Ch. 11 - Ethics and Legal Issues

Chapter 11: Ethical and Legal Considerations

  • Overview of ethical principles in healthcare

  • Importance of informed consent

  • Legal frameworks governing patient rights

  • Case studies highlighting ethical dilemmas in practice

  • Discussion on confidentiality and its implications in healthcare settings is crucial, as it protects patient privacy and fosters trust between patients and providers.

Page 2: Objectives

  • Apply ethical principles to professional nursing practice.

  • Describe how the ANA Code of Ethics applies to nursing education & practice.

  • Explain liability issues pertinent to nursing.

  • Discuss how laws impact nursing practice & patient care.

Page 3: Ethics and Ethical Principles

Ethics

  • Standards of moral conduct in a society.

Ethical Principles

  • Beneficence: Act in the best interest of the patient.

  • Nonmaleficence: Do no harm.

  • Respect for Autonomy: Acknowledge the patient's right to make decisions.

  • Justice: Fairness in treatment and allocation of resources.

  • Veracity: Commitment to truth-telling.

  • Accountability: Accepting responsibility for one's actions.

  • Advocacy: Supporting and representing the patient's needs and interests.

  • Confidentiality: Protecting patient information.

  • Fidelity: Maintaining trust and loyalty in the nurse-patient relationship.

  • Responsibility: Duty to act ethically and professionally.

Bioethics

  • The study of ethical and philosophical issues in biology and medicine, including:

    • Genetic testing and gene editing.

    • End-of-life care.

    • Resource access and allocation.

Page 4: ANA Codes of Ethics

Code of Ethics

  • Defines the values, morals, and standards guiding practice in nursing.

Historical Background

  • Nightingale Pledge: An early ethical foundation in nursing.

  • Current Code: Code of Ethics for Nurses with Interpretive Statements (2015).

Professional Ethical Standards in Education

  • Emphasis on civility within academic settings.

Page 5: Moral Distress

Moral Distress

  • The anguish healthcare professionals face when ethical beliefs are compromised.

Moral Resilience

  • The ability to maintain or restore one's integrity amidst moral complexities and challenges.

Page 6: Sources of Law Impacting Professional Nursing

  • Constitutional Law: Fundamental legal principles.

  • Statutory Law: Created by legislative bodies, includes:

    • Nurse Practice Acts (NPA): Define nursing scope of practice.

  • Regulatory Law: Overseen by administrative agencies.

  • Case Law: Based on court decisions (Common law).

  • Criminal Law: Includes misdemeanors and felonies.

  • Civil Law: Governs individual rights, situations including torts.

Page 7: Types of Torts

Intentional Torts

  • Assault: Threatening harm.

  • Battery: Actual physical harm.

  • Defamation: Injury to character

    • Libel: Written.

    • Slander: Spoken.

  • False Imprisonment: Unlawful restraint of a person.

  • Invasion of Privacy: Breaching patient privacy.

Unintentional Torts

  • Negligence: Failure to behave with the level of care.

  • Malpractice: Professional negligence.

Four D’s of Negligence

  • Duty: Responsibility to care.

  • Dereliction: Breach of duty.

  • Damages: Harm caused.

  • Direct Cause: A direct link between the breach and the harm.

Page 8: Professional Liability Issues

Professional Practice Conduct

  • Considerations include:

    • Social Networking: Maintaining professional boundaries online.

    • Competent Practice: Adherence to standards.

    • Workplace Bullying: Addressing and reporting bullying behaviors.

    • Substance Use Disorder: Recognition and management in the workplace.

Delegation Principles

  • Follow ANA Principles for Delegation.

  • Apply NCSBN Scope of Nursing Practice Decision-Making Framework.

Documentation

  • The importance of accurate and timely documentation.

Page 9: Legal Issues Guiding Patient Care

  • Informed Consent: Ensuring patients understand treatment plans.

  • Patients’ Bill of Rights: Protecting patient rights.

  • Organ Donation, Advance Directives:

    • Living Will: Document reflecting treatment preferences.

    • Power of Attorney: Legal authority granted to another.

    • Durable Power of Attorney: Healthcare proxy specifics.

  • DNR Orders: Physician orders for life-sustaining treatments.

Page 10: Laws Impacting Professional Practice

Licensure

  • Requirements and regulations to practice nursing.

Standards of Care

  • Guidelines to provide quality care.

HIPAA (Health Insurance Portability and Accountability Act)

  • Focus on accessibility, portability, and the privacy of health information.

Page 11: Additional Laws Impacting Professional Practice

  • Good Samaritan Acts: Protection for responding to emergencies.

  • Uniform Determination of Death: Legal definitions regarding death.

  • Medical Aid in Dying vs Euthanasia: Distinctions and legal considerations.

  • Natural Death Acts: Guidelines for end-of-life decisions.

  • Americans With Disabilities Act: Protection against discrimination.

  • Physical Restraints: Regulations regarding their use in care.

  • Proposed Acts in Congress:

    • Registered Nurse Safe Staffing Act.

    • Nurse and Health Care Worker Protection Act.

    • Safe Patient Handling and Movement.

Page 12: Initiatives to Facilitate Safer Practice

  • Importance of certification and educational recommendations.

  • The ultimate responsibility of professional nurses includes:

    • Practicing ethically, competently, and within the laws of their state and nation.