Ethical and Legal Issues Chapter 3 Ethical and Legal Issues Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Values and Morals Attitudes are ideas that help shape our points of view. Can also describe one’s outlook Belief is a conviction that is intellectually accepted as true whether or not it is based in fact. Value is something that is held dear or a feeling about the worth of an item, idea, or behavior. Formed in childhood Morals reflect one’s attitudes, beliefs, and values. Not easily changed. Explain the differences among attitudes, beliefs, values, and morals. Do you have values? Ask students to create a list of their values. Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Values and Morals Children learn their morals from other in their environment. Preschoolers learn right from wrong; adopt family’s beliefs and traditions Children exposed to a variety of values Teens start to identify their own values Human values important in caregivers include a concern for welfare of others-altruism Equality, justice, truth, freedom, and acceptance Values clarification-step by step process to help identify values that have significance 3 steps: Choosing, prizing, and acting Be aware of your values and your client’s values Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. A right is described as a power, privilege, or existence to which one has a just claim. Rights help define social interactions because they contain the principle of justice; they equally and fairly apply to all citizens. Rights also are associated with obligations. Define a right. Describe points in the Patient Care Partnership. Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Client’s Rights The Patient’s Bill of Rights (1972) All clients have the rights to respectful care, privacy, confidentiality, continuity of care, and relevant information. Addresses clients’ rights to Examine their bills Refuse treatment Participate in research The Patient Care Partnership: Understanding Expectations, Rights, and Responsibilities was adopted in 2003. Federal legislation has established mental health parity laws-requiring insurance companies to include coverage for mental illness to be equal to coverage for physical illness Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Care Provider Rights The rights of nurses and other care providers relate to Respect Safety Competent assistance Care providers have the right to respect as individuals. Nurses have the right to full and equal participation as members of the health care team. All health care providers have the right to set standards for quality and develop policies that affect client care. Define care provider rights. What are your rights as a care provider? Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Ethics Ethics is a set of rules or values that govern right behavior. Ethics reflect Values Morals Principles of right and wrong The purpose of ethical behavior is to protect the rights of people Define ethics. Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Ethical Principles Ethical codes serve two purposes: Act as guidelines for standards of practice Let the public know what behaviors can be expected from their health care providers Ethical principles on which codes of ethics are based include the following: Autonomy-right to act for self and make own choices Beneficence-to do good Nonmaleficence-do no harm Justice-treated equally, fairly, and respectfully Confidentiality-duty to respect private information Fidelity-keeping one’s word Veracity-duty to tell the truth Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Codes of Ethics Have been developed by International Council of Nurses American Nurses Association National Federation of Licensed Practical Nurses Canadian Nurses Association Provide information to clients, be truthful, and support your clients, but consult your supervisor if any question of appropriateness arises. Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Ethical Conflict Ethical dilemmas exist when there is uncertainty or disagreement about the moral principles related to a course of action. arise when problems cannot easily be solved by decision-making, logic, or use of scientific data. List and describe the five steps in the ethical decision-making process. What is an example of an ethical dilemma? Who decides if ethical decisions have been made appropriately? Where should a nurse look for guidance in making ethical decisions? What should a nurse do if called on to perform a treatment or a therapy that he or she considers to be unethical? Copyright © 2017 by Elsevier Inc. All rights reserved.

Laws and the Legal System Laws are the controls by which a society governs itself. Apply to every member of society Based on the principles of Justice Change Standards Individual rights and responsibilities Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Public vs. Private Law Public law Focuses on the law between government and its citizens Protects the members of society Also known as criminal law Consists of misdemeanors and felonies Private law Focuses on the law between citizens and/or institutions Torts and contracts Also known as civil law 4 Criteria to Prove Negligence Duty to client Breach of duty Cause Injury Damage due to injury Copyright © 2017 by Elsevier Inc. All rights reserved.

Legal Concepts in Health Care All health care professions are governed by standards and rules. Nurse practice act/Scope of practice https://www.bon.texas.gov/practice_scope_of_practice_lvn.asp Institutional policies Policy-What needs to be done Procedure-How to perform Standards of practice-are developed by health care disciplines-they are there to evaluate the quality and effectiveness of care being provided Describe the legal importance of nurse practice acts. Compare nurse practice acts, institutional policies, and standards. Are there any similarities? What recourse does a nurse have if asked to do something that would violate a nurse practice act, or something outside the scope of practice? Copyright © 2017 by Elsevier Inc. All rights reserved.

Laws and Mental Health Care Client-caregiver relationship Caregiver and client enter into an implied contract of acceptance of service. Care providers are legally responsible for their professional obligations and behaviors Clients retain their legal rights upon entering the mental health care system Copyright © 2017 by Elsevier Inc. All rights reserved.

Adult Psychiatric Admissions When a client initiates the request for mental health services, it is considered a voluntary admission. Voluntarily admitted clients may legally discharge themselves at any time. Involuntary admission is a process for institutionalization initiated by someone other than the client. Involuntary psychiatric admissions provide a protected, therapeutic environment. Emergency admission-can be initiated by police, physicians or representatives of a county administrator Clients may stay for days to years. If committed for indefinitely case will need to be reviewed annually. Compare and contrast voluntary admission and involuntary admission. Describe the process for involuntary admission. What is the key point that is used to decide if an involuntary commitment is necessary? Can a person who has been involuntarily committed leave the hospital? Can a person who has been involuntarily committed refuse medication or treatment? Could there be a situation in which a client who has been involuntarily committed could be forced to accept treatment or medication? Can a person who has been involuntarily committed be physically restrained? Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved. Areas of Liability Homicide Murder Robbery, theft, larceny Defamation Libel-written Slander-verbal Assualt an Battery Invasion of privacy False imprisonment A medical order Need to remove restraints every 2 hours allow movement Need to assessed and monitored every 15 minutes Negligence Malpractice Copyright © 2017 by Elsevier Inc. All rights reserved.

Negligence and Malpractice Both negligence and malpractice are rooted in the “reasonable and prudent person” theory. Negligence Omission (or commission) of an act that a reasonable and prudent person would (or would not) do Malpractice Failure to exercise an accepted degree of professional skill that results in injury, loss, or damage Compare and contrast negligence with malpractice. A nurse has physically restrained a client only because keeping the client in one place makes it easier for her to organize her day. Is this false imprisonment? Could the nurse be negligent in this situation? A supervisor instructs the nursing assistant to give a client a bath. The hot water burns the client. Is the supervisor negligent? A physician orders a treatment that she wants done immediately. The nurse finds out that hospital policy requires that the client sign an informed consent form. If the nurse does not raise objections, is the nurse negligent? Copyright © 2017 by Elsevier Inc. All rights reserved.

Responsibility of the Care Provider Mental health care providers help clients cope with their problems. They provide dignified, humane treatment, which includes protection of rights as human beings, citizens, and clients. Informed consent Dr. responsibility to do, but nurse can assist Elopement Client runs away Duty to warn List three responsibilities of health care providers. Copyright © 2017 by Elsevier Inc. All rights reserved.

Responsibility of the Care Provider List three responsibilities of health care providers. Copyright © 2017 by Elsevier Inc. All rights reserved.

Copyright © 2017 by Elsevier Inc. All rights reserved.