Transcript Chapter 10*Ethical Issues in Health Care

CHAPTER 10ETHICAL ISSUES IN
HEALTH CARE
CHAPTER 10 OBJECTIVES
1. Define the word ethical.
2. Describe what is meant by individual, societal, and situational ethics.
3. Explain why a study of ethics and ethical behavior is important in
nursing.
4. State the purposes of a code of ethics.
5. Explain personal responsibility and accountability as they relate to
ethical behavior.
6. Apply guidelines for ethical decision making in your practice of nursing.
7. Participate in discussions regarding ethical issues in the work
environment.
8. Outline the process for making decisions related to ethical dilemmas.
ETHICS
Study of right and wrong related to human
conduct
Knowledge of right and wrong related to:
Individual
Society
Situation
NURSING AND ETHICS
Nurses
Have the ability and obligation to help
patients
Internalize the concept of what it means
to be a human being
Accept personal responsibility for
relationships
Are obligated to do good and not harm
Are committed to providing high quality
care to all human beings
NURSING AND ETHICS
Code of Ethics
NFLPN and NAPNES (found in Appendix B
& C)
-will be more detailed in PVR 2
Purpose is to provide a list of rules of
good conduct
Attempt to describe the ideals of a group
Identify standards of behavior
PERSONAL ACCOUNTABILITY
Being responsible means to accept being the
cause of an action
Being accountable means to accept the
consequences of the action
UNETHICAL BEHAVIOR
Failure to adhere to a code of ethics
Failure to base practice on high ethical
standards
Disregard for basic human rights
ETHICAL DILEMMAS
Conflict or opposition between:
Personal values
Moral principles
Laws
Personal and professional obligations
The rights of individuals and society
No right or wrong answer
Legal versus ethical problems
ETHICAL ISSUES IN NURSING
Dilemmas exists when there is the belief that
appropriate and safe care cannot be provided
Choosing between the employer's requirements
and what the patient needs
Staffing shortages
Excessive paperwork and administrative tasks
Cost containment measures
Managed care
Mandatory overtime
ETHICAL ISSUES IN NURSING
Risks to personal health and safety
Other issues
Right to refuse to assist with a procedure you
believe is morally or ethically wrong
Cannot refuse to provide nursing care for a
patient
QUESTION
Is the following statement true or false?
A moral dilemma exists when there is no
right or wrong answer.
ANSWER
True
Rationale: The fact that there is no right or
wrong answer is what makes it a
dilemma.
QUESTION
Is the following statement true or false?
Disregard for basic human rights is an ethical
dilemma.
ANSWER
False
Rationale: Disregard for basic human
rights is unethical behavior. There is no
question that this is right or wrong. It is
wrong behavior.
Chapter 11
Legally Responsible
Nursing Practice
CHAPTER 11 OBJECTIVES
1. Discuss the purpose of Good Samaritan laws.
2. Discuss the relationship between the nurse
practice acts and the state boards of nursing.
3. Explain the association among responsibility,
accountability, and legal liability.
4. Define the term breach of contract.
5. Define the term tort.
6. Differentiate negligence and gross negligence.
7. Give examples of crimes that may involve
nurses.
LEGALLY RESPONSIBLE NURSING PRACTICE
A nurse’s duty is to do good and to avoid harm in
accordance with the law
Laws are rules of conduct derived from:
Cultural values
Moral practices
Ethical beliefs
GOOD SAMARITAN STATUTES
• Protect people from prosecution who
voluntarily aid others in an emergency
• Intend to encourage giving emergency care
outside the hospital or health care facility
• Some states require people to help strangers
in distress
• To act or not act is an ethical decision
DISCUSSION TOPIC #1
Search the Web for articles about Good
Samaritan Laws. Answer the following
questions:
This public law is in place in how many states?
If you begin to give emergency care, what is
your obligation to continue?
Can you be held liable if you don’t at least call
for help?
Are RNs and LP/VNs protected when giving
emergency care away
REGULATION OF NURSING PRACTICE
Administrative Law—The Nurse Practice Act
Defines legal functions, powers, and duties of the
state board of nursing
Enforces the Nurse Practice Act
Holds disciplinary hearings
Identifies membership of the board and how to
become a board member
Defines terms
Includes laws governing licensure and legal titles
RESPONSIBILITY AND LIABILITY
Responsibility is being accountable for your actions
Explain the action and accept any consequences
Liability is the legal obligation to make good for the loss
of, or damage to, something for which he or she is
responsible.
Nurses are personally and legally responsible for their
nursing actions.
Best protection against charges:
Carry out duties at or above the standard expected
STANDARDS OF CARE
Guidelines to identify appropriate levels of
professional care
Rules and regulations defining care
expected of professional and
practical/vocational nurses
Accrediting agencies and organizations
develop standards of care
Employer policy and procedure manuals
LEGAL ISSUES FOR NURSES
Contracts
An agreement between two or more parties
Written or verbal promises with exchange of something of value
-Breach of contract
 Failure to fulfill any or all parts of a contractual obligation
Torts
An injury or wrong committed by one person, group, or
organization
against another person, group, or organization
(Strict liability, intentional, negligence)
TORTS VS. CRIMES
Tort
The injured person seeks to prosecute
Crime
An offense committed against the public
welfare or safety
The state seeks to prosecute
LEGAL ISSUES FOR NURSES- EX. OF TORTS
False imprisonment-confining or restraining (verbally or physically)
Violation of confidentiality-HIPPA, “shoptalk”
Defamation of character-false or malicious (slander, libel)
Violating informed consent-direct or implied (the patient clearly
understands the alternatives)
Assault/battery-threatening to touch/touching a person w/o permission
Fraud-intentional deception
Negligence/Gross Negligence-failure to do something or not to do
something/human life endangered (criminal)
DT #2
DISCUSSION TOPIC #2
Determine if the following examples are torts or crimes.
1. Nurse threatens to give an injection when her patient refuses
to take oral medication.
2. Nurse gives the injection despite the patient’s objection.
3. Taking photo of patients using your cell phone without their
consent.
4. Nurse tells her patient that the doctor is incompetent.
5. Taking a dollar from a patient’s nightstand and buying a soda
with it.
6. Fondling your patient’s body parts.
DT #3
DISCUSSION TOPIC #3
Think about the tort known as defamation of
character. Discuss with your classmates what
it means to talk about or to gossip about
others. In your discussion determine whether
or not you have ever committed the tort of
defamation of character. Talk about how
gossip and defamation of character affect
personal and professional relationships.
LEGAL ISSUES FOR NURSES
Documentation
Patient’s medical record is a legal document
Entries must be factual, to the point, accurate, legible,
related to patient’s needs or plan of treatment,
objective, consistent
Use agency-approved abbreviations and chartcorrection procedures
Computer charting confidentiality
LEGAL ISSUES FOR NURSES
Gifts
Don’t accept gifts or money
It is legal but not ethical to accept or solicit
gifts
CRIMES BY NURSES
Practicing without a license/practicing after failing to renew a
license-felony
felonies – serious criminal act, grounds for denying,
suspending, or revoking a nurse’s license
Right-to-die
Violations of federal & state narcotic and controlled substance
laws
Fraud-falsifying patient bills
Robbery-patient’s belongings
Death, murder, patient abuse
QUESTION
Putting a person into his room, locking the
wheelchair wheels and closing the door to
keep him from annoying others is known as:
A. Fraud
B. False imprisonment
C. Battery
D. Violating informed consent
ANSWER
B. False imprisonment
Rationale: Confining a person to a room, locking
the wheelchair locks to prevent the person
from moving about is false imprisonment.
QUESTION
Is the following statement true or false?
It is illegal for a nurse or any other health care
provider to accept or solicit gifts from patients
or families.
ANSWER
False
Rationale: It is legal but not ethical to accept or
solicit gifts from patients or families.
QUESTION
Which of the following is true about
documentation?
A. It is not a legal document
B. Never use abbreviations when charting
C. When making an error, just cross it out so it
is
illegible
D. Entries must be objective and consistent
ANSWER
D. Entries must be objective and consistent
Rationale: The patient’s medical record is a legal document. Use
agency-approved abbreviations and chart correction
Procedures.
QUESTION
Is the following statement true or false?
Laws are rules of conduct that derive from ethical
beliefs, moral practices, and cultural values.
ANSWER
True
Rationale: Laws are rules of conduct that derive
from ethical beliefs, moral practices, and cultural
values.
Q#1