NURS 2210 Roles II: Unit II

Legal and Ethical ConceptsNancy Pares RN, MSN

Metro Community College

Laws define and limit relationships Sources of public law

◦ Constitutional

◦ Administrative

◦ Criminal Felony vs misdemeanor

Obj 1: Review legal standards

Civil Law◦ Contract

Involves compensation, mutual understanding Implied contract

Employer policies, fulfill terms, respect others◦ Tort

Wrongful act against another◦ Protective/reporting

HIPPA Good Samaritan

Adequate assistance

Reasonable conduct from clients

Compensation

Reasonable treatment by co workers

Nurses also have rights

State◦ Unintentional torts

Negligence Duty Breach of Duty Injury Causation

Malpractice

Tort law

Assault

Battery

False imprisonment Restraints (OBRA)

Invasion of privacy Right to be left alone; consent for no treatment

Defamation

fraud

Intentional Torts

Intent is lacking, but a willfull action is evident◦ Defamation of character◦ Invasion of privacy◦ Breech of confidentiality

Quasi intentional

Defined by Practice Acts and Standards of Care

RN is legally responsible to ensure that the client receives competent, safe and holistic care.

Best Defense ◦ Actively participate in NNA◦ Attend continuing ed on legal issues◦ Call State Board with any questions about

practice◦ Stay current in hospital policies and procedures

Legal responsibilities of RN

Unprofessional conduct◦ Delegation, HIPPA, lack of knowledge; abuse, false

documentation, leaving assignment Impaired Nurse

◦ Duty to report Safety

◦ Understaffing◦ Mandatory overtime◦ Reassignment

Executing prescribed orders

Responsibilities

Whistle blowing

Nursing students

Professional liability insurance

Advance Directives

Other legal issues

DNR orders Euthanasia Wills Pronouncement of Death Care of the deceased Organ donation autopsies

Legal issues related to death

Ethics◦ Study of rightness of conduct◦ Vs. morality?

Relationship between ethics and legal◦ Ethical opinions reflect individual differences◦ Human behavior and motivation are too complex

to be accurately reflected in law◦ The legal system judges action rather than

intention◦ Laws change according to social and political

influences

Obj 2 Review ethical principles

Working in a clinic that performs abortions

Honoring a terminally ill client request for no heroic actions

d/c a comotose client life support at the request of the family

Diverting meds from a client for your own use

Ethical vs. Legal…or both

Autonomy Beneficience Confidentiality Double effect Fidelity Justice Nonmaleficence Paternalism Sanctity of life veracity

Ethical Principles

M ….. Massage the dilemma

O…outline options

R…resolve

A…act by applying options

L…look back and evaluate

MORAL model

Maximize client well being Balance client needs with family

responsibilities Support family and enhance support system Carry out hospital policies Protect other client well being Protect nursing standards

Nurse obligations in ethical decisions

Is the action good or neutral?

Is the intent good?

Good effect cannot be achieved by bad action

Balance of good/bad

Critical thinking

Human caring should guide the practice Confidentiality

◦ Privacy, misuse of information Restraints Trust Refusing to provide care Food and fluid

Basics of nursing ethics

Nancy Cruzan

Terri Shiavo

Preventative ethics

Practice with compassion and respect Nurses primary commitment is to the

patient Nurse advocates, protects the patient Nurse is responsible and accountable for

actions Nurse must maintain competence and

professional growth Nurse participates in improving health Nurse contributes to profession thru

community, educational and social situations

Code of Ethics

Dx: missed abortion—client hospitalized, D&C was scheduled—client discussed with MD

Nurse administered preop meds then noted that there was no consent signed. Surgery was postponed awaiting MD. MD arrived and had pt sign and husband also-witnessed by RN.

Procedure resulted in perforation, OB attempted to repair—called in general surgeon-- required removal of 1 ft of bowel

Result: likely to have higher incidence of SBO

Case 1

Was the hospital liable to obtain informed consent?

Issue:

1985- Nurse Midwife advertised ‘Family Birth’

Hospital Chief of Staff – OB wrote a letter to the administration of two hospitals stating that home deliveries were being done without qualified supervision.

Same MD confronted nurse midwife at L&D Nurse midwife was prohibited from the

hospital.

Case 2

Was the slander actionable?

Issue

Client with fx leg—cast applied; orders to have nursing check hourly and call with concerns

Charting notes gap from 4am to 830 am. MD examines at 830—compartment

syndrome and identification of tissue death—leg amputated

Case 3

Was documentation considered substandard and cause for patient to suffer injury?

Issue

Female patient admitted to LTC—noted large diamond ring and informed that she should not keep in her room. Pt kept the ring.

Ring disappeared—investigation proved fruitless—thru a ‘tip’ a nurse aid was implecated—arrested and pled guilty

Case 4

Was the nursing home responsible for the property damage sustained by the resident?

Issue:

Male was admitted to psych unit on Nov 21due to being a threat to himself and others. Meeting held on Nov 23 determined that he was able to be released. (Thanksgiving holiday)

Male entered house on Dec 5 and killed one individual and wounded two others, then shot himself.

Case 5

Was the institution liable for discharging the patient and the subsequent deaths?

Issue

What are they?

What about gossip amongst peers?

What about behaviors of student nurses?

Ethical Behaviors in Professional Nursing

How do we apply these standards in the classroom?

What should be done if student cheats? Lies to instructor? Copies from other’s work Instructor or student ‘bullies’

Legal and ethical standards in the classroom