Legal and Ethical(2)

8/7/2019 Legal and Ethical(2)

1/29

LEGAL AND ETHICALIMPLICATION IN THE CLINICAL

EDUCATION SETTING

By:

Randolph Camolista, R.N.

and

Maria Consolacion Poral, R.N.


2/29

INTRODUCTION:

Teaching clinical nursing courses, faculty face some challenges

more often than others. At one time or another, most faculty

teaching in clinical settings will have to deal with

unsatisfactory clinical performance, grade disputes, and

deviations from approved appearance standards.

Unsatisfactory clinical performance may be associated withissues of safety such as insufficient preparation, difficulties

with skills performance or knowledge transfer, and even

student health problems. Less often, faculty may encounter

problems related to chemical impairment, academic

dishonesty, and breaches of conduct. Violations of this nature

are legally subjected to a different process than those relating

to clinical performance and the resulting grades (Osinski,

2003).


3/29

FACULTY-STUDENT RELATIONSHIP

Characterized by: Openness

Mutual respect

Collaborative approach

have a clear & straightforward expectations and

feedback

Egalitarian and caring interactions with students

Nursing faculty are the gatekeepers of the

profession


4/29

BOX A-1 PRIMARY PREVENTION OF STUDENT-

BASED CLINICAL PROBLEMS

During student orientation to the clinical course:

Review institutional policies related to student

conduct including clinical performance and academic

integrity

Review student obligations regarding clinical agency

policies

Review course requirements written in the syllabus

Review the evaluation tool, procedures, and data

sources to be used Provide students with the opportunity to ask

questions and seek clarification

Provide orientation to clinical site and specific

unit/area


5/29

Assure evaluation tools used are reliable and

valid Create opportunities for student self-evaluation

Provide ongoing, regular feedback regarding

progress in the course

Assure all students are treated equally in termsof evaluation

Assure privacy in interactions with students

when sharing negative evaluative data

Maintain anecdotal notes


6/29

CENTER FOR ACADEMIC INTEGRITY

it offers a meeting place for the identification,

affirmation, and promotion of the values of

academic integrity

the site has a public tier that includes anAcademic Integrity Assessment Guide for use in

the development of an action plan for assessing

learning climate and evaluating academic

policies and procedures.

Time to review the legally mandated student

expectations for the protection of patient safety


7/29

WRITTEN SYLLABUS

Is a contract between the faculty and the student.

Direct observation and interaction with students

evaluative data may be obtained from these

sources:

- Student papers

- Journals

- Agency personnel

- Student presentations

- First-hand accounts of patients and

families


8/29

ORIENTATION

a legal requirement of assuring safe practice of

nursing students

Self-Assessment (for students)

is essential to their developing professional practice.

Ex: journaling of daily or weekly self-evaluation form


9/29

ANECDOTAL NOTES

are written documentations of all conferences with

students, their daily clinical experiences, and theirperformance

are of value in constructing routine feedback, preparingformal student evaluations, and providing documentationof any problematic performance areas.

should be sufficiently detailed as to present the most

accurate picture of the situation at hand. faculty should record both positive and negative aspects of

each students work as objectively as possible, as it relatesto course objectives, the source of the data, and actions theymay have taken in regard to any student deficiencies.

should avoid bias judgment as not to focus on negativeaspect of performance.

avoid comments related to personality traits

these notes are the property of the faculty and are not partof the students academic record.

faculty should retain these notes in a secure file to protectconfidentiality for at least 2 years after students completethe course.


10/29

UNSATISFACTORY CLINICAL PERFORMANCE

Reasons for unsatisfactory performance:

Students unable to transfer knowledge from their

concurrent or prior courses in the current clinical course

Problems with one or more patient safety issues, such as

difficulties with technical skill performance orinadequate performance

Absenteeism/tardiness/late submission of written work

Violation in appearance standards

Violations in conduct (behavior)


11/29

BOX A-2 DUE PROCESS

Assuring Procedural Due Process in Cases of Unsatisfactory

Performance: Sample Policies and Procedure

At any time the students performance or progress is unsatisfactory:

Written notification is provided (Notification of Unsatisfactory

Performance form)

Aplan for addressing deficiencies is provided, which includes an

opportunity for satisfactory improvement within a specified time

Specific ramifications are described that will be enforced if

satisfactory improvement does not occur

If the student believes the assessment of his or her performance

is inaccurate or unfair after meeting with the faculty member,

the student may discuss the matter with the faculty members

immediate supervisor

Notification of unsatisfactory performance is to occur in a

private, face-to-face meeting between faculty and student


12/29

PARAMETERS :

Nursing programs and procedures may provide

guidance in:

1. terms of remediation options,

2. when students must be removed from clinical sites,

and

3. grounds for dismissal from the program.


13/29

HOW TO DOCUMENT AN UNSATISFACTORY

PERFORMANCE?

o Fill up a form

o Both student and faculty should sign the form

o Students signature indicates the form was read

and is not to be construed as an agreement withits contents

o One signed copy is placed in the students

academic record; students must receive a copy,

and the faculty member should retain one.


14/29

BOX A-3 SAFETY CONCERNS

Definitions of Safe and Unsafe Student Clinical Practice

Safe student clinical practice:

Students are expected to demonstrate growth in clinicalpractice through application of knowledge and skills fromprevious and concurrent courses.

Students are expected to demonstrate growth in clinicalpractice as they progress through courses and to meetclinical expectations outlined in each clinical courseevaluation tool.

Students are expected to prepare for clinical practice inorder to provide safe, competent care. Adequate

preparation to assure safety generally means beingprepared to carry out all skills and having all requisiteknowledge that is necessary and available in advance toexecute the activities associated with the clinicalassignment. Preparation expectations are detailed in eachclinical course syllabus.


15/29

Unsafe student clinical practice:

Unsafe clinical practice is behavior that places

the client or staff in either physical or emotional

jeopardy.

Physical jeopardy is creation of the risk of

causing physical harm.

Emotional jeopardy means that the student has

created an environment of anxiety or distress

that puts the client or staff at risk for emotional

or psychologic harm. Unsafe clinical practice is an occurrence, or a

pattern of repeated behavior, involving

unacceptable risk.


16/29

BOX A-4 SAMPLE POLICYFOR STUDENT

DISMISSAL FROM ACLINICAL SITE

Faculty may remove a student from a clinical site

for unsafe practice, violations of clinical agency

policies, or breaches of academic or professional

codes of conduct documented in this handbook.

The student also will have earned a failing grade

in the course.


17/29

CLINICAL GRADE DISPUTES Clinical faculty have the final word in the evaluation if their

students clinical performance.

Clinical courses are commonly graded as pass or fail.Novice faculty - possess limited experience with students in the

clinical setting, become uncertain with their judgments and arehesitant to fail students.

- are often torn between wanting to give students ample opportunityfor success and their sense of obligation to the profession and thepublic

Fear of litigation may inhibit faculty from failing students in theclinical setting

Legal system has supported faculty grading decisions, provided thatthe process of their determination was neither arbitrary norcapricious

Legally, the burden of truth that either criterion was not met falls

to the student When a student does not agree with the grade, a grievance action

must be available to facilitate resolution of the disagreement.

Following well designed due process procedures and affordingstudents the grievance option addresses the final judicialrequirements faculty must meet.


18/29

BOX A-5 STUDENT GRIEVANCE POLICY

FOR GRADE APPEAL DUE PROCESS

If, at the end of the term, the student believes a

course grade is inaccurate or unfair, after

meeting with the faculty for the given course, he

or she may:

Meet with the facultys immediate supervisor

(lead faculty, course coordinator, administrator),

and/or

Request an appeal hearing


19/29

VIOLATIONS OF CONDUCT

Codes of conduct for nursing students

prohibit among other things, acts of

aggression that include harassment,breaches of privacy and confidentiality,

misuse of institutional property, and drug

and alcohol abuse.


20/29

ACADEMIC DISHONESTY

academic dishonesty may occur as plagiarism,submission of an assignment already completed

for another course, falsification of patient

records, lying about an action or inaction or

cheating on a test.

documentation of incident of lying of falsified

records may include statements from agency

personnel, patients or other students.

Turn It In is one such service that evaluates for

evidence of plagiarism


21/29

IMPAIRED PRACTICE

The most common violation of the code of conductin clinical courses is probably the inappropriate

use of drugs or alcohol by students.

Chemical dependency is documented to be the

most common cause of impaired practice.Disorders

depression, anxiety, diabetes, thyroid dysfunction,

seizure disorders, asthma, migraines and even the flu or

a cold may presently intermittently or continuously as

impaired function.

Students who skip breakfast and try to function through a

busy morning commonly develop hypoglycemia, resulting in

both impaired cognition and poor skill performance.


22/29

Adverse effects of over-the-counter (OTC) antihistamines; orprescribed anticonvulsants or corticosteroids may be

responsible for students slowed information processing or skillperformance.

Numerous studies have demonstrated the role of sleepdeprivation in negativity affecting visual acuity, verbal skills,problem-solving abilities, and producing emotional liability andincreased errors.

Pain medication taken for an injury, menstrual cramps, ormigraine headaches also can be responsible for studentsaltered capabilities.

When a clinical faculty member makes theprofessional judgment that the student is chemicallyimpaired, the student should be removed from theclinical setting on the grounds of being unsafe topractice. Liability for the student, the faculty and thenursing program may be attached if an impaired

student provides patient care that is unsafe


23/29

DUE PROCESS IN DISCIPLINARY MISCONDUCT

Violations of academic integrity and breaches ofestablished codes of conduct by nursing students

must be addressed according to guidelines that

support students due process rights.

Student Due Process in Disciplinary Actions

y Oral or written notification of the violation is given to

the student.

y Notification of the violation provides sufficient detail

of the allegations.y Ahearing is conducted in which the student may

hear/see the evidence against herself and present a

defense.


24/29

REASONABLE CLINICAL DISABILITY

ACCOMMODATIONS

The Americans with Disabilities Act requirementfor non-discrimination mandates the creation of

reasonable accommodations for students with

disabilities.

Disabled students must meet the establishedstandards for the course-the course objectives.

The accommodations made should allow the

student to attain the same competencies and

require the same number of clinical hours.

A clinical buddy may be selected, using aninterested and motivated work-study student in

the program, to provide physical assistance in the

clinical or skills laboratory setting.


25/29

CLINICAL NURSE EDUCATOR LIABILITY

Criminal law is concerned with the protection of

society, and violations are punishable at federal,

state, country, and city levels.

Two Classifications of Criminal Law:

Misdemeanors (minor offenses)

Felonies (major offenses)

Civil laws are related to the rights of the

individual, as opposed to society as a whole. Civil,

noncriminal decisions are known as tort actions.


26/29

For a tort charge to be brought, three essentialrequirements must be met.

1. Accused/defendant must have a demonstrableresponsibility to the plaintiff;

2. It is alleged that this responsibility was not met;

3. Damage or injury occurred as a direct result of thisbreach of responsibility.

Negligence is defined as the failure to exercisethe standard of care that a reasonably prudentperson would have exercised in a similarsituation

Liability is assigned when a person is found to belegally accountable, responsible to anotherperson or society at large, and the action isenforceable by civil or criminal penalty.


27/29

COMMON AREAS OF NEGLIGENCE AND

LIABILITYFOR NURSE EDUCATORS

Failure to properly delegate duties to a student

Failure to properly document students nursing

skills

Failure to require students to obtain moreeducation in areas of poor performance

Failure to adequately notify students of areas of

failure/poor performance: the faculty member

fails to discuss or present a plan fro improvement

to the student, outlining areas that need

improvement such as behavior, skills, or

knowledge base


28/29

Failure to facilitate student due process

Failure to protect student safety

Nursing faculty may be involved in legal actions with

students in a number of ways. They named as co-

defendants, along with the school or college or they may be

sued as individual faculty. Depending on the statutes of thestate, some public academic institutions provide faculty

protection from involvement in tort cases according to what

is known as sovereign, or charitable, immunity.

In addition to negligence, clinical nursing faculty also may

be held legally accountable for the adequacy of theirteaching. Students alleging that one or more faculty

breached their duty to teach effectively file what are callededucational malpractice suits.


29/29

THANK YOU AND H AVE A NICE

DAY!!!

Legal and Ethical(2)

Documents