Legal and Ethical Aspects of Nursing

Key Points to Discuss:
- Federal regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) privacy rule and its impact on the health care system.
- Examples of ways a licensed practical/vocational nurse can avoid being involved in a lawsuit.

Laws
- Prescribe how a person should act in society.
- Sanction acceptable behavior and prohibit unacceptable behavior.
- Provide protection for all members of the health care system.
Types of Law:
- Criminal Law: Concerns actions considered harmful to society as a whole.
- Civil Law: Concerns disputes between individuals or organizations, often involving compensation.
Ways Laws are Established:
- Statutory Law: Laws enacted by a legislative body.
- Common Law: Laws developed through court decisions and precedents.

Definition: Refers to professional negligence.
Nursing Responsibilities:
- Include actions taken as well as omitted actions.
Key Elements of Malpractice:
1. Duty: The nurse's obligation to provide care.
2. Breach: Failure to meet the standard of care.
3. Harm: Actual injury or damage caused to the patient.
4. Proximate Cause of Harm: The injury must be directly linked to the negligence.

Definition: Acts whose performance is required, permitted, or prohibited.
Obligations:
- Provide guidance to practicing nurses regarding expectations and legal obligations.
- Includes activities that are obligatory and those that are prohibited.
- Non-adherence can result in legal liability.

Scope of Nursing Practice:
- Coupled with standards of care.
- Must align with laws of individual states.
- Defines the obligations of a nurse, including prohibited standards.
- It is the nurse's responsibility to be aware of nurse practice acts relevant to their state(s).
- Institutions may establish their own policies and procedures in compliance with nurse practice acts.

Key Issues Include:
- Patient's Bill of Rights.
- Informed consent: A patient's understanding and agreement to a procedure or treatment.
- Confidentiality and privacy: Obligations to protect patient information.
- Appropriate use of social media.
- Maintenance of medical records.
- Reporting abuse as a legal requirement.

Overview:
- Enacted in 1996, HIPAA regulates the protection and confidential handling of health information.
Patient Rights Under HIPAA:
- Right to receive care without prejudice.
- Right to be treated with respect and dignity.
- Right to privacy and confidentiality.
- Right to personal safety.
- Right to complete information about one’s health condition and treatment options.

Strategies Include:
- Provide compassionate, competent nursing care.
- Develop a nurse-patient relationship based on trust and respect.
- Use open and honest communication with patients.
- Maintain adherence to standards of care and scope of practice.
- Be mindful that the Good Samaritan Law offers immunity from lawsuits in specific circumstances, especially when providing emergency aid.
- Ensure proper documentation: “Care was not given if it was not charted.”

Types of Policies:
- Professional Liability Insurance:
- Claims-made policy: Covers claims only when the policy is active.
- Occurrence-basis policy: Covers claims for incidents that happened during the period of coverage, even if the claim is filed after.
- Disciplinary Defense Insurance: Covers costs associated with defending against disciplinary actions.
- Potential Sanctions: Discusses possible disciplinary actions against a nursing license.

Key Points to Discuss:
- Differentiate between a legal duty and an ethical duty.
- Explain advance directives, including living wills and durable power of attorney.
- Summarize the influence of culture on individual beliefs, morals, and values.
- Distinguish between ethical and unethical behavior.

Definition of Ethics: A branch of philosophy dealing with what is morally right and wrong.
Advance Directives:
- Documents enabling individuals to specify their preferences regarding medical treatment in the event they become incapacitated.
- Two Main Types:
1. Living Wills: Outline specific medical treatments a person wishes to accept or refuse.
2. Durable Power of Attorney: Designates an individual to make health care decisions on another's behalf.
Patient Self-Determination Act (PSDA) of 1991:
- Requires health care institutions to provide patients written information regarding their rights to make decisions about their health care.

Values: Important beliefs or standards guiding behavior and decision-making.
Value Clarification: The process of identifying and understanding personal values and their impact on choices and actions.
Ethical Dilemma: A situation in which a choice must be made between two or more alternatives that may conflict with moral values.

Fundamental Principles:
1. Respect for People: Trivializes no one and respects individual autonomy and rights.
2. Autonomy: Emphasizes the individual's freedom of choice.
3. Beneficence: Action taken to promote good for the patient.
4. Nonmaleficence: The obligation to not inflict harm intentionally.
5. Justice: The principle of fairness in the distribution of benefits and burdens.

Nurses' Duty: To report observed behaviors that do not meet established standards of care.
Protocol: Follow the appropriate chain of command when reporting unethical conduct.

Dynamic Nature: Ethical issues evolve as society's values change over time.
Examples of Ethical Issues:
- Practitioner-assisted suicide (PAS): Ethical concerns surrounding the providers' involvement in ending life.
- Refusal to treat: Ethical dilemmas faced when a provider declines care for a patient.
- Do Not Resuscitate (DNR) orders: Ethical conflicts regarding the extent of intervention in life-threatening situations.