KM Ethical_Legal Considerations PDF

Code of Ethics Developed by ANA Outlines rules, ideals, duties, and obligations that nursing professionals are expected to upload Has 9 provisions that: ○ Provide compassionate care and respect client ○ Recognize each client & treated with dignity ○ Advoc...

Code of Ethics Developed by ANA Outlines rules, ideals, duties, and obligations that nursing professionals are expected to upload Has 9 provisions that: ○ Provide compassionate care and respect client ○ Recognize each client & treated with dignity ○ Advocate for client’s rights and needs ○ Promote and protect the health and safety of each client 6 Ethical Principles: Autonomy- independence/freedom ○ Nurses obligation to respect clients’s right to make their own decisions ○ Includes right to refuse Beneficence- doing good and minimizing harm ○ ex: fall precautions, providing additional care or support to meet needs ○ Minimize harm and practice in a way that benefits the client Nonmaleficence- doing no harm (ex: don't give meds they are allergic to) ○ Ask self if the action will cause harm to the client Veracity- telling the truth, accurate information for the client ○ Providing all information to make decision, disclosing errors to the client and provider Fidelity- keep promises ○ Following through with promise Justice- fairness Values Definitions - what we believe to be important, good and meaningful Drives our behaviors and actions,and how we respond toward others 5 Professional Core Values of Nursing Altruism- Selfless actions for the benefit of someone else ○ Things done for compassion, not reward ○ Prioritizing client’s need first, doing what’s best for the client Human dignity- each individual should be respected and treated equally ○ Need to be practiced in educational and workplace settings ○ Ex: ensuring privacy, showing respect, providing culturally competent care Integrity- honesty and moral principles to do what is right, even when difficult to sustain Autonomy- right to self determination ○ Includes respecting the right to refuse care ○ Can be difficult when it is not the decision the nurse thinks is right Social justice- Awareness of the basic right to health and well-being of every individual ○ Nurses are obligated to fight social justice throughout the world Ethical Decision Making Process of evaluating and choosing options in an ethically consistent manner using ethical principles Ethical Dilemma- situation where a critical choice must be made, but the solution may not be ethically acceptable ○ The conflict may have no clear right or wrong solution ○ Possible solutions many have both advantages or disadvantages Nurses should make ethical decisions regardless of their personal values or beliefs by abiding to code of ethics 8 Steps of ethical decision-making process 1. Is there an ethical dilemma? Does the problem have a clear right or wrong solution? Identify if an ethical dilemma exists 2. Clearly identify the ethical dilemma Who is affected by the dilemma? What actual problem exists? 3. Identify possible solutions a. Open to idea of all possible solutions, even if they are in opposition of your values 4. Apply ethical principles to the solutions Does it respect client’s autonomy Advantages & disadvantages 5. Include all relevant individuals and factors a. Include everyone possible in the team who can contribute to the solution Ex: client wants Pastor involved Ensure legal issues & facility policies have been considered 6. Decide on a solution a. May not be easy b. Not all parties will agree c. Important the team agree to work together toward the chosen solution d. Previous steps may need revisiting 7. Review the decision a. Look closely at decided upon solutions before action b. Has everything been considered? c. Have everything been overlooked? d. Revisit previous steps if concerns arise 8. Put decision into action & evaluate a. Requires effective collaboration with the team b. Effectiveness should be evaluated Ethical Issues in Health Care 1. Allocation of scarce resources 2. Late termination of pregnancy 3. Medically/physician assisted death 4. Termination of care/treatment 5. Caring for clients with substance use disorders 6. Treating clients in prison Emergency Medical Treatment and Labor Act (EMTALA) Clients cannot be turned away from entering the ED due to insurance or financial status: ○ Includes uninsured, underinsured or inability to pay ○ All clients must have a medical screening evaluation ○ Clients must be stabilized or attempted to stabilize ○ If client cannot provide specific level of care, must transfer to a facility that can Health insurance portability and Accountability (HIPAA) Protect insurance coverage and private information of clients Only client and involved in direct care should have access to information ○ Privacy ○ Confidentiality ○ Violation can have both legal and ethical consequences Social Media & Confidentiality ANA’s principles for social networking ○ Do not post any identifiable client information ○ Maintain professional boundaries when communicating with clients ○ Expect posted information to be potentially viewed by client, peers, & supervisors ○ Use privacy settings and attempt to keep personal vs professional information separate ○ Advocate for client rights and report social media violations ○ Develop effective policies to ensure professional communication with clients & safeguard PHI Genetic Testing Examining a client’s DNA to identify genetic markings that make client unique Used to identify hereditary diseases Can be done prenatally to detect disorders Legal issues- Increased insurance premiums if found to be at increased genetic risk ○ Genetic information & nondiscrimination Act protects from potential discrimination based on results Ethical issues - need to respect client’s autonomy & right to test ○ Ensure the client understands the implications of genetic testing results Legal standard- evidence presented is convincing that a reasonable person must accept the defendant’s guilt as fact Criminal Law Illegal actions & how to punish them Has to prove that a nurse has violated a criminal standard "beyond a reasonable doubt*“ Has to prove there was intent to do harm or error that led to harm Ex: a nurses falsifies a record to cover up a serious mistake Can be used by the public to punish defendants Civil Law Deals with disputes between individuals or organizations Victim can be awarded compensation Usually refers to non-criminal law Tort Law A type of civil law that deals with compensating victims of harm Tort- carrying out an act, or failing to carry out an act, which results in injury or harm to a client Unintentional- nurse does not intend to cause harm, but harm occurs due to: ○ Negligence: when nurse is found to have breached their duty of care ○ Malpractice: when nurse fails to meet the standards of care Intentional: invasion of privacy, defamation, assault, battery threaten with restraints (assault) illegally restraining a client (battery) Touching client inappropriately (battery) How to protect from civil and criminal action Put your client first Follow rules, guidelines, policy, and procedures of your facility Be knowledgeable about nurse practice act of the state Review employer’s protection Obtain separate malpractice insurance coverage Informed Consent Formal written permission to provide care given by client after information is provided ○ Required before any invasive procedure or surgery Both an ethical and legal obligation Client must be competent to make a voluntary decision Provider has legal responsibility to obtain informed consent Nurses’ responsibility to: ○ verify/witness the client sign & verify they have information/knowledge to do so Information provider must give to client before consent: Name of procedure/treatment Who will perform the procedure The purpose of the procedure The complete description of the procedure The expected outcomes The benefits/risks, pain, and discomfort that may occur Other Options for treatment/procedure Benefits/risks to alternatives Client's right to refuse & consequences of doing so Implied Consent Agreement by the client through their actions rather than by verbal or written consent The client has the right to withdraw implied consent at any time Must inform client about the action or intervention planned Examples: ○ Allowing to be examined ○ Checking vital signs ○ Administration of pain medication, injections ○ Insertion of urinary catheter ○ Blood draws Advance Directive Legal documents of a person’s wishes regarding medical treatment Two types: ○ Living Will- Which life-sustaining treatment is wanted once incapacitated ○ Durable Power of Attorney- Individual chosen to make decisions for client behalf if they are unable to do so Does not have to be family member Nurses Role for Advance Directives Explain what’s a advance directive & why documentation is important Encourage client to discuss with family Determine health literacy & any needs Clarify misconceptions with end-of-life care Communicate client status regarding an advance directive Good Samaritan Laws Provides protection to people who provide aid in emergencies without fear of being liable Eliminate liability for well-intentioned actions Actions should be within the HCP’s scope of practice Requirements to be protected: ○ Law will not apply when the person provides care with a disregard of safety = “grossly negligent care” (only covers aid you performed in good faith)  ○ Nurse can’t know of any medical condition of the person they are providing care ○ Cannot receive compensation for the care Whistleblowing Formal reporting on illegal acts, wrongdoing, or unethical practice within an organization Can cause stress and fear due to retaliation Federal and state-level safeguards exist to protect the whistleblower Prior to reporting, ANA recommends: ○ Have all necessary data, keep copies, & get expertise from BON/ lawyers Mandatory Reporting Maltreatment ○ Physical maltreatment: denying food, shelter, or comfort ○ Neglect, denial or denying of care ○ Verbal or emotional maltreatment ○ Sexual maltreatment ○ Financial exploitation ○ Educational maltreatment ○ Lack of protection from harm Incidence of disease- diseases that can pose a threat to the public ○ Intent is to monitor, control, and prevent spread of diseases ○ Ex: anthrax, botulism, chlamydia, gonorrhea, syphilis, influenza, hepatitis A,B,C, HIV, Tuberculosis, Zika virus “Just culture” Described in the ANA Code of Ethics with Interpretive Statement Be accountability for themselves and each other by doing what is right Recognizes the possibility for making mistakes & should be corrected not punished Ex: nurses miss performing care due to being overworked or understaffed ○ Just culture: managerial support & teamwork in adhering safety will yield positive changes, not punish nurses Legal implications related to workforce Issues Client abandonment - when provider deserts client whom they have responsibility for ○ Ex. Leaving unit without coverage, sleeping while assigned to provide care ○ Sometimes, the risk of harm to the nurse is prioritized over moral obligation Client to nurse staff ratio - number of clients nurse is responsible for ○ Leads to increased mortality rates, longer stays, med errors, complaints, and preventable incidents ○ Minimum mandates are needed ○ Only California has a legal mandate of 1:4 Delegation - process of assigning tasks to other members of the team ○ Must properly trained and educated to delegate ○ Responsible for knowing what is legally permitted by state NPA  ○ Must follow the five rights Breach of Nursing Practice Failure to maintain standard of care Breaches in client confidentiality Falsification of health records Standard of Care Standards of Nursing Practice ○ Explanatory statements that describe a competent level of care for all RNs ○ Standards must align with scope of practice ○ All nurses should utilize the nursing process Standards of Professional Performance ○ Expectations for competent and professional behavior though accountability ○ Nurses should elevate their own practice and be responsible for their own actions Standards of Professional Performance ○ Ethics ○ Culturally congruent practice ○ Communication ○ Collaboration ○ Leadership ○ Education ○ Evidence based practice ○ Quality of practice ○ Professional practice evaluation ○ Resource utilization ○ Environmental health Lack of Confidentiality Not only ethically bound, also legally bound to HIPAA to maintain privacy and confidentiality Consequences for violations: disciplinary action at institutional level (suspension, termination), civil penalties (fines), criminal penalties (prison) Breach is usually not on purpose Nurses are obligated to intervene and follow the proper chain of command when breaches in confidentiality occur Falsification of Health Record Documentation must be accurate and truthful Falsification ○ Documentation of inaccurate, incomplete, misleading data, or fail to document data that should be included ○ Disciplinary actions depends on seriousness of the falsification Ex: ○ Does not document an assessment ○ Does not document communication with interprofessional team member ○ Document inaccurate assessment data ○ Documents care, assessments, or activities did not actually occur Nurse Fatigue Physical & psychological exhaustion causes nurses to be unable to function safety & competently Recommendations to decrease fatigue ○ Limit shift lengths and hours worked per week ○ Reduce night shift to 8 hours ○ Provide rest every 2 hours during shift ○ Include time for brief naps ○ Provide timed caffeine ○ Practice healthy sleep habits (7-9 hrs) ○ Take time to rest when off Causes of nurse fatigue ○ Long and verifying shifts ○ Increased client load ○ Nursing shortages Manifestations of nurse fatigue ○ Physical exhaustion ○ Psychological exhaustion Negative effects on the nurses ○ Increased risk of chronic illnesses ○ Increased risk of mental health disorders ○ Decreased clinical judgment ○ Decreased communication with interprofessional team Negative effects on the client ○ Increased risk of medication errors ○ Increased risk of receiving unsafe care ○ Increased client mortality rate Substance use disorder among nurses Impaired nurses are a danger to themselves and their clients ○ Ability to provide safe client care diminishes ○ Errors occur (procedural, medications) Nurses have easy access to controlled substances Encouraged to report suspicions of use ○ Changes in job performance ○ Prolonged and frequent trips to restroom ○ Errors in care ○ Withdrawal from peers ○ Altered verbal and emotional responses ○ Incorrect narcotic counts ○ Volunteering to mediate clients for other nurses