Foundations of Nursing 1

Subtopic:

Nursing and the Law

Contents

A medico-legal case (MLC) occurs when someone is injured or has a health problem, and the police need to investigate to determine what happened and who is responsible.

Learning Objectives

  • Understand the importance of legal frameworks in nursing, including protection of public and patient safety.
  • Distinguish between criminal, civil, and tort law in healthcare contexts.
  • Identify examples of intentional and unintentional torts relevant to nursing practice.
  • Recognize legal liabilities such as negligence, fraud, and breach of confidentiality.
  • Comprehend patient rights and nurse responsibilities in medico-legal cases.
  • Define the roles and legal boundaries for various healthcare professionals (e.g., doctors, nurses, midwives).
  • Apply legal knowledge to assess, manage, and advocate for patient care within scope of practice.
  • Respond to objective questions testing knowledge of legal concepts and professional boundaries.

Why Laws Matter to Nurses

Laws are important for nurses for several reasons. First, they protect the public by making sure only qualified people can practice nursing. Second, laws define what nurses are allowed to do and not do in their job. This also helps protect patients from harm. Understanding the law helps nurses handle legal situations effectively and helps the government decide who gets a nursing license and when to take it away if a nurse is very bad at their job or acts carelessly.

Types of Laws in Medico-legal Situations

There are different types of laws that come into play in medico-legal cases:

  • Criminal Law: This deals with actions that harm the community or society as a whole. The government brings charges against someone who breaks a criminal law. For instance, if a nurse steals drugs, the government might take them to court.
  • Civil Law: This focuses on the rights and responsibilities of individuals. It aims to provide compensation to someone who has been harmed by a healthcare worker. For example, if a nurse is careless and hurts a patient, the patient can sue the nurse to get money to cover the damage. Sometimes, the hospital or clinic where the nurse works might also be held responsible.
  • Tort Law/Crimes: These are wrongdoings that can be punished by law. There are two main types:

Intentional Torts: These are deliberate acts that cause harm. They can lead to both criminal and civil charges. Examples include:

Assault: Threatening to touch or treat someone without their permission. For example, giving an injection to a patient who said no. Patients have the right to refuse treatment at any time. Sexual assault by a healthcare worker is also an example.

False Detention: Holding someone against their will without a good legal reason or their consent. An example might be keeping someone in a medical facility when they shouldn’t be there.

Fraud: Lying on purpose to harm someone else. For example, saying you have qualifications you don’t when applying for a nursing job.

Unintentional Torts (Negligence): This happens when a healthcare worker doesn’t provide the expected level of care, which then hurts the patient. Examples include:

    • Giving the wrong medicine, giving it the wrong way, or giving the wrong amount.
    • Mistaking patients, such as preparing the wrong person for surgery, mixing up babies in the delivery room, or switching bodies in the morgue.
    • Not communicating important information about a patient’s condition, either verbally or in writing.
    • Keeping patient records poorly or not at all.
    • Forgetting surgical tools or sponges inside a patient’s body after surgery.
    • Losing or damaging a patient’s belongings or reputation.
    • Not doing what a reasonable nurse should have done, leading to harm.
    • Causing physical or mental harm to the patient.
    • Not reporting things like child abuse, sexual assault, or if a patient with a mental illness or infectious disease is being harmed.

Abandonment: Stopping a patient’s care without making sure they will get the same or better care from someone else.

Euthanasia (Mercy Killing): Intentionally killing someone to end their suffering, which is considered murder.

Breach of Scope of Practice: Doing things that you are not legally allowed to do as a nurse.

Breach of Confidentiality: Sharing a patient’s private information, like their medical history or treatment details, without their permission.

Patient Rights

For the best care, patients and healthcare providers need to work together. Patient rights are important for:

  • Making patients feel more secure and confident in healthcare settings.
  • Emphasizing the importance of a good relationship between patients and their caregivers.
  • Highlighting the patient’s role in staying healthy.

Here are some key patient rights:

  1. Patients have the right to clear and correct information about their health plan, except in emergencies.
  2. Patients have the right to know who the medical professionals are who are taking care of them.
  3. Patients have the right to be involved in making decisions about their health.
  4. Patients have the right to refuse any treatment or care plan. They should also be told what might happen if they refuse.
  5. If a patient can’t make decisions for themselves, their parents, guardians, or family members have the right to represent them.
  6. Patients have the right to be treated with respect and without discrimination by all healthcare staff, at all times.
  7. Patients have the right to privacy during discussions and consultations about their case. Examinations and treatments should protect their privacy.
  8. All conversations and medical records about a patient’s care must be kept private by the hospital or healthcare team.
  9. Patients have the right to see their medical records and have them explained if needed, unless the law restricts access.
  10. Patients have the right to choose healthcare providers who can give them good quality care.
  11. Patients have the right to complain about their care or ask for better care, both within the hospital and through outside organizations.
  12. Patients have the right to know the hospital’s rules about their care.

Healthcare Team Roles and Responsibilities

Medical Staff (Physicians)

Assessment: Doctors perform full health evaluations, including taking medical histories and doing physical exams. They screen for inherited conditions and preventable diseases. They assess, diagnose, and treat immediate health problems and manage long-term conditions.

Treatment/Management: Doctors provide ongoing care, treating everything from minor illnesses to life-threatening emergencies in various settings. They offer reproductive care, manage sexually transmitted diseases, and provide mental health and palliative care. They also care for patients in the hospital, offer advice to prevent illness, provide vaccinations, and manage chronic diseases. They maintain patient medical records and perform surgeries.

Education/Advocacy: Doctors counsel patients on health topics like birth control and disease prevention. They help patients navigate the healthcare system to get the best and most affordable care. They work with community partners to address the health needs of individuals and the wider community.

Referrals/Collaboration: Doctors help with discharge planning, connect patients with rehabilitation and home care services, and refer them to specialists or other services as needed. They work with mental health providers and refer patients to specialized facilities. They also report births, deaths, and contagious diseases to the government and participate in public health efforts.

Dentist

Dentists are primary healthcare providers for oral health for people of all ages. They diagnose, treat, manage, and coordinate care for patients’ oral health needs.

Registered Nurses (PNO, SPNO)

Assessment: Nurses assess patients’ overall health in all stages of life, including families and communities. They conduct health histories and physical exams, make nursing diagnoses, and understand how health issues affect families. They use assessment tools and can order and interpret basic lab tests, X-rays, ECGs, and ultrasounds.

Treatment/Management: Nurses initiate and manage care for patients with illnesses. They monitor patients with long-term stable conditions, providing medication, counseling, or other therapies. They can prescribe certain medications and use the best available evidence to guide their nursing care, always considering the patient’s perspective.

Education/Advocacy: Nurses identify the need for health promotion and disease prevention strategies for individuals, families, and communities. They provide health education and develop community programs that are sensitive to different cultures and age groups.

Referrals/Collaboration: Nurses consult with doctors or refer patients to other healthcare facilities when necessary.

Registered Nurses & Other Nursing Staff (RN, RPN)

Assessment: Nurses assess patients’ physical, emotional, mental, and spiritual health needs. They analyze assessment results, understand patient records, observe and record how patients are doing, and gather information by talking with patients.

Treatment/Management: Nurses decide on the right service or treatment, who should provide it, or what equipment is needed. They provide nursing care, including therapies and counseling. They help patients find and use health resources, involve them in decisions about their health, and encourage them to take care of themselves. They also create educational materials for other nurses and develop health education programs for patients and communities.

Referrals/Collaboration: Nurses work with other healthcare providers and coordinate patient care.

Midwives

Assessment: Midwives assess and monitor women during pregnancy, provide prenatal education, and order tests if needed.

Treatment/Management: Midwives deliver babies, give certain medications during delivery, manage labor, and perform normal vaginal deliveries. They can perform episiotomies (small cuts) and repair tears, but not those involving the anus or surrounding areas. They can also administer certain substances, take blood samples from mothers and newborns, insert urinary catheters, and prescribe specific medications. They monitor women after delivery and assess newborns.

Education/Advocacy: Midwives help women make informed choices about their care and where they want to give birth.

Referrals/Collaboration: Midwives arrange consultations or transfers to doctors if needed, assist in difficult deliveries, and report births to the government.

Dietitian

Dietitians are experts in nutrition. They help people stay healthy and fight illness through proper nutrition.

Assessment: Dietitians work with individuals to figure out their nutritional needs and conduct nutritional and weight assessments.

Treatment/Management: They develop personalized nutrition plans and provide counseling on nutrition and weight management.

Education/Advocacy: Dietitians promote healthy eating habits and teach people how to make better food choices. They encourage patients to make their own health decisions and lead workshops and seminars. They also work to improve community health through education and advocacy.

Referrals/Collaboration: Dietitians work with doctors on medication plans related to nutrition and share important nutritional information with other healthcare providers.

Pharmacists

Assessment: Pharmacists make sure they have all the necessary information about a patient. They review patient records for allergies, potential drug reactions, and other health issues. They evaluate a patient’s medications to identify and prevent any problems.

Treatment/Management: Pharmacists dispense medications prescribed by doctors and other healthcare professionals. They advise on how to use medications correctly, including dosages, side effects, and interactions. They also manage medication supplies.

Education/Advocacy: Pharmacists educate patients about their medications so they understand how to take them and stick to their treatment plan.

Referrals/Collaboration: Pharmacists refer patients to other healthcare providers if needed and communicate with doctors to ensure patients get the most benefit from their medications and to prevent errors.

Orthopedists (Foot Specialists)

Assessment: Orthopedists assess foot health by gathering information, examining the feet, reviewing medical history and test results. They evaluate how foot and ankle problems affect daily life.

Treatment/Management: They perform foot surgery, give injections in the feet, and prescribe medications. They can also perform surgery on the bones in the front of the foot if they have the right training. They diagnose foot disorders and take X-rays.

Education/Advocacy: They educate patients on preventing and managing foot problems related to chronic diseases like diabetes.

Referrals/Collaboration: They work with other healthcare professionals in hospitals and community settings. They receive referrals and consult with other practitioners to provide good patient care.

Community Health Worker

Community Health Workers (CHWs) connect patients with healthcare providers, especially helping those who have difficulty accessing care. They are members of the community who help identify problems and find solutions.

Assessment: CHWs perform initial intake assessments.

Treatment/Management: They help patients access services like housing, crisis support, and health education. They connect people with the right services, provide short-term crisis intervention, and track progress toward patient goals. They can also help with budgeting, healthy eating, problem-solving, and using public transportation. They support patients in following their treatment plans and finding employment or volunteer work. They also assist with personal care and finding and maintaining housing.

Education/Advocacy: CHWs advocate for patients’ rights and help them use available community services.

Referrals/Collaboration: They work with other professionals on aftercare plans and refer patients to community programs and mental health services.

Objective Questions on Nursing and the Law

1. Objective: To assess understanding of criminal law in nursing.

Question: Which of the following is an example of a criminal law violation by a nurse?

    • a) Administering the wrong medication by mistake
    • b) Stealing drugs from the hospital
    • c) Forgetting to document a patient’s vital signs
    • d) Misplacing a patient’s belongings

Answer: b) Stealing drugs from the hospital

Rationale: Stealing drugs from the hospital is a criminal law violation as it involves theft, which harms the community or society as a whole.

2. Objective: To evaluate knowledge of civil law in nursing.

Question: True or False: Civil law focuses on the rights and responsibilities of individuals and aims to provide compensation to someone who has been harmed by a healthcare worker.

Answer: True

Rationale: Civil law focuses on the rights and responsibilities of individuals and aims to provide compensation to someone who has been harmed by a healthcare worker.

3. Objective: To assess understanding of intentional torts in nursing.

Question: Which of the following is an example of an intentional tort?

    • a) Administering the wrong medication by mistake
    • b) Threatening to treat a patient without their permission
    • c) Forgetting to document a patient’s vital signs
    • d) Misplacing a patient’s belongings

Answer: b) Threatening to treat a patient without their permission

Rationale: Threatening to treat a patient without their permission is an example of assault, which is an intentional tort.

3. Objective: To evaluate knowledge of unintentional torts in nursing.

Question: True or False: Unintentional torts, such as negligence, occur when a healthcare worker does not provide the expected level of care, which then hurts the patient.

Answer: True

Rationale: Unintentional torts, such as negligence, occur when a healthcare worker does not provide the expected level of care, which then hurts the patient.

4.Objective: To assess understanding of patient rights to clear and correct information.

Question: Which scenario best illustrates Nakato’s right to clear and correct information?

    • a) Nakato is given a complex medical report without any explanation.
    • b) Nakato is provided with brochures and invited to ask questions about her condition.
    • c) Nakato is told to follow a treatment plan without any details.
    • d) Nakato is refused access to her medical records.

Answer: b) Nakato is provided with brochures and invited to ask questions about her condition.

Rationale: This scenario illustrates Nakato’s right to clear and correct information by ensuring she understands her condition and treatment plan through brochures and an invitation to ask questions.

5.Objective: To evaluate knowledge of patient rights to know their care team.

Question: True or False: Patients have the right to know who the medical professionals are who are taking care of them.

Answer: True

Rationale: Patients have the right to know who the medical professionals are who are taking care of them to feel more secure and confident in healthcare settings.

6.Objective: To assess understanding of patient rights to be involved in making decisions about their health.

Question: Which scenario best demonstrates Robert’s right to be involved in making decisions about his health?

    • a) Dr. Lubega makes all decisions without consulting Robert.
    • b) Robert is informed about treatment options and asked for his input.
    • c) Robert is given a treatment plan without any explanation.
    • d) Robert is not allowed to ask questions about his treatment.

Answer: b) Robert is informed about treatment options and asked for his input.

Rationale: This scenario demonstrates Robert’s right to be involved in making decisions about his health by being informed about treatment options and asked for his input.

7.Objective: To evaluate knowledge of patient rights to refuse treatment.

Question: True or False: Patients have the right to refuse any treatment or care plan and should be informed about the potential consequences.

Answer: True

Rationale: Patients have the right to refuse any treatment or care plan and should be informed about the potential consequences to make informed decisions about their health.

8.Objective: To assess understanding of representation for incapacitated patients.

Question: Who has the right to make decisions for Museveni, a young boy involved in a serious accident, who cannot make decisions for himself?

    • a) Museveni’s friends
    • b) Museveni’s parents, guardians, or family members
    • c) Museveni’s neighbors
    • d) Museveni’s teachers

Answer: b) Museveni’s parents, guardians, or family members

Rationale: If Museveni cannot make decisions for himself, his parents, guardians, or family members have the right to represent him.

9.Objective: To evaluate knowledge of patient rights to be treated with respect and without discrimination.

Question: True or False: Patients have the right to be treated with respect and without discrimination by all healthcare staff, at all times.

Answer: True

Rationale: Patients have the right to be treated with respect and without discrimination by all healthcare staff, at all times, to ensure high-quality care and a positive healthcare experience.

10.Objective: To assess understanding of patient rights to privacy during discussions and consultations.

Question: Which scenario best illustrates Namatovu’s right to privacy during discussions and consultations?

    • a) Dr. Lubega discusses Namatovu’s case in a crowded waiting room.
    • b) Dr. Lubega ensures the room is private and only necessary staff are present during a consultation.
    • c) A nurse shares Namatovu’s medical information with other patients.
    • d) Namatovu’s medical records are left unattended in a public area.

Answer: b) Dr. Lubega ensures the room is private and only necessary staff are present during a consultation.

Rationale: This scenario illustrates Namatovu’s right to privacy during discussions and consultations by ensuring the room is private and only necessary staff are present.

11.Objective: To evaluate knowledge of confidentiality of medical records.

Question: True or False: All conversations and medical records about Alex’s care must be kept private by the hospital or healthcare team.

Answer: True

Rationale: All conversations and medical records about Alex’s care must be kept private by the hospital or healthcare team to protect the patient’s privacy and maintain trust.

12.Objective: To assess understanding of patient rights to access their medical records.

Question: Which scenario best demonstrates Robert’s right to access his medical records?

    • a) Robert is denied access to his medical records without explanation.
    • b) Robert requests to see his medical records and Nurse Muwanga explains the results to him.
    • c) Robert’s medical records are shared with unauthorized individuals.
    • d) Robert is told he cannot see his medical records under any circumstances.

Answer: b) Robert requests to see his medical records and Nurse Muwanga explains the results to him.

Rationale: This scenario demonstrates Robert’s right to access his medical records by allowing him to see his records and have them explained by Nurse Muwanga.

13.Objective: To evaluate knowledge of patient rights to choose healthcare providers.

Question: True or False: Nakato has the right to choose healthcare providers who can give her good quality care.

Answer: True

Rationale: Nakato has the right to choose healthcare providers who can give her good quality care to ensure she receives the best possible treatment and feels confident in her healthcare decisions.

14.Objective: To assess understanding of the role of physicians in patient care.

Question: Which of the following is NOT a responsibility of physicians in patient care?

    • a) Performing full health evaluations
    • b) Providing ongoing care and treating illnesses
    • c) Developing personalized nutrition plans
    • d) Performing surgeries

Answer: c) Developing personalized nutrition plans

Rationale: Developing personalized nutrition plans is the responsibility of dietitians, not physicians.

15.Objective: To evaluate knowledge of the role of registered nurses in patient care.

Question: True or False: Registered nurses (PNO, SPNO) can order and interpret basic lab tests, X-rays, ECGs, and ultrasounds.

Answer: True

Rationale: Registered nurses (PNO, SPNO) can order and interpret basic lab tests, X-rays, ECGs, and ultrasounds as part of their assessment responsibilities.

 

16.Objective: To assess understanding of the role of midwives in patient care.

Question: Which scenario best illustrates the role of a midwife in patient care?

    • a) Dr. Lubega performs a full health evaluation on a pregnant woman.
    • b) Nurse Muwanga administers medication to a patient.
    • c) Midwife Namazzi delivers a baby and provides prenatal education.
    • d) Pharmacist Kato dispenses medication to a patient.

Answer: c) Midwife Namazzi delivers a baby and provides prenatal education.

Rationale: This scenario illustrates the role of a midwife in patient care by showing Midwife Namazzi delivering a baby and providing prenatal education.

17.Objective: To evaluate knowledge of the role of dietitians in patient care.

Question: True or False: Dietitian Nankya is responsible for developing personalized nutrition plans and providing counseling on nutrition and weight management.

Answer: True

Rationale: Dietitian Nankya is responsible for developing personalized nutrition plans and providing counseling on nutrition and weight management.

18.Objective: To assess understanding of the role of pharmacists in patient care.

Question: Which of the following is NOT a responsibility of pharmacists in patient care?

    • a) Dispensing medications prescribed by doctors
    • b) Advising on medication use, including dosages and side effects
    • c) Performing foot surgery
    • d) Managing medication supplies

Answer: c) Performing foot surgery

Rationale: Performing foot surgery is the responsibility of orthopedists, not pharmacists.

19.Objective: To evaluate knowledge of the role of orthopedists in patient care.

Question: True or False: Orthopedist Dr. Ssembatya is responsible for assessing foot health, performing foot surgery, and diagnosing foot disorders.

Answer: True

Rationale: Orthopedist Dr. Ssembatya is responsible for assessing foot health, performing foot surgery, and diagnosing foot disorders.

20.Objective: To assess understanding of the role of community health workers (CHWs) in patient care.

Question: Which scenario best illustrates the role of a community health worker in patient care?

    • a) Dr. Lubega performs a full health evaluation on a patient.
    • b) Nurse Muwanga administers medication to a patient.
    • c) CHW Namutebi helps a patient access housing and crisis support services.
    • d) Pharmacist Kato dispenses medication to a patient.

Answer: c) CHW Namutebi helps a patient access housing and crisis support services.

Rationale: This scenario illustrates the role of a community health worker in patient care by showing CHW Namutebi helping a patient access housing and crisis support services.

21.Objective: To evaluate knowledge of patient rights to complain about their care.

Question: True or False: Patients have the right to complain about their care or ask for better care, both within the hospital and through outside organizations.

Answer: True

Rationale: Patients have the right to complain about their care or ask for better care, both within the hospital and through outside organizations, to ensure their concerns are addressed and they receive high-quality care.

22.Objective: To assess understanding of patient rights to know hospital rules about their care.

Question: Fill in the blank: Patients have the right to know the hospital’s _______ about their care.

Answer: rules

Rationale: Patients have the right to know the hospital’s rules about their care to understand what to expect and ensure they receive appropriate treatment.

23.Objective: To evaluate knowledge of patient rights to be treated with respect.

Question: Which scenario best illustrates Nakato’s right to be treated with respect by healthcare staff?

    • a) Nakato is ignored by the healthcare staff when she asks a question.
    • b) Nakato is treated kindly and respectfully by Nurse Muwanga during her consultation.
    • c) Nakato is given incorrect information about her treatment.
    • d) Nakato’s privacy is violated during her examination.

Answer: b) Nakato is treated kindly and respectfully by Nurse Muwanga during her consultation.

Rationale: This scenario illustrates Nakato’s right to be treated with respect by healthcare staff by showing Nurse Muwanga treating her kindly and respectfully during her consultation.

24.Objective: To assess understanding of patient rights to privacy during examinations and treatments.

Question: True or False: Patients have the right to privacy during examinations and treatments, and their privacy should be protected by the healthcare team.

Answer: True

Rationale: Patients have the right to privacy during examinations and treatments, and their privacy should be protected by the healthcare team to ensure their dignity and confidentiality.

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