Craven Fundamentals of Nursing: Human Health and Function Chapter 6: Values, Ethics, and Legal Issues 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Learning Objectives: #1. Define values, personal values, and professional values #2. Explain how behaviors relate to values #3. Apply cultural and developmental perspectives when identifying values. #4. Examine value conflicts and resolutions in nursing care situations. #5. Differentiate law and institutional policies from professional values. #6. Discuss the eight principles of healthcare ethics from the American Nurses Association. #7. Describe a systematic approach for resolving ethical dilemmas. #8. Distinguish among licensure, a standard of care, a crime and a tort. #9. Define four elements of negligence. #10. Describe legal protections for nurses and cite measures to take. 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Values Standards for decision making that endure for a significant time in one’s life Ideas developed in life Different meanings for different people based on experience, age, culture Value Systems help people make decisions 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Example A 22 year old diagnosed with Multiple Sclerosis tells you that she has decided against medical treatment and prefers to “eat vegan food and exercise” to maintain her health. The M.D. recommends Interferon treatment. You, as a Nursing Student, know that the treatment, while having side effects, may delay the patient’s disease course. You have seen patients with severe debilitating effects of MS wheelchair-bound and dependent at age 40. How do you feel about this patient’s decision? What conflicts could arise from the different value systems of the patient, student, and M.D? How could you help to prevent or resolve conflict in this case? What assessments are needed? The nurse/student should assess his/her own and the patient’s values. The student might value duty, responsibility, caring, and a desire to prevent illness. The patient might value independence, health, parenthood… The M.D. may value professional duty, treatment…When value systems conflict, people may judge others. 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Value Indicators Attitudes Beliefs Behaviors Mental /emotional mindset; positive or negative Beliefs Ideas one accepts as truth Behaviors Actions that can be observed; value indicators Nurse behaviors reflect professional values How did the patient’s behaviors reflect her attitudes, beliefs and values? What professional values does the student reflect? How? 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Question true or false: Attitudes are the same as values. 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Answer False. Rationale: Although attitudes are linked to values, they are not the same as values. An attitude is one’s disposition toward an object or a situation; it can be a mental or emotional mind-set, and it can be positive or negative. 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Socializing Influences Family interactions We learn first from family, culture School interactions Rules, peers, teachers; encounter different values Religious interactions Ritualize values; affect health care decisions Workplace and service interactions Meeting expectations at work, with friends/spouse/family In adulthood, values grow and become ingrained, but may be more accepting of others’ values with age [or not] 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Values Clarifying values Values inquiry Value conflicts Self-reflection; identify your own personal values Values inquiry Method of examining social issues and values that motivate decisions Multiple viewpoints, value systems, advantages and disadvantages of potential solutions Value conflicts Family conflicts Common; may cause legal, family problems in health care settings End-of-life care, preventative care, health habits [exercise, smoking, eating] Nurses role can be to help set goals, identify values and influences Healthcare conflicts Between patients/families and healthcare providers 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Resolving Healthcare Value Conflicts 1 – Understand your own values 2 – Assess the patient’s perception and values 3 – Assist the patient to explore & clarify their values, beliefs, behaviors 4 – Support the patient’s values while providing safe, ethical care 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Ethics Principles of Healthcare Ethics Beneficence Nonmaleficence Branch of philosophy dealing with standards of conduct and moral judgment Principles of Healthcare Ethics Beneficence doing or promoting good Nonmaleficence avoid doing harm, prevent harm, remove from harm Autonomy Creating conditions in which patients can make their own decisions Includes advance directives, informed consent, healthcare proxy Justice Foundation for decisions about resource allocation; need vs. other 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Professional–Patient Relationships Veracity Truthfulness Influenced by culture, situation, communication skills Fidelity Keeping commitments & promises Requires good judgment Privacy Appropriate use of patient information Personal [body ] privacy Confidentiality Information about patients is private Only those involved in care need to know 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Resolving Ethical Dilemmas Strategies Validate feelings Conduct a case analysis Identify outcomes Identify short- and long-term goals 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Laws and Nursing Sources of law: Types of laws Licensure constitutional, legislative, common law Types of laws Civil, Criminal Licensure Legal ability to practice as a nurse in a state Standards of care Expected level of performance or practice Important in ,malpractice & licensing cases ANA, Joint Commission, Institutional policies 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Question true or false: The living will is an advance directive. 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Answer True. Rationale: A living will is an advance directive that specifies the types of medical treatment patients do and do not want to receive should they become unable to speak for themselves in a terminal or permanently unconscious condition. 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Torts and Crimes Intentional torts Assault and battery Defamation of character Fraud Invasion of privacy False imprisonment 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Question Which of the following terms defines unlawful touching of the body? a. Assault b. Battery c. Libel d. Slander 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Answer b. Battery Rationale: Battery is touching another person without his or her consent (unlawful touching). Assault is the threat of touching another person without his or her consent. Defamation of character is false communication that results in injury to a person’s reputation by means of print (libel) or spoken word (slander). 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Torts and Crimes (Cont’d) Unintentional torts Negligence [omission or commission] Duty and breach of duty Proximate cause Damages Trends in nursing malpractice Increase in nurses being sued for malpractice Medication errors, falls, surgical errors Higher standards of care Delegation of duties to UAP High Acuity – little time – poor communication 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Legally Sensitive Areas of Practice Controlled substances administration Death and dying Recognizing death vs. pronouncing death Assisted suicide Providing means to end life [3 states] Active euthanasia – illegal [murder] Terminal sedation Not euthanasia; pain management at end of life that may hasten death 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Legally Sensitive Areas of Practice (Cont’d) Advance directives Policy required - know it! Resuscitation Know code status DO resuscitate if unknown Good Samaritan laws Protect nurses acting in emergency Limit liability but may still be liable for gross negligence Stay until assistance arrives Covered by personal insurance 9/20/2018 NRS_320_Foundations_Craven_Collings2012

Protecting Yourself Legally Professional practice Realistic, evidence-based, practical Follow policy & procedure Document and communicate changes in patient condition Professional liability insurance A good idea Students are responsible for staying within their scope; may be liable Same competence requirement as RN Documentation Accurate, complete, timely, objective 9/20/2018 NRS_320_Foundations_Craven_Collings2012