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Health and wellness Legal Principles in Nursing
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Concepts in Health Care
Health and Wellness
Legal Principles in Nursing
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Learning Outcomes
• By the end of this lecture, students will be able to:– Define key terms– Discuss models of health and illness– Discuss variables influencing health beliefs and health
practices– Describe health promotion and illness prevention activities– Discuss the preventive levels of health care– Discuss four types of risk factors and the process of risk
factor modification– Describe the impact of illness on the client and family– Discuss some of the legal principles and relationships in
nursing practice– Discuss some of the legal issues in nursing practice
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Definition of Key Terms
• Health:
– “State of complete physical, mental and social wellbeing, not only the absence of disease or infirmity”. (WHO, 1947).
– Is a state of being that people define in relation to their own values, personality and lifestyle.
• Health status:
– “Is a description of health that can be measured by birth rates and death rates, life expectancy, quality of life, morbidity from specific diseases, risk factors, and other factors.
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Models of Health and Illness
• A model is a theoretical way of understanding a concept.
• Models provide various ways of approaching complex concepts such as health and illness.
• Models are used to understand the relationship between these concepts and the client’s attitudes toward health and health practices.
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Health-Illness Continuum Model
• According to this model, health is a dynamic state that fluctuates as a person adapts to changes in the internal or external environments to maintain a state of well-being.
• Illness is a process in which the functioning of a client is diminished or impaired when compared with his/ her previous condition.
• In this model, high-level wellness and severe illness are at opposite ends of the continuum.
• Risk factors, including genetic and physiological, environmental age, and lifestyle, are at the centre of the model.
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Health Belief Model
• Was developed in the 1950s to examine why people did not participate in health-screening programmes
• Was later modified to address compliance to therapeutic regimen
• Is built on the premise that disease prevention and curing regimens will eventually be successful and the belief that health is highly valued. Both premises need to be present in the model to be relevant in explaining health behaviour
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Revised Health Promotion Model
• Has been primarily used in nursing • Describes major components and variables that influence
health promoting behaviours• Emphasises actualisation of health potential and an increase in
the level of wellbeing rather than avoidance of disease• Has three major components of individual characteristics and
experiences, behaviour-specific cognition and affect, and behavioural outcome
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Variables Influencing Health Beliefs and Health Practices
• Internal variables– Developmental stage: The person’s concept of illness
depends on his developmental stage. For example, different techniques of teaching are used about contraception to an adolescent and to an adult
– Intellectual background: Cognitive abilities shape the way a person thinks, including the ability to understand factors involved in illness and to apply knowledge of health and illness to personal health practices
– Emotional factors: A person’s degree of calm or stress can influence health beliefs and practices. A very calm person may have little emotional response during illness, whereas a person unable to cope with stress may either overreact to illness or deny the presence of symptoms.
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– Spiritual factors: Religious practices are one way people exercise spirituality. Nurses must understand client’s spiritual dimensions to involve them in nursing care
• External variables
– Family practices: A person raised in a family that values the importance of preventive care, e.g periodic dental checkups, is more likely to continue those health practices during adulthood.
– Socioeconomic factors: These factors can increase the risk for illness and influence the way a person defines and reacts to illness. A person with low income tend to focus on food for the family than to costly drugs or special diets.
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– Cultural background: Cultural backgrounds influence beliefs, values, and customs. It influences the approach to the health care system, personal health practices, and the nurse-client relationship.
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Health Promotion and Illness Prevention Activities
• Health promotion strategies can be:
– Passive: Clients gain from activities of others without acting themselves, (e.g flouridation, fortification of milk with vitamin D)
– Active: Clients are motivated to adopt specific health programmes (e.g weight reduction, smoking cessation)
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Levels of Preventive Care
• Health activities and nursing care occur at the following levels of prevention:
– Primary: True prevention; preceding disease or dysfunction and is targeting physically and emotionally healthy people (immunisation, personal hygiene)
– Secondary: Focuses on clients who experience health problems or illnesses and who are at risk of developing complications or worsening conditions (e.g early treatment, screening)
– Tertiary: Disability is permanent and irreversible. The aim is to minimise the effects of long-term disease or disability by intervention directed at preventing complications and deterioration (bed sore development).
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Types of Risk Factors
• A risk factor is a situation, habit, environmental condition, physiological condition, that increases the vulnerability of an individual to an illness or accident.
• Risk factors can be grouped into:– Genetic and physiological factors: Diabetes, Pregnancy, or overweight
– Age: Increases risk of heart disease, birth defects when a woman is > 45 yrs.
– Environment: Unclean, crowded dwellings increase the risk of infection and other disease.
– Lifestyle: Overeating, poor nutrition, insufficient rest or sleep, alcohol or smoking
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• The goal of risk factor identification is to assist clients in understanding those areas in the lives that can be modified or eliminated to promote wellness and prevent illness.
• Risk factor identification is the first step in health promotion, wellness education, and illness prevention.
• Once risk factors are identified, health education programmes can be implemented and this may lead a person to change a risky health behaviour, such as smoking cessation, alcohol misuse, lack of exercise, unhealthy food.
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Impact of Illness on Client and family
• Emotional and behavioural changes: Depend on the nature of illness, the client’s attitude, and the reactions of others, to it.
• Short-term, non-life threatening illness produce few behavioural changes in the client’s and family functions (e.g cold)
• Severe life-threatening illness can lead to more extensive emotional and behavioural changes such as shock, anxiety, denial, and withdrawal.
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• Some illnesses result in changes in physical appearance, and clients and families react differently to these changes.
• Changes in body image depend on the type of changes (loss of a limb or an organ).
• Illness may change the roles of the family and client.
• Such changes may be subtle [slight ] and short term that an individual or family can easily adjust to, or drastic [severe] and long term that require an adjustment process similar to grief [الحزن] process. In this latter case, the client and family need specific counselling and guidance to assist them in coping with the role changes.
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Legal Principles in Nursing
• Legal limits of nursing
– An understanding of the law coupled with sound judgment helps to ensure safe and appropriate nursing care.
– Nurses must understand the legal limits that affect nursing practice to know their responsibilities and to protect clients from harm.
– Sources of law: Nursing practice is subject to statutory law, regulatory law, and common law
• Statutory law is created by the US congress and state legislatures. Examples include Americans With Disabilities Act and the Nurse Practice Acts respectively
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• State Boards of nursing create regulatory law when they pass rules and regulation. An example of regulatory law is the duty to report incompetent or unethical nursing behaviour
• Courts create the common law when individual legal cases are decided. Examples include informed consent and the client’s right to refuse treatment
– Statutes [ القوانين أو are either criminal or [التشريعاتcivil:
• Criminal law: is classified as a felony [crime] which is a serious offense, or a misdemeanor [ جنحة] which is a less serious crime.
• Civil law: protects individual rights. Violation of a civil law results in the payment of money to the injured party. A tort [ضرر] is a civil wrong or injury. Torts are classified as intentional or unintentional. Intentional torts are willful acts such as assault Unintentional torts include negligence which is a conduct .[اعتداء]that falls below the standards of care.
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Legal Relationships in Nursing Practice
• Student nurses: Students are responsible for all of their actions (USA) that cause harm to clients. When an injury occurs as a direct consequence to student’s action, the liability for the incorrect action may be shared by the student, the instructor, staff nurses, and the hospital.
• Physician’s prescriptions: Nurses are responsible for carrying out medical treatment unless the prescription is in error, violates hospital policy, or would be harmful to the patient. If the nurse determines that the prescription is wrong or harmful, s(h)e needs to obtain further clarification.
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• If after clarification the physician confirms an order that a nurse still believes that it is inappropriate, the nursing supervisor needs to be informed.
• The nurse should not carry out an order if there is a risk of harm. Otherwise, the nurse may be legally responsible for the harm suffered by the patient . All physician’s prescriptions should be well-written, dated, and timed appropriately.
• Consent: A general signed consent is necessary for all routine treatments, surgery, chemotherapy, and participation in research. A special consent form is signed before specialised procedures may be performed.
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• Death and dying: Nurses must know their legal responsibilities concerning death and dying. A nurse must document all events that occur when the dying client is in his care.
• There are two standards for the determination of death:– Cardiopulmonary standard: requires irreversible cessation of a client’s
circulatory and respiratory functions
– Whole brain standard: requires irreversible cessation of all functions of the entire brain.
• An autopsy requires consent by the client before his death, or a close family member at the time of death.
• Nurses encounter legal issues with caring for terminally ill, severely debilitated, or persistently vegetative clients.
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• A competent client has the right to refuse medication and food.
• A dead client has the right to be treated with dignity and care. Wrong handling can cause emotional harm to family members.
• Organ and tissue donation: A signed consent is required before a client’s body, tissues, or organs can be donated for medical use.
• At the time of death, a qualified health care provider can ask the client’s family members to consider organ donation.
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Legal Issues in Nursing Practice
• Nurses need to be aware of changes in the laws that affect nursing practice and patient care.
• Laws pertinent to narcotics administration are constant, while those of other issues such as abortion and care for clients with HIV are changing– Controlled substances: May be administered by nurses under the
direction of a licensed physician. These agents should be kept securely locked, and only authorised personnel should have access to them. Precise records must be kept. There are criminal penalties for the misuse of controlled substances.
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– HIV: Nurses care for patients with HIV. Nurses must use the standard precautions for the control of transmission of the HIV. Nurses need to safeguard themselves and others from exposure to infectious material.
– Abortion issues: In the USA, the woman can decide to have an abortion as a fundamental right to privacy. This is true during the first trimester without state regulation. In the second trimester, the state may enforce regulations regarding the person who performs abortion and the facility. By the 3rd trimester, when the fetus becomes viable, the state’s interest is to protect the fetus by prohibiting abortion unless necessary.
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