Chapter 8_mcgee

Upholding Legal and Ethical Principles

Chapter 8

Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier Inc.

Legal vs. Ethics Law mandates

How we must behave toward each other Ethics establishes

How we should behave

Copyright © 2014, 2009 by Mosby, Inc., an imprint of Elsevier Inc. 2

Issues in Law Sources of law

Common law Also called case law Law that has arisen from judicial decisions;

“judge-made” decisions Administrative law

Controls the administrative operations of government

Statutory law Constitutional law Enacted law

For example, Nurse Practice Act


Issues in Law (Cont'd) Legal principles

Confidentiality and the right to privacy Health Insurance Portability and Accountability

Act of 1996 (HIPAA) Failure to follow this act: civil and criminal penalties

Patient rights Right to be treated with dignity and respect,

privacy, decision-making, confidentiality, access to health records, and the right to refuse treatment

Informed consent Patient must fully understand what he or she has

consented to for the consent to be validCopyright © 2014, 2009 by Mosby, Inc.,

an imprint of Elsevier Inc. 4

EthicsEthics

Description Branch of philosophy that concerns the distinction between right

and wrong Consists of a sense of morality, behavior in accordance with

customs or tradition Ethical principles

Codes that direct or guide nursing actions, including autonomy, nonmaleficence, beneficence, justice, veracity, and fidelity

Values Beliefs and attitudes that may influence behavior and the process of

decision making Values clarification

Process of analyzing one’s own values for better understanding of what is truly important

Ethical codes Not legally binding but, in most states, the board of nursing has

authority to reprimand nurses for unprofessional conduct that results from violation of ethical codes


Ethics, continued Ethical dilemma

Occurs when there is a conflict between two or more ethical principles

Advocate Represents client’s point of view and

protects client’s rights to make decisions Ethics committee

Takes a multidisciplinary approach to facilitate dialogue regarding ethical dilemmas

Develops and establishes policies and procedures for the prevention and resolution of dilemmas


Issues in Law (Cont'd) Legal principles

Assault and battery Assault: deliberate threat to physically harm

another Battery: actual and intentional act of touching

another without the person’s consent False imprisonment

Verbally or physically forcing an individual to stay in a place against his or her wishes


Negligence and Malpractice

Negligence Failure to use such care as a reasonable

prudent and careful person would use under similar circumstances

Professional negligence (also called medical malpractice or professional malpractice) Omission or commission of an act that departs

from the standard of care that a reasonably prudent person would do in the same or similar circumstances

Accountability Willingness to assume responsibility and

accept the consequences for your actionsCopyright © 2014, 2009 by Mosby, Inc.,


Negligence and Malpractice (Cont'd)

Tort Legal wrong committed against a person or

property Intentional torts

Assault and battery False imprisonment Fraud Invasion of privacy Slander and defamation

Unintentional torts Professional negligence



Malpractice Improper or unethical conduct or

unreasonable lack of skill by a holder of a professional or official position

Medical malpractice Professional misconduct Failure to perform professional duties Failure to meet the professional standards of

care that results in harm to another



Malpractice Four elements must be present for a person to

recover damages Duty to care: obligation exists to conform to a

recognized standard of care Breach of duty: must be a failure to adhere to an

obligation and a deviation from a recognized standard of care

Injury: actual damages have occurred Causation: injury was foreseeable, caused by a

breach of duty, and the conduct was the cause of the injury



Standards used to prove malpractice Standards of care, facility policies and

procedures, protocols, job descriptions, professional literature, expert opinions, your state nurse practice act, and the reasonable person standard

Follow the above standards and use common sense to decrease risk of malpractice.

Accurate documentation will provide your best defense to a lawsuit.



Guidelines to prevent negligence and malpractice Performing only those skills that are within

your scope of practice Staying current in your field of practice Delegating carefully and legally Administering drugs using the six rights Being aware of your own strengths and

weaknesses Advocating for your patients



High-risk areas Medication administration

Most errors: wrong dose, wrong technique, and wrong drug

Emergency department Mental health settings Specialty areas



Most common malpractice claims against nurses Failure to follow standards of care Failure to use equipment in a responsible

manner Failure to communicate Failure to document Failure to assess and monitor Failure to act as a patient advocate


Negligence and Malpractice Question 1

An alert, competent patient wants to leave the hospital but the nurse thinks the patient should see the physician before leaving. The nurse restrains the patient to the bed. Which action did the nurse commit?

1. Assault2. Informed consent 3. False imprisonment4. Unintentional tort


Failure to Rescue Lack of a timely and appropriate

response to changes in a patient’s condition Failure to prevent a clinically important

deterioration, such as death or permanent disability

Critical to monitor patients carefully to identify deteriorations and intervene appropriately

Sentinel events Root-cause analysis


Documentation Functions

For accreditation and regulatory compliance Make reimbursement determination Examined by licensing boards for disciplinary action

Documentation errors Faulty record-keeping Failure to include information Charting after the fact Misplacing records Failure to follow standards of care when charting by

exception


Mandatory Reporting Two specific types

Child abuse and neglect Elder abuse and neglect

Can have legal consequences for not reporting these types of situations


Nursing Ethics Ethics

Branch of philosophy that offers a way of examining moral life

Studies how we make decisions regarding right and wrong

Bioethics Applies ethical theories and principles to

moral issues and problems in the practice of medicine


Nursing Ethics (Cont'd) Morals

What we believe to be right and wrong Often based on religious beliefs, culture, social

influences, and life experiences Values

Enduring beliefs or ideals Largely shaped by one’s culture Can have values conflict


Nursing Ethics (Cont'd) Moral development

How an individual learns to handle moral or ethical dilemmas

Theorists Lawrence Kohlberg

Pre-conventional Conventional Post-conventional

Carol Gilligan Focused on women Moral person: one who responds to need and demonstrates

care and responsibility in relationships


Nursing Ethics (Cont'd) Universal principles of biomedical ethics

Autonomy Freedom to choose and make one’s own

decisions Self-determination

Veracity Truth-telling

Fidelity Practicing faithfully within the legal boundaries Keeping promises


Nursing Ethics (Cont'd) Universal principles of biomedical ethics

Beneficence Preventing harm or promoting/doing good Most critical ethical principle in health care

Nonmaleficence Do no harm

Confidentiality Protection of private health information Right to privacy

Justice Fairness


Ethics and Culture Cultural differences must be recognized

and respected. Culturally competent nursing care

This entails integration of knowledge, attitudes, and skills.

The nurse is able to work within the specific cultural context of an individual, family, or community.

The more insight you have into your own values, attitudes, beliefs, and practices, the more you are prepared.

Cultural competence also extends to the workplace.


Ethical Dilemmas Exist when a conflict arises among health

care professionals, patients, families, and health care organizations

Moral courage Deciding on a right course of action regardless

of the possible consequences Moral distress

Situations in which an individual knows the right action to take, but feels powerless to take that action


Ethics Committees Assist staff, patients, and caregivers in resolving

ethical dilemmas Members are usually multidisciplinary Purposes

Promote, advocate, and protect patient rights, establish a moral care standard, and enhance the quality of patient care

Functions Policy and procedure development, staff and

community education, conflict resolution, case reviews, support, and political advocacy


Ethical Theories Deontology

Action should be judged based on the motive or intent behind the actions and does not rely on outcomes.

Utilitarianism Action should be judged on whether it produces the

greatest good and does rely on outcomes. Virtue ethics

If an individual develops morally desirable virtues, moral decisions and actions are more likely.

The ethic of care This emphasizes caring and relationships.


Ethical TheoriesQuestion 2

A nurse believes that immunizations should be offered to everyone because they provide the most good for the greatest amount of people. Which ethical theory is the nurse using?

1. Virtue ethics2. Utilitarianism3. Ethic of care4. Veracity


answer ANSWER AND RATIONALE: 2. Utilitarianism. Utilitarianism

is a theory that states that actions must be judged based on whether they produce the greatest good (or more happiness than unhappiness).

1. The emphasis of virtue ethics is on the characteristics, traits, or virtues that a person should have such as courage, integrity, magnanimity, honesty, justice, and temperament.

3. The ethic of care emphasizes the caring aspect of the nurse-patient relationship, intuition, minimizing or avoiding harm, and fairness.

4. Veracity is the principle of truth-telling and not intentionally deceiving or misleading patients.


Your Professional Commitment The Code of Ethics for Nurses

Provides a framework for ethical analysis and decision-making

Is nonnegotiable Is applicable to all practice settings and a

variety of nursing roles Outlines nine ethical principles that are the

guidelines for practice as a registered nurse Expresses ethical duties owed to ourselves,

our patients, society, our employers, and our colleagues


Ethical Decision-Making Eight-step model

1. Gathering relevant information2. Stating the practical problem3. Identifying the ethical issues and questions4. Selecting the ethical principles and/or

theoretical frameworks to be considered5. Conducting an analysis and preparing a

justification6. Considering one or more counterarguments7. Exploring the options for action8. Selecting, completing, and evaluating the

actionCopyright © 2014, 2009 by Mosby, Inc.,


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