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Ethical and Legal Issues

Doctrine of Charitable Immunity/Good Samaritan Act-1900s

originally provided immunity from prosecution for hospitals, churches, and schools.

Good Samaritan Legislation-1959

California became the first state to enact it.

Health care risk management

a systematic approach to the prevention of financial loss, evolved in the 1970's to decrease liability exposures, integrate risk reduction strategies, and create a risk-free environment.


the study of values that conform to moral standards of a group or profession.

4 primary principles to guide ethical decisions when it come to clients rights-ANA-1985

right to autonomy, right to beneficence, right to veracity, principle of fidelity.

Ethical dilemmas most frequently encountered by nurses on a daily or weekly basis

cost containment, end-of-life care, informed consent, incompetent, unethical, illegal practices of colleagues, access to care.


when the nurse thinks he/she knows what is best for the clients, often imposing their own methods for care and treatment decisions.

Violation of state's Nurse Practice Act

Failure to act.

Chally/Loriz-1998-6 step ethical decision-making model for nurses when confronted with ethical dilemmas

clarify the ethical dilemma, gather additional data, identify options, make a decision, act/carry out the decision, evaluate the impact

Genetic testing

the lab analysis of cells for gene products, DNA analysis

Gregor Mendel-1865

a botanist considered to be the founder of genetics


X&Y chromosomes identified


term "genetic engineering" came to be


insulin genetically engineered


gene for cystic fibrosis discovered

August 9, 2001

President George W. Bush announced funding of embryonic stem-cell research

Identify 3 ethical dilemmas the nurse may confront during participation in clinical research

informed consent, documentation of research protocols, client's right to full disclosure

The reason for the Bill of Rights for Registered Nurses-2001

recidivism, right to safe environment, right to advocate freely on behalf of their clients and themselves, right to provide safe ,quality client care


conduct that falls below the standard of care established by law for the protection of others


a type of negligence that applies only to professionals

Factors that contribute to the increased number of malpractice cases against nurses

delegation of duties to UAPs, early DC of clients without proper referral to outpatient care, increased workloads, technology requiring technical skills, increased autonomy and responsibility in advanced nursing skills, better-informed consumers, expanded legal definition of liability

"Legal pitfalls"

client falls, failure to follow physician's orders, medication errors, improper use of equipment, failure to remove foreign objects, failure to provide sufficient monitoring, failure to communicate

JCAHO's mission

to improve the quality of care provided at healthcare institutions in the US, grant accreditation, hold institutions accountable for ensuring a safe environment

"Sentinel event"-2002

such an event may result in unanticipated death or major loss of function not related to the client's illness or condition such as suicide or rape in the institution

Intentional torts

willful conduct to do a wrongful act with disregard of the interests of others


injury to a person's reputation or character


oral defamation


written defamation

Client confidentiality

nondisclosure of private information related by one individual to another

Client privacy

the right to be left alone and free from intrusion or control by the public

1995- ANA House of Delegates

approved a policy titled "Privacy and Confidentiality Related to Access to Electronic Data"

1998- ANA Board of Directors

policy titled "Core Principles of Telehealth"

Failure of duty to warn

Tarasoff decision-1976-Tarasoff v. Regents of UOC, may be emphasized in cases involving sexual abuse and pedophilia

Bill of Rights for Psychiatric-Mental Health Clients

receive treatment, refuse treatment, probable-cause hearing within 3 court days of ADM from involuntary detention if found sane in a court of law (writ of habeas corpus), privacy and confidentiality, communicate freely with others, have personal privileges, maintain civil rights, religious freedom and education, maintain respect, dignity, and personal ID, maintain personal safety and assert grievances, be transferred with continuity of care, access own records, obtain explanation of costs and services, obtain aftercare

1990-Patient Self-Determination Act

gave clients with diagnosis of psychiatric disorders the right to formulate APDs (advanced psychiatric directives)

Voluntary psychiatric hospitalization

have the right to refuse treatment prescribed and may initiate DC at anytime, attending may write AMA (against medical advice)

Involuntary psychiatric hospitalization

client poses threat to himself or others may be admitted and detained for at least 72hrs

After 72hrs, what happens to a client who doesn't sign the voluntary ADM form?

opinions by 2 psychiatrists completed and court hearing set

Civil commitment

client is court-ordered to remain in facility for a specified period


incapable of giving informed consent

Voluntariness hearing

a minor /anyone under 18, who has not been court-ordered to receive treatment has a right to this at the time of ADM

OBRA of 1987 (Omnibus Reconciliation Act)

state that a long-term care facility must not admit as of 1/1/89 any new residents needing active treatment for mental illness or mental retardation

PASARR/preadmission screening and annual resident review

screening document determining whether client requires active psychiatric treatment(for long-term care facility)

Diminished capacity

plea asserting that because of mental impairment/mental retardation, defendant couldn't form the specific mental state required for a particular offense-found guilty of lesser offense

Guilty but mentally ill

plea used by individuals who exhibit clinical symptoms of DSM-IV-TR pstchiatric disorders-pyromaniac

Not guilty by reason of insanity

entered in the presence of a mental disease-delusional disorder

Forensic psychiatry

specialized area of mental health that involves evaluation of an individual's competency and mental condition at the time of an alleged crime

Role of the forensic nurse

staff nurse in ER or corrections, nurse scientist, nurse investigator, expert witness, independent consulting, nurse specialist, health educator, client advocate, counsrlor

Ethical dilemma for the forensic nurse

because of duty to the legal system and not the client could conflict wit the issue of confidentiality

LNC/legal nurse consultant

plays an invaluable role in advocating patient rights and safety, evaluates, renders, analyzes informed opinions on the delivery of health care (forensic nurse)

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