Nursing: Ethical & Legal concepts

1. Nursing: Ethical & Legal concepts Introduction to Nursing Profession (NURS 210)

2. Learning Outcomes • Explain how values, moral frameworks, and codes of ethics affect moral decisions. • Discuss how nurses use knowledge of values to make ethical decisions and to assist clients in clarifying their values. • Identify the ethical decision making process, and the strategies necessary to enhance it, when presented with an ethical situation. • Describe ways nurse practice acts, credentialing, standards of care, and agency policies and procedures affect the scope of nursing practice. • Describe the purpose and essential elements of informed consent. • Discriminate between negligence and professional negligence/ malpractice. • Discuss the legal responsibilities of nursing students.

3. What Do You Know About Ethics???

4. Ethics versus Morality • Common Ethical theories • Islamic Ethical Principles • Ethical decision making in nursing • Legal issues in nursing • Areas of potential liability in nursing Potential malpractice situation in nursing

5. Introduction • Nurses' decisions and advocacy for client decisions Need for: • Sensitivity to ethical dimensions • Awareness of nurse and client values • Understand how values influence decisions • Think about approaching moral problems/issues

6. What is the meaning of “Ethics”? • Ethics has several meanings. • A method of inquiry that helps people to understand the morality of human behavior OR: • Expected standards of moral behavior of a particular group as described in the group's formal code of professional ethics (e.g.: Nursing Ethics)

7. What is the meaning of “Morality”? • Morality • Private, personal standards of what is right and wrong in conduct, character, and attitude Concerned with important values and norms-evoke words such as good, bad, wrong, should, and ought

8. Moral Frameworks • Consequence-based (teleological) theories • Utilitarianism: “Utility”. • Principles-based (deontological) theories • Relationships-based (caring) theories

9. Moral Frameworks (Cont.) • Consequence-based (teleological) theories: look to the outcomes (consequences) of an action in judging whether that action is right or wrong. They focus on issues of fairness. • Utilitarianism: views a good act as one that brings the most good and the least harm to the greatest number of people. This is called the principle of “Utility”.

10. Moral Frameworks (Cont.) 2. Principles-based (deontological) theories: • They emphasize individual rights, duties, and obligations. • The morality of an action is determined by whether it is done according to an fair, objective principle. For example, following the rule “Do not lie,” a nurse might believe he or she should tell the truth to a dying client.

11. Moral Frameworks (Cont.) 3. Relationships-based (caring) theories: • Focus on courage, generosity, commitment, and the need to nurture and maintain relationships. • Caring theories promote the common good or the welfare of the group.

12. Moral Principles Statements about broad, general, philosophic concepts. Importance: • Provide the basis for specific prescriptions for actions. • Useful in ethical discussions. • Serve as a basis for the solution acceptable to all parties

13. Moral Principles • Autonomy: the right to make one’s own decisions. • the nurse respects a client’s right to make decisions even when those choices seem to the nurse not to be in the client’s best interest. • Nonmaleficence: is the duty to “do no harm.” • Harm can mean intentionally causing harm, placing someone at risk of harm, and unintentionally causing harm. • Beneficence: means “doing good.” • Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons.

14. Moral Principles (Cont.) • Justice: is frequently referred to as fairness. • Nurses often face decisions in which a sense of justice should prevail. • Fidelity: means to be faithful to agreements and promises. • By virtue nurses, as professional caregivers, have responsibilities to clients, employers, government, and society, as well as to themselves. • Nurses often make promises such as “I’ll be right back with your pain medication”. • Veracity: refers to telling the truth. • Nurses must have professional accountability (i.e., answerable to oneself and others for one’s own actions) and responsibility (i.e., the specific accountability associated with the performance of duties of a particular role).

15. Nursing Ethics • No one profession responsible for ethical decisions • Nowadays, it is mandatory to have “Ethics committees” or similar structure • Purpose of ethics committees • To write guidelines and policies • to provide education, counseling, and support on ethical issues. • Ensure that the relevant facts of a client’s case brought out • Provide a forum to express diverse views, provide support for caregivers, reduce institution's legal risks

16. Figure 5–1 An ethics committee contemplates all aspects of the case being considered.Ghislain & Marie David de Lossy/Alamy.

17. Nursing Code of Ethics Defined as: “Formal statement of ideals and values”. • It is a set of ethical principles that: • Is shared by members of the group, • Reflects common moral judgment over time • Serves as a standard for professional actions • Usually higher standard than legal standard Nurses are responsible for being familiar with the code that governs their practice.

18. Purposes ofNursing Code of Ethics • Inform the public about the minimum standards of the profession • Provide a sign of the profession's commitment to the public • Help the public understand ethical considerations of professional nursing • Aid self-regulation among nurses • Remind nurses of their special responsibilities in caring for the sick

19. Making Ethical Decisions An important first step in ethical decision making is to determine whether a moral situation exists. • Set of criteria may be used to decide whether there is a moral issue or not

20. Criteria used to Make Ethical Decisions • Difficult choice exists between actions that conflict with needs of one or more persons. • Moral principles exist that can be used to provide some justification for the action. • The choice is guided by a process of weighing reasons. • The decision must be freely and consciously chosen. • The choice is affected by personal feelings and by the particular context of the situation. • Whether there is “Moral distress” (i.e., Conflict between client's interests and nurse's personal beliefs)

21. Figure: When there is a need for ethical decisions or client advocacy, many different individuals contribute to the final outcome.Photo Network/Alamy.

22. Ethical Decision Making Process • Identify the moral aspects. (Using criteria determine whether a moral situation exists). • Gather relevant facts that relate to the issue. • Determine ownership of the decision. (For example, for whom is the decision being made? Who should decide and why?) • Clarify and apply personal values. • Identify ethical theories and principles. • Identify applicable laws or hospital policies.

23. Ethical Decision Making Process (Cont.) • Use competent interdisciplinary resources. • Develop alternative actions and project their outcomes on the client and family. • Apply nursing codes of ethics to help guide actions. (Codes of nursing usually support autonomy and nursing advocacy.) • For each alternative action, identify the risk and seriousness of consequences for the nurse. (Some employers may not support nursing autonomy and advocacy in ethical situations.)

24. Strategies to Enhance Ethical Decisions and Practice • Become aware of personal values and ethical aspects of nursing • Be familiar with nursing code of ethics • Seek continuing education to remain knowledgeable about ethical issues in nursing • Respect values, opinions, and responsibilities of other health care professionals • Participate in or establish ethics rounds • Serve on institutional ethics committees • Strive for collaborative practice

25. Islamic values in nursing care • Altruistic relationships are a core value. • All care is spiritual care. • Participants desire greater understanding and respect as nurses and as Muslims. • Nurses have a professional kinship transcending culture, religion, and nationality. • Nursing ethics derive from divine ethics. • Religious teachings promote health. • Life requires a radical acceptance of God’s will, balanced with hope of reward. (Refer to the Reading Article)

26. What Do You Know About Legal Aspects???

27. Introduction • It is important for nurses to know the basics of legal concepts, because nurses are accountable for their professional judgments and actions. • Accountability is an essential concept of professional nursing practice. • Knowledge of laws that regulate and affect nursing practice is needed for two reasons: • To ensure that the nurse’s decisions and actions are consistent with current legal principles. • To protect the nurse from liability.

28. REGULATION OF NURSING PRACTICE • Protection of the public is the legal purpose for defining the scope of nursing practice, licensing requirements, and standards of care. • Nurses who know and follow their nurse practice act and standards of care provide safe, competent nursing care.

29. Credentialing • is the process of determining and maintaining competence in nursing practice. • The credentialing process is one way in which the nursing profession maintains standards of practice and accountability for the educational preparation of its members. • Credentialing includes: • Licensure • Certification, and • Accreditation.

30. LICENSURE • A license: is a legal permit that a government agency grants to individuals to engage in the practice of a profession and to use a particular title. • Nursing licensure is mandatory for all nurses.

31. CERTIFICATION • is the voluntary practice of validating that an individual nurse has met minimum standards of nursing competence in specialty areas such as maternal–child health, pediatrics, mental health, gerontology, and school nursing. • Certification programs are conducted by specialty nursing organizations.

32. ACCREDITATION/APPROVAL OF BASIC NURSING EDUCATION PROGRAMS • As a legal requirement, and to ensure that schools preparing nurses maintain minimum standards of education, nursing educational programs must be either approved or accredited. • Nursing programs can also choose to seek voluntary accreditation from a private organization such as the Accreditation Commission for Education in Nursing (ACEN) • Maintaining voluntary accreditation is a means of informing the public and prospective students that the nursing program has met certain criteria.

33. Standards of Care • Standards of care are the skills and learning commonly possessed by members of a profession (Guido, 2014). • These standards are used to evaluate the quality of care nurses provide and, therefore, become legal guidelines for nursing practice.

34. SELECTED LEGAL ASPECTS OF NURSING PRACTICE • Informed consent. • Delegation. • Violence, abuse, and negligence (Refer to Chapter). • Controlled substances (Refer to Chapter).

35. SELECTED LEGAL ASPECTS OF NURSING PRACTICE1. Informed consent Informed consent is an agreement by a client to accept a course of treatment or a procedure after being provided complete information. It includes: • The benefits and risks of treatment, • Alternatives to the treatment, and • prognosis if not treated by a health care provider.

36. SELECTED LEGAL ASPECTS OF NURSING PRACTICE1. Informed consent Obtaining Informed consent for specific medical and surgical treatments is the responsibility of the person who is going to perform the procedure. Generally this person is the primary care provider (e.g., physician)

37. SELECTED LEGAL ASPECTS OF NURSING PRACTICE1. Informed consent Informed consent has three major elements: • The consent must be given voluntarily (i.e., Client must not feel coerced). • The consent must be given by a client or individual with the capacity and competence to understand. • The client or individual must be given enough information to be the ultimate decision maker.

38. SELECTED LEGAL ASPECTS OF NURSING PRACTICE1. Informed consent: EXCEPTIONS Three groups of people cannot provide consent: • A minor, person 18 years or younger • The unconscious or person injured in such as way that they are unable to consent • A mentally ill person judged by professionals to be incompetent

39. Informed Consent: Nurse’s Role • Nurse's Role • Client gave consent voluntarily. • Signature is authentic. • Client appears competent to give consent. • Client has right to refuse even after signing consent form. • Documentation important aspect

40. Figure 4–3 Obtaining informed consent is the responsibility of the individual performing the procedure. The nurse may be asked to witness the client's signature on the consent form.

41. SELECTED LEGAL ASPECTS OF NURSING PRACTICE2. Delegation Delegation is: “the process for a nurse to direct another person to perform nursing tasks and activities” Nurses must know not only their own scope of practice but also the scope of practice of others (according to their job description & skill level). It is important to the nurse to know that the responsibility for action or inaction on the part of the nurse or delegatee remains with the nurse.

42. Difference between Negligence and Malpractice • Negligence: is misconduct or practice that is below the standard expected of an ordinary, reasonable, and prudent person. Such conduct places another person at risk for harm. • Gross negligence: involves extreme lack of knowledge, skill, or decision making that the person clearly should have known would put another person at risk for harm.

43. Difference between Negligence and Malpractice • Malpractice: is negligence that occurred while the person was performing as a professional. • It applies to all professionals (i.e., physicians, dentists, and generally includes nurses)

44. Legal Responsibilities of Students • Responsible for own action and liable for their own acts of negligence • Lower standards are not applied to nursing students • Function within scope of education, job description and nurse practice act • Follow procedures and policies • Ask for additional help or supervision in situations they feel inadequately prepared • If working as an aide, only perform tasks in job description, not from nursing school