Craven Fundamentals of Nursing: Human Health and Function

1. CravenFundamentals of Nursing: Human Health and Function Chapter 6: Values, Ethics, and Legal Issues NRS_320_Foundations_Craven_Collings2012

2. Learning Objectives: • #1. Define values, personal values, and professional values • #2. Explain how behaviors relate to values • #3. Apply cultural and developmental perspectives when identifying values. • #4. Examine value conflicts and resolutions in nursing care situations. • #5. Differentiate law and institutional policies from professional values. • #6. Discuss the eight principles of healthcare ethics from the American Nurses Association. • #7. Describe a systematic approach for resolving ethical dilemmas. • #8. Distinguish among licensure, a standard of care, a crime and a tort. • #9. Define four elements of negligence. • #10. Describe legal protections for nurses and cite measures to take. NRS_320_Foundations_Craven_Collings2012

3. Values • Standards for decision making that endure for a significant time in one’s life • Ideas developed in life • Different meanings for different people based on experience, age, culture • Value Systems help people make decisions NRS_320_Foundations_Craven_Collings2012

4. Example • A 22 year old diagnosed with Multiple Sclerosis tells you that she has decided against medical treatment and prefers to “eat vegan food and exercise” to maintain her health. The M.D. recommends Interferon treatment. You, as a Nursing Student, know that the treatment, while having side effects, may delay the patient’s disease course. You have seen patients with severe debilitating effects of MS wheelchair-bound and dependent at age 40. • How do you feel about this patient’s decision? • What conflicts could arise from the different value systems of the patient, student, and M.D? • How could you help to prevent or resolve conflict in this case? • What assessments are needed? NRS_320_Foundations_Craven_Collings2012

5. Value Indicators • Attitudes • Mental /emotional mindset; positive or negative • Beliefs • Ideas one accepts as truth • Behaviors • Actions that can be observed; value indicators • Nurse behaviors reflect professional values • How did the patient’s behaviors reflect her attitudes, beliefs and values? • What professional values does the student reflect? How? NRS_320_Foundations_Craven_Collings2012

6. Question true or false: Attitudes are the same as values. NRS_320_Foundations_Craven_Collings2012

7. Answer False. Rationale: Although attitudes are linked to values, they are not the same as values. An attitude is one’s disposition toward an object or a situation; it can be a mental or emotional mind-set, and it can be positive or negative. NRS_320_Foundations_Craven_Collings2012

8. Socializing Influences • Family interactions • We learn first from family, culture • School interactions • Rules, peers, teachers; encounter different values • Religious interactions • Ritualize values; affect health care decisions • Workplace and service interactions • Meeting expectations at work, with friends/spouse/family • In adulthood, values grow and become ingrained, but may be more accepting of others’ values with age [or not] NRS_320_Foundations_Craven_Collings2012

9. Values • Clarifying values • Self-reflection; identify your own personal values • Values inquiry • Method of examining social issues and values that motivate decisions • Multiple viewpoints, value systems, advantages and disadvantages of potential solutions • Value conflicts • Family conflicts • Common; may cause legal, family problems in health care settings • End-of-life care, preventative care, health habits [exercise, smoking, eating] • Nurses role can be to help set goals, identify values and influences • Healthcare conflicts • Between patients/families and healthcare providers NRS_320_Foundations_Craven_Collings2012

10. Resolving Healthcare Value Conflicts • 1 – Understand your own values • 2 – Assess the patient’s perception and values • 3 – Assist the patient to explore & clarify their values, beliefs, behaviors • 4 – Support the patient’s values while providing safe, ethical care NRS_320_Foundations_Craven_Collings2012

11. Ethics • Branch of philosophy dealing with standards of conduct and moral judgment • Principles of Healthcare Ethics • Beneficence • doing or promoting good • Nonmaleficence • avoid doing harm, prevent harm, remove from harm • Autonomy • Creating conditions in which patients can make their own decisions • Includes advance directives, informed consent, healthcare proxy • Justice • Foundation for decisions about resource allocation; need vs. other NRS_320_Foundations_Craven_Collings2012

12. Professional–Patient Relationships • Veracity • Truthfulness • Influenced by culture, situation, communication skills • Fidelity • Keeping commitments & promises • Requires good judgment • Privacy • Appropriate use of patient information • Personal [body ] privacy • Confidentiality • Information about patients is private • Only those involved in care need to know NRS_320_Foundations_Craven_Collings2012

13. Resolving Ethical Dilemmas • Strategies • Validate feelings • Conduct a case analysis • Identify outcomes • Identify short- and long-term goals NRS_320_Foundations_Craven_Collings2012

14. Laws and Nursing • Sources of law: • constitutional, legislative, common law • Types of laws • Civil, Criminal • Licensure • Legal ability to practice as a nurse in a state • Standards of care • Expected level of performance or practice • Important in ,malpractice & licensing cases • ANA, Joint Commission, Institutional policies NRS_320_Foundations_Craven_Collings2012

15. Question true or false: The living will is an advance directive. NRS_320_Foundations_Craven_Collings2012

16. Answer True. Rationale: A living will is an advance directive that specifies the types of medical treatment patients do and do not want to receive should they become unable to speak for themselves in a terminal or permanently unconscious condition. NRS_320_Foundations_Craven_Collings2012

17. Torts and Crimes • Intentional torts • Assault and battery • Defamation of character • Fraud • Invasion of privacy • False imprisonment NRS_320_Foundations_Craven_Collings2012

18. Question Which of the following terms defines unlawful touching of the body? a. Assault b. Battery c. Libel d. Slander NRS_320_Foundations_Craven_Collings2012

19. Answer b. Battery Rationale: Battery is touching another person without his or her consent (unlawful touching). Assault is the threat of touching another person without his or her consent. Defamation of character is false communication that results in injury to a person’s reputation by means of print (libel) or spoken word (slander). NRS_320_Foundations_Craven_Collings2012

20. Torts and Crimes (Cont’d) • Unintentional torts • Negligence [omission or commission] • Duty and breach of duty • Proximate cause • Damages • Trends in nursing malpractice • Increase in nurses being sued for malpractice • Medication errors, falls, surgical errors • Higher standards of care • Delegation of duties to UAP • High Acuity – little time – poor communication NRS_320_Foundations_Craven_Collings2012

21. Legally Sensitive Areas of Practice • Controlled substances administration • Death and dying • Recognizing death vs. pronouncing death • Assisted suicide • Providing means to end life [3 states] • Active euthanasia – illegal [murder] • Terminal sedation • Not euthanasia; pain management at end of life that may hasten death NRS_320_Foundations_Craven_Collings2012

22. Legally Sensitive Areas of Practice (Cont’d) • Advance directives • Policy required - know it! • Resuscitation • Know code status • DO resuscitate if unknown • Good Samaritan laws • Protect nurses acting in emergency • Limit liability but may still be liable for gross negligence • Stay until assistance arrives • Covered by personal insurance NRS_320_Foundations_Craven_Collings2012

23. Protecting Yourself Legally • Professional practice • Realistic, evidence-based, practical • Follow policy & procedure • Document and communicate changes in patient condition • Professional liability insurance • A good idea • Students are responsible for staying within their scope; may be liable • Same competence requirement as RN • Documentation • Accurate, complete, timely, objective NRS_320_Foundations_Craven_Collings2012