This document discusses various aspects of public law, tort law, medical negligence, and nursing standards and responsibilities. It covers topics such as constitutional law, statutory law, criminal law, civil law, intentional and unintentional torts, admission of patients, informed consent, medical records confidentiality, medication administration, infection control, and nursing documentation requirements.

1. Dr. A.Seethalakshmi,M.Sc(N), MA(Psy) Ph.D(N).,
Reader, Faculty of Nursing,
Sri Ramachandra University,
Porur, Chennai 600 116

2. Public Law:
 Constitutional Law—defines/limits powers of
governments
 Statutory Law—enacted by legislative bodies,
state boards and professional practice acts
 Administrative Law—appointed to agencies
entrusted to enforce statutory laws

4.  Criminal Law—felonies / misdemeanors
 Civil Law—relationships
written—contracts
acts— “Tort” laws (a wrongful act or failure to act that
causes injury to person or property)
Intentional torts:
Assault and Battery
Defamation---libel/slander
False Imprisonment—restraints
Leaving against Medical Advice (AMA)
Invasion of Privacy---confidentiality

5. Unintentional torts: Negligence and
Malpractice
 Negligence is a tort—a failure to provide degree
of care an ordinarily prudent person would to
prevent injury
Most malpractice is some form of negligence
Types of negligence
Contributory negligence
Comparative negligence

6.  Admission of patients:
patient identity,
 Name of the patient
 history(within 24 hrs):
Patient or relative
 Band: color: purple,
yellow(fall risk)

7.  Allergies :
risk for and actual:
indicated in the patient
file: red
 Infections:
HIV,HCV,HBV,
communicable diseases
 Electronic medical
records : confidentiality,
RN has to complete it,
review, update and
finalise

8.  Compulsory admission
and involuntary
treatment
 Conscious: alcohol
intoxication or
mentally ill or cognitive
impairment
 Medicolegal cases:
sound professional
judgment, history and
clinical examination
(a)Assault and battery,
domestic violence and
child abuse
(b)Accidents : (RTA),
industrial accidents etc.

9. (c)Cases of trauma with
suspicion of foul play
(d) Electrical injuries
(e) Poisoning, Alcohol
Intoxication
(f) Undiagnosed coma

10. (g) Chemical injuries
(h) Burns and Scalds
(j) Sexual Offences
(k)Criminal abortions
(l) Attempted suicide
(m) Cases of asphyxia as a
result of hanging,
strangulation,
drowning,suffocation
etc.
(n)Custodial deaths
(o) Death in the operation
theatre
(p) Unnatural deaths
(q) Death due to Snake Bite
or Animal Bite
(r) Fire Arm injuries
(s) Drug overdose
(t) Drug abuse
(u) Dead brought to the
Accident and Emergency
dept

11.  Tonsillectomy
 Mastoid surgery
 Deafness degree and
management:
information and types of
aids that can be used
 Tracheostomy:
temproary/ permanent:
information and care,
speech therapy
 Communication with
patients who have
sensory problems

12.  Perforation of eardrum
during removal of ear
wax/foreign bodies
 Tip of glove in the nose
 Loss of vision due to
thrombosis caused in nasal
surgery
 Gauze swabs in place post
tonsillectomy affects
respiration
 Thyroidectomy- reccurent
laryngeal nerve damage
due to edema/blood clot
and compression- voice
change in post operative
period

13.  Mammogram: outcome
information: nature, risks, benefits,
alternatives and risk of no treatment
 Biopsy/
 Reconstruction/Implants
 Radiation
 Chemotherapy
 Insurance coverage for: High-Dose
Chemotherapy/
Autologous Bone
MarrowTransplantation
 Off label drug use

14.  Poly Implant
Prothèse (PIP) (1991-2010)-
clinical negligence,
professional negligence
 Fibrous Capsular Contracture,
Calcification,
Silicone Gel Leakage and
Migration, Infection,
Interference with Mammograms
Degradation, Human
Carcinogenicity, teratogenicity,
immune disorders

15.  Communicable; Pneumonia,
tuberculosis
Broncheictasis, asthma
 Medications: corticosteroids,
antituberculous drugs,
antibiotics
 Intercostal tube drains
 Lobectomy, pleurodesis
 Surgical management of lung
cancer and mechanical
ventilation
 Disability benefits forCOPD,
asthma
 Safety measures in preventing
occupational lung disease.

16.  Failure to diagnose and treat
MI
 Diagnosis: patient information
 Medications:Thrombolytic,
dopamine/inotrops: effect on
extremities
 Vascular conditions and
surgeries:
amputations/prosthesis
 Withold or withdraw
implantable device-patient
refuses, reimplantation,
deactivation

17.  Failure to diagnose
 Procedural complications
 Improper treatment
 To feed or not to feed:
ryles tube, gastrostomy,
jejunostomy
 Colostomy : temproary/
permanent
 Invasive procedures:
endoscopy: consent
 Laporoscopic/ open
surgery: consent
 Cleaning and disinfection
of endoscope:
crossinfection

18.  Thrombolysis for
stroke(AIS): within
window period:
informed consent
 Informed consent
 Surgery

19.  DIL
 Dying declaration
 Advance directives
 Living will
 DNR orders
 Intubation and ventilation
 Sedation
 Organ transplant
1994 Act amended-2003
 Declaration of Brain death
 Right to information Act-
2005

20. Male: Prostate surgery, penile prosthesis,
vasectomy, circumcision, PSA testing
 TURP-Retrograde ejaculation, urethral
stricture and urinary retention
 STD/dermatitis
Female: Removal of uterus
Hormone replacement
Reconstructive surgeries

21. Preoperative:
 Identity, surgery,
investigations
 Consent: mental
status
to give consent,
inform comlications,
 preparation
 Medications;
anxiolytics
 Blood tranfusion
 Nutritional status

22.  Surgery
 Investigations
 Anesthesia
 Medications
 IV fluids
 Wrong
site/procedure/patient
surgery
 Retained surgical items
 Medication error
 Failures in instrument
reprocessing
 Pressure injuries
 Specimen management
errors
 Surgical fires
 Perioperative
hypothermia
 Burns from energy
devices
 Difficult
intubation/airways
emergencies

24.  Wound site
 Dressings
 Blood transfusion

25.  Medication
management
 Look alike, sound alike,
7 rights,
 Medication errors

26.  Criminal negligence
(i)Injecting anesthetic in fatal
dosage or in wrong tissues
(ii) Amputation of wrong
finger, operation on wrong
limb, removal
of wrong organ etc.
(iii) Operation on wrong
patient
(iv) Leaving instruments or
sponges inside the part of
body operated
upon
(v)Leaving tourniquet too
long resulting in gangrene
(vi)Transfusing wrong blood
(vii)Applying too tight
plaster or splints, which
may cause gangrene
or paralysis
(viii) Performing a criminal
abortion.

27.  LAMA
 Missing/ Abscond

28.  Consumer protection
Act(1986)-(2007)
1. A good nurse patient
relationship,
2. open channels of
communication,
3. patient education

29.  Infection control program,
 Infection control
committee and infection
control practitioner
 Compliance and
accreditation standards
 Quality improvement
program maintenance
 Continuum of care
responsibilities, and
 Employee health policies
 Educating and training
HCWs

30.  Premises;
 Handwashing and personal
hygiene
 Use of PPE
 Disposal of sharps
 Waste management
 Instruments and equipment
 Environment
 Spills management
 Support services
 Therapeutic devices
 Surveillance and outbreak
investigations
 HCWs
 Blood or body fluid exposure
 Blood and blood products
 Organ and tissue transplants

31.  MRSA
 Yellow fever, cholera,
plague, rabies,
Japanese encephalitis
and four viral
haemorrhagic fevers,
Ebola
 Monitoring and
evaluation of infection
control procedures

32. Safe disposal
Proper handling
Training workers
Immunisation

33.  Under/overmedication
 Medication at the right time
 Use of controlled substances
as opiods
 Information about pain relief
and side effects
 Cultural influences on pain
management
 Potential for addiction
Documentation includes
a. relevant medical history
b. physical examination
c. diagnostic, therapeutic, and
laboratory results
d. evaluations and
consultations
e. treatment objectives

34. f. discussion with the
patient of
(i) risks and benefits,
(ii) treatment options,
(iii) current medications
(date, type, dosage and
quantity prescribed)
g. rationale for changes in
treatment plan or
medication
h. instructions to and/or
agreements with
patients and
i. periodic reviews

35.  Census, statistics
 Quality indicator
 Admissions, surgeries,
infection, adverse
incidents,
readmissions, follow up,
discharge, homecare.
 Mortality indicators

37. Discharge
Patient discharge
Electronic discharge
Discharge planning
Statistical discharge
Discharge summary
Electronic discharge summary
Hospital discharge
Hospital transfer
Hospital to Community transfer
Inter-professional transfer
Inter-departmental transfer
Inter-hospital transfer
Intra-hospital transfer
Acute care discharge
Discharge medications

38.  Economic –compensate lost wages and
medical care cost
 Noneconomic-compensate pain and
suffering
 Punitive- punish the health care provider
 Jury awards and settlements

39. STANDARDS
 Current license
 Scope of practice
 Legal responsibility
 Accountability
 Meet ethical / moral
obligations of practice
of nursing

41.  Acceptance of
assignments
 Know limitations and
function accordingly
 Good of the patient
 Patient advocacy
 Work within the
framework of the
nursing process
 Train, supervise,
review, interact,
document

42.  Maintain highest
professional
competence
 Career goals
 Legal requirements
 Opportunities

43.  Physician’s orders—
nursing responsibility
 Floating Assignments—
limitations/scope of
practice
 Inadequate Staffing--
notify administration/do
not leave unit
 Critical Care—
assessment skills

44.  Communication
 Listening
 Answering questions
 Proficiency
 Documentation