Ethical and Legal Issues in Nursing Flashcards
Moral Issues Faced by Nurses
Moral Indifference: This occurs when an individual questions why morality in practice is necessary at all.
Moral Uncertainty: A state where an individual is unsure which moral principle or values apply, or even what the moral problem is.
Moral Distress: This occurs when two ethical principles compete. It is frequently experienced in clinical settings when nurses cannot provide what they perceive as the best care or outcome for a patient. Common triggers include disagreements regarding patient interventions and limited patient care resources.
Two Common Approaches to Ethical Decision Making
Deontological Approach: A duty-focused normative approach. It is centered on specific rules or duties from which all actions are derived, regardless of the consequences.
Teleological Approach: An outcome-focused approach. It places emphasis on the results of an action and seeks to protect the interest of the majority.
Principles of Ethical Decision Making
Autonomy: The right of self-determination and the ability of the patient to make their own decisions.
Beneficence: The principle of doing good or acting in the best interest of the patient.
Paternalism: When a healthcare professional makes a decision for a patient without their consent, typically based on the belief that they know what is best for the patient.
Utility: The principle of providing the greatest good for the greatest number of people.
Justice: The principle of fairness and treating all people equally and fairly.
Truth Telling (Veracity): The obligation to tell the truth and not deceive others.
Fidelity: The obligation to be faithful to agreements and responsibilities; keeping promises.
Confidentiality: The duty to respect the privacy of the patient and keep their information protected.
The Decision-Making Process for Ethical Issues
To make appropriate ethical decisions, a practitioner must:
Identify and clarify the problem.
Gather all relevant facts.
Brainstorm potential solutions.
Evaluate the pros and cons of each solution.
Decide on the best course of action through a systematic process.
Traditional ethical problem-solving processes include:
The Nursing Process (Assessment, Diagnosis, Planning, Implementation, Evaluation).
The MORAL decision-making model.
The MORAL Decision-Making Model (Crisham, )
M—Massage the dilemma: Identify the issues and the individuals involved.
O—Outline options: Identify the alternatives and the consequences of those alternatives.
R—Review criteria and resolve: Select the most appropriate course of action based on moral principles.
A—Affirm position and act: Implementation of the strategy.
L—Look back: Evaluate the decision-making process and the outcome.
Legal Foundations: Nurse Practice Acts and Licensure
Nurse Practice Acts (NPA): Regarded as the most important piece of legislation for nurses. They define categories of nurses, set educational and exam requirements, and establish State Boards of Nursing.
State Boards of Nursing: Responsible for developing and implementing rules and regulations for nursing practice.
Nurse Licensure Compact (NLC): Allows RNs to be licensed in one state and practice in others within the compact. The practice is regulated by the law of the state where the patient resides.
Professional Liability: Negligence and Malpractice
Negligence: Equates with carelessness or a deviation from the care a reasonable person would provide.
Malpractice: Also known as ‘professional negligence’; it concerns professional actions or the failure to act. Both involve intentional and nonintentional actions/omissions.
The Six Elements of Malpractice
Duty Owed the Patient: Established via a valid employment contract; based on standards of care or the minimum requirements for acceptable practice.
Breach of Duty Owed the Patient: Failure to uphold the standard of care. This is generally proven in court via expert witness testimony.
Foreseeability: The concept that certain events may reasonably be expected to cause specific results. This is based on professional education and prior knowledge. Common areas include medication errors and patient falls.
Causation: A direct link where what the nurse did (or failed to do) directly caused the patient’s harm.
Injury: The patient must suffer a physical or mental injury.
Damages: The patient must prove injury so that damages can be assessed. The purpose is to compensate for immediate and future medical costs and harm done.
Role of the Nurse Manager in Preventing Malpractice
Strategies for prevention:
Ensure employees meet or exceed standards of care.
Regularly review and revise institutional standards.
Conduct staff evaluations to provide evidence that standards are being met.
Liability Types:
Personal Liability: Responsibility for one’s own actions.
Corporate Liability: Responsibility of the organization for its own environment and operations.
Specific Managerial Concerns in Medical Malpractice
Duty to Orient, Educate, and Evaluate: Responsibility is determined on a case-by-case basis using the standard of ‘reasonableness.’
Failure to Warn: The responsibility to warn future employers about a staff member’s incompetencies or impairments. Protected by "qualified privilege" if communication is in good faith among those with a need to know.
Accreditation: The Joint Commission (TJC) and the Community Health Accreditation Program (CHAP) mandate adequate staffing. Adequacy is determined by patient numbers, acuity scores, and the mix of nursing staff.
Principles of Ethical Decision Making
Autonomy: The right of self-determination and the ability of the patient to make their own decisions.
Beneficence: The principle of doing good or acting in the best interest of the patient.
Paternalism: When a healthcare professional makes a decision for a patient without their consent, typically based on the belief that they know what is best for the patient.
Utility: The principle of providing the greatest good for the greatest number of people.
Justice: The principle of fairness and treating all people equally and fairly.
Truth Telling (Veracity): The obligation to tell the truth and not deceive others.
Fidelity: The obligation to be faithful to agreements and responsibilities; keeping promises.
Confidentiality: The duty to respect the privacy of the patient and keep their information protected.
Professional Liability: Negligence and Malpractice
Negligence: Equates with carelessness or a deviation from the care a reasonable person would provide.
Malpractice: Also known as ‘professional negligence’; it concerns professional actions or the failure to act. Both involve intentional and nonintentional actions/omissions.
The Six Elements of Malpractice
Duty Owed the Patient: Established via a valid employment contract; based on standards of care or the minimum requirements for acceptable practice.
Breach of Duty Owed the Patient: Failure to uphold the standard of care. This is generally proven in court via expert witness testimony.
Foreseeability: The concept that certain events may reasonably be expected to cause specific results. This is based on professional education and prior knowledge. Common areas include medication errors and patient falls.
Causation: A direct link where what the nurse did (or failed to do) directly caused the patient’s harm.
Injury: The patient must suffer a physical or mental injury.
Damages: The patient must prove injury so that damages can be assessed. The purpose is to compensate for immediate and future medical costs and harm done.