Nursing Jurisprudence

NURSING JURISPRUDENCE

NURSING JURISPRUDENCE 

department of law which comprise all legal rules and principles affecting the practice of nursing.

NURSING LEGISLATION 

the making of laws, or the body of laws already affecting the practice of nursing.

LAW 

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a rule of civil conduct prescribed by the supreme power in a state commanding what is right and prohibiting what is wrong. Sum total of rules and regulations by which society is governed

TYPES OF LAW 

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PRIVATE OR CIVIL LAW body of law that deals with relationship among private individuals PUBLIC LAW body of law for the welfare of the general public; relationship between individuals and the government and government agencies

COURT 

An agency in the government wherein the administration of justice is delegated.

LEGAL RIGHT 

a claim which can be enforced by legal means against a person whose duty is to respect it.

COURT MECHANISM LAWSUIT- proceeding in court for a purpose. Purpose: Enforce a right Redress a wrong

QUESTION If you think that a person has done something seriously wrong to you, the correct action to do get redress for the injury received is to: A. systematically plan on how to have a vindication for the damage done B. file a lawsuit against the person for damage C. hire someone to take revenge for you D. nothing, just forget about it 

PARTIES TO A CASE 

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Complainant VS Defendant: Civil case Plaintiff VS Accused: Criminal case Witness- an individual held upon to give necessary details either for the accused or against the accused

QUESTION 

The person who institutes legal proceeding is called: A. Plaintiff B. Respondent C. Defendant D. Accused

QUESTION 

It is promulgated for the common good by one who has legitimate authority: A. Jurisprudence B. Dilemma C. Law D. Ethics

QUESTION 

A hospital filed a case of damages against a nurse for breach of contract. Who is the nurse in the case? A. complainant B. accused C. defendant D. plaintiff

STATUTE OF LIMITATIONS 

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Refers to the length of time following the event during which the plaintiff may file a suit. Example: negligence- filed within 2-3 years from occurrence.

DUE PROCESS A fair and orderly process which aims to protect and enforce a person’s right. FUNDAMENTAL REQUIREMENTS OF DUE PROCESS: 1. Right to be informed 2. Right to remain silent 3. Right to competent counsel 4. No use of violence, threat, torture 5. Right to know the witness face to face 

PHASES OF DUE PROCESS 

PRE-TRIAL- eliminate matters not in dispute, agree on issues or settle procedural matters.

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TRIAL- facts are presented and determined; law applied at the end.

WRITTEN ORDERS OF COURT 

WRIT- legal notes from court SUBPOENA- an order in court  Duces tecum (papers) bring documents, objects, materials, chart to court  Ad testificandum (person) testify as witness at a specified time and place  SUMMON- a writ commanding an authorized person to notify a party to appear in court to answer a complaint made against him. 

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WARRANT- a writing from a competent authority in pursuance of law, directing the doing of an act addressed to a person competent to do it  Warrant

of arrest- a court order to arrest or detain a person  Search warrant- a court order to search for properties

QUESTION 

A process whereby the BON only compel the personal attendance of a witness to bring with him to the court books, papers and the like to elucidate the matters in issue: A. Warrant B. Subpoena C. Subpoena duces tecum D. Summons

LAWS THAT PROMOTE THE WELFARE AND WELL-BElNG OF NURSES 

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P.D. 442- Labor Code Defines among other things, hours of work, contract and nurse staffing in industrial clinics P.D. 807- Civil Service Law Provide for the recruitment and selection of employees in government service; qualification standards; personnel evaluation system; and personnel discipline

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R.A. 7305- Magna Carta for Public Health Workers Has provisions on benefits, rights and responsibilities of public health workers R.A. 8344 “No Deposit Policy” Prohibits hospitals and clinics from demanding advance payments/cash deposits before patients are admitted or treated

LEGAL CONCEPTS AND ISSUES IN NURSING 

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LIABILITY: is an obligation or debt that can be enforced by law A person who is liable for malpractice is usually required to pay for damages. DAMAGES: refer to compensation in money recoverable for a loss of damage

PROFESSIONAL NEGLIGENCE 

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Negligence – failure to do something which a reasonable & prudent person should have done. 2 types: 1. Commission – wrong doing 2. Omission – total neglect of care – didn’t do anything

ELEMENTS OF NEGLIGENCE 

4D’S Duty for nurse Dereliction (breach of duty) Damages as result Direct result (injury, harm or death)

OR… An injury incurred within the Breadth of duty of the nurse where Cause of injury is the failure to perform the Duty!

SPECIFIC EXAMPLES Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath  Objects left inside the patient’s body; sponges suction tips  Falls of the elderly, confused, unconscious, sedated patients  Falls of children whose bed rails were not pulled up and locked  Mistaken identity- drug given to the wrong patient  Wrong medicine, wrong concentration, wrong route, wrong dose  Defects in the equipment 

QUESTION 

Which of the following situations would possibly cause a nurse to be sued due to negligence? A. Nurse gave a client wrong medication, and an hour later, client complained of dyspnea B. While preparing a medication, the nurse notices that instead of 1 tablet, she put two tablets into the client’s medicine cup C. As the nurse was about to administer medication, the client questioned why the medication is still given when in fact the physician discontinued it. D. Nurse administered 2 tablets of analgesic instead of 1 tablet as prescribed. Patient noticed the error and complained.

QUESTION 

Wilfred, 30 years old male, was brought to the hospital due to injuries sustained from a vehicular accident. While being transported to the X-ray department, the straps accidentally broke and the client fell to the floor hitting to his head. In this situation, the nurse is: A. not responsible because of the doctrine of respondent superior B. free from any negligence that caused harm to pt. C. liable along with the employer for the use of a defective equipment that harms the client D. totally responsible for the negligence

QUESTION 

Which of the following statements if made by the nurse, would you consider him/her as a prudent nurse? A. careful giving of medication in a central line B. very cautiously asks supervision all the time C. follows the doctor’s order even when she thinks it is wrong D. questions wrong order of the doctor

QUESTION 

Which of the following actions by a nurse would be considered negligence? A. Playing cards with an 8 y/o boy with diabetes B. Instructing a 6 y/o asthmatic to blow on a pin wheel C. Massaging the abdomen of a 5 y/o with Wilm’s tumor D. Obtaining a blood test on a 6 day old infant

QUESTION A nurse may be found negligent if: 1. a patient is injured 2. the nurse did not follow the standard 3. failure to do the duty 4. the injury incurred by the pt. is foreseeable A. 1,2,3 C. 1,2,4 B. All of the above D. 2,3,4 

QUESTION 

Monica shared with the interviewer her most recent experiences about a restless pediatric patient whom she puts up the side rails of the bed to prevent accidental falls. Which of the following attributes is shown by Monica? A. Resourcefulness B. Prudence C. Honesty D. Reliability

DOCTRINES OF NEGLIGENCE 1. RES IPSA LOQUITOR - “the things speak for itself” - the injury is enough proof of negligence 2. RESPONDEAT SUPERIOR - Let the master answer for the acts of the subordinate - The liability is expanded to include the master as well as the employee

3. FORCE MAJEURE - Irresistible force; unforeseen or inevitable event - No person shall be responsible for those events which cannot be foreseen Ex. Flood, fire, earthquake 

INCOMPETENCE: lack of ability,

legal qualifications or fitness to discharge the required duty

QUESTION 

One of the important conditions that must be present in a negligent act to be considered as force majeure is: A.

B. C. D.

The nurse is unable to predict the possible occurrence of the action hence, she cant prevent it The injury is within the domain of nursing practice The patient did not voluntarily participate in the action The superior is also accountable for the action

QUESTION 

When a staff nurse gives the wrong medication to her patient, the head nurse and supervisor are also made responsible for the error. This is based on what doctrine? A. Respondent superior B. Good Samaritan Act C. Res ipsa loquitur D. Force majeure

QUESTION 

When a nurse causes an injury to the patient and the injury caused becomes the proof of the negligent act, the presence of the injury is said to exemplify the principle of: A. Force majeure B. Respondeat superior C. Res ipsa loquitur D. Holdover doctrine

MALPRACTICE 

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Doing acts or conducts that are not authorized or licensed or competent or skilled to perform, resulting to injuries or non-injurious consequences Stepping beyond one’s authority Negligent act committed in the course of professional performance RN exceeding the scope of nursing practice & does an MD’s job.

ELEMENTS OF MALPRACTICE Duty of the nurse Dereliction or breach of duty Direct result (injury or harm) Damages Exceeds the limits of the standards of care Foreseability of harm

MEDICATIONS & PRESCRIPTIONS 1. Only registered medical, dental and veterinary practitioners are authorized to prescribe drugs. 2. Prescription information (based on R.A. 5921 of the Pharmacy Act)- all prescriptions must contain the following information: Name of MD, PTR, PRC#, location of clinic/ hospital  Name of patient, age, sex  Information about drug – frequency duration  Generic & brand name in prescription 

R.A. 6675- Generics Act of 1988 

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All prescribed drug must be written in generic and brand names or generic name but never the brand name alone Purpose: for the pt. to choose what brand they want

3. Know rights in giving meds 4. Proper identification of pt’s name 5. In cases of doubts and errors in medication, refer to the physician. 6. Special training is required before a nurse can administer IV injection. BON Resolution No. 8 states that who administers IV injection without training shall be held liable whether causing or not an injury or death to the patient)

7. Verbal or telephone order General rule: as possible avoid T.O. “whatever is not written is not an order” Exception: During extreme emergency only! What to do? 7. Nurse should read back such order to the physician to make certain the order has been correctly written. 8. Such order should be signed by the physician within 24 hours. 9. The nurse should sign the physician’s name per her own and note the time and order was received.

QUESTION 

A telephone order is given for a client in your ward. What is your most appropriate action? A. Copy the order on to the chart and sign the physician’s name as close to his original signature as possible B. Repeat the order back to the physician, copy onto the order sheet and indicate that it is a telephone order C. Write the order in the client’s chart and have the head nurse co-sign it D. Tell the physician that you can not take the order but you will call the nurse supervisor

QUESTION 

In an extreme situation and when no other resident or intern is available, should a nurse receive telephone orders, the order has to be correctly written and signed by the physician within: A. 24 hours C. 48 hours B. 36 hours D. 12 hours

INTENTIONAL WRONGS 

TORTS: A legal wrong, committed against a person or property TYPES: 1. Unintentional- do not require intent but do require the element of harm. Ex. Negligence and malpractice

2. Intentional- the act was done on purpose or with intent; no harm, injury or damage is needed to be liable. ASSAULT AND BATTERY ASSAULT- an attempt or threat to touch another person unjustifiably; mental or physical threat Ex.- forcing a pt. to take his medication or treatment C.

BATTERY- physical harm through willful touching of person or clothing without consent. Ex. – giving of injection without pt’s consent 2. FALSE IMPRISONMENT - Unjustifiable detention of a person without a legal warrant - occurs when the person is not allowed to leave a health care facility when there is no legal justification to detain the client. - occurs when restraining devices are used without an appropriate clinical need.

3. INVASION OF PRIVACY  Right

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to privacy is the right to be left alone  Right to be free from unwarranted publicity  Exposure to public view  Divulge information from patient’s chart to improper sources or unauthorized person PRIVILEGED COMMUNICATION: Statements uttered in good faith; not permitted to be divulged in court of justice

Exceptions: Confidential information can be revealed! Pt. consent, if there is Inform HCT for precautionary measures Crimes, child abuse, BWS Communicable disease- R.A. 3573 (Law on Notifiable Diseases) Ethics

4. DEFAMATION Character assassination  There must be a third person who hears or read the comment before it can be considered defamation 

TYPES:  Slander-oral defamation  Libel-written words

QUESTION The nurse writes the following note in the client’s chart, “the physician is incompetent because he ordered the wrong drug dosage.” This statement may lead to a charge of: A. Assault B. Slander C. Libel D. Invasion of privacy 

QUESTION 

Doing a nursing procedure without the patient’s informed consent may bring the health professional to the court of law for what violation? A. Tort C. Negligence B. Assault D. Battery

QUESTION 

Two janitors are having a heated argument as to who shall dispose the waste of a patient with typhoid fever. The first one called the other “lazybone” and “pain in the neck” within the hearing of the rest of the nurses. The case is: A. Libel B. Slander C. Invasion of privacy D. Negligence

QUESTION 

Allowing a person who is in no way involved in the care of the patient to read the patient’s chart constitutes which of the following violations: A. Invasion of pt’s privacy B. Breach of trust C. Malpractice D. Violation of pt’s dignity

QUESTION 

Which of the following persons cannot have the access to the patient record? A. physical therapist B. lawyer of the family C. the patient D. speech therapist

QUESTION 

It is unethical to tell one’s friends and family members data about the patient because doing so is a violation of patients’ rights to: A. Informed consent B. Confidentiality C. Least restrictive environment D. Civil liberty

QUESTION 

Should the accusation be written in the newsletter of the hospital, such liability is a/an: A. Assault B. Libel C. Slander D. Battery

QUESTION 

B. C. D. E.

Confidentiality of patient’s identity and condition is one of the nursing responsibilities in the hospital. Which of the following reasons can information be given without patient consent EXCEPT: Patient is charged with a crime Patient has a TB Patient is a victim of child abuse Patient with cancer

RESTRAINTS Restraints are protective devices used to limit the physical activity of a client or to immobilize a client or an extremity. TYPES:  Physical restraints: restrict client’s movement through the application of a device e.g. restraint jacket, straps,  Chemical restraints: Medications given to inhibit a specific behavior or movement. e.g. sedation, psychotrophic drug 

RESTRAINTS SHOULD NOT BE USED PRN!!! R-equires physician’s order; consent E-mergency, get MD’s order ASAP S-hortest duration, least restrictive type T-o protect pt. and others R-enew order every 24 hours A-ssess every 15 to 30 minutes and document I-ndividualized supervision N-ever used as a punishment T-otal documentation S-eclusion as last step

ALTERNATIVES TO RESTRAINTS 

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Before restraints offer explanations, ask someone to stay with the client, use clocks, calendars, TV & radio (to decrease disorientation) or any relaxation techniques. Use LESS restrictive methods first. RESTRAINTS should always be the last. Assign confuse and disoriented clients to rooms near the nurse’s station. Maintain toileting routines & institute exercise and ambulation schedules as the client condition allows.

QUESTION 

The nurse noticed that restraining patients is a common practice. Which of the following should she remember? A. Restraints are necessary so that the nurse could do more work for patients B. Use of restraints is an effective intervention C. Restraints require a physician’s order D. Refusal to be restrained is a ground for terminating the nurse-patient relationship

CRIMES & OTHER ACTS 

CRIME: An act committed or omitted in violation of the law Two elements: Criminal act  Evil/criminal intent 

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Criminal Actions Acts or offenses against public welfare  Misdemeanor- offenses or acts less than a felony  Felony- a public offense committed with deceit and fault 

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Criminal negligence Reckless imprudence- person does an act from which damage results immediately  Simple imprudence- did not use precaution and the damage was not immediate 

CLASSIFICATION 1. Manner of commission: Deceit (dolo) with criminal intent  Fault (culpa) without; negligence 

2. Stages of Execution 1. Consummated all elements executed, with successful result 2. Frustrated

all elements executed but no successful result

3. Attempted

not all elements executed, no successful result

3. Degree of penalty and fine

Less grave

Capital punishment or >6yrs & 1 day 1 month and 1 day to 6 years

Light felony

1 day to 30 days

grave

above P6k

not > P 6 K but not P 200

4. Degree of participation PRINCIPAL a. By direct participation- doer of the act Primary author

ACCOMPLICE A person who cooperates

b. By inducement-directly force or induce others c. By cooperation- indispensable “cooperates before the fact”absent at the time crime is committed.

ACCESSORY “cooperates after the fact” Profits Conceals/ destroys evidence Assists in the escape of the principal

QUESTION 

A crime can be committed with the element of culpa if: A. the person committed the crime because of ignorance of the law B. the person knows the action is a crime and he chooses to do it C. the person committed the crime because he lacked the competency to act correctly D. all of these

QUESTION 

The nurse out of pity unhooked the patient from a respirator. The patient died after 15 minutes. This type of felony is: A. Consummated B. Frustrated C. Attempted D. Murder

QUESTION 

If the penalty is death, what is the degree of the felony? A. grave B. less grave C. light felony D. none of the above

SITUATION 

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Danaya is two-months pregnant. Her parents do not know this. She informed her friend Alena about the problem. Alena then referred Danaya to Pirena, an abortionist. Danaya had an abortion. If those involved will be charge legally, who is considered the principal? A. Pirena C. Alena B. Dayana D. None of them

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If during the investigation, the pieces of evidence were not found because Gurna, the maid of Pirena burned it. Gurna is considered as: A. Accomplice B. Accessory C. Principal D. Co-principal

QUESTION 

A nurse is liable as an accomplice in an abortion if she; A. Assist in the escape of the offender B. Refers the pregnant mother to the abortionist C. Conceals the evidence of the crime D. None of these

QUESTION 

A person uses the license of another person to practice nursing is liable for what? A. negligence B. malpractice C. misdemeanor D. invasion of privacy

QUESTION 

B. C. D. E.

The receptionist of a clinic was asked by police if a certain doctor charged with murder was hiding in the premises of the clinic. She lied about it but unfortunately the doctor was discovered inside the clinic. She could be charged with: Principal Accessory Accomplice Assistant

Circumstances affecting criminal liability J-E-M-A-A

JUSTIFYING 

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SELF-DEFENSE  Unlawful aggression  Reasonable necessity  Lack of sufficient provocation Fulfillment of Duty Obedience to an order from superior  Order must be lawful  Superior acting within the scope of practice

EXEMPTING Insane/imbecile Performance of a lawful act causes

injury by mere accident Under 9 y/o Under compulsion of uncontrollable force Under impulse of uncontrollable fear Failure to perform an act required by law when prevented by some lawful cause

MITIGATING Under 18y/o or over 70 y/o

Under 18y/o or over 70 y/o No intention to commit so grave a wrong Sufficient provocation/threat preceding the act Immediate vindication of a grave offense Voluntary surrender Deaf & dumb/ with physical defect Suffer from such illness that diminishes willpower

AGGRAVATING Treachery/taking advantage of superior strength or position Price, reward, promise Use of fire, poison, explosion Calamities Craft, fraud or disguise employed Evident Premeditation Cruelty

ALTERNATIVE 

May increase/ decrease criminal liability depending on the nature and effects of the crime

Relationship Intoxication Degree of instruction/ education

DRILLS 1. Under compulsion of uncontrollable force 2. There is sufficient provocation 3. Act is committed with abuse of confidence 4. Fulfillment of a duty 5. Offender is over 70 years old

6. Voluntary surrender 7. Disguise in being employed 8. Defense of a stranger 9. Acts under the impulse of an uncontrollable fear 10. Offender is insane

QUESTION 

Premeditating to commit a crime is considered as: A. justifying B. mitigating C. aggravating D. exempting

QUESTION 

All of the following are exempting circumstances except: A. Imbecile B. 8 year old C. performance of a lawful act D. offender is deaf and dumb

QUESTION 

When a politician takes advantage of his power in the performance of unlawful actions, this is considered as: A. justifying circumstance B. exempting circumstance C. mitigating circumstance D. aggravating circumstance

QUESTION 

When the defendant kills someone accidentally: A. justifying B. exempting C. aggravating D. mitigating

CRIMES CONCERNING THE NURSE

MORAL TURPITUDE 

Are acts contrary to the accepted and customary rule of right

1. Rape: a.) Ordinary rape – forcible penetration of sex organ to a sex organ b.) Sexual assault – anything forcibly inserted to any orifice. 

Intervention Safety (emotional and physical) Report the incidence Referral (if the father is the rapist, refer to DSWD)

ANTI- RAPE LAW (RA 8353)

R.A. 7877 – Anti-sexual Harassment Act 2. Any person who exercises authority 3. Asking sexual favors in exchange of another favor

2.MURDER- killing of another with intent 3. HOMICIDE- unintentional killing of another person 4. PARRICIDE  Killing of a person to whom you have a relationship 1. father 2. mother 3. brothers/sisters 4. ascendants 5. descendants 6. spouse

5. ABORTION- termination of product of conception before the age of viability.

6. INFANTICIDE - the killing of an infant less than three days or 72 hours.

7. ROBBERY - Anyone who gets the personal property of another with the use of force,violence or intimidation. 8. THEFT- -anyone who gets the personal property of another without the latter’s permission.

9. SIMULATION OF BIRTH 1. Pretend that a woman gave birth 2. Substitution or exchanging of babies in the nursery 3. Intentionally putting wrong information in the birth registration form P.D. 651 – Birth Registration Act - requires any person (RN,OB, midwife) who shall assist in giving birth to report within 30 days without penalty any live birth at Local Civil Registrar’s Office.

10. DISPENSING OF PROHIBITED DRUGS R.A. 6425 (1965) – Dangerous Drugs Act A. Prohibited – chemicals or substances that are totally and absolutely can’t be consumed by human being. Ex. Shabu, cocaine, cannabis B. Regulated – can use this drug - with appropriate prescription - MD with appropriated license Ex.- Valium, dormicum

PENALTY FOR VIOLATING THE ACT For licensed health care providers Fines Imprisonment Automatic revocation of license

GUIDELINES TO PREVENT CRIMINAL LIABILITY: 1. Be very familiar with the Philippine Nursing law 2. Be familiar with the laws affecting nursing practice 3. Know agency rules, regulations, policies 4. Upgrade skills and competence

5. Develop good IPR with co-workers 6. Consult superior as needed 7. Verify vague/ erroneous orders 8. Always keep doctor updated regarding patient 9. Ensure accurate recording and reporting 10. Get informed consent 11. Do not delegate responsibilities to others

TIPS FOR AVOIDING LEGAL PITFALLS: 1. Patient Falls  do proper assessment  appropriate assistance  use protective measures  document all nursing interventions

2. Medication errors     

observe the rights of drug administration Check dr’s order Understand the medication you will administer Consult drug handbook/ pharmacy Not exempt from liability for following wrong dr’s order

3. Equipment injuries    

refuse to use a device you do not know how to operate report adverse events to superiors monitor patient regularly bring questionable orders to the attention of the doctor or superior

DRILLS 1. A student nurse is overheard talking in the cafeteria about a client and his suicidal tendencies. 2. A nurse asks a client why he chose Dr. Smith for her physician when this doctor is always rude to the staff.

3. A client is told he must pay the remainder of his medical bill before he can leave the facility. 4. A nurse told the client that she will inject her with sedatives if he does not cooperate. 5. A nurse forcibly opened the mouth of a pedia patient and gave his medication.

6. A nurse takes the wallet of the patient while the latter is sleeping. 7. A nurse takes the wallet of the patient with the use of violence and intimidation.

8. A nurse gives a potent injection of morphine to a patient causing his death. 9. A nurse poisons his client to end his life. 10. A patient died because of wrong medication given.

SEE YOU ALL AGAIN TOMORROW…