Ethical and legal issues in community health nursing.pptx

Introduction, definition, ethical and legal rights, legal right in nursing, patient bills and rights, legal liabilities in nursing

1. Ethical and legal issues By:- Jagdeep Kaur

2. INTRODUCTION In a civilized society, a system of law promotes order, protects the rights of citizen and provides the framework for a wide variety of relationships. In today's complex world, with advancing technologies and an array of societal problems, legal issues are an important aspect of life. For nurses in practice within the current health care system, knowledge of basic legal concepts is vital. Interesting and important development in the system of law affect both the nurse and her practice.

3. Definition “ Ethics is a system of moral principles, and rules of conduct recognized in respect to a particular class of human actions or to a particular group of people.” Or Ethics is a branch of philosophy dealing with values related to human conduct with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.

4. ETHICAL AND LEGAL RIGHTS OF PEOPLE IN COMMUNITY The collection of the individual rights of people reflect the rights of the community. The basic rights of people are as follows: To seek information about health programs. To be respected. To possess confidentiality. Get consent from community people to implement any health program. To access health care services. To participate in any health program. To access quality care from health care professionals. Equal rights for all people with cultural diversity, no discrimination. Right to know details about entry of any epidemic disease and their symptoms.

5. LEGAL LIMITS OF NURSING STANDARD OF CARE :- It is defined as those act that are permitted or prohibited from being performed by a prudent person working within the parameters of her training, license, experiences and conditions existing at the time. REGISTRATION:- One type of law that directly affects nursing practice is nursing practice act. These acts are designed in order to protect the profession from encroachment by other group, and the public from those who practice nursing without a license. Registration is mandatory i.e. to practice nursing one must be licensed as nurse. NURSING COUNCIL ACT:- An aspect of the nurse - society relationship is spelled out in the state nursing practice act(NPA).To practice nursing, one must be registered. This is the way to protect the public from incompetent, unscrupulous and illegal behavior.

6. Board of nursing activities include the following RULES AND REGULATIONS:- Administrative rules and regulation are written within the scope of the authority granted by the legislative body of the respective state. These rules and regulations explain how the act will be implemented, and describe those procedures which are measurable and enforceable. STANDARD OPERATING PROCEDURES:- Each health care agencies has established standard operating procedures that have been approved by its administrative body. Standard operating procedures are written document that contains rules, policies, procedures, regulations and order for the patient care in various stipulated circumstances that are unique to the agency. IPHS are a set of standards envisaged to improve the quality of health care delivery in the country. Our country has a large number of public health institutions in rural areas from Sub- centres at the most peripheral level to the District Hospital at the District level. It is highly desirable that they should be fully functional and deliver quality care in a safe manner.

7. Cont … Standard Operating Procedures and Standard Treatment Protocols for common ailments and the National Health Programmes should be available and followed. To maintain quality of services, external monitoring through Panchayati Raj Institutions and internal monitoring at appropriate intervals is advocated. Guidelines are being provided for management of routine and emergency cases under the National Health Programmes so as to maintain uniformity in Management in tune with the National Health Policy. EMPLOYEE POLICIES It is often described in a handbook that is distributed to all newly appointed employees.It should provide them with the key information about the operation of the organisation .

8. OBJECTIVES OF INDIAN PUBLIC HEALTH STANDARDS (IPHS) FOR CHCS To provide optimal expert care to the community. To achieve and maintain an acceptable standard of quality of care. To ensure that services at CHC are commensurate with universal best practices and are responsive and sensitive to the client needs/expectations.

9. LIST OF STATUTORY COMPLIANCES No objection certificate Maternity Benefit Act 1961. Authorization under Bio-medical Waste. MTP Act 1971. Persons with Disability Act 1995. Authorization from Atomic Energy Pharmacy Act 1948. Registration of Births and Deaths Act Vehicle registration certificates for1969. Consumer Protection Act.

10. Cont.. Drug & Cosmetic Act 1950. Right to Information act. Fatal Accidents Act 1855. Indian Medical Council Act and code of medical ethics. Clinical Establishments Indian Nursing Council Act.

11. PATIENT'S BILL OR RIGH In 1973, the American hospital association has adopted a patient's bill or rights as a national policy statement and had distributed it to its members in the hospitals throughout the country. The summarized 11 rights are -Right to have considerate and respectful care. Right to obtain complete and current information regarding his/ her diagnosis and prognosis from his physician. Right to receive necessary information by physician regarding his/ her treatment. Right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his action. Right to privacy concerning his own medical care programme . Right to expect that all the communications and record pertaining to his care should be treated as confidential. Right to expect that within its capacity a hospital must make reasonable response to the request made by a patient for services. Right to expect reasonable continuity of care.

12. STUDENT NURSES If a client suffers harm as a direct result of the nursing student's action or from the lack of it, the liability for the incorrect action is generally shared by the students, instructors, hospitals, the health care faculty and the educational institution. Student nurses should never be assigned the task for which they are unprepared and should be carefully supervised by instructors when they are learning new procedures

13. TORTS A torts is a civil wrong for which remedy is a common law action for damages that are not liquidated and which is not exclusively the breach of contract or trust or a mere equitable obligation. They are of two types: UNINTENTIONAL TORTS INTENTIONAL TORTS

14. UNINTENTIONAL TORTS NEGLIGENCE It is an act of omission, i.e. neglecting to do something that a reasonably prudent person would do or doing something that he/ she would not do. Common cases of negligence include foreign objects(such as sponges) left inside a patient, burn caused by equipment's or solution etc.

15. INTENTIONAL TORTS ASSAULT - It is the threat touching another person without his or her consent. BATTERY- It is the actual carrying out of such a threat. It is an intentional touching of another body. DEFAMATION OF CHARACTER - This includes false communication resulting in injury to a person's reputation by mean of prints or speech. FRAUD - It is the willful, purposeful, misrepresentation of self or an act that may cause harm to a person or property.

16. DEFENSES The nurse who wants to stay out of court should always remember the following 3 D's of nursing malpractice defense Dedication Demeanor Documentation 3 D’s

17. DEDICATION Competency is of primary importance in avoiding law suits. The licensed practical nurse must maintain the highest level of competency at all times, including maintaining skills through continuing education. A dedicated nurse always gives the best quality care.

18. DEMEANOR The nurse's demeanor is often the determining factor in case the patient sues the nurse. The nurse must never underestimate the significance of demeanor and rapport in malpractice.

19. DOCUMENTATION In the medical record it provides the only credible proof in court to prove that appropriate care was given and the standards of care was met with. The nurse should always remember that if it was not charted, it was not done.

20. LEGAL RESPONSIBILITY Legal responsibility in nursing practice is very important. The purposes of this knowledge for a nurse are to help her understand: The legal responsibilities she has while practicing nursing. Which authority can enforce these responsibilities. What area of nursing practice can mostly create legal difficulties.

21. GUIDES FOR LEGAL RESPONSIBILITY There are 5 areas of authority that gives us guidance on legal responsibility for the nursing practice: Central government act binding by law. State government act binding by law. International code for nurses subscribed by TNAI. Institutional rules. Regulations or standing orders, or an example of what court decision has been made before in a similar case.

22. LIST OF DO'S AND DON'T AS GUIDELINES FOR SAFE PRACTICE DO’S Documentation of all unusual incidences. Know your job description. Follow policies and procedures as established by your employing agency. Keep your registration updated. Perform procedures that you have been taught and that are within the standard scope of your practice. Protect patient from injuring themselves. Remain alert and focused. Establish and maintain rapport with the patients and family. Seek and clarify orders given by the physician. Practice safety with physician's verbal order.

23. DONT'S Remove side rails from patient's bed unless there is an order or hospital policy to do so. Allow patient's to leave the hospital or nursing home unless there is an order or a signed release. Accept money or gifts from patient. Give advice that is contrary to physician order or the nursing care plan. Give medical advice to friend and neighbors. Attempt to practice medicine. Witness a patient's will. Take medications that belong to patients Work as a licensed practical/ vocational nurse in a state in which you are not licensed.