Overview
This lecture covers essential legal and ethical concepts in nursing, including HIPAA, informed consent, tort law, advanced directives, and mandatory reporting, with practical examples and exam tips.
HIPAA, Confidentiality & Privacy
- HIPAA (Health Insurance Portability and Accountability Act) protects client health information privacy.
- Share client information only with team members directly involved in care on a need-to-know basis.
- Never discuss client info in public areas; always use private spaces like nurse stations or rooms.
- Do not access charts or information not required for your current job duties.
- Never share computer passwords; always log off unattended computers.
- Dispose of report sheets securely—never take client information home.
- Release of info to family/friends requires explicit client permission.
- Clients have the right to access their records; parents cannot access adult children’s records without permission.
- Report all breaches of confidentiality immediately.
Legal & Ethical Principles
- Autonomy: Clients have the right to make their own healthcare decisions.
- Advocacy: Nurses protect client rights, health, and safety.
- Beneficence: Promote good—reassure families without causing panic.
- Fidelity: Be faithful and follow through on promises and duties.
- Justice: Treat clients fairly and provide equitable care.
- Non-maleficence: Avoid harm; double-check tasks to prevent errors.
- Veracity: Be honest and truthful, including reporting errors.
Tort Law
- Negligence: Failure to provide adequate care; compared to standard nursing practice.
- Malpractice: Negligence by a licensed professional causing harm.
- Abandonment: Leaving a client without transferring care.
- Intentional Torts: Willful violations—assault (threat), battery (unwanted contact), false imprisonment, invasion of privacy, defamation (slander = spoken, libel = written).
Informed Consent
- Required before procedures; provider must explain risks, benefits, and alternatives.
- Nurses witness and document consent, verify competence, and advocate for client understanding—not provide procedure-specific education.
- Consent given by competent adults, legal guardians, certain emancipated minors, or qualified surrogates.
- Medical interpreter is required for non-English speakers.
- In emergencies, consent may be obtained from family by phone with two witnesses.
Advanced Directives
- Legal documents stating a client’s wishes if unable to communicate (e.g., living will, healthcare proxy/POA).
- Must be accessible in the medical record and to key individuals.
- Notary not required if witnessed by two unrelated individuals.
- Encourage completion in early stages of cognitive decline.
- DNR/DNI and specific resuscitation wishes must be respected.
Refusal of Care & AMA
- Competent clients may refuse care, including AMA (leaving Against Medical Advice).
- Nurse must educate on risks, notify provider, document refusal, and remove lines/tubes.
- Do not call security unless safety is at risk.
- Clients on legal holds, intoxicated, or mentally altered cannot sign out AMA.
Mandatory Reporting & Abuse
- Nurses are legally required to report suspected abuse of children, vulnerable adults, or elders after assessment.
- Key steps: protect from harm, assess in private, gather evidence, provide safety resources.
- Child/elder abuse signs: neglect (malnutrition, poor hygiene), physical (unexplained injuries), emotional (verbal threats, behavioral signs).
- Use open-ended questions and avoid making promises/secrets to victims.
Key Terms & Definitions
- HIPAA — Law protecting privacy of health info.
- Autonomy — Right to self-determination in care.
- Advocacy — Nurse acts to protect client rights.
- Beneficence — Duty to do good.
- Fidelity — Faithfulness to commitments.
- Justice — Fair and equal treatment.
- Non-maleficence — Do no harm.
- Veracity — Truthfulness.
- Negligence — Not meeting care standards.
- Malpractice — Professional negligence causing harm.
- Abandonment — Leaving client care without transfer.
- Assault — Threat of harm.
- Battery — Unwanted physical contact.
- False imprisonment — Unjustified restraint of a client.
- Libel — Written defamation.
- Slander — Spoken defamation.
- Advanced Directive — Legal care preferences if incapacitated.
- POA/Healthcare Proxy — Person chosen to make decisions if client unable.
- DNR/DNI — Do not resuscitate/intubate.
Action Items / Next Steps
- Review study guides and complete provided question banks on legal and ethical nursing topics.
- Read facility policies on HIPAA, informed consent, and mandatory reporting.
- Practice applying key terms to clinical scenarios for exam readiness.