ethical and legal considerations yoost Flashcards
The study of ethics considers the
standards of moral conduct in a society
Personal ethics are influenced by
values, societal norms, and practices Family, friends, beliefs, education, culture, and socioeconomic
Beneficence can be defined as
doing good, considering the best interest of the patient
many nursing interventions are based on beneficence including
medicating for pain, providing vaccinations, and implementing fall prevention protocols
nonmaleficence is
avoidance of harm
The ethical principle of nonmaleficence is challenged most when health care professionals are involved in
end-of-life decisions
euthanasia is
the act of painlessly ending the life of another
euthanasia is illegal in the
united states
Autonomy is
freedom to make decisions supported by knowledge and self-confidence
Justice is
the obligation to act fairly and equitably to everyone regardless of income or power
The ethical principle of veracity is defined
the obligation to always be truthful
Keeping secrets from patients is in direct conflict with
the ethical principles of autonomy and veracity
Accountability is
the willingness to accept responsibility for one’s actions
Advocacy is
Supporting or promoting the interests of others or of a cause greater than oneself
Confidentiality is
ethical concept that limits sharing private patient information
Fidelity is
Keeping promises or agreements made with others
When a nurse acknowledges a patient’s request for pain medication, assesses the patient’s pain level and quality, and returns within a few minutes with the analgesic medication, the nurse is demonstrating the ethical concept of
A.Confidentiality
B.Responsibility
C.Fidelity
D.Advocacy
C.Fidelity
Responsibility is
concept of being dependable and reliable
two main ethical theories are
deontology and utilitarianism
deontology and utilitarianism are based on
rights, justice, and virtue
Deontology is
duty-based
Deontology focuses on
duty-based ethics
tenets of deontology
Meeting the needs of patients while maintaining their right to privacy, confidentiality, autonomy, and dignity
Kant’s assertion that moral rules were applicable to all people, all of the time and in every situation, is particularly challenging in
modern multicultural society
Utilitarianism focuses solely on
consequences and maintains that behaviors are determined to be right or wrong based on their outcome
The utilitarian concept of greatest happiness maintains that
the right action is one that brings the greatest happiness to the most people
phrase that expresses the essence of pure utilitarianism
The end justifies the means
utilitarianism views actions as
neither right nor wrong without knowing how they benefit the greater good or society
utilitarianism becomes challenging when
the individual rights of patients are inconsistent with the needs of society
Rights-based ethical theory focuses on
rights of the individual and does not always take into consideration the effects on society as a whole
Health care research is based on
the research participants
Justice-based ethics emphasizes
the ethical principle of justice
the ethical principle of justice states
that no individual person should have any advantage over another
Justice-based ethics is the underlying tenet of
organ transplantation list
example of Justice-based
having money or power does not give any one person an advantage over others on the list of organ transplant
Virtue-based ethics focuses on
personal traits of individuals rather than societal norms
code of ethics is
formalized statement that defines the values, morals, and standards guiding practice in a specific discipline or profession
The Code of Ethics for Nurses is
a succinct statement of the ethical values, obligations, duties, and professional ideals of nurses individually and collectively
Nurse educators are required to
advise and supervise their students
instill in students the values and professional standards of nursing
identify individual learning needs in the clinical setting and facilitate the educational process
faculty members share responsibility and accountability for the patient care provided by their students
professional nursing is a process of education and formation … that involves
the ongoing acquisition and development of the knowledge, skills, dispositions, practice experiences, commitment, relational maturity, and personal integrity essential for professional practice.
Student nurses are held to the same ethical standards as
professional nurses
National Student Nurses Association (NSNA) adopted the Code of Academic and Clinical Conduct, in which students agree to
promote the highest level of moral and ethical principles” and “promote an environment that respects human rights, values, and choice of cultural and spiritual beliefs
Student nurses and faculty members are expected to
demonstrate high ethical standards at all times—in the classroom, the laboratory, and clinical areas and during all electronic and interpersonal communication
If a peer is acting inappropriately, it is every ___________ responsibility to call the behavior to that __________ attention and solicit the help of a faculty member if the _________does not respond to peer intervention
student’s, student’s, student
Civility is
being polite and respectful
incivility according to the ANA
one or more rude, discourteous, or disrespectful actions that may or may not have a negative intent behind them
Students can successfully meet the professional standards expected by the Code of Ethics for Nurses by
attending class, laboratories, and clinical experiences regularly; seeking new learning experiences; studying and practicing skills; and actively applying ethical principles to patient care
hem.” Faculty members report student behaviors such as
s tardiness, inattentiveness (e.g., texting during class), disrespectful remarks, and more aggressive offenses
Students report being belittled or treated with disrespect by
clinical staff, instructors, or classmates
Bioethics is the study of
ethical and philosophical issues in biology and medicine
Bioethical dilemmas arise on a
consistent basis in health care
Genetic testing can assist in determining the likelihood of
Genetic disorders
results of genetic testing may indicate the existence or future development of
severely debilitating or fatal disorder or potential for development of a serious disease
CRISPR is
clustered regularly interspaced short palindromic repeats technology
Two major roles of a nurse caring for a dying patient are
(1) providing accurate information regarding the disease process and treatment options
(2) offering support for the patient and family without interjecting personal opinions.
(DNR) stands for
do-not-resuscitate
futile care
care that is useless and prolongs the time until death rather than restoring life
increased staffing of registered nurses (RNs) correlates with
better patient care outcomes and fewer preventable postoperative patient deaths
Registered Nurse Safe Staffing Act attempts to
address the issues of patient safety and responsible, professional nursing practice
Organ transplant lists are based on
the ethical principle of justice, resulting in transplants being available based on need rather than financial status.
some choose to obtain further education and experience in the field of bioethics and participate on institutional ethics committees along with
physicians, ethicists, attorneys, and academicians
Moral distress is
the anguish that health care professionals experience when their basic beliefs of what is right and wrong or ethical principles are challenged
Ethical dilemmas may lead to
moral distress for nurses
which act prevent sale of information without patient knowledge and help patient acquire electronic health records
(ARRA) American recovery and reinvestment act
who would cover the nurse if the institution didn’t cover nursing during a suit
The good samaritan law
The good samaritan law grants
immunity from suit if there is no gross negligence
the patient care partnership informs patient that they should expect
1 high quality hospital care
2 a clean and safe environment
3 involvement in their care
4 protection of there privacy
5 help when leaving hospital
6 help with there billing claims
whats moral resilience
a person’s capacity to sustain, restore, or deepen her or his ‘integrity in response to moral complexity, confusion, distress, or setbacks
There are four major sources of law
constitutional, statutory, regulatory, and case law
Constitutional Law is derived from and what does it do
a formal, written constitution that defines the powers of government and the responsibilities of its elected or appointed officials.
nurse practice act (NPA) defined
the scope of nursing practice in the state
regulatory law outlines
how the requirements of statutory law will be met
Nursing rules and regulations are categorized as
Regulatory Law
Judicial decisions from individual court cases determine
case laws
Types of Statutory Law
Criminal law
misdemeanor
felony
Civil law
Criminal law is
the body of state and federal laws written to prevent harm to the country, state, and individual citizens
Criminal laws define the nature of
specific crimes and the required punishment
misdemeanor is
crime of lesser consequence that is punishable by a fine or incarceration in a local or county jail for up to 1 year
A felony is
a more serious crime that results in the perpetrator being imprisoned in a state or federal facility for more than 1 year
examples of felonies
Practicing nursing without a license, child abuse, and illegal drug dealing
Civil law
governs unjust acts against individuals rather than federal or state crimes
Intentional torts are
wrongs committed by individuals who deliberately seek to injure or hurt another person
intentional torts include
assault, battery, defamation of character, false imprisonment, and invasion of privacy
Assault is
threat of bodily harm or violence caused by a demonstration of force by the perpetrator
Battery is
Actual physical harm caused to another person
Battery may involve
angry forceful touching of people their clothes or anything attached to them
example of battery
Performing a surgical procedure without informed consent
inserting an intravenous (IV) catheter or urinary catheter against the will of a patient, also may be classified as
battery
Defamation of character
public statement is made that is false and injurious to another person
Written forms of defamation of character are considered
libel
Broadcasting or reading statements aloud that have the potential to hurt the reputation of another person is considered
libel
Oral defamation of character is
slander
Slander is
spoken information that is untrue, causing prejudice against someone or jeopardizing that person’s reputation
Unauthorized restraint or detention of a person is considered
false imprisonment
Invasion of Privacy include
Public disclosure of private information, use of a person’s name or likeness without permission, intrusion into a person’s place of solitude, and meddling into another’s personal affairs
invasion of privacy is a
(HIPAA) violation
Unintentional Torts are
omissions or acts by individuals that cause unintended harm
unintentional torts of negligence and malpractice are charged when individuals, health care providers, or institutions fail to
act responsibly, causing injury to others
Negligence is
Creating a risk of harm to others by failing to do something that a reasonable person would ordinarily do or doing something that a reasonable person would ordinarily not
Malpractice is
negligence committed by a person functioning in a professional role
Malpractice may occur when a professional (such as a nurse) acts
unethically, demonstrates deficient skills, or fails to meet standards of care required for safe practice
which are four components that must exist to prove professional negligence (malpractice):
Duty
Dereliction
Damages
Direct cause
Duty
It must be proved that the nurse or other health care provider owed a duty of care to the accusing patient.
Dereliction
There must be evidence that the nurse’s actions did not meet the standard of care required or that care was totally omitted; this is known as a breach of the duty
Damages
Actual injury to the accusing patient must be evident
Direct cause
A causal relationship must be established between harm to the accusing patient and the actions or omitted acts of the nurse.
Good intentions are not a defense against
malpractice
Guidelines for Professional Nursing Practice Within Legal Boundaries
- Maintain confidentiality
- Follow legal and ethical guidelines when sharing information
- Document promptly and accurately
- Adhere to established institutional policies governing safety and procedures
- Comply with legal requirements for handling and disposing of controlled substances
- Meet licensure and continuing education requirements
- Practice responsibly within the scope of personal capabilities, professional experience, and education
Professional Liability Issues
Actions especially helpful in avoiding charges of malpractice include maintaining current professional practice knowledge and competent practice skills and maintaining professional relationships with patients and their families
Three professional liability issues of particular concern for nurses are
(1) professional practice conduct
(2) adherence to the Principles for Delegation established by the ANA and legally binding within each state’s nurse practice act
(3) accurate and timely documentation.
Professional Practice Conduct
Building and maintaining trusting relationships with patients and colleagues requires professional communication and competent practice
In all patient care situations, it is imperative that nurses recognize
their authority and take intentional steps to avoid misconduct
Boundary Issues That Violate Ethical and Legal Standards in Nursing
- Stealing a patient’s property
- Personally gaining at a patient’s expense, including accepting gifts
- Intervening in a patient’s personal relationships
- Making seductive or sexually disparaging statements
- Engaging in sexual conduct with a patient or patient’s family member
The National Council of State Boards of Nursing (NCSBN 2018b) recognizes specific nurse behaviors that indicate a potential for professional boundary violations, including the following
- Engaging in excessive self-disclosure of personal information to a patient
- Keeping secrets with a patient; limiting others from conversation and patient information
- Spending excessive amounts of time with one patient
- Acting as if a patient is a family member or close personal friend
- Failing to protect the patient from inappropriate sexual involvement with the nurse
Competent Practice
Nurses must remain current in their knowledge of nursing care and evidence-based practice
Most state NPAs require nurses to complete a certain number of hours of continuing education in order to renew their
nursing licensure
A nurse is also ethically bound to maintain practice competence under
Provision 3 of the Code of Ethics for Nurses
Nurses who engage in professional misconduct are subject to
legal and disciplinary action in their state or jurisdiction
The ANA (2021) defines bullying as
repeated, unwanted, harmful actions intended to humiliate, offend, and cause distress in the recipient
Workplace bullying occurs when
a nurse or other employee is belittled, constantly criticized, the target of gossip, or faced with unreasonable expectations, aggressive comments, or physical intimidation
Individuals may be bullied for reasons associated with their
sex, gender, age, socioeconomic status, culture, race, or work-related issues such as scheduling conflicts or professional jealousy
nursing practice misconduct may include illegally obtaining patient
medication (including narcotics) and engaging in drug abuse
Substance use disorder (SUD)
encompasses a pattern of behaviors that range from misuse to dependency or addiction, whether it is alcohol, legal drugs, or illegal drugs”
Nurses have an ethical and legal responsibility to report ________ suspected of alcohol or drug abuse
colleagues
Changes and Indications of Drug Diversion in Nurses With Substance Use Disorder
- Increased isolation from friends and colleagues
- Diminished job performance
- Increased number of mistakes, including medication administration errors
- Memory lapses, confusion, decreased level of alertness
- Absence from the nursing unit for extended periods of time
- Inaccurate narcotic counts that vary depending on the day and shift
- Repeated medication administration record corrections
- Volunteering to medicate the patients of colleagues for pain
Adherence to Principles of Delegation is
Appropriate delegation by RNs seeks to ensure patient safety and meet nursing standards of care
Accurate and Timely Documentation
Nurses are required to document patient information in written or electronic format. This documentation becomes the legal record of care provided by the nurse
Serious documentation errors include
(1) omitting documentation from patient records,
(2) recording assessment findings obtained by another nurse or unlicensed assistive personnel (UAP), and
(3) recording care not yet provided.
nurses need to be aware of their responsibilities in regard to
informed consent, patients’ rights, organ donation, advance directives, and DNR orders.
Patient’s Bill of Rights informs patients about
specific privileges of which they should be aware
Patient’s Bill of Rights informs patients
about specific privileges which are
(1) high-quality hospital care, (2) a clean and safe environment, (3) involvement in their care, (4) protection of their privacy, (5) help when leaving the hospital, and (6) help with their billing claims.
Patient Self-Determination Act, which requires health care providers to supply all patients with
written information regarding their rights to make medical decisions and implement advance directives
Advance directives consist of two types of documents
living wills and documents appointing a health care proxy, durable powers of attorney for health
Advance care planning is
ongoing process that involves personal reflection, information gathering, discussion with loved ones, decision-making, and documentation of individual choices
Living Will
specifies the treatment a person wants to receive when the patient is unconscious or no longer capable of making decisions independently
power of attorney is
legal document that allows a designated person to make legal and financial decisions on behalf of an individual unable or not permitted to make legal decisions independently.
DNR stands for
do not resuscitate
POLST stand for
Provider Orders for Life-Sustaining Treatment
Standards of care are
minimum requirements for providing safe nursing care
Documentation Required by HIPAA
protect patients’ privacy and personal information. It encompasses accessibility, privacy, security, and confidentiality.
The act makes provisions for verbal, written, and electronic information.
Health care providers of all disciplines and at all levels must remain current on the principles of this act through continuing education at their facility or an accredited educational institution
Civil and criminal penalties are set forth in the act for violation of any provision of the act
Provision 3 of the American Nurses Association Code of Ethics specifically addresses the nurse’s responsibility for protecting the patient’s right to privacy and confidentiality
Privacy is the right to control access to, and disclosure or nondisclosure of, information pertaining to oneself and to control the circumstances, timing, and extent to which information is disclosed
Confidentiality pertains to the nondisclosure of personal information that has been communicated within the nurse–patient relationship
The nurse has the duty to maintain confidentiality of all patient information, both personal and clinical in the work setting and off duty in all venues including social media or any other means of communication
medically sound basis for declaring a person dead are
(1) all spontaneous respiratory and circulatory function stops or
(2) all brain function, including that of the brainstem, ends.
Brain death requirements are set by state laws but have three basic components
(1) the patient is completely unresponsive to painful stimuli
(2) the patient has no involuntary responses to brainstem stimuli, such as pupillary responses
(3) the patient has no spontaneous respirations when removed from a ventilator
MAID stand for
Medical aid in dying
Natural Death Acts allow competent patients to make
health care decisions that may result in their deaths
a living will is invoked only when the patient
is unconscious or unable to make decisions interdentally
the nurse should not document the assessment findings of another nurse because
it increases the chance of introducing errors and it is a violation of the law
quadriplegia is
paralyzed from neck and below
The consensus model address the need for all nurses to be
licensed, graduate from accredited nursing programs, achieve certification in their chosen specialty, and seek graduate education
building consensus is an act of
collective agreement on any given issue
ethic committees purposes
education, case consultation, policy recommendation
dominant values in American society on individual autonomy and self-determination is represented by
advance directive
who is responsible for informing the patient about surgery procedures and their risks
their surgeon
implied and informed consent are consents that are given by and why
patient or guardian in case of surgery or treatment
emancipated minor is
not under the legal control of parents or legal guardian and can make his own decisions with absence of an adult
the Americans with disabilities act provides
employment protection
if a patient tells the nurse the he uses drugs but asks the nurse to keep it confidential what should the nurse do
A. keep it confidential even if it affect the treatment
B. tell the health care provider if it affects the treatment
B. tell the health care provider if it affects the treatment
civil laws protects the ______ of individuals in the society and provide fair treatment in case of civil law violations
right
regulatory laws are
administrative laws and hence reflect decision made by administrative bodies when they pass rules
characteristics that illustrates an ethical problem
conflict of values
it has equally undesirable alterations
the situation is in conflict between personal choice and recommended treatment
what is mastectomy
Surgical removal of the breast tissue.
the professional nursing code of ethics includes
advocacy, responsibility, accountability, and confidentiality
which patient information if not charted can leat to malpractice lawsites
drug allergy
number of patient siblings
discontinued medications
history of cancer
illegible writing
drug allergy
discontinued medications
history of cancer
illegible writing
which information would be provided to guardian before consent can be given for a medical treatment
a compelet explanation of the prcedure or treatment
name and qualification of people preforming the care
a description of possible adverse effects or side effects of the treatment
dpahc can do the following
make health care decisions if patient is unable to comprehend information or communicate wishes
he is a person designated to make health care decisions according to the patient wishes
informed consent includes
must be signned while the patient is free from mind altering medications
may be withdrawn at any time
must be obtained by health care provider and not the nurse
organ donation information includes
prividing consent in written form
informing your family of your desire/ wishes
signing the organ donation form on the back of your license
living wills include
desire for organ donation
consent for performing an autopsy
preferences regarding the termination of ventilator treatment
