Module 8: Ethico-Legal Considerations When Providing Safe Nursing Care - PDF

MODULE 8: ETHICO-LEGAL CONSIDERATIONS WHEN PROVIDING SAFE AND PROFESSIONAL NURSING CARE Objectives: After the discussion, the students will be able to: a. Discuss the 11 patient’s bill of right b. Appreciate the application of inform consent in the clinical area c....

MODULE 8: ETHICO-LEGAL CONSIDERATIONS WHEN PROVIDING SAFE AND PROFESSIONAL NURSING CARE Objectives: After the discussion, the students will be able to: a. Discuss the 11 patient’s bill of right b. Appreciate the application of inform consent in the clinical area c. Differentiate the utilization of will and contract e. Select appropriate nursing care to client aligning to the established nursing law, code of ethics, and data privacy law. A. Patient’s Bill of Right 1. Considerate and respectful care. 2. relevant, current and understandable information concerning diagnosis, treatment prognosis, specific procedures, treatment risks involved, medically reasonable alternative benefits needed to make informed consent. 3. make decisions regarding his plan of care; in case of refusal, he is entitled to other appropriate care and service or be transferred to another hospital; 4. Have advance directive (such as living will) concerning treatment or designating a surrogate decision maker. 5. Every consideration of his privacy such as in case discussion, consultation and treatment; 6. Confidentiality of communications and records. 7. Review his records concerning his medical care and have these explained to him except when restricted by law. 8. Be informed of business relationship among the hospital educational institution, health care providers that may influence the patient’s treatment and care. 9. Consent or decline to participate in experimental research affecting his care. 10.Reasonable continuity of care when appropriate and be informed of other care options when hospital care is no longer appropriate. 11. Be informed of hospital policies and practices that relate to patient care. B.Informed Consent ▪ The process of communication between a patient and physician that results in the patient’s authorization of agreement to undergo a specific medical intervention (American Medical Association) ❖Failure to obtain informed consent renders any physician liable for negligence or battery and constitutes medical malpractice. B.Informed Consent 4 major elements of informed consent: 1. Competence- refers to a patient’s capacity for decision making 2. Disclosure- refers to the content of what a patient is told or informed about during the consent negotiation 3. Comprehension- refers to whether the information given has been understood 4. Voluntariness- means consent should be voluntary Reason for need Informed Consent a. Greater patient safety and satisfaction. b.Attainment of higher ethical standards and organizational morale c.Closer adherence to legal requirements and reduced risk of litigation d.Increased levels of institutional quality (e.g. compliance with accreditation standards) e.Potential time and money savings related to reduced litigation  Responsible for Informed Consent ▪ The clinician has core responsibility…but… a team approach is required with contributions from: Entire clinical staff (clinician, nurse, technologist) Administrative and clinical leadership Legal counsel  When is Informed Consent Required? ▪ In most institutions, for: Surgery Anesthesia Other invasive or complex medical or radiologic procedures ❖Invasive procedure : Any penetration of the skin, use of radiation for treatment, or comparable invasive procedure involving interference with the body tissues  Needed for Informed Consent a.diagnosis, if known b.nature and purpose of a proposed treatment or procedure c.Alternatives (regardless of costs or extent covered by insurance) d.The risk and benefits of alternatives The risks and benefits of not receiving treatments or undergoing procedures Who Can Consent? a.Patient, if adult and competent b.Healthcare Power of Attorney or legal guardian c.Statutory surrogate may give consent in the absence of a legally authorized representative Statutory Surrogates Include, in order of priority, the following: a. Patient's spouse, unless legally separated. b. Adult child of the patient. If more than one child, consent of a majority who are reasonably available c. Parent of the patient. d. If the patient is unmarried, the patient's domestic partner if no other person has assumed any financial responsibility for the patient. e. Brother or sister of patient. f. A close friend of patient who is familiar with the patient's health care views and desires and is willing to become involved in the patient's healthcare and to act in the patient's best interest. What to do to Improve Our Informed Consent a. Simplify language b. Allow time for questions c. Make sure the patient understands d. Plan for language assistance in advance of appointment e.Train support staff Use of Interpreter a.Information must be verbally provided to patient in their native language; consent must be written in English. b.If patient/family refuses hospital interpreter and chooses to use a friend or family member; if must be noted in the medical record. c.If translation services are used the interpreter should sign as a “witness” and specify their name, title, date and time. Signing and Witnessing the Consent ▪ The patient (or the patient’s health care decision maker) should sign the consent ▪ Two persons should witness the patient’s signature. These witnesses are attesting to the fact that the patient signed the form only and need not witness the full consent discussion between the patient and the physician. Therapeutic privilege ▪ Exception of the rule of informed consent ▪ Allows health care provider to proceed : - in case of emergency - incompetence - waiver - implied consent C. 1. Contract Meeting of minds between two persons whereby one binds himself, with respect to the other, to give something or to render some service  Kinds of Contract a. Formal contract agreement among parties involved Required to be in written by some special law b. Informal Contract concluded as the result of a written document or correspondence the law does not require the same to be in writing c. Express Contract conditions and terms of the contract are given orally or in writing by the parties concerned.  Kinds of Contract: d. Implied contract a result of acts of conduct of the parties to which the law ascribes an objective intention to enter into a contract e. Void Contract inexistent from the very beginning and therefore may not be enforced f. Illegal Contract One that is expressly prohibited by law  Requisites of a Contract: a.Two or more persons must participate b.Parties involved must give consent to the contract c.Object which the subject matter of the contract must be specified such as: o All things which are not outside the commerce of man; o All rights which are not in transmissible; o Future inheritance in cases expressly authorized by law. o All services which are not contrary to law, morals, good customs, public order and public policy.  Requisites of a Contract: d. The cause of obligation is established. The time, price, and subject matter are expressed. e. Contracting parties must have the legal capacity to enter into a contract. They must o Be of legal age o Be of sound mind o not be under the influence of intoxicating drugs, or fear of bodily harm o Not be suffering from physical disability such as those who are mentally incompetent  Inexistent or void contracts from the beginning: a.Cause, object or purpose are contrary to laws, morals, good customs, public order or public policy. b.Cause or object did not exist from the time of transaction. c.Object is outside the commerce of man. d.Contemplate an impossible service. e.Intention of the parties to the principal object cannot ascertained. f. Expressly prohibited or declare void by law. g.Absolutely simulated or fictitious.  Illegal Contracts Breach of Contract contact obtained through Failure to perform an use of : agreement, whether expressed o fraud or implied without cause a. Prevention of performance o undue influence b. Failure to perform because of o duress in securing contract inconvenience or difficulty o those expressly prohibited c. Failure of cooperation in by law performance d. Abandonment of duty e. Substitution of performance f. Failure to use due care Advantages of written contracts a. It is certain. Avoids uncertainty of human memory b. It can specify a definite time within which it is binding c. Sets standard d. Set minimum standards for professional practitioners and to protect them against discrimination in compensation e. Definite in many details f. Provide definite procedure in case of complaints g. Creates a minimum of certainty and security for the professional employee C.2. Will An act whereby a person is permitted, with the formalities prescribed by law to control to a certain degree the disposition of his estate, to take effect after his death. Who may make a will? a. All persons who are not expressly prohibited by law may make a will. b. A person who is at least 18 years of age c. Must be of sound mind at the time of the execution of the will 2 kinds of will: a.Notarial will o Acknowledge before a notary public and which requires an attestation clause b.Holographic will o Required to be entirely written, dated and signed in the handwriting of the testator Requisites for a valid NOTARIAL WILL a. Must be in writing. b. Executed in a language or dialect known to the testator. c. Subscribed at the end by the testator himself or by the testator’s name written by some other person in his presence or by his express direction d. Attested and subscribed by 3 or more credible witnesses in the presence of the testator and of one another. e. Each and every page, except the last must be signed by the testator or by the person requested by him to write his name and by the witnesses of the will. Requisites for a valid NOTARIAL WILL f. Each and every page of the will must be numbered correlatively placed on the upper part of each page. g. It must contain an attestation clause stating the following: o Number of page used the will is written. o The fact that the testator signed the will and every page thereof, or caused some other person to write his name, under his express direction, in the presence of the instrumental witnesses o All the instrumental witnesses who witnessed and signed the will. h. It must be acknowledged before a notary public by the testator and the witnesses  May a deaf mute execute a will? YES…….added requirement: a. Testator must personally read the will, if able to do so b. Otherwise, he shall designate two persons to read it and communicate to him in some practicable manner, its contents May a blind person execute a will? Yes, with added requirement, the will shall be read to the testator twice: a. Once by one of the subscribing witnesses; b. by the notary public before whom the will is acknowledged Requisite of Holographic Will (Love Water Drink Sincerely And Endlessly) L= anguage known to the testator W= ritten entirely in the handwriting of the testator D=ated completely S=igned by the testator A=nimus testandi or an intention to make a will E=xecuted at the time holographic wills are allowed. WHO could be a witness Who are disqualified to a will? from being witnesses to a Any person of sound mind will? 18yrs old and above Those who are not domiciled Not blind, deaf or dumb (resident) in the Philippines (cannot speak) Those who have been convicted Able to read and write of falsification of documents, perjury or false testimony D. Code of Ethics for Filipino Nurses Code of Ethics: ▪ A set of principles, established by a profession to guide an individual practitioner. ▪ It gives guidance in terms of ethical accountability within the scope of professional practice ▪ In the Phil, Code of ethics is legally binding. The certificate of registration of a registered nurse shall be revoked or suspended for any violation of the Code of ethics for registered nurses