Leadership/Management Nursing HESI questions and answers

Leadership/Management Nursing HESI questions and answers Laws Governing Nursing Nurse Practice Acts Nurse Practice Acts provide the laws that control the practice of nursing in each state. Mandatory Nurse Practice Acts authorize that, under the law, only licensed professionals an practice nursing. Nurse's Responsibility in making assignments governed by Nurse Practice Acts. 1. Assignments should be commensurate with the nursing personnel's educational preparation, experience, and knowledge. 2. The nurse should supervise the care provided by nursing personnel for which he or she is administratively responsible. 3. Sterile or invasive procedures should be assigned to or supervised by a professional nurse (RN). Torts An act involving injury or damage to another (except breach of contract) resulting in civil liability (i.e., the victim can sue) instead of criminal liability Unintentional Torts Negligence and malpractice Negligence performing an act that a reasonable and prudent person would not perform. The measure of negligence is "reasonableness" (i.e., would a reasonable and prudent nurse act in the same manner under the same circumstances?) Malpractice negligence by professional personnel (e.g., professional misconduct or unreasonable lack of skill in carrying out professional duties) Four elements necessary to prove negligence or malpractice duty, breach of duty, injury/damages, causation Duty Obligation to use due care (what a reasonable, prudent nurse would do); failure to care for and/or to protect others against unreasonable risk. The nurse must anticipate foreseeable risks. Example: If a floor has water on it, the nurse is responsible for anticipating the risk for a client's falling. Breach of duty failure to perform according to the established standard of conduct in providing nursing care Injury/damages failure to meet standard of care, which causes actual injury or damage to the client, either physical or mental. Causation a connection exists between conduct and the resulting injury referred to as "proximate cause" or "remoteness of damage" Hospital policies provide a guide for nursing actions. They are not laws, but courts generally rule against nurses who have violated the employer's policies. Hospital can be liable for poorly formulated or poorly implemented policies Incident reports alert administration to possible liability claims and the need for investigation; they do not protect against legal action being taken for negligence or malpractice Examples of negligence or malpractice 1. Burning a client with a heating pad. 2. Leaving sponges or instruments in a client's body after surgery. 3. Performing incompetent assessments. 4. Failing to heed warning signs of shock or impending MI. 5. Ignoring signs and symptoms of bleeding. 6. Forgetting to give a med or giving the wrong med Intentional Torts Assault and battery, Invasion of privacy, False imprisonment, Exposure of a person, Defamation, Fraud Assault Mental or physical threat (e.g., forcing [without touching] a client to take a medication or treatment) Battery touching, with or without the intent to do harm (e.g., hitting or striking a client). If a mentally competent adult is forced to have a treatment he or she has refused, battery occurs. Invasion of privacy Encroachment or trespassing on another's body or personality False imprisonment confinement without authorization Exposure of a person Exposure or discussion of a client's case. After death, a client has the right to be unobserved, excluded from unwarranted operations, and protected from unauthorized touching of the body. Defamation divulgence of privileged information or communication (e.g., through charts, conversations, or observations) Fraud willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. Examples of fraud include: 1. Presenting false credential for the purpose of entering nursing school, obtaining a license, or obtaining employment. 2. Describing a myth regarding a treatment (e.g., telling a client that a placebo has not side effects and will cure the disease or telling a client that a treatment or diagnostic test will not hurt, when indeed pain is involved in the procedure) Crime An act contrary to a criminal statute. Wrongs punishable by the state, committed against the state, with intent usually present. The nurse remains bound by all criminal laws. Commission of a crime involves... 1. A person commits a deed contrary to criminal law. 2. A person omits an act when there is a legal obligation to perform such an act (e.g., refusing to assist with the birth of a child if such a refusal results in injury to the child). 3. Criminal conspiracy occurs when two or more persons agree to commit a crime. 4. Assisting or giving aid to a person in the commission of a crime makes that person equally guilty of the offense (awareness must be present that the crime is being committed). 5. Ignoring a law is not usually an adequate defense against the commission of a crime (e.g., a nurse who sees another nurse taking narcotics from the unit supply and ignores this observation is not adequately defended against committing a crime). 6. Assault is justified for self-defense. However, to be justified, only enough force can be used as to maintain self-protection. 7. Search warrants are required prior to searching a person's property. 8. It is a crime not to report suspected child abuse (i.e., the nurse's legal responsibility is to report suspected child abuse) Psychiatric Nursing Practice and the Law Civil procedures, Voluntary admission, Involuntary admission, Emergency admission, Legal and civil rights of hospitalized clients, competency hearing, insanity, inability to stand trial. Civil procedures methods used to protect the rights of psychiatric clients Voluntary admission client admits himself or herself to an institution for treatment and retains civil rights involuntary admission someone other than the client applies for the client's admission to an institution. 1. This requires certification by a health care provider that the person is a danger to self or others (Depending on the state, one or two health care provider certifications are required). 2. Individuals have the right to a legal hearing within a certain number of hours or days. 3. Most states limit commitment to 90 days. 4. Extended commitment is usually no longer than 1 year. Emergency admission Any adult may apply for emergency detention of another. However, medical or judicial approval is required to detain anyone beyond 24 hours. 1. A person held against his or her will can file a writ of habeas corpus to try to get the court to hear the case and release the person. 2. The court determines the sanity and alleged unlawful restraint of a person. Legal and civil rights of hospitalized clients 1. The right to wear their own clothes and to keep personal items and a reasonable amount of cash for small purchases. 2. The right to have individual storage space for one's own use. 3. The right to see visitors daily. 4. The right to have reasonable access to a telephone and the opportunity to have private conversations by telephone. 5. The right to receive and send mail (unopened). 6. The right to refuse shock treatments and lobotomy. Competency hearing Legal hearing that is held to determine a person's ability to make responsible decisions about self, dependents, or property. 1. Persons declared incompetent have the legal status of a minor--they cannot: vote, make contracts or wills, drive a car, sue or be sued, hold a professional license. 2. A guardian is appointed by the court for an incompetent person. Declaring a person incompetent can be initiated by the state or the family. Insanity legal term meaning the accused is not criminally responsible for the unlawful act committed because he or she is mentally ill. Inability to stand trial person accused of committing a crime is not mentally capable of standing trial. He or she: 1. Cannot understand the charge against himself or herself. 2. Must be sent to psychiatric unit until legally determined to be competent for trial. 3. Once mentally fit, must stand trial and serve any sentence, if convicted HESI Hint#1 Surgical procedures should be explained by the health care provider. Remember that it is the nurse's responsibility to be sure that the operative permit is signed and is on the chart. It is not the nurse's responsibility to explain the procedure to the client. Patient Identification A. The Joint Commission has implemented new patient identification requirements to meet safety goals. B. Use at least two patient identifies whenever taking blood samples, administering meds, or administering blood products. C. The patient room number may not be used as a form of identification. Surgical Permit Consent to operate (surgical permit) must be obtained prior to any surgical procedure, however minor it might be. Must be 1. written. 2. obtained voluntarily. 3. explained to the client (i.e., informed consent must be obtained). Informed consent operation has been fully explained to the client including: 1. Possible complications and disfigurements 2. Removal of any organs or parts of the body. Surgery permits must be obtained as follows 1. They must be witnessed by an authorized person, such as the HCP or a nurse. 2. They protect the client against unsanctioned surgery, and they protect the HCP and surgeon, hospital, and hospital staff against possible claims of unauthorized operations. 3. Adults and emancipated minors may sign their own operative permits if they are mentally competent. 4. Permission to operate on a minor child or an incompetent or unconscious adult must be obtained from a legally responsible family member or guardian. Consent The law does not require written consent to perform medical treatment. 1. Treatment can be performed if the client has been fully informed about the procedure. 2. Treatment can be performed if the client voluntarily consents to the procedure. 3. If informed consent cannot be obtained (e.g., client is unconscious) and immediate treatment is required to save life or limb, the emergency laws can be applied Verbal consent a notation should be made. 1. It describes in detail how and why verbal consent was obtained. 2. It is placed in the client's record or chart. 3. It is witnessed and signed by two persons. Verbal or written consent can by given by: a. Alert, coherent, or otherwise competent adults. b. A parent or legal guardian. c. A person in loco parentis (a person standing in for a parent with a parent's rights, duties, and responsibilities) in cases of minors or incompetent adults. Consent of minors 1. Minors 14 years of age and older must agree to treatment along with their parents or guardians. 2. Emancipated minors can consent to treatment themselves. Be aware that the definition of an emancipated minor may change from state to state.