Medsurge Mod 2 Lesson 1 & 2

Ethics

• Professional guidelines that inform how nurses should act in clinical settings.

• refers to a set of principles that guide professional conduct and decision-making.

Moral

• Individuals beliefs that influence personal behavior but may vary from person to person.

• Personal or societal beliefs about what is right and wrong. 

It is often shaped by culture

Legal

• Binding rules that ensure nurses practice within the bounds of the law.

• Rules and regulations that are enforced by law. 

• Established by the governing bodies to ensure safe and competent care.

ETHICAL NURSING CARE

• Refers to the practice of making decisions about healthcare aligned with established ethical principles.

• It is not just about following rules, but involves critical thinking and judgement in situations where the right course of action may not always be clear.

ALWAYS THINK OF PATIENT’S BEST INTEREST.

Justice

ETHICAL PRINCIPLES

fairness, to provide care that is just, and equitable, and evenly distributed.

• Fairness

• Distribute care evenly

• Administer care fairly

• Be just and equitable

• equal

• allocation, resources, people

Beneficence

ETHICAL PRINCIPLES

Doing good for the client, doing the right thing. 

• Doing good 

• Doing the right thing for client

• Helping and doing good.

• Just doing good for the benefit of the patient.

• If you don't do this, there is no harm to the patient.

• Promoting well-being

  Ex. Changing position of patient suffering from low RR to semi-fowler position

Non-maleficence

ETHICAL PRINCIPLES

Doing no harm (intentional or unintentional). 

• Doing no harm

• No intentional/unintentional harm

• Not hurting the client

• “Kapag ba ito, hindi ko ginawa, mapapahamak ang patient?”

• Avoiding Harm

Accountability

ETHICAL PRINCIPLES

Accepting responsibility for actions, nursing care, and the consequences of actions. 

• Accepting responsibility for your actions.

• Responsible for your nursing care.

• Responsible for your actions.

• Accept the consequences of your actions.

Fidelity

ETHICAL PRINCIPLES

Keeping promises, remaining true to professional responsibilities. 

• Keeping your promises

• Faithfulness

• True to professional responsibilities

Autonomy

ETHICAL PRINCIPLES

Accepting the client is their own person with their own perspectives, values, and beliefs, allowing the client to make their own decisions without judgement or coercion. 

• “The nurse accepts the client as a unique person who has the innate right to have their own opinions, perspectives, values and beliefs. 

• Encouraging patients to make their own decisions. 

• No judgement/coercion.

• The patient has the right to refuse any/all treatments. 

Veracity

ETHICAL PRINCIPLES

telling the complete truth, not withholding any part of the truth, even if it is upsetting. 

• Telling the truth

• Not withholding information from patients. 

• Telling things completely.

Cases where it's okay to withhold/modify the truth:

A/I (additional info)

A/I

1. The patient will not be harmed. 

2. It's for the best interest of the patient. 

3. Modifying the truth is temporary. 

PRINCIPLE OF EPIKEIA

• Exception to the general rule

• It is a reasonable presumption that the authority making the law will not wish to bind a person in some particular case, even though the case is covered by the letter of the law. 

• Benefit outweighs the risks. 

Ex. Allowing a relative to see a seriously ill patient who expresses the desire to see a former although it is not yet visiting hours.

CONFIDENTIALITY

• If information is not pertinent, nurses should question whether it is prudent to document it in the patient's record. 

• Discussions of patients with members of the health care team is often necessary. These discussions should be done in private.

Threats: 

1. Family members as interpreters. 

2. Easy access to technology. 

3. Keeping all information secret, even identity. 

RESTRAINTS

• Physical and pharmacological _____; an issue with ethical overtones because of the limits on a person's autonomy. 

• Weigh carefully the risks, limiting autonomy and increasing risks of injury. 

• Only when no other viable option is available should restraint be employed (ANA, 2001)

Types of restraints:

A/I

A/I

1. Vest & jacket restraints

2. Mittens

3. Belt restraints

4. Tray tables or  Lap buddies. 

5. Wrist restraints.

6. 2 point restraints. 

7. 3 & 4 point restraints.

TRUST ISSUES

Three ethical dilemmas that directly conflict with Veracity:

1. Use of placebos

2. Not revealing a diagnosis to a patient. 

3. Revealing a diagnosis to people other than the patient. 

INFORMED CONSENT

• Free and rational act. 

• Must be obtained from the patient or his authorized representative (may be his parent/guardian).

If minor: (Informed Consent)

• Parents/someone standing in their behalf. 

• If the minor is married or otherwise emancipated, parental consent is NOOOT needed. 

For sterilization: (Informed Consent)

• Husband and wife: if the operation is primarily to accomplish sterilization. 

• Patient: if due to medical necessity. 

LEGAL CONCEPTS

Advanced Directives

• Legal Document: provides instruction for medical care and ONLY goes into effect if the patient cannot communicate their wishes. 

• Serves as a guide for HCWs and caregivers if the patient is: terminally ill, seriously injured, in a coma, in the late stages of dementia or near the end of life.

Living will

Advanced Directives

• Written Legal Document

• Directive given by the patient as to the type of treatment he wants to receive if and when he gets into respiratory arrest. 

Ex. DNR, DNI, CPR, Mech Vent, Tube feedings, dialysis, palliative care, organ/tissue donation, body donation.

Power of Attorney

Advanced Directives

• Legal assignment of a person who will decide on their behalf

• Legal Guardian

Tort

LEGAL TERMINOLOGY

-A wrongful act or infringement of a right.

an act or omission that gives rise to injury or harm to another and amounts to a civil wrong for which courts impose liability

Negligence

Tort

Failure to take proper care in doing something.  (Nagkulang)

4 Requisites

1. Duty

2. Failure to do the duty

3. Injury

4. Proximate cause (prove the relationship between failure to do the duty and injury).

Malpracitce

Tort

Improper, illegal, or negligent professional activity or treatment. (Sumobra)

Assault

LEGAL TERMINOLOGY

An act, criminal or tortious, that threatens physical harm to a person (whether or not actual harm occurs).

-WORDS

Battery

LEGAL TERMINOLOGY

• Unconsented physical contact with another person, even where the contact is not violent but merely menacing or offensive. 

False Imprisonment

LEGAL TERMINOLOGY

• The state of being imprisoned without legal authority. 

Ex. Telling the Client to he or she cannot leave the hospital

Right to Appropriate Medical Care and Humane Treatment.

PATIENT'S BILL OF RIGHTS

-mandates that everyone receive timely, quality, and respectful healthcare, free from discrimination.

Right to Informed Consent

PATIENT'S BILL OF RIGHTS

-The patient has a right to a clear, truthful, and substantial explanation, in a manner and language understandable to the patient. 

Right to Privacy and Confidentiality.

PATIENT'S BILL OF RIGHTS

The ____ of the patients must be assured at all stages of his treatment.

The Right To Choose Health Care Provider and Facility.

PATIENT'S BILL OF RIGHTS

• The patient is free to choose the health care provider to serve him as well as the facility except when he is under the care of a service facility or when the public health and safety demands so. 

Right to Self-Determination.

• Patient has the right to avail themself of any recommended diagnostic and treatment procedures. 

Right to Religious Beliefs.

The patient has the right to refuse medical treatment or procedures which may be contrary to his religious beliefs.

RA 11166

[PHILIPPINES HIV & AIDS POLICY ACT]

• Signed into law on December 20, 2018. 

HIV Prevention & Education.

RA 11166

• Schools are required to incorporate HIV and AIDS education in their curriculum, focusing on prevention methods such as safe sex practices and the importance of regular testing. 

• Should be age-appropriate and culturally sensitive. 

Statutory

• Written & enacted by legislatures. 

• Specific rules and regulations. 

• Fixed unless amended or repealed by the legislature.

Common Law

• Derived from court rulings. 

• Provide interpretations and fill in the gaps where statutory law is silent/ambiguous. 

• More flexible and can evolve over time as new cases are decided. 

Doctrine of Informed Consent

PERIOPERATIVE RELATED LAWS

Secures that the consent has been obtained, documented and placed in the health record in accordance with the policy of the hospital.

Captain of the Ship Doctrine

PERIOPERATIVE RELATED LAWS

• Head of the OR is held responsible.

Doctrine of Respondeat Superior

PERIOPERATIVE RELATED LAWS

• “Let the master answer”. 

• Holds employees vicariously liable for the negligent acts of their employees that occur in the scope of their enjoyment.

• But the nurse could still face individual legal consequences depending on the severity of the negligence.