Ethics Pp

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  • Morals: private personal standards of what is right and wrong in conduct character, and attitude Ethics: rules or procedures that determine what is right or wrong and implies a high standard of moral quality. Ethics may involve personal decisions or professional practice. Values: personal belief about the worth of a given idea, attitude, custom, or object that sets standards and influences behavior
  • Development is learned thru observation and experience, heavily influenced by environment – takes shape early in life Personal internalize values from society and personalize these
  • Specific knowledge and skills – foundation of nursing science Person-centered Autonomy and accountability – adheres to standards of practice and is responsible for care given Nursing practice validates standards to adhere to with care given Ethical standards: respect for human dignity – give respectful service regardless of client’s personal characteristics confidentiality – does not discuss condition with anyone not involved with care advocacy – protects client from incompetent or unethical practice promotion of public health – committed to local and global goals for health of community
  • Protected relationship: RN or client cannot be forced to reveal communication between them unless the person who would benefit from relationship agrees to reveal it
  • Right to be left alone without unwarranted publicity Right to make personal choices without interference contraception, abortion, refusal of tx Who authorized personnel What data, photos, videos, research When anytime Where pt permission even with family Violated when info revealed to unauthorized or observed without permission
  • Requirements capacity – age (adult) competence-(can make choices and understand consequences) voluntary-freedom of choice without force, fraud, deceit, duress, coercion Info must be in lay terms No consent if intoxicated or premedicated Minors who can consent married minors over certain age (12) for STD tx, HIV testing and tx, drug/alcohol tx seeking birth control psych services pregnant minor-for themselves and fetus after delivery (mom retains rights over baby)
  • Requirements capacity – age (adult) competence-(can make choices and understand consequences) voluntary-freedom of choice without force, fraud, deceit, duress, coercion Info must be in lay terms No consent if intoxicated or premedicated Minors who can consent married minors over certain age (12) for STD tx, HIV testing and tx, drug/alcohol tx seeking birth control psych services pregnant minor-for themselves and fetus after delivery (mom retains rights over baby)
  • Requirements capacity – age (adult) competence-(can make choices and understand consequences) voluntary-freedom of choice without force, fraud, deceit, duress, coercion Info must be in lay terms No consent if intoxicated or premedicated Minors who can consent married minors over certain age (12) for STD tx, HIV testing and tx, drug/alcohol tx seeking birth control psych services pregnant minor-for themselves and fetus after delivery (mom retains rights over baby)
  • Requirements capacity – age (adult) competence-(can make choices and understand consequences) voluntary-freedom of choice without force, fraud, deceit, duress, coercion Info must be in lay terms No consent if intoxicated or premedicated Minors who can consent married minors over certain age (12) for STD tx, HIV testing and tx, drug/alcohol tx seeking birth control psych services pregnant minor-for themselves and fetus after delivery (mom retains rights over baby)
  • Self-Determination Act federal law requiring healthcare facilities to provide written info to adults about rights to make hc decisions Aggressive tx extraordinary support measures used to maintain individuals physiologic processes may be withheld to avoid prolonging life without dignity supportive care to promote comfort and reduce suffering Advanced Directives Wills legal document signed by competent individual that indicates tx or life-saving measures (surgery, CPR, respirator) to be used if individual’s ability to make decisions is lost due to terminal illness or permanently unconscious state indicates who is authorized to make hc decisions if individual becomes incapacitated DPA permits competent adult to appoint surrogate or proxy in event adult becomes incompetent HC provider must follow decisions stated in document
  • Self-Determination Act federal law requiring healthcare facilities to provide written info to adults about rights to make hc decisions Aggressive tx extraordinary support measures used to maintain individuals physiologic processes may be withheld to avoid prolonging life without dignity supportive care to promote comfort and reduce suffering Advanced Directives Wills legal document signed by competent individual that indicates tx or life-saving measures (surgery, CPR, respirator) to be used if individual’s ability to make decisions is lost due to terminal illness or permanently unconscious state indicates who is authorized to make hc decisions if individual becomes incapacitated DPA permits competent adult to appoint surrogate or proxy in event adult becomes incompetent HC provider must follow decisions stated in document
  • Self-Determination Act federal law requiring healthcare facilities to provide written info to adults about rights to make hc decisions Aggressive tx extraordinary support measures used to maintain individuals physiologic processes may be withheld to avoid prolonging life without dignity supportive care to promote comfort and reduce suffering Advanced Directives Wills legal document signed by competent individual that indicates tx or life-saving measures (surgery, CPR, respirator) to be used if individual’s ability to make decisions is lost due to terminal illness or permanently unconscious state indicates who is authorized to make hc decisions if individual becomes incapacitated DPA permits competent adult to appoint surrogate or proxy in event adult becomes incompetent HC provider must follow decisions stated in document
  • OBRA: provides pt with right to be free from physical and chemical restraints imposed for purposes of discipline or convenience and not required to tx medical sx Chemical psych drugs not used to control behavior can be used only for diagnoses-related conditions inappropriate use causes deep sedation, agitation, combativeness Consent: needed for use of restraints if client unable to consent then OK for proxy with full disclosure of risks/benefit without consent is FALSE IMPRISONMENT
  • OBRA: provides pt with right to be free from physical and chemical restraints imposed for purposes of discipline or convenience and not required to tx medical sx Chemical psych drugs not used to control behavior can be used only for diagnoses-related conditions inappropriate use causes deep sedation, agitation, combativeness Consent: needed for use of restraints if client unable to consent then OK for proxy with full disclosure of risks/benefit without consent is FALSE IMPRISONMENT
  • OBRA: provides pt with right to be free from physical and chemical restraints imposed for purposes of discipline or convenience and not required to tx medical sx Chemical psych drugs not used to control behavior can be used only for diagnoses-related conditions inappropriate use causes deep sedation, agitation, combativeness Consent: needed for use of restraints if client unable to consent then OK for proxy with full disclosure of risks/benefit without consent is FALSE IMPRISONMENT
  • Assess and document need Document alternative measures MD order must specify duration and circumstances Cannot order PRN Monitor pt closely and periodically reassess for continued need and document
  • Defend client participation in decision affecting them Communicate client needs to other hc members Safeguard client autonomy and independence Provide client info about needs Provide client options so client can make informed decisions about care
  • Negligence unintentional failure of individual to perform act that reasonable person would or would not perform in similar circumstance can be omission or comission Malpractice professional negligence involving misconduct or lack of skill in carrying out professional responsibilities required elements : duty, breach of duty, causation, injury Invasion of privacy: release of info to unauthorized person without consent Assault intentional threat to cause harm or offensive contact Battery intentional touching without consent
  • Negligence unintentional failure of individual to perform act that reasonable person would or would not perform in similar circumstance can be omission or comission Malpractice professional negligence involving misconduct or lack of skill in carrying out professional responsibilities required elements : duty, breach of duty, causation, injury Invasion of privacy: release of info to unauthorized person without consent Assault intentional threat to cause harm or offensive contact Battery intentional touching without consent
  • Nursing Practice Act defines reasonable care in each state, scope of nursing practice, roles, rules, educational requirements Licensure req. differs slightly among states Good Samaritan Law limits the liability of professionals in emergency situations Tarasoff Act duty to warn of threatened suicide or harm to others
  • Ethics Pp

    1. 1. Ethical & Legal Issues in Nursing
    2. 2. Terminology <ul><li>Morals: private personal standards of what is right and wrong in conduct, character, and attitude </li></ul><ul><li>Ethics: rules or procedures that determine what is right or wrong and implies a high standard of moral quality. Ethics may involve personal decisions or professional practice. </li></ul><ul><li>Values: personal belief about the worth of a given idea, attitude, custom, or object that sets standards and influences behavior </li></ul>
    3. 3. Value Development <ul><li>Learned thru observation and experience </li></ul><ul><li>Heavily influenced by the environment </li></ul><ul><li>Takes shape early in life </li></ul><ul><li>Personally internalize values from society </li></ul>
    4. 4. Professionalism <ul><li>Specific knowledge and skills </li></ul><ul><li>Autonomy independent </li></ul><ul><li>Accountability responsible for own actions </li></ul><ul><li>Nursing practice act adheres to guidelines </li></ul><ul><li>Ethical standards respect for human dignity </li></ul><ul><li>confidentiality </li></ul><ul><li>competence </li></ul><ul><li>advocate for patient </li></ul><ul><li>promotes public health </li></ul>
    5. 5. Therapeutic Nurse/Patient Relationship <ul><li>Patient-centered </li></ul><ul><li>Responsible </li></ul><ul><li>Goal-oriented </li></ul><ul><li>Ethical </li></ul><ul><li>Nurse acts as role model </li></ul><ul><li>Nurse copes with own feelings </li></ul><ul><li>Protected relationship </li></ul>
    6. 6. Patient’s Bill of Rights
    7. 7. Right to Privacy <ul><li>Right to be left alone </li></ul><ul><li>Right to make personal choices without interference </li></ul><ul><li>Right to confidentiality </li></ul><ul><li>WHO?? Authorized personnel </li></ul><ul><li>WHAT?? Data, photos, research </li></ul><ul><li>WHEN?? Anytime </li></ul><ul><li>WHERE?? Need pt permission </li></ul>
    8. 8. Right to Respectful Care Right to Current Information
    9. 9. Right to Informed Consent <ul><li>Requirements </li></ul><ul><li>1. capacity – age (must be adult) </li></ul><ul><li>2. competence – OK to make judgments/choices </li></ul><ul><li>3. voluntary – freedom of choice without force, fraud, deceit, duress, coercion </li></ul><ul><li>4. Information must be in lay terms </li></ul><ul><li>5. No consent if intoxicated or premedicated </li></ul>
    10. 10. Right to Informed Consent <ul><li>Minors who can provide own consent </li></ul><ul><li>1. Married </li></ul><ul><li>2. Over certain age with gyne issues </li></ul><ul><li>3. Seeking psych treatment </li></ul><ul><li>4. Pregnant minor for self and fetus </li></ul><ul><li>5. Postpartum for self and baby </li></ul>
    11. 11. Right to Informed Consent <ul><li>Inclusions </li></ul><ul><li>1. Explanation of treatment/expected results </li></ul><ul><li>2. Anticipated risks and discomforts </li></ul><ul><li>3. Potential benefits and possible alternatives </li></ul><ul><li>4. Answers to questions </li></ul><ul><li>5. Statement that consent can be withdrawn at anytime </li></ul>
    12. 12. Right to Informed Consent <ul><li>Legal responsibility </li></ul><ul><ul><li>1. Rests with the individual performing the procedure </li></ul></ul><ul><ul><li>2. RN can witness if there is reason to believe the client is informed </li></ul></ul>
    13. 13. Right of Refusal of Treatment <ul><li>Self-determination act </li></ul><ul><li>federal law requiring healthcare facilities to provide written info to adults about rights to make healthcare decisions </li></ul>
    14. 14. Right of Refusal of Treatment <ul><li>Aggressive treatment </li></ul><ul><li>extraordinary support measures used to maintain individuals physiologic processes </li></ul><ul><li>may be withheld to avoid prolonging life without dignity supportive care to promote comfort and reduce suffering </li></ul>
    15. 15. Right of Refusal of Treatment <ul><li>Advanced directives </li></ul><ul><li>Living wills </li></ul><ul><li>legal document signed by competent individual </li></ul><ul><li>indicates tx or life-saving measures (surgery, CPR, respirator) </li></ul><ul><li>to be used if individual’s ability to make decisions is lost due to terminal illness or permanently unconscious state </li></ul><ul><li>indicates who is authorized to make healthcare decisions if individual becomes incapacitated </li></ul><ul><li>Durable power of attorney </li></ul><ul><li>permits competent adult to appoint surrogate or proxy in </li></ul><ul><li>event adult becomes incompetent </li></ul><ul><li>Healthcare provider must follow decisions in document </li></ul>
    16. 16. Right to request for services Right to hospital regulations
    17. 17. Restraints
    18. 18. Restraints Regulations <ul><li>Omnibus Budget Reconciliation Act </li></ul><ul><li>provides pt with right to be free from physical and chemical restraints imposed for purposes of discipline or convenience and not required to tx medical sx </li></ul>
    19. 19. Restraints Regulations <ul><li>Chemical restraints </li></ul><ul><li>psych drugs not used to control behavior </li></ul><ul><li>can be used only for diagnoses-related conditions </li></ul><ul><li>inappropriate use causes deep sedation, agitation, combativeness </li></ul>
    20. 20. Restraints Regulations <ul><li>Informed consent </li></ul><ul><li>needed for use of restraints </li></ul><ul><li>if client unable to consent then OK for proxy with full disclosure of risks/benefit </li></ul><ul><li>without consent is: False imprisonment </li></ul>
    21. 21. Nursing Considerations <ul><li>Assess and document need </li></ul><ul><li>Document alternative measures </li></ul><ul><li>MD Order required duration/circumstances </li></ul><ul><li>NO PRN order of restraint </li></ul><ul><li>Monitor patient closely and reassess </li></ul>
    22. 22. Patient Advocacy
    23. 23. Nurse as Client Advocate <ul><li>Support clients’ rights </li></ul><ul><li>Defend clients’ participation </li></ul><ul><li>Communicate clients’ needs </li></ul><ul><li>Safeguard clients’ autonomy </li></ul><ul><li>Provide clients information </li></ul><ul><li>Provide clients options </li></ul>
    24. 24. Legal Issues
    25. 25. Terminology <ul><li>Negligence unintentional failure of individual to perform act that reasonable person would or would not perform in similar circumstance can be omission /comission </li></ul><ul><li>Malpractice professional negligence involving misconduct or lack of skill in carrying out professional responsibilities required elements : duty, breach of duty, causation, injury </li></ul>
    26. 26. Terminology <ul><li>Invasion of privacy release of info to unauthorized person without consent </li></ul><ul><li>Assault intentional threat to cause harm or offensive contact </li></ul><ul><li>Battery intentional touching without consent </li></ul>
    27. 27. State Laws <ul><li>Nursing Practice Act </li></ul><ul><li>Licensure Requirements </li></ul><ul><li>Good Samaritan Laws </li></ul><ul><li>Tarasoff Act </li></ul><ul><li>Assess MD Orders </li></ul><ul><li>Safe patient care </li></ul>
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