ETHICAL_AND_LEGAL_ISSUES_IN_NURSING_

1. For – Post basic B.sc (N)
ETHICAL AND LEGAL
ISSUES IN NURSING
MRS. KANIKA SHARMA

2. INTRODUCTION
 The contribution of nursing to the alleviation of
suffering and to protection and promotion and
restoration of health is a proud in the history. The
image of any organization depends upon the behaviour
of people who constitute it. So, there is great obligation
on the part of employees to behave in an ethical way at
the work place.
 This is equally applicable to the nurses who are
working in different sectors of health care delivery
system. The way nurses behave, reflect the image of
that organization. Today the nurses face a variety of
ethical problems than ever before.
MRS. KANIKA SHARMA

3.  LEGAL STANDARDS: Some things are right or
wrong by laws
 NURSING ETHICS: A standard for professional
behaviour. A guide to identify our conduct in
relation to
 PATIENTS
 FELLOW NURSES
 HEALTH CARE TEAM
 OUR COMMUNITY
 OUR PROFESSION
MRS. KANIKA SHARMA

4. MEANING
 The word Ethics is derived from Greek word “Ethos”
which means customs or guiding beliefs (character).
MRS. KANIKA SHARMA

5. DEFINITIONS
 It can be viewed as a generic term for several ways of
examining the morale of life. -BEAUCHAMP TL
 Ethics is the study of good conduct, character and
motives.
-POTTER
MRS. KANIKA SHARMA

6. ETHICAL PRINCIPLES
1. AUTONOMY
 Autonomy can be defined as „ self-rule with no
control, undue influence or interference from
other”.
 Refers to make one’s own decision.
 Nurses recognize the individual’s uniqueness.
 It is about respecting other people’s wishes and
supporting them in their decisions.
MRS. KANIKA SHARMA

7. 2. BENEFICENCE
 This can be defined as “the principle of doing well
and providing care to others”
 Refers to taking positive actions to help others.
 As employees are we properly trained and
competent to carry out the tasks we are providing
to our children/families/clients/customers.
Eg : child’s immunization may discomfort during
administration, but the benefit of protection from
disease for the individual and society, outweigh the
temporary discomfort.
MRS. KANIKA SHARMA

8. 3. NON-MALEFICENCE
 Refers to avoidance of harm or hurt.
 “Obligation not to inflict harm on others”
 Nurses tries to balance the risks and benefits of a plan of
care. .
 However, do we sometimes cause short term harm for long
term good .
4. JUSTICE
 Simply defined as “equal treatment of equal cases” or the
principle of fairness.
 Treat all clients equally and fairly.
 However, some people need to be treated differently if they
require special care over and above what other people may
MRS. KANIKA SHARMA

9. 5. CONFIDENTIALITY
 It refers to the rights of clients for protection of privacy
without diminishing access to quality care.
 It is important for trusting relationship.
 Nurses will not share information about the client
unless it is agreement from the client or required by
the law.
MRS. KANIKA SHARMA

10. 6. ACCOUNTABILITY:
 It is an ability to answer for one’s own action.
 Nursing professional must agree to evaluate practices
and actions and to take action to preserve nursing
excellence.
7. VERACITY
 It is concerned with being open, honest and truthful with
people.
 It is also the accurate transfer of information in a way
that is suitable for the individual to understand
 “This is not always an easy principle to maintain when
you are asked difficult questions, or your answer may be
MRS. KANIKA SHARMA

11. 8. FIDELITY
Fidelity is about
 Being Faithful
 keeping promises
 always doing what is right
 being trust worthy
 Confidential
 Showing respect and dignity
 respecting autonomy
 Acting in their best interest.
MRS. KANIKA SHARMA

12. MRS. KANIKA SHARMA

13. INTERNATIONAL CODE OF NURSING
ETHICS
THE ICN CODE OF ETHICS FOR NURSES
 An international code of ethics for nurses was first
adopted by the International Council of Nurses (ICN)
in 1953.
MRS. KANIKA SHARMA

14. ELEMENTS OF THE CODE
1. NURSES AND PEOPLE
 In providing care, the nurse promotes an environment in
which the human rights, values, customs and spiritual
beliefs of the individual, family and community are
respected.
 The nurse holds in confidence personal information and
uses judgement in sharing this information.
MRS. KANIKA SHARMA

15. 2. NURSES AND PRACTICE
 The nurse carries personal responsibility and
accountability for nursing practice.
 The nurse at all times maintains standards of personal
conduct.
 The nurse, in providing care, ensures that use of
technology and scientific advances are compatible
with the safety, dignity and rights of people
MRS. KANIKA SHARMA

16. 3. NURSES AND THE PROFESSION
 The nurse assumes the major role in implementing
acceptable standards of clinical nursing practice,
management, research and education.
4. NURSES AND CO-WORKERS
 The nurse sustains a co-operative relationship with co-
workers in nursing and other fields.
 The nurse takes appropriate action to safeguard
individuals, families and communities when their
health is endangered by a co- worker or any other
person
MRS. KANIKA SHARMA

17. 5. NURSES AND SOCIETY
 Participate and share responsibility with other citizens
& other health professionals.
 Recognize and perform the duties of citizenship
 Aware of laws and regulations which affect the
practice of nursing.
MRS. KANIKA SHARMA

18. INC CODE OF ETHICS FOR NURSES
IN INDIA
 The nurse respects the uniqueness of individual in
provision of care.
 Provides care for individuals without consideration of
caste, creed, religion, culture, ethnicity, gender, socio-
economic and political status, personal attributes, or
any other grounds.
 Individualizes the care considering the beliefs, values
and cultural sensitivity.
 Appreciates the place of the individual in family and
community and facilitates participation of significant
others in the care.
MRS. KANIKA SHARMA

19.  Develops and promotes trustful relationship with
individual(s).
 Recognizes uniqueness of response of individuals to
interventions and adapts accordingly.
 The nurse respects the rights of individuals as partner
in care and helps in making informed choices
 Appreciates individual’s right to make decisions about
their care and therefore gives adequate and accurate
information for enabling them to make informed
choices.
 The nurse respects the rights of individuals as partner
in care and helps in making informed choices
 Respects the decisions made by individual (s)
regarding their care.
MRS. KANIKA SHARMA

20.  Advocates special provisions to protect vulnerable
individuals/groups.
 The nurse respects individual’s right to privacy,
maintains confidentiality, and shares information
judiciously.
 Respects the individual’s right to privacy of their
personal information.
 Maintains confidentiality
 Nurse maintains competence in order to render Quality
Nursing Care.
 Nursing care must be provided only by registered nurse.
 Nurse strives to maintain quality nursing care and
upholds the standards of care.
MRS. KANIKA SHARMA

21.  Nurse values continuing education and utilizes all
opportunities for self-development.
 The nurse is obliged to practice within the framework of
ethical and legal boundaries
 Adheres to code of ethics and code of professional
conduct for nurses in India developed by Indian Nursing
council.
 Nurse is obliged to work harmoniously with the
members of the health team.
 Appreciates the team efforts in rendering care.
 Cooperates, coordinates and collaborates with the
members of the health team to meet the needs of the
people.
 Demonstrates personal etiquettes in all dealings.
 Demonstrates professional attributes in all dealings.
MRS. KANIKA SHARMA

22. (FOR
NURSES IN INDIA)
1. PROFESSIONAL RESPONSIBILITY AND
ACCOUNTABILITY:
 Nurse Maintains standards of personal conduct. It is
accountable for his/her own decisions and actions.
 Carries out responsibilities.
 Is accountable for own decisions and actions
 Is responsible for continuous improvement of current
practices
 Provides adequate information to individuals that allows
them informed
MRS. KANIKA SHARMA

23. MRS. KANIKA SHARMA
2. NURSING PRACTICE :
 Provides care in accordance with set standards of
practice
 Treats all individuals and families with human dignity.
 Respects individual and families in the context of
traditional and cultural practices and discouraging
harmful practices.
 Promotes participation of individuals and significant
others in the care
 Ensures safe practice

24. MRS. KANIKA SHARMA
3. COMMUNICATION AND INTERPERSONAL
RELATIONSHIPS:
 Establishes and maintains effective interpersonal
relationship with individuals, families and communities
 Maintains effective interpersonal relationship with
them
 Cooperates with other health professionals to meet
the needs of the individuals, families and community

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4. VALUING HUMAN BEING
 Takes appropriate action to protect individuals from
harmful unethical practice
 Encourage and support individuals in their right to
speak for themselves on issues affecting their health
and welfare
 Respects and supports choices made by individual

26. MRS. KANIKA SHARMA
5. MANAGEMENT
 Ensures appropriate allocation and utilization of
available resources
 Communicates effectively following appropriate
channels of communication
 Participates in performance appraisal
 Participates in evaluation of nursing services

27. ETHICAL ISSUES IN NURSING
MRS. KANIKA SHARMA
 1.UNSAFE PATIENT TO NURSE RATIO:
 2. INAPPPROPRIATE MEDICATION ORDER
 3. UNRESPONSIVE
 4. INAPPROPRIATE TASK
 5.LIFE THREATNING PATIENT DECISIONS

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MEANING
 The word law is derived from an Anglo-Saxon term
meaning that which is laid down or fixed.
DEFINITION
 Law is a body of rules of conduct inherent in human
nature and essential to human society and guide
human functions.

30. PURPOSES
MRS. KANIKA SHARMA
1. Safeguarding the public:
 The public safety is guaranteed
 The individual is secure to the event of sickness or
disability with no fear of anxiety of being cared for by
a competent person.
 It protects the patients /clients against deliberate
injury by a nurse.

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2. Safe guarding the nurse:
 It protects the nurses also against the legal action if
she renders right care.
 Good rapport

32. LEGAL LIABILITY IN NURSING
MRS. KANIKA SHARMA
1. UNINTENTIONAL TORTS:
These types of torts are accidents that cause injury to
another person or property.
 NEGLIGENCE: Nursing negligence usually means
failure by the nurse to take the appropriate action to
protect the patient from harm.
E.g.: Burns, falls, medication errors, failure to observe,
use of defective equipment’s, loss of patient property,
patient mix up.
 MALPRACTICE: Medical malpractice is an act by a
health care provider which deviates from accepted
standards of practice in the medical community and

33. MRS. KANIKA SHARMA
ELEMENTS OF MALPRACTICE
 DUTY- (relationship) nurse’s responsibility to provide care
in an acceptable manner.
 BREACH OF DUTY- failed to provide care in acceptable
manner.
 INJURY (DAMAGES)- nurses act caused harm.
 Leaving foreign objects like sponge or forceps, inside a
patient during surgery.
 Failing to assess and observe patient as directed.
 Failing to report a change in a patient’s condition such as
vital signs, circulatory status and level of consciousness.
 Failure to select appropriate site by the nurse to administer
intramuscular injection that causes permanent damage to
patient’s extremity.
 Falling to obtain an informed consent.

34. MRS. KANIKA SHARMA
2. INTENTIONAL TORTS:
These types of torts are deliberate actions in which the
intent is cause injury to a person or property.
 ASSAULT: Assault is the threat of unlawful touching of
another, the wilful attempt to harm someone. Assault
can be verbally threatening a patient.
 BATTERY: Battery is the unlawful touching of another
without consent or justification. In legal medicine
battery occurs if a medical or surgical procedure is
performed without patient consent.

35. MRS. KANIKA SHARMA
 3. QUASI INTENTIONAL TORTS:
It is usually involving situations of communication and
often violates a person’s reputation, personal privacy
or civil rights.
 Defamation : It is the issuance of a false statement
about another person which causes that person to
suffer harm. (the action of damaging the good
reputation of someone)
 Fraud: Fraud is a crime or offence of deliberately
mislead another in order to damage another to obtain
property or services and a civil law violation.
 Invasion of privacy: Clients have claims for invasion
of privacy , e.g. their private affairs, with which the
public has no concern, have been publicized.

36. LEGAL ISSUES IN NURSING
PRACTICE AREA
MRS. KANIKA SHARMA
 Patients property
 Caring patients with AIDs
 Living wills and health care surrogates
 Deaths and dying
 Autopsy and organ donation

37. LEGAL RESPONSIBILITIES OF
NURSES
MRS. KANIKA SHARMA
1. AT ADMINISTRATIVE AND SUPERVISORY LEVEL
 Appointing and assigning the nurses
 Quality control
 Material management
 Proper documentation system
 Staff management

38. MRS. KANIKA SHARMA
2. AT OPERATIONAL LEVEL
 Carrying out physician’s orders
 Alert for mishap
 Maintaining safe environment
 Use of safe equipment's
 Maintenance of proper records

39. OTHER ISSUES
MRS. KANIKA SHARMA
PATIENT CARE ISSUES
 Nursing shortage
 Low salaries
 Standard care
MANAGEMENT ISSUES
 Turnover
 Funding
 Workload
 Issues regarding malpractice in nursing management
 Issues of delegation and supervision
 Issues related to staffing
 Collaboration issues

40. MRS. KANIKA SHARMA
EMPLOYMENT ISSUES
 Issues related to nursing shortage
 Issues in nurse migration
 The right to work and right to practice
 Exploitation and discrimination
 Misconduct and imposition of punishment
 Sexual harassment at the workplace
 Renewal of nursing registration
 Specialization in clinical area
 Nursing care standards

41. MRS. KANIKA SHARMA