body part or a lasting impairment that has been deemed unlikely to improve.

Professional Position on Ethics • Complex ethical dilemmas require careful communication with company management and the recipients of care. • Ethical framework provide the guidelines within which the nurse makes ethical judgments. • Advocacy role of the OEH nurse to enable the client receive accessible, equitable, and quality health services, including a safe and healthful work environment.

Confidentiality • Unauthorized release of health records could result in personal liability, suspension of license to practice nursing, or termination of employment.