Unit 2 The Nursing Process. An orderly way of developing a plan of care for the individual patient.

Unit 2

• The Nursing Process

The Nursing Process

• An orderly way of developing a plan of care for the individual patient.

Five-Step RN Nursing Process

1. Assessment (Data Collection)

2. Diagnosis

3. Planning

4. Intervention

5. Evaluation

Four-Step LPN Nursing Process

1. Assessment (Data Collection)

2. Planning

3. Intervention

4. Evaluation

Role Differences Between RNs and LPN/LVNs

• RN’s Role– Nursing diagnosis– Independent role in all process areas

• LPN/LVN’s Role– No nursing diagnosis– Dependent role in some process areas– Independent role in some process areas

LPN Nursing ProcessPhase 1: Data Collection

• Systematic information gathering

• Information verification

• Information communication

• Continuing data collection

• Measuring and collecting data accurately

LPN Nursing ProcessPhase 2: Planning

• Assist RN in developing nursing diagnosis

• Assist RN in developing outcomes

• Assist RN in developing nursing interventions

LPN Nursing ProcessPhase 3: Implementation

• Nursing action

• Maintaining patient safety

• Teaching in support of RN’s teaching

• Reporting and documenting

LPN Nursing ProcessPhase 4: Evaluation

• Assisting in determining patient progress toward meeting desired goals and outcomes

• Communicating findings

10

CHAPTER 2

Legal and Ethical Aspects of Nursing

Overview of the Legal System

• Laws– Prescribe how a

person should act in society

– Sanction acceptable behavior and prohibit unacceptable behavior

– Provide protection for all members of the health care system


• Criminal Law– Conduct in issue is offensive to society in

general– Conduct is detrimental to society as a whole– Involves public offenses (ie, robbery, murder,

assault)– Law’s purpose is to punish for the crime and

deter and prevent further crimes.


• Civil Law– Conduct violates a person’s rights– Conduct is detrimental to that individual– Involves an offense that is against an

individual– Law’s purpose is to make the aggrieved

person whole again, to restore them to where they were


• Two Ways Laws Are Established– Statutory Law

• Developed by federal, state, and local governments

– Common Law• Developed in response to specific legal questions

brought before the court and usually follow precedent (previous rulings on an issue)

Overview of the Legal Process

• Civil Litigation– Lawsuit in a civil court– Begins when the plaintiff contacts an attorney

• Plaintiff– The complaining party

• Complaint– Statement by the plaintiff– Written and filed in the appropriate court– States the facts involved in the legal issues

raised and outlines the damages


• Defendant– States the facts involved in the legal issues

raised and outlines the damages– The alleged person liable

• Damages – Compensation sought by the plaintiff

• Summons– Court order that notifies the defendant of the

legal action


• Answer– Detailed response to the charges outlined in

the complaint– Usually prepared and filed by an attorney

hired by the defendant– Will either admit or deny any or all of the

allegations made in the complaint

• Discovery– Pretrial process allowing both sides to

interview witnesses and/or look at documents

Depositions


• Depositions– Out-of-court statements made by a witness under

oath

• Interrogatories– Written questions that must be answered in writing

• Verdict– Decision made after the evidence has been presented– Based on the facts of the case, the evidence and

testimony presented, the credibility of the witnesses, and the laws that pertain to the issue


• Appeal– Request a review of the decision– May be filed by either party if they disagree

with the outcome of the lawsuit

• Criminal Trial– Defendant is arrested for a crime against the

people.– People’s attorney and the defendant’s

attorney present their cases in court.– The judge or jury then deliberates.


• Deliberation– Decide the guilt or innocence of the defendant

• Not Guilty Verdict– Defendant will be released from custody

• Guilty Verdict– Sentence (penalty) will be decided based on

the severity of the crime, the defendant’s past criminal record, and the applicable laws.


• Liability– Legal responsibility– A nurse can be

charged with civil or criminal liability depending on the particular circumstances surrounding the case.

Common Legal Terminology (Review Box 2-2 p. 22)

• Abandonment of care• Assault• Battery• Competency• Defamation• Harm• Libel• malpractice

• Negligence• Slander• Tort


• Legal Relationships– Accountability

• Being responsible for one’s own actions

– Legal Relationship• Nurse-patient relationship

– When the nurse assumes responsibility for the patient’s care

• Failure to provide care to the expected level of expertise gives rise to legal liability.


• Legal Relationships– Advocate

• One who will defend or plead a cause or issue on behalf of another.

• The nurse accepts the role of an advocate for the patient.

• A nurse advocate has a legal and ethical obligation to safeguard the patient’s interests.


• Regulation of Practice– Standards of Care

• Acts that are permitted to be performed or are prohibited from being performed.

• Give direction to the practicing nurse, defining what should or should not be done for patients.

• Every nurse is obligated to know and follow the established standards of care.

• Failure to adhere to these standards gives rise to legal liability.


• Regulation of Practice– Standards of Care

• The legal test is what a reasonably prudent (wise) nurse of similar education and experience would have done under similar circumstances.


• Regulation of Practice– Scope of Nursing Practice

• Each licensed practical/vocational nurse must be familiar with his or her scope of practice.

• The nurse CANNOT use ignorance as an excuse.• Every nurse needs to know what she or he can

and cannot do while providing nursing care.

– Nurse Practice Acts• Define and limit the scope of nursing practice


• Regulation of Practice– Licensure

• All licensed practical/vocational nurses must apply for licensure in the state in which they wish to practice.

• Applicants are carefully screened.• Upon approval by the board, the applicant is

eligible to take the computerized licensing examination at a testing center.


• Regulation of Practice– Licensure

• Once a license is granted, it can be suspended or revoked (taken away) for unprofessional, unethical, immoral, and/or criminal conduct.

– Interstate Compact• Allows multistate practice of nursing• The nurse must be licensed in her or his home

state, and privileges are then granted to practice in other states that have signed the interstate compact.


• Legal Issues– Malpractice

(Professional Negligence)

• Commission– Doing an act

• Omission– Not doing an act

• Legal action that a nurse may be charged with for failing to meet the standards of care


• Legal Issues– Malpractice (Professional

Negligence)• Elements that must be present:

– Duty exist: The nurse-patient relationship establishes a duty.

– Breach of the duty: The nurse fails to perform the duty in a reasonable, prudent manner.

– Harm occurs: This does not have to be physical injury.

– Proximate cause: The breach of duty was the proximate cause of the harm.


• Legal Issues– Malpractice (Professional Negligence)

• Malpractice insurance– The nurse may want to purchase individual coverage

even if the employing institution carries insurance.– Personal malpractice insurance provides more protection

for the nurse while off and on duty.– Most institutions’ policies cover only liability if the nurse

is on duty and acting within the proper capacity.


• Patients’ Rights– The Patient’s Bill of Rights

• Developed by the American Hospital Association in 1972

• Goal is to promote the public’s understanding of their rights and responsibilities as consumers of health care.


• Informed Consent– A person agrees to allow a particular

treatment based on full disclosure of the facts needed to make an intelligent (informed) decision.

– Consent must be obtained before any invasive treatment or procedure.

– Patient needs to be aware of the benefits of the treatment, the risks involved, any alternative treatments, and the consequences of refusing the treatment.


• Informed Consent– The patient has the right to accept or reject

the proposed care.– Failure to secure informed consent may result

in civil liability for battery.• Civil battery

– Unlawful touching of a person; an intent to harm is NOT necessary.


• Confidentiality– The nurse has a duty to protect information

about a patient no matter how that information is received.

– Failure to maintain confidentiality gives rise to legal liability, and legal remedies exist to address confidentiality breaches.

– Health Insurance Portability and Accountability Act of 1996 (HIPAA) set rules and limits on who can look at and receive health care information.


• Medical Records– Medical records are NOT public documents.– The information they contain must be

guarded.– Records may be used by both parties in a

lawsuit to argue facts of the case.– All entries in the medical record must be

permanent, accurate, complete, and legible.


• Invasion of Privacy– The right to be left alone and go unnoticed if

the patient chooses– Legal liability may occur in

• Exposing the patient’s body parts unnecessarily• Discussing the patient inappropriately• Disclosing information about the patient• Using any unauthorized patient information


• Reporting Abuse– The law prescribes when a health care professional

must report certain information to authorities (certain communicable diseases, gunshot wounds, signs of abuse).

– The health care professional is protected from liability when acting in good faith.

– Child Abuse Prevention Treatment Act of 1973• Act made reporting of child abuse mandatory.• Health care professionals may face fines and/or

imprisonment if they fail to report suspected cases of child abuse.


• Practitioner-Assisted Suicide– Form of active

euthanasia– The practitioner taking

an active role in helping to end a patient’s life


• How to Avoid a Lawsuit– Provide compassionate, competent nursing

care• Nurse-patient relationship must be one based on

trust and respect.• Use open and honest communication.• Follow the standards of care and adhere to the

scope of practice for a licensed practical/vocational nurse.


• How to Avoid a Lawsuit– Good Samaritan Law

• Provides immunity from liability in certain circumstances

• Encourages assistance in emergencies occurring outside of a medical facility by providing protection against liability

– Proper documentation• Medical record is used to prove that the standards

of care were met (or were not met).• “IF IT ISN’T CHARTED, IT WASN’T DONE.”

Ethical Aspects• Development of

Ethical Principles– Ethics

• Values that influence a person’s behavior

• An individual’s feelings and beliefs about what is right and wrong

– Customs• Habits, ways of acting• Members of a family

expected to behave in a certain way

• Influenced by religious teachings

Ethical Aspects

• Development of Ethical Principles– Values

• Personal beliefs about the worth of an object, idea, a custom, or an attitude

• Develop over time and change as necessary• Influences behavior behavior and decisions• Learned through experience, observation, and

reasoning

– Values Clarification• The process of self-evaluation that helps a person

gain insight into individually held values

Ethical Aspects

• Development of Ethical Principles– Ethical Dilemmas

• Situations that do not have a clear right or wrong answer

– Identify the problem.– Assess the situation completely.– Consider any ethical principles that might apply.

Ethical Aspects

• Ethical Principles– Respect for Persons

• All human life is sacred.– No one person is more important than another.– Each patient has the same worth as another and is

always entitled to respect.

• Autonomy– Personal freedom of choice– A right to be independent and make decisions– Nurse does not have the right to make decisions for the

patient.

Ethical Aspects

• Code of Ethics– Serves as a way to regulate the actions of

nurses and gives guidelines for ethical behavior

– Promote competent, trustworthy, and accountable health care practitioners in order to safeguard society

Ethical Aspects

• National Federation of Licensed Practical/Vocational Nurses Code of Ethics– Know and function within the scope of practice

for an LPN/LVN– Maintain patient confidences– Provide health care without discrimination– Maintain a high degree of professional and

personal behavior– Take an active role in the development of the

LPN/LVN profession

Ethical Aspects

• Reporting Unethical Behavior– Unethical behavior

• Failing to perform the duties of a competent, caring nurse

– Each member of the nursing profession has a duty to report behavior that does not meet the established standards.

• Follow the proper chain of command• Explain the facts as clearly as possible• Documentation of the incident: objective, accurate,

when and where, other pertinent facts

Ethical Aspects

• Ethical Issues– Practitioner-Assisted Suicide (PAS)

• Legal status is unsettled.• ANA has taken a firm stand against PAS.

– States it is not consistent with the philosophy of nursing

• Right to autonomy and the right to self-determination are issues used to support PAS.

Ethical Aspects

• Ethical Issues– Right to Refuse Treatment

• A competent adult has the right to determine what does or does not happen to him or her.

– Even if the refusal may or will result in death

• Advance directive– Specifies what life-saving treatments he or she does or

does not wish to have

• Living will– Becomes effective when the patient is incapacitated

Ethical Aspects

• Ethical Issues– Right to Refuse Treatment

• Health care proxy– Durable power of attorney– A person to make decisions regarding medical

treatment if the patient is unable to make them

Ethical Aspects

• Do Not Resuscitate Orders– The patient is usually incapacitated with little

hope of recovery.– Physician will consult with the family before

writing a DNR order.– Nurse has a duty to follow the order.

Ethical Aspects

• Refusal to Treat– The nurse cannot refuse to care for a patient

because she disagrees with the decisions the patient makes.

• Nurse does not have to participate in the procedure but cannot refuse to provide care after procedure.

• Do not abandon the patient, but ask for another assignment.

Ethical Aspects

• Refusal to Treat– The nurse DOES NOT have the legal right to

refuse to care for a person with an infectious disease.

• Standard precautions should be applied to every patient and therefore the nurse is at no greater risk.

• The patient has the right to receive care and the nurse has the responsibility to provide care.

Ethical Aspects

• Genetic Research– The National Institutes

of Health’s Human Genome Project

• Comprehensive study of the genes that make up the human body

• Ethical issues– How the information

will be used

– Who owns the information

– Who will have access to the information

Questions

Unit 2 The Nursing Process. An orderly way of developing a plan of care for the individual patient.

Documents

Transcript of Unit 2 The Nursing Process. An orderly way of developing a plan of care for the individual patient.