Ethics - Ethos - comes from Greek work w/c means character/culture character/culture - Branch of Philosophy w/c determines or study morality (right and wrong) - Systematic inquiry into principles of right, from good & evil as they relate to conduct Moral - personal/private interpretation interpretation from what is g ood and bad. TYPES OF ETHICS Those of particular concern to the nurse are: 1. BIOETHICS - branch of ethics that studies moral values in the biomedical sciences 2. CLINICAL ETHICS – concerned with ethical problems “at the bedside” that arise within the context of
caring for actual patients Ex.: Informed consent & how one ought to respond to requests for assisted suicide 3. NURSING ETHICS – study of ethical issues that arise in the daily practice of nursing & of the analysis
used by nurses to make ethical judgement Ex.:cost-containment, Ex.:cost-containment, breaches of patient’s confidentiality, confidentiality, illegal practices of colleagues
Ethical Principles: nurse) Example: 1. Autonomy – the right/freedom to decide (the patient has the right to refuse despite the explanation of the nurse) Example: surgery, or any procedure 2. Nonmaleficence – the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social) 3. Beneficence - for the goodness and welfare of the clients 4. Justice – equality/fairness in terms of resources/personnel 5. Veracity - the act of truthfulness 6. Fidelity – faithfulness/loyalty to clients Moral Principles: 1. Golden Ru Rule 2. The princi principle ple of Totality otality – The The whole whole is greater greater than than its parts parts 3. Epikia Epikia – There There is always always an an exempti exemption on to to the rule 4. One who who acts through through as agent is is herself herself responsibl responsiblee – (instrumen (instrumentt to the crime) crime) 5. No one is is obliged obliged to betray betray hersel herselff – You You cannot cannot betray betray yourself yourself 6. The end does does not not justif justify y the the means means 7. Defect Defectss of of natu nature re maybe maybe correc corrected ted 8. If one is willing willing to to cooperat cooperatee in the act, no justice justice is done to to him 9. A littl littlee more or or a little little less less does does not change change the the substanc substancee of an act. act. 10. No one one is held to to impossi impossible ble Law - rule of conduct commanding what is right and what is wrong. Derived from an Anglo-Saxon term that means “that “that which is laid down or fixed ” fixed ” Court -body/agency in government wherein the administration of justice is delegated. Plaintiff – – complainant or person who files the case (accuser) Defendant – accused/respondent or person who is the subject of complaint Witness – individual held upon to testify in reference to a case either for the accused or against the accused. Written orders of court
Writ – legal notes from the court Subpoena individual/ordering him to appear in court at a specific time and 1. Subpoena Testificandum – a writ/notice to an individual/ordering date as witness. 2. Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all important documents
Summon – notice to a defendant/accused ordering him to appear in court to answer the complaint against him Warrant of Arrest - court order to arrest or detain a person Search warrant - court order to search for properties. Private/Civil Law - body of law that deals with relationships among private individuals Public law - body of law that deals with relationship between individuals and the State/government and government agencies. Laws for the welfare of the general p ublic. Private/Civil Private/Civil Law can be : Contract law – involves the enforcement of agreements among private individuals or the payment of compensation for failure to fulfill the agreements
Ex.
Nurse and client nurse and insurance Nurse and employer client and health agency
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- An agreement between between 2 or more competent person to do or not to do some lawful act. - It maybe written or oral = both equally binding (2) Types of Contract: 1. Expressed – when 2 parties discuss and agree orally or in writing the terms and conditions during the creation of the contract.
Example: Example: Nurse will work at a hospital for only a stated length of time (6 months), under stated conditions (as volunteer, straight AM shift, with food/transportation food/transportation allowance) 2. Implied – one that has not been explicitly agreed to by the parties, but that the law considers to exist.
Example: Example: Nurse newly employed in a hospital is expected to be competent and to follow hospital policies and procedures even though these expectations were not written or discussed. Likewise: the hospital is expected to provide the necessary supplies, equipment needed to provide competent, quality nursing care. Feature/Characteristics/Elements of a lawful contract: 1. Promise or agreement between between 2 or more persons for the performance performance of an action or restraint from certain actions. 2. Mutual Mutual understand understanding ing of the terms terms and and meaning meaning of the contra contract ct by all. all. 3. A lawf lawful ul purp purpose ose – activi activity ty must must be lega legall 4. Compensat Compensation ion in the the form form of of somethi something ng of value-mon value-monetary etary
xxx Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant person’s property. TORT LAW – is a civil wrong committed against a person or a person’s - Person/person’s Person/person’s responsible for the tort are sued for DAMAGES - Is based on: ACT OF COMMISSION –something that was done incorrectly or ACT OF OMMISION – something that should have been done but was not. Classification of Tort
1. Unintentional a. Negligence – misconduct or practice that is below the standard expected of ordinary, ordinary, reasonable and prudent person - Failure to do something due to lack of foresight or prudence - Failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance. - An act of omission or commission wherein a nurse fails to act in accordance with the standard of care. Doctrines of Negligence: 1. Res ipsa loquitor – the thing speaks for itself – the injury is enough proof of negligence 2. Respondeat Superior – let the master answer command responsibility 3. Force majuere – unforeseen event, irresistible force
b. Malpractice – stepping beyond one’s authority (6) elements element s of nursing nursi ng malpractice: malprac tice: 1. Duty – the nurse must have a relationship with the client that involves providing care and following an acceotable standard of care. 2. Breach of duty – the standard of care expected in a situation was not observed by the nurse -is the failure to act as a reasonable, prudent nurse un der the circumstances -something was done that should not have been done or nothing was done when it should have been done 3. Foreseeability – a link must exist between the nurse’s act and the injury suffered 4. Causation – it must be proved that the harm occurred as a direct result of the nurse’s nurse’s failure to follow the standard of care and the nurse should or could have known that the failure to follow the standard of care could result in such harm. 5. Harm/injury – physical, financial, emotional as a result of the breach of duty to the client Example: physical injury, injury, medical cost/expenses, loss of wages, pain and suffering 6. Damages – amount of money in payment of damage/harm/injury damage/harm/injury
2. Intentional Tort Unintentional tort Intentional tort
– do not require intent bur do require the element of HARM – the act was done on PURPOSE or with INTENT
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- No harm/injury/damage is needed to be liable - No expert witnesses are needed 1. Assault – an attempt or threat to touch another person unjustifiably
Example: Example: (1) A person who threatens someone with a club or closed fist. (2) Nurse threatens a client with an injection after refusing to take the meds orally.
2. Battery – wilful touching of a person, person’s clothes clothes or something the person is carrying that may or may not cause harm but the touching was done without permission, without consent, is embarrassing or causes injury. injury.
Example: Example: (1) a nurse threatens the patient with injection if the patient refuses refuses his medsorally. medsorally. If the nurse gave the injection without client’s consent, the nurse would be committing battery even if the client benefits from the nurse’s action.
3. False Imprisonment Imprisonment – unjustifiable detention of a person without legal warrant to confine the person – Occurs when clients are made to wrongful believe that they cannot leave the place
Example: Example: (1) Telling a client no to leave the hospital until bill is paid (2) Use of physical or chemical restraints (3) False Imprisonment Forceful Restraint=Battery
4. Invasion Of Privacy – intrusion into the client’s client’s private domain
Right to be left alone
Types of Invasion the client must be protected from: a. use of client’s name for profit without consent – using one’s name, photograph for advertisements of HC agency or provider without client’s client’s permission b. Unreasonable intrusion – observation or taking of photograph of the client for whatever purpose without client’s consent. c. Public disclosure of private facts – private information is given to others who have no legitimate need for that. d. Putting a person in a false/bad light – publishing information that is normally considered offensive but which is not true.
5. Defamation – communication that is false or made with a careless disregard for the truth and results in injury to the reputation of a person (2) Types: Libel
>defamation by means of print, writing or picture Example: 1. writing in the chart/nurse’s chart/nurse’s notes that doctor A is incompetent because he didn’t respond immediately to a call
Slander
>defamation by the spoken word stating unprivileged (not legally protected) protected) or false word by which a reputation is damaged Example: 1. Nurse a telling a client that nurse B is incompetent 2. Person defamed may bring the lawsuit 3.The material (nurse’s (nurse’s notes) must be communicated to a 3 rd party in order that the person’s reputation maybe harmed xxx
Public Law:
Criminal Law – deals with actions or offences against the safety and welfare of the public.
HOMICIDE ARSON THEFT SEXUAL HARASSMENT ACTIVE EUTHANASIA ILLEGAL POSSESSION OF CONTROLLED DRUGS
> Killing of any person without criminal intent may be done as self-defense > Burning of property > Stealing
xxx
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ETHICO-MORAL ASPECTS OF NURSING PRACTICE Nurses need to: Develop sensitivity to the ethical dimensions of nursing practice Examine their own & client’s value •
• •
•
Understand how values influence their decisions Think a head about the moral problems they are likely to face. Ex.: birth, death, marriage
*Values are important because they influence decisions & actions, including nurses’ ethical decisions even though they may be unspoken questions of values underlie all moral dilemmas VALUES - endu enduri ring ng bel belie iefs fs or or atti attitu tude des s abou aboutt the the worth of a person, objects, idea or action - conc concep epts ts// idea ideas s tha thatt give give mean meanin ing g to one’s life & provide a framework for one’s decision BELIEFS (OPINIONS) - Inter Interpr preta etatio tions ns or concl conclusi usions ons that that peop people le hold as true - Base Based d more more on fai faith th that that fact fact & may/ may/ may may not be true - Belief Beliefs s do not neces necessa saril rily y invo involve lves s valu values es Ex.: If I study hard, I will get good grade ATTITUDES - Mental Mental positi positions ons// feel feeling ings s towa toward rd a person person,, object or idea - Ofte Often n jud judge ged d as as bad bad or or good good,, pos posit itiv ive e or negative, beliefs are judged as correct or incorrect. VALUES - Are Are lea learn rned ed thro throug ugh h obs obser erva vati tion on & experience & are heavily influenced by a person’s sociocultural environment that is by: by: o Societal traditions, cultural, ethical, religious groups, family or peer groups PROFESSIONAL VALUES - Are Are acqu acquir ired ed dur durin ing g socia sociali liza zati tion on from from nursing experience, from teachers, peers & code of ethics *Nurses & nursing students need to examine the values they hold about life, death & illness. One strategy for gaining awareness of personal values is to consider one’s attitude about specific issues as abortion/ euthanasia
(5) VALUES ESSENTIAL FOR PROFESSIONAL NURSES 1. Altr Altrui uism sm >The >The conc concer ern n for for the the welf welfar are e& well-being of others 2. Auto Autonom nomy y >The >The right right for self self-- deter determin minati ation on of professional practice Ex.: When the nurse respects patient’s right to make decisions about their health care 3. Human - Respect for the inherent worth & dignity uniqueness of individual & populations Ex.: when the nurse values & respects all patient’s & colleagues 4. Inte Integr grit ity y - Actin cting g in in acc accor orda danc nce e wit with h an an appropriate appropriate code of ethics & standards of practice Ex.: when the nurse is honest & provides care based on ethical framework that is accepted within profession 5. Social - Upholding moral, legal & Justice humanistic principles. Ex.: when the nurse works to ensure equal treatment under the laws & equal access to quality care. PROFESSIONAL BEHAVIORS ASSOCIATED WITH 5 VALUES 1. Demonstra Demonstrate te understa understanding nding of cultur cultures, es, belief & perspectives of others 2. Demonstra Demonstrates tes accounta accountabili bility ty for own actins 3. Docume Documents nts accu accurat rately ely & honest honestly ly 4. Designs Designs care care with sensitiv sensitivity ity to individu individual al patient needs 5. Advocate Advocates s for for patie patients nts particul particularly arly the most vulnerable 6. Take ake risks risks on behalf behalf of patients patients & colleagues 7. Plans in partnership with patients 8. Honors Honors the rights rights of patient patient & families families to make decisions about healthcare 9. Provide Provide informati information on so patients patients can can make make informed choices 10. Provide culturally culturally competent & sensitive sensitive care 11. Protects Protects the patients privacy privacy & confidentiality 12. Provides Provides honest information information 13. Promotes universal access 14. Seek to remedy errors errors made made 15. Support Support fairness fairness 16. Encourage legislation
ETHICS came from the Greek word ETHOS meaning custom/character custom/character or moral duty
VALUES CLARIFICATION - Proce Process ss by which which people people identi identify, fy, exami examine ne & develop their own individual values
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Method of inquiry that assist people to understand the morality of human behaviour Refers to the expected standards of moral behavior
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How people make judgement in regard to right or wrong
Critical reflection about morality and rational analysis about it
JOHNSTON- examination of all ethical and bioethical issues from the prospective of nursing theory and nursing ethics
VERCOE- the fields of o f nursing ethics eth ics be focuse d on the needs and experiences of practicing nurses, the exploration of its meaning and that of ethical practice in terms of the perception of these nurses
BIOETHICS
Also known as “applied or practical ethics”
Specific domain of ethics that focuses on moral issues in the field of health care
Result of life and death dilemmas faced by health care practitioners
o
Carol Gilligan
Emphasizes care & responsibility
NURSING
An occupation requiring a unique body of
knowledge and skills and which serves society Is nursing a profession? YES. It is a calling, vocation, occupation based on scientific body of knowledge which needs training both in theory and practice guided by a Code of Nursing Ethics, governed by the Nursing Act of 2002, to SERVE mankind for a FEE or FREE. PROFESSION
Systematic Systematic study of human behaviour in the field of life science and health care in the light of moral values and principles
NURSING ETHICS - Refers to the ethical issues that occur in nursing practice - Refers to the conduct or behaviour which by reason of public approval or practice has become customary among professional
An occupation or calling requiring advance training
Experience in some specific or specialized body of knowledge
Provides service to society in society in that special field
The term profession is honoric and should be carried with pride and honor
PROFESSIONAL NURSE
Completed a basic nursing education program Licensed in his/her country or state to practice professional nursing
NURSING PRACTICE MORALS/ MORALITY
Greek work MORALIS
Refers to private, personal standard of what is right & wrong in conduct, character or attitude
Nurses should distinguish MORALITY & LAWS.
LAWS – reflect the moral values of society, they offer guidance in determining what is normal An action can be moral but not legal, on the other hand, an action can be moral but illegal
Morality is what you believe is right and good
Health Care Ethics
Division of ethics that relates to human health Realm of human values, morals, customs, personal beliefs and faith
Primary responsibility responsibility promotion of health and prevention of illness Collaborate with other health care providers o
Curative
o
Preventive
o
Rehabilitative aspects of care
o
Restoration of health
o
Alleviation of suffering
o
Towards a peaceful death
Provide nursing care through the utilization of the nursing process o
Therapeutic use of self
o
Executing health care techniques and procedures
MORAL DEVELOPMENT
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The The proc proces ess s of lea learn rnin ing g to tel telll betw betwee een n right & wrong & of learning what ought not to be done Comp Comple lex x proc proces ess s th that at beg begin ins s in chi child ldho hood od & continues throughout life 2 well ell know known n the theoris rist: o Lawrence Kohlberg
Rights & formal reasoning
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Essential primary health care
o
Comfort measures
o
Health teachings
o
Administration Administration of written prescription for treatment
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o
Therapies
o
Oral
o
Topical
o
Parenteral medications
o
Internal examination during labour in the
(3) TYPES OF MORAL THEORIES
absence of antenatal bleeding and delivery o
Suturing of perineal laceration
Establish linkages with community resources
Coordination with the health team
Provide health education to individuals, families and communities
Teach, guide and supervise students in nursing education programs
1. CONSEQUENCE-BASED (Theological theories) - Looks to the consequences of an action in judging whether the action is right of wrong - Focus ocus on issu issues es of fair fairne ness ss - UTILITARIANISM o Views the good act as one that bring the most good for the greater number or the least harm for the greatest number - PRINCIPLE OF OF UT UTILITY From the utilitarian perspective, th o point of morality is to promote what is intrinsically good by maximizing benefits & minimizing harm TELEOLOGICAL APPROACH
The nurse is required to maintain competence by continual learning through continuing professional education
QUALIFICATIONS QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE
Greek word TELOS or goal or end
The right thing to do is the good thing to do
Professional Preparation
Act utilitarianism- good resides in the promotion of happiness or the greatest net increase of pleasure over pain
o
Have a license to practice
If the act helps people, then it is a good act
o
Bachelor of science degree in nursing
If the act hurts people then it is a bad act
o
Be physically and mentally fit
Personal Qualities and Professional Proficiencies o
Interest and willingness to work and learn
o
Warm personality and concern for people
o
Resourcefulness and creativity, creativity, well
2. PRINCIPLE-BASED (Deontological theories) - Involve logical & formal processes & emphasize individual rights, duties & obligations - The The mora morali lity ty of of an an acti action on is is dete determ rmin ined ed not by its consequences but whether it is done according to an important objective
balanced emotional condition o
DEONTOLOGICAL APPROACH OR DUTY ORIENTED THEORY
Capacity and ability to work cooperatively with others
o
Basic rightness or wrongness of an act depends on the intrinsic nature rather than upon the situation or its consequences
Greek word DEON meaning DUTY
Immanuel Kant- rational human being with freedom and social worth
A person is morally good and admirable if his actions are done from a sense of duty and reason
Skill in decision making
DEFINITION OF LICENSE
A legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a particular jurisdiction
CONTRACT
Meeting of minds between two persons whereby one binds himself, with respect to other, to give something or to render some service A promise or a set of promise which the law recognizes as a duty and when that duty is not performed the law provides a remedy
3. RELATIONSHIP BASED OR CARING THEORIES - Stres Stress s coura courage, ge, gener generosi osity, ty, commit commitmen mentt & need to nurture & maintain relationship Other Moral Theories:
MORAL THEORIES - Provide framework
FLETCHER’S GUIDELINES FOR MAKING ETHICAL DECISIONS
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Broa Broad d gene genera rall conc concep epts ts suc such h as aut auton onomy omy & justice, they provide the foundation for moral values PRICIPLES - useful in ethical decisions because even if people disagree about which action is right in situation, they may be able to agree on the principle that apply
people as human beings 1. Consideration for people
2. Consideration of consequences of consequences 3. Proportionate good Proportionate good to come from the choices 4. Propriety of actual of actual needs over ideal or potential needs
5. A desire to enlarge choices and reduce chance 6. A courageous acceptance of the consequence of the decision W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE SHOULD DO WHEN OTHER RELEVANT FACTORS FACTORS IN A SITUATION SITUATION ARE NOT CONSIDERED
Duties of fidelity- telling the truth, keeping promises
Duties of reparation- righting the wrong we have done to others
Duties of gratitude- recognizing the service others have done for us
Duties of justice- preventing distribution of pleasure or happiness that is not in keeping with the merit of people involved
Duties of beneficence-helping to better the condition of other beings
Duties of self improvement- bearing ourselves with respect to virtue or intelligence
Duties of nonmaleficence- avoiding or preventing injury to others
VIRTUE ETHICS APPROACH
ARETIC, Greek word ARETE, heart of the person performing the act Traits Traits and virtues of a good person, courage, temperance, wisdom, and justice
DIVINE COMMAND ETHICS
Supreme or divine that sets down rules to provide guidance to moral decisions
(5) ATTRIBUTES OF CARING 1. Compassion – sorrow for the suffering or trouble of another, with an urge to HELP. 2. Competence – condition in qualification of being able to perform according to STANDARD. 3. Commitment – DEDICATION to a long-term course of action, engagement or involvement. 4. Confidence – belief in ones own abilities, to feel CERTAIN. 5. Conscientious – doing things according to what is right, showing care and precision, HONEST (held in respect, HONORABLE)
(5) BASIC ETHICAL PRINCIPLES 1. >Our bodies, our life, our human Stewardship nature & everything in this earth are gifts we have dominion over >This means we are responsible for them. We should not harm them, but rather improve & care for them >Ex.: Caring for one’s body is a sign of good stewardship stewardship 2. Totality >Refers to the whole. Every person must develop, use for & preserve all his parts & functions for themselves as well as the good of the whole 3. Doubt >When an act is foreseen to have Effect both good & bad effects, the principle of double effect is applied. >In order that such act be permissible the following conditions should be met: 1. The action itself must be good or at least neutral 2. The good effects is the one directed directed intended by agent & not the evil effect 3. The good effect is not produced by means of the evil effect 4. The foreseen beneficial effect must be equal to or greater g reater than the foreseen harmful effect 4. >The participation of one agent Cooperation with another agent to produce a particular particular effect or joint effect >Cooperation becomes a problem when the action of the primary agent is morally wrong >Cooperation may be: 1. FORMAL nd When the 2 agent willingly participates as when one agrees, advice, counsels, promotes or condones 2. MATERIAL nd When the 2 agent does not willingly participate 5. Solidarity >Means to be one with others. In the provisions of health care, it is important for the provider to be in solidarity with the patient when seeking the latter’s best interest >This is most important when dealing with the poor, disadvantaged & marginalized >Ex.: Should the strong help the weak? MAJOR BIOETHICAL PRINCIPLES
1. Res espe pect ct for for per perso son n a. The recognition of the equality possessed by every human being as unique, worthy, rational, self determining creature having the
MORAL PRINCIPLES
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b. c.
d. e.
capacity & the right to decide what is best for himself Respons Responsibil ibility ity of all all to treat treat perso persons ns as an end never as a means The respe respect ct for for perso person’s n’s autono autonomy my (self governance). The person should be allowed to determine his own destiny, to choose c hoose according to his own values to act accordingly Best Best practi practiced ced in in the prin princip ciple le of free & informed consent The role role of autono autonomy my is is refus refusal al,, confidentiality & veracity
Means to do well, provide a benefit Bringing the action & choosing the most benefit & least harm ”PRICIPLE UTILITY”
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UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS
CONSENT 1. Implied – indicates agreement/ agreement/ nonverbal 2. Expressed – verbal
To determine right or wrong in regard to value issues
Autonomy-
(3) Components of informed consent 1. Must be given voluntary 2. The consent must be given to a client with capacity to understand 3. Given enough information to be the ultimate decision maker Exceptions in giving consent 1. Minor a. Ad Adul ultt who who have have men menta tall capacity of a child b. Marr Married ied who are are mino minors rs c. Pregn regnan antt min minor ors s d. Parent arents s & member members s of of the the military 2. Seve Severe rely ly inju injure red d 3. Ment Mental ally ly ill illed ed per perso son n
1.
Greek Greek word word AUTOS AUTOS meanin meaning g self self and and nomos meaning governance
2.
Self Self dete determ rmin inat atio ion n
3.
Freedo Freedom m to choo choose se and and imple implemen mentt one’ one’s decision
4.
Info Inforrmed con conse sent nt
5.
Allowi Allowing ng the pati patient ent to to refuse refuse trea treatme tment nt if he decides so
6.
The person person making making the decisi decision on must must be deemed competent, intellectual capacity, capacity, legal age
Veracity Health care providers are bound to
tell the
truth
2. Justice
Also termed fairness, means to give to each one what the deserves or what is due Means to treat equals equally
Beneficence Promotes the doing acts of kindness and
mercy that directly benefit the p atient
3. Inv Inviol iolabi abilit lity y of lif life e Also proposed sanctity, dignity or respect for human life It means choosing life to protect it This principle includes measures for the survival of the human species & the freedom to have children It is be against violence, pollution of environment, drug/alcohol addiction, euthanasia, euthanasia, suicide & capital punishment
NONMALEFICENCE-
1. To do no harm
4. Non-maleficence
Circumstances/ Circumstances/ Issues Involving Maleficence Situ Situat atio ions ns whe where re in in not not prol prolon ongi ging ng lif life e is allowed Obli Obliga gato tory ry or opti option onal al trea treatm tmen entt Euthanasia
2.
Not assist assisting ing in in or perf perfor ormin ming g aborti abortion on
3.
Not to assi assist st peop people le to to commi committ suici suicide de
4.
Be inv invol olve ved d in mer mercy cy kil killi ling ng
JUSTICE
1. The right to demand to be treated justly,
Duty to do NO HARM
fairly and equally
Violations of the Principle 1. Physically harming a person as in suicide, abortion, infanticide ( person person who murder infant ), violence 2. Harmi Harming ng a perso person’s n’s repu reputat tation ion & honor by revealing revealing confidential information 3. Exposi Exposing ng the the perso person n to har harm m as in in subjecting the person to unnecessary treatment
CODE OF ETHICS -
A set set of eth ethic ical al pri princ ncip iple le tha thatt all all memb member er of a profession generally generally accept
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Sets Sets the the gro group up exp expec ecta tati tion on & sta stand ndar ard d of behaviour
5. Be Bene nefi fice cenc nce e PRINCIPLES UNDERLYING UNDERLYING CODE OF ETHICS
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1. Responsibility 2. Accountability 3. Confidentiality 4. Judg Judgem emen entt 5. Adv Advoc oca acy
Refers to the execution of duties associated with the nurse’s role Ability to answer for your own action Requires that those with access with health information to a 3 rd party without consent Abil Ab ilit ity y to to for form opin opinio ion n or or dra draw w sound conclusions >Giving ving patie tients nts inf infor orma mati tion on they need to make decision to support those decision >Implies caretaker is drive to understand & clearly state patient’s point of view to other health care provider
others for whom the nurse is responsible
SCOPE OF NURSING
ETHICAL DILEMAS -
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A person shall deemed to be practicing nursing when she/he singly or in collaboration with another which initiates & performs nursing services to individual, family, community in any health care setting
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Nurses Nurses are are prim primari arily ly respo responsi nsible ble for the promotion of health prevention illness
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Nurses Nurses shall shall collab collabora orate te with with other other health health care provider for the curative, preventive, rehabilitative aspects of care, restoration of health, alleviation of suffering & when recovery is not responsible towards a peaceful death
Exis Existt whe when n the the rig right ht thin thing g to to do do is is not not clear/ members of health care team cannot agree what the right thing to do
LEAGL RIGHTS, ROLES & RESPONSIBILITY OF THE NURSE ROLE
RESPONSIBIL ITY 1. Provider of To To provide provid e safe service care, commensurate with the nurses’ preparation experience & circumstances 2. Employee or >To >To fulfill fulf ill the contractor of obligations of service contracted service with the employer >To respect the right & responsibilities of other healthcare providers 3. Citizen
>Protect the right of the recipients of care >To inform clients of the consequences of various alternative of outcome of care >To provide adequate supervision & evaluation of
ROLE
RIGHT
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Right to adequate & classified assistance as necessary
RIGHTS -
>Right to adequate working condition >Right to compensation for services rendered >Right to reasonable & prudent conduct >Right to respect by others of the nurse’s own role & responsibility, right to physical safety >Right to reasonable & prudent conduct for clients
Expe Expect ctat atio ion n abo about ut how how a per perso son n occupying one position behaves toward a person occupying another position
Priv Privil ileg eges es or or fund fundam amen enta tall powe powers rs tha thatt individuals poses, unless they are revoke or given up voluntarily
RESPONSIBILITIES
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Obligations associates associ ates with rights or state of being accountable
IT SHALL BE THE DUTY OF THE NURSE TO:
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Provide nursing care thru the utilization of the nurse Establish linkages with community resources & coordination with the health team Provide health education Teach, guide & supervise students in nursing education programs including the administration administration of nursing services in varied settings Undertake nursing & health human resource development training & research
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The nurse is duty bound to observe the code of ethics for nurses & uphold the standard of safe safe nurse practice
TYPES OF LAWS PERTINENT TO NURSES PUBLIC LAW
The nurse is required required to maintain by continued learning.
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deal deals s wit with h rel relat atio ions nshi hips ps of betw betwee een n individuals & government agencies
STANDARD STANDARD OF CARE C ARE -
Skil Skills ls & lear learni ning ng com commo monl nly y poss posses esse sed d by members of the professional. professional.
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Purpo urpose se:: to to pr protec otectt cons consum ume er
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The The sta stand ndar ards ds are are use used d to eval evalua uate te the the gravity of care of nurses & therefore become legal guideline for nursing practice
CRIME -
an act act in in vio viola lati tion on of publ public ic law law & punishable by a fine or imprisonment
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Crim Crimes es may may be be cla class ssif ifie ied d as: as: o
FELONY
Crime of serious nature such as murder, 1 2 nd degree murder called manslaughter (killing of another person)
Ex.: Patient who died due to incompatible blood transfusion or drug dose
STANDARD STANDARD OF PROFESSIONAL PERFORMANCE Quality of care Performance Appraisal o
Education
MISDEMEANOUR
Collegiality Ethics
An offence of less serious nature & punishable by a fine or short term jail sentence or both
Collaboration Research
CIVIL LAW
Resource utilization
-
SELECTED LEGAL ASPECTS OF NURSING PRACTICE
TORT
LAW -
Comp Compri rise ses s of laws laws that that affe affect ct the the individual rather the whole society
As sys yste tem m of of pri princ ncip iple les s & proc proces esse ses s by by which people attend to control human conduct in an effort to minimize the use of force
-
A civi civill wron wrong g comm commit itte ted d agai agains nstt a per perso son n or person’s property
-
Classified as as: o
Unintentional
o
Intentional
o
Quasi-intension Quasi-intension tort
Functions Functions of LAW in Nursing: Provide a framework for establishing which nursing action in the care of the client are legal It differentiates differentiates the nurse’ responsibilities from those of other health professionals It helps establish boundaries of independent nursing action Assist in maintaining a standard of nursing practice by making nurses accountable under the law
EGB’June09
I. UNINTENTIO UNINTENTIONAL NAL Act committed against person or his property
Classified as: A. NEGLIGENCE
11
Failure to comply with the standards of due care either by omission or commission
Relationship
with a client
2. Brea Breach ch of duty duty Failure
A misconduct or practice that is below the standard expected of an ordinary reasonable & prudent person
to act as a reasonable
prudent 3. Forse orseea eabi bili lity ty Link
must exist between the nurse’s act & injury suffered
Doctrines related to Negligence:
4. Causation
Respondeat Superior or
Must
prove that harm occurred that resulted a nurse’s failure
Respondent supervisor Let
the superior answer 5. Inj Injury ury/ ha harm
An
employee as well as the employer is liable for the any failure
Client
must demonstrate some type of injury
6. Damages The
nurse is held liable for damages to be compensated c ompensated
Res ipsa loquitor Let
the thing speak for
itself COMMON MALPRACTICE ACT
Shows
sufficient proof on the person’s duty & his neglect to perform it
1. Medi Medica cati tion on erro errorr 2. Burn Burnin ing g of clie client nt 3. FALL ALLS S from from the the bed/ bed/ crib crib
B. MALPRACTICE
4. Ignori Ignoring ng a clie client nt comp complai laint nt
Professional
negligence that occurred while the person was performing as a professional
5. Mist Mistak aken en iden identi tity ty
The
failure of the professional professional to act as a reasonable & prudent professional professional with the same education & experience would act in similar situation
II. INTENTIONAL o
o
TYPES OF MALPRACTICE 1. Failure to make referral to provide the patient with appropriate teaching before discharge 2. Learning a foreign object inside patient’s abdomen after surgery 3. Negligence on supervision of subordinate
(6) ELEMENTS OF HOW TO PROVE MALPRACTICE 1. Duty
EGB’June09
The person executed the act with purpose or intent Classified as:
Assault
Battery
False imprisonment
ASSAULT An
attempt or threat to harm person unjustifiability unjustifiability
BATTERY Willful
touching of a person or something the person is carrying carrying that may or may not cause harm
12
PROHIBITIONS IN THE PRACTICE OF NURSING FALSE IMPRISONMENT Practicing Practicing nursing must have certificate of registration (COR)
Illegal
detention of a person without his consent
Who uses his own license/ COR of another Who uses expired/ revoke COR III. QUASI-INTENTION TORT o
o
Who gives false evidence to the board of nursing in order to obtain COR
Voluntary act that directly cause injury or distress
Who poses as RN that conveyed that he/she is RN
Types:
Who appends BSN/TN to his name without being confirmed with a degree
Slander (Verbal) A
false oral statement that unjustly damage a person’s name
Uses names in advertisement
Libel (written)
(5) LEGAL PROTECTION
A
false written or representational statement that unjustly damages a person’s name
1. Good Samaritan act •
Invasion of Privacy A
A nurse who renders first aid or treatment at the scene of an emergency and who does so within the standard of care, acting in good faith, is relieved of the consequences
violation of the person’s right against unreasonable, unreasonable, unwarranted interference with his personal life
2. Carrying out physician’s order
Ex.:
4. Record Keeping
Releasing info. About patient to a 3 rd party allowing unauthorized person
3. Provide competent care
5. Incidental report
Components of incidental report 1. Name LEGAL PRECAUTIONS FOR NURSES -
-
2. date, ti time
Funct unctio ion n wit withi hin n the the scop scope e of of you yourr education, job description of area/ scope of nursing practice
3. descri describe be the the fact facts s of inci inciden dence ce 4. Client Client’s ’s acco account unt for for inci inciden dentt
Follow the procedures & policies of employing agency
5. Witne itness sses es of of incid inciden entt 6. Identi Identify fy equi equipme pment, nt, name name of doses doses
-
Obse Observ rve e & moni monito torr cli clien entt acc accur urat atel ely y 7. signatur ture
-
Commun Communic icate ate & recor record d sig signif nifica icant nt chang changes es in the client’s condition to AP
-
Check any order that client asked/questioned
-
-
NURSES’ BILL OF RIGHTS
1.
Regist Registered ered nurses nurses pro promot motee and rest restore ore health
2.
Preve revent nt illn illneess
3.
Protec Protectt the peop people le entr entrust usted ed to thei theirr care care
4.
Alle Allevi viat atee suff suffer erin ing g
Modi Modify fy the the clie client nt bef befor ore e init initia iati ting ng any any interventions Prote Protect ct the client client from from fal falls ls & pre preve venta ntable ble injuries
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13
5.
Provid Providee servic services es that that maint maintain ain resp respect ect for for human dignity
Must be morally good
Good effect must be willed and the bad effect merely allowed
Good effect must not come from an evil action
Good effect must be greater than the bad effect
PATIENT’S BILL OF RIGHTS
1.
Consid Considera erate te and respe respectf ctful ul care care
2.
Releva Relevant, nt, curre current nt and and under understa standa ndable ble information
3.
Make Make decis decision ionss rega regardi rding ng his his care care plan plan
4.
Have Have advan advance ce dire directi ctive ve (li (livin ving g will) will)
5.
Every Every consid consider erati ation on of of his his priva privacy cy
6.
Confid Confident ential iality ity of commu communic nicati ations ons and and records
7.
8.
9.
3.
The The Pri Princ ncipl iplee of Totali otality ty
4.
Epikia
Review Review his reco records rds conc concern erning ing his his medic medical al care
5.
Be infor informed med of busi busine ness ss relat relation ionshi ship p among among the hospital educational institution
6.
11. Be informed informed of of hospital hospital polices polices and practices
LVING WILLS OR ADVANCE DIRECTIVE
1.
2.
Decisi Decision on to to provi provide de or or withh withhold old lifelifesustaining measures
3.
This This livin living g will will is sign signed ed by the patien patientt
4.
Witness itnessed ed by two two other other perso persons ns who who is is not designated as the person’s person’s health care representative
8.
5.
Dire Direct ctiv ivee has has for force ce of law law
2.
10. A little little more more or less less does not not change the the substance of an act
The go golden ru rule
Do unto others what you would like others do unto you
Stealing
May have bad and good effect
Have more good effects for more people than a smaller group
12. No one one is held to the the impossib impossible le
The The two two fol fold d eff effec ectt
With patient’s consent
11. The greatest greatest good good for the greate greatest st number number
MORAL PRINCIPLES
Corrected by plastic surgery
If one one is is willing willing to coop coopera erate te in in the the act, act, no no injustice is done to him/her
1.
Giving sleeping tablets to someone who has chronic illness
Defect Defectss of natur naturee may may be corre correcte cted d
9.
No one can force any person to answer a question if such will incriminate him/her
The end does does not not justif justify y the the mean meanss
Accept Accept or or refuse refuse any any treat treatmen ment, t, servi service ce or procedure used to diagnose or treat physical or mental condition
Ex. Nurse recommends patient to another clinic for abortion but does not want to perform
No one one is is oblige obliged d to betr betray ay hims himself elf/her /hersel self f
7.
Exception to the general rule
One who acts acts thro through ugh an agen agentt is himsel himself f responsible
Consen Consentt or or decl decline ine to partic participa ipate te experimental research affecting his care
10. Reasonabl Reasonablee continuit continuity y of care care when when appropriate and be informed of other care options
The whole is greater than any of its parts
Do not promise impossible things
13. The morality morality of of cooper cooperation ation
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14
Formal cooperation is an evil act and never allowed
o
patients when they administer care
14. Principle Principle relatin relating g to the the origin origin and destruction of life
Consider the individuality and totality of
•
Article III o
Human life is inviolable
o
Quality and excellence in the care of patients
Thou shall not kill are the goals of the nursing practice
CODE OF GOOD GOVERNANCE •
o
outcomes of delivered care is the hallmark of nursing accountability
Service to others
Commitment to a life of sacrifice and
o
•
genuine selflessness in carrying out their professional duties •
Article IV o
Perform their responsibilities with the
•
highest sense of integrity
Article V o
•
Professional Competence o
Knowledge, technical skills, attitudes and
o
•
Maintain and support one professional organization
•
o
Shall always carry out their professional
•
o
DEFINITION AND MEANING OF LAW LAW
Equality of All professions o
•
•
Man mad regulates social conduct in a formal and binding way
•
Rule of conduct pronounced by controlling authority and which may be enforced
AMENDED CODE OF ETHICS FOR NURSES
o
Section 3 Republic Act No. 877 known as the Philippine Nursing Law and Section 6 of P.D No. 223 the amended Code of Ethics of Nurses
o
Rule is pronounced or expressed
o
Source can be defined
o
A right to enforce the same must be
Preamble- health is a fundamental right of every individual
provided
Article II o
Authority or right to declare that the rule exists
Article I o
•
The sum total of rules and regulations by which society is governed
Shall treat their colleagues with respect and strive to be fair in their dealings with one another
•
The certification of registration of the registered nurse shall either be revoked or suspended for violation of any provisions of this code.
Shall remain open to challenges of a more dynamic and interconnected world
•
Article VII
Global Competitiveness o
Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal
duties with due consideration of the broader interest of the public •
Article VI
Social and Civic Responsibility o
Promotion in local, national, and international efforts to meet health and social needs of the people
Solidarity and teamwork o
Preservation of life, respect for human rights and promotion of healthy environment
experience •
The registered nurse is in solidarity with other members of the healthcare team in working for the patient’s patient’s best interest
Integrity and Objectivity o
Accurate documentation of actions and
•
Controlling authority in our system is the government
•
Fundaments law of the government is the constitution
•
Principal sources of pronouncements
Values, customs and spiritual beliefs held by individual shall be represented
EGB’June09
15
o
Constitution
o
Statutes or legislations
o
o o
Executive branch
o
Case decision/judicial opinions
o
Presidential decrees
o
Letters of instructions
o
o
RESONSIBILITY AND ACCOUNTABILITY ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSING •
Professional Negligence o
Commission or omission of an act, pursuant to a duty
•
Existence of a duty on the part of the person charged to use due care under circumstances
o
•
•
The foresee ability of harm resulting from failure to meet the standard
•
The fact that the breach of this standard resulted in an injury to the plaintiff
o
o
o
•
One shall act with justice, give every man his due, observe honest and good faith
•
Those who in the performance performance of their obligations through negligence causes any injury to another, are liable for damages
o
•
•
o
Errors due to family assistance Administration Administration of medicine without a doctors prescription
Injury was of such nature that it would not normally occur unless there was negligent act Injury was caused by an agency within control of the defendant Plaintiff himself did not engage in any manner that would tend to bring about the injury
The idea of improper or unskilful care of a patient by a nurse Stepping beyond one’s authority with serious consequences Carelessness of professional personnel LESNIK- negligent act committed in the course of professional performance
(2) DOCTRINE OF FORCE MAJEURE
Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath Objects left inside the patient’s body; sponges sponges suction tips, loose loose dentures lodged in the patient’s trachea
•
•
Irresistible force; unforeseen or inevitable No person shall be responsible for those events which cannot be foreseen
•
Floods fire, earthquakes
(3) DOCTRINE OF RESPONDEAT SUPERIOR
Falls of the elderly; confused, unconscious, sedated patients Falls of children whose bed rails were not pulled up and locked
Defects in the equipment
MALPRACTICE
Common acts of negligence o
Wrong medicine, wrong concentration, wrong route, wrong dose
(1) THE DOCTRINE OF RES IPSA LOQUITUR
Article 20 o
Mistaken Mistaken identity- drug given to the wrong patient
Acts of negligence:
• •
Failure to exercise the degree of diligence which the circumstances circumstances of the particular case demands
o
o
Failure to meet the standard of due care
Article 19 of the civil code
Failure to report observations to attending physicians
•
Let the master answer for the acts of the subordinate
•
The liability is expanded to include the master as well as the employee
INCOMPETENCE
Failure to observe and take appropriate action
•
Lack of ability, legal qualifications or fitness to discharge the required duty
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CONSENT TO MEDICAL AND SURGICAL PROCEDURES •
o
improper sources or unauthorized person
Consent o
•
Free and rational act that presupposes knowledge of teh thing to which consent is being given by a person who is legally capable to give consent
o
Defamation o
Character assassination
o
Slander-oral defamation
o
Libel-written Libel-written words
o
There must be a third person who hears or
Signed by the patient or authorized representative/legal representative/legal guardian
o
Divulge information from patient’s chart to
read the comment before it can be considered defamation
An authorization by a patient or a person authorized by law to give the consent on the patient’s behalf
o
CRIMES, MISDEMEANORS, AND FELONIES
Nurse secures the consent of the patient upon admission
•
Informed Consent o
Established principle law that every human being of adult years and sound mind has the right to determine what shall be done with his own body
o
•
May choose whether to be treated or not
CRIME •
the law •
Proof of Consent o
A written written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure
An act committed or omitted in violation of
•
Two elements o
Criminal act
o
Evil/criminal Evil/criminal intent
Conspiracy to commit a crime o
commit a felony
TORTS •
Two or more persons agree to
Definition: A legal wrong, committed against
Principals- who take a direct plan/part
Accomplices- cooperate in the execution
Accessories- having knowledge of the commission of the crime
a person or property •
Assault and Battery o
Imminent threat of harmful or offensive bodily contact
o
Unjustifiable to tough another person or to threaten to do so
•
•
Battery o
o
•
False Imprisonment of Illegal Detention o
Criminal negligence o
o
Invasion of Right to Privacy and breach of
Right to privacy is the right to be left alone
o
Right to be free from u nwarranted publicity
o
Exposure to public view
Simple imprudence- did not use precaution and the damage was not immediate or the impending danger was not evident or manifest
confidentiality o
Reckless imprudence- person does an act or fails to do it voluntarily but without malice
Unjustifiable detention detention of a person without a legal warrant within boundaries
•
Acts or offenses against public welfare
An intentional, unconsented touching of another person
•
Criminal Actions
•
Criminal Intent o
States of mind of a person at the time the criminal act is committed that he/she knows that an act is not
EGB’June09
17
lawful and still decide to do it anyway
WILLS •
A legal declaration of a person’s intentions upon death
•
Testamentary document takes effect after the death of its maker
•
Decedent- person whose property is transmitted through the succession whether or not he left a will
•
If he left a will he is called a testator
•
Woman is testatrix
•
Heir- called to succession either by the provision of a will or by operation of law
•
A person who dies leaving a will is said t have died testate
•
One who dies without will is said said to have died intestate
•
Validation of the will in a court is known as probate
•
A will which is written, dated and signed by the testator is called holographic will
•
An oral will is called nuncupative will or nuncupation- made during the person’s last illness, that it be done in the place in which he died, one or more witnesses to the will
•
Testator must have the expressed intention of making a will
•
Must be right of age
•
Under 18 cannot make a will
•
Required to have sound mind
•
Think clearly ability at the time of its execution
NURSES OBLIGATIONS IN THE EXECUTION EXE CUTION OF A WILL •
The nurse should note the soundness of the patient’s mind
•
There was freedom from fraud or undue influence
•
Make a notation on the patient’s chart of the apparent mental and physical condition of the patient at the time of making the will
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