Nursing Ethics and Moral Issues

Ethics Defined

• It systematically studies conduct and actions regarding self, other humans, and environment
• It justifies of what is right/good and a person's life and relationships
• It concerns doing the right thing

Ethical Issues

• Almost all nursing management decisions involve an ethical component
• Nurses act as agents for multiple stakeholders, which creates conflicting goals
• Family members may want different things for the patient

Moral Issues Faced by Nurses

• Moral indifference, an individual questions the necessity of morality in practice
• Moral uncertainty involves being unsure which moral principle or values apply
• Moral distress stems from knowing the right action but facing organizational constraints
• Heavy workloads preventing proper care is the top dilemma for nurses
• Moral outrage happens when a person witnesses an immoral act but can't stop it

Ethical Practice

• Ethical principles set standards for right and wrong based on important social values and norms
• Autonomy is self-determination, allowing patients to make personal decisions, even against their best interests
• Beneficence means acting in the client's best interest and doing good
• Fidelity involves keeping promises about care offered, stressing faithfulness
• Justice is administering fair, equitable treatment in physical, psychosocial care and resource allocation
• Nonmaleficence means doing no harm, tying into informed consent and risk-benefit analysis
• Veracity is the nurse's duty to tell the truth

Professional Code of Ethics

• It is a set of principles guiding individual practitioners
• The American Nurses Association first adopted a code in the 1950s, revised six times since, most recently in 2015
• Professional codes lack the power of law but guide ethical practice

Ethical Decision-Making in Nursing

• Ethical dilemmas present multiple choice problems with the choice based on decision-maker values and beliefs
• Requires choosing between undesirable alternatives
• Problems are dilemmas if scientific data can't solve them, there are conflicting moral imperatives, and the solution profoundly affects the client

Making Ethical Decisions

• Nurses prioritize professional approaches that avoid trial and error, and focus on proven decision-making/problem-solving processes

Steps in Ethical Decision Making

• Identify if issue is dilemma
• State the dilemma with surrounding facts
• List and analyze all options
• Select option in compliance with ethics
• Justify the selection
• Apply chosen option and evaluate

Legal vs Ethical

• Legal controls are generally much philosophically impartial
• Ethical controls are often unclear and individualized

Strategies to Promote Ethical Behavior

• Separate legal and ethical considerations
• Collaborate through ethics committees
• Use institutional review boards as needed
• Foster an ethical work environment

Sources of Law - State

• State law regulates core nursing practice via the board of nursing
• Boards adopt rules regulating nursing practice, accessible online
• They issue/revoke licenses and set standards for nursing programs

Sources of Law - Federal Regulations

• Health Insurance Portability and Accountability Act (HIPAA)
• Americans with Disabilities Act (ADA)
• Mental Health Parity Act (MHPA)
• Patient Self-Determination Act (PSDA)
• Uniform Anatomical Gift Act (UAGA)
• National Organ Transplant Act (NOTA)
• Emergency Medical Treatment and Active Labor Act (EMTALA)

Criminal Law

• This law relates an individual to the government
• This law categorizes violations as felonies or misdemeanors
• Falsifying records is subject to criminal charges

Civil Cases (Malpractice)

• Individuals seek financial compensation for perceived losses
• Guilt requires a preponderance of evidence

Increased Legal Liability for Nurses

• More authority/independence in decision-making
• Increased accountability
• Expanding practice scope
• Increased salary and malpractice insurance

Torts

• Torts are wrongs against a person/property independently of a contract
• This renders the committer damage liable in a civil action
• Intentional torts include direct invasion of legal rights
• Unintentional torts include an unintended accident that caused damage

Intentional Torts

• Invasion of privacy, or breaking HIPAA
• Defamation includes libel (written) and slander (spoken
• The conduct of one person makes another person fearful and apprehensive
• Battery includes physical contact against one's wishes
• False imprisonment, confinement against will

Unintentional Torts

• Ordinary negligence is an act that doesn't meet standards of care
• Failure to implement falls risk safety is one risk
• Professional negligence (malpractice) is failure to act reasonably/prudently

Standards of Care

• Nurses provide this a the minimal level of expertise that can be delivered to a patient that demonstrates prudence

5 Elements of Negligence/Malpractice

• Duty: standard of care must be in place
• Breach: failure to provide care
• Foreseeability: must be anticipation of possible results
• Causation: breach of duty must have potential to cause harm
• Damages: actual harm

Top Malpractice Lawsuits

• Most suits stem from failure to follow standards or use/document equipment/care properly

Nurses Practice within Law

• Duty requires providing competent/safe care, advocating for client rights, and staying within scope
• One must know healthcare team duties, provide care meeting set standards, and obtain liability protection

Common Lawsuits

• Commonly due to unattended patient falls
• Also due to inaccurate counts of surgical items, medication/test errors, or inadequate charting/communication
• In addition, due to leaving dangerous items within reach

Good Samaritan Immunity

• A nurse is not liable in an emergency if care is at the emergency scene and in good faith by the standard set
• This immunity applies until the scene is turned over

Revocation of License

• Providing care intoxicated
• Administering narcotics without orders
• Misrepresenting as a "nurse practitioner"
• Crimes, substandard care, or false licensure all pose a risk

Risk Reduction

• Reducing danger requires: adherence to scope, policy, and patient rights
• Combine knowledge from various science, ethical and legal behavior, as well as upgrading skills

The Board of Registered Nursing

• Licensure protects citizens by education, standards, and practice
• Boundaries vary state to state, though federal law must be followed

The Nurse Practice Act

• This instrument sets out rules for nursing function
• It grants authority to perform functions meeting set standards

Informed Consent

• This permission requires understanding treatment concepts

Guidelines To Following

• Consent required in all settings
• Implied consent for basic care
• Written consent for invasive procedure

Federal and State Laws

• Laws vary depending on the circumstance, and emergency
• Nurses are responsible for knowing

Signing Informed Consent

• A competent adult
• Has the capacity to fully understand

Those Authorized to Grant Consent

• Legal guardian, proxy, spouse, or other relative may grant
• The clients needs must be met.

The Providers Informed Consent Responsibilities

• Must give full details
• All possible known and unknown affects

Patients Requirements for Informed Consent

• Give it by one's own free will
• A full understanding must be made

Nurses Responsibility

• Is to witness and ensure comprehension
• Use of interpreter is to be included in documentation

To Advocate

• Patients must advocate and define the protecting of all others

Nurses Act Differently As One

• Informing patient of ones rights
• Always intervening on one behalf

Patient Choices

• One must fully differentiate to allow ultimate assisting
• Always giving freedom

Requiring areas

• These include end of life and healthcare access
• They also involve insurance, complex problems, and medical errors

Patient Rights

• It requires for advocacy, comfort, and understanding for better relationships

Subordinate Advocacy

• Advocacy needs for the best interest for every patient and staff

Workplace Advocacy

• Work places must take initiative to advocate for the safety of all employees

Quality Healthcare

• The degree which service betters individual outcomes

Requirements for Quality

• They can include, safety, effectiveness, efficient, and patient centered results

High Reliability Organizations

• High performance through quality indicators and proactive strategies

The Process of Quality control

• Monitor and evaluate services rendered
• Quality can be continual, but ongoing efforts are necessary

Driving the Action

• Both quantitative and qualitative data is used
• It all starts with the criteria.

Focus, PDCA

• Find, organize, clarify and understand

Standards

• They will help with consistency and order

Development of Standards

• Excellence drives the way
• It should be achievable, realistic and well formed

The American Nurses Association Determines Scope

• The organization must have strict rules for practice
• One must follow professional standards as set

Development in the Field

• Each one must be treated to follow all
• From top to bottom

Clinical Practice Guidelines

• Every step must be followed
• They come from the AHQR

Systematically Auditing

• Audit is an account
• All to evaluate

Outcomes Are Valid and the Most Accurate

• Structures are inputs
• Outcomes, measures, and availability of staff

What to Measures Will Vary

• Depends on the structure
• As well as the actions of the individual

Safety is Paramount

• This goes will quality of care
• All this for great satisfaction

The Key

• The overall goal is to improve service for many
• All should be continual

What Is the Typical Steps

• One must always improve for the best

Joint Commission Quality Check

• A non for profit group
• Goal is to oversee and make right for those in need

Quality Always Has Goals

• The reviews
• Care plans and outcomes

The Medicare Program

• All standards are required for services
• Payment and satisfaction

HCAHP

• A survey assessing service and staff
• Ratings always improve outcomes

Pulling Quality

• Adherence to all laws is necessary
• Development relies on this to maintain control

The Steps that Matter

• All incident reports must be logged
• The sentinel event is what you need to see.

Examples of those Events Involve

• Patient harm and harm over time
• Augments are core to help.

The Medication

• Reconciliation must always happens
• In every session

Medical Problems

• Are preventable and a failure to communicate
• Includes all

Adverse Events

• Medical errors
• Create a culture of quality.

Evidence Based

• Are a standard for most people
• Reduce problems across the board

All Must Be Quality

• This helps and leads to a better outcome for the patient
• So it is a major key

Leadership Roles

• All must be involved for the best outcomes