NCM 105 Nursing JursiprudenceAilyn B. PinedaLecturer
LEGAL CONCEPTS AND ISSUES IN NURSING
RESPONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSINGNurses employed in an agency, institution or hospital are directly responsible to their immediate supervisors. Private duty nurses, being independent practitioners, are held to a standard of conduct that is expected of reasonable prudent nurse
WHAT IS LIABILITY?Is an obligation or debt that can be enforced by law. A person who is liable for malpractice is usually required to pay for damages. Damages refer to compensation in money recoverable for a loss of damage.
PROFESSIONAL NEGLIGENCENEGLIGENCE refers to the commission or omission of an act, pursuant to a duty, that a reasonably prudent person in the same or similar circumstance would or would not to, and acting or the non-acting of which is the proximate cause of injury to another person to his property.
ELEMENTS OF PROFESSIONAL NEGLIGENCEExistence of a duty on the part of the person charged to use due care under circumstancesFailure to meet the standard of due careThe foreseeability of harm resulting from failure to meet the standardThe fact that the breach of this standard resulted in an injury to the plaintiff
Errors due to family assistanceAdministration of medicine without a doctors prescription
THE DOCTRINE OF RES IPSA LOQUITURThe thing speaks for itself When the harm that resulted from negligence and the responsibility for the harm are clear that anyone would agree on it, the term res ipsa loquitur is used
SPECIFIC EXAMPLES OF NEGLIGENCEFailure to report observations to attending PhysiciansFailure to exercise the degree of diligence which the circumstances of the particular case demandsMistaken IdentityWrong medicine, wrong concentration, wrong route, wrong doseDefects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients
CONDITIONS THAT ARE NECESSARY FOR THE APPLICATION OF THE DOCTRINE:1. The accident must be a kind which ordinarily does not occur in the absence of someones negligence2. The accident must be caused by an agency or instrumentality within the exclusive control of the defendant3. The accident must not have been due to any voluntary action or contribution on the part of the plaintiff (injured party)
MALPRACTICEImplies the idea of improper or unskillful care of a patient by a nurse. It also denotes stepping beyond ones authority with serious consequences
EXAMPLES OF MALPRACTICE:Misdiagnosis of an illness, failure to diagnose or relay diagnosisBirth InjuriesSurgical ComplicationsPrescription errorsFailure to provide treatmentAnesthesia related complicationsFailure to follow advance directiveFailure of hospital or pharmacy to dispense the right medicine, dosage
DOCTRINE OF FORCE MAJEUREIt is an irresistible or superior force, one that cannot be foreseen or prevented; a fortuitous event, and act of God. No person shall be held liable for nonperformance of what was expected of him/her if the cause of the nonperformance was a force majeure (e.g. devastating typhoons, earthquakes and other calamities)
DOCTRINE OF RESPONDEAT SUPERIORMeans let the superior answer; let the principal answer for the acts of his agentThe doctrine is founded on the principle that he who expects to derive advantage from an act which is done by another for him must answer for any injury which a third person may sustain from it. The doctrine rests upon the proposition that, in doing the acts out of which the accident arose, the servant was representing the master at the time
EXAMPLES:The hospital will be held liable, if, in an effort to cut down on expenses it decides to hire underboard nurses or midwives in place of professional nurses, and these persons prove to be incompetentThe surgeon will be held responsible in case a laparotomy pack is left in a patients abdomen
INCOMPETENCEIs the lack of ability, legal qualifications or fitness to discharge the required dutyAlthough a nurse is registered, if in the performance of her duty she manifests incompetency, there is ground for revocation or suspension of her certificate of registration
LIABILITY OF NURSES FOR THE WORK OF NURSING AIDESNursing aides perform selected nursing activities under the direct supervision of nurses. They usually given on-job-training by the Training staff. Their responsibilities usually pertains to the routine care of chronically ill patients. They are therefore responsible for their own actions.
LIABILITY FOR THE WORK OF NURSING STUDENTSUnder the Philippine Nursing Act of 2002 R.A. 9173, nursing students do not perform professional nursing duties. They are to be supervised by their clinical instructors.
GUIDELINES TO AVOID MISTAKES OF NURSING STUDENTSNursing students should always be under the supervision of their clinical instructorsThey should be given assignments that are at their level of training , experience, and competencyThey should be advised to seek guidance especially if they are performing procedure for the first timeThey should be oriented to the policies of the nursing unit where they are assigned
5. Their performance should be assessed frequently to determine their strengths and weaknesses6. Frequent conferences with the students will reveal their problems which they may want to bring to the attention of their instructors or vice-versa. Discussion of these problems will iron out doubts and possible solutions may be provided.
LEGAL DEFENSE IN NEGLIGENCEThe most common defense in a negligent action is when nurses know and attain that standard of care in giving service and that they have documented the care they give in a concise and accurate mannerIf the patients careless conduct contributes to his own injury, the patient cannot bring suit against the nurse.
MEDICAL ORDERS, DRUGS, AND MEDICATIONSR.A. 6675 states that only validly registered medical, dental, and veterinary practitioners, whether in private institution/corporation or in the government, are authorized to prescribe drugs.In accordance with R.A. 5921, or the pharmacy Act as amended, all prescriptions must contain the following information: name of the prescriber, office address, professional registration number, professional tax receipt number, patients/clients name, age, and sex, and date of prescription. R.A. 6675 requires that the drugs be written in their generic names.
IV Therapy and Legal ImplicationsPhilippine Nursing Act of 1991 Section 28 states that in the administration of intravenous injection, special training shall be required according to protocol establishedBoard of Nursing Resolution No. 8 states that without such training and who administers intravenous injections to patients shall be held liable either criminally under Sec 30 Art. VII of said law or administratively under sec 21 Art III or both (whether causing or not an injury or death to the patient)
SCOPE OF DUTIES AND RESPONSIBLITIES IN IV THERAPYInterpretation of the doctors orders for IV therapyPerformance of venipuncture, insertion of needles, cannulas except TPN and cutdownPreparation, administration, monitoring and termination of intravenous solutions such as additives, intravenous medications, and intravenous pushAdministration of blood/blood products as ordered by the physicians
5. Recognition of solutions and medicine incompatibilities6. Maintenance and replacement of sites, tubings, dressings, in accordance with established procedures7. Establishment of flow rates of solutions, medicines, blood and blood components8. Utilization of thorough knowledge and proficient technical ability in the use/care, maintenance, and evaluation of intravenous equipment
9. Nursing management of total parenteral nutrition, out-patient intravenous care10. Maintenance of established infection control and aseptic nursing interventions11. Maintenance of appropriate documentation, associated with the preparation, administration and termination of all forms of intravenous therapy.
Telephone OrdersDoctors should limit telephone orders to extreme emergency where there is no alternative. The use of telephone in a non emergency as a substitute for the physician himself can lead to serious error and may border on malpractice.Nurse should read back such order to the physician to make certain the order has been correctly written.Such order should be signed by the physician within 24 hoursThe nurse should sign the physicians name per her own and note the time and order was received
CONSENT TO MEDICAL AND SURGICAL PROCEDURE
Consent is defined as a free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consentNature of consent- an authorization by the patient or a person authorized by the law to give the consent on the patients behalf.Informed Consent-A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure
The nurses responsibility in witnessing the giving of informed consent involves: (1) witnessing the exchange b/w the client and the physician (2) witnessing the client affix his signature (3) establishing that the client really understood.
ESSENTIAL ELEMENTS OF INFORMED CONSENT:The diagnosis and explanation of the conditionA fair explanation of the procedures to be done and used and the consequencesA description of alternative treatments or proceduresA description of the benefits to be expectedMaterial rights if any