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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

NURSES -- Practice; PHYSICIANS -- Practice; HOME care
Geographic Term(s): UNITED States
Source: Nursing , Apr2000, Vol. 30 Issue 4, p70, 1p, 1c
Abstract: Presents a question-and-answer advisory on legal matters
concerning nursing and medical professions in the United States.
Transition from medical and surgical nursing to home health care;
Notification of employer on a hepatitis C infected employee; Variations
of health facility restraint standards.
AN: 4065470
ISSN: 0360-4039
 Database: Health Source - Consumer Edition


Considering a big leap

I'm thinking about making the leap from medical/surgical nursing to home
health care. What are some legal pitfalls I should consider?

--C.S., NEV.

A home isn't the controlled environment that a hospital is, so risk
management for a home health care nurse extends far beyond patient care.
For example, each time you visit your patient, you'd be expected to look
for potential hazards in his environment and then to take steps to
correct them.


Your patient' s primary caregiver is a big part of the picture, so
gauging her abilities and limitations is essential. If the patient needs
special equipment, you'd have to determine whether the caregiver is
capable of using it properly. And because the demands on her can be
overwhelming, you'd assess her for signs of exhaustion each time you
visited. Besides the primary caregiver, you may also need to direct home
health care assistants who care for your patient.

Teaching is critical in home health care. The patient and his family
need to know the signs and symptoms of possible complications and
appropriate interventions, plus what to do in an emergency. You'd be
accountable for notifying the physician of any acute changes or signs
and symptoms of complications.

Finally, your documentation should be impeccable. Along with teaching
and other nursing measures, you'd document any changes in your patient's
condition or circumstances, such as an exhausted caregiver.


Keeping mum

Last month I was hired as an LPN at a long-term-care facility. Yesterday
I found out that I have hepatitis C. I'm afraid that if I tell my
employer about the diagnosis, I'll lose my job. Is there a legal
downside to keeping mum about my condition?

--B.D., WIS.

Hepatitis C is a reportable infectious disease, so the laboratory that
performed the test has probably already reported your case. But this
doesn't mean that your employer knows or needs to know about your

The Centers for Disease Control and Prevention considers the risk of an
infected health care worker's transmitting hepatitis C very low and
doesn't call for restrictions. Just continue to follow standard
precautions, such as hand washing and proper sharps disposal, and strict
aseptic technique when indicated.

If your employer were to find out that you have hepatitis C infection,
you shouldn't be discharged because of it. The Americans with
Disabilities Act and case law throughout the nation protect you. Yet
some health care workers with reportable diseases have been discharged,
supposedly for other reasons. If you're terminated and suspect that it's
because your employer found out about your infection, contact the Equal
Employment Opportunity Commission, which is charged with enforcing
discrimination laws.



Different strokes

Having recently switched from acute care nursing to long-term care, I'm
having a problem with my current facility's restraint policies. I asked
the director of nursing (DON) about them, and she said they conform to
the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) standards. But the guidelines here differ from those at the
hospital where I used to work. What's happening?


Different strokes for different folks. The JCAHO has different standards
for medical/surgical patients, patients with behavioral and psychiatric
problems, and residents in long-term-care facilities with an average
length of stay greater than 30 days. Because risks for patients in these
categories differ, the JCAHO standards for restraints vary in these

* how orders for restraint use are obtained
* the length of time an order is valid
* consideration of alternatives
* monitoring intervals for restrained patients.

Restraint regulations are evolving rapidly. For example, the Health Care
Financing Agency has requirements a facility must fulfill in order to
receive Medicare or Medicaid payments. Your facility's DON should be
well versed about the various regulations. If you haste more questions,
contact the agency that oversees long-term care in your state.


Implied, not informed

My neighbor's husband fell off a ladder, hit his head, and arrived at
the hospital unconscious. My neighbor was away from home at the time,
but the neurologist reached her by phone and asked her consent to
perform a craniotomy to drain fluid and release pressure on the brain,
if necessary. She said yes.

When she arrived at the hospital an hour later, a different physician
was performing abdominal surgery on her husband, even though no one had
told her about abdominal injuries and she hadn't given permission for a
laparotomy. The nurse explained that because her husband was
unconscious, the surgeon was operating under "implied consent."

Shouldn't he have waited and gotten consent from my neighbor or another
close relative?

--J.F., ARK.

That depends. If the patient's condition wasn't critical, the surgeon
should have contacted the patient's wife or another close relative
before performing a laparotomy. However, a physician can treat an
incompetent patient (for example, someone who's unconscious) under the
theory of implied consent if waiting would endanger him. In this case,
the patient may have developed sudden signs of abdominal bleeding and
shock and the surgeon may have tried unsuccessfully to reach your

In a situation like this, the physician should tell a hospital
administrator the facts and get administrative consent before operating.
And the nurse should make sure all the details and attempts to reach
significant others are documented in the patient's chart.

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Source: Nursing, Apr2000, Vol. 30 Issue 4, p70, 1p
Item: 4065470