Legal and ethical context of nursing handout 2019 PDF

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This is a complete notes handout on the "Legal and Ethical Context of Nursing" lecture taught by Gerrie Meyers. ...

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Legal & Ethical Context of Nursing I.

Factors that influence clinical decision-making in nursing a. The nature of nursing practice b. The health care system c. The patient d. Legal & ethical principles

II.

Review--Nature of Nursing practice a. Definition of nursing (ANA, 2010) i. “Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities and populations”

III.

The Law and Nursing a. Laws i. Rules or standards of human conduct established by government 1. legislative bodies establish 2. courts interpret 3. purpose—protect rights of citizens ii. Sources of law 1. Statutory law a. Americans with Disabilities Act - federal b. Nurse Practice Acts—State 2. Regulatory law or administrative law 3. Common law—created by courts b. Torts i. a civil wrong against a person or property ii. Intentional 1. Assault a. threat of touching another without his/her consent 2. Battery a. actual carrying out of such a threat 3. Defamation of character—false communication a. Slander—spoken b. Libel—written 4. Fraud—willful, purposeful misrepresentation of self or act that may cause harm to person or property 5. Invasion of privacy a. disclosing confidential info even if true 6. False imprisonment 1

a. Unjustifiable detention of a person without legal warrant to confine the person

iii. Unintentional 1. Negligence/ Malpractice a. Act of omission (neglecting to do something a reasonable prudent nurse would do b. Act of commission (do something a reasonable prudent nurse would not do) c. Malpractice—negligence on a professional’s part 2. Necessary Elements to Malpractice a. a duty to the plaintiff (who is patient) b. a failure to meet the standard of care, or a breach of duty (omission) See P&P, p. 309, Box 23-3 c. Causation—the breach of duty produced injury to the client, foreseeability d. Damage—the client was injured (physically, emotionally, financially, etc.) iv. Common areas for nursing malpractice 1. medication errors 2. Falls 3. inadequate assessment/ judgment 4. inadequate communication 5. burns 6. Mistaken identity of patient 7. Inaccurate sponge, needle, instrument count in OR c. Crimes i. State brings charges against a defendant who has violated criminal statutes 1. Assault/battery, robbery, narcotic law violations, murder d. Minimizing legal liability in nursing practice i. Legal responsibilities of students—see P&P, p. 310-311 1. Held to same standards of performance as RN 2. Students responsible for own actions 3. Comply w/agency/SON policies ii. Document appropriately iii. Comply w/agency policies iv. Ask for help when necessary; question orders when patient questions etc v. Malpractice insurance V.

Ethics and nursing a. Definitions i. Ethics—branch of philosophy that deals with standards of conduct and moral judgment ii. Personal morality—set of beliefs about standards of right and wrong that help a person determine correct or permissible action in a given situation 2

iii. Legal guidelines—drawn from state and federal law. Often establish minimal acceptable conduct while professional ethics establish ideal iv. Professional ethics—involve principles and values with universal application and standards of conduct to be upheld in all situations 1. All professions have code of ethics 2. ANA code of ethics b. Principles of ethics in nursing i. Autonomy 1. Preeminent right 2. Respect another’s right to determine course of action 3. Informed consent ii. Beneficence 1. Doing or promoting good AS DEFINED BY THE PATIENT 2. Values a. Nurses need to clarify client’s values as they influence and relate to nursing care b. What does client value—what is priority for him/ her? c. Help client clarify values i. Make sure client is aware of all alternatives ii. Make sure client has thought about possible results of each action iii. Determine whether client chose freely. iv. Determine how individual feels about the choice v. Affirm the choice vi. Does client act on choice? vii. Does client act with a pattern? 3. Culture a. Each culture has own ideas about health i. maintaining health ii. protecting health iii. restoring health b. nurse must help individual act within cultural value system i. May determine who makes decisions ii. Categories of health practices 1. Beneficial 2. Neutral 3. Dysfunctional c. Cultural belief system of patient must influence decisions nurse makes

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iii. Nonmaleficence 1. Avoid doing harm iv. Justice 1. Treat all clients equally & fairly v. Veracity 1. Telling the truth vi. Fidelity 1. Faithful to one’s commitments and promises vii. Privacy 1. Guarding access to one’s person or one’s personal information (confidentiality) 2. Protecting person from undesirable interactions c. Standards for nurses i. Accountability 1. Ability to answer for one’s own actions ii. Responsibility 1. Reliability and dependability 2. Perform actions well & thoughtfully 3. Seek help when needed 4. Act as a client advocate

Case Studies Case #1 Mrs. Red is a 39-year-old mother of 2. She is 7 weeks pregnant with her third child. A CVS has revealed that the baby has Trisomy 18, characterized by severe mental retardation and multiple deformities. Survival for more than a few months after birth is very rare. Mr. & Mrs. Red have been given information on the disease and its consequences earlier this week. They arrive at a family planning clinic this today to have an elective abortion. They assure the nurse that they are fully informed about the procedure and readily sign the surgical consent. Case #2 Mrs. Brown is the nurse’s neighbor. She came to the outpatient department of the hospital where the nurse works to have a biopsy of a suspicious lump on her left breast. The nurse is worried for her. The nurse is checking her chart in the hospital’s computer on a daily basis to see if the results of the biopsy are back yet. Case #3 Mr. Green is a 48-year-old patient who was involved in a car accident last night. He suffered internal injuries and his spleen had to be removed. His blood counts are dangerously low and the medical staff is afraid that he will have a myocardial infarction (heart attack) unless he has a blood transfusion. Mr. 4

Green and his family are practicing Jehovah’s Witnesses and he is refusing to receive the blood. One of the nurses states that “we should just give the blood anyway while he is asleep.” Case #4 A nurse is shopping at a busy mall. She sees a person clutch his chest and fall to the ground. The nurse has 2 young children with her and does not stop. Can this nurse be charged with malpractice?

Sample test questions 

Which of the following would be an example of an unintentional tort? A. Leaving the siderails down and the client falls. B. Restraining a client who refuses care. C. Taking photos of a client’s surgical wounds. D. Talking to someone about a client’s history of sexually transmitted disease.

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A nurse stopped at an accident scene and began to provide emergency care for the victims. His actions are best labeled as A. Respect for persons B. Beneficence C. Nonmaleficence D. Veracity

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Mrs. Green, an 88 year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extra-special measures taken when her life is at the end. Because she feels this way, she has talked with her daughter about her desires, completed a living will and left directions with her physician. This is an example of a. b. c. d.

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Listing alternatives Choosing freely Affirming a choice Acting on a choice

Which of the following behaviors is most indicative of culturally sensitive nursing practice? a. Discusses the meaning of the medical regime to the patient b. Informs the patient that they must follow the medical regimen or they will become seriously ill. c. Has a family member talk the patient into following the medical regimen. d. Helps the patient recognize the need to adapt health practices to fit commonly accepted practices

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