ASN 180 Transition to Professional Nursing Objective 5

ASN 180 Transition to ASN 180 Transition to Professional NursingProfessional Nursing

Objective 5Objective 5

Objective Objective 5. Examine the legal and ethical 5. Examine the legal and ethical

principles that impact the roles, principles that impact the roles, interventions and outcomes of interventions and outcomes of providing care.providing care.

Legal Foundations of NursingLegal Foundations of Nursing Sources of LawSources of Law

Public LawPublic Law Statutory – enacted by legislationStatutory – enacted by legislation Administrative – appointed groups (state board)Administrative – appointed groups (state board) Criminal – offenses against publicCriminal – offenses against public

Felony - serious (>1 yr. punishment)Felony - serious (>1 yr. punishment) Misdemeanor – less serious (<1 yr. punishment)Misdemeanor – less serious (<1 yr. punishment)

Civil Law – crimes against individualsCivil Law – crimes against individuals Contract Law – enforcement of agreementsContract Law – enforcement of agreements Tort Law – enforcement of duties and rights Tort Law – enforcement of duties and rights

independent of contractsindependent of contracts

Legal Foundations of NursingLegal Foundations of Nursing The Judicial ProcessThe Judicial Process

Precedents – interpreting the law in a Precedents – interpreting the law in a certain mannercertain manner

Lower courts must adhere to the rulings Lower courts must adhere to the rulings of the higher courts in the same of the higher courts in the same jurisdictionjurisdiction

Jurisprudence – “judge-made” lawJurisprudence – “judge-made” law

Legal Foundations of NursingLegal Foundations of Nursing Legal Liability in NursingLegal Liability in Nursing

Liability – four elements: duty, breach of Liability – four elements: duty, breach of duty, injury, causationduty, injury, causation

Negligence – failure of individual to provide Negligence – failure of individual to provide care that a reasonable person wouldcare that a reasonable person would

Malpractice – negligence of a professional Malpractice – negligence of a professional person that does not meet standardsperson that does not meet standards

Expert witness – qualified third partyExpert witness – qualified third party Testimony – factual reporting of written or Testimony – factual reporting of written or

verbal evidenceverbal evidence

Legal Foundations of NursingLegal Foundations of Nursing Legal Liability in Nursing, cont.Legal Liability in Nursing, cont.

Informed ConsentInformed Consent InvasiveInvasive

Assault and BatteryAssault and Battery Assault – intent to touchAssault – intent to touch Battery – touching of another person w/o Battery – touching of another person w/o

consentconsent False ImprisonmentFalse Imprisonment

Restrain and Seclusion (OBRA – 1987)Restrain and Seclusion (OBRA – 1987)


Privacy and ConfidentialityPrivacy and Confidentiality ANA code for NursesANA code for Nurses Health Insurance Portability and Health Insurance Portability and

Accountability Act (HIPAA)Accountability Act (HIPAA) Defamation – damaging information Defamation – damaging information

communicated to a third-partycommunicated to a third-party Libel – in writingLibel – in writing Slander - verballySlander - verbally


Fraud – deliberate deception intended to Fraud – deliberate deception intended to produce unlawful gainproduce unlawful gain

Unprofessional ConductUnprofessional Conduct Failure to use nursing judgmentFailure to use nursing judgment Abuse of a clientAbuse of a client Assuming duties without sufficient preparationAssuming duties without sufficient preparation Knowingly delegating nursing to UAP that puts client Knowingly delegating nursing to UAP that puts client

at riskat risk Falsifying recordsFalsifying records Abandonment of patientsAbandonment of patients


Use of Controlled SubstancesUse of Controlled Substances The Impaired Nurse – you have a duty to The Impaired Nurse – you have a duty to

report to administrationreport to administration SafetySafety

Failure to monitor client statusFailure to monitor client status Medication errorsMedication errors FallsFalls Use of restraintsUse of restraints


Understaffing – must report to Understaffing – must report to administrationadministration

Reassignment – “floating” – cannot refuse, Reassignment – “floating” – cannot refuse, but must not perform what you are not but must not perform what you are not competent to docompetent to do

Executing Prescribed Orders – must Executing Prescribed Orders – must follow the orders follow the orders unless the orders unless the orders would result in client harm.would result in client harm.

Legal Foundations of NursingLegal Foundations of Nursing Legal Responsibilities and RolesLegal Responsibilities and Roles

Provider of Service Provider of Service Expert Witness Expert Witness Forensic Specialist Forensic Specialist Client Educator Client Educator Reporting Responsibilities Reporting Responsibilities

Legal Foundations of NursingLegal Foundations of Nursing Legal Safeguards for Nursing PracticeLegal Safeguards for Nursing Practice

Institutional PoliciesInstitutional Policies Professional Liability InsuranceProfessional Liability Insurance Risk Management ProgramsRisk Management Programs

Incident ReportsIncident Reports

Legal Foundations of NursingLegal Foundations of Nursing Legislation affecting Nursing PracticeLegislation affecting Nursing Practice

Patient Self-Determination ActPatient Self-Determination Act Living WillLiving Will Durable power of Attorney (DPOA)Durable power of Attorney (DPOA) Advanced care medical directiveAdvanced care medical directive

Roe v. Wade (1973)Roe v. Wade (1973) The American with Disabilities Act (1990)The American with Disabilities Act (1990) Good Samaritan ActsGood Samaritan Acts Health Care Quality Improvement Act (1986)Health Care Quality Improvement Act (1986) Occupational Safety and Health Act (1970)Occupational Safety and Health Act (1970)

Legal Foundations of NursingLegal Foundations of Nursing Legal Issues Related to Death and Legal Issues Related to Death and

DyingDying Do Not Resuscitate Orders (DNR)Do Not Resuscitate Orders (DNR) Wills Wills Pronouncement of Death Pronouncement of Death Care of the Deceased Care of the Deceased Autopsies Autopsies Organ Donation Organ Donation

Ethical Foundations of NursingEthical Foundations of Nursing Concept of EthicsConcept of Ethics

Ethics – a branch of philosophy that examines Ethics – a branch of philosophy that examines the difference between right and wrongthe difference between right and wrong

Morality – behavior in accordance with custom Morality – behavior in accordance with custom or tradition and usually reflects personal or or tradition and usually reflects personal or religious beliefsreligious beliefs

Relationship between Legal and Ethical Relationship between Legal and Ethical concepts – laws change, ethics reflect concepts – laws change, ethics reflect individual differencesindividual differences

Bioethics in Health Care – the application Bioethics in Health Care – the application of general ethical principles to health careof general ethical principles to health care

Ethical Foundations of NursingEthical Foundations of Nursing Ethical TheoriesEthical Theories

Telology/Telology/consequentialist theory (Mill) – consequentialist theory (Mill) – the value of a situation is determined by the value of a situation is determined by its consequencesits consequences

Utility – an act must result in the greatest Utility – an act must result in the greatest good for the greatest number of peoplegood for the greatest number of people

DeontologyDeontology/formalism (Kant) - considers /formalism (Kant) - considers the intrinsic significance of the act itself the intrinsic significance of the act itself as the criterion for determination of goodas the criterion for determination of good

Categorical imperative – a person should Categorical imperative – a person should never be treated as a means to an endnever be treated as a means to an end

Ethical Foundations of NursingEthical Foundations of Nursing Ethical PrinciplesEthical Principles

AutonomyAutonomy NonmaleficenceNonmaleficence BeneficenceBeneficence JusticeJustice VeracityVeracity FidelityFidelity

Ethical Foundations of NursingEthical Foundations of Nursing Values and EthicsValues and Ethics

Values – influence the development of Values – influence the development of beliefs and attitudes and thus affect beliefs and attitudes and thus affect behaviors indirectly behaviors indirectly

Values Clarification – the process of Values Clarification – the process of analyzing one’s own values to better analyzing one’s own values to better understand what is truly important. understand what is truly important.

ChoosingChoosing PrizingPrizing ActingActing

Ethical Foundations of NursingEthical Foundations of Nursing Ethical CodesEthical Codes

Professional hallmarkProfessional hallmark International Council of Nurses (ICN)International Council of Nurses (ICN) American Nurses Association Code of EthicsAmerican Nurses Association Code of Ethics Canadian Nurses AssociationCanadian Nurses Association

Ethical Foundations of NursingEthical Foundations of Nursing Clients’ RightsClients’ Rights

PATIENT CARE PARTNERSHIP - American PATIENT CARE PARTNERSHIP - American Hospital Association (AHA) 1972 revised Hospital Association (AHA) 1972 revised in 2003 to be used in short-term acute in 2003 to be used in short-term acute care and extended carecare and extended care

Patient Rights include:Patient Rights include: The right to make decisions regarding their The right to make decisions regarding their

carecare Be actively involved in the treatment processBe actively involved in the treatment process Be treated with dignity and respectBe treated with dignity and respect

Ethical Foundations of NursingEthical Foundations of Nursing Ethical Dilemmas - a conflict between two Ethical Dilemmas - a conflict between two

or more ethical principlesor more ethical principles Euthanasia – Gr. “gentle death” – mercy killingEuthanasia – Gr. “gentle death” – mercy killing

Active – deliberate actions to hasten deathActive – deliberate actions to hasten death Passive – omitting actions that would prolong dyingPassive – omitting actions that would prolong dying Assisted suicide – healthcare professional provides Assisted suicide – healthcare professional provides

client with the means to end their own lifeclient with the means to end their own life Refusal of treatment – must be informedRefusal of treatment – must be informed

Use of Scarce Resources – third-party Use of Scarce Resources – third-party payer denial, limited organs for donationpayer denial, limited organs for donation

Ethical Foundations of NursingEthical Foundations of Nursing Ethical Roles and Responsibilities of Ethical Roles and Responsibilities of

Professional Nurses – Professional Nurses – accountable for accountable for protecting the rights and interests of the protecting the rights and interests of the clientclient Ethics CommitteesEthics Committees – institutional method – institutional method

to decide ethical dilemmas and make policyto decide ethical dilemmas and make policy Client AdvocacyClient Advocacy – nurses empower, – nurses empower,

educate, listen, act as liaisoneducate, listen, act as liaison Whistle-blowingWhistle-blowing – reporting unethical, – reporting unethical,

illegal or incompetent actions of othersillegal or incompetent actions of others

Ethical Foundations of NursingEthical Foundations of Nursing Ethical Decision MakingEthical Decision Making

Ethical Reasoning – thinking through Ethical Reasoning – thinking through what one ought to do in an orderly, what one ought to do in an orderly, systematic manner to provide systematic manner to provide justification of actions based on justification of actions based on principles.principles.

Framework for Ethical Decision MakingFramework for Ethical Decision Making ADPIE ADPIE

Steps for ethical analysisSteps for ethical analysis

1. Determine what type of ethical problem 1. Determine what type of ethical problem exists: principles vs. principles, actions exists: principles vs. principles, actions vs. action, actions vs. principlesvs. action, actions vs. principles

2. Who is most appropriate to make the 2. Who is most appropriate to make the decision?decision?

3. Identify several possible alternatives 3. Identify several possible alternatives and predict outcomesand predict outcomes

4. Select course of action4. Select course of action5. Evaluate the resolution process.5. Evaluate the resolution process.

Ethical Foundations of NursingEthical Foundations of Nursing Practice using ADPIE to solve an ethical Practice using ADPIE to solve an ethical

issueissue ““A coworker often takes Tylenol from a A coworker often takes Tylenol from a

client’s medication drawer. When you client’s medication drawer. When you confront her about the behavior, she confront her about the behavior, she states; ‘It’s only Tylenol. Besides the states; ‘It’s only Tylenol. Besides the patient’s not taking it anymore anyway.’ “patient’s not taking it anymore anyway.’ “

Should you blow the whistle? Why or why not? Should you blow the whistle? Why or why not? Would your response be different if your coworker Would your response be different if your coworker

were taking narcotics from the client?were taking narcotics from the client?

ObjectiveObjective 5. Examine the legal and ethical 5. Examine the legal and ethical

principles that impact the roles, principles that impact the roles, interventions and outcomes of interventions and outcomes of providing care.providing care.

Documents

ASN 180 Transition to Professional Nursing Objective 5