Which of the following are examples of medical battery? Select all that apply.
1. A child is placed in a papoose restraint for suturing of a facial
... [Show More] laceration with the parent present
2. Application of soft wrist restraints to the arms of a confused, adult client with a NG tube
3. The nurse administers 2mg of morphine PRN to a difficult, alert client but tells the client it is saline
4. The nurse inserts a needed urinary catheter even though a competent client refuses it
5. The nurse threatens to put a client in restraints if the client does not stay in bed
3,4
Battery is the intentional touching of a person that is legally defined as unacceptable or occurs without the person's consent. Many routine actions that are permissible when proper consent is obtained would otherwise be considered medical battery. Furthermore, actions can be considered battery even if no physical injury results. Any health care provider (HCP) who performs a medical or surgical procedure without receiving the required informed consent from a competent client (or parent/legal guardian in the case of a child) is committing battery and could be legally charged (Option 3).
A competent client has the right to refuse any treatment, even if it is for the client's benefit. The nurse should help the client understand the need (eg, informed refusal), but the client's decision should be upheld. Proceeding to administer treatment to a competent client who has refused that treatment is medical battery (Option 4).
(Option 1) The temporary restraint for this minor child is needed for a therapeutic intervention, and it is implied that the parent consents to its use.
(Option 2) Using a restraint to prevent a client from inadvertently removing essential medical interventions is an acceptable medical precaution. A prescription from the HCP is required, and the nurse is responsible for performing appropriate, timely assessments related to the restraint. This is not an example of battery as there is a medical reason for the restraint and a prescription/order was obtained.
(Option 5) This is an example of assault. Assault is a deliberate threat with the power to carry out the threat.
Educational objective:
Battery is touching that is legally defined as unacceptable or occurs without consent. Examples include performing a procedure despite a competent client's refusal or without obtaining proper consent from a competent client (or parent/legal guardian when the client is a child). Assault is the threat of battery.
While reviewing prenatal records with a client and her partner, the nurse notes documentation in the medical record indicating that the client is a G2P0. However, the client denies a previous pregnancy. Which action by the nurse is appropriate?
1. Adjust documentation to indicate that the client is a G1P0
2. Ask the client and partner about a previous miscarriage or abortion
3. Confirm the obstetric hx when the client is alone
4. Explain the importance of accurate info to the client and partner
3
When reviewing obstetric history, the GTPAL notation system gives the health care provider information about a client's past pregnancies. This notation may be shortened to gravida (ie, number of previous pregnancies) and para (ie, number of births after 20 weeks). For example, a G2P0 indicates 1 prior pregnancy ending before 20 weeks and 1 current pregnancy.
The nurse should be cautious of discussing obstetric history with a client in front of the partner or family and not assume that others have knowledge of the client's past pregnancies. If there is a discrepancy between what the client discloses in the interview and the medical record, the information should be clarified when the client is alone to maintain confidentiality (Option 3).
(Option 1) The nurse should not change information in the medical record until the information is clarified appropriately with the client.
(Option 2) Although the client's medical record indicates a previous pregnancy, it is not appropriate to ask if the pregnancy was an abortion or a miscarriage in front of the client's partner.
(Option 4) Explaining the need for accurate information is not appropriate at this time and does not assist with clarifying the client's obstetric history in a private manner.
Educational objective:
The nurse should be cautious of discussing a client's obstetric history in front of the client's partner or family to avoid breaching confidentiality. Clarification or further questioning about the client's history should take place when the client is alone.
A visiting family member of a hospitalized client reports sudden onset of a headache and numbness in half of the body. The visitor asks the nurse to take a blood pressure reading. What is the most appropriate response by the nurse?
1. Encourage the visitor to lie down to see if symptoms change
2. Initiate protocol to assist the visitor to the emergency depertment
3. Proced to take the visitor's BP
4. Suggest that the visitor call the HCP
2
Providing care establishes a legal caregiver obligation/relationship between the nurse and the visitor. If a relationship is started, the nurse has a duty to continue care until the visitor is stable or other health care personnel can take over. If proper care is not continued, the nurse could be accused of negligence (ie, failure to act in a prudent manner as would a nurse with similar education/experience).
This visitor's symptoms are potentially serious as sudden onset of headache and numbness in half of the body may indicate stroke. In the event of a visitor emergency, the nurse should not establish a caregiver relationship but rather implement facility protocol to help the visitor get to the emergency department promptly to receive immediate assessment and further evaluation (Option 2).
(Options 1 and 4) Asking the visitor to call the health care provider (HCP) or giving advice to lie down delays the essential assessment and treatment that this visitor with potentially serious symptoms requires.
(Option 3) When a nurse provides care (eg, takes blood pressure), a client-caregiver relationship is established. The nurse caring for a visitor is ill-equipped to provide care without any HCP prescriptions in place and risks being negligent.
Educational objective:
Providing care establishes a legal caregiver obligation/relationship between the nurse and a visitor. In the event of a visitor emergency, the nurse should refrain from actions that establish this relationship and instead implement facility protocol to help get the visitor promptly to the emergency department.
The charge nurse supervising a graduate nurse would need to intervene when the nurse violates health information privacy laws with which action? Select all that apply.
1. Accesses the medical record of a client not currently assigned, but previously cared for, to assess client improvement
2. Advise a client's transport technician, "this client has metastatic breast cancer and must be moved very carefully due to fragile bones"
3. Asks a client quietly "when were you diagnosed with diabetes?" during admission assessment in a semiprivate room with the privacy curtain in place between beds
4. Explains the results of a client's diagnostic testing to the unit clerk who is organizing paperwork to be included in the client's medical record
5. Writes a client's last name on a whiteboard hanging in the nurses' station on which scheduled procedures are logged
1,2,4
Nurses need to maintain privacy and confidentiality when caring for clients. Health care workers (HCWs) need to use the minimum necessary standard (reasonable precautions) to protect a client's health information.
Confidentiality is violated when information about a client's personal health (eg, diagnosis, test results) is accessed by or given to those without permission or without a "need to know." For example, a transport technician may require pertinent client information (eg, fragility) to transport a client safely but never needs to know the client's exact diagnosis (Option 2). Other violations include when HCWs access medical records of clients not currently assigned or discuss client diagnoses with nonessential personnel (Options 1 and 4).
Certain incidental disclosures are allowed if reasonable precautions are taken. Common precautions include:
Allowing medical record access to a HCW only when necessary to perform job duties
Employing room dividers/curtains in semiprivate spaces (Option 3)
Avoiding discussions about clients and their conditions in public areas
Listing only last names on whiteboards at nurses' stations (Option 5)
Placing communication whiteboards where they are least visible to the public
Communicating with lowered voices in semiprivate spaces (eg, nurses' stations, client rooms)
Educational objective:
Only health care personnel requiring client health information to carry out their job duties should have access to or be advised of this information. Nurses, health care providers, and hospitals should take reasonable precautions at all times to safeguard client information.
The nurse prepares to teach an in-service on legal issues related to nursing. Which legal terms are followed by an appropriate example? Select all that apply.
1. Assault: Threatening to admin a benzo if the client does not comply
2. Battery: misinforming a client that a painful injection will not create discomfort
3. False imprisonment: storing a competent client's clothes to prevent the client from leaving prior to a prescribed treatment
4. Informed consent: calling the parent of an emancipated minor for approval prior to providing care
5. Invasion of privacy: posting a medical update on the social media page of a client who is a friend
1,3,5
Assault is an act that threatens the client and causes the client to fear harm, but without the client being touched (Option 1).
False imprisonment is the confinement of a client against the client's will or without legal justification (eg, client is not a threat to self or others) (Option 3).
Invasion of privacy includes disclosing medical information to others without client consent. Under the Health Insurance Portability and Accountability Act (HIPAA), a client's information regarding medical treatment is private and cannot be released without the client's permission (Option 5).
(Option 2) Battery involves making physical contact with the client without permission. This includes harmful acts or acts that the client refuses (eg, performing a procedure). When interacting with the client, it is important to practice veracity, the ethical principle of being truthful.
(Option 4) An emancipated minor is an individual under the age of legal responsibility who has been legally freed from parental control through a court order (eg, due to enlistment in the military, marriage, pregnancy). The parent in this situation would not need to be called. Clients have the right to be informed of risks and benefits of procedures prior to care and to give informed consent.
Educational objective:
Clients have the right to privacy and to give informed consent prior to medical care. Assault is an act that threatens the client, causing the client to fear harm without the client being touched. Battery is physical contact against a client's will or without legal justification. False imprisonment includes restraining a competent client without the client's permission.
The clinic nurse is teaching a client about the advance directive form that needs to be completed. Which statement indicates that the client understands the information?
1. I will get this notarized as soon as I can
2. I will give a copy of this to my daughter, who is listed as my health care proxy
3. I'll put this on my refrigerator, so no one will give me cardiopulmonary resuscitation
4. You and my daughter can witness this for me
2
When the advance directive is completed, a copy should be placed in the client's medical record and copies should be given to everyone listed as health care proxies. The client should also keep a copy in a safe place.
(Option 1) The advance directive form does not need to be notarized, and so it can be completed in the health care setting if there are 2 witnesses.
(Option 3) The advance directive is used to document a client's wishes, but it is not a medical order. It will not prevent from performing CPR on a client when necessary. If this client does not want CPR, a portable "do not resuscitate" (DNR) order should be used to ensure that the DNR order is followed outside the hospital setting. Types of portable orders include a POLST (Portable Orders for Life Sustaining Treatment) form, an out-of-hospital DNR, and a DNR bracelet.
(Option 4) Two witnesses are required for completion of the advance directive form. The witnesses cannot be health care providers involved in the care of the client or individuals named as health care proxies in the document.
Educational objective:
An advance directive is placed in the client's medical record and copies are given to health care proxies. Two witnesses are required for completion of the advance directive, but they should not be the health care proxies listed in the document.
The acute care clinic nurse administers a prescribed narcotic for a client with renal colic and then discharges the client without ensuring that the client has a designated driver. The client is subsequently involved in a motor vehicle accident causing injury to self and others. Which ethical principle did the nurse violate?
1. Autonomy
2. Nonmaleficence
3. Paternalism
4. Veracity
2
The nurse violated the ethical principle "nonmaleficence" (ie, do no harm). It is rare to see a nurse inflict intentional harm. However, problems do occur due to unintentional harm, which is usually a result of poor clinical judgment.
Beneficence is a nurse's duty to promote good and do what is best for the client.
(Option 1) Autonomy is allowing the clients to choose the direction of their care. This is accomplished with advanced directives along with informed consent and choices regarding proposed treatments.
(Option 3) Paternalism is a type of beneficence whereby clients are treated as children. The nurse claims to know what is best for the client and coerces the client to act as the nurse wishes without considering the client's autonomy.
(Option 4) Veracity refers to the duty to tell the truth. This principle should always be applied to client care and documentation.
Educational objective:
Nonmaleficence is the ethical principle of doing no harm. All nurses must exercise sound clinical judgment to prevent harm, even if it is unintentional, to their clients.
A nurse cares for a client on life support who has been declared brain dead. Which intervention is appropriate at this time?
1. Ask the fam members about their plans for the funeral service
2. Call the local organ procurement services representative
3. Discontinue nursing care and provide postmortem care
4. Remove life support as requested by spouse and family
2
Local organ procurement services (OPS) are notified for every client death, per hospital protocol (Option 2). If the client is deemed appropriate as a donor, then OPS collaborate with hospital staff in approaching the client's family about organ donation.
Cardiac support (eg, dopamine, epinephrine) and respiratory support (eg, ventilator) continue as organ donation is discussed and/or performed. Life support is withdrawn only if the client is not a candidate for donation due to physiological reasons or the client/family does not consent.
(Option 1) Organ donation is discussed before final arrangements and funeral plans are made. In most cases, the family is referred to the hospital chaplain or someone outside the hospital for assistance with final arrangements.
(Option 3) Medical and nursing care would continue as organ donation is discussed due to organ and tissue perfusion being necessary for viable donation.
(Option 4) Local OPS are contacted before life support is removed so that physiological support is continued in the event that the client is a viable donor.
Educational objective:
All client deaths are reported to local organ procurement services, per hospital protocol. Life support is continued until a decision for organ donation is reached so that organs and tissues continue to receive perfusion and oxygenation.
The nurse caring for a terminally ill client asks if the client has an advance directive. The client states, "I already have a power of attorney." What is the best response by the nurse?
1. A power of attorney (POA) is good to have in place. It sounds like you are on the right attack
2. Great. Your POA can start to make decisions for you when you are no longer able to do so
3. Many people find a lawyer at this stage of life. A lawyer can help you get your affairs in order
4. There are many types of POAs. Let's clarify if your POA can make health care decisions for you
4
A power of attorney (POA) designates a representative to act on a person's behalf in the event that the individual becomes incapacitated. There are different types of POAs, including medical and financial.
An advance directive or living will describes the client's health care decisions (eg, do not resuscitate). As part of an advance directive, the client may designate a representative to make health care decisions for the client - a durable POA for health care or POA for health care (Canada). This client's statement requires further clarification regarding what type of POA is in place (Option 4).
(Option 1) The nurse should not assume that the client's affairs are in order based on this statement. Further clarification is needed to determine whether the client has made the appropriate arrangements regarding health care decisions.
(Option 2) Although it is correct that the POA makes decisions for a client only when the client is no longer able to make them, the nurse first needs to determine what type of POA is in place.
(Option 3) Lawyers can help with end-of-life paperwork, but the priority is to clarify whether the client has the appropriate POA in place.
Educational objective:
An advance directive makes clear a client's health care wishes (eg, do not resuscitate). A power of attorney (POA) designates a representative to act on a person's behalf. It is important to clarify that the client has the type of POA who can make health care decisions (durable POA for health care, POA for health care [Canada]).
A male client has terminal metastatic disease. He arrives at the emergency department with respirations of 6/min and an advance directive indicating to withhold resuscitative efforts. What should the nurse's response be?
1. Apply O2 at 2L by nasal cannula
2. Ask the client if he wants to change his mind
3. Ask the spouse what she wants done
4. Determine who has medical POA
1
Advance directives are prepared by a client prior to the need to indicate the client's wishes. A living will gives instructions about future medical care and treatment if the client is unable to communicate. A medical power of attorney is the individual designated to make health care decisions should a client become unable to make an informed decision. It allows more flexibility to deal with unique situations.
Because the client has indicated specific desires, these should be honored. This is especially true as the client has a terminal condition (versus, for example, an acute choking episode that could be easily reversed). Oxygen can provide comfort and is not resuscitative when given by nasal cannula.
(Option 2) Advance directives are determined ahead of time to guide decision making at the time of the event. The client can indicate a desire to make a change, and the original decision should be honored. This client could be experiencing hypoxia and thus not thinking as clearly as when the advance directives were made. Asking about changes could imply that he should make a change, which is not true. The original decision should be honored; however, the client can indicate a desire to make a change.
(Option 3) The client's advance directives take legal precedence over the spouse's wishes. The spouse is consulted when there are no advance directives or durable power of attorney for health care.
(Option 4) Advance directives include living wills with written directives on how to handle situations. A medical power of attorney is used in situations not covered by the written directives. This client has indicated his wishes. A durable power of attorney for health care is used only when clients have not expressed wishes or cannot speak for themselves.
Educational objective:
Advance directives include a living will (specific situations put in writing) or a medical power of attorney (an individual appointed when the clients are unable to speak for themselves). The client's wishes should be honored. [Show Less]