Legal Aspects in Nursing

The best guides that nurses may use in the performance of their duties are: 1. Philippine Nursing Act of 2002, RA9173 2. Standards of Safe Nursing Practice 3. Code of Ethics 4. Job description Patients Rights 1. Right to Competent Care - patients have the right to expect that the kind of nursing given them will help them regain or maintain their health.

4. the fact that the breach of this

standards resulted in an injury to the patient

2. Freedom from Harm - There should be an appropriate balance

between potential benefits of the patient's medical regimen & the risks assumed by the patient. The benefits should outweigh the harm. 3. Right to Informed Consent - Informed consent is an agreement by a client to accept a treatment or a procedure after being provided a complete info including the benefits & the risks of the treatment, alternatives to the treatment and prognosis if not treated. 4. Right to Withdraw from Participation - Although consent has been signed, the patient may withdraw from whatever he has consented to because he does not have enough info about what is to be done prior to the consent 5. Right to Confidentiality of Information - Data given to the health team are given in trust & in good faith. Confidential information may be revealed when: 1. patient himself permits such revelation as in claims for hospitalization or sickness benefits 2. In medico-legal cases such as gunshot wounds, attempted suicide or accidents w/c have to be reported to the police or NBI 3. patient is ill with communicable disease where public safety may be jeopardized; or 4. To members of the health team if such info is relevant to his care

Nurses must have the necessary education, training, experience and personality to carry out the services for which they are responsible. If they lack these, they may be charged with incompetence. Nurses may also be sued for malpractice which refers to the negligent acts of person engaged in the professions or occupations in which highly technical or professional skills are employed. Negligence - the commission or omission of an act, pursuant to a duty that a reasonably prudent person in the same or similar circumstances would or would not do, and acting or non-acting is the proximate cause of an injury to another person or his property. Elements of professional negligence 1. existence of a duty on the part of the nurse to the patient 2. foreseeability of harm resulting from failure to meet the standards 3. failure to meet the standards of due care or breach of duty, and

6. Right to be Treated with Dignity and Respect The patient has a right to be treated with dignity & respect as a unique individual regardless of the circumstances of his life. Patient's Responsibilities 1. Providing accurate information A patient has the responsibility to provide to the best of his knowledge accurate & complete info about his complaints, past illnesses, hospitalizations, medications and other matters relating to his health. 2. Complying with instructions A patient is responsible for complying with the treatment plan recommended by the attending physician or the health team. He is expected to keep his appointments, abide by the hospital rules And to inform those concerned if he cannot keep them. 3. Informing the physician of refusal of treatment The patient who refuse treatment or to comply with the treatment regimen should inform the physician of his decision. 4. Paying hospital changes If the patient is in the Pay Service, he is responsible for ensuring that financial obligations of his health care are fulfilled promptly as possible. 5. Following hospital rules and regulations The patient is responsible for following the hospital's rules & regulations that affect his care & treatment, his environment, safety & wellbeing. 6. Showing respect & consideration The patient must be considerate of the rights of other patients & hospital personnel; assist in the control of noise and fire hazards such as smoking and number of visitors.

Accidents or Incident Reports - are to be reported within 24 hours according to the agency policy. Following bits of information are to be included: 1. The patient's name & unit where confined. 2. Date, time & place of the incident. 3. Description of the facts of the incident without any conclusion or blame, of what was seen even if this differs from the impression of others. 4. Identification of all witnesses present, if any; equipment or medication involved or any circumstances surrounding the incident. Incidents involving misconduct of personnel while on duty such as drunkenness, gambling, gross insubordination, gross violation of official duties are to be reported for proper investigation and disciplinary action if needed.

Documentation Nurses are expected to document fully, legibly, accurately, and promptly their observations and a care they render from the time the pt. is admitted to the time of discharge and the pt. responses to the care given him. Inaccurate documentation maybe the basis for lawsuits. Nurses must remember the rule "what was not written was not given nor observed". Charting made by nursing students must be countersigned by their CI's attesting that these were done under their supervision. Legal Guidelines in Documentation: 1. Write legibly or print clearly. Illegible entries can cause misunderstanding leading to errors. 2. Use permanent ink. The used of colored ink will depend on hospital policy. 3. Write entries in consecutive and chronological order as soon as care is provided. Be factual & specific. 4. Give the date and time of every entry. Sign the entry with full signature and position title. The

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7. 8.

signature clarifies who is responsible for the care. Describe the care and the patients response to it. Promptly document any changes in the patient's condition and the action taken based on that changes. Use patients or family quotes. Chart only for yourself. Do not chart in advance as patient's condition may change anytime. Correct errors promptly as these may lead to errors in treatment. To correct an error, simply draw a line through the error and write the word "mistaken entry" above it. Sign your name, and write the date and time this was done.

Three conditions are necessary for the application of this doctrine: 1. The accident must be of a kind which ordinarily does not occur in the absence of someone's negligence. 2. The accident must be caused by an agency or instrumentality within the exclusive control of the defendant. 3. The accident must not have been due to any voluntary action or contribution on the part of plaintiff. Malpractice - means improper or unskillful care of a patient by a nurse. It is also denotes stepping beyond one's authority with serious consequences. Lesnik also states that the term is used properly only when it refers to a negligence act conmmitted in the course of professional performance. Example is that giving of anesthesia by a nurse or prescribing medicines.

When documenting, avoid: 1. Relying on memory. Facts may be forgotten or distorted with the passage of time. 2. Making retaliatory remarks or critical comments regarding the patient or any member of the health team. This may be used against the health team for unprofessional conduct or poor quality of care. 3. Erasing or applying correction fluid or crossing out words beyond recognition. It seems to be an attempt to cover up incriminating evidence. 4. Leaving gaps or black spaces on narrative notes between entries and your signature. Another person may add incorrect data. 5. Using abbreviation except where they are clear and appear on the hospital's list of accepted abbreviations. 6. Using generalized empty phrases such as "status unchanged" or "patient had a good day"

Doctrine of Force Majeure Acts of God It means an irresistible force, one that is foreseen or inevitable. Under the Civil Code of the Philippines, no person shall be responsible for those events which could not be foreseen or which though foreseen, were inevitable, except in cases expressly specified by law. Circumstances as floods, fire, earthquakes, accidents fall under this doctrine and nurses who fail to render service during these circumstances are not held negligent. However, habitual tardiness due to heavy traffic is not considered an excuse for force majeure.

Doctrine of Res Ipsa Loquitor >> "The thing speaks for itself". It means that any wrongful act or injury disputably presumes negligence.

Doctrine of Respondeat Superior >> The term means "let the master be responsible for the act of the subordinates". Under this doctrine, the liability is expanded to include the master as well as the employee and not a short of

liability from the subordinate to the master. When a person through in his negligence injuries another, he remains fully responsible. >> This doctrine applies only to those actions performed by the employee within the scope of his employment.

In accordance with RA 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 name, age, sex, and the date of prescription. RA 6675 requires that the drugs be written in their generic names.

Incompetence - is lack of ability, legal qualifications, or fitness to discharge the required duty. Although a nurse is registered, if in the performance of her duty she manifests incompetence, this is a ground for revocation or suspension of his certificate of registration.

IV Therapy and Legal Implications Nurses now participates in complex

Liability of nurses for the work of nursing aides If a nurse delegates her functions to a nursing aide and the latter commits a mistake then the person responsible is the nurse. Nurses are enjoined to supervise their subordinates and see to it that they perform only those which they have been taught to do and those which they are capable of doing.

Medical Records both scientific and legal the record supplies rich materials for medical and nursing research it serves as a legal protection for the hospital, doctor and nurses by reflecting the disease or condition of the patient and his management

Liability for the work of nursing students Nursing students do not perform professional nursing. They are to be supervised by their clinical instructors. The patient can expect that the care of these students will be in a manner consistent with that which a reasonably prudent person would give.

Nurses must remember the rule "if it was not charted' it was not observed or done". Nurses are expected to record fully, accurately legibly and promptly their observation from admission to the time of the patients discharge. Legal risk for defective equipment One important duty of the nurse is to make sure that the equipment used in procedures and treatments are free from defects. She must see to it these are regularly inspected Make an incident report

Medical orders, Drugs Medication R.A 6675 states that only valid registered medical, dental and veterinary practitioners whether in private institution/corporation or in government, are unauthorized persons constitute illegal practices of medicine and punishable under R.A. 2832 or medical act of 1959, RA 4419 or the dental act and RA 382 or the veterinary act.