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Chapter 5 Ethical and Legal Issues. Along with the privilege of providing professional health care services to consumers, the professional nurse has a commensurate degree of responsibility and accountability to follow ethical principles and standards of care integral to the profession.
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Along with the privilege of providing professional health care services to consumers, the professional nurse has a commensurate degree of responsibility and accountability to follow ethical principles and standards of care integral to the profession. Sheehy, 2006
Learning Objectives • After studying this chapter, you should be able to • Explain the relationship between state Nurse Practice acts and the concepts of risk management and quality assurance • Construct the six-step model of ethical nursing care designed by Chally and Loriz • Articulate why nurses must become knowledgeable about genetics and the issues surrounding this topic • Recognize five forms of nursing malpractice • Discuss implications for psychiatric care related to the Tarasoff ruling of duty to warn • Compare the criteria for voluntary and involuntary admission to a psychiatric facility • Interpret the concept of competency
Learning Objectives (cont.) • Compare the legal rights of adults and minors admitted to psychiatric facilities • Discuss the impact of the Omnibus Reconciliation Act (OBRA) on the placement of clients with psychiatric disorders in long-term care facilities • Distinguish the legal phrases: diminished capacity, not guilty by reason of insanity, and guilty but mentally ill • Explain forensic psychiatry and the role of the forensic nurse
Ethics in Nursing • Model of ethical nursing care • Ethics in pain management • Ethics in genetic testing and clinical research
Ethical Decision-Making Model • Clarify the ethical dilemma • Gather additional data • Identify options • Make a decision • Act or carry out the decision • Evaluate the impact of the decision
Ethical Dilemmas in Clinical Research • Informed consent • Documentation of research protocols • The client’s right to full disclosure
Legal Issues in Nursing • Nurses, now more than ever, are subject to the scrutiny of federal and state regulations as well as the legal system.
Bill of Rights for Registered Nurses • Nurses have the right to • A safe environment • Practice in a manner that ensures the provision of safe care through adherence to professional standards and ethical practice • Advocate freely on behalf of themselves and their clients
Four Elements Required for Nursing Malpractice • Failure to exercise reasonable care or act in an acceptable way when undertaking and providing care to a client • Breach of duty or failure to conform to the required standard of care in treating the client’s condition • Approximate cause, which requires that there be a reasonably close connection between the defendant’s conduct and the resultant injury (ie, the performance of the health care provider caused the injury to the client) • The occurrence of actual damage to the client as a result of malpractice
Other Forms of Malpractice • Intentional torts • Assault • Battery • Defamation • False imprisonment • Failure of duty to warn • Breach of confidentiality and privacy
Bill of Rights for Psychiatric–Mental Health Clients • Engage in religious freedom and education • Maintain respect, dignity, and personal identity • Maintain personal safety and assert grievances • Be transferred and receive continuity of care • Access own records • Obtain an explanation of cost of services • Obtain aftercare • Receive treatment • Refuse treatment • Have a probable cause hearing • Maintain client privacy and confidentiality • Communicate freely with others • Have personal privileges • Maintain one’s civil rights
Psychiatric Hospitalization • Involuntary admission or civil commitment • Voluntary admission • Hospitalization of minors • Long-term care facilities Omnibus Reconciliation Act(OBRA) of 1987
Forensic Psychiatry • Evaluation of an individual’s competency • Diminished capacity • Not guilty by reason of insanity • Guilty but mentally ill • Role of the forensic nurse • The forensic nurse as a legal nurse consultant and expert witness
Key Terms • Advance psychiatric directives • Assault • Battery • Bill of Rights for Registered Nurses • Civil commitment • Client confidentiality • Client privacy • Code of Ethics for Nurses • Defamation • Diminished capacity • Doctrine of Charitable Immunity • Ethics • Failure of duty to warn • False imprisonment • Forensic psychiatry • Genetic testing • Guilty but mentally ill
Key Terms (cont.) • Nurse Practice Act • Omnibus Reconciliation Act • Paternalism • Quality assurance • Risk management • Sentinel event • Slander • Tarasoff decision • Voluntariness hearing • Writ of habeas corpus • Incompetent • Informed consent • Intentional tort • Involuntary admission • Libel • Malpractice • Miranda warning • Negligence • Not guilty by reason of insanity
? Reflection Imagine that you are providing care for a client undergoing a clinical research drug study. The client informs you that she suspects that she is pregnant but has not seen a doctor to confirm the pregnancy. • What informed and effective care decisions do you need to make before taking action?
