Chapter 11 Ethical and Legal Considerations PDF

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Summary

Notes from Fundamentals of Nursing Yoost/Crawford...

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! Ethics and Ethical Theories! • To provide safe and compassionate patient care, nurses must base their decisions and actions on the ethical and legal standards of care, current clinical facility policies, and evidence-based practice guidelines. • The study of ethics considers the standards of moral conduct in a society. Personal ethics are influenced by values, societal norms, and practices. Family, friends, beliefs, education, culture, and socioeconomic status influence the development of ethical behavior.!

‣ Foundation of most professional codes of ethics (including Code of Ethics For Nurses)! ‣ Meeting the needs of patients while maintaining their right to privacy, confidentiality, autonomy, and dignity is consistent with the tenets of deontology.

‣ Utilitarianism views actions as neither right nor wrong without knowing how they benefit the greater good or society ‣ “You should do this because many could benefit from it.”

Essential Principles of Ethics in Nursing • Beneficence - defined as doing good!

• Advocacy - supporting or promoting the interest of others !

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Codes of Ethics • A code of ethics is a formalized statement that defines the values, morals, and standards guiding practices in a specific discipline or profession !

of its commitment to society.”!

Bioethics Challenges in Health Care • Bioethics is the study of ethical and philosophical issues in biology and medicine! • Cloning and embryonic system ! • End-of-life care!

• Ethical decision makers! • Decisions regarding genetic testing, biomedical issues (such as cloning and stem cell research) and end-of-life care in involve intellectual knowledge and ethical evaluation. Specialty trained members of ethic committees can help guide institutional policies

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Moral Distress

• Moral distress is the anguish that health care professional experience when their basic beliefs of what is right and wrong or ethical principles are challenged. !

‣ Ask - am i or others feeling distressed?! ‣ Affirm - validate feelings with others and commit to taking care of yourself! ‣ Assess - identify source, determine severity, determine readiness! ‣ Act - create and implement plan, manage setbacks, preserve integrity, move toward resolving concern ! • Moral resilience is “the capacity of an individual to sustain or restore their integrity in response to moral complexity, confusion, distress, or setbacks”! !

Sources of Law Impacting Professional Nursing • Constitutional law - derived from formal, written constitution that defines the powers of government and the responsibilities of its elected or appointed officials ! • Statutory law - created by legislative bodies such as the U.S. Congress and state legislatures, often referred to as statues

requirement of statutory law will be met ! • Case law - judicial decisions from individual court cases, historically referred to as common law

Types of Statutory Law • May be criminal law or civil in nature!

• Assault - threat of bodily harm or violence caused by demonstration of force • Battery - actual physical harm caused to another person (starting an intravenous (IV) infusion line on a patient against his will)! • Defamation of character - occurs when a public statement is made that is false and injurious to another person!

• Invasion of privacy - public disclosure of private info • Inform patients of procedures before initiating care. If there is any doubt about a patient's comprehension of a procedure, asking the patient to explain what is to be done will alert the nurse to any areas of ambiguity that need clarification and ensure patient understanding.! •Nurses must be careful when discussing information about patients and colleagues. As professionals, nurses are required to share only accurate information in writing and conversation. Nurses should avoid making judgmental statements while documenting or orally communicating information.! •Even sharing with others that a friend or colleague is hospitalized is an invasion of privacy if authorization to share that information publicly has not been secured from the patient. ‣ Unintentional torts - omissions or acts by individuals that cause unintended harm • Negligence - creating a risk for harm by failing to do something • Malpractice - negligence committed by a person functioning in a professional role!

accusing patient.! ‣ Dereliction: There must be evidence that the nurse's actions did not meet the standard of care required or that care was totally omitted.! ‣ Damages: Actual injury to the accusing patient must be evident.! ‣ Direct cause: A causal relationship must be established between harm to the accusing patient and the actions or omitted acts of the nurse.!

Professional Liability Issues

• Adherence to the Principles for Delegation established by the ANA and legally binding within each sate’s nurse practice act! • Accurate and timely documentation ! • Ethical issues have required The Joint Commission to mandate ethics committees.! • The NCSBN (2018) recognizes specific nurse behaviors that indicate a potential for professional boundary violations:!

• Substance Use Disorder (SUD) - “encompasses a pattern of behaviors that range from misuse to dependency or addiction”! !

Legal Issues Guiding Patient Care • Informed consent - permission granted by a pt after discussing each of the following topics with the provider of the procedure!

providing safe, patient-centered care. Helping patients locate frequently updated, evidence-based online sources for health care information increases their health literacy and their ability to make informed health care decisions. • Patient’s Bill of Rights!

planning their care. Factors such as culture, age, level of education, cognitive ability, physical health, and energy affect a patient's ability and desire to actively participate in the process.! • Organ donation ! • Advance directives consist of three documents:!

life in the case of a natural death!

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Laws Impacting Professional Practice • Licensure! • Standards of care - minimum requirements for providing safe nursing care • Health Insurance Portability and Accountability Act (HIPAA) - The American Recovery and Reinvestment Act (ARRA)! • Good Samaritan Acts!

• Medical aid in dying and euthanasia - when a person is mentally competent with a prognosis of 6 months or less to live causes their death by self-administering prescribed meds! • Natural death acts! • Americans with disabilities act! • Physical restraints ! • Additional acts introduced in Congress ! •Each state has a nurse practice act that establishes the standards of care required for legal nursing practice. Licensure, laws, rules, and regulations governing nursing practice are enforced to protect the public from harm. The American Disabilities Act and the Uniform Determination of Death Act are examples of federal laws that were enacted to guide professional practice. Good Samaritan laws and laws governing medical aid in dying and organ donation are specific to states. Nurses are responsible for

•To prevent health care providers and institutions from being held liable if a patient chooses to leave a facility when physicians and nurses think that it is in the patient’s best interest to remain hospitalized, the patient is asked to sign an against medical advice (AMA) form.! !

Initiatives to Facilitate Safer Practice • Certification! • Educational recommendations ! • Ultimate responsibility of professional nurses ! • Specialty certification for nurses and further education are strategies intended to demonstrate nursing competency and improve patient safety.! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !...