Ethics & Legal Module

Code of Ethics for Nurses

Overview of Code of Ethics for Nurses

• Applicability:

  • Mandatory for all nurses (Registered Nurses (RNs) and Practical Nurses (PNs)), including nursing students.

  • Relevant across all practice settings.

  • Applies to both direct and indirect client care as well as social media use.

• Purpose:

  • Clearly defines the ideals, duties, and obligations incumbent upon nurses.

  • Provides guidance for ethical behaviors.

  • Aims to protect both clients and the nursing profession.

International Council of Nurses (ICN) Code of Ethics

• Nature:

  • Considered a supranational code, which serves as a foundation for national nursing codes.

• Key Elements:

  1. Clients and others seeking health care.

  2. Nursing practice.

  3. Professional responsibilities of nurses.

  4. Global health considerations.

• Updates (2021):

  • Inclusion of equity and social justice within care.

  • Addressing the impacts of climate change on health.

  • Incorporation of technology and understanding social determinants of health.

  • Highlighting nurses' roles in achieving the United Nations Sustainable Development Goals established in 2015.

American Nurses Association (ANA) Code of Ethics

• Title:

  • Known as the Code of Ethics for Nurses with Interpretive Statements.

• Structure:

  • Comprises 9 distinct provisions.

• Applicability:

  • Relevant to all nurses, regardless of their specific role or practice setting.

Nurse’s Commitment to Clients

• Core Values in Nursing:

  • Deliver compassionate care.

  • Uphold and respect human dignity and individuality.

  • Advocate for:

  • Client rights.

  • Client needs.

  • Promote and protect:

  • Client health.

  • Client safety.

Duty to Clients and Self

• Focus:

  • Emphasis on accountability and professional responsibility.

• Demonstration of Values:

  • Authority and accountability in the nursing role.

  • Responsibility in actions and decisions.

• Promotion:

  • Best practices within nursing.

• Maintenance:

  • Competence in clinical skills and ethical nursing values.

  • Support the creation of a healthy and safe practice environment.

• Adherence:

  • Follow ethical principles integral to nursing.

Duty Beyond the Individual Client

• Broader Focus:

  • Concern extends to the nursing profession and society as a whole.

• Promotional Activities:

  • Engage in research and inquiry.

• Participation:

  • Involved in the development of practice standards and healthcare policy.

• Collaboration:

  • Work with interprofessional teams.

• Human Rights Protection:

  • Advocate against health disparities and promote the integrity of the nursing profession.

Nursing Practice Standards for Practical Nurses (PNs)

• Establishment:

  • Developed by the National Association for Licensed Practical Nurses (NALPN).

• Expectations for PNs:

  • Commitment to moral and ethical obligations.

  • Adherence to professional standards in all practice settings.

Ethical Principles in Nursing Practice

• Guidance:

  • Ethical principles provide structure and guidance for daily nursing decisions and actions.

1. Autonomy

• Definition:

  • The client's right to make personal healthcare decisions, including the refusal of treatment.

  • Nurses must advocate for these wishes, regardless of family or personal disagreements.

2. Beneficence

• Definition:

  • An obligation to promote good and minimize harm.

  • Involves exceeding minimum requirements to provide enhanced comfort or support.

  • Examples:

  • Implementing fall precautions.

  • Providing emotional support.

  • One-on-one supervision for clients who are confused.

3. Nonmaleficence

• Definition:

  • The obligation to avoid harm to clients.

• Considerations:

  • Weighing potential risks against benefits.

  • Avoiding harmful interventions, especially in experimental treatments.

4. Veracity

• Definition:

  • An obligation to provide clients with truthful, accurate, and complete information.

• Relationship Building:

  • Enhances trust in the nurse-client relationship and includes disclosing errors and answering client inquiries honestly.

5. Fidelity

• Definition:

  • The obligation to maintain promises, honor commitments, and demonstrate loyalty.

• Trust:

  • Strengthens the nurse-client trust relationship.

  • Example:

  • Following through on commitments to contact healthcare providers.

6. Justice

• Definition:

  • The obligation to provide care that is fair, equitable, and impartial.

• Applicability:

  • Relevant irrespective of age, race, gender, or socioeconomic status.

  • Particularly important in situations where resources are limited or during prioritization of care.

Applying Ethical Principles

• Steps Nurses Must Follow:

  • Identify the ethical issue at hand.

  • Apply appropriate ethical principles relevant to the situation.

  • Advocate actively for the client’s interests.

  • Collaborate with others when necessary.

• Importance:

  • Ethical decision-making strengthens client safety, professional integrity, and trust within the nursing field.

Values & Ethical Decision-Making in Nursing

1. Ethics, Values, and Nursing Practice

• Guiding Concepts:

  • Ethical decision-making is influenced by ethical principles, adherence to the Code of Ethics, and personal values of the nurse.

• Self-awareness:

  • Nurses need to acknowledge their own values and respect differences in client values even when they conflict.

• ANA Expectation:

  • Nurses are encouraged to adopt and embrace professional values, rather than merely following them.

2. Values

• Definition:

  • Values refer to beliefs regarding what is important, good, and meaningful.

• Personal Values:

  • Influence behavior and decision-making and form part of self-concept.

• Development:

  • Values develop throughout one’s life via culture, family, education, and community.

• Nursing Consideration:

  • Awareness of personal values helps nurses provide better care and avoid bias.

3. Professional Values in Nursing

• Definition:

  • Professional values represent beliefs and behaviors essential to the nursing profession.

• Universality:

  • These values are applicable to nurses across all specialties and backgrounds.

• ANA Code of Ethics:

  • Serves as a guiding document for professional values in nursing.

• Key Professional Values:

  • Patient-centered care.

  • Maintaining confidentiality.

  • Respecting client autonomy.

  • Displaying compassion and empathy.

  • Upholding professionalism.

  • Commitment to evidence-based practice.

  • Encouraging interdisciplinary collaborations.

  • Lifelong learning commitment.

4. Essentials of Baccalaureate Education (AACN)

• Definition:

  • Developed to clearly articulate the professional values expected of nurses.

• Core Values Identified:

  • Identifies five fundamental professional values shared by nurses across various levels of practice.

5. Value Clarification

• Definition:

  • The process of identifying, examining, and developing personal values.

• Importance:

  • Critical for accommodating clients with diverse values.

  • Enhances self-awareness, helping reduce bias and support ethical decision-making.

6. Five Professional Values of Nursing

1. Altruism:

   • Selfless concern for the well-being of others.

   • Involves prioritizing client needs without expectation of reward.

   • Demonstrated by actions like assisting clients despite personal inconvenience and exhibiting empathy.

2. Human Dignity:

   • The recognition of the inherent worth of each person, without discrimination.

   • Preserved through respectful communication, maintaining privacy and confidentiality, and cultural competence.

   • Nurses are obligated to respect clients and support their independence.

3. Integrity:

   • Acting with honesty, moral courage, and consistency with professional standards.

   • Rooted in the ANA Code of Ethics.

   • Demonstrated through truthful communication and ethical care.

4. Autonomy:

   • The right to self-determination, allowing clients to make healthcare choices and refuse treatments.

   • Nurses must respect and advocate for these rights, even in disagreement with others.

   • It is a legal and ethical responsibility, unless potential harm to others exists.

5. Social Justice:

   • Commitment to equity, fairness, and equal access to care.

   • Based on principles outlined in the ANA Code of Ethics and applicable on multiple levels: individual, community, national, and global.

   • Promoted through nondiscriminatory practices, advocacy for marginalized groups, and addressing healthcare disparities.

Nursing Application of Professional Values

• Demonstration:

  • Professional nursing values are shown through advocacy, ethical decision-making, respect for diverse client backgrounds, fair allocation of resources, and honest communication.

• Professional Behavior:

  • Reflects nursing’s responsibility to society and a commitment to ethical practices.

Ethical Dilemmas & Ethical Decision-Making

1. Ethical Dilemmas in Nursing

• Definition:

  • Occur when conflicts arise:

  • Between differing ethical principles.

  • Between a nurse's values and those of the client.

  • In situations without clear right or wrong answers.

• Consequences:

  • Each potential resolution can offer both advantages and disadvantages requiring careful consideration.

2. Nurse’s Role in Ethical Dilemmas

• Expectations:

  • Nurses must advocate for their clients and ensure client autonomy.

  • Collaborate effectively with an interprofessional team.

  • Many healthcare facilities have ethics committees to aid in resolution.

  • Ethical dilemmas necessitate a structured decision-making approach and team collaboration.

3. Ethical Decision-Making Process

• Structure:

  • A systematic model designed to:

  • Identify ethical dilemmas.

  • Evaluate possible options.

  • Arrive at the best decision for the client.

• Common Model:

  • Comprises 8 essential steps to facilitate ethical decision-making.

Ethical & Legal Issues in Nursing

1. Ethical Issues Faced by Nurses

• Prevalence:

  • Nurses routinely confront ethical issues necessitating sound ethical reasoning and decision-making processes.

• Examples of Common Ethical Issues:

  • Stem cell research.

  • Late terminations of pregnancy.

  • Medically assisted death.

  • Rejection or withdrawal of care/treatment.

  • Caring for clients who have substance use disorders.

  • Cases of abuse and neglect.

  • Clients under legal custody.

  • Allocation of scarce health resources.

2. Ethical Challenges for Student Nurses

• Challenges:

  • Exposure to unethical practices within clinical placement.

  • Limited autonomy in critical decision-making processes.

  • Reluctance to confront unethical behaviors encountered.

• Supportive Measures:

  • Education and empowerment are essential in upholding the Code of Ethics and ensuring client advocacy.

3. Ethical Practice & Legal Protection

• Importance:

  • Ethical nursing practice prioritizes client safety, dignity, and protection.

• Key Laws Protecting Clients and Nurses:

  • Emergency Medical Treatment and Labor Act (EMTALA).

  • Health Insurance Portability and Accountability Act (HIPAA).

4. Emergency Medical Treatment and Labor Act (EMTALA)

• Purpose:

  • Ensures provision of equal emergency medical care irrespective of a client’s ability to pay.

• Requirements Under EMTALA:

  1. Medical Screening Exam (MSE) is mandatory for all clients seeking emergency department (ED) care.

  2. Stabilization of emergency situations must occur prior to transfer.

  3. Transfers must only happen if a physician certifies that the advantages outweigh the risks when a patient is unstable.

• Implication:

  • Emergency departments cannot deny care based on financial status or insurance coverage.

5. Health Insurance Portability and Accountability Act (HIPAA)

• Purpose:

  • Protects client privacy and security of health information.

• Key Points of HIPAA:

  • Access to Protected Health Information (PHI) is restricted exclusively to the client and authorized care team members.

  • HIPAA applies in all formats (verbal, written, electronic).

  • Disclosures without client authorization are strictly prohibited.

6. Privacy vs. Confidentiality

• Privacy:

  • Defined as the right of individuals to control their personal information.

• Confidentiality:

  • Defined as the obligation to safeguard information from unauthorized disclosure.

7. Consequences of HIPAA Violations

• For Nurses:

  • Possible termination or suspension of employment.

  • Financial penalties, which could reach millions.

  • Risk of criminal charges, with potential imprisonment of up to 10 years.

  • License loss or disciplinary action by the relevant nursing board.

8. Social Media & Confidentiality

• Protection of Client Information:

  • Nurses must ensure the confidentiality of client information even when using personal social media.

• ANA's Social Media Principles:

  • Avoid posting identifiable client information.

  • Maintain professional boundaries at all times.

  • Assume all posts are public; use privacy settings wisely.

  • Report any privacy violations promptly.

  • Adhere to employer’s social media policies.

9. Genetic Testing: Ethical & Legal Issues

• Legal Considerations:

  • Be aware of the potential for discrimination stemming from genetic testing results.

  • Governed by the Genetic Information Nondiscrimination Act (GINA).

• Ethical Considerations:

  • Autonomy must be respected, allowing clients the right to accept or refuse testing.

  • Confidentiality of genetic results should be maintained.

  • Informed decision-making is crucial for all clients.

• Nurse’s Role:

  • Provide comprehensive education regarding genetic testing.

  • Respect client values when discussing testing options.

  • Coordinate appropriate referrals to certified genetic counselors.

10. Criminal vs. Civil Law

• Criminal Law:

  • Targets actions harmful to societal welfare.

  • Requires proof of actions