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TOPIC 8.LEGAL ASPECTS OF NURSING
8. INTRODUCTION TO MEDICO LEGAL ASPECTS OF NURSING.
Nurses face ethical issues daily regardless of where they practice. They are faced with ethical decisions that can impact them and their patients. Ethics is the science relating to moral action and one’s value system. Nursing ethics provides the standards for professional behavior and is the study of principles of right and wrong conduct for nurses.
Nursing ethics states the duties and obligations of nurses to their clients, other health professional, the profession, and the community. Ethics promotes the philosophical and theological study of morality, mental judgments and moral problems.
Nurses adhere to certain ethical principle when caring for patients. These principles include beneficence, which is doing no harm to the patient, maleficence which is doing harm to a patient for positive outcome, justice in allocating care based on need not status and patient autonomy which is respecting the patient’s right to make health decision.
LEARNING OUTCOMES
After completing the lectures, students will be able to:
- Discuss nurse practice act
- Discuss credentialing in nursing.
- describe standard of care in nursing.
- Describe the legal aspects in nursing
8.1. REGISTRATION AND LICENSURE
NURSE PRACTICE ACTS
To protects the public by legally defining and describing the scope of nursing practice. Legally control nursing practice through licensing requirements. E.g., license for SRN/ Nurse Midwife.3. Each state has a nurse practice act. Nurse responsibility to know the nurse practice act of the state which he/she practice.
a. CREDENTIALING IN NURSING
It is the process of determining and maintaining standard of practice and accountability for competence in nursing practice. Credentialing includes- Licensure, Certification and Accreditation.
b. NURSING LICENSURE
A Legal permit that a government agency grants to individuals to engage in the practice of profession which is mandatory in all state. To obtain the licensure, three criteria to meet obtain the right to license: The objectives is to protect the public safety or welfare while the occupation clearly delineated as separate, distinct area of work., thus, proper authority to assume obligations of the licensing process (e.g., state board of nursing)
c. NURSING CERTIFICATION
The voluntary practice of validating that individual nurse has meet minimum standards of nursing competence in specialty areas. (e.g., maternal-child health, pediatric, mental health, gerontology). And certification programs are conducted by specialty nursing organization.
8.2. ACCREDITATION/APPROVAL OF BASIC NURSING EDUCATION PROGRAMS
The state board nursing ensure school preparing nurses maintain minimum standard of education with legal requirement. The college / university must be accredited by MQA to maintaining voluntary accreditation means of informing the public and students that the nursing program has certain criteria.
a. STANDARD OF CARE IN NURSING
Standard of care are the skills and learning commonly possessed by members of a profession (Guido, 2006). Nurses must know their institution policies and procedures. Nurses need to remain competent through reading professional journals, attending CNE and in-services programs.
The purpose of standard of care: To protect the consume and to evaluate the quality-of-care nurses provide with Legal guidelines for nursing practice.
Nursing standard of care classified into categories can be divided into Internal standard and External standard.
Internal standards consist of nurse’s job description, education, and expertise as well as individual institutional policies and procedures.
And the External standard consist nurse practice acts, professional organization (e.g., ANA), nursing specialty-practice organization (e.g., Oncology nursing society/ emergency nurse association) and Federal organizations and federal guidelines (e.g., joint commission on accreditation of healthcare organizations JCAHO)
Nursing Practice Act - law that mandates the Board to set out the scope of practice and responsibilities for RNs. Standard of care - the skills and learning commonly possessed by members in the profession and used to evaluate the quality-of-care nurses provide.
b. NURSING BOARD MALAYSIA
Registration Units role is to ensure that all Registered Nurses, Community Nurses, Midwife Nurses Part 1, Midwife Nurses Part 11, Public Health nurses and mental Health Nurses who have passed the Malaysian Board Exam/Malaysian Midwifery Board Examination and BPL Final Examination from MOH Colleges of Nursing, IPTA.IPTS that are recognised and registered with the Malaysian Board Exam/Malaysian Midwifery Board in accordance with the Nurses Act 1950 and Regulations 1985 and Nurse Midwifes Act 1966 and Regulation 1990.Nursing Board Malaysia is responsible for the issuance of the certificate of Annual Practice to ensure nurses to practice nursing in Malaysia,
c. NURSING BOARD MALAYSIA MAIN FUNCTIONS
1. Maintain a register of qualified nurses through nursing licensure.
2. Set professional standards and guidelines for all levels of nursing education, nursing practices, management and research.
3. Regulate the conduct and competency of nurses.
4. Evaluate, approve and accredited all nursing programmes offered locally by both public and private educational institution.
5. The board shall approve institution as training school to provide training for admission by examination to the register. The board manages the nursing education and nursing practice according to the Nurses Act 1950 and Nurses Registration Regulation 1985.The nursing board is a regulatory body established under section 3 of the nurses Act 1950 (Act 14) and the nurses Registration Regulation 1985.
The Board shall approve institution as training schools to provide training for admission by examination to the Register ( Nurses Act 4 (1) )
i. Register (Registration Cert., Badge)
ii. Annual Nurse Practicing Certificate
iii. Disciplinary proceedings
It main objectives is to ensure that all Registered Nurses, Community Nurses, Midwife Nurses Part 1, Midwife Nurses Part 11, Public Health nurses and mental Health Nurses who passed the examination are registered with the Nursing Board Malaysia/ Midwifery Board Malaysia.
To make sure every nurses registered with the Nursing Board Malaysia (NBM) maintains his/her competency in order to practice nursing.
1.Registrations
All nurses who have passed to the Nursing Board Malaysia (NBM), Midwifery Board Malaysia IMBM) and final examination of Ministry of Health Malaysia IPTS and IPTA recognized in Malaysia and Malaysian Nurses trained outside Malaysia.
2.Annual Practicing Certificate (APC) FOR Nurses
APC is issued to all registered nurses who register to with (NBM) to practice nursing at health facilities in Malaysia.
3. Retention of Names
This procedure is done as to maintain the registered status in (NBM) for nurses who are not practicing nursing in Malaysia, further their studies or working abroad.
4 Confirmation of Registration.
This procedure is to verify and certify nurses who will future study in the field of nursing in institution of Higher Learning and to nurses who are applying to work abroad in order to register with the Nursing of the respective countries.
5. Verification Transcript Training
to verify and certify training transcript for nurses who have registered with NBM or MBM or as stipulated in the act.
6. Letter of Good Standing
To certify nurses registered within the NBM/MBM have maintained their registered status through the service and never being revoked.
7.. Approval of Notice of Intent to Midwives in the Hospital/Private Clinic
The Board shall have disciplinary jurisdiction over all persons registered under these Regulations.
Disciplinary punishments – The Board may , in the exercise of its disciplinary jurisdiction , impose any of the following punishments :-
i. Order the name of a registered person to be removed from the Register
ii. Order the name of a registered person to be suspended from the Register for such period as it may think fit
8.3. PROFESSIONAL ORGANIZATION BODY
• Malaysian Nursing Board(MNB)
• Malaysian Nursing Association(MNA)
• Malaysian Nursing Union(MNU)
• Association of Nurse Tutors(ANT)
• International Council of Nurses(ICN)
• World Health Organization(WHO)
8.4.. DICIPLINARY PROCEEDINGS
Disciplinary jurisdiction of the Board - The Board shall have disciplinary jurisdiction over all persons registered under these regulations.
Disciplinary punishment - The Board may, in the exercise of its disciplinary jurisdiction, impose any of the following punishments:
Order the name of a registered person to be removed from the register; Order the name of the registered person to be suspended from the register for some period as it may think fit; Order a registered person to be reprimanded; or Make any of the above orders but suspended its application subject to such condition as the Board may think fit for a period or periods in the aggregate not exceeding two years.
Has obtained registration by fraud or misrepresentation; Was not at the time of his registration entitled to be registered; Has been removed from the register of nurses maintained in any place outside Malaysia; Or has been certified to be a drug dependent by a government medical officer or a registered medical practitioner under the Drug Dependants (Treatment and Rehabilitation Act 1983.)
8.4. CONTINUING PROFESSIONAL DEVELOPMENT (CPD) FOR NURSES
Continuing professional development (CPD) has always been important in nursing. It helps nurses and midwives keep up to date with their training so they can deliver the best care to patients. Planned and organized proses of learning.
a. OBJECTIVE OF CPD
To enable nurses to maintain, improve and broaden their professional knowledge, expertise and competency. To meet their obligation to provide ethical, effective, safe and competent practice. Maintain professional competence in an ever-changing technological environment alongside numerous challenges.
This guideline refers to registered nurses, registered under the General Part and Supplementary Part of Nurses Act 1950 and also Midwives Registered in Part l, ll and lll of the Midwives Act 1966.Registered nurses are the largest group in healthcare providing direct care to patients/clients. They have great potential to contribute to the health of the community and to achieve the goals of the National Health policy.
Process of lifelong learning aimed at fulfilling patients’ needs and improving health outcomes by systemic improvement of knowledge, understanding and skills in the development of personal qualities which are necessary for the execution of professional duties, including the acquisition of new roles and responsibilities. Increasing public expectations and demands for greater quality.
Nurses face these challenges in embracing new methods of care delivery and integration of new knowledge into practice that will provide quality services that is truly patient/client – centered.
Nursing Board have taken serious concern regarding CPD activities by coordinating the approval and monitoring achievement of CPD points for the renewal of Annual Practicing Certificate (APC) or Temporary Practicing Certificate (TPC) of nurses practicing throughout Malaysia.
Performing CPD activities will be beneficial for improvement career development, job satisfaction and provision of services among nurses and midwives.
b. GUIDELINES TO APPLY FOR THE YEARLY ANNUAL PRACTICING CERTIFICATE
This logbook is designed to guide nursing professionals in recording and updating all CPD activities they have been involved in and to allocate credit points in each of the CPD activities as listed in CPD Credit Points System, respectively.
There is a requirement for annual minimum Credit Points achievement for each professional group to enable them to renew their APC.
The numbers of CPD to be collected yearly will be recommended by the Malaysia Nursing Board
However, there is no upper limit in acquiring points for CPD especially when there is growing evidence of the need to link CPD with organizational/institutional goals.
As outlined in the CPD Credit Points System, a health care professional may be involved in or attend many CPD activities of the same category, but only the maximum credit points of that category would be taken into consideration for the annual minimum.
Each CPD activity undertaken must be recorded in the logbook and be verified by the immediate supervisor with documented proof.
For renewing the APC, the collection of CPD points must be made from 1 st September of the previous year to 31st August of the current year. This applies to the renewal of APC for the coming year. However, once a 3 nurse has achieved the required CPD points, she/he is allowed to renew her/his APC earlier.
The request for renewal of the APC should be submitted to Malaysian Nursing Board by 1st September of the current year.
All completed logbook should be verified and signed by the immediate supervisor.
The logbook and summary shall be kept for future reference.
The CPD Committee at organizational level will be responsible for ensuring the implementation of this system.
The CPD committees will also be responsible to deal with any appeals from officers regarding disagreement on points awarded and the local verification process.
c. INSTRUCTIONS FOR NURSES
• Nurses are encouraged to plan their CPD activities at the beginning of each year.
• All personal profile and Healthcare provider information should be updated regularly.
• Please show your logbook to your immediate supervisor, appointed by the Head of Unit or Department/Discipline, at least 4-monthly to verify your CPD activities.
• The certificates of attendance and relevant verification documents must be produced for the purpose of verification by the immediate supervisor.
• Any appeal regarding disagreement on points awarded or the verification process should be made to the local CPD committee.
• Complete CPD-LB Pind.1/2018 form at the end of the year to determine the summary of CPD points achieved. Submit the completed CPD-LB Pind.1/2018 form to the supervisor.
VERIFICATION OF CPD POINTS BY SUPERVISOR/WARD SISTER/WARD MANAGERS
8.5 INTRODUCTION LEGAL RISKS IN PROFESSIONAL NURSING
Laws are set of enforceable principles and rules established to protect society. Legal principles form a framework within which nurse will practice the art of nursing. Of all the health personnel's, nursing personnel's have most frequent and prolonged contact with the patient. As such, are most often in a position to intervene protecting on the patient's behalf.
With the increased emphasis on clients/ patients' rights, nurses today must understand the legal obligations and responsibilities to clients. Nurses who give competent care based on their education will seldom need to worry about malpractice lawsuit. Many clients are knowledgeable about their rights related to their health and illness. Therefore, nurses should take it as a challenge to become patients advocates.
LEARNING OUTCOMES:
At the end of the lectures, students will be able to:
- discuss Malaysia legal system and law
- discuss the nurse's role as witness.
- Discuss unprofessional conduct.
- Discuss the professional liability insurance.
- Discuss nurse's role in legal issues related to nursing practices.
a. LEGAL SYSTEM
Law is, generally a system of rules which are enforced through social institutions to govern behavior (Robertson, 2006), although the term ‘law’ has no universally accepted definition (Lord Lloyd of Hampstead, 1975).Laws can be made by legislatures through legislation (resulting in statutes), the executive through decrees and regulations, or judges through binding precedents (normally in common law jurisdiction)
In general, legal systems can be split between civil law and common law systems. Historically, religious laws played a significant role in setting of peculiar matters in some religious communities. Islamic Sharia law is the world’s most widely used religious law.
Law is generally divided into two main areas.
Criminal law deals with conduct that is considered harmful to social order and in which the guilty party may be imprisoned or fined.
Civil law deals with the resolutions of lawsuits (disputes) between individuals or organizations. These resolutions seek to provide a legal remedy (often monetary damages)
b. LAW OF MALAYSIA
The law of Malaysia is mainly on the common law system. This was a direct result of the colonization by Britain. The supreme law in Malaysia –the Constitution of Malaysia sets on the legal framework and rights of Malaysian citizen.
Federal laws enacted by the Parliament of Malaysia applies throughout the country. There are also state laws enacted by the State Legislative assemblies which applies in the particular state.
The constitution of Malaysia also provides for a unique dual justice system- the secular laws (criminal and civil) and shariah laws. Shariah or Islamic law is a state law matter with the exception of the Federal Territories of Malaysia. Law also raises important and complex issues, concerning equality, fairness and justice
There is an old saying that “all are equal before the law”.
c. COMMON LAW
The laws of Malaysia can be divided into two types of laws- written law and unwritten law. Written laws are laws which have been enacted in the constitution or in legislations. Unwritten laws are laws which are contained in any statutes and can be found in case decisions.
c. CRIMINAL LAW
Criminal law, also known as penal law pertains to crimes and punishments. It regulates the definitions of and penalties for offences. Examples of crimes includes murder, assault, fraud and theft.
d.LABOUR LAW
Labour law (also labor law or employment law) mediates the relationship between workers(employees), employers, trade unions and the government.
Individual labour law concerns employees right at work and through the contract for work.
The basic feature of labour law in almost every country is that the rights and obligations of the worker and employer through a contract of employment between the two.
Many contract terms and conditions are covered by legislations or common law. One example of employment terms in many countries is the duty to provide written particulars of employment with the essential terms to an employee.
This aims to allow the employee to know what to expect and what is expected. It covers compensation, holiday, sick leave rights, notice in the event of dismissed and job description.
8.6. MEDICO LEGAL ASPECTS IN NURSING
When nurses embark on to practice their profession, they are considered responsible and accountable for the quality of nursing care in line with their duties and responsibilities. Nurses should be directly conscious of their immediate supervisors and self-regulating. Nurses are bound to a standard of conduct that is expected of a reasonably prudent nurse. The practicing license is proof that they are able to give holistic and quality care to their client as a professional nurse.
a.LEGAL PRACTICE OF NURSING
To practice nursing legally, a nurse must possess a valid and current license from the appropriate agency. i.e Nursing Board/ Council. The primary purpose of a licensure law is to protect public from injury by unqualified practitioners through informant of minimum practice standards.
b. LICENSURE IS MANDATORY
The law governing nursing licensure include the sections that specify licensing board or council, compositions and responsibilities, definition of professional, educational and evaluation requirements for licensure procedures for determining proficiency, penalties for practicing without license.
c. DEFINITION OF PROFESSIONAL NURSING PRACTICE
Professional nursing practice encompass the full scope of nursing practice and consists of application of nursing theory to the planning development, implementation and evaluation of nursing care plans for individuals, families and communities.
d. STANDARDS OF PRACTICE
Clinical guidelines, standards of professional performance, standards of practice and standards of care are often used interchangeably. The legal definition of standard of care looks to what a reasonable and prudent nurse would be in the same or similar situation. Nurse practice act: Standards of practice may have their basis in the nurse practice act (from Nursing Board/ Council)
e. NURSE AND LAW
Legal responsibility in nursing practice means the way in which nurses are obligated to obey the law in professional activities.
A professional nurse needs to update with the fast changing and advancing professional knowledge to provide safe nursing to their clients/patients.
Nursing professionals should be aware of their limitations and shall be familiar with the law and nursing practice of their own country.
Nurses should not give any room for ‘tort’ i.e negligence for malpractice in their practice.
f. NEGLIGENCE
The failure of an individual to do something that a reasonable person would in a particular circumstance in standard of care to which a nurse is legally bound.
Negligence is conduct that falls below the standard of care. If nurses give care that does not meet appropriate standards, they may be held liable for negligence.
g. THE PROBLEMS FOR WHICH NURSES ARE OFTEN FOUND NEGLIGENCE IN DURIES:
- Failure to use aseptic techniques where required.
- Leaving a foreign object in a patient's body during the surgery, eg, errors in sponge, instruments or needle count in surgical cases
- Failing to respond promptly to patient symptoms impending disaster.
- Medication and treatment errors
- Administering wrong medicine, wrong dose to a patient
- Failing to protect patient from falling, falls resulting injuries to patient.
- Administering medication inappropriately, i.e intravenous therapy, errors resulting in infiltration or phlebitis.
- Administering a care in such a manner that a patient suffers injury e.g improper handling of hot water bags, burns to clients.
- Failure to document
- Failure to assess and monitor.
Nurses are responsible for performing all procedures, correctly and exercising professional judgment for which they have autonomy to do so or in carrying out doctors' orders.Any nurse who does not meet accepted standards or practice or care or who performs duties in a careless manner, runs a risk of being found negligent.
h. MALPRACTICE
Malpractice is a negligence or carelessness by a professional person. It concerns professionals' actions and in the failure of a person with professional education, skills and knowledge to act in a reasonable and prudent manner.
Issues of malpractice have become increasingly prominent to the nurses as nursing's authority, accountability and autonomy have increased.
i.TIPS TO AVOID LAWSUITS
Follow standards of care
- Give competent health care
- Develop empathetic interpersonal relationship with client
- Complete and objective documentations
- Keep updated with current practice
- Follow SOP of the institution
j. ACCOUNTABILITY
Professional accountability applies to everyone involved in health care. Accountability is a legal obligation; in health care it is also an ethical and moral obligations. Within the realm of professional accountability-Assuming responsibility for one's own nursing practice is the most important.
A professional nurse has the responsibility to practice within her scope of care, using appropriate knowledge and skills to make decisions in the best interest of the patient. The level of responsibility and accountability depends on professional levels. Professionals nursing is based on altruism, integrity, accountability and social justice. Altruism refers to the ethical obligation to serve others without self interest.
k. ASSAULT AND BATTERY
As an attempt or threat to touch another person unjustifiably. For example: - The person who threatens someone by making a menacing gesture with a club or a closed fist is guilty of assault. A nurse who threatens a client with an injection after the client refuses to take the medication orally would be committing assault.
It is the situation where touching of a person (or person’s clothes or even something the person is carrying) that may or may not cause harm or consent required before procedures are performed.
Example: Nurse gave injection without the client’s consent. Nurse would be committing battery even physician ordered the medication.
l. PROFESSIONAL LIABILITY INSURANCE
Increase number of malpractice lawsuits against health professionals. Pphysicians, or doctor can be sued because of the negligent conduct of a nurse. Nurse can be also sued and held liable for negligence or malpractices and nurses are advised to carry their own liability insurance.
The nurses are advised to provide their own insurance coverage and not rely on hospital-provided insurance. Liability insurance coverage usually defrays all costs of defending a nurse including the costs of retaining an attorney.
m. CARRYING OUT PHYSICIAN ORDERS
Nurses are expected to analyze procedures and medications ordered by the physician. Seek clarification if seemingly erroneous orders from the prescribing doctor.
There are several categories of orders that nurses must question to protect themselves legally such as question any order a client questions, question any order if the client condition has changed,
question and record verbal orders to avoid miscommunication and question any order that is illegible, unclear or incomplete.
Competent practice is a major legal safeguard for nurses. Nurses need to provide their care within the legal boundaries. Competency also involved care that protects clients from harm. Application of nursing process – provide care and effective client care. Effective communication – protect nurse from negligence claims.
n. LEGAL PROTECTION FOR NURSES
Function within the scope of your education, job description and nurse practice act.
Follow the procedures and policies of the employing agency. To build and maintain good rapports with clients. Always check the identity of the client to make sure it is the right client. Observed and monitor the client accurately. Communicate and record significantly in the client’s condition to the physician. Be alert when implementing nursing interventions and give each task full attention and skills.
Perform procedure correctly and appropriately. Make sure given correct medication to the patient.
Delegating correctly to the right person. Protects clients from injury. Reports all incidences involving clients.
Always check any order that a client question. Know your strengths and weakness. Maintain your clinical competent.
8.7. DOCUMENTATION IN NURSING PRACTICES
Objective of documentation is to develop a better understanding of the different aspects of documentation to motivate nurses to become better documenter. To standardize the nursing documentation and ensure accurate record keeping. The effectiveness of documentation are Use of Common Vocabulary the legibility of hand writing , the proper of abbreviations and symbols in nursing reports, organization, accuracy and confidentiality of the patients reports
Use of Common Vocabulary - Enhances the quality of documentation. Supports the efforts of research and improves communication and lessens the chance of misunderstanding between members of the health team.
Legibility of the hand writing - Print if necessary, do not erase or obliterate writing, draw one line through an erroneous entry, state the reason for the error, and ssSign and date the correction.
Abbreviations and Symbols - always refer to the facility’s approved listing and avoid abbreviations that can be misunderstood.
Organization of the nursing reports - Start every entry with the date and time. Chart in chronological order. Chart in a timely fashion to avoid omissions. Chart medications immediately after administration. Sign your name after each entry.
Accuracy - Use factual, descriptive terms to chart exactly what was observed or done. Use correct spelling and grammar. Write complete sentences. Maintain continuity of care by recording with respect to notes made on previous shifts.
Documenting a Medication Error - Chart the medication on the MAR. Document in the nurses’ progress notes: Name and dosage of the medication Name of the practitioner who was notified of the error Time of the notification Nursing interventions or medical treatment and client’s response to treatment
Confidentiality - The nurse is responsible for protecting the privacy and confidentiality of client interactions, assessments, and care. The client’s significant others, insurance companies, or other parties not directly involved in care provided by the health team may not have access to clients’ records.
8.8. INCIDENT REPORTS
Used to document any unusual occurrence or accident in the delivery of client care. The incident report is not part of the medical record, but it may be used later in litigation. When an accident occurs, the nurse should first assess the client and intervene to prevent injury.
It is defined as An incident report is a form that filled up in order to record the details of accidents, patient injury and other unusual events that occur in a health care facility such as a hospital or nursing home. It is also called an accident report which documents the exact details of the accident or unusual event while the information is still fresh in the minds of those who witness the event.
• Written at the first opportunity after the incident so that the details are not blurry or forgotten.
• Written with a pen (ink) not pencil. Information written using a pencil can be erased.
• Details should be complete and accurate.
a.The patient should be identified with the following details:
• Full name
• Hospital bed number
• Hospital ID
• Patients' diagnosis
• Patient’s condition before and after the incident
Other details included are: Details of ward or clinical area Date, time and place of incident
• Details of equipment's used to include the serial number or asset tag identification (if appropriate)
b. PURPOSES OF AN INCIDENT REPORT
To document the exact detail of an accident or unusual incident that occurred in a health-care institution. To be used in the future when dealing with liability issues stemming from the incident.
To protect the nursing staff against unjust accusation. To protect and safeguard the client in case of negligence on the part of the nurse. Helps in the evaluation of nursing care to ensure safe care to all patients.
8.9. REPORTING CRIMES, TORTS & UNSAFE PRACTICES
Nurses may need to report nursing colleagues or other health and safety or professionals for practices that endanger the health and safety of clients. When reporting an incident, the nurse must be careful to described observed behavior only and not make inferences as to what might be happening.
Write a clear description of the situation you believe you should report. Make sure that your statements are factual and complete. Make sure you are credible. Obtain support from at least one trustworthy person before filing the report.
Report the matter starting at the lowest possible level in the agency hierarchy. Assume responsibility for reporting the individual by being open about it. Sign your name to the letter. See the problem through once you have reported it.
Thus, the responsibilities of the students undergoing the training should be responsible for their own actions and liable for their own actions and liable for their own acts of negligence committed during clinical experiences. When they are performed duties that are within the scope of professional nursing: Example : administration of drugs – there are legally held to the same standard of skills and competence as a registered nurse.
To fulfill responsibilities to clients and to minimize chances for liability, nursing students needs to Make sure they are prepared to carry out necessary care for assigned clients. Ask for additional help or supervision in situation for which they feel inadequately prepared. Comply with the policies of the agency in which they obtain their clinical experience, and comply with the policies and definitions of responsibility supplied by the school of nursing
8.10. INTRODUCTION INFORMED CONSENT AND CONFIDENTIALITY
Informed consent and patient confidentiality are legal concepts that are usually defined by state laws. For legal purposes, it is important to obtain consent for health care. The health care provider should be the one who obtains informed consent.
LEARNING OUTCOMES
At the end of the lectures, students will be able to:
- describe consent.
- describe nurse's role in delegation, violence, abuse and neglect.
- Discuss law related controlled substances
- Discuss nurse's role in legal issues related to death and patients confidentiality.
a. DEFINITION OF INFORMED CONSENT
It is a person’s agreement to allow something to happen based on a full disclosure of facts needed to make an intelligent decision.
“Every human being of adult years and sound mind has the right to determine what shall be done with his/her body” (Schloendorff V, Society of New York Hospital, 1994, cited in Hess 1993, p.296)
. A competent client’s ability to make health care decisions based on:
- full disclosure of the benefits,
- Risks
- potentials consequences of a recommended treatment plan
- alternative treatment
b. CLIENT’S DECISION
It’s including no treatment, client’s agreement to the treatment as indicated by client signing a consent form and nurses must obtain consent form for nursing procedures.
The form is a recorded of the informed consent not the informed consent itself.
There are three major elements of informed consent in which the consent must be given voluntarily, Consent must be given by client or individual with the capacity and competence to understand and client must be given enough information to be the ultimate decision maker.
Generally, it is the physician to obtaining informed consent for specific medical and surgical treatments is the responsibility of person who is going to perform the procedure.
c. TYPES OF INFORMED CONSENT
There are two types of consent that is the Express consent and Implied consent
Express consent is either Oral or written agreement while the more invasive a procedure and/or the greater the potential for risk to the client the greeter need for written permission.
Implied consent to be taken when the individual's nonverbal behavior indicates agreement. E.g. Client who position their bodies for an injection and cooperate with taking of vital signs
It is EXCEPTION for Group people cannot provide consent.
There are 3 groups namely.
- the Minors (children, adult with mental capacity)
- (Parent or guardian must give consent before obtain treatment.
- Unconscious or injured that they unable to give consent
- Consent usually obtain from closest adult relative
- Consent implied in life-threatening emergency
- Mentally ill patients
d. WHAT ARE THE NURSES ROLES IN TAKING THE INFORMED CONSENT
- Nurse is not responsible for explaining the procedure but for witnessing the client signature on the form.
- The nurse signature confirms three things as a witness:
The client gave consent voluntary, with the signature is authentic while the client appears competent to give consent.
8.11. DEFINITION OF CONFIDENTIALITY
It is defined as the ethical principle or legal right that a physician or other health professional will hold secret all information relating to a patient, unless the patient gives consent permitting disclosure.
The general rules and privacy for confidentiality are cconfidentiality must be maintained. If needed to break get consent e.g., interest of public. To remember that there can be potential harm to patient if confidentiality is not maintained.
Some health information needs to be told for treatment. Information can be personal or private.
Information can be verbal information about body and information about health or medical history with
Respect human dignity.
In honesty in the relationship there may be good news or there may be bad news is the key to establish relationships.
a. TRUST IN THE HANDS OF THE HEALTH CARE PROFESSIONAL
The patient must have significant trust and if there are abuse of trust can be a problem.
Respect in the person - a rational being i.e., capable of reasoning and capacity to communicate and be communicated with.
8.12. INTRODUCTION EVIDENCE-BASED PRACTICES
Evidence based nursing practice focuses on critical thinking and proven outcomes. Evidence based practice (EBP) is a problem – solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values (Fireout – Overholt E., 2010). Evidence – based practice helps professional nurses make informed decisions by learning from what others in the field have researched.
LEARNING OUTCOMES:
At the end of the lecture, student will be able to:
A. Understand the concept of EBP.
B. Reflect on the purpose of EBP in relation to practice
a. DEFINITION:
Nursing Research is the scientific process that validates and refines existing knowledge and generates new knowledge that directly and indirectly influences nursing practice.
Evidence – Based Nursing Practice is an integration of the best evidence available nursing practice and the values and preferences of the individuals, families and communities who are served”.
Kozier & Erbs,( 2008) stated that the EBP the nurse integrates research findings with clinical experiences and available resources in planning and implementation of care
b. PURPOSE AND OBJECTIVESEVIDENCE-BASED PRACTICE
It seeks to make practice a less subjective enterprise and to raise it to a higher level of accountability. It is associated with efforts to identify best practices in nursing and other disciplines (Bauman, S.L., 2010).
Evidence – Based nursing aims to:
- provide the highest quality and most cost-efficient nursing care possible
- advance quality of care provided by nurses.
- increase satisfaction of patients.
- focus nursing practice away from habits and traditions to evidence and research.
c. COMPONENTS OF EVIDENCE-BASED PRACTICE
Key elements of a best practice culture a EBP mentors, partnership between academic and clinical settings, EBP champions, clearly written research, time and resources and administrative support. (Fireout – Overholt, E., 2005). When delivered in a context of caring and in a supportive organizational culture, EBP can help to achieve the highest quality of care and best patient outcomes. (Bauman, S.L., 2010)
d. WAY OF ACQUISITING KNOWLEDGE IN NURSING
It acquisitor knowledge in nursing through – Traditions, Authority, Borrowing, Trial and error, Personal experience, Role modeling, Intuition, Reasoning and Research
e. PHASES OF THE RESEARCH PROCESS
The processes include the stating the study problem, defining the purpose of the research, literature reviewing to develop a Theoretical Framework, selecting Research Design, selecting the Population and Sample, conducting a Pilot Study, collecting data, analyzing the Data, communicating Findings and recommendations
f. EBN PROCESSESS FOLLOWING THE STAGES:
- Asking a clinical question.
- Searching the literature for relevant research.
- Critically appraising what has been found. It change is required, following steps occur.
- Implementing a practice change.
- Evaluating the change in practice.
g. STEPS IN EBN
- Select appropriate topic.
- Collect appropriate and accurate data to generate evidence for nursing practice.
- Analyse data from clinical practice.
- Design interventions based on evidence.
- Predict and analyse outcomes.
- Examine pattern of behaviour and outcomes.
- Identify gaps in evidence for practice.
- Evaluate project to determine and implement best practice.
h. SOURCES OF EBN INFORMATION
Systematic Reviews
-Cochrane Collaboration. (www.cochrane.org)
-Evidenced- Based Journals.