Ethical & Legal Issues in Critical Care Nursing

Ethical & Legal Issues in Critical Care Nursing

• Critical care nurses face ethical and legal dilemmas related to informed consent, withholding or withdrawing life- sustaining treatment, organ and tissue transplantation, confidentiality, justice in healthcare resources distribution.

Morals and Ethics

• Morals are principles of "shoulds" and "should nots" in behaviors based on cultural and religious values, governing social interactions.
• Ethics concern the basis of actions and rules to prevent harm, reflecting beliefs and values of a community or profession.

Moral Distress of Nurses

• Moral distress can arise from emergency situations, conflicts with others, complex clinical cases, new technologies, increasing regulatory requirements, acquiring new skills/knowledge, staffing, financial constraints, workplace violence.

Ethical Principles

• Autonomy: Respecting individual decision-making regarding health without coercion.
• Beneficence: Acting to benefit and prevent harm to patients.
• Non-maleficence: Avoiding harm or bringing harm to others.
• Veracity: The obligation to tell the truth.
• Fidelity: Maintaining faithfulness and commitment to promises and obligations.
• Confidentiality: Respecting an individual's right to control their health information.
• Privacy: Respecting personal space, data, choices, and relationships.
• Justice: Being fair in the distribution of healthcare resources and consequences of actions.

The Nursing Code of Ethics (American Nurses Association)

• Practices with compassion and respect for individual dignity, worth, and uniqueness, regardless of social or economic status.
• Primary commitment is to the patient, whether an individual, family, group, or community.
• Promotes, advocates, and protects the health, safety, and rights of the patient.
• Nurses are responsible and accountable for their practice and appropriate task delegation for optimal patient care.
• Nurses owe the same duties to themselves as others, including maintaining integrity, competence, and professional growth.
• Participates in creating and improving healthcare environments for quality care.
• Participates in advancing the profession through contributions to practice, education, administration, and knowledge development.
• Collaborates with other healthcare professionals and the public to address health needs.
• Represents and shapes social policy through associations and other members.

Ethical Dilemmas

• An ethical dilemma arises when two or more morally correct actions clash, leading to both right and wrong consequences.

Early Indicators for Ethical Dilemmas

• Signs of conflict among healthcare team members, family members, and healthcare teams and families.
• Signs of patient suffering.
• Signs of nurse distress.
• Signs of ethics violations.
• Signs of unrealistic expectations.
• Signs of poor communication.

Steps in Ethical Decision-Making

• Identify the health problem.
• Define the ethical issue.
• Gather additional information.
• Delineate the decision-maker.
• Examine ethical and moral principles.
• Explore alternative options.
• Implement decisions.
• Evaluate and modify actions.

Informed Consent

• Informed consent is the process of educating a patient about risks, benefits, and alternatives of a procedure or intervention.
• Consent must be voluntary and the patient must be competent to understand the information and make a decision.

Elements of Informed Consent

• Competence: The patient's ability to understand relevant information about the proposed treatment.
• Voluntariness: Consent given freely, without coercion or fraud.
• Disclosure of Information: Providing sufficient information about diagnosis, treatment, benefits, risks, alternatives, and prognoses.

What the Patient Needs to Know

• Diagnosis of their health problem.
• Nature, duration, and purpose of the proposed treatment.
• Probable outcome of intervention.
• Benefits of intervention.
• Potential risks.
• Alternative treatments and feasibility.
• Short-term and long-term prognoses without treatment.

Elements of Good Ethical Practice in Medical Decisions in the ICU

• Careful assessment of the patient's condition.
• Evaluation of risks and benefits.
• Clear communication with the patient or proxy.
• Respect for patient or proxy preferences.
• Plan of care based on clinical assessment and shared goals.
• Tolerance for uncertainty in decision-making.
• Tolerance for disagreement among parties.
• Ongoing dialogue to resolve difficult situations.

Critical Care Nursing Practice

• Deals with human responses to life-threatening problems.
• CCNs require judgment and clinical knowledge development.

Thought and Action

• Clinical grasp & clinical inquiry: Problem identification and clinical problem-solving.
• Clinical forethought: Anticipating and preventing potential problems.

9 Categories of Critical Care Nursing Practice

• Diagnosing and managing unstable patients' vital functions.
• Managing crises using skilled know-how.
• Providing comfort measures for the critically ill.
• Caring for patients' families.
• Preventing hazards in a technologically advanced environment.
• End-of-life care and decision making.
• Communicating and negotiating diverse perspectives.
• Monitoring quality and managing breakdowns.
• Clinical leadership and coaching/mentoring others.

Communication with Patients

• Communication is vital for respecting patients, understanding their needs, values, and preferences.
• Effective communication fosters trust and facilitates ongoing care.

Factors Affecting Communication in the ICU

• Insufficient time for staff and patients to build trust.
• Discomfort or fear of discussing illness and death, focus on physiological function.
• Lack of a conducive communication setting.

This quiz explores the ethical and legal challenges faced by critical care nurses, including informed consent, treatment decisions, and confidentiality. It also addresses the concepts of morals and ethics, along with the impact of moral distress. Assess your understanding of these vital issues in nursing practice.