1. Craven Fundamentals of Nursing: Human Health and Function
Chapter 6: Values, Ethics, and Legal Issues
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2. Learning Objectives:
#1. Define values, personal values, and professional values
#2. Explain how behaviors relate to values
#3. Apply cultural and developmental perspectives when identifying values.
#4. Examine value conflicts and resolutions in nursing care situations.
#5. Differentiate law and institutional policies from professional values.
#6. Discuss the eight principles of healthcare ethics from the American Nurses Association.
#7. Describe a systematic approach for resolving ethical dilemmas.
#8. Distinguish among licensure, a standard of care, a crime and a tort.
#9. Define four elements of negligence.
#10. Describe legal protections for nurses and cite measures to take.
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3. Values
Standards for decision making that endure for a significant time in one’s life
Ideas developed in life
Different meanings for different people based on experience, age, culture
Value Systems help people make decisions
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4. Example
A 22 year old diagnosed with Multiple Sclerosis tells you that she has decided against medical treatment and prefers to “eat vegan food and exercise” to maintain her health. The M.D. recommends Interferon treatment. You, as a Nursing Student, know that the treatment, while having side effects, may delay the patient’s disease course. You have seen patients with severe debilitating effects of MS wheelchair-bound and dependent at age 40.
How do you feel about this patient’s decision?
What conflicts could arise from the different value systems of the patient, student, and M.D?
How could you help to prevent or resolve conflict in this case?
What assessments are needed?
The nurse/student should assess his/her own and the patient’s values. The student might value duty, responsibility, caring, and a desire to prevent illness. The patient might value independence, health, parenthood… The M.D. may value professional duty, treatment…When value systems conflict, people may judge others.
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5. Value Indicators Attitudes Beliefs Behaviors
Mental /emotional mindset; positive or negative
Beliefs
Ideas one accepts as truth
Behaviors
Actions that can be observed; value indicators
Nurse behaviors reflect professional values
How did the patient’s behaviors reflect her attitudes, beliefs and values?
What professional values does the student reflect? How?
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6. Question true or false: Attitudes are the same as values. 9/20/2018
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7. Answer
False. Rationale: Although attitudes are linked to values, they are not the same as values. An attitude is one’s disposition toward an object or a situation; it can be a mental or emotional mind-set, and it can be positive or negative.
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8. Socializing Influences
Family interactions
We learn first from family, culture
School interactions
Rules, peers, teachers; encounter different values
Religious interactions
Ritualize values; affect health care decisions
Workplace and service interactions
Meeting expectations at work, with friends/spouse/family
In adulthood, values grow and become ingrained, but may be more accepting of others’ values with age [or not]
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9. Values Clarifying values Values inquiry Value conflicts
Self-reflection; identify your own personal values
Values inquiry
Method of examining social issues and values that motivate decisions
Multiple viewpoints, value systems, advantages and disadvantages of potential solutions
Value conflicts
Family conflicts
Common; may cause legal, family problems in health care settings
End-of-life care, preventative care, health habits [exercise, smoking, eating]
Nurses role can be to help set goals, identify values and influences
Healthcare conflicts
Between patients/families and healthcare providers
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10. Resolving Healthcare Value Conflicts
1 – Understand your own values
2 – Assess the patient’s perception and values
3 – Assist the patient to explore & clarify their values, beliefs, behaviors
4 – Support the patient’s values while providing safe, ethical care
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11. Ethics Principles of Healthcare Ethics Beneficence Nonmaleficence
Branch of philosophy dealing with standards of conduct and moral judgment
Principles of Healthcare Ethics
Beneficence
doing or promoting good
Nonmaleficence
avoid doing harm, prevent harm, remove from harm
Autonomy
Creating conditions in which patients can make their own decisions
Includes advance directives, informed consent, healthcare proxy
Justice
Foundation for decisions about resource allocation; need vs. other
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12. Professional–Patient Relationships
Veracity
Truthfulness
Influenced by culture, situation, communication skills
Fidelity
Keeping commitments & promises
Requires good judgment
Privacy
Appropriate use of patient information
Personal [body ] privacy
Confidentiality
Information about patients is private
Only those involved in care need to know
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13. Resolving Ethical Dilemmas
Strategies
Validate feelings
Conduct a case analysis
Identify outcomes
Identify short- and long-term goals
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14. Laws and Nursing Sources of law: Types of laws Licensure
constitutional, legislative, common law
Types of laws
Civil, Criminal
Licensure
Legal ability to practice as a nurse in a state
Standards of care
Expected level of performance or practice
Important in ,malpractice & licensing cases
ANA, Joint Commission, Institutional policies
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15. Question true or false: The living will is an advance directive.
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16. Answer
True. Rationale: A living will is an advance directive that specifies the types of medical treatment patients do and do not want to receive should they become unable to speak for themselves in a terminal or permanently unconscious condition.
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17. Torts and Crimes Intentional torts Assault and battery
Defamation of character
Fraud
Invasion of privacy
False imprisonment
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18. Question
Which of the following terms defines unlawful touching of the body? a. Assault b. Battery c. Libel d. Slander
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19. Answer
b. Battery Rationale: Battery is touching another person without his or her consent (unlawful touching). Assault is the threat of touching another person without his or her consent. Defamation of character is false communication that results in injury to a person’s reputation by means of print (libel) or spoken word (slander).
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20. Torts and Crimes (Cont’d)
Unintentional torts
Negligence [omission or commission]
Duty and breach of duty
Proximate cause
Damages
Trends in nursing malpractice
Increase in nurses being sued for malpractice
Medication errors, falls, surgical errors
Higher standards of care
Delegation of duties to UAP
High Acuity – little time – poor communication
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21. Legally Sensitive Areas of Practice
Controlled substances administration
Death and dying
Recognizing death vs. pronouncing death
Assisted suicide
Providing means to end life [3 states]
Active euthanasia – illegal [murder]
Terminal sedation
Not euthanasia; pain management at end of life that may hasten death
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22. Legally Sensitive Areas of Practice (Cont’d)
Advance directives
Policy required - know it!
Resuscitation
Know code status
DO resuscitate if unknown
Good Samaritan laws
Protect nurses acting in emergency
Limit liability but may still be liable for gross negligence
Stay until assistance arrives
Covered by personal insurance
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23. Protecting Yourself Legally
Professional practice
Realistic, evidence-based, practical
Follow policy & procedure
Document and communicate changes in patient condition
Professional liability insurance
A good idea
Students are responsible for staying within their scope; may be liable
Same competence requirement as RN
Documentation
Accurate, complete, timely, objective
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