Chapter 5 Ethical and Legal Issues

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 5Ethical and Legal Issues


Along with the privilege of providing professional health care services to consumers, the professional nurse has a commensurate degree of responsibility and accountability to follow ethical principles and standards of care integral to the profession.

Sheehy, 2006


Learning ObjectivesAfter studying this chapter, you should be able to

• Explain the relationship between state Nurse Practice acts and the concepts of risk management and quality assurance

• Construct the six-step model of ethical nursing care designed by Chally and Loriz

• Articulate why nurses must become knowledgeable about genetics and the issues surrounding this topic

• Recognize five forms of nursing malpractice

• Discuss implications for psychiatric care related to the Tarasoff ruling of duty to warn

• Compare the criteria for voluntary and involuntary admission to a psychiatric facility

• Interpret the concept of competency


Learning Objectives (cont.)

• Compare the legal rights of adults and minors admitted to psychiatric facilities

• Discuss the impact of the Omnibus Reconciliation Act (OBRA) on the placement of clients with psychiatric disorders in long-term care facilities

• Distinguish the legal phrases: diminished capacity, not guilty by reason of insanity, and guilty but mentally ill

• Explain forensic psychiatry and the role of the forensic nurse


Ethics in Nursing

• Model of ethical nursing care

• Ethics in pain management

• Ethics in genetic testing and clinical research


Ethical Decision-Making Model

• Clarify the ethical dilemma

• Gather additional data

• Identify options

• Make a decision

• Act or carry out the decision

• Evaluate the impact of the decision


Ethical Dilemmas in Clinical Research

• Informed consent

• Documentation of research protocols

• The client’s right to full disclosure


Legal Issues in Nursing

• Nurses, now more than ever, are subject to the scrutiny of federal and state regulations as well as the legal system.


Bill of Rights for Registered Nurses

Nurses have the right to

• A safe environment

• Practice in a manner that ensures the provision of safe care through adherence to professional standards and ethical practice

• Advocate freely on behalf of themselves and their clients


Four Elements Required for Nursing Malpractice• Failure to exercise reasonable care or act in an

acceptable way when undertaking and providing care to a client

• Breach of duty or failure to conform to the required standard of care in treating the client’s condition

• Approximate cause, which requires that there be a reasonably close connection between the defendant’s conduct and the resultant injury (ie, the performance of the health care provider caused the injury to the client)

• The occurrence of actual damage to the client as a result of malpractice


Other Forms of Malpractice

• Intentional torts

• Assault

• Battery

• Defamation

• False imprisonment

• Failure of duty to warn

• Breach of confidentiality and privacy


Bill of Rights for Psychiatric–Mental Health Clients

• Receive treatment

• Refuse treatment

• Have a probable cause hearing

• Maintain client privacy and confidentiality

• Communicate freely with others

• Have personal privileges

• Maintain one’s civil rights

• Engage in religious freedom and education

• Maintain respect, dignity, and personal identity

• Maintain personal safety and assert grievances

• Be transferred and receive continuity of care

• Access own records

• Obtain an explanation of cost of services

• Obtain aftercare


Psychiatric Hospitalization

• Involuntary admission or civil commitment

• Voluntary admission

• Hospitalization of minors

• Long-term care facilities

Omnibus Reconciliation Act (OBRA) of 1987


Forensic Psychiatry

• Evaluation of an individual’s competency

• Diminished capacity

• Not guilty by reason of insanity

• Guilty but mentally ill

• Role of the forensic nurse

• The forensic nurse as a legal nurse consultant and expert witness


Key Terms• Advance psychiatric directives

• Assault

• Battery

• Bill of Rights for Registered Nurses

• Civil commitment

• Client confidentiality

• Client privacy

• Code of Ethics for Nurses

• Defamation

• Diminished capacity

• Doctrine of Charitable Immunity

• Ethics

• Failure of duty to warn

• False imprisonment

• Forensic psychiatry

• Genetic testing

• Guilty but mentally ill


Key Terms (cont.)

• Incompetent

• Informed consent

• Intentional tort

• Involuntary admission

• Libel

• Malpractice

• Miranda warning

• Negligence

• Not guilty by reason of insanity

• Nurse Practice Act

• Omnibus Reconciliation Act

• Paternalism

• Quality assurance

• Risk management

• Sentinel event

• Slander

• Tarasoff decision

• Voluntariness hearing

• Writ of habeas corpus


Reflection

Imagine that you are providing care for a client undergoing a clinical research drug study. The client informs you that she suspects that she is pregnant but has not seen a doctor to confirm the pregnancy.

??• What informed and effective

care decisions do you need to make before taking action?

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Chapter 5 Ethical and Legal Issues