Ethics, Law, and Delegation in Nursing

Ethics, Law, and Delegation in Nursing

Ethical Issues in Nursing

• Values: Personal beliefs about something's worth.

• Ethics: Values influencing a person's decisions and behavior.

• A nurse's primary concern is the patient's welfare.

• Ethical Dilemma: A situation requiring a decision between two opposing alternatives.

Providing Ethical Patient Care

• Patients' Rights: To be treated with respect, dignity, honesty, and compassion.

• Ethical Guideline: Treat every patient as you would want to be treated.

• Civility: Treating others with courtesy, politeness, and respect, even in disagreement.

Advocating for the Patient

• The nurse as an advocate stands up for what is in the patient's best interest, especially when they cannot do so themselves.

• Patient Care Partnership (PCP): Discusses patient expectations, rights, and responsibilities during a hospital stay.

• Empathy is essential in patient care.

Do Not Attempt to Resuscitate Orders (DNAR)

• Legal Requirement: CPR must be initiated unless there is a written DNAR order.

• DNAR Order Details:

  • Used in terminal stages of disease.

  • Written by a health-care provider.

  • The nurse supports the patient and family.

Ethics Committees

• Role: Developing policies and procedures for handling ethical issues in the health-care facility.

• Focus: Patients and their rights.

• Family Involvement: Family members can request ethics committee consultation for difficult decisions or disagreements with medical staff decisions.

Legal Issues in Nursing

• Nurses must understand state and federal laws, rules, and regulations governing nursing practice.

• Laws and ethics define boundaries for nurses to work within and avoid lawsuits.

• Respect and dignity for all patients are crucial.

• Developing a trusting relationship with each patient is important.

Common Legal Terminology

• Abandonment of patient: Deserting a patient in your charge, leaving without appropriate nursing replacement, or wrongful termination of care.

• Advance directive: A written statement indicating a patient’s wishes regarding future medical care if the patient is unable to voice their decisions.

• Appeal: To challenge a court's decision in a higher court.

• Assault: Purposely threatening physical harm to an individual.

• Battery: Touching an individual without consent.

• Civil law: The individual or personal rights guaranteed by federal law.

• Competency: Legal qualification to make one’s own decisions.

• Consent: To give permission for or agree to a treatment; it generally must be written.

• Controlled substances: Drugs regulated by laws with potential for abuse.

• Criminal law: Laws that protect the public or society.

• Damages: Money awarded to a plaintiff upon proving injury by the defendant.

• Defendant: The one accused of breaking criminal or civil law.

• Durable medical power of attorney: Legal written designation making another person responsible for one’s medical decisions.

• Emancipated minor: Legal consideration of one younger than age 18 years as an adult because he or she lives alone and is self-supporting, has joined the military, is married, or is a parent.

• Liability: One’s responsibility for his or her own actions.

• Libel: False written statements about another made publicly known, with intent to harm.

• Malpractice: Injury, loss, or damage to a patient because of failure to provide a reasonable standard of care or demonstrate a reasonable level of skill.

• Negligence: Failure to provide certain care that another person of the same education and locale would generally provide under the same circumstances.

• Plaintiff: The one accusing another of criminal or civil law violation.

• Statute: A written law.

• Tort: A violation of a civil law involving a wrong against an individual or his or her property.

Types of Laws

• Constitutional: Protects constitutional rights (Bill of Rights).

• Statutory: Federal, state, and local laws (Nurse Practice Acts).

• Case or judicial: Written in response to court cases.

• Criminal: Protect the public as a whole.

• Civil: Involve an individual’s personal rights.

Statutory Laws Affecting Nurses

• Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Provides for confidential maintenance of protected health information.

  • Privacy rule: Establishes national standards designed to protect health information.

  • Security rule: Requires reasonable safeguards to ensure the confidentiality and security of protected health information to include the electronic health record (HER).

• Health Information Technology for Economic and Clinical Health (HITECH) Act (2009):

  • Stimulated the adoption of the EHR and established penalties for those health-care providers not using an EHR by 2015.

  • The Breach Notification Rule requires health-care businesses to notify individuals in writing when private health information is known to have been accessed without authorization.

• Nurse Practice Acts (NPA):

  • Each state has an NPA that defines the scope of nursing within its state.

  • Boards on nursing: State agency designated to administer and enforce the NPA.

    • Has authority to:

      • License nurses.

      • Take disciplinary measures against nurses who fail to follow the NPA.

      • Regulate the practice of nursing as well as nursing education.

    • National Council of State Boards of Nursing (NCSBN):

      • Protect public’s health, safety, and welfare.

      • Licensure through NCLEX™.

• Mandatory Reporting Law:

  • Most states have laws requiring the reporting of certain situations to the proper authorities.

  • Statutes:

    • Outbreaks of disease or illnesses.

    • Child abuse.

    • Abuse of disabled individuals.

    • Elder abuse.

• The Good Samaritan Law

  • Provides legal protection to the voluntary caregiver at sites of accidents and emergencies

  • It serves to protect a citizen, nurse, or other health-care provider from legal liability if they choose to stop

  • It does not apply to staff in health-care facilities or to individuals who are employed as emergency response workers

Civil Laws Affecting Nurses (Tort Laws)

• Malpractice: A nurse’s action failing to meet professional standards of care and injures a patient.

• Negligence: When a nurse does something that a reasonably prudent person would not do or fails to do something that a reasonably prudent person would do.

• False imprisonment: Restraint devices.

• Assault and battery:

  • Assault: Threatening a patient with harm or showing intent to touch a patient without permission.

  • Battery: Intentional physical contact without consent that causes injury or offensive touching.

• Sexual harassment:

  • Harassment: Continued unwanted or annoying actions.

  • Sexual harassment: Harassment that includes unwelcome sexual advances, comments of a sexual nature, or offensive remarks about a person’s sex.

Civil Protection for Nurses

• Good Samaritan Law:

  • Legal protection for voluntary caregivers.

  • Applies to emergency situations.

  • Does not apply to health-care staff or emergency response workers.

Legal Documents

• Patient health record: A health record kept on patients who enter the health-care system.

  • Provides data about the patient’s health status.

  • Communication among health-care providers.

  • Serves as a source of information about the patient’s condition.

• Informed consent:

  • A voluntary agreement made by a well-advised, mentally competent patient to be treated by a health-care provider or institution.

• Advance directive:

  • Written documents that provide guidelines for making medical decisions in the event a person becomes incapacitated and unable to make wishes known.

• Incident report:

  • Completed in the event of an unusual occurrence or an accident.

Professional Responsibilities

• Being accountable: Responsible for your actions.

  • Assure assignments are within your ability.

  • Refuse extra shift if you are fatigued.

  • Do not abandon patient assignments.

• Securing professional liability insurance.

• Establishing professional boundaries.

  • Inappropriate involvement:

    • Seeing a patient socially.

    • Physical or sexual relationship with patient or patient’s family.

    • Taking money or gifts from patient.

• Delegating tasks:

  • NCSBN five rights of delegation:

    • The right task.

    • Under the right circumstances.

    • To the right person.

    • With the right directions and communication.

    • Under the right supervision and evaluation.

  • Some activities cannot be delegated:

    • Judgment.

    • Critical decision making.

    • Care for an unstable patient unless this is within the delegatee’s scope of practice in the NPA for that state.

• Achieving competence:

  • Performing as a nurse successfully and efficiently.

  • Comes with practice and experience.

• Following standards of care:

  • Represent the level of skill and nursing care that another nurse in the same area of the country, with the same educational level, would perform in the same situation.

• Continuing your education:

  • Helps the nurse maintain, improve, expand, and enhance their knowledge.

  • Nursing is dynamic and ever-changing; continuing education is necessary to stay abreast of these changes.