Presentation on theme: "Legal and Ethical Considerations"— Presentation transcript:
1 Legal and Ethical Considerations Chapter 3Introduction to Medical-Surgical Nursing
2 Ethics Values relevant to human conduct Defines what actions are right and wrong and whether the motives and outcomes of those actions are good or badChoices are often shades of gray, not black and white, or a choice must be made between two good or two bad options
3 Ethical Dilemmas Ethics does not prescribe one right answer Define formal processes to explore what is proper conductBioethicsEthical questions that arise in the context of health careWhen does an ethical dilemma exist?The concept of morality is closely related to ethics because moral beliefs provide a foundation for rules of action.When no one solution seems to be satisfactory because of conflicting morals or ethical principles, an ethical dilemma exists.
4 Ethical Dilemmas cont’d MoralityShared ideas of what is right or good within a society or cultureMoral distressOccurs when nurse feels powerless because his/her moral beliefs cannot be followed because of institutional or other barriersOne reason that some nurses leave nursing
5 Ethical Dilemmas Moral outrage May occur when another person in the health care setting acts in a way that the nurse believes is immoral and the nurse feels powerless to intervene
6 Principles of Ethics Autonomy Recognition is inherent in the concept of informed consent and in advance directivesRespect for the rights of people to make decisions about their own health and health care, such as accepting or refusing blood transfusions or medicationsWhat are the five concepts of health care ethics?
7 Principles of Ethics cont’d BeneficenceActions to promote good, prevent harm, or remove the patient from harmNurse behaves in the patient’s best interestThe problem is to define good, recognizing that the definitions of the patient, the family, the nurse, and the physician may differAn example of preventing harm is reporting a co-worker who is impaired or incompetent
8 Principles of Ethics cont’d JusticeFairness, equity, appropriateness of treatmentRecognition that goods and services are limitedDecisions about who will receive limited resources are based on various philosophies and might use the criteria of equal distribution; individual need, merit, social contribution, rights, or effort; or serving the greatest good for the greatest number of individuals
9 Principles of Ethics cont’d NonmaleficenceRequires that the nurse “do no harm”Therapeutic interventions can be uncomfortable; benefits must justify the discomfortA patient getting out of bed for the first time after surgery likely will experience some pain, but the benefits of mobilization far outweigh temporary discomfort
10 Principles of Ethics cont’d ConfidentialityPatient information must be protectedPatients have the right to control who has access to personal informationNurses must guard against the careless, accidental, or deliberate sharing of private informationVeracity (truth)Nurses must be honest with patients as well as in documentation and communication with colleaguesNursing and other professions have sets of ethical principles that are accepted as basic to the profession.What are the common themes in documents that define ethical codes for nurses?
11 ValuesBeliefs and attitudes important to a person that influence daily choicesResult of cultural, social, and personal experiencesFamily is foundation for values formationValues essential for professional nurses: altruism, equality, aesthetics, freedom, human dignity, justice, and truthWhat are some modes by which values may be acquired?
12 Values cont’d Values conflicts Values of individuals and institutions are differentRisk that patient’s values may not be recognized or respectedAs a nurse, you can recognize values conflicts by being aware of your own values and learning about those of your patientsTry to understand the other person’s views and find common ground
13 Philosophical Basis of Ethics Feminist ethicsInequalities between people on the basis of gender; also places value on relationshipsEthics of careCare is a “central activity of human behavior and one that deserves special attention in health care”
14 Steps in Processing Ethical Dilemmas Determine that it is an ethical problemEthical problems have all of the following characteristicsScientific information does not provide the answerThe problem is perplexing, i.e., the answer is not simpleThe solution is profoundly relevant to several areas of human concern
15 Institutional Ethics Committees Most institutions have committees to process ethical dilemmasMultidisciplinary membership seeks input from patients, families, professionals, administratorsFunctions of the ethics committee: education, policy recommendation, oversight of policy implementation, consultation on specific cases
16 Legal Implications for Nursing Practice Law defines the boundaries of nursing practiceNurses must know their functions and limitations in order to protect their patients and themselvesA nursing license is granted only to those who have met specific educational standards and demonstrated the minimal required level of knowledge as assessed by an examinationThe state board of nursing can revoke or suspend the license of a nurse who violates the provisions of the licensing statutes
17 Types of Law: Statutory Laws Created by elected legislative bodies, including nurse practice actsClassified as either civil or criminalCriminal laws are concerned with preventing harm to society or punishing violatorsCivil laws protect individual rights
18 Types of Law: Regulatory Laws Created by administrative bodies, such as state boards of nursingRules and regulations that address the conduct of nursesCommon lawResult of judicial decisions made when individual cases are decided in the courts
19 Types of Law: TortA tort is a civil wrong against a person or property
20 Types of Law: Intentional Tort AssaultContact without the patient’s consentBatteryTouching in an offensive or harmful manner without consentInvasion of privacyUnwanted intrusion into the patient’s private affairsDefamation of characterReleasing information that could damage a person’s reputation
21 Types of Law: Unintentional Tort NegligenceConduct that falls below the standard of careMalpracticeProfessional negligenceTo be found liable, it must be shown that the nurse owed a duty to the patient, the nurse did not carry out that duty, the patient was injured, and the injury was caused by the nurse’s failure to carry out the duty
22 Types of Law: Unintentional Tort cont’d Nurse’s best protection against charges of negligence and malpracticeAdhere to standards of care; provide competent care; communicate with other members of the health care team; fully document assessments, interventions, and evaluations; and establish good relations with patientsStudent nurses are held to the same standards of care as are licensed nursesStudents should never perform care for which they have not been prepared
23 Malpractice Insurance Health care institutions commonly provide malpractice insurance for nurses they employCovers legal fees and awards if nurse is sued for professional negligence or medical malpracticeIf the act in question occurs outside place of employment, the agency insurance does not cover the nurseNurses need to decide whether to carry personal liability insurance as well
24 Malpractice Insurance cont’d At times, nurses assist at accident scenes. As long as actions are within accepted standards, Good Samaritan laws protect them from liabilityState laws vary; nurses should acquaint themselves with the laws in their states of residence
25 ConfidentialityEvery patient’s right: medical diagnoses and treatment must be kept confidentialProtect the privacy of patient records and avoid public discussion of patient informationNever copy/remove any part of a patient’s recordHIPAA laws of 2003 made health care providers acutely aware of the actions needed to protect patient confidentialityPatients have a right to expect that their personal information, including medical diagnoses and treatment, will be kept confidential.Your employing agency should have written policies for informing patients of their rights and how their health care information can be used.
26 ConsentPatients have the right to make decisions about their own care; caregivers may not impose care against a patient’s wishesInformed consentProvide sufficient information for the patient to make an informed decisionElements of informed consent: patient decision-making capacity, sufficient information, and voluntary agreement
27 Consent cont’dState law defines who can give consent for minors and people incapable of making their own decisionsA confused or sedated person cannot give consent even if usually capable of making decisionsSignatures on consent forms must be obtained before administering preoperative medicationsConsent must be voluntaryThere can be no real or implied coercionThe patient must be making the decision freely without fear of retaliation for refusal or because of an expectation of some real or implied reward beyond the medical benefit.Can a patient sign a consent form after receiving preoperative sedation medications?
28 Consent cont’dRequired for hospital admission, surgery, some treatments, and research participationPhysician is responsible for obtaining informed consentNurses may obtain patient signatures and serve as witnesses to the signature per agency policyIf the nurse suspects the patient lacks decision-making capacity or does not fully understand the implications of the consent form, the physician should be contacted and the supervisor notifiedYou should know the agency policies regarding the need for signed consent forms.
29 Physician Orders Legal, appropriate orders should be carried out If nurse believes an order is inappropriate, physician should be contacted for confirmation or correctionIf physician confirms order and LVN/LPN still believes it is inappropriate, the nurse should contact the supervisor to interveneNurse may share responsibility for harm that follows implementation of an inappropriate orderVerbal orders increase the risk for error; follow agency policy
30 DNR (Do Not Resuscitate) Orders Resuscitation will not be initiated if a patient ceases to breathe or the heart stopsOrders should be written and reviewed regularly in case patient’s status changesIn many states, in the absence of a written order, it is assumed that resuscitation is appropriateWho makes the decision to initiate a DNR order?“Slow code” orders may be interpreted as below the standard of care.
31 Short Staffing Staffing inadequate for competent care The supervisor should be notifiedWritten protest submitted when required to accept an assignment without adequate staffingNurses should know their state regulations and agency policies for such situations
32 Short Staffing: Patient Abandonment Walking out or refusing an assignment could be viewed as patient abandonmentIncludes sleeping on the job, leaving in the middle of a shift without notifying anyone, failing to show up or complete an agreed assignment in a home setting, and leaving the patient care area and remaining unavailable such that patient safety may be compromised
33 Short Staffing: Safe Harbor A nurse may be able to invoke “safe harbor” if given an assignment that the nurse believes violates his or her duty to the patientProtects nurses from actions against their license when they notify the supervisor at the time the assignment is madeAgency policies and state law must be considered by the individual nurse.
34 FloatingNurses are obligated to inform supervisors if they lack the skill to care for particular patientsNurses who float to new units must be oriented to the setting and trained for the new area
35 Right to Refuse Treatment Patients have the right to refuse medical treatment, including life-sustaining careWhen a patient is incompetent to make his or her own decisions, an effort is made to determine what the person would have wantedAdvance directives help define the patient’s wishesWhat has increased public awareness of the importance of making one’s wishes known in writing while still able to make decisions?
36 Nurse Practice ActNursing is a specific profession that has legal definitions as to scope or boundaries of practice.The law that defines and regulates the practice of nursing in the United States is the Nurse Practice Act.Laws are written by the legislature of each state.Go to
37 The legislative power to initiate, regulate, and enforce the provisions of the Nurse Practice Act is delegated to the State Board of NursingThe National Council of State Board of Nursing is responsible for the NCLEX exam.Revoking a License
38 Good Samaritan ActA law that protects individuals from liability if they give emergency care within the limits of first aid and if the individual acts in a reasonable and prudent manner.
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