Ethics, Values, and Legal Accountability Flashcards
Ethics and Nursing
- Frequently encountered in the nursing role
- Central to the nursing profession
- Inter-professional input is important
- Nurses are patient advocates
Ethics and Nursing cont’d
- Ethical knowledge is necessary for professional competence
- Studying ethics helps improved decision-making skills
- Ethical reasoning is necessary for nursing credibility
- Ethical proficiency is essential for holistic care
Sources of Moral and Ethical Problems in Nursing
- Increased consumer awareness
- Technological advances
- Multicultural population
- Cost containment
Sources of Moral and Ethical Problems in Nursing cont’d
- Nurses’ ethical problems
- Nursing’s unique position in healthcare organizations
- Nature of the nursing profession
Ethical Frameworks
- Consequentialism (Utilitarianism)
- Deontology (Categorical Imperative)
- Feminist Ethics
- Ethics of Caring
Ethical Concepts and Principles
- Autonomy
- Nonmaleficence
- Beneficence
- Fidelity
- Veracity
- Justice
Common Ethical Issues in Healthcare
- Abortion
- Informed Consent
- Advanced Directives
- Organ transplantation
- Allocation of healthcare goods and services
- Reproductive technologies
- Confidentiality and privacy
- Withdrawing life-sustaining measures
Professional Guidelines for Ethical Decision Making
- ANA Code of Ethics
- ICN Code of Ethics for Nurses
- ANA Standards of Care
- The Patient Care Partnership
- TJC Accreditation Standards
Professional Guidelines for Ethical Decision Making
- ANA Code of Ethics
- ICN Code of Ethics for Nurses
- ANA Standards of Care
- The Patient Care Partnership
- TJC Accreditation Standards
How To Work Through Ethical Decisions…
M - Massage the dilemma O - Outline the options R - Resolve the dilemma A - Act by applying the chosen option L - Look back and evaluate
Nursing and Legal Accountability
The basic function of laws is to protect society by establishing acceptable patterns and behaviors
Derivates of Law
Constitutional
Statutory
Administrative
Common
Federal Laws Guiding Nursing Practice
- Bill of Rights
- HIPAA
- Health Information Technology for Economic and Clinical Health Act (HITECH)
- Emergency Medical Treatment and Active Labor Act (EMTALA)
- Patient Self-Determination Act
- ADA
State Laws Guiding Nursing Practice
- Mandatory reporting laws
- Good Samaritan laws
- State Nurse Practice Acts
Other Guidelines for Nursing Practice
- Institutional policies and procedures
- ANA Code of Ethics
- ANA Bill of Rights
- ANA Standards of Practice
- Patient care partnership
Types of Law
- Criminal
- Civil
- Tort
Liability vs Malpractice
Proof of Malpractice
- 4 elements that must be present to prove malpractice:
- existence of a duty
- breach of a duty
- causation
- damages
Common Nursing Malpractice Claims
- Failure to Assess and Diagnose
- Failure to Plan
- Failure to Implement a Plan of Care
- Failure to Evaluate
Minimizing Your Malpractice Risk
- Practice proper documentation
- Observe standards of practice
- Use the nursing process
- Avoid medication and treatment errors
- Report and document accurately (incident reports; charting = FACTUAL)
- Obtain informed consent
- Attend to client safety
- Avoid use of personal cellphones and social media in the workplace
Minimizing Your Malpractice Risk cont’d
- Maintain client confidentiality
- Provide education and counseling
- Delegate, assign, and supervise properly
- Accept appropriate assignments
- Participate in continuing education
- Observe professional boundaries
- Observe mandatory reporting regulations (impaired nurses; unauthorized practice; abuse and communicable diseases)
- Be aware of legal safeguards for nurses (Safe Harbor Laws; professional liability insurance)
The Tuskegee Syphilis Study of 1932
- A legal and ethical case against the United States Public Health Department
- Study began in 1932 and was projected to last 6 months
- Involved 600 Black men (399 positive for syphilis, 201 negative for syphilis)
- Participants were told they were being treated for “bad blood”
- Participants were given free medical exams, free meals, and burial insurance
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Are learned from external influences and communicated through various systems (e.g., religious, political, educational, societal)
Morals
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Is that which is consistent with customs or traditions based on the external influence (such as religious beliefs)
Moral behavior
?
Is the study of a system of moral principles and standards, or the process of using them to decide your conduct and actions
Ethics
?
Is a belief about the worth of something; serves as a principle or a standard that influences decision making
Value(s)
Values are ideals, beliefs, customs, modes of conduct, qualities, or goals that are highly prized or preferred by individuals, groups, or society
When situational constraints prevent nurses from acting on their moral decisions, moral ___ may occur
distress
- Moral distress can occur when nurses are unable to act as moral agents
Providers experience moral ___ when they perceive that others are behaving immorally
outrage
- Is similar to moral distress except that in cases of moral outrage, nurses do not participate in the act
- They don’t believe that they’re responsible for doing wrong, but that they’re powerless to prevent others from doing so
A ___ is a person who reveals information about practices of others that are perceived as wrong, fraudulent, corrupt, illegal, or a detriment to the health, safety, and welfare of the clients they serve
whistleblower
Moral Development Theorists
- Lawrence Kohlberg
* Carol Gilligan
Three-Stage Approach - Gilligan
- Caring for Oneself
- Caring for Others
- Caring for Self and Others
Stage ___
Moral reasoning is based on personal interest and avoiding punishment
I
Stage ___
Moral principles are based on universal and impartial principles of justice. This is the final level; it occurs in adulthood
III
Stage ___
Principles focus on pleasing others and following rules
II
In ___ theories, the rightness or wrongness of an action depends on the consequences of the act rather than on the act itself
consequentialist
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The most familiar consequentialist theory; asserts that the value of an action is determined by its usefulness
Utilitarianism
___ uses rules, principles, and standards to determine whether an action is right or wrong; consequences of the act are not the major considerations
Deontology
?
This principle, established by Kant, states that one should act only if the action is based on a principle that is universal - or in other words, if you believe that everyone should act in the same way in a similar situation
The Categorical Imperative
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Is based on the belief that traditional ethical models provide a mostly masculine perspective and that they devalue the moral experience of women
Feminist ethics
An ___ nursing philosophy directs attention to the specific situations of individual patients, viewed within the context of their life narrative;
- What is the story of this person’s life?
- What is going on right now in his life?
- And what does that have to do with the morality of the action I’m considering?
ethics-of-care
?
Refers to a person’s right to choose and ability to act on that choice; based on respect for human dignity
Autonomy
Autonomy incorporates ___ - the right of competent patients to decide whether to agree to a proposed treatment
informed consent
Principle of ___ is the twofold duty to (1) do no harm and to (2) prevent harm; encompasses actual harm, risk of harm and intentional and unintentional harm
- It requires that you think critically and identify the potential risks and benefits in the treatment plan; you should then analyze whether the treatment causes more harm than good
nonmaleficence
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Is the duty to do or promote good
beneficence
?
Is the duty to keep promises
Fidelity
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Is the duty to tell the truth
- Always consider the context
Veracity
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Is the duty to tell the truth
- Always consider the context
Veracity
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Is the obligation to be fair; implies equal treatment of all patients
Justice
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Is the obligation to be fair; implies equal treatment of all patients
Justice
ANA Code of Ethics
“establishes the ethical standard for the profession” and serves as a “guide for nurses to use in ethical analysis and decision making”
Has 9 provisions with interpretive statements
ICN Code of Ethics for Nurses
Code of Ethics for Nurses as a “guide for action based on social values and needs” and serves as the standard for nurses worldwide
ANA Standards of Care
Nursing: Scope and Standards of Practice
i.e. standard 7 focuses on ethical practice
The Patient Care Partnership
Patients are entitled to specific rights in terms of their treatment
Encourages healthcare providers to be more aware of the need to treat patients in an ethical manner and to protect their rights
The Joint Commission Accreditation Standards
Contain sections on organizational ethics and individual rights
Be a Patient Advocate
- You have special knowledge that the patient does not have
- Your professional role includes defending clients’ autonomous decisions
- You have a special relationship with patients
- Your role as an advocate is to inform, support, and communicate
- You should inform clients about advance directives
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Is one source of legal liability; means that a professional person has failed to act in a reasonable and prudent manner
Malpractice
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Means that person is financially or legally responsible for something
Liability
A ___ is a system of fundamental laws and principles that prescribes the nature, functions, and limits of a government
constitution
___ law refers to the laws that govern the activities of administrative systems
administrative
A ___ is a law passed by Congress or by a state legislative body
NPAs, are examples of this
statute; statutory law
A compilation of laws made by judges or courts is known as ___ law
common (Judicial)
?
Intent is to protect people who cannot protect themselves and to protect society against the spread of communicable diseases
Vary from state to state
Protect you when reporting abuse; if you fail to report, you can be charged with a criminal misdemeanor or be subject to disciplinary action
Duty to report takes priority over patient’s right to privacy
Mandatory Reporting Laws
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Are designed to protect from liability those who provide emergency care to someone who is in need of medical services
Vary from state to state
Good Samaritan Laws
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Are statutory laws passed by each state’s legislative body that define the practice of nursing
(State) Nurse Practice Acts
Other Guidelines for Practice
Institutional policies and procedures
- Usually are more specific and detailed than standards set by professional organizations
- Describe care that is reasonable, appropriate, and expected in the context of the facility
The ___ ___ describes the standards of professional responsibility for nurses and provides insight into ethical and acceptable behavior
ANA Code of Ethics for Nurses
The ___ ___ is a policy statement adopted by the ANA to identify the seven conditions that nurses should expect from their workplace that are necessary for sound professional practice
ANA Nurses’ Bill of Rights
The ANA ___ have 3 components:
- Professional standards of care
- Professional performance standards
- Practice guidelines
Standards of Practice
The ___ replaced the American Hospital Association’s Patient Bill of Rights
Explains expectations to patients during hospitalization
Patient Care Partnership (PCP)
___ law deals with wrongs or offenses against society
State or federal government brings charges against a person
Criminal
___ law involves a dispute between individuals or entities
Civil
___ law involves a written or oral agreement between 2 parties in which 1 party accepts an offer made by the other party to perform or not perform certain acts in exchange for something of value
i.e. employment contract
Contract
___ law deals with wrongs done to 1 person by another person that do not involve contracts
Tort
A ___ is a civil wrong and there are 3 types;
- quasi-intentional
- intentional
- unintentional
tort
___ involve actions that injure a person’s reputation; overall concept for these is defamation of character
Quasi-intentional torts
___ is the spoken or verbal form of defamation of character
Slander
___ is the written or published form of defamation of character
Libel
An ___ tort is an action taken by one person with the intent to harm another person; person must have merely intended to cause harm or known the action would bring about the harm
intentional
An ___ occurs when a nurse intentionally places a patient in immediate fear of personal violence or offensive contact
i.e. “I will slap you” and raises hand
assault
A ___ is committed when (1) an offensive or harmful physical contact is made to the client without his consent or (2) there is unauthorized touching of a person’s body by another person
- Always obtain informed consent before providing certain treatments
battery
An ___ occurs when there is the intent to cause a person fear combined with an offensive or harmful contact
assault and battery
What are my legal responsibilities as a nursing student?
- Prepare carefully for each clinical experience
- Never attempt a procedure or make a judgment about which you feel unsure; if you lack theoretical/practical knowledge, notify clinical instructor
- Notify instructor or staff nurse if patient’s condition changes significantly
- Unless otherwise arranged, take instructions only from clinical instructor
What does F-A-C-T-U-A-L stand for?
F - factual (and objective)
A - accurate
C - complete
T - timely
U - (always document) unusual occurrences
A - (document) assessment data
L - (the medical record is a) legal document
