1. Chapter 10Ethical Issues in Health Care

2. Chapter 10 objectives
1. Define the word ethical. 2. Describe what is meant by individual, societal, and situational ethics. 3. Explain why a study of ethics and ethical behavior is important in nursing. 4. State the purposes of a code of ethics. 5. Explain personal responsibility and accountability as they relate to ethical behavior. 6. Apply guidelines for ethical decision making in your practice of nursing. 7. Participate in discussions regarding ethical issues in the work environment. 8. Outline the process for making decisions related to ethical dilemmas.

3. Study of right and wrong related to human conduct
Ethics
Study of right and wrong related to human conduct
Knowledge of right and wrong related to:
Individual
Society
Situation

4. Have the ability and obligation to help patients
Nursing and Ethics
Nurses
Have the ability and obligation to help patients
Internalize the concept of what it means to be a human being
Accept personal responsibility for relationships
Are obligated to do good and not harm
Are committed to providing high quality care to all human beings

5. NFLPN and NAPNES (found in Appendix B & C)
Nursing and Ethics
Code of Ethics
NFLPN and NAPNES (found in Appendix B & C)
-will be more detailed in PVR 2
Purpose is to provide a list of rules of good conduct
Attempt to describe the ideals of a group
Identify standards of behavior

6. Personal Accountability
Being responsible means to accept being the cause of an action Being accountable means to accept the consequences of the action

7. Unethical Behavior
Failure to adhere to a code of ethics Failure to base practice on high ethical standards Disregard for basic human rights

8. Conflict or opposition between: Personal values Moral principles Laws
Ethical Dilemmas
Conflict or opposition between:
Personal values
Moral principles
Laws
Personal and professional obligations
The rights of individuals and society
No right or wrong answer
Legal versus ethical problems

9. Ethical Issues in Nursing
Dilemmas exists when there is the belief that appropriate and safe care cannot be provided
Choosing between the employer's requirements and what the patient needs
Staffing shortages
Excessive paperwork and administrative tasks
Cost containment measures
Managed care
Mandatory overtime

10. Ethical Issues in Nursing
Risks to personal health and safety
Other issues
Right to refuse to assist with a procedure you believe is morally or ethically wrong
Cannot refuse to provide nursing care for a patient

11. Question
Is the following statement true or false? A moral dilemma exists when there is no right or wrong answer.

12. Answer
True Rationale: The fact that there is no right or wrong answer is what makes it a dilemma.

13. Question
Is the following statement true or false? Disregard for basic human rights is an ethical dilemma.

14. Answer
False Rationale: Disregard for basic human rights is unethical behavior. There is no question that this is right or wrong. It is wrong behavior.

15. Chapter 11
Legally Responsible Nursing Practice

16. CHAPTER 11 OBJECTIVES
1. Discuss the purpose of Good Samaritan laws. 2. Discuss the relationship between the nurse practice acts and the state boards of nursing. 3. Explain the association among responsibility, accountability, and legal liability. 4. Define the term breach of contract. 5. Define the term tort. 6. Differentiate negligence and gross negligence. 7. Give examples of crimes that may involve nurses.

17. Legally Responsible Nursing Practice
A nurse’s duty is to do good and to avoid harm in accordance with the law
Laws are rules of conduct derived from:
Cultural values
Moral practices
Ethical beliefs

18. Good Samaritan Statutes
Protect people from prosecution who voluntarily aid others in an emergency
Intend to encourage giving emergency care outside the hospital or health care facility
Some states require people to help strangers in distress
To act or not act is an ethical decision

19. This public law is in place in how many states?
Discussion Topic #1
Search the Web for articles about Good Samaritan Laws. Answer the following questions:
This public law is in place in how many states?
If you begin to give emergency care, what is your obligation to continue?
Can you be held liable if you don’t at least call for help?
Are RNs and LP/VNs protected when giving emergency care away

20. Regulation of Nursing Practice
Administrative Law—The Nurse Practice Act
Defines legal functions, powers, and duties of the state board of nursing
Enforces the Nurse Practice Act
Holds disciplinary hearings
Identifies membership of the board and how to become a board member
Defines terms
Includes laws governing licensure and legal titles

21. Responsibility and Liability
Responsibility is being accountable for your actions
Explain the action and accept any consequences
Liability is the legal obligation to make good for the loss of, or damage to, something for which he or she is responsible.
Nurses are personally and legally responsible for their nursing actions.
Best protection against charges:
Carry out duties at or above the standard expected

22. Standards of Care
Guidelines to identify appropriate levels of professional care Rules and regulations defining care expected of professional and practical/vocational nurses Accrediting agencies and organizations develop standards of care Employer policy and procedure manuals

23. Legal Issues for Nurses
Contracts
An agreement between two or more parties
Written or verbal promises with exchange of something of value
-Breach of contract
Failure to fulfill any or all parts of a contractual obligation
Torts
An injury or wrong committed by one person, group, or organization
against another person, group, or organization
(Strict liability, intentional, negligence)

24. The injured person seeks to prosecute Crime
Torts vs. Crimes
Tort
The injured person seeks to prosecute
Crime
An offense committed against the public welfare or safety
The state seeks to prosecute

25. Legal Issues For Nurses- ex. of torts
False imprisonment-confining or restraining (verbally or physically)
Violation of confidentiality-HIPPA, “shoptalk”
Defamation of character-false or malicious (slander, libel)
Violating informed consent-direct or implied (the patient clearly understands the alternatives)
Assault/battery-threatening to touch/touching a person w/o permission
Fraud-intentional deception
Negligence/Gross Negligence-failure to do something or not to do something/human life endangered (criminal)
DT #2

26. Discussion Topic #2
Determine if the following examples are torts or crimes. 1. Nurse threatens to give an injection when her patient refuses to take oral medication. 2. Nurse gives the injection despite the patient’s objection. 3. Taking photo of patients using your cell phone without their consent. 4. Nurse tells her patient that the doctor is incompetent. 5. Taking a dollar from a patient’s nightstand and buying a soda with it. 6. Fondling your patient’s body parts. DT #3

27. Discussion Topic #3
Think about the tort known as defamation of character. Discuss with your classmates what it means to talk about or to gossip about others. In your discussion determine whether or not you have ever committed the tort of defamation of character. Talk about how gossip and defamation of character affect personal and professional relationships.

28. Legal Issues for Nurses
Documentation Patient’s medical record is a legal document Entries must be factual, to the point, accurate, legible, related to patient’s needs or plan of treatment, objective, consistent Use agency-approved abbreviations and chart- correction procedures Computer charting confidentiality

29. Legal Issues for Nurses
Gifts Don’t accept gifts or money It is legal but not ethical to accept or solicit gifts

30. Crimes by Nurses
Practicing without a license/practicing after failing to renew a license-felony felonies – serious criminal act, grounds for denying, suspending, or revoking a nurse’s license Right-to-die Violations of federal & state narcotic and controlled substance laws Fraud-falsifying patient bills Robbery-patient’s belongings Death, murder, patient abuse

31. Question
Putting a person into his room, locking the wheelchair wheels and closing the door to keep him from annoying others is known as: A. Fraud B. False imprisonment C. Battery D. Violating informed consent

32. Answer
B. False imprisonment Rationale: Confining a person to a room, locking the wheelchair locks to prevent the person from moving about is false imprisonment.

33. Question
Is the following statement true or false? It is illegal for a nurse or any other health care provider to accept or solicit gifts from patients or families.

34. Answer
False Rationale: It is legal but not ethical to accept or solicit gifts from patients or families.

35. Question
Which of the following is true about documentation? A. It is not a legal document B. Never use abbreviations when charting C. When making an error, just cross it out so it is illegible D. Entries must be objective and consistent

36. Answer
D. Entries must be objective and consistent Rationale: The patient’s medical record is a legal document. Use agency-approved abbreviations and chart correction Procedures.

37. Question
Is the following statement true or false? Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.

38. Answer
True
Rationale: Laws are rules of conduct that derive from ethical beliefs, moral practices, and cultural values.
Q#1