LEGAL ASPECTS AND THE NURSE Professional Negligence Negligence- 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 not do, and acting or the non acting of which is the proximate cause of injury to another person of his property. 4 Elements of professional negligence 1. existence of a duty on the part of the person charged to use due care under circumstances. 2. failure to meet the standard of due care 3. the foresee ability of harm resulting fromfailure to meet the standard 4. the fact that the breach of this standard resulted in an injury to the plaintiff Article 19 of the Civil Code states that one shall act with justice, give every man his due, observe honesty and good faith. Article 20 states the those who, in the performance of their obligations through negligence cause any injury to another, are liable for damages. Common acts of negligence are: Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath Objects left inside the patients body Falls of the elderly Falls of the children whose side rails of beds were not pulled up and locked Failure to observe and take appropriate action as needed. Specific Examples of Negligence 1. Failure to report observations to attending physicians. 2. Failure to exercise the degree of diligence which the circumstances of the particular case demands. 3. Mistaken identity. 4. Wrong medicine, wrong concentration, wrong route, wrong dose. 5. Defects in the equipment such as stretchers and wheelchairs may lead to falls thus injuring the patients. 6. Errors due to family assistance. 7. Administration of medicine without a doctors prescription. The Doctrine of RES IPSA LOQUITUR 3 conditions are required to establish a defendants negligence without proving specific conduct. 1. that the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone 2. that the injury was caused by an agency within control of the defendant

3. that the plaintiff himself did not engage in any manner that would tend to bring about the injury MALPRACTICE In the usual sense implies the idea of improper or unskillful care of a patient by a nurse. Also denotes stepping beyond ones authority with serious consequences. Is the term for negligence or carelessness of professional personnel. Lesnik (1962) states that the term malpractice is used properly only when it refers to a negligent act commited in the course of professional performance. IV THERAPY AND LEGAL IMPLICATIONS Nurses now participate in complex intravenous therapy procedures that were once performed only by doctors.. Philippines Nursing Act of 1991 Section 28 states that in the administration of intravenous injections, special training shall be required according to protocol established Nurses should also follow the policies of heir agencies, even if nurses have formal training on IV therapy, if the hospital does not aloe them to do so, then they may to do the procedure. Board of Nursing Resolution No. 8 states that any registered nurse without such training and who administers IV injections too 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 RESPONSIBILITIES IN IV THERAPY The duties and responsibilities of nurses in IV therapy include the ff. 1. interpretation of the doctors orders for IV therapy 2. performance of venipuncture, insertion of needles, cannulas except TPN and cutdown 3. preparation, administration, monitoring and termination of IV solution such as additives, IV meds. And IV push 4. admin. Of blood/blood products as ordered by physicians 5. recognition of solution and med. Incompatibilities 6. maintainace and replacement of sites, tubings, dressings, in accordance w/ established procedures 7. Establishment of flow rates of solutions, medicines, blood and blood components. 8. Utilization of thorough knowledge and proficient technical ability in eh use/care, maintenance, and evaluation of IV equipment. 9. nursing management of Total Parenteral Nutrition, out-patient IV care 10. maintenance of established infection control and specific nursing IV, and 11. maintenance of appropriate documentation, associated w/ the preparation, administration and termination of all forms of IV therapy

 nurses should remember that if they have not been taught venipuncture, they may refuse to carry out the procedure until after they have received proper training. Before the administration of blood transfusion, the Resident on Futy, the Head Nurse or Senior Nurse, and the staff Nurse should check that the blood is correct type and is properly crosssmatched. They should sign their names as they attest to these. Proper documentation provides protection for nurses and the hospitals. The IV therapy may be documented on the progress notes, a special IV therapy sheet or nursing care plan on the patients chart.

TELEPHONE ORDERS There are legal risks in telephone orders. Sometimes, message from telephones may sound unclear or grabbed because of some trouble in the phone lines. Most importantly, the signature of the ordering physician is not resent and this order may later be denied in case errors happen or court litigations arise. Only in an extreme emergency and when no other resident or intern is available should a nurse receive telephone orders. Such order should sign the name of physician her own and note the time the order was received. It is safer that when a telephone order is given, another resident physician or intern n the same services receive it since the latter can discuss with the former the actual condition of the patient. It is in the interest of safety that only those who have more experience and a greater knowledge of drugs should receive the order.

Consent to Medical and Surgical Procedures Consent 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 consent. Battery the intentional touching or unlawful beating of another person without authorization to do so is a legal wrong. Nature of Consent Informed Consent Hayt and Hayt state that It is established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with his own body. 6 Essential elements of informed consent: 1. the diagnosis and explanation of the condition

2. a fair explanation of the procedures to be done and used and the consequences 3. a description of alternative tx or procedures 4. a description of the benefits to be expected 5. material rights if any 6. the prognosis, if the recommended care, procedure, is refused Proof of Consent Who must consent Consent of Minors Consent of Mentally Ill Emergency situation Refusal to Consent Consent for Sterilization

MEDICAL CRECORDS: -it saves duplication in future cases and aids in prompt treatment -it serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of the patient and his management. CHARTING DONE BY NURSING STUDENTS MEDICAL RECORDS IN LEGAL PROCEEDINGS: Medical records-are usually used to give important evidence in legal proceedings such as police investigations, determining cause of death, extent of injury incurred by the patient, among others. LEGAL RISKS FOR DEFFECTIVE EQUIPMENT -One important duty of the nurse is to make sure that the equipment used in procedures and treatments is not defective. TORTS: Tort-is a legal wrong, committed against a person or property independent of a contract which renders the person who commits it liable for damages in a civil action. EXAMPLES OF TORTS ARE: 1.Assault and battery Assault-is the imminent threat of harmful or offensive bodily contact. Battery-is an intentional, unconsented touching of another person.

2.false imprisonment or illegal detention False imprisonment- means the unjustifiable detention of a person without a legal warrant boundaries fixed by the defendant by an act or violation of duty intended to result in such confinement. 3.Invasion of Right to Privacy and Breach of Confidentiality The right to privacy- is the right to be left alone, the right to be free from unwarranted publicity and exposure to public view as well as the right to live ones life without having anyones name, picture or private affairs made public against ones will. 4.Defamation Slander-is oral defamation of a person by speaking unprivileged or false words by which his reputation is damaged. Libel- is defamation by written words, cartoons or such representations that cause a person to be avoided, ridiculed or held in contempt or tend to injure him in his work.