Chapter 10Ethical Issues in Health Care

Chapter 10 objectives 1. Define the word ethical. 2. Describe what is meant by individual, societal, and situational ethics. 3. Explain why a study of ethics and ethical behavior is important in nursing. 4. State the purposes of a code of ethics. 5. Explain personal responsibility and accountability as they relate to ethical behavior. 6. Apply guidelines for ethical decision making in your practice of nursing. 7. Participate in discussions regarding ethical issues in the work environment. 8. Outline the process for making decisions related to ethical dilemmas.

Study of right and wrong related to human conduct Ethics Study of right and wrong related to human conduct Knowledge of right and wrong related to: Individual Society Situation

Have the ability and obligation to help patients Nursing and Ethics Nurses Have the ability and obligation to help patients Internalize the concept of what it means to be a human being Accept personal responsibility for relationships Are obligated to do good and not harm Are committed to providing high quality care to all human beings

NFLPN and NAPNES (found in Appendix B & C) Nursing and Ethics Code of Ethics NFLPN and NAPNES (found in Appendix B & C) -will be more detailed in PVR 2 Purpose is to provide a list of rules of good conduct Attempt to describe the ideals of a group Identify standards of behavior

Personal Accountability Being responsible means to accept being the cause of an action Being accountable means to accept the consequences of the action

Unethical Behavior Failure to adhere to a code of ethics Failure to base practice on high ethical standards Disregard for basic human rights

Conflict or opposition between: Personal values Moral principles Laws Ethical Dilemmas Conflict or opposition between: Personal values Moral principles Laws Personal and professional obligations The rights of individuals and society No right or wrong answer Legal versus ethical problems

Ethical Issues in Nursing Dilemmas exists when there is the belief that appropriate and safe care cannot be provided Choosing between the employer's requirements and what the patient needs Staffing shortages Excessive paperwork and administrative tasks Cost containment measures Managed care Mandatory overtime

Ethical Issues in Nursing Risks to personal health and safety Other issues Right to refuse to assist with a procedure you believe is morally or ethically wrong Cannot refuse to provide nursing care for a patient

Question Is the following statement true or false? A moral dilemma exists when there is no right or wrong answer.

Answer True Rationale: The fact that there is no right or wrong answer is what makes it a dilemma.

Question Is the following statement true or false? Disregard for basic human rights is an ethical dilemma.

Answer False Rationale: Disregard for basic human rights is unethical behavior. There is no question that this is right or wrong. It is wrong behavior.

Chapter 11 Legally Responsible Nursing Practice

CHAPTER 11 OBJECTIVES 1. Discuss the purpose of Good Samaritan laws. 2. Discuss the relationship between the nurse practice acts and the state boards of nursing. 3. Explain the association among responsibility, accountability, and legal liability. 4. Define the term breach of contract. 5. Define the term tort. 6. Differentiate negligence and gross negligence. 7. Give examples of crimes that may involve nurses.

Legally Responsible Nursing Practice A nurse’s duty is to do good and to avoid harm in accordance with the law Laws are rules of conduct derived from: Cultural values Moral practices Ethical beliefs

Good Samaritan Statutes Protect people from prosecution who voluntarily aid others in an emergency Intend to encourage giving emergency care outside the hospital or health care facility Some states require people to help strangers in distress To act or not act is an ethical decision

This public law is in place in how many states? Discussion Topic #1 Search the Web for articles about Good Samaritan Laws. Answer the following questions: This public law is in place in how many states? If you begin to give emergency care, what is your obligation to continue? Can you be held liable if you don’t at least call for help? Are RNs and LP/VNs protected when giving emergency care away

Regulation of Nursing Practice Administrative Law—The Nurse Practice Act Defines legal functions, powers, and duties of the state board of nursing Enforces the Nurse Practice Act Holds disciplinary hearings Identifies membership of the board and how to become a board member Defines terms Includes laws governing licensure and legal titles

Responsibility and Liability Responsibility is being accountable for your actions Explain the action and accept any consequences Liability is the legal obligation to make good for the loss of, or damage to, something for which he or she is responsible. Nurses are personally and legally responsible for their nursing actions. Best protection against charges: Carry out duties at or above the standard expected

Standards of Care Guidelines to identify appropriate levels of professional care Rules and regulations defining care expected of professional and practical/vocational nurses Accrediting agencies and organizations develop standards of care Employer policy and procedure manuals

Legal Issues for Nurses Contracts An agreement between two or more parties Written or verbal promises with exchange of something of value -Breach of contract Failure to fulfill any or all parts of a contractual obligation Torts An injury or wrong committed by one person, group, or organization against another person, group, or organization (Strict liability, intentional, negligence)

The injured person seeks to prosecute Crime Torts vs. Crimes Tort The injured person seeks to prosecute Crime An offense committed against the public welfare or safety The state seeks to prosecute

Legal Issues For Nurses- ex. of torts False imprisonment-confining or restraining (verbally or physically) Violation of confidentiality-HIPPA, “shoptalk” Defamation of character-false or malicious (slander, libel) Violating informed consent-direct or implied (the patient clearly understands the alternatives) Assault/battery-threatening to touch/touching a person w/o permission Fraud-intentional deception Negligence/Gross Negligence-failure to do something or not to do something/human life endangered (criminal) DT #2

Discussion Topic #2 Determine if the following examples are torts or crimes. 1. Nurse threatens to give an injection when her patient refuses to take oral medication. 2. Nurse gives the injection despite the patient’s objection. 3. Taking photo of patients using your cell phone without their consent. 4. Nurse tells her patient that the doctor is incompetent. 5. Taking a dollar from a patient’s nightstand and buying a soda with it. 6. Fondling your patient’s body parts. DT #3

Discussion Topic #3 Think about the tort known as defamation of character. Discuss with your classmates what it means to talk about or to gossip about others. In your discussion determine whether or not you have ever committed the tort of defamation of character. Talk about how gossip and defamation of character affect personal and professional relationships.

Legal Issues for Nurses Documentation Patient’s medical record is a legal document Entries must be factual, to the point, accurate, legible, related to patient’s needs or plan of treatment, objective, consistent Use agency-approved abbreviations and chart- correction procedures Computer charting confidentiality

Legal Issues for Nurses Gifts Don’t accept gifts or money It is legal but not ethical to accept or solicit gifts

Crimes by Nurses Practicing without a license/practicing after failing to renew a license-felony felonies – serious criminal act, grounds for denying, suspending, or revoking a nurse’s license Right-to-die Violations of federal & state narcotic and controlled substance laws Fraud-falsifying patient bills Robbery-patient’s belongings Death, murder, patient abuse

Question Putting a person into his room, locking the wheelchair wheels and closing the door to keep him from annoying others is known as: A. Fraud B. False imprisonment C. Battery D. Violating informed consent

Answer B. False imprisonment Rationale: Confining a person to a room, locking the wheelchair locks to prevent the person from moving about is false imprisonment.

Question Is the following statement true or false? It is illegal for a nurse or any other health care provider to accept or solicit gifts from patients or families.

Answer False Rationale: It is legal but not ethical to accept or solicit gifts from patients or families.

Question Which of the following is true about documentation? A. It is not a legal document B. Never use abbreviations when charting C. When making an error, just cross it out so it is illegible D. Entries must be objective and consistent

Answer D. Entries must be objective and consistent Rationale: The patient’s medical record is a legal document. Use agency-approved abbreviations and chart correction Procedures.

Question Is the following statement true or false? Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.

Answer True Rationale: Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values. Q#1