§  Patient abandonment

·         Proper to refuse pt assignments for valid reasons, but nurse must be sure the pt isn’t abandoned – nurse can’t refuse assignment for moral/religious reasons if there is no one else to care for the pt

·         Abandonment constitutes negligence on the part of the nurse

§  Litigation

·         Malpractice litigation is civil litigation (no felony charges, no mark on record, really just about $$)

·         Malpractice – failure of a professional to act in accordance with the prevailing professional standards or failure to foresee consequences that a professional person should see; negligence or carelessness by a professional person

o   Can be commission of an error or omission of something

·         Standard of care – skill and knowledge commonly possessed by members of the profession; what is expected of a reasonable, prudent professional in a given situation

o   Expectations are derived from the professional’s background and job description, scopes of practice, written standards, guidelines, precedent court decisions

§  What a plaintiff must prove for a litigation to occur

·         Duty owed to patient – show that professional relationship existed

·         Breach of duty – show that deviation from standard of care occurred

·         Injury – show that physical, financial, emotional injury resulted from breach of duty

·         Foreseeability – show that injury was the foreseeable result of the breach of duty (you should have known injury would occur)

·         Causation – show that injury resulted directly from breach of duty

·         Damages – show that injury caused recoverable financial loss ($$, compensation for damages)

§  Informed consent 

Information about informed consent

·         Implied – consent inferred from circumstances (ex. Routine care that doesn’t involve significant risk); rarely documented

·         Expressed – verbal/written consent by the pt to undergo specific procedure/treatment (ex. Invasive procedures, significant risk); documented on consent form

o   Nurses share responsibility to ensure pts understand (but not nurses responsibility to obtain consent)

·         Who can consent – competent adults, emancipated minors, appropriate surrogate decision makes

·         When consent is needed:

o   NOT in an emergency

o   Surgery (including anesthesia administration)

o   Radiation/chemotherapy

o   Blood transfusion

o   Inserting surgical device/appliance

o   Experimental medication/device, using approved med/device in experimental manner

·         Components

o   Description of procedure, benefits, risks, alternatives

o   Risks must include the most serious (even though rare) and the most frequent (even though minor)

o   Added risks based on pt’s medical history or other medical problems

·         Special consents needed for MR, abortions, ECT, sterilizations

§  Informed refusal 

·         Components (same components as informed consent)

o   Description of procedure, benefits, risks, alternatives

o   Risks must include the most serious (even though rare) and the most frequent (even though minor)

o   Added risks based on pt’s medical history or other medical problems

·         Assess decision making capacity

·         Description of risks, benefits, alternatives to leaving/continued treatment

·         Arrange appropriate discharge follow-up and perform discharge teaching

·         Pt signs discharge AMA form

·         Thorough documentation

* Good practice – usually determined at state level and by employer

*Good communication – clear and effective oral and written communication between healthcare professionals, patients, and families

·         Good documentation – documentation is the most important form of communication

§  Malpractice insurance

·         Occurrence policy – provides coverage for all events that occurred within the policy year, regardless of when malpractice claim is filed

·         Claims Made policy – provides coverage for all malpractice claims filed within policy year, regardless of date of the event

·         Tail policy – covers and potential gaps in coverage when practitioner moves from one policy/employer to another

§  Competency and guardianship

·         Competency – able to understand consequences of decisions and make judgments based on rational understanding

·         Guardian (aka conservator) – person who acquires legal responsibility for another (the ward) through the legal process of guardianship

o   Exception – parents considered to be the natural guardians of their minor children (no court proceedings required)

·         Guardian ad litem – impartial person appointed by the court to assure that the rights of incompetent indie are protected during legal proceeding; guardian for the purpose of litigation

§  Abusive situations

·         Physical abuse, neglect by caregiver/others, self-neglect, psychological/emotional abuse, sexual abuse, financial abuse/exploitation

·         Family violence – child physical abuse/neglect, child sexual abuse, domestic partner abuse, elder/vulnerable adult mistreatment/abuse/exploitation

·         Nurses must be able to identify children in abusive situations (discrepancy between physical findings and explanation for how incident occurred is valid reason for nurse to suspect abuse)

·         Mandated to report child/vulnerable adult/elder abuse

·         No mandatory reporting requirement for partner abuse unless abused partner is vulnerable adult

o   Nursing assessment/interventions – asking the right questions, referrals to appropriate social service/law enforcement agency

§  Americans with Disabilities Act

·         Intent – to end discrimination against qualified persons with disabilities by removing barriers that prevent them from enjoying same opportunities available to persons without disabilities

·         Health care facilities must provide reasonable accommodation to pts and families with sensory disabilities (vision, hearing impairment → need interpreters, or another way to communicate with pts)

·         Right to make health choices, including refusal of care

·         Right to an advance directive

§  EMTLA 

– Emergency Medical Treatment and Labor Act (aka “antidumping” law)

·         Prohibits refusal of care for indignant and uninsured pts seeking medical assistance in ED/urgent care clinic

·         Prohibits the transfer of unstable pts from one facility to another

·         Requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status, or ability to pay

·         Pts can only be discharged under their own informed consent or when their condition requires transfer to a hospital better equipped to administer treatment