Ethics
-study of human behavior and ideal ways of being
-conduct and character
-right and wrong choices we make
-process oriented= systematic approach to understanding right and wrong
Morals
-specific beliefs, behaviors and ways of being based on personal judgments derived from one's ethics
-one's morals are judged good or bad
-growing up you have self-centered ethics and become more group-oriented
Moral Reasoning
-making decision about how humans ought to be and act
-identify possible actions that could be pursued and the likely consequences of each action
-matures overtime and changes with life experiences
Moral Distress
-pain or anguish affecting the mind, body, or relationships in response to a situation in which the person is aware of a moral problem. acknowledges moral responsibility, and makes a moral judgment about the correct action
-as a result of real or perceive
Bioethics
-application of ethical theories and principles to issues in health care
-determining what should be done in certain instances according to moral principles
-who should live/die/decide
Ethical Concepts
-right
-standard of best interest
-paternalism
Right
-something owed to an individual
-self determination= right to decide (autonomy)
-privacy= free from intrusion, to be left alone
Standard of Best Interest
-what is the best for that person
-ask yourselves: are we doing it because it the right thing to do? or are we doing it because we can?
-quality v. quantity of life
Paternalism
-unilateral decision making
-deliberate overriding of a patient's autonomy for patient's own good/safety
Utilitarianism
-rightness of an action is determined solely by its consequence
-"the end justifies the means"
-greatest old for the greatest number
-consequences matter
Deontology
-duty based action
-ethical action comes from doing one's duty
-consequences doesn't matter
-moral actions should be an end in themselves
Autonomy
-respect for individual
-self determination
-make own decisions
-patient refuses treatment and transportation for care
Beneficence
-duty to do good
-not required of general public (required as healthcare professional
-nurses take actions to benefit patients and to facilitate the patient's well being
-what is good?
-turning bed-bound patient so they don't get be sores
Nonmaleficence
-duty to do no harm
-all persons have this duty (shouldn't cause harm to another)
-refraining from action that might harm others
-malpractice is based on this
-when is doing good harmful to the patient
Fidelity
-duty to keep agreements, commitments, carry out care
-creates trust
-must all promises be kept?
-following through on your promises
Veracity
-duty to tell the truth
-intentional deception= right or wrong?
-truthtelling= patients trust nurse is competent in their practice
Justice
-duty to be fair to all people
-distributive justice= is healthcare a right or a privilege?
-everyone should have right to resources
Code of Ethics
-implied contract
-expression of its values and duties to the public
-profession's nonnegotiable ethical standard
-applies to all nurses regardless of their role
-"Nightingale Pledge"= first nurse code
-ANA Code of Ethics for Nurses
-ICN Code of Ethics fo
ANA Code of Ethics
-fundamental values and commitments of the nurse (1-3)
-identifies the boundaries of duty and loyalty (4-6)
-describes nursing duties beyond individual patient encounters (7-9)
Ethical Dilemma
-arise from conflicts in personal value systems, professional values, peer and others' behaviors, patients' rights, institutional and societal issues
-conflicts occur among health care providers, families, patients and people in community about the right
Ethical Decision-Making Process
-clarify the ethical dilemma= what is the specific dilemma/conflict
-gather additional data= what info do you need to have?
-identify options
-make a decision= what will you do based on choices?
-act= go through with identified option
-evaluate= did my ac
Ethical Decision-Making
-rational
-systematic
-based on ethical principles and civil law
-not based on= precedent, emotions, intuition, fixed policies
Ethical Issues Related to Nursing
-commitment to the patient= respect for human dignity, cultural competence, patient's trust
-commitment to employer= work ethic
-commitment to colleagues= lateral or horizontal violence/incivility, protection of patients
-self evaluation= improvement, com
Impaired Nurse
-extent of the problem
-what is the concern?= personal, to patients
-identifying symptoms
-what should you do?= confront, report, to whom
Patient Advocacy
nurses work collaboratively with others to address the healthcare needs of patients
Licensure
-permit granted to a person to engage in the practice of a profession and to use a particular title
-mandatory= any person who practices the profession must be licensed
-license can be revoked for just cause
State Board of Nursing
-obligation to protect safety of public
-licensure
-Nurse Practice Act (NPA)
-disciplinary actions
-alternative programs
-state accreditation of nursing educational programs
Nurse Practice Acts (NPA)
-statute that legally defines and describes the scope of nursing practice
-purpose is to protect the public
-who creates this?=
state government creates and must uphold and maintain
-board of nursing acts on discipline
What Does the NPA Do?
-defines practice of a professional nurse
-sets educational qualifications and requirements for licensure
-determines legal titles and abbreviations (RN)
-provides disciplinary action of licenses for certain causes
-fee, NCLEX, background check, graduate
Nursing Scope and Standards
-nursing scope of practice describes who, what, where, when, why, and how of nursing practice
-standards of nursing practice defined as "authoritative statements of the duties of all registered nurses, regardless of role, population or specialty, are expe
Accreditation
-voluntary review process of educational programs by professional organizations
-CCNE or ACNE
National Council of State Boards of Nursing
-provides guidance and continuity for nursing regulation
-all 50 states and 5 territories
-NCLEX-RN= NCLEX creators
Licensure Examination
-test critical thinking and nursing competence in all phases of the nursing process
Mobility
-licensure by endorsement
Nursing Licensure Compact
-mutual recognition model for nursing licensure= allows you to practice physically, electronically or telephonically in other states that are members
-maintain home state license, but may practice in any party state= must adhere to the laws and regulation
Multistate licensure
-advantages= can help a wider range of people and combat shortages
-concerns= states have less control over scope of practice because varies state to state
-home state vs. party state
Statutory Law
-written by state legislator (can also be federal)
-goes into law and nurses follow
Administrative Law
-different agencies make laws delegated from legislature
-regulations
Common Law
-judge's law
-created out of a court case
-ex: Roe v Wade
Criminal Law
-protect society from harmful acts of others
-misdemeanor= speeding ticket, DWI
-felony= murder, go to jail
-how are violations punished?
-violations of NPA= mandated statutory law that we all have to follow as nurses, done by state legislature and change
Civil Law
-involves relationships between individuals or between individual and the government
-how are violations punished?
-money, fines to wronged party
-Judge Judy law
Torts
-person is affected somehow
-civil wrongs committed by one person against another person or a person's property
-physical harm= trip and fall
-psychological harm= PTSD
-harm to livelihood= no longer work bc of something done to you
-harm to reputation= sl
Intentional Torts
-set out to harm in some way
-fraud
-slander
-libel
Unintentional Torts
-not set out to harm
-most healthcare suits
-car accident where you speed past a yellow light and someone walks in street
-negligence is most common (slip and fall)
Malpractice
-professional negligence
-failure to act as a prudent professional according to the standards of care
-scope and standards of practice
-held accountable to standard
-anyone can be at risk
Four Essential Elements of Malpractice
1) harm= injury is proved
2) duty= responsibility for patient
3) breach of duty= failure to act as a reasonably prudent person in this situation, did not meet standard of care
4) causation= failure to meet standard of care caused harm
Standards of Practice
-used to determine if the nurse fulfilled his/her duty
-statutes= laws in place for standard of practice
-facility policies= stay up to date
-ANA Standards of Clinical Practice
-accrediting body
-current literature
-manufacturer's instructions
-expert tes
Why Does Malpractice Occur?
-stressful situation
-careless actions/inactions= not sterile foley catheter
-fatigue
-distractions
-communication barriers= delegation, lack of communication
-system issues= double sign off a med, everyone knew but didn't do anything about it
Delegation
-right task
-right circumstances
-right person
-right directions/ communication
-right supervision/ evaluation
Factors Contributing to Malpractice Claims
-social factors
-large, impersonal systems= lots of people and nurses interact with the patient
-public awareness of large judgments= someone else had a similar problems and got money
-victim mentality= it wasn't my fault
Suit-Prone Patients
-hostile attitudes
-unable to accept personal responsibility
Suit-Prone Nurses
-bitch nurse
-insensitive
-complaining about lack of time
Preventing Malpractice Claims
-develop caring relationships with patients and families
-maintain clinical competence
-follow policies and procedures
-good communication= documentation
-defensive documentation of all patient care, treatments, interventions and responses
-accept only ap
Errors
-medication errors
-we must self report errors and disclose to patients
-fewer lawsuits when telling about an error versus keeping it hidden
Fraud
-nurse imposter
-promising miracle cure= false hope
Assault
-threat of bodily harm to another
-threat of injection
-"If you don't swallow this pill I will inject you"
-"If you don't pee I will stick this foley catheter
Battery
-actual bodily harm to another person without permission
-unlawful touching
-surgical procedures without consent
-patient in right state of mind but is screaming no
False Imprisonment
-restraints
-detaining patients
-held against their will
-can't keep a medical patient in a hospital if they don't want to be there, can't force medical treatment
Defamation of Character
-libel= written in patient charts
-slander= uncooperative, unintelligent, drug-seeking
Liability
-an obligation that can be enforced by law
-personal liability= you are legally responsible for your own action
-student liability= held to standard of RN
-employer liability= extends responsibility to the employer
-supervisory liability= delegation
Liability Insurance
-you need your own!
-provides legal counsel
-payment for a judgment
Common Legal Issues
-duty to report or seek medical care for a patient= patient advocate
Protect Privacy
-confidentiality and the right to privacy
-HIPAA= federal law, need to know basis (only if you are providing care for them)
-need to know
-must have parent of guardian authorization
-photographs
Common Causes of Nursing Liability
-failure to follow standards of care
-failure to use equipment in responsible manner
-failure to communicate
-failure to document
-failure to assess and monitor
-failure to act as patient advocate
Informed Consent 4 Elements
-voluntary
-complete and accurate info
-understanding
-competence
Informed Consent
-MD/NP must give information (nurse can't give initial info)
-nurse may witness the signature of the patient
-consent may be withdrawn
Patient Self-Determination Act
-federal law
-requires that patients be given information to allow them to make informed choices about end-of-life care
-for all patients
-not required to have one but required to give info
Advance Directives
-legal documents
1) living will= provides direction for end of life issues
2) durable power of attorney for health care= substitute decision maker, facilitates the provision of care wanted by the patient
3) DNR/CCO/AND
Care in Emergency Situations
-implied consent
-Good Samaritan statues= relieve you of some liability when reasonable care is used
GINA
-Genetic Information Nondiscrimination Act
-federal Law- can't discriminate based on your DNA information
-health insurance and employment is covered
-life, disability, and liability insurance not covered
-states may have more detailed laws
-can't not pro
Ethics
-study of human behavior and ideal ways of being
-conduct and character
-right and wrong choices we make
-process oriented= systematic approach to understanding right and wrong
Morals
-specific beliefs, behaviors and ways of being based on personal judgments derived from one's ethics
-one's morals are judged good or bad
-growing up you have self-centered ethics and become more group-oriented
Moral Reasoning
-making decision about how humans ought to be and act
-identify possible actions that could be pursued and the likely consequences of each action
-matures overtime and changes with life experiences
Moral Distress
-pain or anguish affecting the mind, body, or relationships in response to a situation in which the person is aware of a moral problem. acknowledges moral responsibility, and makes a moral judgment about the correct action
-as a result of real or perceive
Bioethics
-application of ethical theories and principles to issues in health care
-determining what should be done in certain instances according to moral principles
-who should live/die/decide
Ethical Concepts
-right
-standard of best interest
-paternalism
Right
-something owed to an individual
-self determination= right to decide (autonomy)
-privacy= free from intrusion, to be left alone
Standard of Best Interest
-what is the best for that person
-ask yourselves: are we doing it because it the right thing to do? or are we doing it because we can?
-quality v. quantity of life
Paternalism
-unilateral decision making
-deliberate overriding of a patient's autonomy for patient's own good/safety
Utilitarianism
-rightness of an action is determined solely by its consequence
-"the end justifies the means"
-greatest old for the greatest number
-consequences matter
Deontology
-duty based action
-ethical action comes from doing one's duty
-consequences doesn't matter
-moral actions should be an end in themselves
Autonomy
-respect for individual
-self determination
-make own decisions
-patient refuses treatment and transportation for care
Beneficence
-duty to do good
-not required of general public (required as healthcare professional
-nurses take actions to benefit patients and to facilitate the patient's well being
-what is good?
-turning bed-bound patient so they don't get be sores
Nonmaleficence
-duty to do no harm
-all persons have this duty (shouldn't cause harm to another)
-refraining from action that might harm others
-malpractice is based on this
-when is doing good harmful to the patient
Fidelity
-duty to keep agreements, commitments, carry out care
-creates trust
-must all promises be kept?
-following through on your promises
Veracity
-duty to tell the truth
-intentional deception= right or wrong?
-truthtelling= patients trust nurse is competent in their practice
Justice
-duty to be fair to all people
-distributive justice= is healthcare a right or a privilege?
-everyone should have right to resources
Code of Ethics
-implied contract
-expression of its values and duties to the public
-profession's nonnegotiable ethical standard
-applies to all nurses regardless of their role
-"Nightingale Pledge"= first nurse code
-ANA Code of Ethics for Nurses
-ICN Code of Ethics fo
ANA Code of Ethics
-fundamental values and commitments of the nurse (1-3)
-identifies the boundaries of duty and loyalty (4-6)
-describes nursing duties beyond individual patient encounters (7-9)
Ethical Dilemma
-arise from conflicts in personal value systems, professional values, peer and others' behaviors, patients' rights, institutional and societal issues
-conflicts occur among health care providers, families, patients and people in community about the right
Ethical Decision-Making Process
-clarify the ethical dilemma= what is the specific dilemma/conflict
-gather additional data= what info do you need to have?
-identify options
-make a decision= what will you do based on choices?
-act= go through with identified option
-evaluate= did my ac
Ethical Decision-Making
-rational
-systematic
-based on ethical principles and civil law
-not based on= precedent, emotions, intuition, fixed policies
Ethical Issues Related to Nursing
-commitment to the patient= respect for human dignity, cultural competence, patient's trust
-commitment to employer= work ethic
-commitment to colleagues= lateral or horizontal violence/incivility, protection of patients
-self evaluation= improvement, com
Impaired Nurse
-extent of the problem
-what is the concern?= personal, to patients
-identifying symptoms
-what should you do?= confront, report, to whom
Patient Advocacy
nurses work collaboratively with others to address the healthcare needs of patients
Licensure
-permit granted to a person to engage in the practice of a profession and to use a particular title
-mandatory= any person who practices the profession must be licensed
-license can be revoked for just cause
State Board of Nursing
-obligation to protect safety of public
-licensure
-Nurse Practice Act (NPA)
-disciplinary actions
-alternative programs
-state accreditation of nursing educational programs
Nurse Practice Acts (NPA)
-statute that legally defines and describes the scope of nursing practice
-purpose is to protect the public
-who creates this?=
state government creates and must uphold and maintain
-board of nursing acts on discipline
What Does the NPA Do?
-defines practice of a professional nurse
-sets educational qualifications and requirements for licensure
-determines legal titles and abbreviations (RN)
-provides disciplinary action of licenses for certain causes
-fee, NCLEX, background check, graduate
Nursing Scope and Standards
-nursing scope of practice describes who, what, where, when, why, and how of nursing practice
-standards of nursing practice defined as "authoritative statements of the duties of all registered nurses, regardless of role, population or specialty, are expe
Accreditation
-voluntary review process of educational programs by professional organizations
-CCNE or ACNE
National Council of State Boards of Nursing
-provides guidance and continuity for nursing regulation
-all 50 states and 5 territories
-NCLEX-RN= NCLEX creators
Licensure Examination
-test critical thinking and nursing competence in all phases of the nursing process
Mobility
-licensure by endorsement
Nursing Licensure Compact
-mutual recognition model for nursing licensure= allows you to practice physically, electronically or telephonically in other states that are members
-maintain home state license, but may practice in any party state= must adhere to the laws and regulation
Multistate licensure
-advantages= can help a wider range of people and combat shortages
-concerns= states have less control over scope of practice because varies state to state
-home state vs. party state
Statutory Law
-written by state legislator (can also be federal)
-goes into law and nurses follow
Administrative Law
-different agencies make laws delegated from legislature
-regulations
Common Law
-judge's law
-created out of a court case
-ex: Roe v Wade
Criminal Law
-protect society from harmful acts of others
-misdemeanor= speeding ticket, DWI
-felony= murder, go to jail
-how are violations punished?
-violations of NPA= mandated statutory law that we all have to follow as nurses, done by state legislature and change
Civil Law
-involves relationships between individuals or between individual and the government
-how are violations punished?
-money, fines to wronged party
-Judge Judy law
Torts
-person is affected somehow
-civil wrongs committed by one person against another person or a person's property
-physical harm= trip and fall
-psychological harm= PTSD
-harm to livelihood= no longer work bc of something done to you
-harm to reputation= sl
Intentional Torts
-set out to harm in some way
-fraud
-slander
-libel
Unintentional Torts
-not set out to harm
-most healthcare suits
-car accident where you speed past a yellow light and someone walks in street
-negligence is most common (slip and fall)
Malpractice
-professional negligence
-failure to act as a prudent professional according to the standards of care
-scope and standards of practice
-held accountable to standard
-anyone can be at risk
Four Essential Elements of Malpractice
1) harm= injury is proved
2) duty= responsibility for patient
3) breach of duty= failure to act as a reasonably prudent person in this situation, did not meet standard of care
4) causation= failure to meet standard of care caused harm
Standards of Practice
-used to determine if the nurse fulfilled his/her duty
-statutes= laws in place for standard of practice
-facility policies= stay up to date
-ANA Standards of Clinical Practice
-accrediting body
-current literature
-manufacturer's instructions
-expert tes
Why Does Malpractice Occur?
-stressful situation
-careless actions/inactions= not sterile foley catheter
-fatigue
-distractions
-communication barriers= delegation, lack of communication
-system issues= double sign off a med, everyone knew but didn't do anything about it
Delegation
-right task
-right circumstances
-right person
-right directions/ communication
-right supervision/ evaluation
Factors Contributing to Malpractice Claims
-social factors
-large, impersonal systems= lots of people and nurses interact with the patient
-public awareness of large judgments= someone else had a similar problems and got money
-victim mentality= it wasn't my fault
Suit-Prone Patients
-hostile attitudes
-unable to accept personal responsibility
Suit-Prone Nurses
-bitch nurse
-insensitive
-complaining about lack of time
Preventing Malpractice Claims
-develop caring relationships with patients and families
-maintain clinical competence
-follow policies and procedures
-good communication= documentation
-defensive documentation of all patient care, treatments, interventions and responses
-accept only ap
Errors
-medication errors
-we must self report errors and disclose to patients
-fewer lawsuits when telling about an error versus keeping it hidden
Fraud
-nurse imposter
-promising miracle cure= false hope
Assault
-threat of bodily harm to another
-threat of injection
-"If you don't swallow this pill I will inject you"
-"If you don't pee I will stick this foley catheter
Battery
-actual bodily harm to another person without permission
-unlawful touching
-surgical procedures without consent
-patient in right state of mind but is screaming no
False Imprisonment
-restraints
-detaining patients
-held against their will
-can't keep a medical patient in a hospital if they don't want to be there, can't force medical treatment
Defamation of Character
-libel= written in patient charts
-slander= uncooperative, unintelligent, drug-seeking
Liability
-an obligation that can be enforced by law
-personal liability= you are legally responsible for your own action
-student liability= held to standard of RN
-employer liability= extends responsibility to the employer
-supervisory liability= delegation
Liability Insurance
-you need your own!
-provides legal counsel
-payment for a judgment
Common Legal Issues
-duty to report or seek medical care for a patient= patient advocate
Protect Privacy
-confidentiality and the right to privacy
-HIPAA= federal law, need to know basis (only if you are providing care for them)
-need to know
-must have parent of guardian authorization
-photographs
Common Causes of Nursing Liability
-failure to follow standards of care
-failure to use equipment in responsible manner
-failure to communicate
-failure to document
-failure to assess and monitor
-failure to act as patient advocate
Informed Consent 4 Elements
-voluntary
-complete and accurate info
-understanding
-competence
Informed Consent
-MD/NP must give information (nurse can't give initial info)
-nurse may witness the signature of the patient
-consent may be withdrawn
Patient Self-Determination Act
-federal law
-requires that patients be given information to allow them to make informed choices about end-of-life care
-for all patients
-not required to have one but required to give info
Advance Directives
-legal documents
1) living will= provides direction for end of life issues
2) durable power of attorney for health care= substitute decision maker, facilitates the provision of care wanted by the patient
3) DNR/CCO/AND
Care in Emergency Situations
-implied consent
-Good Samaritan statues= relieve you of some liability when reasonable care is used
GINA
-Genetic Information Nondiscrimination Act
-federal Law- can't discriminate based on your DNA information
-health insurance and employment is covered
-life, disability, and liability insurance not covered
-states may have more detailed laws
-can't not pro