Legal uworld nursing PDF

Preview

Summary

uworld nursing legel and nursing mangment...

Description

Advance directives:

1) LIVING WILL: This is a written document that specifies what types of medical treatment are desired. A living will can be very specific or very general.

*The most common statement in a living will is to the effect that: If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that lifesustaining measures that would serve only to prolong my dying be withheld or discontinued. 2) HEALTH CARE PROXY: This is a legal document in which an individual designates another person to make health care decisions if he or she is rendered incapable of making their wishes known. The health care proxy has, in essence, the same rights to request or refuse treatment that the individual would have if capable of making and communicating decisions 3) POWER OF ATTORNEY: This is the third type of advance directive. Individuals may draft legal documents providing power of attorney to others in the case of incapacitating medical condition. The durable power of attorney allows an individual to make bank transactions, sign Social Security checks, apply for disability, or simply write checks to pay the utility bill while an individual is medically incapacitated.

U world When a client is unable to make decisions, the health care proxy is legally able to make decisions for the client. In the event that the health care proxy is unable to fulfill this role, the responsibility goes to the alternate proxies identified on the advance directive. If the client does not have a health care proxy, the family members would make decisions for the client. Occasionally, there is no family and no proxy. If this happens, a proxy may be appointed, an ethics board may make the decision, or the HCP may be responsible for making the decision. A power of attorney (POA) designates a representative to act on a person's behalf in the event that the individual becomes incapacitated. There are different types of POAs, including medical and financial. An advance directive or living will describes the client's health care decisions (eg, do not resuscitate). As part of an advance directive, the client may designate a representative to make health care decisions for the client - a durable POA for health care or POA for health care (Canada). This client's statement requires further clarification regarding what type of POA is in place. The 2 most common forms of advance directives are living wills and durable power of attorney for health care (health care surrogate/proxy). These take effect when the client cannot self-advocate. A living will represents the client's wishes regarding actions to be taken in specific situations. A durable power of attorney is an individual who decides actions to fluid situations according to an understanding of the client's wishes. Battery is the intentional touching of a person that is legally defined as unacceptable or occurs without the person's consent. Many routine actions that are permissible when proper consent is obtained would otherwise be considered medical battery. Furthermore, actions can be considered battery even if no physical injury results. Any health care provider (HCP) who performs a medical or surgical procedure without receiving the required informed consent from a competent client (or parent/legal guardian in the case of a child) is committing battery and could be legally charged . A competent client has the right to refuse any treatment, even if it is for the client's benefit. The nurse should help the client understand the need (eg, informed refusal), but the client's decision should be upheld. Proceeding to administer treatment to a competent client who has refused that treatment is medical battery. ( *Assault is a deliberate threat with the power to carry out the threat.

Educational objective: Battery is touching that is legally defined as unacceptable or occurs without consent. Examples include performing a procedure despite a competent client's refusal or without obtaining proper consent from a competent client (or parent/legal guardian when the client is a child). Assault is the threat of battery. "Mature minors" are adolescents who are age 14-18 and are deemed able to understand treatment risks. They are legally allowed to give independent consent to receive/refuse treatment for some limited conditions. Classically, these conditions include testing and treatment for STIs, family planning, drug and alcohol abuse, blood donation, and mental health care "nonmaleficence" (ie, do no harm). It is rare to see a nurse inflict intentional harm. However, problems do occur due to unintentional harm, which is usually a result of poor clinical judgment. Beneficence is a nurse's duty to promote good and do what is best for the client. Autonomy is allowing the clients to choose the direction of their care. This is accomplished with advanced directives along with informed consent and choices regarding proposed treatments. Paternalism is a type of beneficence whereby clients are treated as children. The nurse claims to know what is best for the client and coerces the client to act as the nurse wishes without considering the client's autonomy. Veracity refers to the duty to tell the truth. This principle should always be applied to client care and documentation. An impaired nurse cannot safely give care regardless of the reason for impairment. If impairment is suspected, the nurse has a duty to take action that will both protect the client and ensure that the impaired individual receives assistance. The charge nurse/nurse supervisor should be notified (so the nurse can be replaced and sent home safely), the incident documented, and the nurse not allowed to give care while impaired, The off-going nurse will not stay on the new shift to watch for impairment. The impaired nurse may not behave in an obvious manner while the off-going nurse is watching. Regardless of these factors, the nurse has alcohol on the breath and slurred speech; by definition there is evidence of impairment. If the client's medical POA agent is present, treatment should not be delayed by requesting a living will as the agent will advocate for the client's wishes and has final decision-making authority The National Council of State Boards of Nursing advises any individual who has knowledge of a potential violation of a nursing law or rule to file a complaint with the appropriate state board of nursing. A nurse should be knowledgeable concerning the presiding board's stance on mandatory reporting and which actions are considered reportable. In general, reportable actions may include any behavior by a licensed nurse that is unsafe, unethical, incompetent, impaired (eg, by substances or a mental or physical condition), or in violation of nursing law.

   

Practicing outside of the scope of the license is reportable even if the practice meets quality standards. Documenting an intervention that was not performed is considered falsification of records regarding client care and is a reportable action. Stealing narcotics is a criminal offense (a violation punishable by the state that can result in prison or a fine) and is reportable in all states. Many states offer an alternate rehabilitation program to nurses who diverted or abused drugs. Abandonment (eg, leaving without proper replacement of personnel and transfer of responsibility for client care) is reportable in all states.

Incident/occurrence reports are used in a health facility to document events that pose unanticipated actual or potential risk to the health or safety of a client, visitor, or employee. Incident/occurrence reporting is a method of quality improvement and should not be considered punitive in nature or be documented in the health record. Examples of events requiring reporting include: Assault and injury   

Physical, verbal, or sexual assault occurring in a health facility Client falls, with or without injury Staff and visitor falls, regardless of acceptance or refusal of treatment

Treatment and intervention    

Failure to obtain or intervene upon the results of diagnostic procedures Inadequate or delayed diagnosis and monitoring Delay, omission, or incorrect performance or administration of prescribed therapies and medications Hospital equipment failure

When the advance directive is completed, a copy should be placed in the client's medical record and copies should be given to everyone listed as health care proxies. The client should also keep a copy in a safe place. *The advance directive form does not need to be notarized, and so it can be completed in the health care setting if there are 2 witnesses. *Two witnesses are required for completion of the advance directive form. The witnesses cannot be health care providers involved in the care of the client or individuals named as health care proxies in the document. An emancipated minor is an individual under the age of legal responsibility who has been legally freed from parental control through a court order (eg, due to enlistment in the military, marriage, pregnancy).

The parent in this situation would not need to be called. Clients have the right to be informed of risks and benefits of procedures prior to care and to give informed consent....