Chapter 79.pdf

9/25/2022 Chapter 79 Ethical and Legal Issues of Caring-Based Practice Dr. Asomani 1 Ethical Issues Def...

9/25/2022 Chapter 79 Ethical and Legal Issues of Caring-Based Practice Dr. Asomani 1 Ethical Issues Definitions Ethics: what one ought to do Bioethics: when the moral choice involves health care Dilemma: a situation where there are several unequally satisfying solutions, or when there is a conflict between one’s values 2 A N A’s Code of Ethics: Nine Provisions The nurse practices with compassion and respect for the inherent dignity, worth, and personal attributes of every person, without prejudice. The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. 3 1  9/25/2022 A N A’s Code of Ethics: Nine Provisions (continued_1) 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 care. 4 A N A’s Code of Ethics: Nine Provisions (continued_2) 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 action, establishes, maintains, and improves the moral environment of the work setting and the conditions of employment, conducive to quality health care. 5 A N A’s Code of Ethics: Nine Provisions (continued_3) The nurse, whether in research, practice, education, or administration, contributes to the advancement of the profession through research and scholarly inquiry, professional standards development, and generation of nursing and health policies. 6 2  9/25/2022 A N A’s Code of Ethics: Nine Provisions (continued_4) The nurse collaborates with other health professionals and the public to protect and promote human rights, health diplomacy, and health initiatives. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. 7 Theoretical Approaches Deontology Immanuel Kant Principle of Universalizability Act the same in similar situations The means justify the end 8 Theoretical Approaches (continued) Teleology Virtue ethics Utilitarianism (John Stuart Mill) The greatest amount of happiness and the least amount of harm The end justifies the means 9 3  9/25/2022 Ethical Principles Autonomy Self-determination Respect for all persons Restricted by parentalism Paternalism Maternalism Competence, capacity, and substituted judgment Example: informed consent 10 Ethical Principles (continued_1) Beneficence Requires positive action Balancing of harms versus benefits Uses the principle of proportionality Example: caring for extremely contagious patients 11 Ethical Principles (continued_2) Nonmaleficence Do no harm The foundation of health care Does not require taking positive action Example: coercing a patient to participate in unwanted chemotherapy 12 4  9/25/2022 Ethical Principles (continued_3) Veracity Truth-telling Must use language that the patient understands Example: honestly explaining an advance directive 13 Ethical Principles (continued_4) Confidentiality Respect for privileged information Crucial in the provider-patient relationship HIPAA Example: not sharing patient’s condition with visitors 14 Ethical Principles (continued_5) Fidelity Keep promises Avoid false expectations Example: telling the patient you will request a consultation, and then following up on it 15 5  9/25/2022 Ethical Principles (continued_6) Justice Fairness, individual rights Complex and difficult to apply in health care Healthy People 2020: eliminate health disparities Examples: Who should get the heart transplant? Who should get the remaining ventilator? 16 Resolution Guidelines E: Examine all the data T: Think of all who should be involved H: Humanize by making a decision tree I: Incorporate principles, statutes, standards C: Choose an action A: Act L: Look back and evaluate 17 Relationship Between Ethics and Law What is legal is not always ethical What is ethical is not always legal Sometimes situations are both legal and ethical Sometimes situations are both illegal and unethical 18 6  9/25/2022 Scope of Practice Know the duties and responsibilities of your license Know your State Practice Act Know which governing body is responsible for A P R N’s in your state 19 Model for Advanced Practice A P R N Consensus Work Group National Council of State Boards of Nursing A P R N Committee Established expectations for A P R N’s (L A C E) L: Licensure A: Accreditation C: Certification E: Education 20 Legal Issues Prescriptive Authority Different regulations; important for A P R N’s to know the extent of and restrictions to prescriptive authority Medication errors Reimbursement Unequal pay Legislative challenge and barrier to full-practice authority 21 7  9/25/2022 Malpractice Discuss the pros and cons of carrying insurance Three components to establish malpractice Must have duty to patient Must deviate from standard of care Harm or damages must occur as a result 22 I O M Report: The Future of Nursing 1. Nurses should practice to the full extent of their education and training 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression 3. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States 23 I O M Report: The Future of Nursing (continued) 4. Effective workforce planning and policy making require improved data collection and a developed information infrastructure 24 8  9/25/2022 Institute of Medicine (I O M) Five Core Educational Competencies Provide patient-centered care Work in interdisciplinary teams Use evidence-based practice Apply quality improvement Use informatics 25 Some Questions for Health-Care Reform Does preventive care produce significant long-term cost savings? Would an employer “pay or play” requirement increase coverage levels? What’s the relationship between tort reform and medical malpractice costs? What can be done about prescription drug prices? 26 9