Ethical and Legal Issues in Nursing Practice

Ethical and Legal Issues IN NURSING PRACTICE COURSE OUTCOME Explain the professional, ethical, and legal guidelines used in nursing practice. COMPETENCY Identify ethical and legal guidelines for nursing practice. Discuss issues related to accountability for nursing care provided CONCEPTS Ethics...

Ethical and Legal Issues IN NURSING PRACTICE COURSE OUTCOME Explain the professional, ethical, and legal guidelines used in nursing practice. COMPETENCY Identify ethical and legal guidelines for nursing practice. Discuss issues related to accountability for nursing care provided CONCEPTS Ethics: System of moral principles or standards which govern behavior and relationships which is based on professional nursing beliefs and values. Concepts Legal Issues: Encompasses the rights, responsibilities, and scope of nursing practice as defined by state nurse practice acts and as legislated through criminal and civil law. All clients have a privilege, demand or claim by virtue of law or right (that which is proper or just) to expect competent nursing services. Unit Outcomes Identify major categories of the basic principles of the ANA Code of Ethics for Nurses. Discuss self-awareness of beliefs and values as they relate to professional nursing practice. Discuss the rights of patients to refuse care. Discuss Standards of Nursing Practice Discuss the Ohio Nurse Practice Act regarding practice as a student nurse. Discuss the major role of the State Board of Nursing. Unit Outcomes Continued Define common law and criminal law. Identify implications of civil law in nursing practice. Discuss the basic requirements for negligence or malpractice. Introduce mandatory reporting laws. Legal Terms and Concepts What is it we are concerned about in nursing and medicine when it comes to legal issues? Malpractice Various forms of the law 1. Statutory Law 2. Administrative Law 3. Common Law 4. Civil law  Statutory Law: Made by legislative branches of government (US Congress, state legislatures, etc.) Statutory Example: Nurse Practice Act is a type of statutory law and Administrat ive Administrative Law: Statutory laws designate the administration and enforcement of laws to administrating agencies Ex. State boards of nursing Commo n Law: Civil and Crimin al Common Law From court decisions, not through government legislation Based on judges’ interpretation of constitutional and statutory laws Apply the same rules and principles applied in previous similar cases Criminal Law Conduct that is harmful to another individual or to society punishable by fine or imprisonment Seek to punish a person for an offense against society Guilt beyond a reasonable doubt Criminal crimes can be felonies or misdemeanors. Civil Law Deals with the rights and duties of practice individuals or citizens. Enforced predominately through lawsuits. Seeks to resolve a disagreement between a private individual and another individual. Punishment includes payment of money. 2 Types of Civil Law 1. Contract Law 2. Tort Law Civil Law – 1. Contract Law Contract law is based on legally enforceable agreement, a contract between individuals. Includes employment contracts in which a nurse is expected to follow an employer’s policies and standards consistent with federal and state law. (Travel Nurse Contracts) The nurse must also meet the responsibilities expected by the employer. Example: Joint Commission (regulate and perform accreditation hospitals) * Hospitals develop internal standards based on the Joint Commission. * Internal standards of care are specific and need to be accessible on all nursing units * A policy/procedure outlining the steps to follow when changing a dressing or administering medication provides specific information about how nurses in the THIS facility MUST perform to comply with contract law (and civil law). Civil Law – 2. Tort Law -A tort is a civil wrong imposed on another person. -Can be intentional or unintentional (omission) and result in harm. -Example: Intentional tort deliberate act that occurs or is threatened to occur. ◦ “Stop yelling or I will move you to the end of the hall” ◦ “If you don’t behave, you can’t have your pain medication.” Civil Law – Tort Law -Making false verbal statements ◦ “ Nurse is incompetent” – without any supportive data -Making false written statements ◦ “Mr. X in room 00001 is a child molester, I heard his family talking.” Documenting false information about anyone or anything Audio defamation case Warning: Language https://www.bing.com/videos/search? q=audio+deframation+case+washington+post+anesthe siologist&ru=%2fsearch%3fq%3daudio%2520deframation %2520case%2520washington%2520post %2520anesthesiologist%26qs%3dn%26form%3dQBRE %26%3dSearch%2520%257B0%257D%2520for %2520%257B1%257D%26%3dSearch%2520work %2520for%2520%257B0%257D%26%3d%2525eManage %2520Your%2520Search%2520History%2525E %26msbsrank%3d1_1__0%26sp%3d-1%26pq%3daudio %2520deframation%2520case%2520washington %2520post%2520anesthesiologist%26sc%3d1-55%26sk %3d%26cvid %3d0C9D5F685A03452A9897E85B995352E9%26sid %3d0036093BA6A7645F06FD1863A7106522%26format %3dsnrjson%26jsoncbid %3d1&view=detail&mid=1090EF601D3400A0C3CB1090E F601D3400A0C3CB&&mmscn=vwrc&FORM=VDRVSR Civil Law – Tort Law- Unintentional Tort Committing or omitting an action that results in harm to another person. Failure to provide reasonable care according to standards that result in injury to another MUST BE NO intent to do harm 2 Types of Unintentional Torts: 1. Negligence 2. Malpractice 1. Negligence - layperson Definition: Conduct that deviates from what a reasonable person would do in the same or similar circumstance. Must result in physical, emotional, or financial harm 2. Malpractice – Professional Negligence Professional Negligence Nurse does not provide care consistent with professional standards of practice Nurse does not act how another nurse would in similar circumstances Must result in physical, emotional, or financial harm One of the most important areas of law for nurses Civil Law: Malpractice 4 elements of liability. 1. Duty 2. Breach of duty 3. Cause/ Forseeability 4. Injury All must be proven for malpractice to occur  To prove malpractice, the injured person must establish based on evidence all 4 elements of liability 1. Duty - nurse-patient relationship is established 2. Breach of duty – the nurse did not provide care consistent with professional Civil Law – standards of practice established by facility policy or procedure, Nurse Malpractic Practice Act or standards of care e – Civil established by professional organizations. suit 3. Cause – the nurse’s breach of duty directly caused the harm and the nurse should have known that the breach of duty could result in harm. 4. Injury – harm or injury was the RESULT of the breach of duty (pain, disability, disfigurement)  Failure to assess the patient ◦ Failure to rescue due to absence of assessment of change Failure to design a plan of a care with appropriate nursing interventions Common ◦ Nurse will assist frail 97 year old patient with transfer from bed to chair Malpractic -if omitted from care plan and patient e Claims falls Failure to implement care correctly ◦ Not providing complete information at the change of shift report to the next nurse Ohio State Laws and Regulations that Guide Nursing Practice ◦ State Laws ◦ Mandatory reporting laws require the nurse to report in collaboration with the employer ◦Abuse of Older Adult – Police and Elder Services ◦Abuse of Children – Police and Child Protective Services ◦Physical, Sexual, Emotional Abuse - Police Mandatory Reporting Nurse has a duty to report to protect older adult and/or child Do not have to have proof ◦ Up to the agency you reported it to; to investigate. Required ◦ Can lose your license for failure to report and open yourself up to civil and criminal legal action. Person making the report has legal immunity if the report is done in good faith. Ohio Law – Good Samaritan Law Immunity from liability in malpractice litigation to health-care professionals who provide assistance at the scene of an accident. Varies state to state. Require nurses to follow standard of practice and act in a manner as another nurse in similar circumstance Only provide care that is urgent and in the scope of nursing practice. Divergence from standards of care or scope of practice can lead to litigation Ohio – does not require nurses to render care at the scene of an accident Example A nurse is the first person on the scene of an accident. The victim has a puncture wound to the side of the chest. The nurse hears air leaking out. The nurse knows the victim needs a chest tube to help the victims breathing. Decision: 1. Use what is available to make shift a chest tube and insert 2. Close off the puncture wound with the cleanest cloth available and support the patient’s breathing until EMS arrives. Answer: 2 Rationale: A nurse would not have been trained in performing a chest tube insertion and doing so would be beyond the scope of practice, (what the nurse has been educated to do). The nurse would not be protected by the Good Samaritan Law because the nurse acted outside of the scope of practice. The nurse should act within what the nurse was educated to do in this circumstance. Nurse Practice Act Nurse Practice Act gives the Ohio Board of Nursing the power to Safeguard the public Regulates nursing practice, and nursing education including licensing, credentialing, and disciplinary procedures. Approval of Nursing Program – monitor a nursing program Licensing of nurses NCLEX –RN passing standards to be licensed in Ohio Disciplinary procedures – unprofessional conduct that has violated the Nurse Practice Act, Rules and Regulations. Patient’s Bill of Rights * Also called Patient Care Partnership ◦ Patients have rights regarding their treatment when admitted to a health care facility: ◦ Quality care, clean, safe environment, involved in decisions, ability to refuse care, protection of confidentiality, preparation for discharge from the facility. Standards of Practice Guide the practice of nursing by outlining the scope, function, and role of nurses and nursing practice. Sources of Standards of Practice: * Ohio Nurse Practice Act * American Nurses Association * Organizational policies and procedures * Professional nursing organizations Role as a Student Nurse Are standards of practice lessened because one is a student nurse? Role of the Student Nurse Nursing students are expected to perform as professional RNs nurses would in providing patient care. Different levels of standards do not apply. A nursing student is equal to an RN and MUST provide safe, competent and professional attitude toward patient care and other healthcare providers. ONLY provide care you have been educated to provide. The standard used for nursing students demands that student nurses must meet the standards of a professional RN. Professional Liability Insurance Lakeland Community College Nursing Students have limited Liability Insurance. Only in effect when: ◦ The student is in a Lakeland Community College Nursing program course clinical ◦ The nursing faculty is physically at the clinical site ◦ The student is in the STUDENT role during the day and time the nursing faculty is present ◦ The student is providing care at the current level of education and requests guidance and assistance to provide safe quality patient care.  * Started 1996 Health * minimize exclusion if you Information had a pre-existing condition Portability and Accountabil * Provisions for privacy ity Act * Created a national HIPAA standard * Provisions to protect your data New Law in State Effective Ohio becomes Mutual January 1, a compact law recognition 2023 state. Questions? Ethics Standards of right and wrong that influence human behavior, usually in terms of rights, obligations, fairness, benefit to society, or specific virtues. Ethics is applied in professional nursing System of moral principles and standards governing behaviors and relationships based on professional nursing beliefs and values Morality: private, personal standards of what is right and wrong in conduct, character, and attitude  Nurse is to deliver and practice in an ethical manner. Expectatio Are ethics the n same for everyone? Where do your ethics or beliefs come from? Advocacy Defends or represents the cause of another Nurses advocate for the patient’s best interest on the patient’s values (not the nurse’s values) Advocacy can take many forms Component of ethical behavior Examples?  1. Begin with self- reflection. Ethical Nursing Practice What are your values and personal beliefs? These typically drive one’s actions and behaviors. Often based on your values, character, morals, and ethics.  2. Can you as the nurse develop a professional ethical self that does not impose one’s personal beliefs and values onto patients, their family’s or other healthcare providers? Ethical Nursing May take clarifying and re- examining values along the way. Practice Essential to care and keeping care patient focused  Why is the self- reflection piece so important? Ethical Nursing Practice Why is it important not to impose one’s beliefs on to a patient or others? Autonomy Altruism Beneficence Social Justice Nonmaleficenc Human Dignity e Integrity Justice Veracity Fidelity Principles Related to Ethical Practice Principles Related to Ethical Practice Autonomy – patient has the right to make personal choices and decisions about care ◦ Signing a consent form ◦ Continuing the intake of salt when a low sodium diet is recommended ◦ Refusing blood products because of religious beliefs Beneficence - Action one takes should promote good. Nurse’s actions are helpful/beneficial ◦ Turning and positioning an immobile patient to increase comfort Principles Related to Ethical Practice Nonmaleficence – preventing harm, promote safety ◦ Assist a patient experiencing paralysis of the right leg to transfer to a wheelchair /with the brakes in the locked position Justice –fairness and equal treatment of all patients with respect for their individuality. Treating all patients fairly in accordance with honor, respect, standards, and the law. ◦ All people have access to health care regardless of ability to pay or available health insurance. Principles Related to Ethical Practice Fidelity – You are faithful or true to your word. Make promises or commitments that can be kept. ◦ “I will be back in 10 minutes to assist you back to bed.” ◦ Nurse returns in 10 minutes Veracity – Being truthful and honest. ◦ “I am going to draw your blood. You maybe uncomfortable for a few moments.” Principles Related to Ethical Practice Altruism: Concern or welfare of others Human Dignity: Inherent worth and uniqueness of individuals and populations. Integrity: Acting in accordance with appropriate code of ethics and standards. Does the right thing at all times. Social Justice: Upholds what is fair on a social scale. All patients treated equally American Nurses Association (ANA): Code of Ethics for Nurses Code of ethics are standards and behaviors core to nursing practice. Every profession has a code of ethics. Codes of ethics is a social contract with the public ◦ defines a profession. Florence Nightingale had first code of ethics. ANA Code of Ethics (book and in the handbook) ◦ States the ethical values, obligations, and duties of every individual who enters the nursing profession. ◦ Serves as the profession’s nonnegotiable ethical standard. ◦ Expresses nursing’s own understanding of its commitment to society. ANA Code of Ethics for Nurses 9 Provisions divided in 3 categories 1. Most fundamental values and commitments of the nurse: -compassion, respect, dignity of every person 2. Boundaries of duty to the patient: -accountability, responsibility, nursing judgment, professional nurse- patient relationship 3. Focus on the nurses responsibility to the nursing profession and society: -membership in professional nursing organizations, participate in social policy development ANA Ethics Provisions Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. Provision 2 The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient. Provision 4 The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal ANA Ethics Provisions Provision 5 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. Provision 6 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 healthcare. Provision 7 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 ANA Ethics Provisions Provision 8 The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. Provision 9 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.  Which of the following is a violation of the Code of Ethics? Code of A. Calling the physician with blood Ethics work results. B. Checking results of a throat culture for your neighbor’s child. Link the concept of ethics: ◦ Teenager seeking information about birth control ◦ Substance abuse ◦ Use of fertility medications ◦ Practicing on a patient without their permission ◦ Patient’s wife and girlfriend visit the patient at different times Questions?