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Legal issues in critical care nursing - Coggle Diagram
Legal issues in critical care nursing
Torts: Civil wrongs causing harm or injury to another person.
Two main types
Unintentional torts – e.g., negligence or malpractice causing harm.
Intentional torts – e.g., assault, battery, defamation.
Tort law: Provides the basis for a claim by the injured party.
Unintentional acts
Nurse causes harm unintentionally by failing to use proper skills or knowledge.
Negligence: Failure to provide the level of care that a reasonable nurse would give in similar circumstances.
Elements of negligence:
Duty – nurse has a duty to care for the patient.
Breach of duty – nurse fails to meet that duty.
Harm – patient suffers injury or damage.
Causation – harm results directly from the breach.
Commission: Doing something that should not have been done.
Omission: Failing to do something that should have been done.
Malpractice :Involves unreasonable lack of skills or improper conduct in professional duties.
Elements of malpractice:
Duty: Nurse owed a duty to care for the patient.
Breach of duty: Nurse deviated from the accepted standard of care.
Causation: The nurse’s action caused the patient’s harm.
Damages: Patient (plaintiff) deserves compensation for injuries.
Intentional acts
Nurse knows (or should know) her actions violate patient’s rights.
No actual harm is required; the violation itself causes liability.
Assault
A threat or attempt to touch a person offensively or intimidatingly.
Example: Threatening a patient with an NG tube insertion.
Battery
Actual physical contact with a patient or their property without consent.
Examples
Forcing a patient to walk against their will.
Restraining a patient to perform a procedure.
Note: Must respect patient’s cultural beliefs and obtain legal consent.
Defamation
Communicating false information that harms a patient’s reputation.
Types
Libel: Written defamation.
Slander: Verbal defamation.
Example: Writing “patient acts crazy” or “is a prostitute” in medical records.
Nurses must document objectively, not subjectively.
Informed consent
Patients must receive enough information to make an informed, intelligent choice about treatment.
Includes details about procedure, risks, benefits, and alternatives.
Purpose: To allow patients to accept or refuse treatment knowledgeably.
Challenge in critical care: Patients are often too ill to decide; consent may come from family or legal representative
Responsibility: Obtaining informed consent is the physician’s duty, not the nurse’s.
Nurse’s role:
Witness the patient’s signing of the consent form.
Document in notes: “Consent procedure witnessed.”
This protects the nurse and facility if later claims arise about lack of informed consent.
Advance Directives
Definition: Written statements that express a patient’s treatment wishes in case of terminal or irreversible illness.
Purpose: They take effect when the patient can no longer communicate decisions.
Three types:
Living Will: Specifies desired or refused treatments in critical illness.
Durable Power of Attorney for Health Care: Appoints a person to make health decisions for the patient.
Do Not Resuscitate (DNR) Order: Indicates the patient’s wish not to receive CPR if the heart or breathing stops.
Savvy patients: Often prepare both a living will and a durable power of attorney, ensuring decisions reflect their true wishes
Key ICU Ethical/Legal Issues:
Do Not Resuscitate (DNR) Orders:
No CPR or life-saving measures if cardiac or respiratory arrest occurs.
Advance Directives:
Written instructions for future care when the patient can’t decide.
Withholding/Withdrawing Life Support:
Decision to stop or not start life-sustaining treatments (e.g., ventilator).
Refusal of Treatment for Religious Reasons:
Patients may refuse certain procedures (e.g., blood transfusions).
Autonomy Principle:
The patient or legal surrogate has the right to accept, refuse, or withdraw treatment.
Especially applies to those with terminal or irreversible conditions.
Withholding or Withdrawing Life Support – Key Guidelines:
Comprehensive understanding of the patient’s diagnosis, physical and functional status, and comorbidities.
Team agreement: Seek full consensus among all healthcare providers.
Informed consent: Obtain from the competent patient or legal surrogate.
Comfort-focused treatment plan: Prioritize patient comfort and emotional support.
Timely execution: Once the decision is made, carry it out promptly and respectfully.
Family involvement: Allow family access to the patient and provide emotional and physical support.
Privacy: If the dying process is prolonged, transfer the patient to a private room.
Symptom control: Administer medications freely for pain, dyspnea, or other distressing symptoms.
Continued care: Nursing and physician attention must remain diligent and compassionate throughout.
Brain death
Definition:
Irreversible cessation of circulatory and respiratory functions, or
Irreversible cessation of all functions of the entire brain, including brainstem.
Coma vs Brain Death:
Coma: Unarousable unawareness, but some brain activity remains.
Brain death: Irreversible loss of all brain and brainstem functions
Clinical diagnosis
Irreversible coma / unresponsiveness
Absence of brainstem reflexes (areflexia)
Apnea (no spontaneous respiration)
Clinical signs
No eye, motor, or verbal response to stimuli.
Pupils mid-position or dilated, no light reaction.
Absent corneal, gag, and cough reflexes.
Absent oculocephalic (“doll’s eyes”) and oculovestibular (cold water) reflexes.
No respiratory effort when PCO₂ ↑ by >20 mmHg above baseline.
Confirmatory tests
Absence of cerebral blood flow confirmed by:
Cerebral angiography
Transcranial Doppler
EEG
Somatosensory evoked potentials
MRI / CT angiography
Ethical & legal points
Brain-dead = legally dead.
No need to maintain ventilation except for organ donation.
No family permission needed to stop life support.
Physician duties :
Inform family of death.
Request organ donation.
If refused, inform that medical interventions will be withdrawn.
Five Legal Responsibilities of the Critical Care Nurse
Performs only functions within education and experience.
Performs all duties competently and safely.
Delegates tasks only to qualified and competent personnel.
Takes appropriate actions based on patient observations.
Is familiar with the policies and procedures of the employing agency