Ethics & Legal

ETHICS AND LEGAL DERIVATIVES

Definition of Ethics

  • Ethics: A system of moral principles or standards governing behaviors.

  • Ethics in Nursing: Similar definition, focusing on how moral principles and standards govern behaviors and relationships based on professional nursing beliefs and values.

Essential Values for Professional Nurses

  • Altruism: Commitment to providing care without expecting anything in return.

  • Autonomy: Respecting the rights of patients to make their own decisions regarding their health care.

  • Human Dignity: Believing in the inherent worth of every individual.

  • Integrity: Adherence to moral and ethical principles, acting in accordance with one’s professional values.

  • Social Justice: Upholding moral, legal, and humanistic principles that affect societal rules and policies.

American Nurses Association (ANA) Code of Ethics for Nurses

  • Purpose of the Code:
        - Statement of Ethical Obligations: Defines the ethical obligations and duties of nurses.
        - Nonnegotiable Ethical Standards: Establishes the standard for ethical practice in nursing.
        - Commitment to Society: Reinforces nurses' commitment to the community they serve.

  • Updated Code of Ethics: Current version updated in 2025 as per ANA standards.

Principles of Ethical Decision Making

  • List of Key Principles:
        - Autonomy: Respect for individual self-determination.
        - Beneficence: Promoting good and taking actions that benefit patients.
        - Nonmaleficence: Commitment to do no harm.
        - Justice: Fair treatment and equality in care delivery.
        - Veracity: Commitment to truthfulness.
        - Fidelity: Honoring commitments and keeping promises to patients.

  • Source: ATI Fundamentals p.11.

Applying Ethical Principles

  • Approach to Ethical Decision Making:
        - Goals: Arrive at decisions that prioritize the patient's best interests.
        - Process: Involves collaboration, communication, and compromise among health care team members.

Patient Rights

  • Rights to be Aware of Care:
        - Patients have the right to be informed about their care and options available.

  • Communication in Preferred Language:
        - Information must be provided in a manner that aligns with the patient’s language and comprehension.

  • Rights to Make Decisions:
        - Patients can accept or refuse care and must be aware of the identities of their caregivers.

  • Right to Safe Care:
        - Patients should receive care that meets safety standards and addresses any present pain.

Informed Consent

  • Definition: Written consent provided by patients after they have been educated about risks, benefits, and alternatives regarding procedures.

  • Nursing Role: Essential in ensuring that patients comprehend the information about their care for well-informed decision making.

Health Insurance Portability and Accountability Act (HIPAA)

  • HIPAA Privacy Rule:
        - Establishes national standards for protecting individuals' medical records and personal health information, termed as Protected Health Information (PHI).

  • Definition of PHI: Any information that identifies the patient and is protected under HIPAA regulations.

Invasion of Privacy

  • Examples of Invasion of Privacy:
        - Sharing patient information with unauthorized individuals.
        - Discussing patient cases in public settings.
        - Displaying PHI where it can be seen by others.
        - Taking observations or photographs without consent.

Nurse Practice Act

  • Definition: State-specific laws governing nursing practice, established by state legislation and enforced by state boards of nursing.

  • Delaware's Nurse Practice Act:
        - Cited as Title 24, Chapter 19, which outlines the state-specific regulations for nursing practice.

Basic Components of Nurse Practice Act

  1. Standards and Scope of Nursing Practice

  2. Licensure Requirements: Including ongoing education and renewal processes.

  3. Disciplinary Grounds: Conditions leading to disciplinary action against nurses.

Board of Nursing

  • Purpose: Protect public health, safety, and welfare.

  • Functions:
        - Establishing professional competency standards.
        - Regulating nursing practice through rules and regulations.
        - Granting and renewing nursing licenses.
        - Investigating complaints and disciplining unsafe nursing practices.
        - Accrediting nursing academic programs.

Mandatory Duty to Report

  • Definition: Legal requirement to report known or suspected incidents as outlined by local/state laws.

  • Nurse’s Responsibility: Does not require full investigation but requires a good faith belief based on existing information.

  • Good Faith Immunity: Protects nurses from liability when reporting in good faith.

Mandatory Reporting in Delaware

  • Specifics Mandated Reporting:
        - Reporting suspected unprofessional conduct or unfit medical practitioners.
        - Child abuse or neglect.
        - Unsafe nursing practices or conditions.
        - Self-reporting of any criminal charges related to nursing practice.

Documentation

  • Purposes of Maintaining Patient Records:
        - Communication & Continuity of Care.
        - Care Planning.
        - Auditing Health Agencies (e.g., The Joint Commission).
        - Research and Quality Improvement.

  • Legal Document: Medical records serve as a legal document that records facts and events during patient care delivery.

Documentation Systems

  • Source-oriented System:
        - Different disciplines document in specialized sections.
        - Separated into sections such as history, progress notes, laboratory reports, etc.

  • Problem-Oriented Medical Record (POMR):
        - Includes a database of patient history, a problem list, and documentation focused on the identified problems.

Types of Nursing Progress Notes

  • Narrative Note: Chronological “story” of care.
        - Advantages: Tracks changing patient status.
        - Disadvantages: May lead to lengthy, repetitive records making it difficult to locate specific outcomes.

Charting by Exception

  • Description: Document only significant findings or exceptions.
        - Advantages: Simplifies documentation and highlights changes in condition.
        - Disadvantages: May result in assumptions of routine care, leading to omission or errors.

Focus Charting

  • Description: Highlights a client's concerns using a structured format (Data, Action, Response - DAR).
        - Advantages: Provides a holistic, patient-centered view.
        - Disadvantages: Tracking progress may be complicated.

DAR Notes Structure

  • Components:
        - Date & Time: Document when the note is made.
        - Reason: Title/reason for the note.
        - Data: Subjective and objective assessments.
        - Action: Interventions taken based on assessments.
        - Response: Patient’s outcome from the interventions.

Example of a DAR Note

  • Instance:
        - Reason: Nausea
        - Data: Patient reports nausea and vomited 100 mLs clear fluid.
        - Action: Administered prochlorperazine (Compazine) 2.5 mg IV.
        - Response: Patient reported no further nausea after treatment.
        - Documented by: Carolyn Fleury, RN.

Effective Documentation Practices

  • Be well-versed with facility forms and documentation policies.

  • Ensure timely documentation including all aspects of care.

  • Maintain a chronological order, using correct spelling and grammar.

  • Be concise and direct, utilizing approved abbreviations.

  • Reinforce the mantra: NOT DOCUMENTED is NOT DONE.

Practice Sections

  • Areas presented for practical applications and exercises related to the topics presented.