1. Ethical and Legal Issues
Chapter 3
Ethical and Legal Issues
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Learning Objectives
State the differences among values, rights, and ethics.
Explain the purpose of the Patient Care Partnership.
List six steps for making ethical decisions.
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Learning Objectives
Identify the legal importance of practice acts.
Describe the process of involuntary psychiatric commitment.
Name four areas of potential legal liability for mental health care providers.
Know the difference between the legal terms negligence and malpractice.
Discuss three legal responsibilities that relate to nursing and health care providers.
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Values and Morals (p. 20)
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 between attitudes, beliefs, values, and morals.
Do you have values? Ask students to create a list of their values.
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Rights (p. 21)
A right is described as a power, privilege, or existence to which one has a just claim.
Rights help to 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’s Bill of Rights.
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Client’s Rights (p. 22)
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.
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7. Care Provider Rights (p. 22)
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?
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Ethics (p. 22)
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.
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9. Ethical Principles (p. 23)
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
Beneficence
Nonmaleficence
Justice
Fidelity
Veracity
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Codes of Ethics (p. 23)
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.
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Ethical Conflict (p. 23)
Ethical dilemmas exist when there is uncertainty or disagreement about the moral principles related to a course of action.
Ethical dilemmas 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 decision?
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?
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12. Laws and the Legal System (p. 23)
Laws are the controls by which a society governs itself.
Apply to every member of society
Created as a result of
Rules
Regulations
Morals
Ethical principles
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13. Public vs. Private Law (p. 24)
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
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14. Legal Concepts in Health Care (p. 25)
All health care professions are governed by standards and rules.
Nurse practice act
Institutional policies
Standards of practice
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?
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15. Laws and Mental Health Care (p. 25)
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
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16. Adult Psychiatric Admissions (pp. 25-26)
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
Clients may stay for days to years.
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?
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17. Areas of Potential Liability (pp. 26-27)
Care providers in mental health are faced with balancing client rights and the need to protect society.
The most common crimes in health care settings include homicide, controlled substance violations, and theft.
List the areas of legal liability for mental health care providers.
A client has refused evening medications. The nurse tells the client in a very loud and authoritative voice to take his medication immediately, or he will be forced to take it. Is this acceptable?
A client is walking up and down the halls of a nursing unit, shouting loudly and waving her arms. She is not threatening other clients. Can she be forcibly restrained?
A client’s mother calls a nurse and asks for detailed information about her son’s emotional and psychological state. Should the nurse give her any information? If so, how much? How should the nurse decide whether or not to give her information?
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18. Negligence and Malpractice (p. 27)
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?
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19. Responsibility of the Care Provider (pp. 27-28)
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.
List three responsibilities of health care providers.
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Question 1
Which of the following is something that is “held dear and represents a feeling about the worth of an item, idea, or behavior”?
Attitude
Moral
Value
Belief
Correct Answer: 3
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Question 2
The nurse is working in a hospital emergency room. A 55-year-old female alcoholic, who has been in a car accident, presents to the ER. She is legally intoxicated, and a child in the car that she hit has died. The nurse thinks about the family of the child, and despite her feelings, she decides to take care of the client. This is an example of which stage of value clarification?
Choosing
Prizing
Acting
Accepting
Correct Answer: 3
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Question 3
Health care practitioners have a legal responsibility to practice in all of the following ways except:
In a safe, competent manner
With accurate and objective record keeping
Within their legal limitations
Within a reasonable financial cost
Correct Answer: 4
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Question 4
The nurse has a client who always is agitated and tells people she is going to leave the institution. The nurse fails to keep a close watch on this client and fails to notify her supervisor. The client leaves the institution by escaping when no one is watching. This is called:
AWOL
Autonomy
Beneficence
Elopement
Correct Answer: 4
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Question 5
To be considered negligent, professional misconduct must meet four requirements. Which of the following is not one of the requirements?
The care provider owed a duty to the client.
The care provider did not carry out the duty.
The client was injured as a result of the care provider’s action or inaction.
The care provider gained a financial profit.
Correct Answer: 4
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