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personal standards of conduct derived from society expectations of behavior.
systematic study of moral values such as autonomy, nonmaleficence, beneficence, justice, fidelity, veracity, confidentiality.
rules and regulations established and promoted by a government to protect or to restrict the people.
Respect for life
Life is the most basic possession; respect for the value of life and quality of life
Freedom to choose one’s life plan and values
Not inflicting harm
Taking positive steps to do good for the benefit of others
Treating others fairly
The duty to keep promises
The duty to tell the truth
The duty to protect privileged information
Nurses decisions are______
- based on ethical principles.
- Our role is also to promote self-care and enhance SCA by assisting patients in clarifying their values.
- – shape responses to patient questions and statements
- – motivate patients to examine personal thoughts and actions.
Values clarification goes beyond expressing feelings to:
- –gaining an awareness of personal priorities
- –identifying unclear values
- –resolving conflicts between values and behaviors
What you need:
- –interest in others
- –teaching skills
- –self awareness
- –non-judgmental listening skills
Three steps to value clarification
- –Choosing one’s beliefs and behaviors
- –Prizing one’s beliefs and behaviors
- –Acting on one’s belief
Nurse Practice Acts include:
- Definition of nursing
- Requirements for licensure
- Exceptions to the practice act
- Actions or conditions that can result in loss of licensure
- Administrative structure that implements and administers the practice act
- Create the legal foundation and set the statutory boundaries for decision making for nurses.
- Differ among states
- (created by legislative bodies eg U. S. Congress)
- Types: criminal and civil•
- Eg. State statutes are the Nurse Practice Acts
- (created by administrative bodies eg. BRN)
- Eg. Duty to report to BRN incompetent nurse
- (based on previous court judgments)
- Within each category federal, state and local laws may exist.
deals with conduct considered offensive to society as a whole
penalty ranges from at least one year imprisonment to death
disconnecting life support systems without appropriate consent
working while under the influence of alcohol and causing a patient’s death.
- penalty fine or imprisonment less than one year
- •alteration of medical records
- •Battery (no major injury)
concerned with legal rights and relationships that exist between private persons
civil wrong by one person against the person or property of another.
pain and suffering?
Person harmed may sue for monetary damages and may seek compensation for non-monetary damages (pain and suffering)
(part of civil law; common law also used here in court) violation of professional standard of care that results in injury to a patient.
Required to sue for malpractice
- –Duty = created by a professional relationship
- –have a duty to meet the standard of care
- –to act as a reasonably prudent professional working in similar circumstances
- -Breach of duty
- –must show that the breach of duty caused the injury
- –3 year statute of limitation in California with exceptions
- False imprisonment
- Defamation (slander, libel,
- -Most common basis for lawsuits against nurses.
threatening or attempting to make contact without consent.
An assault that is carried out.
restraining without legal justification or consent.
Purposeful misrepresentation that causes harm
- a form of negligence that addresses the negligent conduct of professionals including nurses.
- •In court case such as malpractice
- •Plaintiff is patient
- •Defendant is the nurse or person being sued
- •It is violation of a professional standard of care that results in injury to a patient.
- •Leaving foreign object inside patient after surgery
- •Failing to recognize and report significant changes
- •Failing to ensure patient’s informed consent
- •Carelessness with patient’s personal property
- •Failing to respond to patient’s signal for service
- •Failing to use adequate steps to prevent injury
- •Failing to carry out orders for medications or treatments
- •Failing to report own fatigue or illness
- •Failing to recognize dangers inherent in an order
- •Inattention to dying patient’s request for clergy, etc.
- •Assigning others to responsibilities for which they have no education, experience, or license to perform
- •Failing to take steps in emergency to protect the patient
- •Failing to remove faulty equipment from use
- •Failing to report staff member’s negligence that you witnessed
Hospital Policies and Procedures
- –Set allowable scope of practice within the institution
- –May not expand the legal scope of practice
Avoiding malpractice charges
- •Avoid being rude or disrespectful
- •Validate information with patient
- •Include patient in planning and decision making
- •Do not offer opinion on medical diagnosis
- •Maintain confidentiality at all times
- •Document verbal orders
- •Do not correct or revise a medical record•Never treat without doctor’s order
- •Understand order before doing anything
- •Do not carry out an order you question
- •Participate in surgical procedure only if proper consent is obtained
- •Never force treatment on patient
- •Be familiar with equipment you use
- •Take precautions to prevent falls
Your Legal Responsibility
Nursing students are expected to perform as professional nurses would in providing safe patient care!
Delegation of tasks
Nurse retains responsibility for determining competency and retains responsibility for planning, implementing and evaluating care.
- –Co-worker incompetence
- –Child abuse, elder abuse, domestic violence
- –Communicable diseases (TB, HIV, STDs, chicken pox, hepatitis)
Sexual misconduct indicators (Crossing the Line)
- •Spend more time than is clinically necessary with a patient
- •Made plans to see a patient when not on duty
- •Dressed for work with a particular patient in mind
- •Felt that others misunderstood or were too critical of a patient
- •Made or kept secrets with a patient
- •considered a certain patient to be “yours”
- •Been guarded or defensive when questioned about your interaction or relationship with a patient
- •Accepted gifts, letters or phone calls from a patient after he or she was discharged
- •Chosen sides with a patient against family members
- •Flirted with a patient
Preventing sexual misconduct
- Be aware of any sexual attraction you have toward a patient.
- Discuss your feelings with a trusted supervisor or colleague.
- Transfer the care of the patient to another nurse
- Learn to recognize signs that a patient may be interested in forming a sexual relationship.
- Establishing professional boundaries is your responsibility.
- Respect patient dignity and privacy at all times.
- Provide a professional explanation for all aspects of care.
- Maintain clear, appropriate, and professional communication with patients.
- Don’t discuss your personal problems or any aspect of your intimate life with patients.
- Document and report observations of inappropriate behavior to supervisor and to state regulatory agency if necessary.
Legal implications of medical records
- –Medical records are evidence in legal actions!
- –Medical records are considered highly credible and are given great weight in legal proceedings. –“Assessments should be documented objectively, indicating facts, observations, patient’s statements, and other measurable criteria.
- –Subjective documentation should be avoided, because it states the writer’s conclusions without supporting facts and it allows a third party (such as attorney) to suggest any number of scenarios to clarify the subjective documentation.”
Good Samaritan Statutes
- Provide immunity for acts that might otherwise result in a claim of negligence when acts occur outside your place of employment.
- Good Samaritan statutes were written with the hope that you will act.
- Individuals who perform rescue as part of their job are legally responsible to help.
- Others are protected by both common law and statutory law.
Civil Law: Good Samaritan Statutes: Common law
many cases over the years have supported the “good Samaritan”.
Civil Law: Good Samaritan Statutes: Statutory Law
- Statutory law: would have to prove
- you owed the victim a duty to assist
- you breached that duty
- the victim was harmed
- better than 50% probability that your actions caused the harm.
- Gross negligence and intentional harm are not protected. i.e. intentional, reckless actions.
Willful infliction of physical injury or mental anguish and the deprivation by the caregiver of essential service
Forms of abuse
- Physical abuse
- Sexual abuse ~ incest
- Emotional abuse
- Economic abuse
- Spousal abuse ~ Domestic violence
Deliberate violent action that inflicts pain and/or nonaccidental injury
- Any type of sexual contact between an adult and anyone younger than 18, or between a significantly older child and a younger child.
- If a family member sexually abuses another family member, this is called incest
Deliberate and willful destruction or significant impairment of a person's sense of competence by battering the victim's self-esteem and inhibiting normal psychosocial development.