Chapter 8_mcgee

Upholding Legal and Ethical
Principles
Chapter 8
Copyright © 2014, 2009 by Mosby, Inc.,
an imprint of Elsevier Inc.

 Law mandates
 How we must behave toward each other
 Ethics establishes
 How we should behave
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 Sources of law
 Common law
 Also called case law
 Law that has arisen from judicial decisions; “judge-
made” decisions
 Administrative law
 Controls the administrative operations of government
 Statutory law
 Constitutional law
 Enacted law
 For example, Nurse Practice Act
3

 Legal principles
 Confidentiality and the right to privacy
 Health Insurance Portability and Accountability Act of
1996 (HIPAA)
 Failure to follow this act: civil and criminal penalties
 Patient rights
 Right to be treated with dignity and respect, privacy,
decision-making, confidentiality, access to health
records, and the right to refuse treatment
 Informed consent
 Patient must fully understand what he or she has
consented to for the consent to be valid
4

Ethics
 Description
 Branch of philosophy that concerns the distinction between right and
wrong
 Consists of a sense of morality, behavior in accordance with customs or
tradition
 Ethical principles
 Codes that direct or guide nursing actions, including autonomy,
nonmaleficence, beneficence, justice, veracity, and fidelity
 Values
 Beliefs and attitudes that may influence behavior and the process of
decision making
 Values clarification
 Process of analyzing one’s own values for better understanding of what
is truly important
 Ethical codes
 Not legally binding but, in most states, the board of nursing has
authority to reprimand nurses for unprofessional conduct that results
from violation of ethical codes
an imprint of Elsevier Inc. 5

 Ethical dilemma
 Occurs when there is a conflict between two or
more ethical principles
 Advocate
 Represents client’s point of view and protects
client’s rights to make decisions
 Ethics committee
 Takes a multidisciplinary approach to facilitate
dialogue regarding ethical dilemmas
 Develops and establishes policies and procedures
for the prevention and resolution of dilemmas

 Legal principles
 Assault and battery
 Assault: deliberate threat to physically harm another
 Battery: actual and intentional act of touching another
without the person’s consent
 False imprisonment
 Verbally or physically forcing an individual to stay in a
place against his or her wishes
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 Negligence
 Failure to use such care as a reasonable prudent and
careful person would use under similar
circumstances
 Professional negligence (also called medical
malpractice or professional malpractice)
 Omission or commission of an act that departs from the
standard of care that a reasonably prudent person
would do in the same or similar circumstances
 Accountability
 Willingness to assume responsibility and accept the
consequences for your actions
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 Tort
 Legal wrong committed against a person or property
 Intentional torts
 Assault and battery
 False imprisonment
 Fraud
 Invasion of privacy
 Slander and defamation
 Unintentional torts
 Professional negligence
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 Malpractice
 Improper or unethical conduct or unreasonable lack
of skill by a holder of a professional or official
position
 Medical malpractice
 Professional misconduct
 Failure to perform professional duties
 Failure to meet the professional standards of care that
results in harm to another
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 Malpractice
 Four elements must be present for a person to
recover damages
 Duty to care: obligation exists to conform to a
recognized standard of care
 Breach of duty: must be a failure to adhere to an
obligation and a deviation from a recognized standard
of care
 Injury: actual damages have occurred
 Causation: injury was foreseeable, caused by a breach
of duty, and the conduct was the cause of the injury
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 Standards used to prove malpractice
 Standards of care, facility policies and procedures,
protocols, job descriptions, professional literature,
expert opinions, your state nurse practice act, and
the reasonable person standard
 Follow the above standards and use common sense
to decrease risk of malpractice.
 Accurate documentation will provide your best
defense to a lawsuit.
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 Guidelines to prevent negligence and
malpractice
 Performing only those skills that are within your
scope of practice
 Staying current in your field of practice
 Delegating carefully and legally
 Administering drugs using the six rights
 Being aware of your own strengths and weaknesses
 Advocating for your patients
13

 High-risk areas
 Medication administration
 Most errors: wrong dose, wrong technique, and wrong
drug
 Emergency department
 Mental health settings
 Specialty areas
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 Most common malpractice claims against
nurses
 Failure to follow standards of care
 Failure to use equipment in a responsible manner
 Failure to communicate
 Failure to document
 Failure to assess and monitor
 Failure to act as a patient advocate
15

An alert, competent patient wants to leave the
hospital but the nurse thinks the patient should see
the physician before leaving. The nurse restrains
the patient to the bed. Which action did the nurse
commit?
1. Assault
2. Informed consent
3. False imprisonment
4. Unintentional tort
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 Lack of a timely and appropriate response to
changes in a patient’s condition
 Failure to prevent a clinically important
deterioration, such as death or permanent disability
 Critical to monitor patients carefully to identify
deteriorations and intervene appropriately
 Sentinel events
 Root-cause analysis
17

 Functions
 For accreditation and regulatory compliance
 Make reimbursement determination
 Examined by licensing boards for disciplinary action
 Documentation errors
 Faulty record-keeping
 Failure to include information
 Charting after the fact
 Misplacing records
 Failure to follow standards of care when charting by exception
18

 Two specific types
 Child abuse and neglect
 Elder abuse and neglect
 Can have legal consequences for not reporting
these types of situations
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 Ethics
 Branch of philosophy that offers a way of examining
moral life
 Studies how we make decisions regarding right and
wrong
 Bioethics
 Applies ethical theories and principles to moral
issues and problems in the practice of medicine
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 Morals
 What we believe to be right and wrong
 Often based on religious beliefs, culture, social
influences, and life experiences
 Values
 Enduring beliefs or ideals
 Largely shaped by one’s culture
 Can have values conflict
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 Moral development
 How an individual learns to handle moral or ethical dilemmas
 Theorists
 Lawrence Kohlberg
 Pre-conventional
 Conventional
 Post-conventional
 Carol Gilligan
 Focused on women
 Moral person: one who responds to need and demonstrates care
and responsibility in relationships
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 Universal principles of biomedical ethics
 Autonomy
 Freedom to choose and make one’s own decisions
 Self-determination
 Veracity
 Truth-telling
 Fidelity
 Practicing faithfully within the legal boundaries
 Keeping promises
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 Universal principles of biomedical ethics
 Beneficence
 Preventing harm or promoting/doing good
 Most critical ethical principle in health care
 Nonmaleficence
 Do no harm
 Confidentiality
 Protection of private health information
 Right to privacy
 Justice
 Fairness
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 Cultural differences must be recognized and
respected.
 Culturally competent nursing care
 This entails integration of knowledge, attitudes, and
skills.
 The nurse is able to work within the specific cultural
context of an individual, family, or community.
 The more insight you have into your own values,
attitudes, beliefs, and practices, the more you are
prepared.
 Cultural competence also extends to the workplace.
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 Exist when a conflict arises among health care
professionals, patients, families, and health
care organizations
 Moral courage
 Deciding on a right course of action regardless of the
possible consequences
 Moral distress
 Situations in which an individual knows the right
action to take, but feels powerless to take that action
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 Assist staff, patients, and caregivers in resolving ethical
dilemmas
 Members are usually multidisciplinary
 Purposes
 Promote, advocate, and protect patient rights, establish a moral
care standard, and enhance the quality of patient care
 Functions
 Policy and procedure development, staff and community
education, conflict resolution, case reviews, support, and
political advocacy
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 Deontology
 Action should be judged based on the motive or intent behind
the actions and does not rely on outcomes.
 Utilitarianism
 Action should be judged on whether it produces the greatest
good and does rely on outcomes.
 Virtue ethics
 If an individual develops morally desirable virtues, moral
decisions and actions are more likely.
 The ethic of care
 This emphasizes caring and relationships.
28

A nurse believes that immunizations should be
offered to everyone because they provide the most
good for the greatest amount of people. Which
ethical theory is the nurse using?
1. Virtue ethics
2. Utilitarianism
3. Ethic of care
4. Veracity
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 ANSWER AND RATIONALE: 2. Utilitarianism. Utilitarianism is a
theory that states that actions must be judged based on whether they
produce the greatest good (or more happiness than unhappiness).
 1. The emphasis of virtue ethics is on the characteristics, traits, or
virtues that a person should have such as courage, integrity,
magnanimity, honesty, justice, and temperament.
 3. The ethic of care emphasizes the caring aspect of the nurse-patient
relationship, intuition, minimizing or avoiding harm, and fairness.
 4. Veracity is the principle of truth-telling and not intentionally
deceiving or misleading patients.

 The Code of Ethics for Nurses
 Provides a framework for ethical analysis and
decision-making
 Is nonnegotiable
 Is applicable to all practice settings and a variety of
nursing roles
 Outlines nine ethical principles that are the
guidelines for practice as a registered nurse
 Expresses ethical duties owed to ourselves, our
patients, society, our employers, and our colleagues
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 Eight-step model
1. Gathering relevant information
2. Stating the practical problem
3. Identifying the ethical issues and questions
4. Selecting the ethical principles and/or theoretical
frameworks to be considered
5. Conducting an analysis and preparing a justification
6. Considering one or more counterarguments
7. Exploring the options for action
8. Selecting, completing, and evaluating the action
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