Legal Aspects of Nursing Notes II

       CRIMES AFFECTING NURSES

I.   Crime

            - Act committed in violation of social law.

            a. Tort (fraud, negligence & malpractice)

                        - Legal wrong committed against a person, his rights & property.

1.    Fraud – misrepresentation of fact with intentions for it to be acted on by another person ( such as falsifying graduate nursing programs)

2.    Negligence

3.    Malpractice

Negligence                             versus                  Malpractice

Definition:                                                                    Definition:                                           

-  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 one’s professional stan-

   person 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 one’s       resulting to injurious or non-injurious

   interest, the degree of care, and vigilance      consequences.

   of circumstances.                                                      - stepping beyond one’s 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 patient’s property

f. failure or ignore to report to the superiors or

     client’s family

g. mistaken identity, wrong medicine, dose & route

ELEMENTS OF NEGLIGENCE LAWSUIT  (B-R-O-D)            ELEMENTS OF MALPRACTICE(p-r-e)

B- breach of duty was the cause of the         P- professional SPECIFIC standards of care

     plaintiff’s injury                                                            is required

R- Real or actual proof injuries                       R- required obedience

      to the standards of care

O- owed specific nursing duty                        E- exceeds the limits of the standards of care

D- defendant breach the duty

                                                Intentional Torts

Assault                                                                                                            Battery

-Mental or physical threat                                           -physical harm through willful touching of

                                                                         person or clothing without consent.

Example                                                                      Example

a.  threatening or attempting to do                              a. actually touching or wounding a person in

     violence to another                                                    offensive manner

b. forcing a medication or treatment                         b. hitting or striking a client

    when the patient doesn’t want it                             c. immediately injecting a surgical needle

c. threatening children to take the medication               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.

                       Legal aspect regarding Restraints

Restraints are protective devices used to limit the physical activity of a client or to immobilize a client or an extremity.

Physical restraints:  restrict client movement through the application of a device.

Chemical restraints: Medications given to inhibit a specific behavior or movement.

Under Omnibus Budget Reconciliation Act: any client or patient has the right to be free from Physical (such as restraint jackets) and chemical (sedation, psychotropic drugs) restraints

Imposed for the purpose o discipline or convenience and should not be required to treat medical

or psychiatric symptoms.

            Lawful Requirements & Nursing Actions for Using Restraints

            According to (JCAHO) Joint Commission on ACCREDIATATION OF  

                                                 HEALTHCARE ORGANIZATIONS

1. RESTRAINTS SHOULD NOT BE USED PRN!!!
2. Informed consent and a Doctors order is needed to use restraints.
3. Doctors orders for restraints  should be renewed within a specific time frame

according to the agencies policies.

4. Restraints should not interfere with any treatments or affect the client’s health problems.
5. Document the following:

                       Reason for the restraints

                       Method of restraints

                       Date and time of application

                       Duration of use and clients response

                       Release from the restraints (every 30 minutes) with periodic exercise and

                       Circulatory, neurovascular and skin assessment

                       Evaluation of client’s response

     6.     DON’T ASK PERMISSION IF THE PATIENT HAS AN ALTERED LEVEL
             OF CONSCIOUSNESS!!!

     7.     If the client is unable to give consent to a restraint procedure, then consent of proxy

             must be obtained AFTER FULL DISCLOSURE OF ALL RISK AND BENEFITS.

      8.    Use a clove hitch knot so that restraint can be changed and release easily and ensure

             that there is enough slack on the straps to allow some movement o the body part.

      9.    Never secure restraints to bed rails or mattress. Secure restraints to parts of the bed or

             chair that will move with client & not constrict movement.

                                      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 nurse’s 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 co-

                        worker to witness the record. RESTRAINTS OF ANY DEGREE MAY CONSTI-

                        TUTE FALSE IMPRISONEMENT.  Freedom from any UNLAWFUL restraint is a

                        Basic human right protected by law. In July 1992 the FDA (Food and Drug Admi-

                        nistration) issued a warning that the use of restraints is – NO LONGER

                        REPRESENTS RESPONSIBLE PRIMARY MANAGEMENT of a client’s

                        behavioral problem.