1. Ethical and Legal Issues
Chapter 3
Ethical and Legal Issues
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Values and Morals
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 among attitudes, beliefs, values, and morals.
Do you have values? Ask students to create a list of their values.
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Values and Morals
Children learn their morals from other in their environment.
Preschoolers learn right from wrong; adopt family’s beliefs and traditions
Children exposed to a variety of values
Teens start to identify their own values
Human values important in caregivers include a concern for welfare of others-altruism
Equality, justice, truth, freedom, and acceptance
Values clarification-step by step process to help identify values that have significance
3 steps: Choosing, prizing, and acting
Be aware of your values and your client’s values
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A right is described as a power, privilege, or existence to which one has a just claim.
Rights help 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 Care Partnership.
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Client’s Rights
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.
Federal legislation has established mental health parity laws-requiring insurance companies to include coverage for mental illness to be equal to coverage for physical illness
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Care Provider Rights
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
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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Ethical Principles
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-right to act for self and make own choices
Beneficence-to do good
Nonmaleficence-do no harm
Justice-treated equally, fairly, and respectfully
Confidentiality-duty to respect private information
Fidelity-keeping one’s word
Veracity-duty to tell the truth
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Codes of Ethics
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
Ethical dilemmas
exist when there is uncertainty or disagreement about the moral principles related to a course of action.
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 dilemma?
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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11. Laws and the Legal System
Laws are the controls by which a society governs itself.
Apply to every member of society
Based on the principles of
Justice
Change
Standards
Individual rights and responsibilities
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Public vs. Private Law
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
4 Criteria to Prove Negligence
Duty to client
Breach of duty
Cause Injury
Damage due to injury
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13. Legal Concepts in Health Care
All health care professions are governed by standards and rules.
Nurse practice act/Scope of practice
Institutional policies
Policy-What needs to be done
Procedure-How to perform
Standards of practice-are developed by health care disciplines-they are there to evaluate the quality and effectiveness of care being provided
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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14. Laws and Mental Health Care
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
Clients retain their legal rights upon entering the mental health care system
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15. Adult Psychiatric Admissions
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.
Emergency admission-can be initiated by police, physicians or representatives of a county administrator
Clients may stay for days to years. If committed for indefinitely case will need to be reviewed annually.
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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Areas of Liability
Homicide
Murder
Robbery, theft, larceny
Defamation
Libel-written
Slander-verbal
Assualt an Battery
Invasion of privacy
False imprisonment
A medical order
Need to remove restraints every 2 hours allow movement
Need to assessed and monitored every 15 minutes
Negligence
Malpractice
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17. Negligence and Malpractice
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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18. Responsibility of the Care Provider
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.
Informed consent
Dr. responsibility to do, but nurse can assist
Elopement
Client runs away
Duty to warn
List three responsibilities of health care providers.
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19. Responsibility of the Care Provider
List three responsibilities of health care providers.
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