Nursing Ethics PDF

# Nursing ethics ## Introduction about Nursing Ethics - Outlines: - Introduction - Definition of ethics - Definition of nursing ethics - How are ethics and laws related? - Discrepancy between that legal and ethical - Introduction: - Ethics is concerned with 'right and wrong...

# Nursing ethics ## Introduction about Nursing Ethics - Outlines: - Introduction - Definition of ethics - Definition of nursing ethics - How are ethics and laws related? - Discrepancy between that legal and ethical - Introduction: - Ethics is concerned with 'right and wrong', although agreeing what is 'right' can be challenging. An understanding of ethics is essential to the delivery of skilled professional care. It is vital that nurses appreciate the value of ethics in their work. Ethics is relevant to clinical, practice-based issues and affects all areas of the professional nursing role. To apply ethics effectively, nurses must develop reasoning skills and understand the concepts and principles that assist ethical analysis - Nursing ethics has undergone evolution from an early focus on nursing etiquette to a serious exploration of the knowledge and skills required by nurses to enable them to bring the same professionalism to their ethical decision-making that they seek to apply their clinical educational managerial role. ## Definition - Moral: refers to established rules in situations where a decision about right and wrong must be made. It provides standards of behavior. These standard guide behaviors of an individual or social group. Example: "good people do not lie." - The standards of right and wrong that one learns through socialization. And are usually based on customs, traditions, culture, and religious beliefs. Morals are typically highly personal. - Ethics: is a term used to reflect the "should" of human behavior. - It identifies what should be done to live with one another. - It is a process oriented and involves critical analysis of action. - Example: if ethicists reflected on the moral statement "one should not lie" they would clarify definitions of lying and explore the circumstances under which lying might be acceptable. - A moral philosophy, a science of judging the relationship of means to ends, and the art of controlling means so they will serve human ends. - Fundamental to all human interaction and for the advanced nurse practitioner in nursing practice. - A discipline involved in the judgment of rightness or wrongness, unfairness or fairness virtue or vice, ends, objects, or states of affairs. ## Law - Binding rules of conduct enforced by authority. - Based on what's right and good. - Once a law states how care must be provided, the nurse and the patient lose the ability to deal with the situation on an individual basis. - Established for the welfare of society - Not stagnant. It changes when society's needs change. - The system of law is divided into the laws that govern the relationships between individuals and society as a whole (criminal laws) and the laws governing relationships among individual members of a society (civil laws). - Criminal Law: Acts or offences against the welfare or safety of the public - Civil Law: The second type of law is Civil Law which deals with crimes against a person or persons in such legal matters as: Contracts, Torts, Protective Reporting Law. ## Nursing Ethics - A system of principles governing the conduct of a nurse. - Deals with the relationship of a nurse to the patient, the patient's family, associates, and fellow nurses, and society at large. ## How are ethics and laws related? - Laws are intended to reflect popular belief about the "rightness and wrongness" of particular acts and are, like ethics, build upon a moral function. - Laws represent an attempt to codify ethics and serve as the public's instrument for converting morality into clear-cut social guidelines, and stipulating punishments for offenses. - Laws would be congruent with the prevailing moral values of society; indeed, they usually are. - As society's needs and attitudes evolve, laws emerge to reflect these changes. Occasionally, however, governments create and enforce laws that many people believe to be unjust or immoral. <start_of_image> This document discusses the relationship between ethics and law in nursing. - Ethics is concerned with "right and wrong." - Law is a set of rules enforced by authority. - There can be a discrepancy between what is legal and what is ethical. Some reasons for this discrepancy include: 1. Different ethical points of view (deontology vs. utilitarianism) 2. The complexity of human behavior 3. The legal system’s focus on action rather than motivation 4. The changing nature of law ## What are some reasons for the possible discrepancy between that which is legal and that which is ethical? - There are differences between ethical points of view. - Deontology and utilitarianism offer quite opposite answers to some basic ethical questions. - While the utilitarian perspective would allow consideration of abortion or euthanasia to provide for the good of many, deontology views might require that life be protected regardless of circumstance. - Thus, a law thought to be ethical by the utilitarian might be considered unethical by the deontology. - Human behavior and motivation are more complex than can be fairly reflected in law. - Individuals may consider the same act either right or wrong, depending on their stage of moral development - The legal system judges action rather than motivation. - For example, nurses following personal moral convictions and professional ethical codes can find themselves at odds with policies or practices of their employer. - In certain instances, the legal system may determine that an employer has the right to dismiss or discipline a nurse for laying aside institutional policy in favor of ethical considerations. - Depending upon the political climate and other variables, laws change. - Recent examples of laws that have changed include those related to the expanded roles of nurses, abortion, fetal tissue use, organ transplantation, self-determination, congeniality of AIDS patients, informed consent, and legal definition of death. - Integrity is fidelity in adherence to moral norms sustained over time. ## Bioethics - When ethical theories and principles are applied to problems in health care. - Bioethics as an area of ethical inquiry came into existence around 1970 when health care began to shift its focus from curing disease toward concern for the total patient. - A new term, clinical ethics, is increasingly being used. ## Nursing Code of Ethics - Outlines: - Introduction - Nursing Code of Ethics - History of the Nursing Code of Ethics - Principles of Ethics for Nurses - Provisions of the Nursing Code of Ethics - Introduction: - According to the American Nurses Association (ANA), the nursing code of ethics is a guide for "carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession." - Ethics, in general, are the moral principles that dictate how a person will conduct themselves. - Ethical values are essential for ALL healthcare workers, especially nurses. ## Nursing Code of Ethics - An essential characteristic of professions is that they have a code of ethics. - A code of ethics is an implied contract through which the profession informs society of the principles and rules by which it functions. - Ethical codes help with professional self-regulation. - Serves as guidelines to the members of the profession who then can meet the societal need for trustworthy, qualified, and accountable caregiver. - Cods are useful only if they are upheld by the members of the profession. ## History of the Nursing Code of Ethics: - Interestingly, the nursing code of ethics is suggested to have been founded in 1893 and named the "Nightingale Pledge" after Florence Nightingale, the founder of modern nursing. - As a modification of the Hippocratic Oath, taken by medical doctors, the Nightingale Pledge has been recited by nursing students at graduations with little changes since inception - The formal code of ethics was developed in the 1950s by the American Nurses Association (ANA) and has undergone numerous modifications since. - The most significant recent change was in 2015 when 9 interpretative statements or provisions were added to the code of ethics to help guide nursing practice in a more definitive way. ## Principles of Ethics for Nurses: - Autonomy: - The principle of autonomy is the claim that individuals are *"permitted personal liberty to determine their own actions according to plans they themselves have chosen."* - Freedom to make one's own decisions is respected under the principle of autonomy. - The principle refers to the control individuals have over their own lives. - Respect for the individual is the cornerstone of this principle.. - The principle of autonomy is demonstrated by the use of informed consent. - The patient receives information about the condition, treatment, or plan. - He then demonstrates an understanding of this information, ultimately arriving at a decision to accept or reject the plan. Certain situations may limit autonomy. - Two examples include : - When the rights of one person interfere with the rights of another. - When there is a high probability that a person may injure themselves or others. - Beneficence: indicates that the actions one takes should be in an effort to promote good *"obligation to do good and not harm."* - It involves five rules: - Protecting and defending the rights of others. - Preventing harm from occurring to others. - Removing conditions that will cause harm to others. - Helping persons with disabilities. - Rescuing persons in dangers. - This principle can support providing extensive, painful treatments to increase quantity and quality of life or allowing a person to die peacefully without life support. - Confidentiality: is securing the person's privacy through silence. - Veracity: indicates that people should be honest and tell the truth. - It applies to telling patients and staff the truth so they can make well-informed decisions. - Fidelity: is keeping one's commitments and promises. - One should not make a promise to a patient or worker that cannot be kept. - It also refers to individual's faithfulness or loyalty to agreements and responsibilities that he has accepted. - Nurses demonstrate the principle of fidelity by providing safe, up-to-date, current care that is appropriate to the patient's needs and maintaining competences in nursing practice. - It includes accountability, confidentiality, and veracity. - This principle is not absolute. - Various factors such as culture, or situations in which truth-telling may harm the patient, can cause deviation from this principle. - Justice: means treating people equally and fairly.. - It is useful to apply when making decisions about competition for scarce resources or benefits. - Health care providers apply the principle of justice when care is given based on the person's needs. - Distributive justice implies that benefits and burdens should be distributed equally regardless of gender, race, religion, or socioeconomic status. - Nonmaleficence: means if you cannot do good, at least do not harm. - Nurses may need to remember that even pain and suffering can bring about good for the patient when they are performing painful procedures for the patient’s benefit. - Health care providers apply the principle of nonmaleficence with actions to promote a patient’s safety. - For example: a nurse might report a coworker who is abusing drugs to a supervisor, who then suspends the coworker’s employment. - Paternalism: allows one to make decisions for another, limits freedom of choice, and is seen as an undesirable principle. - Most see it as justified only to keep another person from harm. - Respect for others: is considered the highest principle that incorporates all the other principles. It transcends cultural, gender, and racial issues. - Utility: indicates that what is best for the common good outweighs what is best for the individuals. - It could justify paternalism. - One using utility needs to be careful not to become less humanistic. ## Nursing Code of Ethics Interpretive Statements - Revised in 2015 to include 9 provisions, the ANA's nursing code of ethics now includes interpretative statements that can provide more specific guidance for nursing practice. ## Provisions of the Nursing Code of Ethics - The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. - The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. - The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. - The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care. - The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. - The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. - The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. - The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. - The profession of nursing, collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. - The aforementioned nine provisions were implemented to help guide nurses in ethical decision-making throughout their practice. # Ethical theories - Outlines: - Introduction - Ethical theories - Theories of moral development ## Introduction - Ethical Theories are attempts to provide a clear, unified account of what our ethical obligations are. - They are attempts, in other words, to tell a single "story" about what we are obligated to do, without referring directly to specific examples. - It is common in discussions of business ethics to appeal to one or more ethical theories in an attempt to clarify what it is right or wrong to do in particular situations. - Some of the philosophical ethical theories commonly appealed to include: ## Ethical Theories - Deontological: theories focus on the intent of the action and are duty and rights based. - Emphasis is on individual rights, duties, and obligations and the dignity of human beings (moral obligation or commitment). - Can be further divided into either act or rule. - Act deontologist determines the right thing to do by gathering all the facts and then making a decision. - Much time and energy are needed to carefully judge each situation. - Once a decision is made, there is commitment to universalizing it. *"If one makes a moral judgment in one situation, the same judgment will be made in any similar situation."* - Rule deontologist emphasize that principles guide our actions. - In all situations, the rule is to be followed. - Deontologists are not concerned with the consequences of always following certain rules or actions. - If the principle believed in is *"always keep the promise"* the deontologist will keep promises, even if circumstances have changed. - Teleological: theories derive the rules and norms for conduct from utilitarian consequences of actions. - They favor the common good. - Right has good consequences, and wrong has bad consequences. - Principlism: a deontological theory that includes ethical principles. - The ethical principles control ethical decision-making more than the ethical theories. - The principles are moral norms, including autonomy, beneficence, fidelity, justice, nonmaleficence, paternalism, respect for others, utility, and veracity. - Utilitarianism: a consequentialist theory that considers a good act as one that causes the least harm and brings the most good to the most people. - Utilitarian ethics calculates the effect of all alternative actions on the general welfare of present and the future generation. - Egoism: is based on self-interest and self-centeredness. - Decisions are made for personal comfort. - It is based on the principle that the right decision is the one that brings pleasure to the decision-maker. - Relationships: a caring-based theory that emphasizes generosity and promoting common good for the welfare of the group rather than individual rights. - Obligationism: a theory that tries to balance distributive justice and beneficence. - One should do what is good and prevent harm and evil. - It is useful for determining public policy. - Social Contract Theory: based on a concept of original position and considers the least advantaged persons in society as the norm. - The determination of what is right or wrong is from the perspective of the least advantaged people, such as children or handicapped people. - Natural Law: is called the virtue of ethics. - Actions are considered right when in accord with human nature. - People should do good, avoid evil, and have opportunities to reach their potential. ## Theories of moral development: - Moral development describes how a person learns to deal with moral dilemmas from childhood through adulthood. ## Kohlberg's levels of moral development - Kohlberg proposed three levels of moral development: - Preconventional level: the individual is inattentive to the norm of society when responding to moral problems. - Instead, the individual perspective is self-centered. - At this level, what the individual wants or needs takes precedence over right or wrong. - Kohlberg saw this level of moral development in most children under nine years of age, some adolescents, and adult criminal offenders. - Conventional level: characterized by making moral decisions that conform to the expectations of one's family, group, or society. - According to Kohlberg, most adolescents and adults generally function at this level. - Postconventional level: involves a more independent mode of thinking than previous stages, so that the individual is able to define his or her own moral values. - People at the postconventional level may ignore self-interests and group norms in making moral choices. - They create their own morality, which may differ from society's norms. - Kohlberg believed that only a minority of adults achieve this level. - Each stage is sequential and is characterized by higher capacity for logical reasoning than the preceding stage. ## Gilligan's Levels of moral development - Kohlberg did not give acknowledgement to the experiences of women in moral development. - Kohlberg's theories had largely been generated from research with men and boys. - When women were tested regarding their moral development, they scored lower than men. - Gilligan believed that this was due not to poor moral development in women but to the fact that women's identities are largely dependent on relationships with others. - Gilligan's level of development are: - Orientation and individual survival. - A focus on goodness as self-sacrifice. - The morality of nonviolence. - She believed that the moral person is one who responds to need and demonstrates a consideration of care and responsibility in relationships. - The theories define the relationship between the two moral orientations of justice and care. - They determined that both perspectives were present when people faced real life moral dilemmas, but people generally tended to focus on one set of concerns and paid only minimal attention to the other perspective. - As expected, the care focus was more often exhibited by women, and the justice focus was more often exemplified by men. # Ethical dilemma - Outlines: - Definition - Factors contributing to ethical dilemmas - Types of ethical dilemmas (according to ethical principles) - Understanding ethical dilemmas in nursing ## Definition - A situation that requires an individual to make a choice between two equally unfavorable alternatives. - By its very nature, there is no one good solution and decision made often has to be defended against those who disagree with it. ## Factors contributing to ethical dilemmas: - Socio-culture changes: - Changes in attitudes about women and women’s roles. - Beliefs and practice related to family. - Family structure changes. - Increase emphasis on individual rights. - Religious values. - Increased culture diversity. - Governmental funding for health care. - Demographic changes (increase in poverty and number of older adults) - Values that society places on life and the right to die with dignity. - Scientific and technological advances: - Sophisticated patient monitoring and treatment devices. - Life-sustaining devices. - Organ transportation, donors, and artificial organs, stem-cell research. - Computerized diagnostic equipment and treatment devices. - Legal issues: - Abortion adoption and baby selling. - In vitro fertilization. - Right to die. - Right to refuse care. - Violence. - Substance abuse. - Changes in occupational status of health care worker: - Nursing shortage. - Advanced practice. - Changes in roles and responsibility. - Educational preparation. - Consumer involvement in care: - Consumer demand for increased voice in health care decisions. - Demand for more personalized health care delivery. - Increase knowledge of patient as consumer of health care. - Patient advocacy. ## Types of Ethical Dilemmas (according to ethical principles) - Dilemmas of beneficence: dilemmas that involve deciding what is good as opposed to what is harmful. - Dilemmas of nonmaleficence: dilemmas that involve the avoidance of harm. - Dilemmas of autonomy: a dilemma that involves deciding what course of actions maximizes the patient's right of self-determination. - Dilemmas of justice: ethical issues of fairness and equity, such as dilemmas that involve dividing limited health-care resources fairly. - Dilemmas of fidelity: dilemmas that involve honoring promises. ## Understanding Ethical Dilemmas in Nursing - Many ethical dilemmas arise in nursing because of conflicts between patients, health-care professionals, and/or institutions: to understand these conflicts, the following areas will be explored: - Personal value systems. - Peer's and other professionals' behaviors. - Patient's rights. - Institutional and societal issues. ## The role of Personal Value Systems - Value systems are learned beliefs that help a person choose between difficult alternatives. This value system has a beginning foundation in beliefs, purpose, attitudes, qualities, and objects that are important to one’s parents. - Personal Value Systems: is a rank ordering of values with respect to their importance to one another. - Variations in value systems become highly significant when dealing with critical issues such as health and illness or life and health. ## Dilemmas involving peers’ and other professionals’ behavior: - Conflict can be easily developed particularly in stressful circumstances. - Conflicts can evolve because of differing value systems. - Some conflicts develop because individuals are not respectful of the human rights of other individuals. ## Conflict regarding patients' rights: - Many have been identified, including informed consent, the right to die, privacy, confidentiality, respectful care, and information concerning their medical condition and treatment. - Also, the patient has the right to be informed if any aspect of treatment is experimental. - Based on that knowledge, the patient can refuse to participate in any research project. ## Conflict created by Institutional and Societal Issues - Nurses experience ethical dilemmas when conflicts develop between policies of their employing institution and themselves. - Grave concerns over health care have centered around the cost of care. - All health care agencies are stressing cost containment measures in order to survive. - At times, cost containment polices conflict with the nurse’s value system, whose goal is to provide high-quality, individualized patient care. - Institutional and societal concerns can result in ethical dilemmas for the nurse whose personal value system does not support the policies set forth by those in authority. - Ethics committees have been created to deal with ethical dilemmas in institutional settings. Ethics committees are usually multidisciplinary groups charged with the responsibility of making difficult ethical choices. # Ethical decision-making: - Outline: - Introduction - Definition of decision making - Ethical Decision Making (EDM) - Characteristics of ethical dilemma - Types of ethical choices - Ethical decision making Process - Decision making methods or style - Factors that influence Ethical Decision Making (EDM) - Outcomes that influence the effectiveness of decision - Guidelines for making ethical decisions - Ethical Decision Making (EDM) Model ## Introduction - Nurses make decisions every day that must take into account law and ethical standards. - Therefore, in order to make appropriate decisions, nurses require an understanding of how laws, ethics, and nursing interface. - Ethical dilemmas in health care involve issues surrounding professional actions and client care decisions. They can lead to discomfort and conflict among the members of the health-care team or between the providers and the client and family. ## Definition of decision-making - The process of selecting one action from alternatives. - Decision-making is the learned & scientific problem-solving process. ## Ethical Decision Making (EDM) - When faced with an ethical dilemma the objective is to make a judgment based on well-reasoned, defensible ethical principles. - It is a systematic ethical decision-making and problem-solving process. - Reduces personal bias. - Facilitates better decision-making. - Managers feel more comfortable about decisions they have made. - Values, beliefs, and personal philosophy play a major role in the ethical decision-making. - Ethical Decision Making (EDM): Nurses encounter situations daily that require them to make professional judgments and act on those judgments. - The judgments or decisions are often made in conjunction with other persons involved in the situation, nurses need to be knowledgeable about the steps in ethical decision-making. ## Types of Ethical Choices - Right vs. wrong: choosing right from wrong is the easiest. - Right vs. right - Situation contains shades of gray i.e. all alternative have desirable and undesirable results - Choosing *"the lesser of two evils"* - Choose decision between two equally desirable or undesirable alternatives ## Ethical decision-making process - Nurses commonly use the nursing process model for decision-making. - The process generally includes problem identification based on assessment; development of a plan for care, guided by desired outcomes; implementation of interventions; evaluation of the outcomes; and revision of the plan over time. - The process of decision-making in ethics follows a procedure that is similar to the scientific process. There are five-step process of ethical decision-making. 1. Articulate the ethical problem. 2. Gather data & Identify conflicting option 3. Explore strategies 4. Implement the strategy(Make a decision( 5. Evaluate outcomes of action ## 1) Articulate the ethical problem - Identify the problem - Defining the problem: What is wrong? Where is improvement needed? - EDM Begins when someone suggests that there is a moral problem - The nurse manager can identify the problem by analyzing the situation. - What is the desirable situation? - What is the current situation? - Who is involved? - When? Where? How? - When you clearly define the problem, you will be in a good position to judge if the problem is an ethical or a practical dilemma. - Develop feasible hypotheses and eliminate hypotheses that fail to conform to the facts. - Feasible hypotheses should be further tested for causal validity. - By analyzing available information, the manager should begin exploring possible solutions. ## 2) (Gather data & Identify conflicting option - Identification of the conflicting moral claims that constitute the ethical dilemma is the first part of the process. - You should examine the situation for conflicting obligations, principles, duties, rights, values, or beliefs. - Identify the key persons involved in the decision-making process and delineate each person’s role. - Determining duties, rights, authority and capacities of decision-makers is a critical component of the process. ## 3) Explore strategies - There must be at least two alternative solutions from which to choose. - If the situation is not covered by policy, the manager must draw on his education and experience, but it may be inadequate. - More experienced managers have more alternatives to be suggested for solving a variety of problems. - Health care is changing rapidly; managers should learn how others are solving similar problems. - This can be done through continuing education, professional meetings, review of the literature, and brainstorming with staff. - Choose the most desirable alternative and determine the desired outcomes: - One alternative is not always clearly superior to all others. - The manager must try to balance multiple factors such as pt safety, staff acceptance, morale, public acceptance, cost, and risk of failure. - *The following questions may be asked:* - Will this decision accomplish the stated objectives? (yes or no ( - Dose it maximize effectiveness and efficiency? Use available resources before seeking outside assistance. - Can the decision be implemented? If not, it will not solve the problem. ## 4) Implement the strategy (Make a decision) - Taking action is a major goal of the process, but can be one of the most difficult parts of the process. - It can stir numerous emotions laced with both certainty and doubt about the rightness of the decision. - The manager will need to communicate the decision to appropriate staff smoothly to win their cooperation. ## 5) (Evaluate outcomes of action - After acting upon the decision, participants begin a process of response and evaluation. - Evaluate the results of the chosen alternative. - Ask *"has the original ethical problem been resolved? and have other problems emerged related to the action?"* - Be alert: solutions to old problems sometimes create new problems, so you need additional decisions. ## Decision-making methods or styles - There are five decision-making methods or styles. - AI- You solve the problem or make the decision alone, using information available to you at that time. - AII- You obtain the necessary information from your subordinates, and make a decision. - The role of your subordinates in making the decision is providing the necessary information to you, rather than generating or evaluating alternative solutions. - CI- You share the problem with relevant subordinates individually. - Getting their ideas and suggestions, - Then you make the decision that may or may not reflect your subordinates' influence. - CII- You share the problem with your group subordinates - Obtaining their ideas and suggestions, - Then you make the decision that may or may not reflect your subordinate’s influence. - GII- (group decision-making ( - You share a problem with your subordinates as a group. - Together, you generate and evaluate alternatives & reach agreement (consensus) on a solution. - Your role is much like that of a chairman. - Don’t try to influence the group to adopt *"your"* solution, & be willing to accept and implement a group-supported solution. ## Factors that influence Ethical Decision Making (EDM) - Codes for Nurses - The patient’s rights - Social and cultural attitudes - Science and technology - Legislation - Judicial decisions - Funding - Personal religious and philosophic viewpoint. ## Outcomes that influence the effectiveness of decision 1. The quality of the decision. 2. Acceptance of the decision by the subordinates. 3. Available time needed to make the decision. ## Guidelines for making ethical decisions 1. Choose correct moral language. *(Often*, the way in which you initially conceptualize a situation will affect what moral conclusions you will make). 2. Be as clear as you can about the facts, both empirical and philosophical. 3. Consider the relevant moral principles and rules and make your best judgment. ## Ethical Decision-Making (EDM) Model - Ethical issues are real-life issues. - Ethical decision-making models provide mechanisms or structures that help you think through or clarify an ethical issue. - There are a number of models from which to choose from, but there is no one best way to approach ethical decision-making. - Ethical decision-making models are not formulas and they do not ensure that the decision you take will be the right one. - Model I: A guide to moral decision-making: - It outlines a step-by-step process that considers the many aspects of ethical decision-making: - M. – Massage the dilemma. - Collect data about the ethical problem. - O. – Outline options.. - Identify & analyze alternatives and consequences of each. - R. – Review criteria and resolve. - Weigh the option’s effect in the decision - A. – Affirm position and act. - Develop implementation strategy - L. – Look back. - Evaluate the decision-making. # Legal aspect of nursing ## Special concerns in professional nursing practice: - Several areas of nursing practice are particularly fraught with legal risk, including: malpractice, delegation, assault and battery, informed consent, and confidentiality. ## Malpractice - To understand malpractice, you must first understand the legal concepts of torts and negligence. - Torts: are civil wrongs against a person and may be either intentional or unintentional. The harm does not have to be physical. Emotional or economic harm may also result in a tort. - Negligence: It is lacking in care and typically concerns nonprofessionals. Many experts equate negligence with carelessness, a deviation from the standard of care that a reasonable person would deliver. - Malpractice: is negligence applied to the acts of a professional. - Malpractice occurs when a professional fails to act as a reasonably prudent professional would under specific circumstances. - Malpratice is classified as an unintentional tort. ## Delegation - Delegation is *"empowering one to act for another."* - Professional nurses retain accountability for acts delegated to another person and are responsible for determining that the delegate is competent to perform the delegated act. - The professional nurse is legally liable for the nursing acts delegated to others. ## Assault and Battery - Assault and battery is an intentional tort that is often the basis of legal action against a nurse defendant. - Assault: is a threat or an attempt to make bodily contact with another person without the person's consent. - Battery: is the assault carried out, the impermissible, unprivileged touching by one person of another. - Assault precedes battery, it causes the person to fear that battery is about to occur. ## Informed Consent - All patients should be given an opportunity to grant informed consent prior to treatment unless there is an emergency that is life-threatening. - There are three major elements of informed consent: 1. Consent must be given voluntarily. 2. Consent must be given by an individual with the capacity and competence to understand. 3. The patient must be given enough information to be the ultimate decision-maker. - Informed consent is a full, knowing authorization by the patient for care, treatment, and procedures and must include information about the risk, benefits, side effects, costs, and alternatives. - In order for informed consent to be legally valid, elements of completeness, competency, and voluntariness are evaluated. - Completeness refers to the quality of the information provided. - Competency takes into account the capability of a particular patient to understand the information given and make a choice. - Voluntariness refers to the freedom the patient has to accept or reject alternatives. ## Role of nurse in informed consent: - Collaborate with the primary provider (most often the physician or surgeon). - Witness patient’s signing of informed consent documentation. - Determining that the elements for valid consent are in place. - Providing feedback if the patient wishes to change consent. - Communicating the patient’s need for further information to the primary provider. ## Confidentiality - It is both a legal and an ethical concern in nursing practice. - Confidentiality is the protection of private information gathered about a patient during the provision of health care services. ## Preventing Legal Problems in Nursing Practice - There are a number of effective strategies that professional nurses can use to limit the possibility of legal action. ## 1. Practice in a safe setting: - Facilities in which nurses work must be committed to safe patient care. - The safest situation is one in which the agency: - Employs an appropriate number and quality of personnel to address the numbers and acuity of patients. - Have policies, procedures, and personnel practices that promote quality improvement. - Keep equipment in good working order. - Provides orientation to new employees, supervisors, all levels of employees and provides opportunities to learn new procedures consistent with the level of health care services provided by the agency. - Each health care institution should have risk management programs. ## 2. Communicate with other health professionals: - Nurses must have open and clear communication with nurses, physicians, and other health-care professionals. - A key aspect of communication essential in preventing legal problems is keeping good patient records. - Assessments, plans, interventions, and evaluation of the patient’s progress must be reflected in a patient’s clinical record if malpractice is alleged. ## 3. Meet the standard of care: - It involves being technically competent, keeping up-to-date with health care innovations, being aware of peer expectations, and participating as an equal on the health care team. ## 4.Promote positive interpersonal relationships: - The best strategy for the professional nurse is to prevent legal action through positive interpersonal relationships. - It includes giving