Chapter 2 Ethical, Legal, and Economic Foundations of the Educational Process

1. Chapter 2Ethical, Legal, and Economic Foundations of the Educational Process

2. Differentiated View of Ethics, Morality and Law • Natural law (basis) • Deontological (Golden Rule) • Teleological (greatest good for the greatest number)

3. Evolution of Ethical/Legal Principles in Health Care • Charitable Immunity • Cardozo Decision of 1914 A. Informed consent B. Right to self-determination

4. Cardozo Decision • Informed Consent: the right to full disclosure; the right to make one’s own decisions • Right to self-determination: the right to protect one’s own body and to determine how it shall be treated

5. Government Regulations & Professional Standards • National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research • President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research • American Nurses Association’s Code of Ethics for Nurses with Interpretative Statements • American Hospital Association’s Patient’s Bill of Rights

6. Application of Ethical and Legal Principles 1. Autonomy 2. Veracity 3.Confidentiality 4. Nonmalfeasance • Negligence • Malpractice • Duty 5. Beneficence 6. Justice

7. Definition of Ethical Principles 1. Autonomy: the right of a client to self-determination 2. Veracity: truth telling; the honesty by a professional in providing full disclosure to a client of the risks and benefits of any invasive medical procedure

8. Definition of Ethical Principles (cont’d) 3. Confidentiality: a binding social contract or covenant to protect another’s privacy; a professional obligation to respect privileged information between health professional and client.

9. Definition of Ethical Principles (cont’d) 4. Nonmalfeasance: the principle of doing no harm A. Negligence: the doing or nondoing of an act, pursuant to a duty, that a reasonable person in the same circumstances would or would not do, with these actions or nonactions leading to injury of another person or his/her property.

10. Definition of Ethical Principles (cont’d) B. Malpractice: refers to a limited class of negligent activities that fall within the scope of performance by those pursuing a particular profession involving highly skilled and technical services. C. Duty: a standard of behavior; a behavioral expectation relevant to one’s personal or professional status in life.

11. Definition of Ethical Principles (cont’d) 5. Beneficence: The principle of doing good; acting in the best interest of a client through adherence to professional performance standards and procedural protocols. 6. Justice: Equal distribution of goods, services, benefits, and burdens regardless of client diagnosis, culture, national origin, religious orientation, sexual preference and the like.

12. Legality of Patient Education and Information • Patients’ Bill of Rights • Joint Commission on Accreditation of Healthcare Organizations • State Regulations • Federal Regulations

13. Documentation of Patient Education... “…probably the most undocumented skilled service….”(Casey, 1995) Documentation is required by: • JCAHO • Third-Party Reimbursement: insurance companies, Medicare and Medicaid programs, or “private pay” • Respondeat Superior: The employer may be held liable for the negligence or other unlawful acts of the employee during the performance of his or her job-related responsibilities.

14. Economic Factors of Patient Education: Justice and Duty Revisited Challenge for health care providers: • efficient & cost-effective patient education • legal responsibility of all nurses • little preparation on pre-licensure level

15. Financial Terminology • Direct Costs • Fixed Costs • Variable Costs • Indirect Costs • Cost Savings, Benefit, and Recovery

16. Financial Terminology Direct Costs: those that are tangible and predictable, such as rent, food, heating, etc. Fixed Costs: those that are stable and ongoing, such as salaries, mortgage, utilities, durable equipment, etc. Variable Costs: those related to fluctuation in volume, program attendance, occupancy rates, etc.

17. Financial Terminology (cont’d) Indirect Costs: those that may be fixed but not necessarily directly related to a particular activity, such as expenses of heating, lighting, housekeeping, maintenance, etc.

18. Financial Terminology (cont’d) 4. Cost Savings: money realized through decreased use of costly services, shortened lengths of stay, or fewer complications resulting from preventive services or patient education.

19. Financial Terminology (cont’d) 5. Cost Benefit: occurs when the institution realizes an economic gain resulting from the educational program, such as a drop in readmission rates. 6. Cost Recovery: occurs when revenues generated are equal to or greater than expenditures.

20. Program Planning and Implementation • Revenue Generation • Relationship of Costs and Outcomes • Cost-Effectiveness Analysis • Cost-Benefit Analysis

21. Program Planning and Implementation (cont’d) Revenue Generation: profit realized when fees for an educational program exceed the aggregate costs of program preparation and delivery.

22. Program Planning and Implementation (cont’d) Cost-Effectiveness Analysis: refers to determining the economic value of an educational offering by making a comparison between two or more programs, based on reliable measures of positive changes in the behaviors of participants as well as evidence of maintenance of these behaviors, when a real monetary value cannot be assigned to the achievement of program outcomes.

23. Program Planning and Implementation (cont’d) Cost-Benefit Analysis: the relationship (ratio) between actual program costs and actual program benefits, as measured in monetary terms, to determine if revenue generation was realized.

24. State of the Evidence • Legal and ethical issues • Documentation of practice • New technologies • Health related outcomes • Economic implications