Ethical & Legal Cosiderations
Ethical and Code of Ethics for Nurses
Roles for Nurses: Protect client privacy, conduct, and behaviors towards clients, while upholding the profession's integrity. Nurses act as advocates, educators, and caregivers, consistently maintaining professional standards and ethical responsibilities.
Nine Provisions:
1-3: Focus on direct patient care and advocacy.
Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
Provision 2: The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
Provision 3: The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
4-6: Emphasize duty and loyalty; accountability and responsibility for personal and patient care.
Provision 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.
Provision 5: The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve integrity and character, maintain competence, and continue personal and professional growth.
Provision 6: The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
7-9: Promote the nursing profession through research, standards development, collaboration to reduce health disparities, and uphold integrity.
Provision 7: The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
Provision 8: The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
Provision 9: The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
Ethical Principles:
Autonomy: Respect for individuals' rights to make their own decisions about their care, even if those decisions conflict with medical advice. This includes informed consent.
Beneficence: Acting in the best interest of the client, performing actions that benefit others. This principle guides nurses to do good and promote patient well-being.
Nonmaleficence: Avoiding harm to achieve positive outcomes, ensuring that interventions do not cause unnecessary suffering or injury. The duty to do no harm, or to minimize it as much as possible.
Justice: Fairness in the distribution of resources and care. Ensuring equal access to quality care and treating all patients equitably.
Veracity: Commitment to honesty and truthfulness in all interactions with patients, families, and colleagues. Providing complete and accurate information.
Fidelity: Keeping promises and commitments made to patients, maintaining trust, and being loyal to those under one's care.
Accountability: Taking responsibility for one's actions, decisions, and omissions in patient care.
Confidentiality: Protecting sensitive patient information and upholding privacy.
Professional Values:
Altruism: selfless concern for the well-being of others; demonstrating compassion and empathy.
Human Dignity: Respect for the inherent worth and uniqueness of all individuals, regardless of their background or condition.
Integrity: Adherence to a strict moral or ethical code, demonstrating honesty and strong moral principles in all actions.
Social Justice: Upholding moral, legal, and humanistic principles, ensuring equal access to quality care and advocating for vulnerable populations.
Ethical Dilemmas: Situations requiring difficult decisions, often with no clear ethical solution, where choices must be made between two or more morally acceptable or undesirable actions.
Ethical Decision Making Process:
Identify the ethical dilemma: Clearly define the problem and the conflicting moral duties.
Identify possible solutions: Brainstorm a range of potential actions, considering all viewpoints.
Apply ethical principles to solutions: Evaluate each solution using principles like autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity.
Include relevant individuals and factors: Involve the patient, family, healthcare team, and institutional policies in the discussion. Consider emotional, social, and cultural factors.
Decide on a solution: Choose the best course of action after careful consideration and discussion.
Review the decision: Reflect on the outcome and evaluate if the chosen solution was effective and if any lessons can be learned for future dilemmas.
Implement the decision: Put the chosen solution into action.
Common Ethical Issues for Nurses: Stem cell research, late-term pregnancy termination, medically assisted death, refusal of treatment (e.g., blood transfusions, chemotherapy), care for patients with substance abuse, and resource allocation (e.g., organ donation, ICU beds).
Key Legislation:
EMTALA (Emergency Medical Treatment and Labor Act): Ensures equal access to emergency medical care for everyone, regardless of their ability to pay or insurance status. Prohibits hospitals from turning away patients in an emergency.
HIPAA (Health Insurance Portability and Accountability Act): Protects client privacy and health insurance coverage. Establishes standards for the security and privacy of individually identifiable health information.
Social Media and Confidentiality: Strict prohibition against posting identifiable patient information online. Any breach can lead to severe legal and professional consequences.
Professional Boundaries: Define appropriate audience for social media; maintain separate personal and professional platforms to prevent blurring lines. Nurses must consistently advocate for client rights in policies and procedures, ensuring patient welfare and privacy are paramount.