Transcript Legal Aspects of Gerontological Nursing

Chapter 8
Legal Aspects of Gerontological
Nursing
Older Adults: Legal Issues
• Older Adults may be easy victims of unscrupulous
practices due to:
– The multiple problems faced by older adults.
– A high prevalence of frailty.
– A lack of familiarity with laws and regulations.
Advocacy: An Integral Part of
Gerontological Nursing
• Nurses need to be concerned about protecting the rights
of their elderly patients.
• Nurses must have knowledge of basic laws and ensure
that their practice falls within legally sound boundaries.
Legal Risks Associated with
Gerontological Nursing
• Working in highly independent roles.
• Having responsibility for nonprofessional staff.
• Working with patients with multiple and complex
conditions.
• Giving advice or guidance to patients and families in
difficult situations.
Laws Governing Gerontological Nursing
Practice
• Public Laws: govern relationships between private
parties and the government.
– The scope of nursing practice.
– The requirements for being licensed as a home
health agency.
• Private Laws: involve relationships between individuals
and organizations.
– Involves contracts and torts.
Examples of Torts
• Wrongful acts against another party:
– Assault
– Battery
– False imprisonment
– Invasion of privacy
Factors Increasing Liability for Nurses
• Working without sufficient resources.
• Not checking agency policy or procedure.
• Bending a rule.
• Giving someone a break.
• Taking shortcuts.
• Trying to work when physically or emotionally exhausted.
Malpractice: Conditions That Warrant
Damages
• Duty: a relationship between the nurse and the patient
in which the nurse has assumed responsibility for the
care of the patient.
• Negligence: failure to conform to the standard of care.
• Injury: physical or mental harm to the patient, or
violation of the patient’s rights resulting from the
negligent act.
Consent
• Patients are entitled to know the full implications of
procedures.
• Patients make an independent decision as to whether or
not they choose to have a procedure performed.
• Consent must be obtained before performing any medical
or surgical procedure.
– Performing procedures without consent can be
considered battery.
Procedures Requiring Consent
• Any entry into the body, either by incision or through
natural body openings.
• Any use of anesthesia.
• Use of cobalt or radiation therapy.
• Use of electroshock therapy or experimental procedures.
• Any type of research participation, invasive or not.
• Any procedure, diagnostic, or treatment, that carries
more than a slight risk.
Elements of an Informed Consent Form
• Written description of the procedure and its purpose also
explained by the person performing it.
• List of alternatives to the procedure.
• List of expected consequences and risks.
• Witnessed and dated signature of the patient.
• Consent obtained by the person performing the
procedure.
Competency Issues
• Persons who are mentally incompetent are unable to give
legal consent.
• Often staff will turn to the next of kin to obtain consent
for procedures.
– The appointment of a guardian is the responsibility of
the court.
– Staff should encourage family members to seek legal
guardianship of the patient.
Legal Risks for Nurses
• Permitting unqualified or incompetent persons to deliver
care.
• Failing to follow up on delegated tasks.
• Assigning tasks to staff members for which they are not
qualified or competent.
• Allowing staff to work under conditions with known risks.
Potential Areas of Liability for Nurses
• Administering Medications.
• Using restraints.
• Accepting phone orders.
• Following no-code orders.
• Dealing with end-of-life issues.
• Pronouncing death.
Advance Directives
• Advance directives express the desires of a competent
adult regarding:
– Terminal care
– Life-sustaining measures
– Other acts pertaining to death and dying
Examples of Elder Abuse
• Inflicting pain or injury.
• Stealing or mismanaging funds.
• Misusing medications.
• Causing psychological distress.
• Withholding food or care; or sexually abusing
• Exploiting, or confining a person.
Signs of Elder Abuse
• Delay in seeking necessary medical care
• Malnutrition
• Dehydration
• Skin breaks, bruises
• Poor hygiene and grooming
• Urine odor, urine-stained clothing/linens
• Excoriation or abrasions of genitalia
Signs of Elder Abuse (cont.)
• Inappropriate administration of medications
• Repeated infections, injuries, or preventable
complications from existing diseases
• Elder’s evasivenss in describing condition, symptoms,
problems, and home life
• Unsafe living environment
• Social isolation
• Anxiety, suspiciousness, and depression
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).