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PART 1. Introduction to the Law and the Judicial Process

Chapter 1. Legal Concepts and the Judicial Process=1

Definition of Law=2

Sources of Law=2

Constitutional Law=2

Statutory Laws=3

Administrative Laws=3

EXERCISE 1-1=3

Attorney General's Opinions=4

Judicial Laws=4

Classifications (Types) of Law=5

Common Law=5

Civil Law=5

Public Law=6

Criminal Law=6

EXERCISE 1-2=7

Substantive Law=7

Procedural Law=7

Due Process of Law and Equal Protection of the Law=7

The Judicial Process=9

Questions of Law or Fact=9

Jurisdiction of the Courts=9

State Courts=10

Trial Courts=10

State Appellate Courts=10

State Supreme Courts=11

EXERCISE 1-3=11

Federal Courts=11

District Courts=11

Courts of Appeal=11

Supreme Court=11

EXERCISE 1-4=12

Statutes of Limitations=12

EXERCISE 1-5=13

Summary=13

Apply Your Legal Knowledge=13

You Be the Judge=13

References=14

Chapter 2. Anatomy of a Lawsuit=15

The Trial Process=16

Step One Initiation of the Lawsuit=16

EXERCISE 2-1=19

Step Two Pleadings and Pretrial Motions=19

Step Three Pretrial Discovery of Evidence=20

Step Four The Trial=22

EXERCISE 2-2=24

Step Five Appeals=24

Step Six Execution of Judgment=24

Expert and Lay Witnesses=25

Lay Witness=25

Expert Witness=25

EXERCISE 2-3=28

Summary=29

Apply Your Legal Knowledge=29

You Be the Judge=29

References=30

PART 2. Ethics

Chapter 3. Introduction to Ethics=31

Definitions of Ethics and Values=32

Distinction Between Ethics and the Law=32

Ethical Theories=33

EXERCISE 3-1=35

Ethical principles=35

Autonomy=35

Beneficence=36

Nonmaleficence=36

Veracity=37

Fidelity=37

Paternalism=37

Justice=38

Respect for Others=38

EXERCISE 3-2=39

Ethics Committee=39

EXERCISE 3-3=40

Summary=40

Apply Your Ethical Knowledge=40

You Be the Ethicist=41

References=41

Chapter 4. Application of Ethics in Nursing Practice Settings=42

Professional Codes of Ethics=43

Ethical Decision-Making Frameworks=43

EXERCISE 4-1=44

Advocacy as a Nursing Role=45

EXERCISE 4-2=46

Moral Distress=46

EXERCISE 4-3=48

Therapeutic Jurisprudence=48

Slippery Slope Arguments=50

Health Policy=50

EXERCISE 4-4=51

Summary=51

Apply Your Ethical Knowledge=51

You Be the Judge=52

References=52

PART 3. Liability Issues

Chapter 5. Standards of Care=54

Definition of Standards of Care=54

EXERCISE 5-1=55

Establishment of Nursing Standards of Care=55

Internal Standards=55

EXERCISE 5-2=58

External Standards=58

EXERCISE 5-3=62

National and Local Standards of Care=62

Importance of Standards of Care to the Individual Nurse=63

EXERCISE 5-4=64

Expert Testimony=65

Expanded Nursing Roles=65

EXERCISE 5-5=65

Ethical Issues and Standards of Care=65

Summary=66

Apply Your Legal Knowledge=66

You Be the Judge=66

References=66

Chapter 6. Tort Law=68

Definition of Torts=69

Negligence Versus Malpractice=69

EXERCISE 6-1=70

Elements of Malpractice or Negligence=70

Duty Owed the Patient=70

Breach of Duty Owed the Patient=72

Foreseeability=72

Causation=74

Tests for Causation=75

Proximate Cause=76

Injury=77

Damages=78

EXERCISE 6-2=80

Doctrine of res ipsa loquitur=80

Locality Rule=82

Avoiding Malpractice Claims=83

EXERCISE 6-3=84

Patient Education and Tort Law=84

Definition of Intentional Torts=86

Intentional Torts=86

Assault=86

Battery=87

False Imprisonment=88

Conversion of Property=89

Trespass to Land=90

Intentional Infliction of Emotional Distress=90

EXERCISE 6-4=91

Quasi-Intentional Torts=91

Invasion of Privacy=91

Defamation=92

EXERCISE 6-5=93

Defenses=94

Ethical Issues and Tort Laws=94

Summary=95

Apply Your Legal Knowledge=96

You Be the Judge=96

References=96

Chapter 7. Nursing Liability : Defenses=99

Defenses Against Liability=99

Defenses Against Intentional Torts=99

Consent=100

Self-Defense and Defense of Others=100

Necessity=101

Defenses Against Quasi-Intentional Torts=101

Consent=101

EXERCISE 7-1=102

Truth=102

Privilege=103

Disclosure Statutes=103

Access Laws=106

Qualified Privilege=106

Defenses Against Nonintentional Torts=107

Release=107

Contributory and Comparative Negligence=107

EXERCISE 7-2=109

Assumption of the Risk=109

Unavoidable Accident=110

Assumption of the Risk―Defense of the Fact=110

Immunity=110

Good Samaritan Laws=110

Statute of Limitations=112

Products Liability=112

Collective and Alternative Liability=113

Caveats in Products Liability Lawsuits=114

EXERCISE 7-3=114

Selected Ethical Issues=114

Summary=114

Apply Your Legal Knowledge=115

You Be the Judge=115

References=115

Chapter 8. Informed Consent and Patient Self-Determination=117

Role of Consent=118

Consent Versus Informed Consent=118

Inclusions in Informed Consent=119

Forms of Informed Consent=119

Standards of Informed Consent=120

EXERCISE 8-1=121

Exceptions to Informed Consent=121

Accountability for Obtaining Informed Consent=122

Nurses' Role in Obtaining Consent=123

EXERCISE 8-2=124

Consent Forms=124

Who Must Consent=126

Competent Adult=126

Incompetent Adult=127

Minors=127

EXERCISE 8-3=128

Right to Refuse Consent=129

Limitations on Refusal of Therapy=129

Law Enforcement=130

Informed Consent in Human Experimentation=131

Health Literacy=133

Genetic Testing=134

Patient Education in Genetic Testing=135

Patient Self-Determination=135

The Issue of Consent=135

Living Wills=137

Natural Death Acts=138

Durable Power of Attorney for Health Care=139

Third-Generation Advance Directives=140

Uniform Rights of the Terminally Ill Act=140

Physician Orders for Life-Sustaining Treatment=140

Patient Self-Determination Act of 1990=141

Do-Not-Resuscitate Directives=143

Mature Minors and the Right to Die=144

EXERCISE 8-4=145

Hospice Care=145

Assisted Suicide=145

Ethical Issues=148

EXERCISE 8-5=149

Summary=149

Apply Your Legal Knowledge=150

You Be the Judge=150

References=150

Chapter 9. Documentation and Confidentiality=153

Medical Records=154

Contents of the Record=154

Effective Documentation=154

Make an Entry for Every Observation=154

EXERCISE 9-1=156

Follow-Up as Needed=156

Read Nurses' Notes before Giving Care=158

Always Make an Entry, Even If It Is Late=158

Make the Chart Entry after the Event=160

Use Clear and Objective Language=160

Be Realistic and Factual=161

EXERCISE 9-2=163

Chart Only Your Own Observations=163

Chart Patient's Refusal for Care=163

Clearly Chart All Patient Education=164

Correct Charting Errors=164

Never Alter a Record at Someone Else's Request=166

Identify Yourself after Every Entry=166

Use Standardized Checklists or Flow Sheets=166

Leave No Room for Liability=167

EXERCISE 9-3=168

Electronic Medical Record (Computerized Charting)=168

Charting by Exception=169

Alteration of Records=170

Retention of Records=170

Ownership of the Record=172

Access to Medical Records=173

Incident Reports=174

EXERCISE 9-4=175

Electronic Transfer of Medical Records=175

Confidentiality of Medical Records=176

EXERCISE 9-5=176

Health Insurance Portability and Accountability Act of 1996=177

Electronic Mail and the Internet=180

Reporting and Access Laws=181

Common-Law Duty to Disclose=181

Contagious Diseases=181

Threats to an Identified Person=181

Limitations to Disclosure=183

Substance and Alcohol Abuse Confidentiality=183

HIV/AIDS Confidentiality=183

Selected Ethical Concerns=184

EXERCISE 9-6=184

Summary=185

Apply Your Legal Knowledge=185

You Be the Judge=185

References=186

Chapter 10. Professional liability Insurance=188

Professional Liability Insurance=188

Insurance Policies=189

Types of Policies=189

EXERCISE 10-1=190

Declarations=190

Coverage Agreements=190

Limits and Deductibles=190

Additional Clauses in Insurance Policies=190

EXERCISE 10-2=192

Licensure Protection=195

Individual Versus Employer Liability Coverage=195

EXERCISE 10-3=196

Reasons to Purchase Individual Liability Insurance=196

Arguments for Having Professional Liability Insurance=196

Summary=197

Apply Your Legal Knowledge=197

You Be the Judge=198

References=198

PART 4. Impact of the Law on the Professional Practice of Nursing

Chapter 11. Nurse Practice Acts, Licensure, and the Scope of Practice=199

Credentials=200

Professional Licensure=200

State Boards of Nursing=200

Mandatory Licensure=201

Permissive Licensure=201

Institutional Licensure=202

EXERCISE 11-1=202

Nurse Practice Acts=202

EXERCISE 11-2=203

Elements of Nurse Practice Acts=203

Definition of Professional Nursing=203

Requirements for Licensure=204

Exemptions=204

Licensure Across Jurisdictions=205

Disciplinary Action and Due Process Requirements=206

EXERCISE 11-3=211

Penalties for Practicing Without a License=211

Diversion Programs=211

EXERCISE 11-4=212

Articulation with Medical Practice Acts=213

Scope of Practice Issues=213

Updating Nurse Practice Acts=215

Continuing Education for Practicing Nurses=216

Reporting Professional Violations of the Nurse Practice Act=216

Certification=217

EXERCISE 11-5=217

Complementary and Alternative Medicine=218

Medicinal Use of Cannabis (Marijuana)=218

Mutual Recognition Compacts=219

Some Ethical Concerns=220

Summary=221

Apply Your Legal Knowledge=221

You Be the Judge=221

References=222

Chapter 12. Advanced Nursing Practice Roles=224

Historical Overview of Advanced Nursing Practice Roles=225

Nurse Anesthetist=225

Nurse Midwifery=225

Advanced Nurse Practitioners=226

Clinical Nurse Specialist=226

Clinical Nurse Leader=227

Doctor of Nursing Practice=228

EXERCISE 12-1=228

Legal Liability of Expanded Nursing Roles=228

Scope of Practice Issues=228

Reimbursement Issues=230

Malpractice Issues=231

Standards of Care=231

EXERCISE 12-2=235

Prescriptive Authority=235

Admitting (Hospital) Privileges=235

EXERCISE 12-3=236

Direct Access to Patient Populations=236

Statute of Limitations=236

Ethical Perspectives and Advanced Nursing Practice=237

EXERCISE 12-4=237

Summary=237

Apply Your Legal Knowledge=238

You Be the Judge=238

References=238

Chapter 13. Corporate Liability Issues and Employment Laws=240

Theories of Vicarious Liability=241

Respondeat Superior=241

Scope and Course of Employment=242

EXERCISE 13-1=244

Borrowed Servant and Dual Servant Doctrines=244

Corporate Liability=244

Negligent Hiring and Retention=245

Ostensible Authority=246

Subjectivism=246

Inherent Function=246

Reliance=246

Control=246

Theories of Independent Liability=246

Independent Contractor Status=246

Personal Liability=247

Indemnification=247

EXERCISE 13-2=247

Employment Laws=247

Equal Employment Opportunity Laws=248

EXERCISE 13-3=253

Federal Torts Claims Act of 1946=253

Age Discrimination in Employment Act of 1967=253

Rehabilitation Act of 1973=254

Affirmative Action=254

Occupational Safety and Health Act=255

Employment-at-Will and Wrongful Discharge=256

EXERCISE 13-4=258

EXERCISE 13-5=261

Collective Bargaining=262

Case Law and the National Labor Relations Act=265

EXERCISE 13-6=267

Family and Medical Leave Act of 1993=267

Workers' Compensation Laws=269

EXERCISE 13-7=270

Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act=270

Ethical Concerns in This Area of the Law=270

Summary=271

Apply Your Legal Knowledge=272

You Be the Judge=272

References=272

Chapter 14. Federal Laws : The Americans with Disabilities Act of 1990 and the Civil Rights Act of 1991=275

The Americans with Disabilities Act of 1990=276

Background of the Act=276

Definitions in the Act=276

EXERCISE 14-1=277

Exclusions from the Definition of Disability=277

Provisions of the ADA=277

Title I=277

Title II=278

Title III=278

Title IV=278

Title V=278

Lawsuits Under the ADA=278

Disability Discrimination=278

Reasonable Accommodation=282

EXERCISE 14-2=284

Essential Job Functions=284

EXERCISE 14-3=285

Cases Under Titles III and IV=286

Enforcement of the ADA=286

ADA Summary=287

EXERCISE 14-4=287

Civil Rights Act of 1991=288

Background of the Act=288

Definition of Sexual Harassment=288

Quid Pro Quo Sexual Harassment=288

Hostile Work Environment=288

Preferential Treatment or Sexual Favoritism=291

EXERCISE 14-5=291

Ethical Concerns=291

Summary=291

Apply Your Legal Knowledge=292

You Be the Judge=292

References=292

Chapter 15. Nursing Management and the Nurse-Manager=294

Liability=295

Causes of Malpractice for Nurse-Managers=296

Duty to Orient, Educate, and Evaluate=297

Failure to Warn=298

Hiring Practices=299

EXERCISE 15-1=299

Staffing Issues=299

Adequate Numbers of Staff=299

EXERCISE 15-2=301

Float Staff=303

Agency Personnel=305

EXERCISE 15-3=307

Policies and Procedures=307

Contract Principles=307

Legal Elements of a Contract=308

Types of Contracts=308

EXERCISE 15-4=309

Termination of a Contract=309

Alternative Dispute Resolution=311

Mediation=311

Arbitration=311

Fact Finding=311

Summary Jury Trial=311

Nurses and Contracts=311

EXERCISE 15-5=312

Contracts that Arise After Employment=312

Ethical Issues=312

Summary=313

Apply Your Legal Knowledge=313

You Be the Judge=313

References=314

Chapter 16. Delegation. Supervision, and Patient Advocacy=315

Delegation, Assignment, and Supervision=316

EXERCISE 16-1=318

Principles of Effective Delegation=319

Unlicensed Assistive Personnel=320

EXERCISE 16-2=321

Patient Advocacy=323

EXERCISE 16-3=326

EXERCISE 16-4=327

Ethical Considerations=328

Summary=329

Apply Your Legal Knowledge=329

You Be the Judge=329

References=330

PART 5. Impact of the Law on Nursing in Selected Practice Settings

Chapter 17. Nursing in Acute Care Settings=331

Acute Care Nursing=332

Patient Safety=332

Psychiatric and Vulnerable Patients=332

Suicide Prevention=333

EXERCISE 17-1=336

Warning of Intent to Harm=336

Failure to Protect from Harm=337

False Imprisonment/Wrongful Commitment=340

Level of Care Required=341

Confidentiality Right of Mentally Ill Patients=341

EXERCISE 17-2=341

Restraints=342

EXERCISE 17-3=345

Medication Errors=346

Incorrect Patient=346

Incorrect Dosage, Medication, or Incorrect Route of Administration=346

Improper Injection Technique=348

Incorrect Time of Administration=348

Failure to Note Patient Allergies=348

Inaccurate Knowledge Regarding the Medication and Its Side Effects=348

EXERCISE 17-4=349

Failure to Document Appropriately=349

Patient Falls=350

EXERCISE 17-5=352

Technology and Equipment=352

Failure to Adequately Assess, Monitor, and Communicate=353

Failure to Monitor=353

Failure to Assess and Notify=354

EXERCISE 17-6=357

Failure to Listen and Communicate with Patients=358

Communicating with Culturally and Ethnically Diverse Individuals=358

EXERCISE 17-7=360

Failure to Act as a Patient Advocate=360

Patient Education=360

Ethical Issues in Acute Care Settings=360

Summary=361

Apply Your Legal Knowledge=362

You Be the Judge=362

References=362

Chapter 18. Nursing in Ambulatory and Managed Care Settings=366

Ambulatory Care Nursing=367

Patient Education=367

Distance Delivery of Health Care=368

EXERCISE 18-1=371

Violence=372

EXERCISE 18-2=373

Volunteer Services=373

Donating Health-Related Advice=374

Managed Health Care Organizations=376

EXERCISE 18-3=377

Patient-Centered Medical Home Model=378

Legal Issues Surrounding Managed Care=379

Employment Retirement Income Security Act=379

EXERCISE 18-4=380

Gag Rules and End-of-Year Profit Sharing=380

Standards of Care=381

Emergency Medical Treatment and Labor Act=382

EXERCISE 18-5=385

EXERCISE 18-6=387

EXERCISE 18-7=389

Antitrust Issues in Managed Care=389

Patient Rights=390

EXERCISE 18-8=392

Ethical Issues in Ambulatory and Managed Health Care=392

Summary=393

Apply Your Legal Knowledge=393

You Be the Judge=393

References=394

Chapter 19. Public and Community Health Care=396

Overview of Public and Community Health Nursing=396

Federal Statutes=397

Social Security Act of 1935=397

Public Health Service Act of 1944=397

Legal Responsibilities=397

Public and Community Health Nursing=397

Home Health Care=398

State Legislation=400

EXERCISE 19-1=400

Standing Orders=401

Contract Law=401

EXERCISE 19-2=403

Confidentiality=403

Refusal of Care=404

Agency Policies=404

Malpractice and Negligence=405

Patient Education=406

EXERCISE 19-3=406

Parish Nursing=407

Occupational Health Nursing=407

EXERCISE 19-4=408

School Health Nursing=408

Correctional Nursing=410

EXERCISE 19-5=413

Disaster Nursing=413

Selected Ethical Issues=414

Summary=415

Apply Your Legal Knowledge=415

You Be the Judge=416

References=416

Chapter 20. Nursing in Long-Term Care Settings=418

Long-Term Care Settings=419

Nursing Homes=419

Assisted Living Centers=419

Hospice Nursing Centers=419

Elder Day Care Centers=420

Nursing Home Reform Act of 1987=420

EXERCISE 20-1=422

Long-Term Care Nursing : Providing Quality Care=422

Falls and Restraints=423

EXERCISE 20-2=425

Skin and Wound Care=425

EXERCISE 20-3=426

Nutrition and Hydration=427

Patient Safety Issues=428

Resident Transfers=430

EXERCISE 20-4=430

Duty to Assess, Monitor, and Communicate=431

Intentional and Quasi-Intentional Torts=431

Involuntary Discharge=432

End-of-Life Care and Patient Education=433

Elder Abuse=433

EXERCISE 20-5=438

Selected Ethical Issues in Long-Term Care=438

Summary=439

Apply Your Legal Knowledge=439

You Be the Judge=439

References=440

Index=442

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For courses in nursing ethics and law in nursing programs at all levels.

Fully updated, revised, and expanded, the new edition of Legal and Ethical Issues in Nursing reflects current and emerging influences of the law, legal issues, and ethical issues on nursing practice. It addresses the expanding autonomous roles of nurses at all levels of education and licensure, and in all settings. It also reflects innovative health care delivery models, as well as new federal and state laws, including the ACA. This edition's new ethical scenarios more realistically integrate ethics with personal legal accountability, and encourage deeper reflection on connections between law and ethics. Popular features from previous editions are retained, including chapter previews, objectives, key terms, application exercises, guidelines, chapter summaries, and "You Be the Judge" features at the end of each chapter.