Code of Ethics

Code of Ethics

• Establishes ethical standards for nursing

• Last updated in $2015$

• $9$ provisions that define ethical nursing practice and professionalism

• Succinct statement of ethical values, obligations, & professional ideals of nurses

Ethical Principles for Client Care

• Autonomy: the right to make one’s own personal decisions, even when those decisions might not be in that person’s own best interest

• Beneficence: action that promotes good for others, without any self-interest

• Fidelity: fulfillment of promises

• Justice: fairness in care delivery and use of resources

• Nonmaleficence: a commitment to do no harm

• Veracity: a commitment to tell the truth

Ethical Dilemmas

• Problems that involve more than one choice and stem from differences in the values and beliefs of the decision makers

• An ethical dilemma exists when:

  • A review of scientific data is not enough to solve it

  • It involves a conflict between two moral imperatives

  • The answer will have a profound effect on the situation and the client

Ethical Decision Making

• Steps to follow:
  1) Identify whether the issue is an ethical dilemma
  2) Gather information
  3) Reflect on your own values as they relate to the dilemma
  4) State the ethical dilemma, including all surrounding issues and the individuals it involves
  5) List & analyze all options for resolving the dilemma and review the implications
  6) Select the option that supports the ethical principle that applies to this situation, the decision maker’s values and beliefs, and the profession’s values for client care. Justify selecting that option
  7) Apply this decision to the dilemma and evaluate the outcomes

Nurse's Role in Ethical Practice

• Agent for clients facing ethical decisions

• Decision maker for health care delivery

Ethics Committees

• Address unusual or complex medical issues

• Serve as advisors, not decision makers

Breaches and Ethical Violations (examples)

• Lack of confidentiality (confidentiality breach)

• Falsification of health records

• Substance use disorder issues

Nursing Associations

• Operate at local, state, national, and international levels

• Support the mission of nursing through specific goals, objectives, and functions

• Vary with specialty

• Benefits include: networking, leadership skills, political influence, professional commitment

Accountability of Nurses

• Practicing nursing within the confines of the law to shield themselves from liability

• Advocating for clients’ rights

• Providing care within the nurse’s scope of practice

• Discerning responsibilities of nursing relative to other health care team members

• Providing safe, proficient care consistent with standards of care

Federal Policies

• Health Insurance Portability and Accountability Act (HIPAA)

• Americans with Disabilities Act (ADA)

• Mental Health Parity Act (MHPA)

• Patient Self-Determination Act (PSDA)

Criminal & Civil Law

• Criminal law: a subsection of public law; relates to the relationship between an individual and the government

• Civil laws: protect individual rights

Torts

• Unintentional torts: NEGLIGENCE, MALPRACTICE (PROFESSIONAL NEGLIGENCE)

• Intentional torts: ASSAULT, BATTERY, FALSE IMPRISONMENT

• Quasi-intentional torts: BREACH OF CONFIDENTIALITY, DEFAMATION OF CHARACTER

State Policies & Licensure

• Boards of nursing have the authority to:

  • Adopt rules and regulations that further regulate nursing practice

  • Issue and revoke a nursing license

  • Set standards for nursing programs and delineate the scope of practice for RNs, PNs, and advanced practice nurses

  • Enforce Good Samaritan Law

• Licensure

  • Professional nurses must be licensed by their state board of nursing

  • Periodic license renewal is required to maintain the right to practice nursing

  • The Nurse Licensure Compact (NLC) permits nurses to practice in their home state and other compact states under one multistate license

State Nurse Practice Acts

• Regulate nursing within each U.S. state and territory

• Executed by state boards of nursing

• Identify conditions for nursing licensure

• Identify specific nursing titles (RN, LPN, etc.) and definitions

• Determine scope and standards of practice based on license provisions

Informed Consent (Legal Process)

• Legal process by which a client or the client’s legally appointed designee has given written permission for a procedure or treatment

Informed Consent Components

• The reason the client needs the treatment or procedure

• How the treatment or procedure will benefit the client

• The risks involved if the client chooses to receive the treatment or procedure

• Other options to treat the problem, including not treating

• Components of informed consent

Informed Consent Responsibilities

• Provider: obtain consent

  • Describe the purpose of the procedure

  • Provide a complete description of the procedure

  • Identify professionals who will perform and participate

  • Describe potential harm, pain, or discomfort

  • Outline options for other treatments

  • State the option to refuse treatment and consequences

• Client: give consent

  • Give it voluntarily (no coercion)

  • Be competent and of legal age or emancipated minor

  • If unable to give consent, another authorized person must

  • Receive enough information to decide based on understanding what to expect

• Nurse: witness consent

  • Ensure provider gave necessary information

  • Ensure client understood and is competent to consent

  • Have the client sign the consent document

  • Notify the provider if questions arise or if understanding is incomplete

  • Document questions, provider notification, reinforcement of teaching, and use of an interpreter if needed

Refusal of Treatment

• Clients have a right to refuse ANY treatment

• Must sign a document indicating they understand risks

Standards of Care

• Define and direct the level of care nurses should provide

• They implicate nurses who did not follow standards in malpractice lawsuits

• Based on state nurse practice acts and published standards from the American Nurses Association (ANA) and other specialty associations

Living Will and Advanced Directives

• Living Will

• ADVANCE DIRECTIVES

• Durable Power of Attorney

• Provider's Orders

Reporting Obligations

• Legal obligation to report findings in accordance with state law

• What must be reported: abuse, communicable diseases (mandatory reporting)

Political Involvement

• Healthcare access and delivery are influenced by healthcare policy

• Healthcare lobbying groups

Health Policy & Policy Making

• Policy: Affordable Care Act, Medicare, Medicaid

Health Policy in Nursing Practice

• Practice is highly regulated by health policy

• Serves to safeguard as a consumer

Patient-Centered Care (PCC)

• The provision of caring, compassionate, culturally sensitive care addressing physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values

• The client is included in the decision-making process

• Foundational to the nurse’s practice and revolves around caring practices

• Improves client satisfaction

Factors to Consider in PCC

• Health Care Disparities

• Advocacy

• Client Education

• Client Rights

Nurse’s Role in Providing PCC

• Investigate client preferences and cultural practices, including spirituality, to provide holistic care

• Invite clients to participate in decision-making and be full members of the health care team

• Provide information to clients so they understand issues surrounding their care to promote autonomy and self-determination

Key Takeaways

• Ethics are the foundations of good nursing care

• Health care policy directly impacts healthcare delivery

• State nurse practice acts and nursing associations promote standards of care that ensure safe and effective care

• The patient is a valuable part of the health care team

References

• Assessment Technologies Institute, LLC, 2022

• Huber, Leadership & Nursing Care Management, 6th edition