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Legal aspects and issues in nursing

  1. “LEGALASPECTS AND LEGAL ISSUES IN NURSING” LIPI MONDAL SENIOR TUTOR, JCN
  2. IMPORTANCE OF LAW IN NURSING • To provide a framework to establish nursing actions in the care of clients those are legal. • To difference the nurses’ responsibilities from other health professionals. • To demarcate the boundaries of independent nursing actions. • To assist in maintaining standards of nursing practice. • To safeguard and protect the rights of self & clients.
  3. LEGAL LIABILITIES IN NURSING • The duty of care (It is a legal obligation to follow the standard in caring patients.) • Breach of duty (It means the falling on the part of nurses to act/care as per standard.) • Causation ( It is an element of liability to prove that the failure to meet standard of care which caused the harm to the patient.) • Damages (It is a term used for the actual harm to a patient resulting from a definite cause.)
  4. LEGAL ISSUES IN NURSING • Nursing Negligence It is the failure by the nurse to take the appropriate action to protect the patient from harm. A nurse who fails to put side-rails on the sides of the bed of a confused patient of fails to initiate standard safety precautions to prevent patient harm is by the charge of negligence under civil law. If the negligence is gross, complete disregard of the client’s life dealt under both civil & criminal law.
  5. CONTD… The common examples of negligence are: • Burns resulting by use of hot water bottle, applying heating pads, administering steam inhalation & sitz bath. • The incidence of fall among elderly, sedated, pre-operatively, post-operatively, confused, dizzy,blind & semiconscious when nursed without fixing bed side-railing. • Patients had fallen due to a slippery or waxed floor. • Administration of wrong medications, wrong dose of medication to wrong patients.
  6. CONTD… • Malpractice Malpractice is negligence by nurses causing an injury or harm to the patients due to professional misconduct or lack of skill in performing standards of care. Nurses need to comply six International “ Patient Safety Goals”: identifying patients correctly, improving communication, safety of high alert medications, eliminating wrong-site, wrong patient, wrong procedure surgery, reducing the risk of hospital-acquired infections & reducing the risk of patient harm resulting from falls in the clinical practice, failing which ca be resulted negligence or malpractice.
  7. CONTD… The common malpractices in nursing practice can be: Failure to select an appropriate site by the nurse to administer an IM injection that causes permanent damage to the patient’s extremity. Failing to obtain a proper informed consent. Failing to provide patient’s safety: physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types of failure.
  8. CONTD… • Assault & Battery Assault is an intentional, unlawful threat or attempts to make bodily contact with another person without that patient’s consent. The unconsented touching of the body is the example of an Assault. The battery is an unjustified harmful or offensive touching with the intention of a crime or doing wrong with a person.
  9. CONTD… • Restraints These are physical, chemical or environmental measures used to control the physical or behavioral activity of a person or a portion of his/her body. Physical restraints limit a client’s least restraint practices & the right to refuse proposed interventions. For example use of bed, rails are routine in many hospitals & other care facilities. Law requires to use that most involuntary medical restraint when ordered by a physician.
  10. CONTD… • Defamation of Character It is an intentional tort or the issuance of a false statement about another person, causing harm to a person. Slander is oral defamation of character and libel is a defamation of character in writing. Defamation of character can be grounded both in criminal or civil law based on the amount of harm done to the plaintiff. Nurses who make false statements about the patient or their co-workers have the risk of being sued for slander or libel.
  11. CONTD… • Invasion of privacy All the information of the patient in any form is considered private, confidential, legal. Privacy is a human right to maintain autonomy. Certain actions of nurse can constitute an invasion of privacy, e.g. unnecessary exposing patient while assisting for examination, discussing patient information with other people insisting patient to provide information not required, research without the consent of the patient.
  12. CONTD… • Fraud A person who either practices without registration or mispresenting him or her to obtain a registration to practice nursing is fraud under the law. The misinterpretation of a procedure or treatment may also consider as a fraud.
  13. REGULATION OF NURSING PRACTICE • Licensure to Practice The INC is a statutory body, which regulates standards of education & practices through licensure. In 1948, the Nursing Council Act came into being as an autonomous body. It was constituted by the central government, with the purpose of safeguarding nursing education in the country. Every state has its own State Nursing Council that pertains to the registration of nurses upon completion of training. On completing training, a nurse must register name & details with the State Nursing Council to indicate status as a registered nurse. Nurses employed for the nursing service required possessing a valid registration certificate issued by providing qualified nurses.
  14. CONTD… • Professional Code of Conduct Nurses abide by the INC Professional Code of Conduct & Code of Ethics, & Code of Ethics by Trained Nurses Association Of India in sustaining ethical behavior of nurses. On entering profession formally, they have to take the “Nightingale Pledge” which is a way of stating that they will adhere to professional conduct. They also have to abide by laws relating to penalty for misconducts defined by State Councils or Statutory Authorities.
  15. CONTD… • Standards of Care Each institution/hospital needs to have the policies & procedures defining the standards of care for the nurses of different levels. The department must have policies & standard operative procedures to follow. The standards of care are inbuilt in the INC code of ethics & professional conduct for nurses, followed by State Nursing Councils.
  16. CONTD… • Standing Orders/ Instructions Hospital policies having standing orders for nurses can regulate nursing practice. Nurses are required to execute prescribed orders. In case of emergency, if the doctor/medical personnel is not available, each nursing service area should have standing instruction or orders for the nurses to carry out.
  17. LEGAL SAFEGUARD FOR NURSES IN PRACTICE Informed Consent Physician Order Correct Identity Accurate Documentation Negotiation Drug Maintenance Reporting crimes & Unsafe Practices
  18. LEGAL RESPONSIBILITIES IN NURSING • Administrative and Supervisory Level  Appointment, assignment & transfer of staff  Quality control management  Material management  Maintaining proper documentation  Maintaining public relation  Disaster management  Staff management
  19. CONTD… • At Operational level Carrying out physician’s order Transcription of verbal orders Do not resuscitate orders Prevention of negligence Maintaining a safe environment Proper use of equipment Maintaining proper records Intimation of short staff Maintaining & using controlled substances Dealing with death & dying patients Correct identity of clients Information regarding absconding patient
  20. MEDICO-LEGAL CASES MLC is a case requiring investigations by law enforcing agencies apart from the medical treatment to fix the responsibility to cause of injury/illness & to assess its health status or the condition. The medico-legal cases have both medical & legal implications. Usually attending doctor in the emergency department has the authority to decide the case as MLC in a situation where the police brought the case, a referred case as MLC from another hospital, or by examining the patients by attending doctor in an emergency.
  21. DEALING WITH MEDICO-LEGAL CASES • The persons who met a roadside accident, factory accidents, unnatural mishaps or any other disaster. • All burn cases of any cause. • Suspected or evident homicides, suicides. • All type of poisoning cases, sexual offences & criminal abortions. • Injury cases where there is a likelihood of death shortly. • A patient who dies immediately after admission. • Death of a patient within 24 hours in the hospital. • Death in OT during MTP, delivery. • Alcohol or drug related deaths. • Patient absconded from the ward.
  22. Guidelines for dealing Medico-legal Cases & Issues • Availability of well-defined guidelines in each department. • Well equipped with functional monitors, life-saving drugs & resuscitation equipment in the emergency OPD. • Send the information to the civil police in writing immediately, on admission & discharge, the death of MLC. • Make sure that the doctor prepares a medico-legal report of the patient in duplicate with the marking of ‘medico- legal case’ & hand over to the security officer on duty.
  23. CONTD… • Take consent for any medical examination from the patient or legal guardian. • All clothing worn by injured/deceased, bloodstains, gastric lavage, bullets, vomits material, should be preserved, sealed properly & handed over to police on request after obtaining a proper receipt. • Take care of all X-rays of MLCs which are of vital importance. Mark “medico-legal case” marks at the topic of all investigations slips & X-ray requisitions. • Keep all the information & records of MLC confidential. • Keep all medico-legal reports & registers in proper safe custody as per institutional policy.
  24. CONTD… • Collect the required samples/specimen, label, preserve & seal & send for investigation if required. • Keep an up-to-date chart of the treatment & antidotes of all types of poisoning cases. • Make the availability of essential investigation facilities. • Give due care with all the precautions while administering IV fluids & transfusing blood.
  25. THANK YOU!!!
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