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ETHICAL AND LEGAL ISSUES
IN COMMUNITY HEALTH
Ethics is a system of moral principles
and rules of conduct recognized in
respect to a particular class of human
actions or to a particular group of
Ethics are a branch
of philosophy dealing
with values relating to
human conduct with
respect to the
wrongness of certain
actions and to the
badness of the
motives and ends of
earliest recognitions of clients rights concerning
health was made by the national convention on
the French revolution in 1973.
health and the right to health care as extensions
of basic human rights
rights to informed consent
RIGHT TO HEALTH
RIGHT TO HEALTH CARE
The right to health is a
negative right to a illness
The right to health care
is a positive right to
goods and services in
order to maintain and
improve whatever state
of health exists
Consideration of privacy.
Obtain complete medical information.
Consideration and respectful care.
Receive information necessary for giving
Expect reasonable continuity of care.
Confidential treatment of personal
information and medical records.
Information on other institution and
individuals related to care and treatment.
Refuse participation in research projects.
ETHICS IN NURSING
. It is the systematic study of what a
person’s conduct and actions ought to
be with regard to self, other human
beings, and the environment. Many
nurses envision ethics as dealing with
principles of morality and what is right
or wrong (Yoder-Wise, 2007
ETHICS IN NURSING
In a nursing perspective, ethics is that
ethics is concerned with motives and
attitudes and the relationship of these
attitudes to the overall care of the individual.
It is the justification of what is right or wrong,
and the study of what one’s life and
relationships ought to be, not what they are
(Marquis & Huston, 2006).
Morality concerns the social
nature of the community,
codes of behavior, and
community expectations (Hall,
2000; Perle, 2004)
CODE OF ETHICS
The professional code of ethics for nurses
prescribes moral behavior and actions
based on moral principles.
Some of the rules may even have legal
ties to licensure requirements concerning
CODE OF ETHICS
Professional code of
ethics is statements
encompassing rules that
apply to persons in
DUTY OF VERACITY
Truthfulness has long been regarded as
fundamental to the existence of trust
among human beings. Persons have a duty
of veracity to all the truth and don’t lie or
RULE OF CONFIDENTIALITY
If health care professionals did not
follow rule of confidentiality, clients
might not sought help when they
Eg. The family planning services
DUTY OF ADVOCACY
advocacy in the care or safety of clients is
As the code of nurses states,
the nurse must be
alert to and take appropriate action
regarding any instances of incompetent
any action on the part of others that places
the rights or best interests of the client in
DUTY OF ADVOCACY
Role of an advocate is difficult for the
community health nurses.
It must be recognized that clients should always
determine what is in their best interests.
The duty of advocacy extends to population at
risk, which may bring the community health
nurses into conflict with health policy or
established professional practices within a
community or institution.
In the code for nurses accountability, it
is defined as being answerable to
someone for something one has done.
It includes providing an explanation to
one’s self, to the client, to the
employing agency and to the nursing
ETHICAL PRINCIPLES IN
PRINCIPLE OF BENEFICENCE
“we ought to do well and prevent or avoid
It includes the idea that beneficence is a
duty to help others gain what is of benefit
to them but does not carry the obligation
to risk one’s own welfare or interiors in
APPLICATION OF PRINCIPLE OF
BENEFICENCE IN COMMUNITY HEALTH
It can be applied for balance harms
and benefits to client population.
Cost beneficial analysis is a specific
application of this principle. To
measure the benefits and costs of
alternative approaches to a problem or
to decide how to distribute health
PRINCIPLE OF AUTONOMY
Autonomy refers to freedom
of action, as chosen by
individual persons who are
autonomers and are capable
of choosing and acting on
plans they themselves have
APPLICATION IN COMMUNITY HEALTH
Respect for persons,
The protection of privacy
The provision of informed consent.
Freedom of choice including treatment refusal.
The protection of diminished autonomy.
The client should be given a choice or even
considered in the treatment plan.
States that a person should do no
Health care providers often use the
concept of a detrimental-benefit
analysis when the issue of non mal
eficence is raised.
PRINCIPLE OF JUSTICE
The formal principle of justice claims
that equals should be treated equally
and that those who are unequal should
be treated differently
APPLICATION IN COMMUNITY HEALTH
distribute resources among the citizenry to decide how
expenditure or the use of resources will achieve the
greatest net total of good and serve the largest number of
this method of distribution is appealing.
everyone is entitled to whatever they get in the
natural lottery at birth and there is no responsibility
for government or it’s agencies to improve the lot of
those less fortunate than others.
inequalities between individuals in matters of health,
position and wealth are tolerated. Only aggression or
harms against others.
THE PRIORITY OF ETHICAL PRINCIPLES
places a great emphasis on the observation of
principles of autonomy and beneficence than the
principle of justice in most nursing actions.
. The ethical principle of beneficence is given
slightly less emphasis in the code for nurses
. The principle of justice is not strongly
emphasized in the professional code of ethics.
ACCOUNTABILITY IN COMMUNITY HEALTH
The application of this principle indicates that
how a community health nurses morally provide
health services so as to provide maximize total
net health of population .
Professional etiquette, good manners based on
Knowing the lines of authority and responsibility.
Each person should be treated with dignity and
When death occurs they need empathy, support
and understanding. More practice is needed in an
Should know what others are doing and be faithful in
supporting each other.
Co ordinate with all
Have partnership and co operation with physician.
Good communication based giving and receiving
Without open criticism, incompetence of person should be
The nurse relates in the community as a worker and to
improve health standards
A rule established by authority, society or
The body of rules governing the affairs of
people, communities, states, corporations
A set of rules or customs governing a
discrete field or activity
Common law is derived from
principles rather than rules and
regulations. Common law is based on
justice, reason, and common sense. It
represents law made by judges
through decisions in specific cases
Also called continental law, is the
predominant system of law in the world. In
contrast to common law, civil law was
promulgated after the French Revolution in
France and is based on rules and
regulations that became normative
The major constitutional power of the
state’s relating to population centered
nursing practice is the states’ rights to
intervene in a reasonable manner to
protect the health, safety and welfare of
THE STATE CAN ISOLATE AN INDIVIDUAL UNDER THE
There is a compelling state interest in
preventing an epidemic.
The isolation is necessary to protect the
health, safety, and welfare of individuals
in the community or the public as a whole.
The isolations are done in a reasonable
JUDICIAL AND COMMON LAW
Judicial law is based on court decisions.
The opinions of the courts are referred to
as case law. The court uses other types of
laws to make its decisions including
previous court decisions. Precedent one
principle of common law, this means that
judges are bound by previous decisions
unless they are convinced that the older
law is no longer relevant or valid.
LAWS SPECIFIC TO NURSING PRACTICE
The first is the statutory authority for
the profession and its scope of
practice and the second is the
professional negligence and
SCOPE OF PRACTICE
The issue of scope of practice involves defining
nursing, setting its credentials, and then
distinguishing between the practices of nurses,
physicians and other health care providers. The
issue is especially important to nurses in
community settings, who have traditionally
practiced with much autonomy.
CUSTOMARY PRACTICES OF NURSING
CAN IDENTIFIED BY
Content of nursing educational programmes
Experience of other practicing nurses
Statements and standards of nursing professional
Policies and procedures of agencies employing
Needs and interests of the community.
Updated literature, including research, books, texts
SCOPE OF PRACTICE
Health care practitioners are subject to the laws of
the state in which they practice, and they can
practice only with license.
The nurse practice act of each state accomplishes
at least four functions;
defining the practice of professional nursing,
identifying the scope of nursing practice,
setting educational qualification and other
requirements for licensure,
and determining the legal titles nurses may use to
Professional negligence or malpractice is defined
as an act that leads to injury of a client. To recover
money damages in a malpractice action, the client
must prove all the following,
the nurse owed a duty to the client or was
responsible for the clients care.
the duty to act the way a reasonable, prudent
nurse would act in the same circumstances was not
the failure to act reasonably under the
circumstances led to the alleged injuries.
LEGAL ISSUES AFFECTING HEALTH CARE
Specific legal issues of nursing vary depending on
the setting where care is delivered. The law,
including legislation and judicial opinions,
significantly affects each of the following areas of
nursing practice. Nurses responsible for setting and
implementing programme priorities need to identify
and monitor laws related to each special area of
SCHOOL AND FAMILY HEALTH
Nurses employed by health departments may
deliver school and family health nursing.
School health legislation establishes a
minimum of services that must be provided
to children in public and private schools.
Children must have had a physical
examination at least onetime before entering
Of special concern are the state workers
compensation statutes, which provide the legal
foundation for claims of workers injured on the
Access to records, confidentiality and the use of
standing orders are legal issues that have great
practice significance to nurses employed in
HOMECARE AND HOSPICE SERVICES
Homecare and hospice services rendered by
nurses are shaped through state statutes and have
specific nursing requirements for licensure and
Compliance with these laws is directly linked to
the method of payment for the services.
many states have passed laws requiring nurses to
report elder abuse to the proper authorities, as is
done with children and youths.
The legislative process begins with ideas that are
developed in to bills. After a bill is drafted, it is
introduced to the legislature, given a number, read
and assigned to committee, amends it as
necessary and votes on it.
. Many professional nursing associations have
legislative committees made up of volunteers,
governmental relations staff professionals and
sometimes political action committees, all engaged
in efforts to monitor, analyze and shape health
NURSES ROLE IN THE POLICY
Statement of a healthcare problem.
Statement of policy options to address the health
Adoption of a particular policy option.
Implementation of the policy product
Evaluation of the policy’s intended and unintended
consequences in solving the original health problem