1. CHAPTER 4 LEGAL AND ETHICAL PRINCIPLES
Scope of practice Confidential
Ethics Jurisprudent
Legal Liable
Libel Malpractice
Moral Negligence
Slander
Journal question: Why is confidentiality important to the patient

2. Chapter 4 Learning Objectives
Define at least 10 terms relating to legal and ethical principles.
Describe at least five examples of ethical behavior for the health care worker.
Identify at least five situations that show improper ethical or legal behavior.

3. Chapter 4 Learning Objectives
Explain the importance of confidentiality in health care, including privacy issues resulting from advanced technology.
Describe at least two examples of rights of the health care patient.

4. Chapter 4 Learning Objectives
Describe the role of the health care worker regarding current legal issues, including advance directives and telemedicine.

5. Professional Codes of Conduct
Health care workers must stay within a scope of practice.
Illegal and unethical to perform skills or tasks that are outside scope of practice
Limits of practice are established by each state.
Nurse Practice Acts
Laws that determine which tasks nurses may legally perform
Scope of practice is based on a health care worker’s training, qualifications, and job description.
The Nurse Practice Acts are state laws that determine which tasks nurses may legally perform.

6. Professional Codes of Conduct
Ethics are the principles and values that determine appropriate behavior.
Respect for cultural, social, and ethical differences of the clients and other workers
Practicing within the guidelines of laws, policies, and regulations established for each type of employment

7. Sample Scope of Practice
Compare and contrast each of the job descriptions for nursing in the sample scope of practice.

8. Code of Ethics
Discuss the term ethics. Ask the student to give their interpretation of a code of ethics.
Discuss the difference between ethics and morals.
Discuss why it is important for a health care worker to abide by the code of ethics.

9. Nightingale Pledge
The Nightingale Pledge is a modified Hippocratic Oath.
Named after Florence Nightingale, the Nightingale Pledge was composed by a committee of nursing instructors at the Old Harper Hospital in Detroit, Michigan. It was first used by its graduating class in the spring of 1893.

10. Health Careers and the Law
The health care provider is legally responsible (liable) for his or her behavior and the care given.
The employer also may be liable for the actions of a health care provider that are not reasonably prudent (negligent) or that reflect bad practice (malpractice)
Explain and discuss the terms negligent and not reasonably prudent. Ask the students to provide examples.

11. Malpractice Liability
• It is considered malpractice when the health care worker is
Performing skills that are beyond the level of the health care worker’s education and training
Neglecting to do something that is considered to be common practice, such as leaving the client in a safe situation
Have the students give other examples for each of the malpractice liability considerations.

12. Confidentiality
A patient’s health care is considered confidential, or private.
The health care worker is ethically responsible to maintain the patient’s privacy.
Confidentiality allows the patient to tell the health care worker personal information related to health care without fear of it being shared with someone who is not involved in the patient’s health care.

13. Health Insurance Portability and Accountability Act (HIPAA)
HIPAA was passed by Congress in 1996.
It was established to reduce administrative overhead and ensure the ability of the patient with preexisting conditions to change insurance plans.
Standards for Privacy of Individually Identifiable Health Information became effective in 2003.

14. Patient’s Rights
In 1973, the American Hospital Association (AHA) adopted the Patient’s Bill of Rights.
The patient has a right to confidentiality and personal privacy.
The patient has a right to quality care without mistreatment, neglect, or abuse.
The patient has a right to voice grievances without fear of retaliation.
The patient’s personal possessions must be cared for and kept secure while care is being given.
Obtain a copy of the Patient’s Bill of Rights from a local hospital. Discuss where copies are placed in the facility.
Ask the students why they think the Patient’s Bill of Rights was created by the AHA.

15. Patient’s Rights
In 1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued report designed to protect consumers.
It listed specific rights and responsibilities for the patient:
Right and responsibility to participate or have a representative in making treatment decisions
Responsibility to communicate honestly and show respect for health care providers
Responsibility for making a good-faith effort to pay for care
Responsibility for following the procedures of the health care plan
Discuss the Consumer’s Bill of Rights and Responsibilities, and compare it with the AHA’s Patient’s Bill of Rights.

16. Legal Directives
Legal directives are documents that allow patients to express their wishes about their health care and treatment.
Emphasize that it is a health care worker’s responsibility to know about and respect the patient’s legal directives.

17. Advance Directives Living will Durable power of attorney
Allows a person to state in advance whether to receive life support and what life support procedures to withhold if the person is terminally ill and permanently unconscious
Durable power of attorney
Allows a second person or agent to make decisions if the first person is unable to make them
Obtain sample copies of advance directives and a durable power of attorney for the students to view and discuss.

18. Elements of Advance Care Directives
Discuss each of the elements of advance care directives.

19. Health Care and the Internet
• Patients can
Access health care information
Join chat groups
Purchase drugs and other medical items
Consult a health care practitioner online
Informatics describes the development and use of information technology.
Assign groups of students the task of finding examples of the Internet services mentioned.

20. Health Care and the Internet
Telehealth is a broader term for telemedicine.
It includes
Prevention
Promotion
Cure

21. Health Care and the Internet
Uses of telehealth
Patient monitoring (e.g., electrocardiogram, lung capacity)
Patient consultation by videoconference
Transmission of images for diagnosis
Robotic surgery (telesurgery)

22. Documentation
A chart is the written documentation that serves as the legal record of the care given to the client.
A chart must be precise, clear, and concise in describing the activities of care.
Stress the importance of accuracy in charting.
Stress the importance of keeping information confidential.

23. Summary Six ways to demonstrate ethical behavior Promote wellness
Preserve life
Provide adequate and continuous care for all patients
Know and do not exceed the limits of practice
Maintain competence by continuing education
Practice jurisprudence

24. Summary Five situations that show improper ethical or legal behavior
Disrespecting a patient’s religion
Assault
Libel
Slander
Malpractice

25. Summary
Confidentiality in health care is important to ensure that the patient will share personal information regarding health without fear of it being told to someone not involved in the health care.

26. Summary Two rights of the health care patient
The right to voice grievances
The right to security of personal possessions

27. Summary
The health care worker must be aware of and respect legal issues such as advance directives.

28. Review Question
Failure to execute the care that a reasonable person exercises is known as:
a. Malpractice
b. Slander
c. Negligence
d. Jurisprudence
e. Libel

29. Review Question
Failure to execute the care that a reasonable person exercises is known as:
a. Malpractice
b. Slander
c. Negligence
d. Jurisprudence
e. Libel

30. Review Question Ethical standards are based on:
a. Morals and expectations
b. Statutes and laws
c. Oaths
d. Pledges
e. a, c, and d

31. Review Question Ethical standards are based on:
a. Morals and expectations
b. Statutes and laws
c. Oaths
d. Pledges
e. a, c, and d