1. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Chapter 12 Legal and Ethical Responsibilities

2. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Foundations of Nursing Law –That which is laid down or fixed –Public Individual’s relationship to state –Civil Relations between individuals

3. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sources of Law Public law –Statutory Enacted by legislative bodies –Administrative Regulatory law –Criminal Acts against welfare or safety of public (continued)

4. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sources of Law Civil law –Contract Enforcement of agreements among private individuals –Tort Enforcement of duties and rights among individuals independent of contractual agreements

5. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Judicial Process Precedent setting Jurisprudence

6. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Liability in Nursing Negligence and malpractice –Liability Obligation one has incurred or might incur through any act or failure to act (continued)

7. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Liability in Nursing Negligence –Failure of individual to provide care that reasonable person would ordinarily use in similar circumstances (continued)

8. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Liability in Nursing Malpractice –Wrongful conduct, improper discharge of professional duties, or failure to meet standards of acceptable care Results in harm to another person (continued)

9. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Liability in Nursing Negligence and malpractice –Proof of liability Duty Breach of duty Injury Causation

10. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Informed Consent Consent –Voluntary act of agreement Informed consent –When client understands reasons, risks, and benefits of intervention and agrees to treatment

11. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Assault and Battery Assault –Stated intent to touch person in offensive, insulting, or physically intimidating manner Battery –Touching another person without that person’s consent

12. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. False Imprisonment When clients made to believe they cannot leave –Physical or chemical restraints –Seclusion

13. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Privacy and Confidentiality Health Insurance Portability and Accountability Act (HIPAA) –Prohibition of posting client names –Prohibition of public viewing of charts –Prohibition of calling client names aloud in public areas –Secure storage of medical records

14. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Defamation When information communicated to third party causes damage to someone else’s reputation –Libel In writing –Slander Verbal

15. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fraud Deliberate deception intended to produce unlawful gain Nursing activities to deter fraud: –Document facts accurately –Report illegal activities –Educate peers and public

16. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Unprofessional Conduct Acts that could adversely affect health and welfare of public

17. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Use of Controlled Substances Impaired nurse –Habitually intemperate –Addicted to alcohol or habit-forming drugs

18. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Safety Areas regarding client safety that put nurses at legal risk: –Failure to monitor client status –Medication errors –Falls –Use of restraints –Use of medical equipment

19. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Understaffing Facility’s failure to provide sufficient number of professional staff to meet client needs Reassignment –Also known as floating –Acceptable, legal practice –Requires orientation before reassignment

20. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Executing Prescribed Orders Obligation to follow physician’s orders unless orders would result in harm to client Responsibility to ensure order is clear and appropriate Must use good nursing judgment

21. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Responsibilities and Roles Provider of care Expert witness Forensic specialist Client educator Reporter when responsible to do so

22. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Responsibilities of Students When performing nursing duties, act as reasonably prudent people equivalent with education and experience When employed as caregivers, must perform only tasks for which they are competent to perform

23. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Safeguards for Nursing Practice Institutional policies Professional liability insurance Risk management programs –Incident reports

24. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legislation Affecting Nursing Practice Patient Self-Determination Act Roe v. Wade Americans with Disabilities Act Good Samaritan Acts Health Care Quality Improvement Act Occupational Safety and Health Administration (OSHA)

25. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Legal Issues Related to Death and Dying Do not resuscitate (DNR) orders Wills Pronouncement of death Care of deceased Autopsies Organ donation

26. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Foundations of Nursing Concept of ethics –Determining right and wrong –Study of rightness of conduct

27. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Relationship Between Legal and Ethical Concepts Reasons for discrepancies: –Individual differences –Complex human behavior and motivation –Legal system that judges action Rather than intent –Laws influenced by social and political forces

28. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Bioethics Factors: –Increasingly technological society –Changing fabric of society –More knowledgeable clients –Decreasing total federal funds for health care

29. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Theories Teleology –Principle of utility Deontology –Concept of categorical imperative

30. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Principles Autonomy –Individual’s right to choose –Ability to act on that choice Nonmaleficence –Duty to cause no harm to others (continued)

31. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Principles Beneficence –Duty to promote good and prevent harm Justice –Based on concept of fairness (continued)

32. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Principles Veracity –Truthfulness –Neither lying nor deceiving others Fidelity –Faithfulness –Keeping promises

33. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Values and Ethics Values clarification –Process of analyzing one’s own values to better understand what is important Choosing Prizing Acting

34. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Codes International Council of Nurses code for nurses ANA Code of Ethics Canadian Nurses Association Code of Ethics for Registered Nurses

35. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Client’s Rights Include, but not limited to, right to: –Make decisions regarding care –Be actively involved in treatment –Be treated with dignity and respect

36. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Dilemmas Occur when conflict between two or more ethical principles Nurse must make choice between two alternatives that may be equally unsatisfactory E.g., euthanasia, refusal of treatment, use of scarce resources

37. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Roles and Responsibilities of Professional Nurses Ethics committee Client advocacy Whistle-blowing

38. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Decision Making Ethical reasoning –Process of thinking through what one ought to do in orderly, systematic manner to provide justification of actions based on principles (continued)

39. Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Ethical Decision Making Framework –Theories involved –Principles involved –Who is affected –Ethical options