Chapter 5 Assignment

Read the Case Law and answer the questions. Instructions:1. Read the Case Law – Werth vs. Taylor2. Then, answer the questions below. a. Did this case turn out the way you thought it would? Why or why not? b. How could Cindy have assured herself that she would not receive any blood no matter what happened? c. Would it have made any difference in the outcome of the case if the anesthesiologist had interviewed Cindy before the procedure and told her that her life could be in danger if she refused blood during both procedures? d. What kind of consent is it when there is an emergency situation and the physician/healthcare worker needs to act or the patient may lose their life? 3. Your paper should be: o One (1) page o Typed according to APA style for margins, formatting and spacing standards o Typed into a Microsoft Word document, save the file, and then upload the file
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Case Law
Werth vs. Taylor
475 N.W.2d 426, 427 (Mich. Ct. App. 1991)
Cindy Werth was expecting twins. Because she was a Jehovah’s Witness and had
a firm belief in the religion’s teaching “that it is a sin to receive blood transfusions”, Cindy
signed a “Refusal to Permit Blood Transfusions” form as part of her hospital
preregistration.
After delivery, Cindy had complications and was experiencing uterine bleeding.
She was advised to undergo a dilatation and curettage and agreed. Again, she discussed
her refusal to allow a blood transfusion with her obstetrician/gynecologist (OB/Gyn). After
being placed under anesthesia and despite the specialist’s efforts during surgery, Cindy
continued to bleed and was experiencing, among other things, premature ventricular
activity and a significant decrease in blood pressure. The anesthesiologist (Dr. Michael
Taylor) determined that Cindy needed a blood transfusion to sustain her life. Cindy’s
OB/Gyn expressed Cindy’s refusal of blood transfusions, but the anesthesiologist
proceeded anyway stating that it was medically necessary.
The Werth’s filed a malpractice suit, alleging that Dr. Taylor committed battery by
performing the transfusion without Cindy’s consent. Dr. Taylor moved for a summary
disposition “because Cindy’s refusal was not conscious, competent, contemporaneous
and fully informed.”
The trial court found that Cindy’s refusals of a transfusion were made when she
contemplated “merely routine elective surgery” and not life-threatening circumstances,
and that, “it could not be said that she made the decision to refuse a blood transfusion
while in a competent state and while fully aware that death would result from such refusal.”
The record apparently reflected “the unexpected development of a medical emergency
requiring blood transfusion to prevent death or serious compromise of the patient’s wellbeing.” The trial court therefore granted summary disposition in favor of Dr. Taylor.
NUR4827
Chapter 5
Page 1 of 1
Chapter 5 – Assignment
Read the Case Law and answer the questions.
Instructions:
1. Read the Case Law – Werth vs. Taylor
2. Then, answer the questions below.
a. Did this case turn out the way you thought it would? Why or why not?
b. How could Cindy have assured herself that she would not receive any blood
no matter what happened?
c. Would it have made any difference in the outcome of the case if the
anesthesiologist had interviewed Cindy before the procedure and told her
that her life could be in danger if she refused blood during both procedures?
d. What kind of consent is it when there is an emergency situation and the
physician/healthcare worker needs to act or the patient may lose their life?
3. Your paper should be:
o
o
o
One (1) page
Typed according to APA style for margins, formatting and spacing standards
Typed into a Microsoft Word document, save the file, and then upload the
file
Chapter 5
Legal and Legislative Issues
Purpose of Law and Legislation
• The primary purpose is to protect the patient and the
nurse.
• Laws and legislation define the scope of acceptable
practice and protect individual rights.
• Nurses who are aware of their rights and duties in legal
matters are better able to protect themselves against
liability or loss of professional licensure.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Sources of Law
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question
Tell whether the following statement is true or false:
Nurse practice acts are examples of statutes.
A. True
B. False
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Answer
A. True
Rationale: The 51 Nurse Practice Acts representing the 50
states and the District of Columbia are examples of
statutes. These Nurse Practice Acts define and limit the
practice of nursing, thereby stating what constitutes
authorized practice as well as what exceeds the scope of
authority
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Types of Laws and Courts
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Question
A nurse is charged with administering a fatal dose of
morphine to a patient on hospice. In which type of court
would this nurse be charged?
A. Civil
B. Criminal
C. Administrative
D. None of the above
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Answer
B. Criminal
Rationale: Nurses found guilty of intentionally administering
fatal doses of drugs to patients would be charged in a
criminal court. In civil cases, one individual sues another for
money to compensate for a perceived loss. In
administrative cases, an individual is sued by a state or
federal governmental agency assigned the responsibility of
implementing governmental programs.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Legal Doctrines Guiding Courts in Decision
Making
• Stare decisis (let the decision stand): uses precedents as
a decision-making guide
• Res judicata (a thing or matter settled by judgment):
applies only when a competent court has decided a legal
dispute and when no further appeals are possible
• Respondeat superior (the master is responsible for the
acts of his servants): an employer should be held legally
liable for the conduct of employees whose actions he or
she has a right to direct or control
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Two Types of Negligence
• Ordinary negligence
• Professional negligence (also called malpractice)
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Nurses Are at Increased Legal Liability in
the 21st Century Owing to the Following
• They have more authority and independence in
decision making.
• They have increased legal accountability for decision
making.
• They are performing more actions that used to be in
the realm of medical practice.
• They are making more money.
• More nurses are carrying malpractice insurance.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question
Which of the following accurately describes why nurses are
at increased liability for malpractice suits?
A. Their realm of responsibility has decreased.
B. Fewer nurses have liability insurance.
C. Nurses are making more money.
D. Nurses currently have less independence in decision
making.
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Answer
C. Nurses are making more money.
Rationale: Higher salaries have corresponded to increased
liability in the nursing profession.
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Malpractice Insurance Dilemma
Nurses need malpractice insurance because of their
expanded roles, but they also incur a greater
likelihood of being sued if they have malpractice
insurance because injured parties will always seek
damages from as many individuals with financial
resources as possible.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Elements of Malpractice
• Negligence: the omission to do something that a
reasonable person, guided by the considerations that
ordinarily regulate human affairs, would do—or as doing
something that a reasonable and prudent person would
not do
• Malpractice: the failure of a person with professional
training to act in a reasonable and prudent manner—also
called professional negligence
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Five Components Necessary for
Professional Negligence to Occur
•
A standard of care is in place (minimal level of
expertise delivered to a patient).
•
There is a failure to meet the standard of care (breach
of duty).
•
Foreseeability of harm must exist (ignorance is not an
excuse).
•
There must be a provable correlation between care
and harm.
•
Actual patient injury must occur.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Being Sued for Malpractice
• “Just following physician orders” is not a defense for
malpractice.
• Nurses have an independent responsibility to take
appropriate steps to safeguard patients.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question
Tell whether the following statement is true or false:
Following a physician’s order is a valid excuse in a
malpractice case.
A. True
B. False
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Answer
B. False
Rationale: Nurses have a responsibility to safeguard their
patients, independent of physician’s orders.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Reducing the Risk of Malpractice Claims
• Practice within the scope of the nurse practice act.
• Observe agency policies and procedures.
• Model practice after established standards by using
evidence-based practice.
• Always put patient’s rights and welfare first.
• Be aware of relevant law and legal doctrines.
• Practice within the area of individual competence and
upgrade technical skills consistently.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Incident Reports (Adverse Event Forms)
• Records of unusual or unexpected incidents that occur in
the course of a client’s treatment
• Generally considered confidential communications and
cannot be subpoenaed by clients or used as evidence in
their lawsuits in most states
• A copy of an incident report should not be left in the
chart, and no entry should be made in the patient’s
record about the existence of an incident report.
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Intentional Torts
• Assault and battery
• False imprisonment
• Invasion of privacy
• Defamation of character
– Slander (spoken)
– Libel (written)
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Question
Which is not an intentional tort?
A. False imprisonment
B. Defamation of character
C. Invasion of privacy
D. Negligence
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Answer
D. Negligence
Rationale: An intentional tort requires that the act be
committed with the awareness of the perpetrator.
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Responsibilities of the Nurse-Manager
• Reporting dangerous understaffing
• Checking staff credentials and qualifications
• Carrying out appropriate discipline
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Guidelines for Informed Consent
The person(s) giving consent must fully comprehend:
1. The procedure to be performed
2. The risks involved
3. Expected or desired outcomes
4. Expected complications or side effects that may occur as
a result of treatment
5. Alternative treatments that are available
Consent may be given by:
1. A competent adult
2. A legal guardian or individual holding durable power of
attorney
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Guidelines for Informed Consent—(cont.)
3. An emancipated or married minor
4. Mature minor (varies by state)
5. Parent of a minor child
6. Court order
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Patient Medical Records
• Patient owns the information, but the record belongs to
the facility that made it and is storing it.
• Patients must have reasonable access to the record.
• Collaboration between health-care providers and
patients, and documentation thereof, is a good indication
of well-provided clinical care.
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Patient Self-Determination Act (PSDA)
• Required health-care organizations that received federal
funding (Medicare and Medicaid) to provide education for
staff and patients on issues concerning treatment and
end-of-life issues
– Includes the use of advance directives (ADs), written
instructions regarding desired end-of-life care
– Also likely includes durable power of attorney for
health care (health-care proxy)
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Good Samaritan Laws
• Suggest that health-care providers are typically
protected from potential liability if they volunteer their
nursing skills away from the workplace (generally limited
to emergencies), provided that actions taken are not
grossly negligent and if the health-care worker does not
exceed his or her training or scope of practice in
performing the emergency services
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Health Insurance Portability and
Accountability Act of 1996
• Provides patient right to confidentiality
• Essentially represents two areas for implementation
– Administrative simplification plan
– Privacy rules
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Common Causes of Professional Nursing
License Suspension or Revocation
• Professional negligence
• Practicing medicine or nursing without a license
• Obtaining a nursing license by fraud or allowing others to
use your license
• Felony conviction for any offense substantially related to
the function or duties of an RN
• Participating professionally in criminal abortions
• Not reporting substandard medical or nursing care
• Providing patient care while under the influence of drugs
or alcohol
Copyright © 2018 Wolters Kluwer · All Rights Reserved
Common Causes of Professional Nursing
License Suspension or Revocation—(cont.)
• Giving narcotic drugs without an order
• Falsely holding oneself out to the public or to any healthcare practitioner as a “nurse practitioner”
Copyright © 2018 Wolters Kluwer · All Rights Reserved
• Please show Leadership Video Case: Breach of
Confidentiality, available as part of Lippincott CoursePoint
for Marquis and Huston: Leadership Roles and
Management Functions in Nursing, 9th edition.
• For more info, visit thePoint.lww.com/CPMarquis9e.
Copyright © 2018 Wolters Kluwer · All Rights Reserved

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