Legal Issues in Adult Health

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Legal Issues in Adult Health

There is an array of legal issues that are related to nursing practice in adult health and as

future health care professionals some of us may be face with legal issues and will have to make

decisions that will govern our actions. And because as future nurses we carry the responsibilityfor our nursing practice we definitely need to be knowledgeable about legal issues in adult

health. Some of the legal issues that I will address in adult health are negligence, malpractice,

informed consent and intention torts.

Negligence: Lucille A. Joel, the author of Kellys Dimensions of Professional nursing defines

negligence as "any conduct that falls below the standard established by law for the protection of

others against unreasonable risk of harm". In adult health, for a nursing professional to have a

cause of action based on negligence four elements must be present: Firstly, duty must be owed

(legal responsibility); duty must breach (failure to live up to the standard); injury or damage must

be have been acquired, and lastly an injury must occur.For example, if a nurse fails to teach a

patient in preparation for discharge because of the time it takes and the patient goes home and is

injured. The nurse could be charged with negligence because it was the nurse responsibility for

providing appropriate teaching to the patient or caregiver.

Read PPT: Other examples of negligence in adult health are:

Informed Consent: is the voluntary authorization by a patient of a patient's legal representative

to do something to the patient (Guido, 2010). A patient has the right to be informed which is a

fundamental concept in the provision of health care that has legal dimensions because inadequate

informed consent processes can result in patients undergoing unwarranted procedures while

incurring preventable harm.

It is generally accepted that complete informed consent includes a discussion of: the nature of the

decision/procedure; reasonable alternatives to the proposed intervention; the relevant risks,

benefits, and uncertainties related to each alternative; assessment of the patients understanding

and the acceptance to the intervention by the patient.

Read PPT: The nurses role is to ensure the patientor legal guardian understands everything and

is the person who signs the consent form. The nurse should not explain the procedure to the

patient after the doctor has done so. In addition the patient should always be invited to ask

questions and be free of coercion and unfair persuasions or inducements. The key is

voluntarism: freedom of choice without duress.


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Then say: Even if there is no physical injury, decisions that occur in the absence of informed

consent can undermine the autonomy of the patient.

Malpractice:Read PPT: Malpractice is negligence by a professional. May result in injury or

loss.

Then: Additionally, in adult health to prove malpractice the four elements previously stated in

negligence must also be present. According to Reising and Allen in a 2007 article entitled:

Protecting Yourself from malpractice claims. American Nursing Today,The most common

causes of malpractice in adult health are failure to follow the standard of care, failure to use

equipment in a reasonable manner, failure to communicate, failure to document, failure to access

and monitor, and failure to act as a patient advocate. In adult health, malpractice can happen in a

number of ways. For example, if a staff nurse comes to work intoxicated and injects a medication

intended for a patients veins into a patients muscle that causes the patient to suffer paralysis to

the body. The staff nurse can be charged with malpractice because of failure to act reasonably

prudent; in that a reasonable nurse would not give an injection when intoxicated. Therefore, as a

result of her unreasonable imprudent behavior the patient sustained injury to the body.

Intentional Torts: Intentional torts are intended to cause a particular result while unlawfully

assailing the interest of another (Joel, 2011).

They include: read PPT- Assault & Battery: Assault is the behavior that makes a person fearful

of harm. Battery is an intentional physical contact with a person that causes injury.

False Imprisonment: Any unlawful confinement within fixed boundaries, can be physical,

emotional, or chemical.

Defamation of character (slander): Which is a quasi-intentional tort (intent is missing, but there

is a willful action directly causing suffering) is communicating to a third party information that

can hurt character or self-esteem.

Invasion of privacy: also a quasi-intentional tort, whereas the interest protected is that of an

individuals right to be free from unreasonable intrusion into his or her private affairs. The

exception here is the mandatory reporting requirements.

In addition other intentional torts include: conversion of property, which involves interference

with the patients right to possess his or her property by controlling, transferring, altering or

disposing and Breach of confidentiality which includes sharing patient information to those not

involved in the patient care.


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Examples: Conversion: if a patient is admitted to a ward and a nurse without cause searches a

patients belongings or removes the patient items when the patient goes for surgery the nurse has

dispossessed the patient of his or her possession.

Breach of Confidentiality: if a student nurse uncovers that a patient she is managing is HIV

positive and discloses that information to another patient she is managing. That nurse has

violated her patientsconfidential information.

Role of Nurse in Adult Health

In legal and ethical issues in adult health the role of the nurse is patient advocacy. This simply

means that the nurse must provide active support to the patient in her care by always following

the standards of care outlined in the nursing practice and code of ethics. In doing so competent

health care will be administered to all patients. If there is an issue or a foreseeable problem

proper communicate with all health care providers involved in the management of the patient is

essential. The nurse must always document care given, assessments performed, interventions

administered and evaluations made; which may limit any erroneous patient issues, always

cultivate empathetic rapport with all patients and most necessary the nurse must maintain the

patients rights. In addition, as a patient advocate the nurse must continually communicate with

the patient, explaining procedures and obtaining the patients permission. If the patient refuses to

allow a particular procedure, the patient rights must be respected.

Case Study

Mr. Howard is a 63year old man was referred to a home health nurse for evaluation and

treatment of stasis ulcers (a breakdown of the skin (ulcer) caused by fluid build-up in the

skin from poor vein function (venous insufficiency) on his legs.When Karla Long, the home

service nurse visited the home, she found large, oozing, sticky areas of raw tissue on Mr.

Howards legs. The nurse cleaned and dressed the ulcers and continues visiting Mr. Howard

several times per week. As the ulcers began to heal, the nurse engaged the Howard in discussionsabout nutrition and hydration and encouraged him to start a weight reduction program (both of

the Howards were grossly obese). Mr. Howard and Mrs. Howard were not interested in the

weight reduction and the nurse visits were over. Several months went by and Mr. Howards

ulcers began to deteriorate. He was hospitalized, treated and returned home. When his condition

deteriorated a second time, Mr. Howard was again hospitalized but, after a few days, he

signed himself out of the hospital.Angered by Mr. Howards decision, his physician refused


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to continue treating him Ms. Long was then left without continuing physician orders to

visit the home. She explained the situation to Mr. Howard and taught Mrs. Howard to

wash her husbands legs and apply the medication that she had been applying. Mr.

Howard seemed satisfied with this. He claimed that the physician had not really improved

the condition of his legs and that he had no intention of seeking any medical help for his

condition in the future. Ms. Long left her telephone number with the Howards in case they

ran into any further problems.

Nearly a year passed. One summer day, Mrs. Howard called and said her husband was

awfully sick and could not even get out of bed. The policy of the home health agency allowed

Ms. Long to make a one-time-only evaluation visit, so she did. She found Mr. Howard legs alive

with larvae of the summer flies attracted to the unairconditioned bedroom.

She urged Mr. Howard to be hospitalized. He agreed and was transported to the local

hospital by ambulance. Because of the extreme condition of his legs, a bilateral leg amputation

was performed. When news of Mr. Howards general condition got out (he had created quite asensation in the emergency room of the local hospital), the citizens of the small town were

aghast. How could a man be allowed to rot away? Where were the home health services for the

poor? Who was responsible? An investigation was done but months later, no fault was found,

and it was announced that the community health services had insufficient mechanisms to prevent

such a thing from happening again. But Ms. Long was not satisfied.Didnt patients have a

right to refuse services they did not want? (patient self determination)

- Ultimately it is the patients rights to choose whether or not to submit services and

Any patient who has capacity to consent may also decline any or all healthcare at

any time, even when this is contrary to medical recommendations and incircumstances where such a decision to decline healthcare may result in the death

of the patient. Where a patient lacks the capacity to make healthcare decisions, their

decision to decline healthcare may be made known by a valid Advance Health

Directive, made at a time when they had capacity to make their wishes about future

healthcare known The ethical principle of autonomy gives a patient the right to a

self-determined course of action, support for independent decision making, personal

freedom and the right to choose. However, when a patient declines or withdraws

consent, the following should be considered:

o confirming the patient has capacity to make the decision

o

checking the patients understanding and looking for any health literacy or

communication issues

o exploring the reasons for the decision including:

There are limitations on the refusal of therapy: 1. Preservation of the life if the

patient does not have an incurable or terminal disease (Stasis ulcers is not

considered an incurable or terminal disease). Mr. Howard was advised by the nurse

to lose weight which is a risk factor of the condition. However, he was not interested.


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2. Protection of minor dependents (Mr. Howard is over 18years). 3. Protection of the

public health ( Mr. Howard posed no threat to public health)

If patients refused certain services, should health care be totally withdrawn?

-

Legally health care can be withdrawn on the basis that: services are no longerneeded, the patient dismisses the physician, or the patient and physician mutually

agree to terminate the relationship and the patient is competent to make the

decision. However, Mr. Howard also has the right to expect reasonable continuity of

care when appropriate and to be informed by health care providers of available and

realistic patient care options when hospital care is no longer appropriate. The mere

fact that the physician withdrew total care due to non-compliance and did not

provide Mr. Howard with alternative care option or simply reassigned him to

another physician before cutting off all services due to non-compliance is a violation

of Mr. Howards patient rightsto make decision about his plan of care and to

refuse the recommended treatment and to be informed of the medical consequencesof his action. Mr. Howard had a right to be notified of any policy that might have

affected his choice to leave the hospital. The physician actions could be considered

abandonment because of the healthcare relationship that was already established .

Therefore even though Mr. Howard checked himself out of the hospital he should

have been provided with reasonable notice supported by documentation and

sufficient time to secure other care if desired.

- The physician took a paternalistic attitude towards Mr. Howard.

Should health care be provided to some individuals against their will and without their

voluntary consent?

- Yes care can be provided to some individuals against their will and without

voluntary consent because the healthcare professional is obligation to provide the

best standard of care (beneficence). Care can be provided involuntary to patient in:

emergency situations, mental illness, dangerous behavior towards self and others

and the need for treatment.

This case study uncovered several real and potential ethical issues:

1) Determining decision making capacity,

2) Balancing respect for a patients right to autonomy and refusal of treatment with the

professional obligation to provide the best standard of care (beneficence),

3) Termination of the healthcare relationship in the setting of non-compliance.

Documents

Legal Issues in Adult Health