NCM 118 Module 2 Ethical and Legal Issues in Critical Care Nursing

What defines critical care nursing and its key characteristics?

Critical care nursing involves assessment, critical thinking, and rapid decision-making in high-stakes situations.

How are ethics and law interconnected in critical care nursing

• Ethics (Foundation): Guides moral behavior (“what should we do”), explores gray areas, informs laws.

• Law (Mandate): Sets enforceable minimum standards (“what we must do”), backed by penalties.

Moral:

• Traditions or beliefs about right and wrong behavior

• Informed by individual and group values

• Guides standards of conduct (principles, virtues, rights, responsibilities)

Personal or cultural beliefs about right and wrong; what people feel is good or bad behavior.

Ethics:

• Reasoned inquiry into a moral life

• Systematic examination of right and wrong

• Applied ethics evaluates conduct and resolves problems

Systematic thinking about morals; rules or principles used to decide what is right in difficult situations.

What are the fundamental ethical principles in nursing

• Autonomy: Patient’s right to make informed decisions

• Beneficence: Act in patient’s best interest

• Non-Maleficence: Do no harm

• Justice: Fair and equitable treatment/resources

• Veracity: Be truthful with patients/families

• Fidelity: Keep promises & maintain confidentiality

What is a cognitive ethical problem?

Uncertainty about the right course of action.
Hint: “I don’t know what the right thing to do is.”

What is a social ethical problem?

Disagreement among healthcare team members.
Hint: Conflicts between colleagues.

What is a volitional ethical problem?

Knowing the right action but facing barriers to perform it.
Hint: “I know what I should do, but I can’t.”

Give examples of end-of-life ethical dilemmas.

Withdrawal/withholding life support, palliative vs aggressive treatment, futility of treatment, surrogate decision-making.
Hint: Decisions about continuing or stopping treatment.

What are challenges in informed consent in critical care?

Patients with altered mental status, emergency situations, complexity of treatments.
Hint: Consent issues when patient capacity is limite

What is an ethical dilemma related to resource allocation?

Scarcity of beds, equipment, or staff; requires ethical frameworks for triage.
Hint: Deciding who gets limited resources

What are confidentiality and privacy dilemmas in critical care?

Sharing information on a need-to-know basis, visitor access in open ICUs, social media concerns.
Hint: Protecting patient information in complex settings.

What is moral distress in nursing?

When nurses know the ethically correct action but are unable to act due to constraints, affecting well-being and patient safety.

What is burnout in critical care nursing?

Emotional, physical, and mental exhaustion from prolonged stress and ethical conflicts.

How can nurses recognize moral distress and burnout?

Identify emotional exhaustion, frustration, anxiety, detachment, or reduced performance.

What are mitigation strategies for moral distress and burnout?

Use ethics consultations, peer support, policy involvement, self-care, and debriefing sessions.

What is the Agenda Framework for Ethical Care?

A structured guide including:

• Ethics integration in nursing process

• SFNO Ethical Deliberation Model for complex cases

• Role of critical care nurses in ethical responsibilities

• Case study application using SFNO model

How are ethical principles integrated into the nursing process?

• Assessment – Defining the Problem

  • Identify critical facts, moral principles, and decision-making procedures.

• Planning – Exploring Solutions

  • Set primary aims, achievable objectives, and consider patient preferences, values, cultural and spiritual beliefs.

• Implementation – Taking Action

  • Execute interventions, weigh costs/benefits, monitor success, and ensure clear communication.

• Evaluation – Reviewing Outcomes

  • Debrief, provide feedback, review pros/cons, and reflect on impact on patient well-being and team dynamics.

The SNFO is a

Comprehensive Framework for ethical deliberation ensuring all aspects are considered

Stakeholders

Identify all parties affected, their interests, power dynamics, and vulnerabilities.

Facts

Gather necessary factual information, distinguish objective facts from subjective interpretations, and note potential disagreements.

Norms

Recognize relevant ethical principles, moral norms, professional codes (e.g., Nursing Code of Ethics), and conflicts between them.

Options

Brainstorm alternative actions, considering the values and implications of each option.

The Foundational steps in ethical decision making are

Thoroughly identifying stakeholders and verifying facts

Decision-Making Criteria (SFNO):

• Necessity: Is infringing values needed?

• Effectiveness: Will it achieve the goal?

• Proportionality: Is goal important enough to override another principle?

• Least Infringement: Minimize conflict with other values

• Proper Process: Use fair, established procedures

Critical Care Nurse Ethical Roles

• Advocate: Protect patient rights.

• Facilitator: Guide family decisions.

• Collaborator: Work with team & ethics committees.

• Uphold Codes: Follow nursing ethical standards.

Infringement

Violation or interference with a right, rule, or principle.

In Context (Ethics): Acting in a way that limits or conflicts with someone’s values or rights.

Sources of Law

• Statutory Law: Nurse Practice Acts define legal nursing scope.

• Common Law: Court rulings set precedents.

• Administrative Law: Licensing boards enforce regulations.

Negligence

Failure to act as a reasonably prudent nurse, leading to potential harm

Malpractice

• Professional negligence causing patient harm.

  • Elements: Duty, Breach, Causation, Harm

Duty

Definition: Nurse-patient relationship creates responsibility to provide care.

• Absence of Duty: No duty if nurse wasn’t assigned or working during the incident.

• Example: Lunsford vs Board of Nurses Examiners

Breach of Duty

Definition: Failure to act according to the standard of care.

• Proof: Patient must show nurse didn’t provide required care.

• Example: Sparks vs. St. Luke’s Regional Medical Center

Causation

Definition: Nurse’s breach must directly cause patient injury.

• Proof: Link negligence to harm.

• Example: Mullen vs. Ohio State University Hospitals

Damage

Definition: Monetary value of patient injury.

• Proof: Show nurse’s action caused financial loss or harm.