E3

• Healthcare Law


  Legislation and regulation pertaining to delivery of health care and nursing practice
• Where do we get healthcare laws from?


  • Constitution (Federal & State)
  • Legislation (Legislative)
  • Administrative Law and Regulations (Executive)
  • Litigation (Judicial Branch)
• Constitution


  • Establishes governments & delineates rights & obligations of government and individuals. Federal Constitution restrains government more than it confers individual rights. Bill of Rights specifically guarantees several important rights.
• Legislation


  • The creation of law through the federal or state legislatures. Also known as statutory laws.
• Administrative Law and Regulations


  • Specific rules that promote & enforce legislative policy. Regulatory agencies are given the authority to create & enforce specific laws. Nurse Practice Act creates the BON.
• Litigation


  • The process of filing a lawsuit and seeking the help of the courts to redress a perceived wrong. Judicial branch makes decisions or establishes rules, creating case law.
• Case Law


  • Right to Die (Karen Ann Quinlan, 1977)
  • Abortion Rights (Roe v Wade)
• Federal Healthcare Laws


  • US Constitution
  • Social Security Act
  • EMTALA
  • ADA
  • Patient-Self Determination Act
  • HIPPA
  • ACA
• Social Security Act


  Gives the government a little power to regulate healthcare
• EMTALA


  Emergency medical treatment& active Labor Act. Cannot assess wallet first, triage & stabilize ALWAYS.
• ADA


  Americans with Disabilities: Ramps, elevator, brail. Accessibility!
• Patient-Self Determination Act


  Required to ask for advanced directives or if they want one.
• HIPPA


  Health insurance; Privacy & Portability Act- providing patient privacy.
• ACA


  "Obama Care" easily accessible HC; improve affordability & medical records.
• State Healthcare Laws


  • Nurse Practice Act
  • Licensing
  • Public Health & Disease Prevention
  • Good Samaritan Law
  • Consent
  • Advanced Directives
• Nurse Practice Act


  • Creates Board of Nursing. Nursing scope of practice. Types of titles & licenses. Education program standards.
• Licensing


  Of providers and facilities (scope of practice)
• Public Health & Disease Prevention


  • Dept. of Health (DOH). Disease surveillance. Disaster preparedness.
• Good Samaritan Law


  Protect healthcare workers when they help in an emergency if it is within your scope (outside of healthcare setting/ in the streets).
• Consent


  • Self-determination- have the right to make decisions about their body
  • Privacy & protection- against actions of others
  • Informed Consent - education; translator, pt has right to ask questions & refuse, must be competent & have capacity to make a decision
• Advanced Directives


  Required to ask & obtain from each patient. DNR, DNI. Right to refuse treatment & right to appoint someone to make decisions for them.
• Tort Law


  • Negligence
  • Malpractice
• Negligence


  Conduct that falls below the standard of care. Can include acts of commission & omission. Can be held liable for not meeting appropriate standards of care.
• Malpractice


  Required criteria: Owed the patient a duty/standard of care, Breached the duty/standard to provide adequate care, Caused injury to the patient (causation), Caused an injury that resulted in damages.
• Ways to protect yourself


  • Know your policies
  • Safe harbor
  • Professional liability insurance
• Pitfalls in practice


  • Assault/battery
  • False imprisonment
  • Fraud
• Ethics


  The study or examination of morality through a variety of different approaches. The values, virtues, principles, and polices that guide moral delivery of health care. Laws, principles, beliefs, and moral reasoning at individual, organizational, & societal level.
• Categories of Ethics


  • Societal
  • Organizational
  • Bioethics/clinical
  • Professional
  • Personal
• Societal Ethics


  • Behavior commonly accepted/practiced within a group. Basis of acceptable & unacceptable behavior. Influenced by laws and regulations. Examples: clinical standards of care, negligence, malpractice, and liability.
• Organizational Ethics


  • Guides actions within an organization. Formal and informal values. Directs all aspects of an organization: actions, behaviors, decisions.
• Bioethics/Clinical Ethics


  • Bioethics: involved in biological sciences and technology. Clinical: involved in patient care decisions in action (bedside). Research: ethics as it applies to research (on humans and animals).
• Professional Ethics


  • Standards and expectations of a particular profession. Nurses held to higher standard. Code of conduct. Ethical Committee.
• Personal Ethics


  • Major overlap with other categories. Usually where a conflict can evolve. Not permanent, they can change over time. Must be able to separate your own bias and beliefs.
• Ethical Analysis & Decision Making


  1. Identify existence of ethical dilemma

  2. Gather and analyze relevant information including stakeholders, collaborators, patients, family, provider

  3. Clarify and identify personal bias

  4. Determine options (alternative, risks, etc.)

  5. Select best option & collaborate on decision before implementing

  6. Evaluate impact
• Ethical Principles


  • Autonomy
  • Beneficence
  • Nonmaleficence
  • Justice
  • Fidelity
  • Veracity
• Autonomy


  Right to self-determination. Help patients make their own decisions about their care.
• Beneficence


  Do what is best for your patient. Act in their best interest, promote welfare.
• Nonmaleficence


  Avoid causing any harm to patients and anyone else as much as possible. (Do no harm)
• Justice


  To treat people equal, fair, & appropriately. Offer everyone the same treatment & care regardless of barriers.
• Fidelity


  Keep promises, fulfill expectations, perform your duties, be trustworthy.