Legal/Ethical- NSG1

Altruism

Concern for the welfare and well-being of others (nurses’ concern for welfare of patients)

Autonomy

Right to self determination

Human Dignity

Respect for the inherent worth and uniqueness of individuals and populations

Integrity

Acting in accordance with an appropriate code of ethics or accepted standards of practice

Social Justice

Upholding moral, legal, and humanistic issues

Ethics

A systematic study of principles of right and wrong conduct

Ethical development begins in

childhood and develops gradually

The fact that an action is legal or customary does not

make the action ethically or morally right

Nursing Ethics

Formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make and evaluate judgements

Autonomy

Right for patients or surrogates make their own decisions

Nonmaleficence

Avoid causing harm

Beneficence

Balance benefits against risk and harms

Justice

Give each their due: Act Fairly

Fidelity

Keep promises

Care Base approach: Nurse-patient

relationship is center

Care Based Approach:

Directs attention to the specific situations of individual patients viewed within the context of their life narrative

A care based approach is

essential to person-centered care

Characteristics of Care-based approach

Centrality of the caring relationship

• Promotion of the dignity and respect of patients as people

• Attention to the particulars of individual patients

• Cultivation of responsiveness to others and professional responsibility

• Redefinition of fundamental moral skills to include virtues like kindness, attentiveness, empathy, compassion, and reliability

Ethical Dilemmas

Arise when attempted adherence to basic ethical principles result in two conflicting courses of action

Nurses committed to high-quality care base their practice on professional

standards of ethical conduct as well as professional values

Nurses should Cultivate the virtues of nursing

• They should understand ethical theories that dictate and justify professional conduct

• Be familiar with codes of ethics for nursing and standards of professional conduct

When nurses are unable to translate their ethical

judgements into action, their integrity is compromised

Necessary capacities to deal with moral distress: recognizing symptoms of moral

distress and specking up about ethical concerns

Moral Distress symptoms

• Frustration, anxiety, withdrawal, guilt

• Neck Pain, heart palpitations, vomiting,

• Depression, emotional exhaustion, decreased job satisfaction, nightmares

Moral Resilience

The capacity to recover, adapt, and even thrive in the face of morally distressing situations

How to build Moral Resilience

• Cultivating good relationships

• Accepting that change is a part of living

• Refusing to view crises as insurmountable

• Nurturing a positive view of self and self-care

• Keeping things in perspective

Moral Distress

Knowing the right thing to do but not being able to do it

Moral Distress Example

Unsafe staffing ratios

Ethical Dilemma

Patient will not take their meds, you understand but they need their medicine

Virtues

Human excellences

Some virtues you will have naturally

others you may have to work at it

Virtues of Good Nurses

• Competent

• Compassionate

• Trustworthy

• Intelligent

• Courage

• Integrity

Many larger institutions have ethics

committees as a resource in their facility

American Nurses’ Association website has

resources available for ethical decision making

ADPIE

A- Assess the situation

D- Diagnose the ethical problem

P- Plan

I- Implement your decision

E- Evaluate

Advocacy

Protection and support of another’s rights

When respecting autonomy, the nurse supports the patient’s right to make

decisions with informed choice and acts in the best interest of the patient

We do not make ethical decisions FOR our patients, we

facilitate the patients’ own decision-making

If patients do not want to make their own decisions, nurses can help

delegate that decision to family members or others per the patient’s wishes

Our health care system is becoming more market-driven, so there is no guarantees that the

health care system will work to secure patient safety and health

Each state has a nurse practice that protects the public

by broadly defining the legal scope of nursing practice

Voluntary Standards

Not mandatory but are used as guidelines for peer review

Legal standards-developed by legislature and are implemented by authority granted by the state to determine minimum standards for the education

nurses, set requirements for licensure, and reasons why a nurse’s license should be revoked an suspend

Credentialing

refers to ways in which professional competence is ensured and maintained

Accreditation

Process by which an educational program is evaluated to make sure they meet certain standards

Licensure

Process by which the stat determines that a candidate meets certain minimum requirement to practice in the profession and grants a license to do so

Certification

Process by which a person who has met certain criteria establish

Licensure is not a constitutional right, it is

a revokable privilege

Crime

Violation punishable by the state

Tort

Subject to action in a civil court with damage usually being settled with money

Crime example

Controlled substance abuse, criminal negligence, rape, theft, illegal possession of drugs

Crime is

tried in criminal law court

Tort may be

unintentional or intentional

An act that is a Tort can also

be crime (Tried in both criminal and civil court)

Tort Examples

Intentional assault and battery, false imprisonment, fraud, invasion of privacy. Can result in prosecution

Unintentional Tort is referred to

as negligence

A nurse who fails to initiate proper precautions

to prevent patient harm

Assault

A threat to or an attempt to make bodily contact with another person without their consent

Battery

Assault that is carried out in a willful and angry way

Battery examples

Forcibly removing a patient’s clothes, administering and injection after PT has refused

Assault Ecample

Threatening to do thing

Defamation of character

Making derogatory comments about another

False imprisonment

Unjustified retention or prevention of the movement of another person without proper consent

• Restraints

  • A person of sound mind cannot be forced to stay at a hospital and get treatment

We DO NOT restrain patients without

a doctor’s orders

Fraud

willful or purposeful misrepresentation that could cause harm to a person or property

Fraud Example

Reporting vital signs or other assessment data that they have not obtained

Invasion of Privacy

Patients have a right for information to be kept confidential

• All patient information is considered CONFIDENTIAL

HIPAA

Health Insurance Portability and Accountability Act

HIPAA ensures that patients have the following rights

• See and copy their health records

• Update their health record

• Request correction of any mistakes

• Get a list of the disclosures made my health care institutions

• Choose how to receive health information

Patient must sign a release for you to talk

to anyone about their health status

Inappropriately discussing a patient’s problem with a

third party and may subject the nurse to liability

HIPAA includes punishments for anyone caught violating

patient privacy-intentional or unintentional!

Cybersecurity has become type

priority for all health care systems

• Cyber attacks for patient information from outside parties

Informed and voluntary consent is needed for admission

and specialized diagnostic or treatment procedure

Good Samaritan Law

Designed to protect health care providers when the aide people in emergency situations

CPR, Basic first aide, life-saving actions are

covered by the Good Samaritan Laws! `

Performing an action you are not trained in or that is outside of your scope as and RN:

not covered & you could be held responsible for any harm that arises from your actions

Nurses are legally responsible for carrying out the orders of a legitimate provider unless

a reasonable person would anticipate the order would lead to injury

Written orders (on the computer usually) are best practice. If

telephone order, make sure to repeat back for accuracy

If you think an order is

questionable, QUESTION IT!

The 1090 Americans with Disabilities Act

Prohibits businesses from discriminating against people with disabilities

The purpose of advance directives is to communicate a clinet’s wishes

regarding end of life care should should the client become unable to do so

Types of Advance Directive

• Living will, your own decisions as far as end of life care

• Durable power of attorney-person who makes decisions for the patient

• Provider’s orders-orders form a physician regarding end of life care