LEGAL AND ETHICAL ISSUES IN MATERNAL-NEWBORN NURSING AND WOMENS HEALTH

Introductionhttp://www.youtube.com/watch?v=serV18MirGgQuote for the Day:Get involved... The world is run by those who show up!"

Legal and Ethical Issues in Maternal/Newborn and Womens HealthDeveloped by D. Ann Currie,R.N.,M.S.N.2012LEGAL CONSIDERATIONSGENERAL LEGAL CONCEPTSARENAS FOR CONSIDERATIONLITIGATIONRISK MANAGEMENTQUALITY ASSURANCEDOCUMENTATIONCLINCAL EXAMPLES OF COMMON LEGAL ISSUESGENERAL LEGAL CONCEPTSLAW CAN BE DEFINED ASTHOSE RULES MADE BY HUMANS WHICH REGULATE SOCIAL CONDUCT IN A FORMALLY PRESCRIBED AND LEGALLY BINDING MANNER.(BERNZWEIG)FUNCTIONS OF THE LAW IN NURSINGTHE LAW SERVES A NUMBER OF FUNCTIONS IN NURSING:IT PROVIDES A FRAMEWORK FOR ESTABLISHING WHICH NURSING ACTIONS IN THE CARE OF THE CLIENTS ARE LEGALIT DIFFERENTIATES THE NURSESRESPONSIBILITIES FROM THOSE OF OTHER HEALTH PROFESSIONALCONT. FUNCTIONSIT HELPS ESTABLISH THE BOUNDARIES OF INDEPENDENT NURSING ACTION.IT ASSISTS IN MAINTAINING A STANDARD OF NURSING PRACTICE BY MAKING NURSES ACCOUNTABLE UNDER THE LAW.SOURCES OF LAWCONSTITUTIONLEGISLATION (STATUTES)COMMON LAWTYPES OF LAWSPUBLIC LAW- CRIMINAL LAWPRIVATE LAW-CIVIL LAWCONTRACT LAWTORT LAWARENAS OF LEGAL CONSIDERATIONPERSONAL PROFESSIONAL PRACTICECLIENT CARE AND ADVOCACYLEGAL CONSIDERATIONS IN PERSONAL PROFESSIONAL PRACTICESCOPE OF PRACTICESTANDARDS OF CARELICENSURECOLLECTIVE BARGAININGSCOPE OF PRACTICETHE NURSE PRACTICE ACT----BROAD DEFINITION OF PERMISSIBLE BOUNDARIES OF PRACTICE WITHIN A STATE.DISTINGUISHES NURSING PRACTICE FROM THE PRACTICE OF OTHER HEALTH PROFESSIONALSSCOPE OF PRACTICEEXCLUDES UNTRAINED OR UNLICENSED INDIVIDUALS FROM PRACTICING NURSING.RULES AND REGULATIONS PROMULGATED BY STATE BOARDS OF NURSING PROVIDE OFFICIAL INTERPRETATION OF NURSING ACTS.SCOPE OF PRACTICECORRECT INTERPRETATION AND UNDERSTANDING OF STATE PRACTICE ACTS ENABLES THE NURSE: TO PROVIDE SAFE CARE WITHIN THE LIMITS OF NURSING PRACTICE AND TO AVOID THE RISK OF BEING ACCUSED OF PRACTICING MEDICINE WITHOUT A LICENSEREAD AND KNOW THE NURSE PRACTICE ACT ****.STANDARDS OF CAREDEFINITION:MINIMUM CRITERIA FOR COMPETENT,PROFICIENT DELIVERY OF NURSING CARE.USED TO EVALUATE THE QUALITY OF CARE PROVIDEDFORMULATED FROM SKILLS AND KNOWLEDGE COMMONLY POSSESSED BY MEMBERS OFCONT.A PROFESSION.NURSES.IDENTIFY HEALTH,DEMOGRAPHIC,ENIRONMENTAL,AND PSYCHOSOCIAL PARAMETERS OF CAREREFLECTS CURRENT KNOWLEDGE IN THE FIELD,AND,THEREFORE,ARE DYNAMIC AND SUBJECT TO CHANGE.USES OF STANDARDS OF CARECRITERION FOR DETERMINING IF A NURSE HAS VIOLATED THE STATE -NURSE PRACTICE ACT.CRITERION FOR DETERMINING IF A NURSE HAS VIOLATED STATE OR CITY CRIMINAL CODESCRITERION ELEVATING NURSING PRACTICE TO A PROFESSIONAL LEVEL.INTERNAL STANDARDS OF CAREINDIVDUALINSTITUTIONALSET BY ROLE AND EDUCATION OF THE NURSE: JOB DESCRIPTION,EDUCATION,AND EXPERTISESET BY INDIVIDUAL INSTITUTIONS: POLICIES AND PROCEDURES.EXTERNAL OR NATIONAL STANDARDS OF CAREEXTERNAL BECAUSE THEY SUPERCEDE INDIVIDUAL PRACTITIONERS AND INSTITUTIONS.BROADER THAN LOCALITY RULES: STANDARDS OF CARE VEIWED FROM THE PERSPECTIVE OF CARE WITHIN A GEOGRAPHIC AREA.CONT. EXTERNAL STANDARDS OF CAREBASED ON REASONABLENESS AND AVERAGE DEGREE OF SKILL,CARE, AND DILIGENCE PRACTICED BY MEMBERS OF THE PROFESSION ACROSS THE NATION.NURSES IN A VARIETY OF SETTINGS AND LOCALS MUST MEET THE SAME STANDARDS: HOMES,BIRTHING CENTERS,HOSPITALS ETC.CONT. ETERNAL STANDARDS OF CARESTANDARDS ESTABLISHED BY:STATE BOARDS OF NURSING THROUGH NURSE PRACTCE ACTS OR PROMULGATED RULES AND REGULATIONS.PROFESSIOAL ORGANIZATIONS: ANA,ICN,OR CONGRESS FOR NURSING PRACTICE.CONT. EXTERNAL STANDARDS OF CARESPECIALITY NURSING ORGANIZATIONS:AWHONN,NANN, ACNM.FEDERAL ORGANIZATIONS AND GUIDELINE: JCAHO AND MEDICARE RULES.STANDARD OF CARE NEGLIGENCE AND MALPRACTICENEGLIGENCE- IT IS OMITTING AN ACT OR DEVIATION FROM THE STANDARD OF CARE THAT A REASONABLY PRUDENT PERSON WOULD NOT OMIT OR COMMIT UNDER SIMILAR CIRCUMSTANCES.MALPRACTICE- IT IS A NEGLIGENT ACTION OF A PROFESSIONALELEMENTS OF NEGLIGENCETHERE WAS A DUTY TO PROVIDE CARE.THE DUTY WAS BREACHED.INJURY OCCURRED.THE BREACH OF DUTY CAUSED INJURYEXAMPLES OF NEGLIGENCEEXAMPLES OF OMISSION: FAILING TO GIVE A MEDICATION, FAILING TO ASSESS PROPERLY,FAILING TO NOTIFY A PHYSICIAN OF A CHANGE IN A CLIENTS CONDITION OR STAUS.EXAMPLES OF COMMISSION:GIVING WRONG MEDICATION OR TO WRONG CLIENTCONT.PLACING INFANT IN WRONG CRIB OR GIVING INFANT TO WRONG MOTHER.CONT.NURSES NOT MEETING APPROPRIATE STANDARDS OF CARE COULD BE SUBJECT TO ALEGATIONS OF NEGLIGENCE OR MALPRACTICE.NURSES RESPONSILITY IN PREVENTING NEGLIGENCE AND MALPRACTICEOBTAIN AND MAINTAIN CURRENT INFORMATION REGARDING THE STATE NURSE PRACTICE ACT- GET A COPY AND READ IT AND KNOW IT..READ PUBLICATION FROM THE STATE (BON), VISIT WEB SITE FOR BNE INFORMATION AND ATTEND BNE WORKSHOPS.CONT. NURSE RESPONSIBLITYOBTAIN AND MAINTAIN CURRENT INFORMATION ON INTERNAL AND EXTERNAL STANDARDS OF PRACTICE,SEEK CONTINUING EDUCATION TO REMAIN CURRENT IN SPECALITY AREAS USE THE NURSING PROCESS WHEN GIVING CLIENT CARE.CONT. NURSES RESPONSIBILITY

DEVELOPE A POSITIVE, EMPOWERING RELATIONSHIP WITH CLIENTS---SEE CLIENTS AS AN IMPORTANT MEMBER OF THE HEALTH TEAM.BE THROUGH IN COMPLETING AND REPORTING ASSESSMENTS AND IMPLEMENTING CARE.

CONT NURSES RESPONSIBLITYMAINTAIN CLEAR, CONCISE, ACCURATE, COMPLETE, AND LEDGIBLE DOCUMENTATION.QUESTION APPROPRIATENESS OF CARE WHEN HARM CAN BE DONE TO CLIENT.CHECK MEDICAL ORDERS FREQUENTLY.USE CHAIN OF COMMAND.LEGAL CONSIDERATIONS FOR CLIENT CAREHEALTHCARE REFORMMANAGED CARESHORTENED HOSPITAL STAYSUNLICENSED ASSISTIVE PERSONNNEL(UAP)NURSES ROLE AS CLIENT ADVOCATE.Healthcare reformThe USA leads the world in healthcare spending, yet has one of the highest infant mortality rates among the industrialized nations..One of the primary factors related to infant mortality(deaths under one year of age per 1000 live births) is an increase in the delivery of low birth weight infants, which is linked to lack of prenatal care.Healthcare ReformBarriers to access to prenatal care 1) Costs of health care2) Limited financial resources 3)Uncoordinated service systems 4) Individual behaviors and beliefs concerning health care 5)Bureaucratic obstacles, such as complicated, lengthy forms for Medicaid33HEALTHCARE REFORMBarriers to prenatal care 6) Unavailability of maternal services in certain parts of the country 7) Underfunded and overcrowded publicly supervised clinics 8) Difficulty in recruiting and retaining healthcare providers in publicly subsidized clinicsHealthcare reformBarriers to prenatal care9) Lack of coordinated services for needy individuals 10) Inaccessibility to prenatal services because of transportation, location, and lack of child care facilities.11) Other.HEALTHCARE REFORMFederal and state governments, through policies and legislation, have begun to implement strategies to resolve these barriers by:1) Broadening health insurance coverage for childbearing women and infants2) Improving coordination and funding of public programsHealthcare Reforms

3) Simplifying bureaucratic procedures 4) Increasing the number of maternity care providers 5) Establishing a national council on children and health6) Raising public awareness throughout the country7) Other..HEALTHCARE REFORMNEED TO CONTINUE to seek reform to further control costs, improve access to healthcare, and improve quality of healthcareMANAGED CAREPrivate sector solution for decreasing healthcare costs1) Health insurance plans that combine: delivery of healthcare services, financing of those services, controlling the use of services.2) Philosophy of managed care organizations includes:

Managed CareCont. Health promotion and disease prevention, desire to avoid serious disease and costly treatment services 3)To meet expenses and make a reasonable profits 4) Creates a climate in which providers have: little time and few resources with which to provide care and financial MANAGED CARECONT. -DISINCENTIVES FOR PROVIDERS TO GIVE ADEQUATE SERVICES TO THEIR CLIENTS.5) CONSEQUENCES : FEWER EXPENSIVE TESTS OR COSTLY PROCEDURS PERFORMED, SHORTENED HOSPITAL STAYS AND INCREASED USE OF UNLICENSED HEALTHCARE WORKERS.SHORTENED HOSPITAL STAYSDuring the early to mid-1990 hospital stays after birth were shortened to 24 hours or less.Consequently, there was not enough time for maternal and parental teaching regarding self care and infant care- problems in infant care and health developed, breast-feeding problems, and self care problems in the mothers.SHORTENED HOSPITAL STAYSSeveral states passed laws requiring longer stays for maternity and neonatal clients..U.S. Congress passed Senate Bill 969, the Newborns and Mothers Protection Act of 1996:1) Set a national standard requiring health insurance and employer-provided benefit plans to cover minimum hospital stay: 48hrs-vaginal delivery,SHORTENED HOSPITAL STAYS96 hrs for c/s, early discharge with home health care..within 24-72 hrs of discharge.2) Even with federal law mandating a longer postpartum stay, nurses are still responsible for: verbal and written instructions about infant and self-care, and s/s indicating problems and what to do, and f/u visit. In Texas nurses must teach about PP depression

SHORTENED HOSPITAL STAYSCont. evaluation of parents learning, recommending timely follow-up care, incliding a home visit,whenmom seems at risk after a longer stay.UNLICENSED ASSISTIVE PERSONNEL (UAP)UAPs are healthcare workers who have no defined body of knowledge or educational preparation upon which to base their practiceUncreditentialedNo state or federal regulatory body to validate their competence

UAPSNurses are responsible for the delegation of tasks to UAPssee Texas BON guidelines for delegation .UAPs can perform repetitive taskswhich are clearly defined and for which they have been trained.Nurses should obtain information on UAPs training and skills prior to delegating tasks.UAPSInappropriate delegation to UAPs increases the nurses liability and may jeopardize the nurses license.What should not be delegated to UAPs: Essential nursing processes of assessing,diagnosing of a problem, planning client care, implementing that care, and evaluating the outcomes.And judgements about client status.NURSES ROLE AS CLIENT ADVOCATEMaintain current information about issues critical to client care.Educate clients and other significant persons about such issuesBecome involved in the political process as an advocate for quality healthcare for all healthcare recipients.Other...LITIGATIONStatues of limitations:Maternal or Women Health Care Patients-2 yearsNeonate/Infant-Majority plus 2years- Texas Majority is 18years old plus 2year= 20 yearsLITIGATIONWhat to do if you receive a notice you are being suedDo not panicTalk and hire a your own lawyer. Dont talk to anyone except your lawyer. You may have to talk to your employers lawyer/s. But talk to your lawyer first.You must notify the Texas BONDo not lie, change chart, or talk too muchFollow your lawyers advise.

RISK MANGEMENTIt is to help improve the patient-care and /or environment of the hospital or organization and safety of patients, visitors, and/or employee.Incident/Variance reports do not chart in Nursing Notes you did oneQUALITY IMPROVEMENTA System to Improve Patient CareExamples of QI in Maternal/Newborn Care and Womens Health Care Areas.ID of mother/baby couplet.Documentation of Pain ManagementNurse to Nurse Reports or handoffTime out prior to Cesarean sections or Bilateral Tubal LigationsDOCUMENTATIONA nurses best friend or worst nightmare.What is important in Nursing DocumentationGood spelling and grammarClear, Concise, and CompleteFacts and DataUse the Systematic problem solving process(Nursing Process), know and use Standards of Care, and legal requirements.CLINICAL EXAMPLES OF LEGAL ISSUESOxytocin administrationNonreassuring Fetal Heart Rate PatternsBad patient outcomes for patients-mother, baby, or woman.Other.

ETHICAL CONSIDERATIONSETHICS IS BASED ON A RESPONSIBILITY OR DUTY MODEL EXAMINING WHAT OUR BEHAVIOR OUGHT TO BE IN RELATION TO OURSELVES, OTHER HUMAN BEINGS,AND THE ENVIRONMENTETHICSETHICS INCORPORATES FACTORS SUCH AS: RISKS.BENEFITS,OTHER RELATIONSHIPS, CONCERNS, AND THE NEEDS AND ABILITIES OF PERSONS AFFECTED BY AND AFFECTING DECISIONS.IT IS SUBJECT TO PHILOSOPHICAL, MORAL, AND INDIVIDUAL INTERPRETATIONS.ETHICAL PRINCIPLES SHOULD BE USE IN CLINICAL PRACTICERESPECTAUTONOMYBENEFICENCENONMALEFICENCEVERACITY: DUTY TO TELL THE TRUTHCONT. ETHICAL PRINCIPLESFIDELITY: DUTY TO KEEP ONES PROMISEJUSTICECONFIDENTIALITYINFORMED CONSENTUNIVERSALITYETHICAL DECISION-MAKING FRAMEWORKMORALM:ESSAGE THE DILEMMAO:OUTLINE THE OPTIONSR:RESOLVE THE DILEMMAA:ACT BY APPLYING THE CHOSEN OPTIONL:LOOK BACK AND EVALUATE THE ENTIRE PROCESSMORALM: MESSAGE THE DILEMMAIDENTIFY AND DEFINE ISSUES IN THE DILEMMADETERMINE WHO OWNS THE PROBLEM,THE INFORMATION,THE DECISION, AND THE CONSEQUENCES OF IT.CONT. MESTABLISH THE FACTS AS BEST AS POSSIBLE.CONSIDER THE OPTIONS,VALUES, AND MORAL POSITION OF THE MAJOR PLAYERS.IDENTIFY VALUE CONFLICTS.O: OUTLINE THE OPTIONSEXAMINE ALL OPTIONS FULLY,INCLUDING THE LESS REALISTIC AND CONFLICTING ONESIDENTIFY PROS AND CONS OF ALL THE OPTIONSFULLY COMPREHEND THE OPTIONS AND ALTERATIVES AVAILABLE/R: RESOLVE THE DILEMMA

REVIEW THE ISSUES AND OPTIONSAPPLY ETHICAL PRINCIPLES TO EACH OPTIONDECIDE THE BEST OPTION FOR ACTION ON THE VIEWS OF ALL THOSE CONCERNED

A: ACT BY APPLYING THE CHOSEN OPTIONIMPLEMENT THE CHOSEN OPTIONL: LOOK BACK AND EVALUATE THE ENTIRE PROCESSINCLUDING IMPLEMENTATION.ENSURE THAT ALL THOSE INVOLVED ARE ABLE TO FOLLOW THROUGH ON THE FINAL OPTIONREVISE THE DECISION AS INDICATED,STARTING THE PROCESS WITH THE INITIAL STEP.WHERE TO GET HELP TO MAKE AN ETHICAL DECISION.Ethics committee in your organizationhospital.ClergyEthics depart.Text...ETHICAL CONSIDERATIONS IN MATERNITY NURSINGASSISTED REPRODUCTIONABORTIONFETAL OR EMBRYO RESEACHCORD BLOOD BANKINGTHE HUMAN GENOME PROJECTGENETIC COUNSELINGFETAL RIGHTS VERSUS MATERNAL RIGHTSNURSES RESPONSPONSIBLITIESLearn to anticipate ethical dilemmasIdentify attitudes,values, and beliefs about ethical dilemmas taking into consideration the influence of cultural,religious, and social factors on the development of values.Recognize the influence personal values have on care provided for clients by engaging in self-values clarification activities.

NURSESRESPONSIBILTIESReview and update theoretical bases: gather current information on technological advances and changing trends in maternity nursing, review ethical principles and practice codes in regard to new technology and trends, become familiar with the clients knowledge base by reading lay literature related to maternity and neonatal advancesNURSES RESPONSIBILTIESAttend cont. ed. Programs related to ethical issues and decision making-- participate in ethics committees with other healthcare professionals and inservice peers on ethical issues and decision making.Review research journals regarding current trends in ethical decision making .comparing and contrasting the results with what is occurring in the clinical practice.NURSES RESPONSIBILITESEvaluate current social norms by following social,legal,religious, and political debates that may influence clinical decision making and quality care for clients experiencing dilemmas in the maternal, neontal, or womens health areas.Avoid judgements about the life decisions of others.NURSESS RESPONSIBILITIESAim to accept the values of others and their decisions regarding issues and provisions of care.Dont allow personal beliefs and values to interfere with provision of quality care.Understand the legal implications of the issuesDevelop appropriate strategies for ethical decision making.QUESTIONS

THANK YOUhttp://www.youtube.com/watch?v=74J8Dl2ib-s&feature=related

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