Ethical & Legal Issues PPT

what guide nurse decision-making?

Ethical principles

what should nurses always do first?

protect patient’s safety, welfare and rights first

what are nursing accountable for?

their own actions

is “ignorance of the law” a viable defense?

NO

who is the nurse’s duty to?

the patient, and the family in all interactions

when is nurse competency and client care accountability compromised?

when the nurse has inadequate knowledge about laws that guide nursing practice.

define ethics

A branch of philosophy that deals with distinguishing right from wrong

define bioethics

term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health

define moral behavior

Conduct that results from serious critical thinking about how individuals should treat others

define values

Personal beliefs about what is important and desirable

define values clarification

A process of self-exploration by which people identify and rank their own personal values

define right

A valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

define absolute right

When there is no restriction whatsoever on the individual’s
entitlement

define legal right

a right in which
society has agreed and
formalized into law

define utilitarianism

An ethical theory that promotes action based on the end result that produces the most good (happiness/benefit) for the most people.

define Kantianism

Suggests that decisions and actions are bound by a sense of duty and respect for moral law rather than about the outcome. 

define Christian ethics

Do unto others as you would have them do unto you.

define natural law theories

Do good and avoid evil. Human knowledge of the difference between good and evil directs decision-making.

define ethical egoism

Decisions are based on what is best for the individual making the decision.

where is the “golden rule” found?

in other religions, not just Christianity

what does the ANA code of ethics for nurses do?

• Guides our nursing practice 

• Clarifies expectations of the nurse

what are the different ANA Codes of Ethics for nurses?

#1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 

#3 The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. 

#4  The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care.

define ethical dilemmas

• Ethical dilemmas are situations that require individuals to make a choice between two equally unfavorable alternatives.

• Taking no action is considered an action taken.

• Ethics committee

what are the different principles of ethics?

autonomy, beneficence, non-maleficence, justice, veracity

what is autonomy (an ethical principle)?

emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected. Patient makes decisions whenever possible.

what is beneficence (an ethical principle)?

refers to one’s duty to benefit or promote the good of others.  Serve the client’s best interest.

what is non-maleficence (an ethical principle)?

Abstaining from negative acts toward another; includes acting carefully to
avoid harm. Do no harm.

what is justice (an ethical principle)?

Principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly.

what is veracity (an ethical principle)?

Principle that refers to one’s duty to always be truthful. Protects the clients right to know.  Truth telling and honesty.

what’s the “model for making ethical decisions”?

1. Assessment

2. Problem identification

3. Planning

4. Implementation

5. Evaluation

define competence

• Person is assumed competent unless proven by a court

• Mental incompetence is the inability of a person to make or carry out important decisions regarding his or her affairs.  An individual is defined as mentally incompetent if h/she is manifestly psychotic or otherwise of unsound mind, either consistently or sporadically, by reason of mental defect. Few examples of such mental defect are intellectual disability, schizophrenia, and dementia.

what does “competent” or “competency” mean?

means mental ability to stand trial. A person is mentally competent to stand trial if he or she is able to understand the character and consequences of the proceedings against him or her and is able properly to assist in his or her defense

what are the legal portions of incompetence in TX?

• Art. 46B.024.  FACTORS CONSIDERED IN EXAMINATION.  During an examination under this subchapter and in any report based on that examination, an expert shall consider, in addition to other issues determined relevant by the expert, the following:

(1)  the capacity of the defendant during criminal proceedings to:

–(A)  rationally understand the charges against the defendant and the potential consequences of the pending criminal proceedings;

–(B)  disclose to counsel pertinent facts, events, and states of mind;

–(C)  engage in a reasoned choice of legal strategies and options;

–(D)  understand the adversarial nature of criminal proceedings;

–(E)  exhibit appropriate courtroom behavior; and

–(F)  testify;

(2)  as supported by current indications and the defendant's personal history, whether the defendant:

–(A)  is a person with mental illness; or

–(B)  is a person with an intellectual disability;

(3)  whether the identified condition has lasted or is expected to last continuously for at least one year;

(4)  the degree of impairment resulting from the mental illness or intellectual disability, if existent, and the specific impact on the defendant's capacity to engage with counsel in a reasonable and rational manner; and

(5)  if the defendant is taking psychoactive or other medication:

–(A)  whether the medication is necessary to maintain the defendant's competency; and

–(B)  the effect, if any, of the medication on the defendant's appearance, demeanor, or ability to participate in the proceedings.

what is the criteria for admitting someone?

• Harm to self

• Harm to others

• Unable to meet basic safety needs

with regards to Ethical Issues in Psychiatric/Mental Health Nursing, what are all pts entitled to?

• The right to treatment

• The right to refuse treatment (including medication)

• The right to the least restrictive treatment alternative

what is someone’s “right to tx”?

Anyone who is admitted to a hospital has the right to treatment (plan within 24 hours)

when would someone be involuntarily hospitalized?

risk of harming themselves or others and do not recognize the dangerousness of their symptoms.

all pts have a right to refuse tx. what is an exception to this with regards to meds?

Clients who refuse medication must be judged incompetent to evaluate the benefits of the treatment in question.

in emergency cases of involuntary hospitalization, what may be used?

sedative medication may be administered without the patient’s consent in order to protect patients from harming themselves or others.

what has texas created in the event of pts refusing medication?

Texas courts can mandate medication. 

what are the characteristics of the pt’s right to the least restrictive tx alternative?

• Clients who can be adequately treated in an outpatient setting should not be hospitalized, and if they are hospitalized, they should not be sedated, restrained, or secluded unless other less restrictive measures were found to be unsuccessful.

• Clients have a right to whatever level of treatment is effective and least restricts their freedom.

what is required in an inpatient admission (both voluntary and involuntary) with regards to every pts right to the least restrictive tx alternative?

Inpatient admission (voluntary and involuntary):

–Dangerous to themselves

–Dangerous to others

–Unable to meet their basic safety needs

what are ALL patients, even those involuntarily hospitalized, considered competency wise?

competent to refuse treatment, but a legal guardian may authorize treatment (judge) [Rogers v. Oken].

what are the different types of laws nurses must consider?

• Statutory law – enacted by legislature or governing body.  Like Nurse Practice Act

• Common law – decisions form previous legal cases.  What nurses can refuse to provide.

what’s statutory law?

enacted by legislature or governing body.  Like Nurse Practice Act

what’s common law?

decisions from previous legal cases.  What nurses can refuse to provide.(civil & criminal)

what are the subgroups of common law?

civil and criminal 

what does civil law do?

Protects the private and property rights of individuals and businesses (sub types of common law)

– Torts (wrongful conduct/harmed someone)

– Contracts (failed to fulfill an obligation)

what does criminal law do?

Provides protection
from conduct deemed injurious
to the public welfare (stealing medication) - subtype of common law

in psych nursing, what must a nurse do if a pt tells them about intent to harm?

it is the duty of the nurse to report this information to the psychiatrist or to other team members. 

is reporting a pts intent to harm oneself considered a breach of confidentiality?

NO, not a breach of confidentiality, and the nurse may be considered negligent for failure to do so.  All members of the treatment team must be made aware of the potential danger that the client poses to self or others.

what is essential in the event of pts saying they intent to harm oneself after reporting?

Detailed written documentation of the situation

what are the components of informed consent in psych nursing?

consist of:

–Knowledge (information or education)

–Competency (cognitive skills)

–Free Will (without pressure)

• Exceptions….. Unconscious, psychotic, impaired by substance

• Emergency situations….. Consent from nearest relative or appoint a guardian or hospital administrator

what is the legal stance on restraints and seclusion in psych/mental health nursing?

• Restraints are never to be used as punishment or for the convenience of staff.

Decrease agitation:

–“talking down” (verbal intervention)

–Chemical restraints (tranquilizing medication)

–Mechanical/physical restraints

–Seclusion

• Joint Commission

• Close monitoring and observation

–False imprisonment of voluntary patients

what are the components of emergency commitments?

(72 hours) (after this time another hearing may be set and time may be extended 7 to 21 days)

what are the components of Involuntary outpatient commitment?

this is partial hospitalization 

what are the portions of nursing liability?

malpractice and negligence

what are the basic elements of a nursing malpractice lawsuit?

–A duty to the patient existed based on the recognized standard of care.

–A breach of duty occurred, meaning that the care rendered was not consistent with the recognized standard of care

–The client was injured.

–The injury was directly caused by the breach of a standard of care.

what are the different types of lawsuits that occur in psychiatric nursing with regards to breaching of rights?

–Breach of confidentiality

–Defamation of character:

■Libel (written)

■Slander (spoken)

–Invasion of privacy (searched or records)

–Assault (threat) and battery (physical harm)

–False imprisonment

what are some protective things for nurses that reduce liability?

–Handoff information/SBAR

–Responding to the patient (avoiding failure to rescue)

–Educating the patient

–Complying with the standard of care/policies and scope of practice

–Supervising care

–Adhering to the nursing process

–Documenting carefully

Following up by evaluating the care that was given

what’s TX Order of Protective Custody/Mental Health Warrant?

Credible person presents evidence to a judge who makes decision and issues warrant (not a criminal warrant).  Person is picked up and taken to hospital for evaluation and treatment.  No more than 72 hours.  Discharge home, or to other suitable facility.  Can be extended up to 90 days after a hearing.

what’s TX Emergency Peace Officer Warrant/Emergency Peace Officer Commitment?

Police officer certifies that the person is at risk of imminent harm and should be protected from actions.  Preliminary exam must take place in 24 hours.  May be kept for another 24 hours and released or transferred to HLOC after by 4:00 pm the following business day after 24 hours.

mastery content

• Ethical principles guide nurse decision-making

• Nurses should protect patient’s safety, welfare and rights first

• The above items guide nursing actions

• Nurses are accountable for their own actions

• Ignorance of the law is not a defense