Ethics, Law, and Delegation in Nursing

Chapter 3: Ethics, Law, and Delegation in Nursing

Ethical Issues in Nursing

• Values: Refers to personal beliefs regarding worth.
• Ethics: The values shaping decisions and behaviors.
• Primary Concern: The welfare of the patient is paramount.
• Ethical Dilemma: A situation necessitating a choice between opposing alternatives.

Providing Ethical Patient Care

• Patient's Rights: Every patient deserves respect, dignity, honesty, and compassion.
  • Golden Rule: Treat every patient as you wish to be treated.
• Civility: Engaging others with courtesy and respect, even amidst disagreements.

Advocating for the Patient

• Role of the Nurse as Advocate: Nurses advocate for patients' best interests, especially when patients cannot voice their needs.
• Patient Care Partnership (PCP): Outlines patient expectations, rights, and responsibilities during hospital stays.
• Empathy in Care: Essential for nurses to connect and support patients effectively.

Do Not Attempt to Resuscitate Orders (DNAR)

• CPR Requirement: Mandatory initiation unless a written DNAR is present.
• Purpose of DNAR: Used in terminal stages to respect patient wishes.
• Nurses' Role: Support patients and families in understanding DNAR orders.

Ethics Committees

• Function: Develop policies for addressing ethical issues within healthcare facilities.
• Focus: Ensures patient rights are considered; families can request committee assistance.

Legal Issues in Nursing

• Understanding Laws: Nurses must know state and federal regulations governing nursing practice.
• Defined Boundaries: Laws and ethics set limits that protect nurses from lawsuits.
• Patient Treatment: All patients must be treated with dignity and respect.
• Trust Building: Nurses should foster trust with patients.

Common Legal Terminology

• Abandonment of Patient: Leaving a patient without proper care.
• Advance Directive: A written statement of a patient's medical care preferences if incapacitated.
• Assault: Threatening physical harm to a person.
• Battery: Unauthorized physical contact.
• Civil Law: Protects individual rights as defined by the Constitution.
• Malpractice: Failing to deliver adequate care resulting in patient harm.
• Negligence: Not providing a standard of care expected from a nurse in similar circumstances.

Types of Laws

• Constitutional Law: Protects constitutional rights.
• Statutory Law: Consists of written laws at local, state, or federal levels (e.g., Nurse Practice Acts).
• Criminal Law: Protects society by defining punishable offenses.
• Civil Law: Relates to personal rights and remedies for individuals.

Statutory Laws Affecting Nurses

• HIPAA: Ensures confidentiality of patient health information.
  • Privacy Rule: Establishes standards to protect health information.
  • Security Rule: Requires safeguards for health information, especially electronic records.
• HITECH Act: Promotes EHR adoption and mandates breach notifications.
• Nurse Practice Acts: Define nursing scope; regulated by state board of nursing.
  • Responsibilities include licensing and disciplinary actions.
• Mandatory Reporting Laws: Require reporting specific situations like disease outbreaks or abuse.

Laws Affecting Nurses

• Good Samaritan Law: Provides legal immunity to those assisting in emergencies.
• Civil Laws: Involve malpractice and negligence claims against nurses.
  • False Imprisonment: Illegally restraining a patient.
  • Assault and Battery: Threatening harm or unwanted physical contact.
  • Sexual Harassment: Unwelcome sexual advances or comments.

Legal Documents

• Patient Health Record: Critical for tracking patient care and status.
• Informed Consent: Must be voluntary and from a competent patient.
• Advance Directive: Guides future medical decisions if a patient is incapacitated.
• Incident Report: Document unusual occurrences or accidents for quality improvement.

Professional Responsibilities

• Accountability: Nurses are responsible for their actions; they should refuse unsuitable workloads.
• Liability Insurance: Recommended to protect against legal claims.
• Professional Boundaries: Avoid personal relationships with patients; refuse gifts or money.
• Delegation: Must adhere to the five rights of delegation set by NCSBN.
  • Includes the right task, circumstances, person, directions, and supervision.
• Competence: Essential for effective nursing practice; developed through experience.
• Continuing Education: Required to maintain and enhance nursing skills due to the evolving nature of healthcare.