IPR chapter 2
Lesson 3.1: Legal Requirements and Terminology (Slide 1 of 2)
Objective: To provide student nurses with a foundational understanding of the legal requirements and terminology inherent to nursing practice, emphasizing their direct relevance and impact on professional responsibilities and patient care.
Legal Requirements for Nursing Practice:
Governed primarily by individual state Nurse Practice Acts (NPAs), which are statutory laws. These acts legally define the scope of practice, educational requirements, licensure criteria, and grounds for disciplinary action for all levels of nursing (e.g., RN, LPN, APRN).
Defines the acceptable boundaries and duties of nurses, ensuring public safety and professional accountability.
Consequences of Violating the Nurse Practice Act:
Violations can lead to severe disciplinary actions by the state Board of Nursing, including formal reprimand, probation, temporary suspension, or permanent revocation of one's nursing license. Such actions can significantly impact a nurse's career and ability to practice.
Professional Accountability:
A paramount obligation for all nurses to provide safe, competent, and ethical care, taking responsibility for one's actions and decisions.
Includes adhering to established standards of care, maintaining professional boundaries, ensuring patient safety, continuous professional development, and ethical conduct.
Comparative Terms:
Negligence: Refers to a general failure to act as a reasonably prudent person would have acted under similar circumstances. This failure to exercise due care can lead to harm but does not necessarily involve a professional context.
Malpractice: A specific form of negligence committed by a licensed professional (e.g., nurse, physician) who fails to adhere to established professional standards of care, resulting in actual injury or harm to a client. It requires proof of duty, breach of duty, causation, and damages.
Lesson 3.1: Legal Requirements and Terminology (Slide 2 of 2)
Impact of Laws on Nursing Practice:
Discrimination laws: Enacted to safeguard against unfair treatment and ensure equal access to care and employment opportunities based on protected characteristics such as race, color, national origin, religion, sex, age, disability, or genetic information. Examples include the Civil Rights Act and the Americans with Disabilities Act.
Workplace safety laws: Mandate employers to provide a safe and healthy working environment, primarily enforced by the Occupational Safety and Health Administration (OSHA). These laws ensure health and environmental safety in clinical settings by regulating exposure to hazardous materials, infectious agents, and promoting ergonomic practices.
Child abuse laws: Legally mandate certain professionals, including nurses, to report suspected instances of child abuse or neglect to the appropriate authorities. These are often referred to as mandatory reporting laws.
Sexual harassment policies: Clearly define unacceptable workplace behaviors, including unwelcomed sexual advances, requests for sexual favors, and other verbal or physical harassment of a sexual nature, when such conduct explicitly or implicitly affects an individual's employment, interferes with work performance, or creates a hostile work environment.
National Patient Safety Goals:
Developed annually by The Joint Commission, these are specific, evidence-based recommendations designed to address critical vulnerabilities in patient safety and improve the quality of patient care in accredited healthcare organizations.
Goals address key areas such as accurate patient identification, effective staff communication, medication safety, infection prevention, surgical site safety, and reduction of patient harm due to falls.
Patient Rights:
Patients possess fundamental rights in various healthcare settings, including hospitals, clinics, and nursing homes, legally recognized to ensure their dignity, autonomy, privacy, and right to information are maintained. These rights are often outlined in documents like "The Patient Care Partnership."
Source of Law (Slide 1 of 2)
Definition of Law: A system of rules developed and enforced by governmental or societal institutions to regulate conduct, maintain order, resolve disputes, and promote justice within society.
Three Sources of Law:
Constitution and Bill of Rights: The supreme law of the land (U.S. Constitution) and its amendments (Bill of Rights) establish fundamental individual rights, civil liberties, and the framework for government structure and powers. Examples include freedom of speech, right to privacy, and due process.
Statutory Law: Formal laws enacted by legislative bodies at the federal, state, and local levels (e.g., U.S. Congress, state legislatures, city councils). These are written laws that define specific actions and their consequences. The Nurse Practice Acts are primary examples of state statutory law.
Regulatory Law: Rules and regulations created by administrative agencies (e.g., State Boards of Nursing, Centers for Medicare & Medicaid Services) that are authorized by legislative bodies to implement and enforce specific statutes. These laws provide detailed guidance on how statutory laws are to be applied.
Source of Law (Slide 2 of 2)
Types of Law:
Constitutional Law: Derives from the U.S. Constitution and state constitutions, defining fundamental rights, powers, and limits of the government. It governs issues such as civil rights, voting rights, and the separation of powers among government branches.
Judicial Law (Case Law/Common Law): Evolves from decisions made by courts in individual cases, interpreting constitutional, statutory, and regulatory laws. These court decisions establish precedents that guide future legal rulings, forming the basis of the common law system.
Administrative Law: Deals with the powers, procedures, and decisions of governmental agencies. It includes regulatory guidelines and decisions from governmental agencies (e.g., the National Labor Relations Board, Environmental Protection Agency) and is crucial in defining the scope of practice for many professions, including nursing.
Civil and Criminal Law
Understanding Civil Law:
Encompasses the rights and duties between individuals, organizations, or between citizens and the government, focusing on disputes that do not involve criminal offenses. It protects individual rights and seeks to compensate victims for harm (e.g., contract disputes, property law, family law, tort law).
Tort: A civil wrong committed against a person or property (excluding breach of contract), for which a court can provide a remedy in the form of damages. Torts can be intentional (e.g., assault, battery, defamation) or unintentional (e.g., negligence, malpractice).
Definition of Crime:
An offense against society as a whole, rather than an individual. Crimes are classified by severity as misdemeanors (less serious, punishable by fines or short imprisonment) or felonies (more serious, punishable by longer imprisonment or death) and are prosecuted by the government with the goal of punishment and deterrence.
Nurse Practice Acts and Scope of Practice
Nurse Practice Acts (NPAs):
Legally define the scope of nursing practice, educational requirements, and responsibilities for registered nurses (RNs), licensed practical/vocational nurses (LPNs/LVNs), and in many states, advanced practice registered nurses (APRNs).
These acts are regulated by each state’s Board of Nursing, which establishes specific rules and regulations to implement the NPA, ensuring the competence of licensed nurses and protecting the public from unsafe practice.
Licensure
Eligibility for Licensure:
Determined by a state's Board of Nursing, typically requiring completion of an approved nursing education program, a criminal background check, and passing the National Council Licensure Examination (NCLEX).
NCLEX Exam: The National Council Licensure Examination is a standardized, comprehensive national examination that all prospective nurses must pass to determine their readiness and competency for entry-level nursing practice.
Reciprocity and compacts: Laws and agreements, such as the Nurse Licensure Compact (NLC), enable a nurse’s license issued in one compact state to be recognized and valid in other compact states, facilitating multistate practice without obtaining separate licenses in each state.
Student Nurses
Responsibilities of Student Nurses:
Student nurses are held to the same legal standards and liabilities as licensed nurses when performing clinical duties. This means they are responsible for their own actions and decisions and must exercise the same level of care that a reasonable and prudent licensed nurse would in similar circumstances.
Must seek guidance from qualified clinical instructors when in doubt, feel unprepared for a task, or encounter unfamiliar situations to ensure patient safety.
Should be knowledgeable about their pertinent state's Nurse Practice Act and institutional policies, as these define their legal and ethical obligations in the clinical setting.
Professional Accountability
Definition:
A profound commitment by nurses to meet patient needs safely, competently, and ethically, taking full responsibility for their actions and the outcomes of the care they provide.
Students are required to actively apply theoretical knowledge learned in the classroom to clinical practice, critically thinking through patient situations and making informed decisions.
Accountability involves continuous learning, adherence to organizational policies and ethical guidelines, advocacy for patients, and adapting practice to new health care standards and evidence-based research.
Delegation
Definition of Delegation:
The process by which a licensed nurse directs another individual (e.g., unlicensed assistive personnel [UAP], another licensed nurse) to perform specific nursing tasks that are within the delegating nurse's scope of practice but are allowed by law and policy to be performed by the delegatee.
Responsibilities of the delegating nurse:
The delegating nurse retains ultimate accountability for the delegated task. Responsibilities include assessing the patient's condition, clearly communicating the task, ensuring the delegatee's competence for the task, providing adequate supervision, and evaluating the care provided and its outcome.
Understanding what tasks can be appropriately delegated to LPNs or nursing assistants (NAs) is governed by state Nurse Practice Acts and facility policies (often guided by the "Five Rights of Delegation": Right Task, Right Circumstance, Right Person, Right Direction/Communication, Right Supervision/Evaluation).
Standards of Care
Definition:
Established guidelines that define the appropriate, evidence-based, and legally acceptable level of care that a reasonably prudent nurse would provide in a similar situation and under similar circumstances. These standards are derived from Nurse Practice Acts, professional organizations (e.g., American Nurses Association), federal and state laws, institutional policies, and expert testimony.
Crucial in legal cases (e.g., malpractice lawsuits) as they serve as the benchmark against which a nurse’s actions are assessed to determine if the care provided was appropriate and met professional expectations.
Professional Discipline
Regulatory Authority:
Managed by state Boards of Nursing, which are empowered to investigate complaints, hold hearings, and impose disciplinary actions against nurses who violate the Nurse Practice Act or ethical standards. Their primary role is to protect the public's health and safety.
Common Reasons for Disciplinary Actions:
Include, but are not limited to, substance abuse (e.g., diversion of narcotics), gross incompetence, practicing outside of one's scope of practice, patient abuse (physical, emotional, sexual), falsification of records, breach of patient confidentiality, and failure to report known misconduct.
Continuing Education
Requirement:
Many states mandate ongoing continuing education (CE) hours after initial nursing licensure to ensure that nurses remain current with advancements in health care practices, technologies, ethical considerations, and evolving patient care standards.
Critical for maintaining current knowledge and skills, promoting professional growth, enhancing patient safety, and often required for license renewal.
Laws and Guidelines Affecting Nursing Practice
Key Regulations:
OSHA (Occupational Safety and Health Act): A federal law aimed at ensuring safe and healthful working conditions for employees by setting and enforcing standards, including regulations for handling hazardous materials, bloodborne pathogens, and providing personal protective equipment.
CAPTA (Child Abuse Prevention and Treatment Act): Defines child abuse and neglect and mandates reporting requirements for licensed professionals who suspect abuse, providing federal funding to states that develop and implement child protection programs.
Discrimination Laws: Federal and state laws (e.g., Title VII of the Civil Rights Act) that protect individuals from biased treatment in employment and healthcare delivery based on protected characteristics, ensuring equality and fairness.
Good Samaritan Laws: State laws that offer legal protection to individuals (including healthcare professionals) who voluntarily provide reasonable assistance to those they believe to be injured, ill, in peril, or otherwise incapacitated in emergency situations, provided they act in good faith and without gross negligence.
Health Insurance Portability and Accountability Act (HIPAA): A comprehensive federal law establishing strict regulations protecting patient health information privacy and security, governing how protected health information (PHI) can be used and disclosed.
Patient Rights: A set of ethical and legal principles affirming patients' entitlements to respect, dignity, information about their care, informed decision-making, and privacy in medical settings.
National Patient Safety Goals: Specific, evidence-based recommendations from The Joint Commission designed to improve the quality of patient care and prevent adverse events within healthcare facilities.
Occupational Safety and Health Administration (OSHA)
Focus:
Enforces stringent regulations around workplace safety for employees in all industries, specifically including healthcare. This encompasses safe handling of hazardous materials, proper disposal of biohazardous waste, prevention of needlestick injuries, fire safety, and emergency preparedness protocols.
Requires employers to provide comprehensive training on exposure to infectious agents (e.g., bloodborne pathogens), chemical hazards, fire safety (e.g., RACE, PASS), and emergency action plans.
Institutions must maintain and provide accessible Safety Data Sheets (SDS, formerly Material Safety Data Sheets or MSDS) for all chemicals used in the workplace, detailing their properties, health hazards, and safety precautions.
Child Abuse Prevention and Treatment Act (CAPTA)
Definition of Child Abuse:
Defined by CAPTA as any recent act or series of acts, or a failure to act, on the part of a parent or caretaker, that results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act that presents an imminent risk of serious harm to a child.
Mandatory reporting by healthcare professionals (including nurses) is a legal and ethical obligation for anyone who, in their professional capacity, suspects child abuse or neglect. Failure to report can result in legal penalties and professional discipline.
Discrimination
Definition:
The unjust or prejudicial treatment of different categories of people or things, especially on the grounds of race, age, sex, sexual orientation, gender identity, religion, national origin, or disability, rather than on their individual merit or capacity.
In healthcare employment, employers are strictly prohibited from gathering sensitive demographic information on application forms that could lead to discriminatory hiring practices and must ensure equal opportunities and fair treatment for all employees.
Sexual Harassment
Definition:
Unwanted conduct of a sexual nature that is unwelcome, personally offensive, interferes with work effectiveness, or creates an intimidating, hostile, or offensive working environment. It can manifest verbally (e.g., comments, jokes), nonverbally (e.g., gestures, leering), or physically (e.g., unwanted touching).
Considered illegal when it is severe or pervasive enough to alter the conditions of employment, unreasonably interferes with an individual's work performance, or creates a hostile, offensive, or intimidating work environment. It can also occur in a "quid pro quo" form, where employment decisions are based on providing sexual favors.
Good Samaritan Laws
Definition:
State-specific laws enacted to encourage individuals to voluntarily provide assistance to others in emergency situations without fear of legal reprisal. These laws protect healthcare workers from civil liability when they render aid in emergent situations outside a clinical setting, provided they act reasonably and in good faith.
The protection is limited unless gross negligence, wanton misconduct, or intentional harm is demonstrated, or if the individual demands payment for their voluntary assistance. The care provided must generally be within the scope of the rescuer's training.
Patient’s Rights
Update:
The American Hospital Association (AHA) replaced the "Patient's Bill of Rights" with "The Patient Care Partnership" in 2003. This document, written in more accessible language, emphasizes ethical over strictly legal considerations, fostering a stronger relationship between patients and healthcare providers.
It ensures core rights such as dignity, respect, privacy, confidentiality of medical information, effective communication, participation in care decisions, access to medical records, and the right to make informed decisions about treatment and care among patient communities.
These rights are often enforceable through state laws and regulations safeguarding prescribed patient rights, providing recourse for violations.
National Patient Safety Goals
Purpose:
To address critical issues and high-risk aspects of patient safety, providing actionable guidance for healthcare organizations to implement and continuously improve patient outcomes. These goals are based on expert recommendations, scientific evidence, and analysis of adverse events (like sentinel events).
Sentinel Events: Are unexpected occurrences involving death or serious physical or psychological injury, or the risk thereof. They frequently result from underlying issues such as communication failures among healthcare providers, inadequate patient assessment, medication errors, or problems with care planning, requiring immediate investigation and response (root cause analysis).
Lesson 3.2: Protection from Lawsuits and Code of Ethics (Slide 1 of 2)
Objectives:
Identify proactive strategies and legal safeguards for nurses and healthcare facilities to protect against potential lawsuits related to patient care.
Distinguish between a code of ethics and legal regulations, assessing their similarities, differences, and complementary roles in guiding nursing practice.
Summarize the key standards of practice promulgated by the National Association for Practical Nurse Education and Service (NAPNES), outlining their significance for LPNs/LVNs.
Lesson 3.2: Protection from Lawsuits and Code of Ethics (Slide 2 of 2)
Informed Consent:
A legal and ethical process where a patient, or their legally authorized representative, grants permission for a specific medical treatment, procedure, or participation in research after receiving comprehensive information. Elements include the clear communication of adequate information about the proposed treatment (benefits, risks, alternatives, prognosis without treatment), verification of the patient's voluntary decision-making, and assurance of the patient's mental competence and capacity to understand and make a decision. The physician is responsible for providing the information, while the nurse's role is to ensure the patient understands and to witness the signature.
Advance Directives:
Legally recognized documents that allow individuals to express their preferences for medical treatment and end-of-life care in advance, should they become unable to communicate their wishes due to incapacitation. These documents legally guide healthcare providers and family members when a patient cannot make decisions for themselves.
Includes specific directives like a Durable Power of Attorney for Healthcare (appointing a healthcare proxy) and Do-Not-Resuscitate (DNR) orders (physician's order clarifying that no CPR or life-sustaining measures should be taken), which are taken seriously by healthcare providers and must be honored.
Legal Documents: The Medical Record
Definition:
A comprehensive, confidential, and legal document that meticulously chronicles a patient's entire healthcare journey, encompassing all aspects of care, treatment, and clinical observations from admission to discharge. It serves as a vital communication tool among healthcare professionals and as legal evidence of the care provided.
Requires strict confidentiality, accessible only to authorized personnel directly involved in the patient's care or for legitimate administrative, legal, or educational purposes, adhering to HIPAA regulations.
While the information within the record belongs to the patient, the physical or electronic record itself remains the property of the healthcare entity that created it, not the individual patient.
Health Insurance Portability and Accountability Act (HIPAA)
Purpose:
A landmark federal law enacted in 1996 primarily to protect patients' privacy rights regarding their medical records and electronic health information (Protected Health Information - PHI). It established national standards for the security of electronic health care transactions and the privacy of individual health information.
Non-compliance with HIPAA regulations can result in significant civil penalties (fines) up to millions of dollars, and intentional, knowing violations can lead to criminal charges, including substantial fines and imprisonment for individuals or organizations.
Consent
Definition:
A legal document or verbal agreement confirming a patient's explicit permission to undergo specific medical treatments, procedures, or interventions. It signifies the patient's voluntary agreement after being adequately informed.
Informed Consent: Is a critical type of consent that must ensure the patient's clear understanding of the proposed treatment, including its nature, risks, benefits, alternatives, and the prognosis without treatment, as well as their ability to make informed, voluntary decisions. Special considerations apply to minors, emancipated minors, and individuals with impaired cognitive capacity, often requiring consent from a legal guardian or proxy.
Release
Definition:
A legal document that allows one party to exempt another party from liability or responsibility under specified conditions. It formally documents a patient's decision or grants permission for specific actions.
Commonly used in situations like a patient signing a Leave Against Medical Advice (Leave AMA) form, which absolves the healthcare facility and providers of responsibility for potential negative health outcomes due to the patient's early departure. It's also used for transferring medical records to another entity or releasing information to third parties.
Witnessing Wills or Other Legal Documents
Guideline:
Most health care entities have strict policies disallowing nurses and other healthcare personnel from witnessing legal documents such as wills, living wills, durable powers of attorney, or property deeds for patients. This policy is primarily to avoid potential conflicts of interest, allegations of undue influence, or later litigation challenging the validity of the document, which could involve the nurse in legal proceedings.
Patients seeking to have wills or other legal documents notarized or witnessed should be responsibly directed to official notaries public, legal professionals, or appropriate external resources to ensure legal impartiality and avoid compromising the nurse-patient relationship or institutional integrity.
Advance Directives
Overview:
Comprehensive legal instructions (known as advance directives) that enable competent individuals to clearly express their healthcare treatment preferences, particularly concerning end-of-life care, in anticipation of a time when they might become critically ill or incapacitated and unable to communicate their wishes directly.
These include various mechanisms such as Living Wills (specifying treatments to accept or refuse), Durable Powers of Attorney for Healthcare (designating a healthcare agent to make decisions), and physician-issued Do-Not-Resuscitate (DNR) orders, ensuring the patient's autonomy and wishes are honored and legally binding by healthcare providers.
Violations of Law: Negligence and Malpractice
Negligence Definition:
The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation, resulting in harm. For professional negligence (malpractice), four elements must be proven in court:
Duty: The nurse had a professional obligation to provide care to the patient.
Breach of Duty: The nurse failed to meet the accepted standard of care (e.g., acted carelessly or incompetently).
Causation: The nurse's breach of duty directly caused the patient's injury.
Damages: The patient suffered actual harm or injury (e.g., physical, financial, emotional).
Malpractice Definition:
A specific and professional form of negligence where a healthcare professional, such as a nurse, deviates from accepted standards of care, skill, or diligence recognized by the profession, resulting in injury, loss, or damage to the patient.
May include egregious actions such as administering the wrong medication, delaying treatment, misinterpreting physician orders, or falsifying patient data, which can consequently lead to serious patient complications, increased morbidity, and in some tragic cases, fatalities.
Common Legal Issues
Risks for Nurses:
Nurses, by virtue of their direct patient contact, access to sensitive patient information, and critical role in healthcare delivery, face increased vulnerability to legal actions and litigation when professional boundaries are crossed, standards of care are violated, or legal and ethical duties are neglected. This often arises from issues like documentation errors, medication errors, patient falls, or confidentiality breaches.
Assault and Battery
Definition of Assault:
A civil and criminal offense involving an intentional act that causes another person to reasonably apprehend immediate harmful or offensive contact. It is the threat or attempt to injure another person, creating fear, even if no physical contact actually occurs (e.g., threatening to give an injection against a patient's will).
Definition of Battery:
The actual, unlawful, and unwarranted physical contact with another person or their property without their consent, which causes harm or offends. Unlike assault, battery requires direct physical touching, even if minimal (e.g., administering an injection without consent, forcing a patient to ambulate when they refuse).
Defamation
Definition:
The act of making false statements, either spoken or written, about another person that harms their reputation, causes them ridicule, contempt, or hatred, or damages their professional standing in the eyes of others. Truth is an absolute defense against defamation.
Two Types of Defamation:
Slander: Oral defamation, involving the spoken word (e.g., verbally spreading false rumors about a colleague's competency).
Libel: Written defamation, including false statements published in print, online, or broadcast media (e.g., writing negative, false comments about a patient or colleague in social media or a patient's chart that is not factual).
Invasion of Privacy
Definition:
Violating an individual's right to seclusion, freedom from unwarranted public exposure, or the unauthorized disclosure of private patient information, thereby breaching the confidentiality inherent in a nurse-patient relationship. This can involve intruding into a patient's personal affairs or publicizing private facts without consent.
Can result in significant emotional distress, loss of dignity, or humiliation for the patient, and can lead to civil lawsuits and HIPAA violations for the nurse.
False Imprisonment
Definition:
The unlawful restraint or confinement of an individual against their will. This includes forbidding a competent individual from leaving a healthcare facility, unlawfully restricting their physical movement (e.g., holding a patient down without proper authorization), or coercing them to remain.
Can occur when protective devices (restraints) are used improperly or without a valid physician's order. Involuntary commitment for urgent protection against self-injury or harm to others may occur without consent for a limited period, but strict legal protocols must be followed.
Protective Devices
Definition:
The use of physical, mechanical, or chemical restraints (e.g., vests, wrist restraints, side rails, sedatives) that compromise an individual's freedom of movement or access to their own body. If misused, such devices can lead to serious injury, psychological trauma, and claims of false imprisonment.
Their application requires a legitimate medical or safety justification (e.g., to prevent a patient from harming themselves or others) and must be ordered by a physician based on a comprehensive assessment. Nurses must adhere to strict policies for monitoring, documentation, and regular reassessment to ensure the least restrictive alternative is always used.
Decreasing Legal Risk
Strategies:
Enhance nursing competence: Continuously update knowledge, skills, and judgment through continuing education and adherence to best practices.
File incident reports diligently: Documenting unusual occurrences accurately and promptly serves as a vital component of risk management.
Acquire professional liability insurance: Provides essential financial protection and legal defense in the event of a lawsuit, covering attorney fees and potential settlements.
Maintain thorough and accurate documentation: "If it wasn't documented, it wasn't done" is a critical principle.
Adhere to the Nurse Practice Act and institutional policies: Practice within legal and ethical boundaries.
Nursing Competence
Definition:
A dynamic combination of essential skills, specialized knowledge, critical thinking abilities, and professional experience required for providing safe, effective, and quality nursing care. It is developed and maintained through continuous learning, adherence to evidence-based practices, and reflective practice.
Adequate, timely, and accurate documentation serves as objective evidence of the care provided, observations made, and actions taken. This comprehensive record can powerfully protect nurses from allegations of liability and malpractice by demonstrating that appropriate standards of care were met.
Incident or Occurrence Reports
Purpose:
These are internal, confidential documents used by healthcare facilities to formally record and analyze unusual, adverse, or suspicious happenings that deviate from expected patient care or operational procedures (e.g., medication errors, patient falls, equipment malfunction, visitor injuries).
They outline what transpired, detail the participants involved, identify external witnesses, and describe interventions taken. Importantly, these reports are typically maintained separately from patient charts to ensure confidentiality and are used for quality improvement, risk management, and prevention of future similar events, not as part of the patient's legal medical record.
Liability Insurance
Function:
Professional liability (or malpractice) insurance provides crucial financial protection and legal representation for nurses in the event they are named in a lawsuit alleging negligence or malpractice. It covers the costs of legal defense, court fees, and potential settlements or judgments awarded to the plaintiff within the policy limits.
While many employers carry liability insurance, individual nurses are highly encouraged to acquire their own personal policy, as employer policies may prioritize the institution's interests, have coverage limits, or not cover actions taken outside the scope of employment.
Ethics in Nursing
Concept of Ethics:
A systematic framework of agreed-upon moral principles, values, and standards that guide the conduct, choices, and decision-making of individuals or a group (e.g., nursing profession). Ethics explore what is considered right, good, and just.
Ethics fundamentally differ from laws in that they are moral guidelines which, while influential, are not inherently mandatory or legally enforceable by the state, although ethical violations can often lead to legal consequences or professional discipline.
Codes of Ethics
Essential Components:
Formal documents developed by professional organizations (e.g., American Nurses Association [ANA] Code of Ethics) that articulate the primary ethical obligations and values of the nursing profession. Key components include unwavering respect for human dignity, inherent worth, uniqueness, and self-determination of all individuals.
Emphasizes non-discrimination in care delivery, commitment to ongoing professional development, advocacy for patient rights, maintenance of strict confidentiality in nurse-patient relationships, and fostering accountability within the nursing profession by providing a framework for ethical decision-making.
Ethical Committees
Composition:
These are interdisciplinary bodies within healthcare institutions, typically comprised of diverse members including physicians, nurses, social workers, ethicists, lawyers, chaplains, and community representatives. Their collective expertise enables them to address complex ethical dilemmas that arise in patient care.
Committees develop and assess ethical guidelines for practice, provide education to staff, review specific patient cases, and offer recommendations to patients, families, and healthcare teams facing difficult moral decisions, without making binding decisions.
Ethical Dilemmas
Common Ethical Issues:
Situations involving a conflict between two or more deeply held moral principles, where choosing one course of action means compromising another deeply held moral value (e.g., balancing patient autonomy with beneficence).
Common dilemmas include decisions regarding life-sustaining treatments (e.g., mechanical ventilation, artificial nutrition/hydration), end-of-life care, euthanasia, physician-assisted suicide, truth-telling, resource allocation (e.g., organ transplantation, ICU beds), and navigating cultural or religious conflicts impacting patient care choices.
Questions for Review
Question 1: Universal guidelines defining acceptable nursing interventions are referred to as:
Scope of practice.
Advocacy.
Standard of care.
Prudent practice.
Correct Answer: 3. Standard of care.
Question 2: A nurse’s principal duty: report unethical behavior unless it involves:
Personal relationships.
Attendance issues among staff.
Interpersonal conflicts.
Arguments on workflows.
Correct Answer: 1. Unethical behavior is always reportable.
Question 3: In malpractice, necessary elements include: Duty, Breach of Duty, and Causation. Which is NOT an element?
Defamation.
Duty.
Breach of Duty.
Causation.
Correct Answer: 1. Defamation is unrelated to malpractice.
Question 4: In suspected elder abuse details, whom may a nurse NOT report to?
Their supervisor.
Law enforcement.