Ethics and Legal Standards Flashcards
- General codes of ethics
- *guide for a profession’s membership, social contract with public that it serves
- American Nurses Association (ANA) Code of Ethics for Nurses.
- International Council of Nurses (ICN) Code of Ethics
Nursing Codes of Ethics
- The right to self determination. This requires the nurse to be knowledgeable about the patients moral and legal rights.
- The nurses primary commitment is to the patient.
- The nurse promotes, advocates for and strives to protect the health, safety and rights of the patient both privacy and confidentiality.
- The nurse is responsible and accountable for their actions and judgements as an individual.
- The nurse owes the same duties to self as to others.
- The nurse’s goal is to create, promote, and maintain an ethical environment.
- The nurse participates in the advancement of the profession. (Get your bachelors degree)
- The nurse collaborates with other health professionals.
- The profession of nursing as represented by associations and their members is responsible for articulating nursing values.
ANA’s code of ethics for nurses
The nurse is asked to give a medication to a client that will terminate the clients pregnancy. The nurse is opposed to this method of abortion. The following strategy is the appropriate action of the nurse.
Have self-awareness of value and beliefs.
***Recognize that this is an ethical issue and encourage the client to discuss her feelings.
a mode of ending life in which the intent is to cause the patient’s death in a single act (also called mercy killing).
active euthanasia
the ending of life by the deliberate withholding of drugs or other life-sustaining treatment.
passive euthanasia
client or family gives consent
Voluntary euthanasia
against client and family’s wishes
Involuntary euthanasia
they make decisions and sign consents only when patient is not capable
Healthcare proxy
identified person to make decisions when patient becomes unable to speak for themselves.
Durable Power of attorney
- improves quality of life of clients, families,
- Physical, psychosocial, spiritual support
- Should be provided to all clients.
- Important for older adults with acute life-threatening illness
- For children with chronic disorder, should begin at time of dx.
- Allows dying clients to die with dignity.
Palliative Care
- Provides comfort care for clients in last phase of incurable disease
- End-of-life care at home, long-term care facility or hospital
- Added to Medicare program
- Routine visits to client’s home
- Continuous care available for client in crisis
Hospice Care
[palliative care]
- No CPR-No Code
- This is a physician’s order
- the decision is usually made between the patient and family
- States the clients wishes to withhold cardiopulmonary resuscitation (CPR)
- Only covers CPR it does not pertain to any other treatment
DNR#1
Patient will be treated as medically indicated, using therapies except those initiated to prevent cardiac or pulmonary arrest. If pulmonary or cardiac arrest happen, no efforts will be made to resuscitate.
- NO CPR
- Do not provide artificial ventilation
- Do not provide Dysrhythmia protocol
- Do not provide vasoactive agents
- Do not provide artificial nutrition via NG/PEG
- Do not provide artificial hydration via NG/PEG
- Do not provide blood or blood products
- Do not provide surgical/invasive procedures
- Do not perform dialysis
- Do not provide ABX
DNR #2
Pt will receive nursing and medical treatment necessary for hygiene and comfort. Provide treatments of comfort even if they contribute to cardiac or respiratory depression. Life sustaining therapies already initiated may be discontinued by written order. If cardiac or pulmonary arrest occurs, no efforts will be taken to resuscitate.
DNR #3
They have the right to:
- Be treated as a living human being until I die
- Maintain a sense of hopefulness
- Express my feelings and emotions about my approaching death in my own way
- Participate in decisions concerning my care
- Expect continuing medical and nursing attention even though cure goals must be changed to comfort goals.
The Dying Person’s Bill of Rights
I have the right to: Not die alone To be free from pain To have my questions answered honestly Not to be deceived To have help from and for my family in accepting my death To die in peace and with dignity
The Dying Person’s bill of rights
I have the right:
- To remain my individuality and not be judged for my decisions, which may be contrary to the beliefs of others.
- to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.
The dying person’s bill of rights
- Reasonable access to care
- Receive care that is considerate and to be respected for his/her personal values and beliefs
- To be informed and participate in decision making regarding their care.
- To have personal information secured, and confidential
- To designate decision maker if unable to do so for themselves
- To the hospital methods of informing the patient of these issues identified.
- to the hospital methods of education staff about patient rights and their roll in supporting those rights
- To access protective services
Patients Bill of Rights
Living patient
- High quality nursing care
- Respect and Non-discrimination
- A clean safe environment
- Involvement in their care
- Protection of their privacy
- Help when leaving the hospital (d/c home, health care needs)
- Help with billing claims (complaints and appeals)
Patients Bill of Rights
Living Patient
Pain and symptom management Hygiene care Therapeutic communication Clergy visit or religious rituals Family, friends
Nursing expectations
Client's pain level State of awareness -closed awareness -suspected awareness -mutual pretense awareness -open awareness Spiritual, emotional needs
Assess
Following a motor vehicle crash, the parents refuse to permit withdrawal of life support from their child, who has no apparent brain function. Although the nurse believes the child should be allowed to die and organ donation considered, the nurse supports their decision. Which moral principle provides the basis for the nurses action?
Respect for Autonomy
*When a patient wishes to donate and the family does not agree.
Some states have a law that mandates that a request for organ donation be made at the time of death.
Written consent and hospital policies/procedures must be followed.
There is no financial cost to the patient or their families.
Organ Donation
-Consent under Uniform Anatomical Gift Act
-Organ procurement and transplantation Network (OPTN): Delaware’s Organ Procurement Organization (OPO).
OPTN is a contracted service of the US Department of health and human services
Maintains the only national patient waiting list for organ transplantation.
Organ Procurement
- When the principle of beneficence is called into question.
- Medical care or treatment to a patient when there is no reasonable hope of a cure or benefit
- Care is never futile, but medical interventions sometimes are
Futility of Care
Formal mechanism for monitoring ethics. Written organizational code of conduct. Nursing leads professions viewed as honest and ethical. Daily ethical situations. -Behavior -Conflicts -Staffing issues Resources for ethical practice -Supportive colleagues, educators -Approachable responsible managers
Creating an ethical work environment
- Right to informed consent guaranteed by federal law
- States have additional laws protecting clients
- Healthcare facilities patient bill of rights
- ANA Standards of Practice, Code of Ethics
- Joint Commission standards for accreditation; speak up program.
Patient Rights & Organizational Ethics
- The systemic investigation into and study of materials and sources in order to establish facts and reach new conclusions.
- Currently there is a gap between theory and practice that results in inadequate patient/client care.
Research Legal/Ethics
-Problem identification: this is the first step in beginning research. Identify and describe the problem of interest.
-Literature review: This is a long process of reviewing.
Peer reviewed articles and other research topics that are the same or similar to the topic that is being researched.
-Research design: Here is where it is determined whether the study will be qualitative or quantitative approach will be used.
Research Process
- Data Collection and Analysis gathering of pertinent information that is relevant to the research question and analyzing the information.
- Research Dissemination: Getting the information out to the masses. Either getting the research published or for use within the facility for use by the staff.
Research Process cont.
EBP: is an interdisciplinary approach to clinical practice that has been gaining ground following its formal introduction in 1992.
*EBP: is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient.
Evidence Based Practice
- Institute revue board is required to evaluate and permit/deny permission for any experimental study to take place that involves human subjects.
- The National Research Act, passed in 1974, mandated that all federally funded proposed research with human subjects be approved by an institutional review board (IRB)-Tuskegee experiment and Standford prison experiment.
IRB (Institute Revue Board)
Assessments Change in condition Objective descriptions Statements Interventions use of safety devices/equipment Deviations or achievement of outcomes MD notifications Procedures Consultations Involvement of family/others Activities
What to document in chart
Gaps Bias Deviation from policy an procedure Safety/Security of information contained on/in computer Does not reflect patient needs No descriptions of events/situations that are out of the ordinary Content is incomplete/inconsistent Handwriting/signature is illegible
Documenting Pitfalls
Begin at start of each shift Document accurately Know the requirements for your facility Provide details about client condition Remember that it is a permanent record and all information within is confidential Document as soon as you provide care or make an observation Chart chronologically Date and time all notes Use a pen; blue or black Use a single line to mark out an error.
Documenting Do’s!!
