Ethics in Nursing Profession (PDF)

Ethics in Nursing profession Prepared by Prof. Dr. Samah Mohamed AbdAllah Professor of Nursing Administration Faculty of Nursing - Assuit University Dr. Maha Muhammad Rashed Lecturer of Nursing Administration Faculty of Nursing - Assuit University ‫اﻟﻣﻌﮭد...

Ethics in Nursing profession Prepared by Prof. Dr. Samah Mohamed AbdAllah Professor of Nursing Administration Faculty of Nursing - Assuit University Dr. Maha Muhammad Rashed Lecturer of Nursing Administration Faculty of Nursing - Assuit University ‫اﻟﻣﻌﮭد اﻟﻔﻧﻰ ﻟﻠﺗﻣرﯾض‬ ‫اﻟﻔرﻗﺔ اﻻوﻟﻰ‬ 2024/2025 ‫اﻟﻔﺻل اﻟدراﺳﻰ اﻻول‬ Technical nursing institute 2025/2024  List of content No. Topic Page 1 Code of ethics 4 2 The Nine Provisions of the ANA Code of Ethics 11 application and violation 2 Ethical principals in nursing 19 3 Informed consent 30 4 Law in nursing 43 5 Legal issues in nursing 51 6 Nurses’ rights and responsibilities 62 7 Patient rights and responsibilities 75 8 Work place violence 83 9 Ethical dilemma in nursing 92 3  Code of ethics Out lines:  Introduction.  Definitions.  Importance to learn code of ethics.  Provisions of code of ethics.  Most common violations of the nursing code of ethics  Consequences of violating the nursing code of ethics. 4 Objectives At the end of this lecture the student will be able to: 1. Define the nursing code of ethics. 2. Explain the importance to learn the nursing code of ethics. 3. List code of nursing ethics provisions. 4. Analyses most common violations of the nursing code of ethics 5. Expect what are consequences of violating the nursing code of ethics. 5 Introduction 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. Definition 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.” American Nurses Association (ANA) Ethics, in general, are the moral principles that dictate how a person will conduct themselves. Ethical values are essential for ALL healthcare workers, but ethical principles in nursing are particularly important given their role as caregivers. Importance of code of ethics to nursing.  Guidance: It provides a framework for ethical decision-making and guides nurses in delivering care that is in the best interest of the patient while upholding professional integrity. 6   Accountability: It holds nurses accountable to the highest ethical standards, ensuring that they act in ways that promote the well-being of patients and the community.  Professional Identity: It reinforces the identity of nursing as a profession grounded in ethical practice, distinguishing it from other healthcare roles. Provisions of the Nursing Code of Ethics Currently, the nurse’s code of ethics contains 9 main provisions: Provisions of the Nursing Code of Ethics in details 1. “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” 1.1 Respect for human dignity: 1.2 Relationships with patients: 1.3 The nature of health: 1.4 The right to self-determination: 1.5 Relationships with Colleagues and others: 2. “The nurse's primary commitment is to the patient, whether an individual, family, group, community, or population.” 2.1 Primacy of the patient's interests: 2.2 Conflict of interest for nurses: 2.3 Collaboration: 2.4 Professional Boundaries: 3. “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” 7 3.1 Protection of the rights of privacy and confidentiality: 3.2 Protection of human participants in research: 3.3 Performance standards and review mechanisms: 3.4 Professional responsibility in promoting a culture of safety: 3.5 Protection of patient health and safety by acting on questionable practice: 3.6 Patient protection and impaired practice: 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 care.” 4.1 Authority, accountability, and responsibility: 4.2 Accountability for nursing judgments, decisions, and actions: 4.3 Responsibility for nursing judgments, decisions, and actions: 4.4 Assignment and delegation of nursing activities or tasks: 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.” 5.1 Duties to self and others: 5.2 Promotion of personal health, safety, and well-being: 5.3 Preservation of wholeness of character: 5.4 Preservation of integrity: 5.5 Maintenance of Competence and Continuation of Professional Growth: 5.6 Continuation of Personal Growth: 8 6. “The nurse, through individual and collective efforts, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.” 6.1 The environment and moral virtue: 6.2 The environment and ethical obligation: 6.3 Responsibility for the healthcare environment: 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.” 7.1 Contributions through research and scholarly inquiry: 7.2 Contributions Through Developing, Maintaining, And Implementing Professional Practice Standards: 7.3 Contributions through nursing and health policy development: 8. “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” 8.1 Health is a universal right: 8.2 Collaboration for Health, Human Rights, and Health Diplomacy: 8.3 Obligation to advance health and human rights and reduce disparities: 8.4 Collaboration for human rights in complex, extreme, or extraordinary practice settings: 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.” 9 9.1 Articulation and assertion of values: 9.2 Integrity of the profession: 9.3 Integrating Social Justice: 9.4 Social Justice in nursing and health policy: 10  The Nine Provisions of the ANA Code of Ethics application and violation The ANA Code of Ethics is structured around nine provisions, each of which addresses a different aspect of nursing ethics. These provisions are the backbone of ethical nursing practice, guiding nurses in their responsibilities to patients, the profession, and society. 3.1 Provision 1: Respect for Human Dignity and Rights  Principle: Nurses must practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person.  Application: This provision emphasizes the nurse’s responsibility to treat all patients with respect, regardless of their socioeconomic status, race, religion, gender, or health condition. It also includes respecting patients' rights to self- determination and informed decision-making. 3.2 Provision 2: Commitment to the Patient  Principle: The nurse's primary commitment is to the patient, whether an individual, family, group, or community.  Application: Nurses must prioritize the needs and well-being of their patients, advocating for their interests and ensuring that their care is centered around the patient’s goals and values. This provision also involves managing conflicts of interest and maintaining professional boundaries. 11 3.3 Provision 3: Advocacy for the Health, Safety, and Rights of Patients  Principle: Nurses promote, advocate for, and protect the rights, health, and safety of the patient.  Application: This provision highlights the nurse’s role as an advocate, particularly in situations where patients are vulnerable or unable to speak for themselves. Nurses must ensure that patients receive safe, high-quality care and that their rights are upheld, including their right to privacy and confidentiality. 3.4 Provision 4: Responsibility and Accountability for Nursing Practice  Principle: Nurses are responsible and accountable for their own practice and must make decisions that reflect their professional judgment and competence.  Application: Nurses must maintain high standards of practice, continuing to develop their skills and knowledge to provide safe and effective care. This provision also covers the delegation of tasks, ensuring that those who receive delegated tasks are competent and that the tasks are appropriate for their level of training. 3.5 Provision 5: Duty to Self and Others  Principle: Nurses owe the same duties to themselves as they do to others, including the responsibility to promote health and safety, preserve integrity, and maintain competence.  Application: Nurses must take care of their own physical, mental, and emotional health to provide effective care to others. This includes managing stress, maintaining a work-life balance, and engaging in continuous learning and self-reflection to enhance their professional practice. 12 3.6 Provision 6: Contribution to Healthcare Environments  Principle: Nurses should establish, maintain, and improve the ethical environment of the workplace and the conditions of employment conducive to safe, quality healthcare.  Application: Nurses have a role in creating and sustaining ethical work environments, where respect, collaboration, and ethical practice are prioritized. This provision encourages nurses to address issues like workplace safety, resource allocation, and the moral climate of healthcare institutions. 3.7 Provision 7: Advancement of the Nursing Profession  Principle: Nurses must advance the profession through research, scholarly inquiry, professional standards development, and the generation of both nursing and health policy.  Application: Nurses are encouraged to contribute to the evolution of the profession by engaging in research, participating in professional organizations, and advocating for policies that improve healthcare delivery and patient outcomes. 3.8 Provision 8: Collaboration with Other Health Professionals  Principle: Nurses must collaborate with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.  Application: This provision underscores the importance of teamwork and interprofessional collaboration in healthcare. Nurses must work with other professionals to address complex health issues, advocate for social justice, and contribute to global health initiatives. 13 3.9 Provision 9: Maintaining the Integrity of the Profession  Principle: The nursing profession, 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.  Application: Nurses have a collective responsibility to uphold the integrity of the profession by adhering to ethical standards, promoting public trust, and engaging in social justice advocacy. This provision also encourages nurses to participate in professional organizations and contribute to the development of policies that impact the profession and healthcare. Violations of the nursing code of ethics 1. Violations of Patient Privacy (Violation of ANA Code of Ethics): One of the most common violations of the Nursing Code of Ethics is the violation of a patient's right to privacy. Violation of a patient's privacy can occur in several ways. To prevent this type of Code of Ethics violation, nurses must be careful to discuss patient information only with the people providing care for the patient and anyone else the patient or his legal representative approves. Conversations regarding a patient should occur away from the public and in areas designated for care. 2. Failure to Promote a Safe Healthcare Environment (Violation of ANA Code of Ethics Provision): Nurses are responsible for knowing which acts or behavior constitute unsafe nursing practices. Further, the ANA Nursing Code of Ethics encourages nurses to avoid any behavior that jeopardizes patient or nursing safety and well-being. Any time nurses feel the need to question any behavior and its ethicality, they should be able to do so without fear of negative consequences. 14 However, even in the face of unfavorable consequences, the nurse should always err on the side of provisions outlined in the Nursing Code of Ethics. 3. Ethical dilemmas regarding informed consent are common (Violation of ANA Code of Ethics Provision): Healthcare providers must explain treatment options and procedures and obtain consent from the patient or her legal representative before care is administered. Before patients or their representatives can submit informed consent, the nurse's responsibility is to make sure they understand all aspects of the proposed treatment. If a patient does not fully understand a proposed treatment and is afraid to ask questions, the nurse may assume he understands and proceed with care, creating a violation of the Code of Ethics which protects the patient's right to make informed decisions for himself. 4. Lack of professional growth (Violation of ANA Code of Ethics): Healthcare is ever-growing and expanding. New medications are developed daily. According to the American Nurses Association Code of Ethics, nurses must evaluate their own performance and competencies and strive for personal and professional growth. Professional growth in nursing requires a lifelong commitment to learning. When nurses do not pursue avenues to expand their knowledge and develop new skills, their disinterest can result in the delivery of patient care that is not up to date with current standards. 5. Allowing Personal Biases and/or Beliefs to Interfere with Patient Care (Violation of ANA Code of Ethics Provision): There are instances when nurses have the right to refuse to participate in certain activities or assignments. One example of when it is appropriate to decline participation in the care of a patient is if the type of care being provided conflicts with the nurse's religious beliefs. While it is sometimes acceptable for nurses to refuse to participate in a type of care, it is never appropriate 15 to refuse care based on the nurse's personal dislike for or discrimination against a person. For example, it is inappropriate for a nurse to refuse patient care when the patient is a prison inmate because the nurse disagrees with the inmate's illegal behavior. 6. Failure to Report Suspected Impairment of a Coworker/Peer (Violation of ANA Code of Ethics Provision): Understandably, nurses may feel apprehensive about reporting suspected impaired behavior of a coworker. However, the Nursing Code of Ethics is clear about the importance of protecting patients and the profession by addressing impaired practice. 7. Withholding Important Information from Patients About Their Health (Violation of ANA Code of Ethics Provision): At times, nurses are faced with the ethical dilemma of being asked to withhold the seriousness of a diagnosis from their patients. It is not uncommon for family members to want to spare their loved ones the anguish of knowing how dire their health situation is. However, if the patient is of sound mind, it is his right to make decisions about his care, including deciding who else can know about his illness, disease, or prognosis. 8. Avoiding Action Against Questionable Practices (Violation of ANA Code of Ethics): A nurse’s primary focus should be the health, safety, and well-being of patients. If a nurse suspects inappropriate or unethical practices regarding the provision or denial of care, their concerns should be expressed. Failure to address questionable practices put the patient, healthcare team, and the profession at risk for harm. Therefore, the nurse must always address concerns with the person carrying out the practice and, if appropriate, escalate the concern to a higher authority. 9. Not Accepting Responsibility for One’s Judgment and Nursing Actions 16 (Violation of ANA Code of Ethics): Even the best nurses have bad days and make mistakes. One of the most professional characteristics a nurse can demonstrate is the willingness to be accountable and responsible for his own actions. Being ethical means being accountable for one’s nursing judgment and actions, even if it means owning up to a mistake or a misunderstanding. 10. Delegating Assignments to the Appropriate Person (Violation of ANA Code of Ethics): Charge nurses, nurse supervisors, and administrative nurses assign nursing staff to care for patients and perform specific procedures or treatments. While the nurse may have authority to delegate, the nurse also has the responsibility to make decisions based upon the knowledge and skills of the nurse to whom assignments are delegated. Nurses who delegate assignments to personnel who are not adequately trained or comfortable providing that type of care violate the patient's right to safe care and the Nursing Code of Ethics. Consequences of Violating The Nursing Code of Ethics Violations of the ANA Nursing Code of Ethics for nurses can have dire consequences. It is vital for nurses to be aware of the possible consequences of violating the Code and make every effort to avoid violations. The following are examples of consequences associated with Code of Ethics violations for nurses. 1. Disciplinary Action from Employer: Nurses who violate ethical codes of conduct can expect to face disciplinary action from their employers. Depending on the violation and whether the nurse has a history of previous misconduct, the nurse could face a verbal or written reprimand or suspension. 2. Loss of Job: 3. Disciplinary Action from the State Board of Nursing: 17 4. Loss of Nursing License: 5. May be Subject to a Civil Personal Injury Claim: 6. Criminal Prosecution: 7. Loss of Professional Relationships: References American Nurses Association. Code of Ethics for Nurses. American Nurses Publishing, 2015. 18  Ethical principals in nursing Outlines:  Introduction  Definition.  Purpose of studying ethics  Nursing principles  How you can use the principles  American nurse Association Code of Ethics  Ethical nursing principles  Tips to implement ethical principles as you navigate the complexities of the nursing profession  Ethical Dilemma  Types of Ethical Problems 19 Objectives At the end of this lecture the student will be able to : 1- Define ethics, ethical principals , professional ethics 2- Determine the purpose to study ethics 3- List nursing principals 4- Suppose how can use the principles 5- Determine American Nurse Association Code of Ethics 6- List ethical nursing principles 7- Apply tips to implement ethical principles as you navigate the complexities of the nursing profession 8- Define ethical Dilemma 9- Determine types of Ethical Problems 20  Introduction The principles of nursing practice describe what everyone, from nursing staff to patients, can expect from nursing. Find out about each principle here, and how you can use them as a nursing professional or student. The principles describe what constitutes safe and effective nursing care, and cover the aspects of behavior, attitude and approach that underpin good care. Each of the principles was developed by the Royal College of Nursing in partnership with the Department of Health and the Nursing and Midwifery Council. Patients, the public and health care staff were also involved in developing them. Definition. Ethics Refers to well based standards of right or wrong that prescribes what human ought to do, usually in terms of rights, obligations, benefits to society, fairness, or specific virtues. Ethics Refers to the study and development of one’s ethical standards. Ethical principles are part of a normative theory that justifies or defends moral rules and/or moral judgments; they are not dependent on one's subjective viewpoints. Professional Ethics A branch of moral science concerned with the obligations that a member of the profession owes to the public, to his profession, to his brethren, and to his clients  Norms of behavior or Code of Ethics of professionals to help members of the discipline to coordinate their actions or activities and to establish the public’s trust on the discipline 21 Purpose of studying ethics 1. Providing guidelines in knowing What is GOOD or what is BAD? What is RIGHT and what is WRONG? 2. Ethics enables us to make correct judgement of different types of situations. 3. In order to choose the right course of action that will help us towards the attainment of our goals which is to attain a happy and fruitful life. Nursing principles Principle A Nurses and nursing staff treat everyone in their care with dignity and humanity – they understand their individual needs, show compassion and sensitivity, and provide care in a way that respects all people equally. Principle B Nurses and nursing staff take responsibility for the care they provide and answer for their own judgments and actions – they carry out these actions in a way that is agreed with their patients, and the families and carers of their patients, and in a way that meets the requirements of their professional bodies and the law. Principle C Nurses and nursing staff manage risk, are vigilant about risk, and help to keep everyone safe in the places they receive health care Principle D Nurses and nursing staff provide and promote care that puts people at the centre, involves patients, service users, their families and their carers in decisions and helps them make informed choices about their treatment and care 22 Principle E Nurses and nursing staff are at the heart of the communication process: they assess, record and report on treatment and care, handle information sensitively and confidentially, deal with complaints effectively, and are conscientious in reporting the things they are concerned about. Principle F Nurses and nursing staff have up-to-date knowledge and skills, and use these with intelligence, insight and understanding in line with the needs of each individual in their care. Principle G Nurses and nursing staff work closely with their own team and with other professionals, making sure patients’ care and treatment is co-ordinated, is of a high standard and has the best possible outcome. Principle H Nurses and nursing staff lead by example, develop themselves and other staff, and influence the way care is given in a manner that is open and responds to individual needs. How you can use the principles As a nursing professional or nursing student you can use the principles to:  understand what patients, colleagues, families and carers can expect from nursing  help you reflect on your practice and develop as a professional 23   generate discussions with your colleagues or if you are student with your mentor, tutor or fellow students on the aspects of behaviour, attitude and approach that underpin good nursing care  identify where the principles are being practised within your organisation, and to identify instances where you think they are not being practised  see how they relate to a trust’s own set of nursing values. Patients and their families can use the principles to: evaluate the care they have received by using them as a checklist. Ethical nursing principles The ANA categorizes its ethical nursing principles into four key areas, which are: Autonomy is a nursing principle that recognizes a patient’s right to make decisions and determinations for themselves. Nurses adhere to this principle by making sure that patients have all the information needed to make a decision, including any treatment options, risks, benefits and complications. When the patient has this information, the nurse respects their right to make a decision that aligns with their goals and wishes, even if they don’t necessarily agree with the decision. Beneficence is another of the four ethical principles in nursing set forth by the ANA, and it refers to actions that benefit others. Actions guided by compassion and consideration of the welfare of others are considered beneficial, and nurses can apply the principles of charity and kindness when caring for patients and the communities they serve This principle also involves showing patients, their families and extended communities empathy and courtesy in all circumstances. Successful nurses demonstrate compassion and respect toward their colleagues and even themselves 24 Justice The principle of justice indicates the need for fairness in all decisions made by nurses and other health care professionals. They are responsible to provide the same quality of care regardless of a patient’s gender, race, religious preference, financial history or appearance. Nurses may work in facilities where they provide care to people who struggle with addiction or other challenging conditions, but their commitment to justice in the profession dictates that they will provide the same level of care. Nonmaleficience Nonmaleficence means to do no harm. Of the nursing ethics, this is one of the most well-known as it also applies to physicians and others in the health care industry. The responsibility of nurses is to choose care, interventions and treatment options that will do the least amount of harm. This principle protects the patient when receiving care. The principle of nonmaleficence also applies to nurses when treating patients who may cause harm to themselves or another person, and they need intervention. Tips to implement ethical principles as you navigate the complexities of the nursing profession. Maintain patient confidentiality One way to implement ethical principles in nursing is to maintain the confidentiality of the patient. This respects the patient’s right to autonomy, which is the first of the principles outlined in the ANA’s code of ethics and protects their private information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that also requires health care providers, including nurses, to protect sensitive information and prevent the disclosure of information without the patient’s consent 25 Provide companionate care Nurses perform tasks that make them caregivers to their patients, but certain tasks go beyond the scope of standard care. Administering these tasks in a kind and compassionate way can help a patient and their family feels cared for in a more effective way. For example, if a patient is nearing the end of their life, a nurse might hold their hand to comfort them and help them feel that they aren’t alone Evaluate solutions and outcomes: The responsibility to evaluate solutions and outcomes often falls on the nurse in a health care facility. A willingness to self-evaluate and make changes to the standard of care can help the patients who receive treatment at a particular facility. Since nurses provide direct patient care, they often have insights into what works and what doesn’t and can share that information with the decision-makers. Ethical Dilemma Occurs when the decisions available in making an ethical decision are equally justifiable alternatives. When there is only one course of action, or when conflict does not co-exist, there is no ethical dilemma. Sometimes, it requires an individual to make a choice between two equally unfavourable alternatives. It occurs because people have different ethical philosophy, follows different philosophy in life and see life situations at different perspectives. In many instances, decisions must be made quickly because patient’s medical condition is rapidly deteriorating. 26 Types of Ethical Problems 1. Decision-focused problems 2. Action-focused problems Decision-focused problems Difficulty lies in deciding what to do. “What should I do?” Moral Dilemma – Being between a rock and a hard plate – Difficulty is internal and personal – Addressed by: learning to make better decisions Reviewing personal value system Attending staff development offerings and ethics rounds. Action-focused problems Difficulty lies not in making the decision but in implementing it. “What can I do?” What risk am I willing to take to do what is right?” Moral distress 27 – Nurse knows the right course of action but cannot carry it out because of institutional policies or other constraints Ethics Committees in Hospitals Composed of interdisciplinary group of health care providers (doctors and nurses), community representatives (government officials, NGOs, clergy), and non medical representatives (social workers, ethicist) 1. They discuss sensitive issues such as: – when to withdraw or withhold treatment for an adult and the treatment of a severely handicapped newborn – Some may include topics such as the right to die – informal consent – right to choose or refuse treatment – right to know who is treating the patient. 2. Ethics committee serves as a forum in which nurse and other health care professionals can challenge a treatment decision. Increase communication between health care providers, patients, and their families in order to clarify issues, conflicts, and expectations. With increased understanding between them, lawsuits can be avoided. Formulate organizational code of ethics. Functions: 1. Give advice about policies and cases regarding ethical issues. 2. Consultation and case review by providing a forum for exchanging ideas in order to show the involved people the different courses of action available to them. 3. Formulating policies to help guide ethical decision making (children, unconscious, mentally incompetent) are for their best interest. 28  Why be Moral? Perhaps sometimes you were told by your classmates while doing you surgical hand washing during your duty in the O.R. “Why do we have to follow all these sterile techniques when our CI won’t know anyway because she’s out there on the ward most of the time?” So why be moral if there is no one to see and judge you anyway? The Answer of Divine Command. – We strive to become moral because God is good and He commands it to us to be also good. 2. The Answer that Morality pays. – This means that we should act from self interest. This emphasizes that good deeds are rewarded. Whenever a person does the right thing, his action is always to his advantage. References 1. Maharjan L. Health professionals running scared. The Himalayan Times [Internet]. 2009 Dec 24 [cited 2019 Aug 15]; Available from: https://thehimalayantimes.com/opini on/health-professionals-runningscared/ 2. Iglesias MEL, Vallejo R. Nurse attitudes in relation to health care ethics and legal regulations for nursing. Journal of Acta Bioethical [Internet]. 2014 [cited 2019 Aug 17];20(2):255-264. Available from: /paper/Nurse attitudes in relation to health care ethics Iglesias Vallejo. 3. Kumar H, Gokhale, Jain K, Mathur DR. Legal awareness and responsibilities of nursing staff in administration of patient care in a trust hospital. Journal of clinical diagnosis Research. 2013 Dec;7(12):2814–7. 4. HMHP. Ethics: The American Heritage Dictionary: [Internet]. [cited 2019 Aug 17]. Available from: https://ahdictionary.com/ 5. International council of nurses. The ICN code of ethics for nurses. International council of nurses [Internet]. 2012 [cited 2019 Aug 17]. Available from: https://www.icn.ch 29  Informed consent Outlines:  Introduction  Definition  Types of consent  Basic Elements of Informed Consent  Key information requirement:  Components of informed consent.  Informed Consent, The Right to Refuse Treatment  Children and Consent  Clinical Trials and Research  Informed Consent Guidance  Formats of informed consent 30 31 Objectives At the end of the lecture student will be able to :  Define informed consent.  Differentiate types of consent.  Determine basic elements of informed consent.  List key information requirement.  List components of informed consent.  Explore informed consent, the right to refuse treatment  Show informed consent with children.  Suggest clinical trials and research.  Design informed consent guidance  Show formats of informed consent 32  Introduction Informed consent is one of the primary principles on which the framework of protections for human subjects in research is built. In the United States, informed consent was codified in law via the statutes at the Code of Federal Regulations, yet the intellectual scaffolding on which it has been built over time has shifted, just as the landscape of human subjects research itself has changed. The main purpose of the informed consent process is to protect the patient. A consent form is a legal document that ensures an ongoing communication process between you and your health care provider. Definition Informed consent is a process in which a person learns. key facts about a clinical trial, including potential risks and. benefits, before deciding whether or not to participate in. a study Informed consent: The process by which a patient learns about and understands the purpose, benefits, and potential risks of a medical or surgical intervention, including clinical trials, and then agrees to receive the treatment or participate in the trial. Informed consent generally requires the patient or responsible party to sign a statement confirming that they understand the risks and benefits of the procedure or treatment. What are the 4 types of consent? 1. Implied consent. 2. Express consent. 33  3. Informed consent. 4. Unanimous consent. Basic Elements of Informed Consent  Description of Clinical Investigation.  Risks and Discomforts....  Benefits....  Alternative Procedures or Treatments....  Confidentiality....  Compensation and Medical Treatment in Event of Injury....  Contacts....  Voluntary Participation. Key information requirement: (1) The fact that consent is being sought for research and that participation is voluntary. (2) The purposes of the research, the expected duration of the prospective subject's participation, and the procedures to be followed in the research; (3) The reasonably foreseeable risks or discomforts to the prospective subject; (4) The benefits to the prospective subject or to others that may reasonably be expected from the research; and (5) Appropriate alternative procedures or courses of treatments, if any, that might be advantageous to the prospective subject 34 Components of informed 1. Decision capacity. 2. Documentation of consent. 3. Disclosure. 4. Competency.  Doctors will give you information about a particular treatment or test in order for you to decide whether or not you wish to undergo a treatment or test. This process of understanding the risks and benefits of treatment is known as in  The most common exceptions are these: o An emergency in which medical care is needed immediately to prevent serious or irreversible harm o Incompetence in which someone is unable to give permission (or to refuse permission) for testing or treatment Decision-Making Capacity Decision-making capacity is often referred to by the legal term competency. It is one of the most important components of informed consent. Decision-making capacity is not black and white. You may have the capacity to make some decisions, but not others. The components of decision-making capacity are as follows:  The ability to understand the options  The ability to understand the consequences of choosing each of the options  The ability to evaluate the personal cost and benefit of each of the consequences and relate them to your own set of values and priorities 35  If you are not able to do all of the components, family members, court-appointed guardians, or others (as determined by state law) may act as "surrogate decision- makers" and make decisions for you. To have decision-making capacity does not mean that you, as the patient, will always make "good" decisions, or decisions that your doctor agrees with. Likewise, making a "bad" decision does not mean that you, as a patient, are "incompetent" or do not have decision-making capacity. Decision-making capacity, or competency, simply means that you can understand and explain the options, their implications, and give a rational reason why you would decide on a particular option instead of the others. Disclosure In order for you to give your informed consent for treatment or tests, the doctor or health care provider must give (or disclose) to you enough information so that you can make an informed decision. It is not necessary or expected that you would receive every detail of the test, treatment, or procedure. You need only the information that would be expected by a reasonable person to make an intelligent decision. This information should include the risks and likelihood (or probability) of each of the risks and the benefits, and likelihood (or probability) of benefit. Any questions you have should be fully explained, in language and terminology that you can understand. The information disclosed should include:  The condition/disorder/disease that the patient is having/suffering from  Necessity for further testing  Natural course of the condition and possible complications 36  Consequences of non-treatment  Treatment options available  Potential risks and benefits of treatment options  Duration and approximate cost of treatment  Expected outcome  Follow-up required Documentation of Consent For many tests and procedures, such as routine blood tests, X-rays, and splints or casts, consent is implied. No written documentation of the consent process is obtained. For many invasive tests or for treatments with significant risk, you should be given a written consent form and a verbal explanation, both preferably in your native language. The following components should be discussed and included in the written consent form. If they are not, you should request that information:  An explanation of the medical condition that warrants the test, procedure, or treatment  An explanation of the purpose and benefits of the proposed test, procedure, or treatment  An explanation or description of the proposed test, procedure, or treatment, including possible complications or adverse events  A description of alternative treatments, procedures, or tests, if any, and their relative benefits and risks  A discussion of the consequences of not accepting the test, procedure, or treatment 37 The consent form should be signed and dated both by the doctor and by you, as the patient. You would sign for your child. You may ask for a copy of the signed consent form. Competency Competency is a legal term used to indicate that a person has the ability to make and be held accountable for their decisions. The term is often used loosely in medicine to indicate whether a person has decision-making capacity, as described previously. Technically, a person can only be declared "incompetent" by a court of law. Informed Consent, The Right to Refuse Treatment Except for legally authorized involuntary treatment, patients who are legally competent to make medical decisions and who are judged by health care providers to have decision-making capacity have the legal and moral right to refuse any or all treatment. This is true even if the patient chooses to make a "bad decision" that may result in serious disability or even death:  To document that you have been given the option of obtaining a recommended treatment or test and have chosen not to, you may be asked to sign an Against Medical Advice (AMA) form to protect the health care provider from legal liability for not providing the disputed treatment. Refusing a test, treatment, or procedure does not necessarily mean that you are refusing all care. The next best treatment should always be offered to anyone who refuses the recommended care.  If, because of intoxication, injury, illness, emotional stress,or other reason, a healthcare provider decides that a patient does not have decision-making capacity, the patient may not be able to refuse treatment. The law presumes that the average reasonable person would consent to treatment in most emergencies to prevent permanent disability or death. 38   Advance directives and living wills are documents that you can complete before an emergency occurs. These legal documents direct doctors and other healthcare providers as to what specific treatments you want, or do not want, should illness or injury prevent you from having decision-making capacity. Children and Consent The concept of informed consent has little direct application in children. Although minors may have appropriate decision-making capacity, they usually do not have the legal empowerment to give informed consent. Therefore, parents or other surrogate decision-makers may give informed permission for diagnosis and treatment of a child, preferably with the assent of the child whenever possible.  In most cases, parents are assumed to act in the best interest of their child. But circumstances may occur where there is a conflict between what the parents and the health care providers feel is in the best interest. State laws cover some of these areas of potential dispute, for example, in cases of suspected child abuse.  Other disagreements in care may result in court orders that specify what treatment should occur (for example, blood transfusions), or in the court-ordered appointment of a guardian to make medical decisions for the child.  Most states have laws that designate certain minors as emancipated and entitled to the full rights of adults, including children in these situations: o Self-supporting and/or not living at home o Married o Pregnant or a parent o In the military o Declared emancipated by a court  Most states also give decision-making authority to otherwise un emancipated minors with decision-making capacity (mature minors) who are seeking 39 treatment for certain medical conditions, such as drug or alcohol abuse, pregnancy, or sexually transmitted diseases. Informed Consent Guidance – How to Prepare a Readable Consent Form The JHM IRB recommends that the reading level of the informed consent document should be no higher than an 8th grade level. The IRB recognizes that some consent forms are of such a technical nature that it may not be possible to keep to an 8th grade reading level. The investigator may discuss with the OHSR Consent Form Specialists problems she/he has in trying to keep consent text at a low reading level. To test the level and clarity of the consent form, we suggest that you: a) read the form out loud to colleagues/staff and test it on a target audience; and b) use the word processing tool available to check grade level. [For Microsoft Word, (1) on the “File” tab, click the “Options” button; (2) on the “Proofing” tab, under “When correcting spelling and grammar in Word”, make sure “Check grammar with spelling” is selected; (3) under “When correcting spelling and grammar in Word”, select the “Show readability statistics” check box. After the grammar check is complete, Word displays a message box showing you the readability grade-level ] Drafting tips for preparing consent forms:  Use words familiar to the non-medical reader.  If possible, keep words to 3 syllables or fewer. 40  Write short, simple, and direct sentences. Divide sentences into two when necessary.  Keep paragraphs short and limited to one idea.  Use active verbs.  Use the second person (you) not third person (the participant) to increase personal identification.  Avoid contractions.  Use page numbers on protocol, consent and any other documents.  Use at least 12-point font and consider a larger font based on your audience.  Check the text to see if each idea is clear and logically sequential.  Highlight important points; use underline, bold, boxes rather than italics or all caps.  Avoid repetition.  Avoid large blocks of printed text.  Use photos, graphics or tables if they will help clarify procedures.  Be consistent with use of all terminology, such as drug names and abbreviations.  Brand names of drugs or devices must be capitalized and include either the trademark or registered symbol the first time the drug name is mentioned.  Generic drug or device names are lowercase.  Use the appropriate abbreviation the first time a drug name is used in the consent. 41   Abbreviations such as DNA, HIV and AIDS that have come to be accepted as standard by your proposed study population need not be spelled out.  Do not use e.g. or etc., use instead, "for example," "so forth."  Spell out acronyms when first used.  In general, do not use capital letters (all CAPS) or bold items  Formats of informed consent CONSENT I have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost. I understand that I will be given a copy of this consent form. I voluntarily agree to take part in this study. Participant's signature ______________________________ Date __________ Investigator's signature _____________________________ Date __________ References Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 5th edn. Oxford: Oxford University Press; 2001. [Google Scholar] 2. Madhava Menon NR. Medical ethics and health care - issues and perspectives. Karnataka Med J. 2000;71:2–9. [Google Scholar] 42  Law in nursing Out lines: ▪ Introduction ▪ Definition ▪ Relevance to healthcare ▪ Criminal and civil law ▪ Primary sources of law ▪ Secondary law ▪ Statutory instruments ▪ Parliament's role ▪ Affirmative procedure ▪ Negative procedure ▪ Sources of law ▪ Stages of making laws 43  Objectives 1. Define the term law. 2. Determine relevance to healthcare 3. Know criminal and civil law 4. List primary sources of law 5. List secondary law 6. Discuss statutory instruments 7. Determine parliament's role 8. Analyze affirmative procedure 9. Analyze negative procedure 10. Design diagram show sources of law 11.List stages of making laws  38881003 : ‫واتس اب‬  ‫ البريد اإللكتروني‬: [email protected]  ‫شارع الشيخ دعيج – القضيبية – مملكة البحرين‬  54040.‫ب‬.‫ص‬  ‫إضغط لالشتراك بخدمة الواتساب‬ 44 ‫ة‬Introduction It is necessary for nurse to study law and ethics. The reality is that law is now fundamental to the study of nursing and underpins your relationship with the profession and with your patients. The law informs nursing at every stage and it is essential that you understand and are able to critically reflect on the legal issues relevant to nursing practice. As a registered nurse you will be legally and professionally accountable for your actions, irrespective of whether you are following the instruction of another or using your own initiative. Healthcare litigation is growing and patients are increasingly prepared to assert their legal rights. In accordance with an ethical and legal framework that ensures the primacy of patient and client interest. Definition of law: A typical dictionary would define law as: A rule enacted or customary in a community and recognized as commanding or forbidding certain actions. Positive rules 10 Positive rules impose a legal obligation to do or refrain from doing something. If a positive rule is breached, a sanction may be imposed for breaking the law. 13 Normative rules 16 Normative rules set out what a person should do, or what they should refrain from doing. Note the word should – the individual is not compelled to abide by normative rules, they simply ought to. Normative rules are based on values that highlight a desired form of conduct but they do not carry legal force. 1 2 45 Relevance to healthcare In healthcare we see a drawing together of normative and positive rules. The law imposes a minimum standard of acceptable care and behavior on you as a registered nurse. Patients, however, deserve the highest possible standard of care and behavior, so the health and social care organization where you work and the profession, through The Code (2008), will require a standard that is higher than the law expects. In a clear drawing together of both normative and positive rules, it requires that as a registered nurse you: Respect the patient or client as an individual. Obtain consent before you give any treatment or care. Protect confidential information. Cooperate with others in the team. Maintain your professional knowledge and competence. Be trustworthy; Act to identify and minimize risk to patients and clients. Criminal and civil law The same unlawful action can be dealt with in different ways by the law. For example, touching a person without permission – that is, without consent – can be both a crime and a tort – a civil wrong. The crime would be charged under the Offences Against the Person Act 1861. This very old statute is still very much in force today and forbids many forms of unlawful touching, such as actual bodily harm (section 47), wounding (sections 18 and 20), or even procuring a miscarriage (section 58). 46 A crime is an act that is capable of being followed by criminal proceedings and with an outcome, an acquittal or a conviction that is criminal in nature. Unlawful touching can also be pursued through the civil courts as the tort of trespass to the person. The law of tort is primarily concerned with providing a remedy, by way of compensation, to persons who have been harmed by the conduct of others. Primary sources of law Although there are many textbooks and periodicals that discuss legal issues in nursing, it is best whenever possible to study the primary legal material as well. This will give you a detailed understanding of the law as it relates to nursing. Primary sources are the actual laws and rules issued by governing bodies that tell us what we can and cannot do. The four primary sources are 1- Constitutions 2- Statutes 3- Cases 4- Regulations. These laws and rules are issued by official bodies from the three branches of government Secondary law Is law created by ministers (or other bodies) under powers given to them by an Act of Parliament. It is used to fill in the details of Acts (primary legislation). These details provide practical measures that enable the law to be enforced and operate in daily life. Secondary legislation can be used to set the date for when provisions of an Act will come into effect as law, or to amend existing laws. 47 For example, governments often use secondary legislation to ban new substances in response to new information about their dangers by adding them to a list under the Misuse of Drugs Act 1971. Statutory instruments Statutory Instruments (SIs) are documents drafted by a government department to make changes to the law. They are published with an explanatory memorandum, which outlines the purpose of the SI and why the change is necessary. SIs are the most frequently used type of secondary legislation, with approximately 3,500 made each year, although only about 1,000 need to be considered by Parliament. Parliament's role Parliament can either approve or reject an SI, but cannot amend it. Parliament's role in considering an SI varies depending on what is stated in its parent Act. The Joint Committee on Statutory Instruments (JCSI) checks SIs to make sure the law they contain is clear and follows the powers given by the parent Act. If the JCSI identifies an issue, they publish recommendations on the SI. In the House of Lords, affirmative SIs cannot be debated before the JCSI make their recommendations. The JCSI generally only takes evidence from the government department who wrote the SI. They can consider submissions from the public but only on points of law. If an SI deals with financial matters it is only considered by the members of the committee from the Commons (Select Committee on Statutory Instruments). How Parliament considers SIs depends on whether they follow the negative or affirmative procedure, which is outlined in the parent Act. 48 Members of the public cannot table a motion to object to or stop an SI. They must contact a member of either House and ask them to do it. Affirmative procedure Draft affirmative is laid in parliament need to be approved by parliament before they can be made (signed into law) and brought into effect as law. Most SIs subject to this procedure must be debated and approved by both Houses. Some SIs dealing with tax or financial matters only need approval from the House of Commons. Draft affirmative SIs can be stopped if either House votes against or rejects the Government's motion calling for the SI to be approved. In the House of Lords, Members may propose an amendment to the Government's motion, formally stating that the House declines to approve the instrument. For example, the House of Lords debated an amendment to the Government's motion seeking approval of the draft Legal Aid, Sentencing and Punishment of Offenders Act 2012 (amendment of Schedule 1) Order 2012. The amendment said that the House declined to approve the instrument, and gave reasons for the disagreement. This amendment was agreed to in a vote. As the House of Lords had not approved the instrument, it could not then become law. In an emergency, certain Acts can allow the government to use the made affirmative procedure. This brings an SI into effect immediately and gives Parliament a set time to approve it (normally 28 or 40 days). It stops being law if Parliament does not approve the SI within that time. 49 This emergency procedure is only allowed by a few Acts when it's important for the government to make changes quickly. For example, to stop an outbreak of foot and mouth disease or to ban a terrorist organisation. About 20% of SIs are laid under the affirmative procedure. Negative procedure Negative SIs do not need active approval by Parliament. Usually negative SIs are made (signed by the minister) before being laid in Parliament. They will automatically come into effect as law unless either House stops (annuls) them within a fixed period after they have been laid - usually 40 days, excluding days when both Houses are in recess or adjourned for more than four days. The motion to annul is called a prayer motion. It is more likely for negative SIs to be debated in the House of Lords. Though, they can be debated in the House of Commons if there is significant opposition to them. A successful motion to stop the SI is rare. The House of Commons last did this in 1979 and the House of Lords in 2000. 50  8 Sources of Law Types of law  Constitution  Legislation  Administrative Law  Common Law Stages of making laws 1proposal stage The draft law is submitted by the government to the House of Representatives, or the House of Representatives submits a (proposal of a law) and is referred to the government to put it in the form of a (draft law) and refer it to the House of Representatives. The House of Representatives' office shall include the project on the agenda of the first following session of the House of Representatives. 51  2Parliament voting stage for study The House of Representatives shall vote to refer the draft law to the relevant committee for study and to the Legislative and Legal Affairs Committee for its comments. 3Discussion stage The specialized committee submits its report with the opinion of the Legislative and Legal Affairs Committee to the Council for discussion and vote. When voting “No” (rejecting the project) When voting “Yes”, the project is referred to the Shura Council with the decision of the House of Representatives on it. 4Approval and ratification stage In the event that the Shura Council approves the opinion of the House of Representatives on the draft, it is referred to the government to submit it to His Majesty the King to issue it. But if the two councils disagree on the draft law twice, the National Assembly meets, and for its approval, a majority vote of the members present is required. References Hanson, S (2009) Legal Method, Skills and Reasoning, 3rd edn. London: Routledge-Cavendish. Holland, J and Webb, J (2006) Learning Legal Rules: A student’s guide to legal method and reasoning. London: Blackstone Press. To understand health law in context it is useful to have an understanding of health policy and the following can be recommended. Crinson, I (2008) Health Policy: A critical perspective. London: Sage. Ham, C (2009) Health Policy in Britain, 6th edn. London: Palgrave Macmillan3 52  Legal issues in nursing Out lines  Introduction  Definitions  Purpose to study legal aspect in nursing  Legal liability in nursing:  Legal issues in nursing practice area.  Legal responsibilities of nurses.  How should nurses protect themselves when faced with unsafe working conditions?  How can nurses protect themselves from litigation 53 Objectives At the end of this lecture the student will be able to  Define legal issues  List purpose to study legal aspect in nursing  Determine legal liability in nursing:  Show legal issues in nursing practice area.  List legal responsibilities of nurses.  Determine should nurses protect themselves when faced with unsafe working conditions.  List how can nurses protect themselves from litigation. 54 Introduction Nurses are highly vulnerable to facing ethical and legal issues as they deal with human life and death. Moreover, the accusation of malpractice and negligence is rising every day in health sector. Nurses are at risk of falling into a legal disaster while working with a patient. As a nurse it has become absolute necessity to be aware of ethical and legal aspects associated with the management of patients. Nurses are the largest group of health professionals directly involved in patient care. They deal with human life events as birth, death, illness, and well-being thus their working environment consists of ethical and legal constraints The image of any organization depends upon the behaviour of people who constitute it. So, there is great obligation on the part of employees to behave in an ethical way at the work place.  Legal standards: Some things are right or wrong by laws  Nursing ethics A standard for professional behaviour. A guide to identify our conduct in relation to:  Patients.  Fellow nurses.  Health care team.  Our community.  Our profession. Meaning The word law is derived from an Anglo-Saxon term meaning that which is laid down or fixed. 55  Law is a body of rules of conduct inherent in human nature and essential to human society and guide human functions. Purpose to study legal aspect in nursing 1. Safeguarding the public:  The public safety is guaranteed  The individual is secure to the event of sickness or disability with no fear of anxiety of being cared for by a competent person.  It protects the patients /clients against deliberate injury by a nurse.  Safe guarding the nurse:  It protects the nurses also against the legal action if she renders right care.  Good rapport Legal liability in nursing: Unintentional torts: These types of torts are accidents that cause injury to another person or property.  NEGLIGENCE: Nursing negligence usually means failure by the nurse to take the appropriate action to protect the patient from harm. E.g.: Burns, falls, medication errors, failure to observe, use of defective equipment’s, loss of patient property, patient mix up.  MALPRACTICE: Medical malpractice is an act by a health care provider which deviates from accepted standards of practice in the medical community and which cause injury to the patient. 56  ELEMENTS OF MALPRACTICE  DUTY- (relationship) nurse’s responsibility to provide care in an acceptable manner.  BREACH OF DUTY- failed to provide care in acceptable manner.  INJURY (DAMAGES)- nurses act caused harm.  Leaving foreign objects like sponge or forceps, inside a patient during surgery.  Failing to assess and observe patient as directed.  Failing to report a change in a patient’s condition such as vital signs, circulatory status and level of consciousness.  Failure to select appropriate site by the nurse to administer intramuscular injection that causes permanent damage to patient’s extremity.  Falling to obtain an informed consent.. INTENTIONAL TORTS: These types of torts are deliberate actions in which the intent is cause injury to a person or property.  ASSAULT: Assault is the threat of unlawful touching of another, the wilful attempt to harm someone. Assault can be verbally threatening a patient.  BATTERY: Battery is the unlawful touching of another without consent or justification. In legal medicine battery occurs if a medical or surgical procedure is performed without patient consent.  QUASI INTENTIONAL TORTS: 57  It is usually involving situations of communication and often violates a person’s reputation, personal privacy or civil rights.  Defamation : It is the issuance of a false statement about another person which causes that person to suffer harm. (the action of damaging the good reputation of someone)  Fraud: Fraud is a crime or offence of deliberately mislead another in order to damage another to obtain property or services and a civil law violation.  Invasion of privacy: Clients have claims for invasion of privacy, e.g. their private affairs, with which the public has no concern, have been publicized. Legal issues in nursing practice area.  Patients property  Caring patients with AIDs  Living wills and health care surrogates  Deaths and dying  Autopsy and organ donation Legal responsibilities of nurses.. A administrative and supervisory level Appointing and assigning the nurses Quality control Material management Proper documentation system 58  Staff management At operational level  Carrying out physician’s orders  Alert for mishap  Maintaining safe environment  Use of safe equipment's  Maintenance of proper records  OTHER ISSUES PATIENT CARE ISSUES  Nursing shortage  Low salaries  Standard care MANAGEMENT ISSUES  Turnover  Funding  Workload  Issues regarding malpractice in nursing management  Issues of delegation and supervision  Issues related to staffing  Collaboration issues  EMPLOYMENT ISSUES 1. Issues related to nursing shortage 2. Issues in nurse migration 3. The right to work and right to practice 59  4. Exploitation and discrimination 5. Misconduct and imposition of punishment 6. Sexual harassment at the workplace 7. Renewal of nursing registration 8. Specialization in clinical area 9. Nursing care standards Examples of behaviors for which nurses are legally responsible Due to the intimate nature of the relationship between nurses and clients, nurses are legally responsible in many ways. Some clients may interpret a nurse’s touching as false imprisonment when clients wrongfully believe they cannot leave a place. The use of physical restraints might be construed as battery or false imprisonment. Nurses may not reveal confidential information, go through a client’s belongings, or photograph a client without permission. Nurses can be charged with defamation if they communicate information (libel if in writing and slander if verbal) to a third party that causes damage to someone else’s reputation. Nurses can be accused of fraud when they deliberately practice deception to produce unlawful gain. Nurses are also responsible for proper use of controlled substances, such as narcotics, depressants, stimulants, and hallucinogens, and for reporting colleagues who are impaired to nursing administration in a confidential manner. Nurses are legally responsible for client safety, particularly for failure to monitor client status, medication errors, falls, and the use of restraints. 60 How should nurses protect themselves when faced with unsafe working conditions? Nurses who are faced with unsafe working conditions should 1. Prioritize the care that is needed, 2. Receive orientation to those areas, 3. Document any information pertinent to safety issues. How can nurses protect themselves from litigation? Nurses can protect themselves from litigation by (1) following institutional policies, procedures, and protocols; (2) filing incident reports; (3) keeping clients informed and listening to what they say; (4) educating clients on their care; (5) charting as soon as possible and with accuracy; (6) meeting client‘s needs on a timely basis, (7) maintaining clinical knowledge and skills; (8) using appropriate standards of care. Reference. http://www.delmarlearning.com/companions/content/0766838366/students/ch8/f aq.asp 61  Nurses’ right and responsibilities Out lines Out lines  Introduction  Definitions  Essential responsibilities for nurses  Nurses’ rights.  Importance of nurses’ right  Composition of Nurses’ rights  Human and civil rights,  Rights based on health care legislation,  Rights based on professional ethics  Nurses’ earned rights 62 Objectives At the end of this lecture the student will be able to  Define nurse and all categories  List essential responsibilities for nurses  Explain nurses’ rights.  List importance of nurses’ right  Differentiate between composition of Nurses’ rights  Describe human and civil rights,  Describe rights based on health care legislation,  Describe rights based on professional ethics  Describe nurses’ earned rights 63 Introduction Nurses’ duties and patients’ rights have been important foci in nursing. Nurses’ rights legitimate the power and responsibility of the profession. As nurses go about their daily practice, they cite factors in the workplace that make it difficult for them to do their jobs, or to feel safe and respected as professionals. Nurses play an important role in providing care for patients to help manage their physical needs, treat health conditions and prevent illnesses. As highly trained members of the medical team, most nurses have a broad skill set and a wide range of responsibilities that can vary from one patient to the next. If you are starting your career as a nurse or looking to become one, understanding what nurses are responsible for may benefit you. Definition of the nurse A nurse is a medical professional who provides general patient care and triage. Nurses usually work with a team of other medical professionals, such as physicians and other healthcare specialists Nurses can work in a wide variety of environments, including  Hospitals  Clinics  Doctors' offices  Schools  Correctional facilities  Homeless shelters  Rehabilitation centers  Senior care homes Nurses may also hold different levels of certification, including:  Registered nurse (RN): These nurses assist doctors and other medical professionals by providing hands-on care for patients. They also manage and maintain medical records. 64   Nurse practitioner (NP): In this role, nurses often diagnose and treat minor conditions and injuries. They may also provide prescriptions to their patients.  Certified nurse midwife (CNM): These nurses provide gynecological and obstetrics services for women. They may work in hospitals, birthing clinics or private residences.  Clinical nurse specialist (CNS): In this role, nurses can treat both mental and physical conditions. They often work in clinics, hospitals, senior care homes, community health centers or independent practices.  Certified registered nurse anesthetist (CRNA): These nurses administer sedation treatments to patients to alleviate pain or prepare them for surgery. Essential responsibilities for nurses A nurse's responsibilities may vary depending on where they work, what licenses they have obtained and how experienced they are. Here are 13 of the most common tasks nurses are responsible for: 1. Recording medical history and symptoms Nurses record and maintain accurate documentation of their patients' health to ensure they receive the proper treatment. Most nurses begin this process by asking patients questions about their medical history to gather information about previous diagnoses and surgeries, current medications, allergies and relevant family medical information. They may also ask the patient questions about any symptoms they are currently experiencing and record their vitals. If the patient receives a new diagnosis, medication or treatment plan during their visit, a nurse may be responsible for updating their medical record with this 65 information. Maintaining detailed and accurate medical records is critical for ensuring patients receive the best possible care. 2. Administering medications and treatments Most nurses can administer medications and treatments to their patients with a physician's order. They can also help develop a treatment plan for their patients. Specialized nurses, such as nurse practitioners, may be able to prescribe medications without a doctor's approval. Some treatments nurses may help with include cleaning and dressing wounds, changing bandages and inserting catheters. Nurses may also assist doctors with more advanced procedures or administer emergency care to patients in critical condition. 3. Collaborating with teams for patient care Nurses play a vital role in collecting information from patients and sharing it with the rest of their medical team. Because this is such a key responsibility for those in the nursing profession, nurses must have excellent verbal and written communication skills to effectively collaborate with physicians and other healthcare providers. Clear, concise communication can also ensure that patients and their family members understand all of the information they receive. 4. Performing diagnostic tests Nurses may perform a wide variety of diagnostic tests, including checking vitals and collecting tissue, blood, stool or urine samples for analysis. It is important for nurses to pay close attention to detail to ensure these tests are administered properly because they need this information to diagnose patients and develop treatment plans. 66 Nurses may also be responsible for analyzing the results and sharing what they find with the rest of their medical team. 5. Conducting physical examinations Nurses often conduct a physical examination of patients at the beginning of their visit to assess their overall health. This may involve taking the patient's temperature, recording their weight, monitoring their heartbeat and checking their blood pressure. This examination may also include testing the patient's reflexes, checking their lymph nodes and examining their eyes, ears, nose and throat. The physical examination provides nurses and the rest of the medical team with a current update on the patient's health and an opportunity to talk to patients about their health goals and concerns. 6. Monitoring patients' health Nurses must carefully monitor and observe their patients to record any symptoms or relevant information that could lead to a diagnosis or a change in their treatment plan. This may involve carefully checking patient records to ensure the correct medications and dosages are listed, maintaining intravenous (IV) lines to ensure they are changed regularly and monitoring the patient's vital signs. Nurses must also pay close attention to nonverbal cues from their patients to help them identify underlying causes for their health-related issues. 7. Providing support and advice to patients It is important to make sure patients feel cared for, listened to and understood, especially when nurses need to deliver challenging medical news. Patients often look to nurses for support and advice to help them process their diagnoses and 67 determine what steps they should take next. Nurses who are empathetic toward patients and their family members can provide comfort and guidance during these situations. They may also equip their patients with effective coping strategies or provide them with inpatient and outpatient resources. 8. Operating medical equipment Nurses use a wide variety of diagnostic tools to care for their patients, including stethoscopes, glucometers, pulse oximeters, thermometers and blood pressure machines. Depending on where they work and what licenses they hold, nurses may also be trained to operate more specialized machinery, such as intravenous infusion pumps, ventilation equipment and wound drainage systems. Having a strong background in technology and mathematics can help nurses properly operate medical equipment and analyze the results. 9. Educating patients about how to manage an illness Part of a nurse's role is to educate their patients about various medical conditions and provide clear instructions on how they can manage their symptoms. This could include explaining what medications the patient needs to take, when the patient should schedule a follow-up appointment and instructions for rehabilitative exercises or practices. Nurses may also be responsible for explaining additional post-treatment home care needs to a patient's family or caregiver. This can include recommendations for the patient's diet and nutrition, exercise routine and physical therapy. Some nurses may also proactively educate people about common diseases by speaking at seminars, helping with blood drives or offering their services at health screening. 68 10. Advocating for the health and well-being of patients In order to properly care for their patients and ensure their safety, nurses may often act as advocates for their health and overall well-being. This can involve translating the medical information or diagnosis a doctor provides to ensure the patient understands the important details, encouraging patients to ask questions or connecting patients with resources at another facility that's better suited for their needs. Nurses can also advocate for their patients by taking the time to actively listen to their concerns, respecting their wishes and communicating what the patient wants with their family or other staff members. 11. Providing basic bedside care Nurses may be responsible for a wide range of basic bedside care tasks, depending on their particular working environment. These tasks can include helping patients bathe, use the bathroom and perform other hygiene-related activities. Bedside nurses also offer their patients emotional support, administer medications and track their vitals. 12. Training and educating staff In addition to the clinical work they do to take care of patients, qualified nurses with an appropriate amount of experience may help train and supervise newer members of their medical team, including practical nurses and nurses' aides. Some nurses may even work with nursing students by offering training courses through a local college or providing continuing education programs for nurses looking to advance in their careers. 13. Maintaining inventory 69 Experienced nurses may take on extra job roles, such as maintaining inventory and ordering supplies. This is often a shared responsibility, but tenured nurses may supervise entire departments. Making sure supplies are properly organized, accounted for and restocked on time can help ensure the medical team has all of the resources they need to provide quality care for their patients. Nurses’ rights. First, they are part of ethics and legislation on a general health policy level.  The issues here include the status of nurses in society,  their duties and rights,  the goal of healthcare. Second, they are part of the ethics of managing nursing services:  how nurses’ work is organized  how their duties and tasks are defined. Third, they are linked to the question of professional nursing ethics (i.e. nursing as a profession in relation to other health care professions), as well as to the status of patients. Fourth , questions of nurses’ rights are part of clinical nursing ethics: Does the Bill of Rights offer nurses any protections at work? The Bill of Rights is a statement of professional rights, not a legal document. It can help guide development of organizational policy or focus discussions between nurses and employers regarding employment contracts and work agreements. Use the Bill of Rights to work through problems at work 70 As nurses approach employers with patient care or health and safety concerns in the workplace, nationally-recognized consensus documents can lend credibility to their discussions. Importance of nurses’ right Rights provide freedom and power to make decisions about one’s own affairs in relation to other people or society.10 In addition, the question of which rights are important and which are not vary from time to time. Composition of Nurses’ rights  Human and civil rights,  Rights based on health care legislation,  Rights based on professional ethics,  Earned rights. Nurses’ human and civil rights Human and civil rights are the foundation of nurses’ rights. They are close to each other in terms of their content. A salient difference is related to their source: human rights are based on international documents presenting the norms of human rights, whereas civil rights are based on the national constitution and laws of each country. Human rights are ethical by nature. They apply to all people and protect them from political, juridical and social mistreatment.1,23 Human rights aim to ensure that every person has inherent value and uniqueness, as demonstrated by the basic elements of human rights: freedom, equality, justice and impartiality. Civil rights 71 are based on the national constitution of each country. They are the basic legal rights a person must enjoy. They can be divided into o Personal liberty rights, o political rights and freedom, o Rights of equality, o Economic, o Social and o Cultural rights. Nurses’ rights based on health care legislation The focus of health care legislation is on patients, but nurses also have legislation- based rights. These vary from country to country, and there is little research on such nurses’ rights across countries. From this point of view it is important to open up these national legal starting points to international discussion about nurses’ rights based on health care legislation. This section of this article opens up these rights from the point of view of Finnish health care legislation, in which nurses’ rights are divided into three main categories: (1) the right to practice the nursing profession; (2) rights pertaining to nurses’ employment contract; (3) rights concerning the safety of working conditions. First, the right to practice the nursing profession refers, for example, to the right to use an occupational title and serve people using health care facilities. Nurses have the right to confine their right to practice their profession, or abolish or call off their professional license. 72 Second, according to Finnish legislation, nurses have the right to a written or an oral contract of employment and to compliance with that contract. They have the right to break their contract, and also rights about giving notice, temporary dismissal, and working schedules (holidays, free time, family leave). Third, Finnish nurses have rights to personal safety while at work and a healthy working environment. This includes plans to ensure a safe working environment, the right to participate in such planning, and the possibility of using the proper tools for the work if needed. They also have the right to work without any harassment or unequal treatment. Nurses have the right to attend to the rights of their profession, working environment and benefits. They can promote these both personally and as authorized professional representatives. The powerful status of patients is a good starting point for developing nursing practice. However, this has an impact on nurses’ status and their rights. Patients are increasingly aware of their rights, so nurses need to be prepared to advocate themselves, even from a juridical point of view. Nurses’ rights based on professional rights In addition to legal rights, nurses have rights based on professional ethics, which can be understood as a tool for ethical consideration, as guidelines for nursing practice, and as pertaining to their political significance. Nurses’ earned rights The fourth source of nurses’ rights is earned rights, which are both legal and ethical by nature. Earned rights do not belong to all nurses. They are for nurses who are committed to professional ethics and have adequate qualification to enjoy these rights. Earned rights are not the privilege of every nurse; nor are they expectations concerning 73 behavior or rules imposed by other professions or society. Earned rights are accumulated through education and work experience. If a nurse is not worthy of them, they can be taken away, either juridically or institutionally, officially by enforcement or unofficially by colleagues or patients. References 1. Griffith R, Tengnah C. Law and professional issues in nursing. Exeter: Learning Matters, 2008. 2. Elder R, Price J, Williams G. Difference in ethical attitudes between registered nurses and medical students. Nurs Ethics 2003;10: 149–61. 3. Tzeng HM. SARS infection control in Taiwan: investigation of nurses’ professional obligation. Outcomes Manag 2003; 7: 186–93. 74  Patient rights and responsibilities Out lines  Introduction  Definition  Importance of patient right  Patient’ rights  Children and Adolescents  Patient Responsibilities 75 Objectives At the end of this lecture the student will be able to  Define patient rights  List importance of patient right  Discuss patient’ rights  Determine rights in children and adolescents  List patient responsibilities 76 Introduction. The members of healthcare team have an important role in implementation and protection of patient’s rights. Contemporary nursing entails an ethical responsibility to advocate and protect the patients’ rights. Patient rights are a subset of human rights. Whereas the concept of human rights refers to minimum standards for the ways persons can expect to be treated by others, the concept of ethics refers to customary standards for the ways persons should treat others. As such, rights and ethics are usually flip sides of the same coin, and behind every ‘patient right’ is one or more ethical principle from which that right is derived. Definition A set of rights, responsibilities, and duties under which individuals seek and receive health care services. Refer to the human rights to which patients are entitled while they are in the care of health services It refers to rights that are secured by international agreements, laws, and other legislation, which are granted entirely on the basis of the humanity of individuals who require health services Importance of patient right  Helps standardize care across healthcare fields  Enables patients to have uniform expectations during their treatment.  To empower people to take an active role in improving their health  Gives patients the right to make decisions about themselves 77 Patient’ rights 1. A patient has the right to respectful care given by competent workers. 2. A patient has the right to know the names and the jobs of his or her caregivers. 3. A patient has the right to privacy with respect to his or her medical condition. A patient’s care and treatment will be discussed only with those who need to know. 4. A patient has the right to have his or her medical records treated as confidential and read only by people with a need to know. Information about a patient will be released only with permission from the patient or as required by law. 5. A patient has the right to request amendments to and obtain information on disclosures of his or her health information, in accordance with law and regulation. 6. A patient has the right to know what facility rules and regulations apply to his or her conduct as a patient. 7. A patient has the right to have emergency procedures done without unnecessary delay. 8. A patient has the right to good quality care and high professional standards that are continually maintained and reviewed. 9. A patient has the right to make informed decisions regarding his or her care and has the right to include family members in those decisions. 10.A patient has the right to information from his or her doctor in order to make informed decisions about his or her care. This means that patients will be given information about their diagnosis, prognosis, and different treatment choices. This information will be given in terms that the patient can understand. This may not be possible in an emergency. 78 11.A patient given the option to participate in research studies has the right to complete information and may refuse to participate in the program. A patient who chooses to participate has the right to stop at any time. Any refusal to participate in a research program will not affect the patient’s access to care. 12.A patient has the right to refuse any drugs, treatment or procedures to the extent permitted by law after hearing the medical consequences of refusing the drug, treatment or procedure. 13.A patient has the right to have help getting another doctor’s opinion at his or her request and expense. 14.A patient has the right to care without regard to race, color, religion, disability, sex, sexual orientation, national origin, or source of payment. 15.A patient has the right to be given information in a manner that he or she can understand. A patient who does not speak English, or is hearing or speech impaired, has the right to an interpreter, when possible. 16.Upon request, a patient has the right to access all information contained in the patient’s medical records within a reasonable timeframe. This access may be restricted by the patient’s doctor only for sound medical reasons. A patient has the right to have information in the medical record explained to him or her. 17.A patient has the right not to be awakened by staff unless it is medically necessary. 18.A patient has the right to be free from needless duplication of medical and nursing procedures. 19.A patient has the right to treatment that avoids unnecessary discomfort. 20.A patient has the right to be transferred to another facility only after care and arrangements have been made and the patient has been given complete information about the hospital’s obligations under law. 79 21.A patient has the right to a copy of his or her bills. A patient also has the right to have the bill explained. 22.A patient has the right to request help in finding ways to pay his or her medical bills. 23.A patient has the right to help in planning for his or her discharge so that he or she will know about continuing health care needs after discharge and how to meet them. 24.A patient has the right to access people or agencies to act on the patient’s behalf or to protect the patient’s right under law. A patient has the right to have protective services contacted when he or she or the patient’s family members are concerned about safety. 25.A patient has the right to be informed of his or her rights at the earliest possible time in the course of his or her treatment. 26.A patient has the right to make advance directives (such as a living will, health care power of attorney and advance instruction for mental health treatment) and to have those directives followed to the extent permitted by law. 27.A patient has the right to personal privacy and to receive care in a safe and secure setting. 28.A Medicare patient has the right to appeal decisions about his or her care to a local Medicare Review Board. The Facility will provide the name, address, and phone number of the local Medicare Review Board and information about filing an appeal. 29.A patient has the right to be free from all forms of abuse or harassment. 30.A patient has the right to be free from the use of seclusion and restraint, unless medically authorized by the physician. Restraints and seclusion will be used only as a last resort and in the least restrictive manner possible to protect the 80  patient or others from harm and will be removed or ended at the earliest possible time. 31.A patient has the right to designate visitors who shall receive the same visitation privileges as the patient’s immediate family members, regardless of whether the visitors are legally related to the patient. 32.A patient has the right to pastoral care and other spiritual services. 33.A patient has the right to be involved in resolving dilemmas about care decisions. 34.A patient has the right to have his or her complaints about care resolved. 35.A patient and his or her family have the right to request assistance from the Nash Hospitals, Inc ad hoc ethics committee for ethical issues, such as starting or stopping treatments to keep patients alive, differences of opinion or when advance directives cannot be honored. 36.The patient has the right to appropriate pain management. 37.A patient has the right to be free from financial exploitation by the health care facility. Children and Adolescents 1. The family/guardian of a child or adolescent patient has the right and responsibility to be involved in decisions about the care of the child. A child or adolescent has the right to have his or her wishes considered in the decision- making as limited by law. 2. A child or adolescent patient has the right to expect that care and the physical environment will be appropriate to his or her age, size, and needs. 3. A child or adolescent patient whose treatment requires a long absence from school has the right to education services. These services will be arranged with the local school system. 81 Patient Responsibilities 1. Patients are responsible for providing correct and complete information about their health and past medical history. 2. Patients are responsible for reporting changes in their general health condition, symptoms, or allergies to the responsible caregiver. 3. Patients are responsible for reporting if they do not understand the planned treatment or their part in the plan. 4. Patients are responsible for following the recommended treatment plan they have agreed to, including instruction from nurses and other health personnel. 5. Patients are responsible for keeping appointments. 6. Patients are responsible for treating others with respect. 7. Patients are responsible for following facility rules regarding smoking, noise, and use of electrical equipment. 8. Patients are responsible for what happens if they refuse the planned treatment. 9. Patients are responsible for paying for their care. 10.Patients are responsible for respecting the property and rights of others. 11.Patients are responsible for assisting in the control of noise and the number of visitors in their rooms 12.References Onal G. Rights of patients in prison. In: Ulman YI, Gul TB, Kadıoglu FG, Yıldırım G, Edisan Z, editors. Expanding Medical Ethics to Bioethics. Ankara: Turkish Bioethics Association Publications; 2009. pp. 248–55 HHS.gov Office for Civil Rights online complaint form 82  Workplace violence