Topic 5-6 Legal Aspects of Nursing Practice - NPA

Legal Aspects of Nursing
Dr. Yousef Jaradat

Dr. Loai Abu Rayyan
Kareem Sbaih
Spring 2024
Objectives
• Describe general legal concepts applied to nursing
• Recognize nurses’ legal responsibilities with selected aspects of
nsg practice
• Describe legal roles of nurses
• Describe the purpose &essential elements of informed consent.
• Discuss the impaired nurse &available diversion or peer
assistance programs.
• Discriminate bet negligence and malpractice.
• Delineate the elements of malpractice.
• Compare -contrast intentional torts and unintentional torts
• Describe laws &strategies that protect the nurse from litigation.
• Discuss legal responsibilities of nursing students.
Nurse Practice Acts (NPA)
• Define and describe “scope of nursing
practice”
• Control practice through licensing
Where can you find our country

Nurse Practice Act? State of Palestine
Credentialing ‫اﻻﻋﺗﻣﺎد‬
❑ Medical credentialing verifies that nurses, doctors are properly
trained, certified and have the required professional experience to
provide healthcare services to pts. It’s a crucial aspect of
maintaining high standards of safety in the medical profession.
❑ Maintaining competence in nursing practice

▪ Licensure
▪ Certification
▪ Accreditation
Licensure Models
• State-based
• Separate license required for each state!
• Challenged by changes in health care delivery
Certification
• A practice validating- an individual has met
minimum standards of competence in a specialty
area.
Standards of care
• Internal standards • External standards (National)
• NPA (nursing practice act) ‫ﻗﺎﻧون‬
• Job description
‫))ﻣﻣﺎرﺳﺔ اﻟﺗﻣرﯾض‬
• Educational level
• Professional organizations
• Expertise
• Nsg specialty-practice
• Institutional policies
organizations
and procedures
• Other organizations
guidelines (MOH, MOE)
Legal Aspects of Nursing Practice
“legal responsibilities”
• Informed consent (IC)
• Delegation
• Violence, abuse, neglect

• Controlled substances
• Impaired nurse
• Death and related issues!
Informed Consent
• Purpose
o Provides client with complete information prior to
obtaining agreement by client to accept a course of
treatment or procedure
– The IC is the record of the IC, not the IC itself
IC
• Types
I. Express consent ‫ﻣواﻓﻘﺔ ﺻرﯾﺣﺔ‬
• Oral or written (more invasive) agreement
II. Implied consent ‫ﺿﻣﻧﯾﺔ‬

• Individual’s nonverbal behavior indicates agreement
• Medical emergency when a person cannot express
content because of physical condition.
IC
• Essential elements
• Must be voluntary -No coercion/force/fear of disapproval
• Must be given by client/individual with capacity to understand
• Must be given enough information to be the ultimate decision
maker
Discussion- Arab world? Illiterate?
▪ Illiteracy in the Arab world (1 out of 3 in Arab world illiterate, half of the
women); only 63% of adult Arab population can read and write with
understanding. Literacy is the highest in Jordan 98%, Palestine 96.67%,
and Qatar 97.76%, and lowest in Egypt 75.84%, Mauritania 52.12%, South
Sudan 31.98%, Yemen 69.96%
https://wisevoter.com/country-rankings/literacy-rate-by-country/#denmark
IC
❖ Exceptions (who cannot provide IC):
• A minor ‫ﻗﺎﺻر‬, person 18 years or younger
• The unconscious or person injured in such as way that
they are unable to consent
• A mentally ill person judged by professionals to be
incompetent
✔ A parent, legal guardian, or representative provides or refuses
consent for these individuals
IC
• Consider problem of illiteracy, language barriers
• Consent must be read to the client or an interpreter appropriately
used to be certain client understands
• Nurses Role:
▪ Nurse witness the signature but not explain the
procedure.
▪ Assess client’s understanding, identify misconceptions
▪ The nurse signature confirm that:
• Client gave consent voluntarily
• Signature is authentic ‫أﺻﻠﻲ‬
• Client appears competent
• Client have the right to refuse after signature
Delegation
“The process for a nurse to direct another person to perform nursing
tasks and activities” [National Council of State Boards of Nursing (NCSBN)]
“The transfer of responsibility for the performance of an activity
from one person to another while retaining ‫ ﯾﺣﺗﻔظ‬accountability for
the outcome” [American Nurses Association (ANA), 1997]
• The nurse’s authority to delegate is based on laws &regulations.,
nurses must be familiar with their NPA.
•Nurses must know their own scope of practice, also the scope of
practice of the Unlicensed Assistive Person (UAP,) which may vary
depending on a facility’s policies and procedures.
The Impaired Nurse
• Inability to perform essential job functions due
to:
✔ Chemical dependency on drugs
✔ Alcoholism
✔ Mental illness
• Nurse promotes, advocates for, and strives to protect
the health, safety, and rights of the patient.
• Nurses need to advocate for their colleagues who
have substance abuse
(Code of Ethics for Nurses, ANA 2010)
Advanced health care directives
• Allow persons to specify aspects of care they wish to receive if unable to make decisions
• Patient Self-Determination Act
– Recognize advance directives
– Ask clients if they have advance directives
– Providing educational material
• The two types of advance health care directives are the living will
and the health care proxy or surrogate ‫ﺑدﯾل‬
- The living ‫وﺻﯾﺔ اﻟﺣﯾﺎة‬: specific instructions about what medical
treatment the client chooses to omit ‫ ﺣذف‬or refuse (e.g.,
ventilatory support) in the event that the client is unable to make
those decisions.
- The health care proxy ‫وﻛﯾل اﻟرﻋﯾﺔ اﻟﺻﺣﯾﺔ‬, (a durable power of
attorney for health care) is a certified or witnessed statement
appointing someone else (e.g., a relative or trusted friend) to
manage health care treatment decisions when the client is unable
to do so.
Do-Not-Resuscitate, DNR
• Order is generally written when client wishes for
no resuscitation
• Values and choices given highest priority
• DNR explicitly discussed with client, family, and
designated decision maker, and health care team
• DNR clearly documented, reviewed, updated
• Other care should not be withdrawn
Crimes
• An act committed in violation of public (criminal)
law
• Punishable by a fine or imprisonment
• Does not have to be intended in order to be a
crime
– Example: accidentally administering an additional and
lethal dose of a narcotic to relieve discomfort
Negligence
• Misconduct or practice that is below the standard
expected of an ordinary, reasonable, and prudent
person
• Places another person at risk for harm

• Gross negligence
– Extreme lack of knowledge, decision making, or skill
that should have been known that put others at risk
for harm
Malpractice
• Negligence that occurred while the person was
performing as a professional
– Applies to physicians, dentists, lawyers, nurses
• Measures to prevent malpractice:
• Check and recheck medications-medication error
• Check side rails before leaving a client-client safety
• Do not ignore a clients complaint-failure to observe and
take appropriate action
• Right client-mistaken identity
Intentional Torts ‫أﺿرارﻣﺗﻌﻣدة‬
• Assault‫ اﻋﺗداء‬: Attempt or threat to touch unjustifiably
• Battery ‫ ﺿرب‬: Willful ‫ ﻟﻣس‬touching that may or may not

cause harm
• False imprisonment ‫ﺳﺟن ﺧﺎطﺊ‬

• Invasion of privacy
Unprofessional conduct
• Incompetence or gross negligence
• Conviction for practicing without a license
• Falsification ‫ ﺗزوﯾر‬of client’s records
• Illegally obtaining, using, or possessing controlled substances
• Need to retain professional boundaries
• Violation of professional ethical codes
• Breach of confidentiality
• Fraud ‫اﻟﻐش‬
• Refusing to care for clients of specific socioeconomic or cultural
origins
Legal Protection in Nursing Practice
❖ Carrying out a physicians order
• Nurses should analyze procedures &medications ordered
by the physician
• Seek clarification for ambiguous or erroneous orders
• Categories nurses should question to protect
themselves:
✔ Question any order a client questions
✔ Question any order if the client’s condition changed
✔ Question & record verbal order to avoid miscommunication.
✔ Question any order that is illegible, unclear, or incomplete.
CONT
❖ Providing competent nsg care
• Provide care within the legal boundaries
• Be familiar with job description-experience & education
match the Job description.
• Care to protect clients from harm
• Anticipate sources for injury
• Educate clients about hazards
• Implement measures to prevent injury
• Client’s need to be assessed and monitored appropriately
• Communicate with client’s with sincere concern
CONT
❖ Documentation
• Medical chart is a legal document
• Provide accurate and complete documentation of
the nursing care provided
• Failure to document can constitute negligence
• Insufficient or inaccurate assessments can hinder
proper diagnosis and treatment causing harm to
client.
CONT
❖ Incident Reports
• Agency record of an incident or unusual
occurrence (also called unusual occurrence
report)
• Why TO report incidents??
✔ Make all the facts available to agency personnel
✔ Contribute to statistical data about incidents
✔ Help health personnel prevent future incidents
• Filed according to agency policy
Information included on incident reports
• Identify the client by name, initials, and hospital or
identification number
• Name, Date, time, place of the incident
• Description of the facts of the incident (no conclusions or
blame)
• Incorporation of the client’s account of the incident in
quotes
• Identification of all witnesses
• Identification of any equipment by number and any
medication by name and dosage.
Legal responsibilities of students
• Responsible for own action and liable for their own acts of
negligence
• Function within scope of education, job description and nurse
practice act
• Follow procedures and policies
• Ask for additional help or supervision in situations they feel

inadequately prepared
• Comply with the polices and definitions of responsibility supplied

by the school of nursing.

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Legal Aspects of Nursing

Dr. Yousef Jaradat

Where can you find our country

❑ Maintaining competence in nursing practice

• Violence, abuse, neglect

II. Implied consent ‫ﺿﻣﻧﯾﺔ‬

• Places another person at risk for harm

• Battery ‫ ﺿرب‬: Willful ‫ ﻟﻣس‬touching that may or may not

• False imprisonment ‫ﺳﺟن ﺧﺎطﺊ‬

• Ask for additional help or supervision in situations they feel

• Comply with the polices and definitions of responsibility supplied

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