ASN 180 Transition to Professional Nursing Objective 5

Objective 5. Examine the legal and ethical principles that impact the roles, interventions and outcomes of providing care. 5. Examine the legal and ethical principles that impact the roles, interventions and outcomes of providing care.

Legal Foundations of Nursing Sources of Law Sources of Law Public Law Public Law Statutory – enacted by legislation Statutory – enacted by legislation Administrative – appointed groups (state board) Administrative – appointed groups (state board) Criminal – offenses against public Criminal – offenses against public Felony - serious (>1 yr. punishment) Felony - serious (>1 yr. punishment) Misdemeanor – less serious (<1 yr. punishment) Misdemeanor – less serious (<1 yr. punishment) Civil Law – crimes against individuals Civil Law – crimes against individuals Contract Law – enforcement of agreements Contract Law – enforcement of agreements Tort Law – enforcement of duties and rights independent of contracts Tort Law – enforcement of duties and rights independent of contracts

Legal Foundations of Nursing The Judicial Process The Judicial Process Precedents – interpreting the law in a certain manner Precedents – interpreting the law in a certain manner Lower courts must adhere to the rulings of the higher courts in the same jurisdiction Lower courts must adhere to the rulings of the higher courts in the same jurisdiction Jurisprudence – “judge-made” law Jurisprudence – “judge-made” law

Legal Foundations of Nursing Legal Liability in Nursing Legal Liability in Nursing Liability – four elements: duty, breach of duty, injury, causation Liability – four elements: duty, breach of duty, injury, causation Negligence – failure of individual to provide care that a reasonable person would Negligence – failure of individual to provide care that a reasonable person would Malpractice – negligence of a professional person that does not meet standards Malpractice – negligence of a professional person that does not meet standards Expert witness – qualified third party Expert witness – qualified third party Testimony – factual reporting of written or verbal evidence Testimony – factual reporting of written or verbal evidence

Legal Foundations of Nursing Legal Liability in Nursing, cont. Legal Liability in Nursing, cont. Informed Consent Informed Consent Invasive Invasive Assault and Battery Assault and Battery Assault – intent to touch Assault – intent to touch Battery – touching of another person w/o consent Battery – touching of another person w/o consent False Imprisonment False Imprisonment Restrain and Seclusion (OBRA – 1987) Restrain and Seclusion (OBRA – 1987)

Legal Foundations of Nursing Legal Liability in Nursing, cont. Legal Liability in Nursing, cont. Privacy and Confidentiality Privacy and Confidentiality ANA code for Nurses ANA code for Nurses Health Insurance Portability and Accountability Act (HIPAA) Health Insurance Portability and Accountability Act (HIPAA) Defamation – damaging information communicated to a third-party Defamation – damaging information communicated to a third-party Libel – in writing Libel – in writing Slander - verbally Slander - verbally

Legal Foundations of Nursing Legal Liability in Nursing, cont. Legal Liability in Nursing, cont. Fraud – deliberate deception intended to produce unlawful gain Fraud – deliberate deception intended to produce unlawful gain Unprofessional Conduct Unprofessional Conduct Failure to use nursing judgment Failure to use nursing judgment Abuse of a client Abuse of a client Assuming duties without sufficient preparation Assuming duties without sufficient preparation Knowingly delegating nursing to UAP that puts client at risk Knowingly delegating nursing to UAP that puts client at risk Falsifying records Falsifying records Abandonment of patients Abandonment of patients

Legal Foundations of Nursing Legal Liability in Nursing, cont. Legal Liability in Nursing, cont. Use of Controlled Substances Use of Controlled Substances The Impaired Nurse – you have a duty to report to administration The Impaired Nurse – you have a duty to report to administration Safety Safety Failure to monitor client status Failure to monitor client status Medication errors Medication errors Falls Falls Use of restraints Use of restraints

Legal Foundations of Nursing Legal Liability in Nursing, cont. Legal Liability in Nursing, cont. Understaffing – must report to administration Understaffing – must report to administration Reassignment – “floating” – cannot refuse, but must not perform what you are not competent to do Reassignment – “floating” – cannot refuse, but must not perform what you are not competent to do Executing Prescribed Orders – must follow the orders unless the orders would result in client harm. Executing Prescribed Orders – must follow the orders unless the orders would result in client harm.

Legal Foundations of Nursing Legal Responsibilities and Roles Legal Responsibilities and Roles Provider of Service Provider of Service Expert Witness Expert Witness Forensic Specialist Forensic Specialist Client Educator Client Educator Reporting Responsibilities Reporting Responsibilities

Legal Foundations of Nursing Legal Safeguards for Nursing Practice Legal Safeguards for Nursing Practice Institutional Policies Institutional Policies Professional Liability Insurance Professional Liability Insurance Risk Management Programs Risk Management Programs Incident Reports Incident Reports

Legal Foundations of Nursing Legislation affecting Nursing Practice Legislation affecting Nursing Practice Patient Self-Determination Act Patient Self-Determination Act Living Will Living Will Durable power of Attorney (DPOA) Durable power of Attorney (DPOA) Advanced care medical directive Advanced care medical directive Roe v. Wade (1973) Roe v. Wade (1973) The American with Disabilities Act (1990) The American with Disabilities Act (1990) Good Samaritan Acts Good Samaritan Acts Health Care Quality Improvement Act (1986) Health Care Quality Improvement Act (1986) Occupational Safety and Health Act (1970) Occupational Safety and Health Act (1970)

Legal Foundations of Nursing Legal Issues Related to Death and Dying Legal Issues Related to Death and Dying Do Not Resuscitate Orders (DNR) Do Not Resuscitate Orders (DNR) Wills Wills Pronouncement of Death Pronouncement of Death Care of the Deceased Care of the Deceased Autopsies Autopsies Organ Donation Organ Donation

Ethical Foundations of Nursing Concept of Ethics Concept of Ethics Ethics – a branch of philosophy that examines the difference between right and wrong Ethics – a branch of philosophy that examines the difference between right and wrong Morality – behavior in accordance with custom or tradition and usually reflects personal or religious beliefs Morality – behavior in accordance with custom or tradition and usually reflects personal or religious beliefs Relationship between Legal and Ethical concepts – laws change, ethics reflect individual differences Relationship between Legal and Ethical concepts – laws change, ethics reflect individual differences Bioethics in Health Care – the application of general ethical principles to health care Bioethics in Health Care – the application of general ethical principles to health care

Ethical Foundations of Nursing Ethical Theories Ethical Theories Telology/consequentialist theory (Mill) – the value of a situation is determined by its consequences Telology/consequentialist theory (Mill) – the value of a situation is determined by its consequences Utility – an act must result in the greatest good for the greatest number of people Utility – an act must result in the greatest good for the greatest number of people Deontology/formalism (Kant) - considers the intrinsic significance of the act itself as the criterion for determination of good Deontology/formalism (Kant) - considers the intrinsic significance of the act itself as the criterion for determination of good Categorical imperative – a person should never be treated as a means to an end Categorical imperative – a person should never be treated as a means to an end

Ethical Foundations of Nursing Ethical Principles Ethical Principles Autonomy Autonomy Nonmaleficence Nonmaleficence Beneficence Beneficence Justice Justice Veracity Veracity Fidelity Fidelity

Ethical Foundations of Nursing Values and Ethics Values and Ethics Values – influence the development of beliefs and attitudes and thus affect behaviors indirectly Values – influence the development of beliefs and attitudes and thus affect behaviors indirectly Values Clarification – the process of analyzing one’s own values to better understand what is truly important. Values Clarification – the process of analyzing one’s own values to better understand what is truly important. Choosing Choosing Prizing Prizing Acting Acting

Ethical Foundations of Nursing Ethical Codes Ethical Codes Professional hallmark Professional hallmark International Council of Nurses (ICN) International Council of Nurses (ICN) American Nurses Association Code of Ethics American Nurses Association Code of Ethics Canadian Nurses Association Canadian Nurses Association

Ethical Foundations of Nursing Clients’ Rights Clients’ Rights PATIENT CARE PARTNERSHIP - American Hospital Association (AHA) 1972 revised in 2003 to be used in short-term acute care and extended care PATIENT CARE PARTNERSHIP - American Hospital Association (AHA) 1972 revised in 2003 to be used in short-term acute care and extended care Patient Rights include: Patient Rights include: The right to make decisions regarding their care The right to make decisions regarding their care Be actively involved in the treatment process Be actively involved in the treatment process Be treated with dignity and respect Be treated with dignity and respect

Ethical Foundations of Nursing Ethical Dilemmas - a conflict between two or more ethical principles Ethical Dilemmas - a conflict between two or more ethical principles Euthanasia – Gr. “gentle death” – mercy killing Euthanasia – Gr. “gentle death” – mercy killing Active – deliberate actions to hasten death Active – deliberate actions to hasten death Passive – omitting actions that would prolong dying Passive – omitting actions that would prolong dying Assisted suicide – healthcare professional provides client with the means to end their own life Assisted suicide – healthcare professional provides client with the means to end their own life Refusal of treatment – must be informed Refusal of treatment – must be informed Use of Scarce Resources – third-party payer denial, limited organs for donation Use of Scarce Resources – third-party payer denial, limited organs for donation

Ethical Foundations of Nursing Ethical Roles and Responsibilities of Professional Nurses – accountable for protecting the rights and interests of the client Ethical Roles and Responsibilities of Professional Nurses – accountable for protecting the rights and interests of the client Ethics Committees – institutional method to decide ethical dilemmas and make policy Ethics Committees – institutional method to decide ethical dilemmas and make policy Client Advocacy – nurses empower, educate, listen, act as liaison Client Advocacy – nurses empower, educate, listen, act as liaison Whistle-blowing – reporting unethical, illegal or incompetent actions of others Whistle-blowing – reporting unethical, illegal or incompetent actions of others

Ethical Foundations of Nursing Ethical Decision Making Ethical Decision Making Ethical Reasoning – thinking through what one ought to do in an orderly, systematic manner to provide justification of actions based on principles. Ethical Reasoning – thinking through what one ought to do in an orderly, systematic manner to provide justification of actions based on principles. Framework for Ethical Decision Making Framework for Ethical Decision Making ADPIE ADPIE

Steps for ethical analysis 1. Determine what type of ethical problem exists: principles vs. principles, actions vs. action, actions vs. principles 2. Who is most appropriate to make the decision? 3. Identify several possible alternatives and predict outcomes 4. Select course of action 5. Evaluate the resolution process.

Ethical Foundations of Nursing Practice using ADPIE to solve an ethical issue Practice using ADPIE to solve an ethical issue “A coworker often takes Tylenol from a client’s medication drawer. When you confront her about the behavior, she states; ‘It’s only Tylenol. Besides the patient’s not taking it anymore anyway.’ “ “A coworker often takes Tylenol from a client’s medication drawer. When you confront her about the behavior, she states; ‘It’s only Tylenol. Besides the patient’s not taking it anymore anyway.’ “ Should you blow the whistle? Why or why not? Should you blow the whistle? Why or why not? Would your response be different if your coworker were taking narcotics from the client? Would your response be different if your coworker were taking narcotics from the client?

Objective 5. Examine the legal and ethical principles that impact the roles, interventions and outcomes of providing care. 5. Examine the legal and ethical principles that impact the roles, interventions and outcomes of providing care.