Week 1 & 2

Hand Hygiene
Welcome to the
BSN 502 Health Law and Ethics Course
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

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Original material supplied by Health Protection Scotland. Responsibility for the editing and use of these materials lies with the individual and not Health Protection Scotland or Healthcare A2Z.
fchs.ac.ae
Hand Hygiene
Law for Nursing Practice
Weeks 1 & 2
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org fchs.ac.ae
Hand Hygiene
Learning Outcomes (1 of 2)
By the end of this lecture, the student will be able to:
• Define law
• Recognize the difference between law and ethics.
• Discuss the relevance of law to nursing practice.
• Describe sources of law for nursing practice in the UAE.
• Distinguish between statutory law, administrative law, common law and

criminal law.
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Learning Outcomes (2 of 2)
• Describe different types of torts with examples.
• Identify common acts of nursing negligence and methods nurses can use
to reduce liability.
• Discuss the UAE Professional Code of Conduct and Scope of Practice.
Familiar with the basics of Legal Aspects of

Professional Nursing Practice

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Definition of Law
Law is: “A system of rules of action or conduct, that

govern the behavior of people in respect to relationships
with others and with government” (Burkhardt &
Nathaniel, 2014, p. 189).
Legal decision: “A type of decision that is made in relation

to what is required to be done or forbidden to be done by
law to avoid sanctions and punishments”. (Johnstone,
2019.p 18)

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What is Ethics?
Ethics
“Refers to a personal
consciousness of the moral
importance that guides personal
action in particular situations. An ethic
is derived from an individual’s innate
values” (Burkhardt & Nathaniel, 2014,
p. 163).

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Functions of the Law?
 Defines the rules of behavior for members of the society.

 Determines which actions are permissible and are not permissible in
society, and what punishments enforce the rules.
 Protects public safety and property.
 Promotes non-discrimination.
 Regulates professions.
 Provides the distribution of goods and services.
 Protects the interests of society.

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Why Should Nurses Know the Law?
Nursing practice is governed by many legal concepts. Nurses must have a basic knowledge
of the law because it:
Authorizes boundaries of nursing practice.
Protects us against liability.
Protects the rights of patients.
Protects patients from poor practice and harm.
Assists in maintaining a standard of nursing practice by making nurses accountable
under the law.
Is a component of ethical decision making.
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Decision Making in Nursing
Nurses need to make many decisions everyday.
They could be :
 Legal decisions
 Ethical decisions
 Clinical decisions
(Johnstone, 2016)

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How to Protect Yourself
1. Know the state laws that affect nursing practice.
2. Follow the state’s nurse practice act rules and regulations.
3. Deliver safe competent nursing care.
4. Develop and use your critical thinking abilities and skills.
(Johnstone, 2016)

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Felonies Hand Hygiene
Malpractice
Public Criminal Law
Misdemeanors
Negligence
Unintentional
Types ofLaw
Defamation of
Law Contract Law
tort Character
Quasi Invasion of Privacy

Intentional Tort
Tort Law
Private Fraud
Property Law
Intentional tort Assault
Corporation
Law Battery
False
Imprisonment
© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org 12 fchs.ac.ae
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Public Law Types of Law
Private Law
• Defines a person’s rights • Generally, involves
and obligations in relation relationships between
to the government individuals rather than
the government
• Example: Criminal Law
• Example: Property Law -
Tort Law

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Types of Public Law
1. Criminal Law
Deals with crimes – Actions that are harmful to society
 Felonies - serious crimes that carry significant fines and jail sentences.
Example– Nurse causing harm/death of a patient by administering the wrong
medication.
 Misdemeanors - less serious crimes, usually punishable with fines.

Example – Failure to renew License; or a nurse who slaps a patient.

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Learning Activity
 Read the UAE Professional Code of Conduct and the Scope of Practice for
Nursing. Discuss how these 2 documents guide nursing practice.
 http://www.uaenmc.gov.ae/Data/Files/Code%20of%20Conduct.pdf
 http://www.uaenmc.gov.ae/Data/Files/Nursing%20and%20Midwifery%20Scope%20of%2
0Practice%202012.pdf

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Types of Private Law
Contract Law Tort Law

Deals with rights and obligations of A tort is a wrong or injury that a
people who make contracts (among person suffers because of someone
private individuals). else’s action.
Could be written or oral; expressed
or implied. Types: Unintentional torts, Quasi-
Intentional torts, Intentional torts
• Example: The Nurse-patient
relationship is an implied contract; A
nurse employment contract is an
expressed contract.

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Tort Law: Unintentional Tort
Unintentional Torts:
Occur when an act causes unintentional injury or harm to another person. Examples
in Nursing practice – Malpractice and Negligence
 Negligence – Conduct or practice that fails to use reasonable care.

Example: Ignoring water spilled on the floor (Risk of falls)
 Malpractice – Negligence by a person in a professional capacity (professional

negligence), such as doctors and nurses.
Example: Medication errors
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Medical Malpractice in the UAE (Sep. 2016)
 In 2015, 13 doctors were suspended in the UAE due to cases of

medical malpractice.
 In 2014, nine physicians were suspended or had their licenses
revoked.
 More than 500 medical malpractice claims were made across
the country in 2013
 The number of medical malpractice claims in the UAE is similar
to the ratio in Britain.
https://gulfnews.com/news/uae/health/know-your-rights-under-new-medical-liability-law-1.1897413

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Nursing Malpractice
Nursing malpractice must meet certain criteria (Burckhardt & Nathaniel, 2008; Potter & Perry,
2009):
Duty • The nurse owed a duty to the patient.
Breach of duty • The nurse did not carry out that duty.
Foreseeability • A link exists between the Nurse’s act and the occurred injury.
Causation • The nurse’s failure to carry out the duty caused harm.
Harm or Injury • The patient suffered some type of harm or injury (physical, financial, or emotional).
Damages • The nurse is held liable for damages that may be compensated.

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Common Negligent Acts in Nursing
 Failure to assess and monitor the patient in a timely manner

 Failure to respond to a patient in a timely manner
 Improper use or lack of the right equipment to monitor the patient
 Inadequate documentation
 Failure to inform the physician of patient problems/change in
condition
 Improper medication administration
 Inadequate safety measures appropriate to the patient's condition
 Failure to implement the polices and procedures of the organization
(Potter & Perry 2009)
 Inadequate delegation or supervision of activities
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Malpractice

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Malpractice Examples
• Administering the wrong medication or dosage, leading to adverse reactions or
harm.
• Failing to properly clean and dress a wound, leading to infection or delayed
healing.
• Failing to properly monitor a patient’s condition, leading to delayed diagnosis or
treatment.
• Failing to properly administer or monitor the use of medical equipment, such as
ventilators or feeding tubes.
• Failing to follow infection control protocols, leading to the spread of infectious
diseases.
• Failing to provide appropriate patient education or discharge instructions, leading
to poor health outcomes or readmission to the hospital.
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Minimizing Risks for Negligence (1 of 2)
Nurses can limit negligent actions and the risks of lawsuits by:
1. Following best practices in nursing care
2. Being competent and keeping up-to-date with knowledge and skills
3. Practicing within the professional and statutory scope
4. Not attempting any unfamiliar task
5. Developing a rapport with the patient
6. Being courteous, respectful and a good listener with patient

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Minimizing Risks for Negligence (2 of 2)
7. Involving patients in care and decision making
8. Communicating fully with other healthcare professionals
9. Seeking attention for patients with changing health conditions
10. Documenting assessments and care truthfully, legibly, and in a timely manner
11. Following the policies and procedures of the employing agency
12. Being astute (attentive) to common sources of injury to patients such as falls,
infections, and medication errors

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Tort Law: Quasi-intentional Torts (1 of 2)
Acts causing harm, but the intent may be questionable.
 Invasion of Privacy – violation of a person’s right to privacy: the release of a

patient’s medical information to an unauthorized person (like the press, the patient’s
employer, or patient’s family). The patient’s medical record information is confidential
and may be shared only with health care providers for the purpose of medical
treatment (Potter and Perry, 2009).
 Note: In some cases, the government requires that hospitals report certain infectious or communicable
diseases.

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Tort Law: Quasi-intentional Torts (2 of 2)
Defamation of Character – Harming one’s reputation and good name to a

third person.
 Slander – Defaming a name or reputation using
false words.
Example: making false claims that the patient is
uncooperative or has an STD.
 Libel – Printed defamation, using written words

or images.
Example: Charting false entries in the medical records.
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Tort Law: Intentional Torts
This occurs when someone intentionally injures another person or property.
• Intentional attempt or threat to a person without consent resulting in harm.
Assault • Example: Threat or attempt to injure a patient
• Intentional, unconsented, violent harm to a person’s body.

Battery • Example: Surgical procedures performed without consent
• Deliberate deception for unlawful gain.

Fraud • Example: Falsification of records
False • Unjustifiable restraint of a person within fixed boundaries.

Imprisonment • Example: Physical restraints

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Sources of Law That Hand Hygiene
Affect Nursing Practice
Constitutional Statutory
Law Law
Nursing
Practice
Administrative/Regulatory Common/Civil
Law Law

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Sources of Law That Affect Hand Hygiene
Nursing Practice (1 of 2)
1. Constitutional Law: Description on how to interpret the rules and principles

that govern the powers of the government and the rights of the people.
Example: Human Rights policy of the UAE constitution:
https://u.ae/en/about-the-uae/human-rights-in-the-uae/human-rights-are-guaranteed-by-
constitution#:~:text=The%20UAE%20Constitution%20outlines%20the,the%20practice%20of%20religious%20beliefs.
2. Statutory Law (legislation): Formal laws written and enacted by a body of

legislators at the level of the federal government.
Example: In the UAE, Federal Laws No. 5 (1984) covers the licensing and duties
of medical practitioners

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Sources of Law That Affect Hand Hygiene
Nursing Practice (2 of 2)
3. Administrative/Regulatory Law: Enforceable, legal powers granted to administrative
bodies to carry out the work of the government, by passing rules and regulations.
Example: In Abu Dhabi, the Department of Health Abu Dhabi (DOH) is the
administrative body that regulates nursing practice. Example of a law (the requirement
to report incompetent or unethical nursing conduct to the State Board of Nursing).
4. Common/Civil Law: Legal guidelines from individual cases heard in courts (laws
evolving from court decisions). Decisions from similar and previous cases are
known as precedents. It usually involve a violation against a person or
property.
Example: Torts

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Statutory Law Affecting Nursing Practice
(1 of 2)
Licensure for Nurses
 The DoH regulates licensing of all nurses in the state of Abu Dhabi.
 Licensure provides permission to use the term “nurse” and to give nursing
service to the public.
 It protects the public from those who do not meet a minimal requirement set by
the regulatory organization.
 The requirement for licensure often includes a minimum number of years of
nursing education from a recognized school of nursing and an exam.

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Statutory Law Affecting Nursing
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(2 of 2)
 The DoH has the authority to cancel or suspend a nurse’s license if there is a serious
complaint and just cause (John Dennett, Sept 10, 2009).
 The DoH must follow due process in handling a complaint against a nurse:
1. The nurse must first be notified of the complaint
2. The nurse may defend against the charges
3. All aspects of the case are heard including statements and accounts from the nurse,
the patient, witnesses, experts on nursing care, and documentation is examined.
4. Hearings in Abu Dhabi occur before a body of professionals who make the decision
whether a nurse acted appropriately or violated a law.

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Legal Concerns with Practice Issues Hand Hygiene
(1 of 3)
1. Short (Inadequate) Staffing and Floating

 Affects provision of competent care to patients.
 If patient assignment is not reasonable and safe, the concern should be documented
and raised to the supervisor.
 *Do not walk out of your shift as this would be considered abandonment.
 Nurses may find themselves assigned or “floated” to another unit.
 Nurses who float and do not have the expertise or experience to care for the types
of patients on that unit should alert the supervisor otherwise they could be liable.

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(2 of 3)
2. Doctors Orders
 Nurses are expected to clarify orders with the doctor.
 If still not satisfied, seek the assistance of their supervisor. Trust your knowledge!
 Nurses who carry out inaccurate or inappropriate orders are legally liable.
 Nurses must be particularly careful with verbal orders from doctors (follow the
organization policy and procedure).

 These must be verified by writing them down and reading back the information received.

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(3 of 3)
3. Risk Management
 Potential hazards in the workplace include but not limited to:
 faulty equipment
 poor patient identification practices
 falls risks
 Errors made and even potential errors (near misses) must be reported usually by
means of an “occurrence” report.
 Nurses can be held liable if they fail to complete documentation on hazards, errors,
or near errors.

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Let's Review..
The nurse gave a postoperative patient the wrong blood because she forgot
to check the identification label on the blood with the patient’s identification
arm band. The nurse’s failure to act as a reasonable and prudent nurse would
in a similar circumstance can be classified as:
a. an intentional tort
b. an unintentional tort
c. a felony
d. a legal complaint of professional incompetence

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Let's Review..
In the cafeteria, Nurse Sally was telling her friend from the Human Resources
department about a patient she admitted who is HIV seropositive. This behavior is an
example of:
a. libel
b. negligence
c. fraud
d. Invasion of Privacy
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Learning Activities
 Read the UAE Professional Code of Conduct and the Scope of Practice for Nursing. Discuss
how these 2 documents guide nursing practice.
 http://www.uaenmc.gov.ae/Data/Files/Code%20of%20Conduct.pdf
 http://www.uaenmc.gov.ae/Data/Files/Nursing%20and%20Midwifery%20Scope%20of%20Practice%2020
12.pdf
 Research instances of nurses' negligence on the Internet or in the UAE newspapers.

 Discuss areas of potential liability in your areas of work in your role as student nurses in
clinical practice.
 Discuss how the way in which you practice protects you from being accused of negligence.

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Discussion Activity
Case Scenario: In Kentucky, USA, on May 2006, a jury awarded $20 million to the family of Mr. Richards,
an 84 year old man who died in the nation’s largest nursing home chain. In addition to the nursing
home corporation, 2 nurses were found responsible for Mr. Richards death. In his final hours,
Richards screamed in pain as he pleaded for help “I need a doctor or a nurse… Don’t let me die”
(Yetter 2006). He died 10 hours after his first complaint of pain caused by an untreated bowel
obstruction. There were 100 patients in the home on that day, cared for by 13 staff, 3 of whom
were nurses. At one point that day, 10 of the 13 staff were on break, including all 3 nurses. This left
3 nursing assistants to care for everyone. The jury heard testimony that the nurses failed to
monitor Richard’s condition or respond to symptoms including pain and vomiting. The family
alleged there was a shortage of staff at the home. Defendants’ responded that the case was about
family greed (Kocher, 2006). (Adopted from Burkhardt & Nathaniel 2014, p. 216)
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Discussion Activity:
Critical Thinking Questions:

1. What feelings are evoked from this scenario?
2. If the nursing home was understaffed, why were the nurses found to be
responsible?
3. Why were the nursing assistants not deemed responsible?
4. What standards of care did the nurses ignore?
5. What would you have done?

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Hand Hygiene

BSN 502 Health Law and Ethics Course

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Law for Nursing Practice

By the end of this lecture, the student will be able to:

• Recognize the difference between law and ethics.

• Discuss the relevance of law to nursing practice.

• Describe sources of law for nursing practice in the UAE.

• Distinguish between statutory law, administrative law, common law and

• Describe different types of torts with examples.

• Discuss the UAE Professional Code of Conduct and Scope of Practice.

Familiar with the basics of Legal Aspects of

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Law is: “A system of rules of action or conduct, that

Legal decision: “A type of decision that is made in relation

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Functions of the Law?

 Defines the rules of behavior for members of the society.

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Why Should Nurses Know the Law?

Decision Making in Nursing

Nurses need to make many decisions everyday.

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

How to Protect Yourself

1. Know the state laws that affect nursing practice.

2. Follow the state’s nurse practice act rules and regulations.

3. Deliver safe competent nursing care.

4. Develop and use your critical thinking abilities and skills.

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Quasi Invasion of Privacy

Public Law Types of Law

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Types of Public Law

 Misdemeanors - less serious crimes, usually punishable with fines.

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Contract Law Tort Law

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Tort Law: Unintentional Tort

 Negligence – Conduct or practice that fails to use reasonable care.

 Malpractice – Negligence by a person in a professional capacity (professional

 In 2015, 13 doctors were suspended in the UAE due to cases of

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

Common Negligent Acts in Nursing

 Failure to assess and monitor the patient in a timely manner

© 2006, original content developed by Healthcare A2Z, www.healthcareA2Z.org

1. Following best practices in nursing care

2. Being competent and keeping up-to-date with knowledge and skills

3. Practicing within the professional and statutory scope

4. Not attempting any unfamiliar task

5. Developing a rapport with the patient

6. Being courteous, respectful and a good listener with patient

7. Involving patients in care and decision making

8. Communicating fully with other healthcare professionals

9. Seeking attention for patients with changing health conditions

11. Following the policies and procedures of the employing agency