Legal, Ethical, and Professional Issues in Nursing Lecture Review

Interpretations that people believe as true (including religion)

Feelings/position towards a topic

Personal values
Internalization of beliefs, often from family and society, and societal norms

Professional values
Acquired via socialization into nursing

Varied meanings, nurses have own code of ethics (nurses generally viewed as most honest and ethical profession)

Moral principals nurses must adhere to
autonomy, non-maleficence, beneficence, justice, fidelity, veracity, accountability, responsibility

Intentional torts
assault, battery, false imprisonment, invasion of privacy, defamation (libel, slander)

Defamation by print/pictures

Defamation by spoken word

Nurse Practice Acts
Regulate nursing behavior, can be refined by facilities; generally defines scope of practice and protects the public by legally defining what can and can’t be done by a nurse

States that one is an expert in a certain area- add to one’s title, can be done via test taking, publications, and continuing education.

Regulated by state board, which is generally a government appointed body

Mutual Recognition Models
For licensure. Compacts/contracts between states for mutual recognition of license, credentials

Schools accredited by ACEN/CNNE/other independent accreditation agency. UALR is accredited by ACEN, and the process includes resource reviews, faculty, staff, and data reviews, standards of education confirmation, and clinical reviews.

Standards of care
Set standards that must be maintained by nurses in a facility

Informed consent
Required for any kind of invasive procedure. In order to give consent, patient must be AA&O, and physician must explain the procedure BEFORE a consent form can be signed. There are two types of consent, expressed and implied.

As time goes on, we will learn more about what tasks can be delegated to assistants, ect. Assessments, initial teaching, evaluation, and med administration CANNOT be delegated to UAP.

Violence, abuse, neglect
Nurses are mandatory reporters

Americans with disabilities act- two elements: 1) treatment of nurses that are disabled, 2) treatment of patients that are disabled

Controlled substances and impaired nurses
States how to deal with med diversions, alcoholic/high nurses

Pg 72, Box 4-6. Information distributed on a need-to-know basis, cannot copy or print info about a patient, only notes can leave the hospital. Photos are not allowed. HIPPA fines are getting larger.

Nurses must include a clear description, factual and complete statements, must be credible, have support of at least 1 trustworthy person, follow the chain of command, assume responsibility for the report, and see the problem through

Nursing Students Practicing
Nursing students do not practice under the instructor’s license and are not considered employees of agencies. Student nurses should be prepared to carry out necessary tasks within guidelines, and ask for help if necessary

Essential Nursing Values
Pg 81, Table 5-1. Altruism, autonomy, human dignity, integrity, social justice.

A concern for the welfare and well-being of others. In professional practice, altruism is reflected by the nurse’s concern for the welfare of patients, other nurses, and other health care providers.

The right to self-determination. Professional practice reflects autonomy when the nurse respects patient’s rights to make decisions about their health care.

Human dignity
is respect for the inherent worth and uniqueness of individuals and populations. In professional practice, human dignity is referenced when the nurse values and respects all patients and colleagues.

Acting in accordance with an appropriate code of ethics and accepted standards of practice. Integrity is reflected in professional practice when the nurse is honest and provides care based on an ethical framework that is accepted within the profession.

Social justice
Acting in accordance with fair treatment regardless of economic status, race, ethnicity, age, citizenship, disability, or sexual orientation.

International Council of Nurses code of Ethics
A.k.a ICN Code of ethics. Preamble: Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health, and to alleviate suffering. The need for nursing is universal. Elements of code: nurses and people, nurses and practice, nurses and profession, nurses and co-workers.

6 Purposes of Code of Ethics
1) Inform the public about the minimum standards of the profession and help them understand professional nursing conduct. 2) Provide a sign of the profession’s commitment to the public it serves. 3) Outline the major ethical considerations of the profession. 4) Provide ethical standards for professional behavior. 5) Guide the profession in self-regulation. 6) Remind nurses of the special responsibility they assume when caring for the sick.

American Nurses Association Code of Ethics for Nurses
9 aspects. 1) Nurse practices with compassion and respect for inherent dignity of individual, unrestricted, 2) Nurse’s primary commitment is to patient, 3) nurse promotes, advocates for, and strives to protect health/safety/rights of patient, 4) Nurse is responsible for nursing practices and determines appropriate delegation, 5) Nurse owes same duties to self as to others, 6) Nurse participates in establishment/maintenance/improvement of healthcare environments, 7) Nurse participates in advancement of profession via practice, education, admin, knowledge, 8) Nurse collaborates w/ others, 9) Profession represented by associations and members/shape social policy.

Role: Provider of Service
Responsibility: to provide safe and competent care commensurate with the nurse’s preparation, experience, and circumstances; to inform clients of the consequences of various alternatives and outcomes of care; to provide adequate supervision and evaluation of others for whom the nurse is responsible, and to remain competent. Associated Rights: Right to adequate and qualified assistance as necessary, Right to reasonable and prudent conduct from clients

Role: Employee or contractor for service
Responsibility: to fulfill obligations of contracted service with the employer, to respect the employer, to respect rights and responsibilities of other health care providers. Associated Rights: Right to adequate working conditions, right to compensation for services rendered, right to reasonable and prudent conduct by other health care providers

Role: Citizen
Responsibility: To protect the rights of the recipients of care. Associated Rights: Right to respect by others of the nurse’s own rights and responsibilities, right to physical safety

Categories of Negligence that Result in Malpractice Lawsuits
Failure to follow standards of care, failure to use equipment in a responsible manner, failure to communicate, failure to document, failure to assess and monitor, failure to act as a client advocate (Box 4-5, pg. 69

Failure to follow standards of care
Examples: Failure to perform a complete admission assessment or design a plan of care, failure to institute a fall protocol, failure to adhere to standardized protocols or institutional policies and procedures (includes using an improper injection site), failure to follow a primary care provider’s verbal or written orders

Failure to use equipment in a responsible manner
Examples: Failure to follow manufacturer’s recommendations for operation, failure to check equipment for safety prior to use, failure to place equipment properly during treatment, failure to learn function of equip

Failure to communicate
Examples: Failure to notify a primary care provider in a timely manner when warranted, failure to listen to client and act on complaints, failure to communicate effectively, failure to communicate assessment findings to incoming nurse, failure to seek higher medical authorization for a treatment

Failure to document
Examples: Failure to record a client’s progress, response, injuries, pertinent nursing information, primary care provider’s orders, info on telephone conversations including time, content, actions taken

Failure to assess and monitor
Examples: Failure to complete a shift assignment, implement a plan of care, observe a clients ongoing progress, interpret a client’s signs and symptoms, recognize significant changes in a clients condition and communicate them promptly

Failure to act as a client advocate
Examples: Failure to question discharge orders when a client’s condition warrants orders, question incomplete or illegible medical orders, provide a safe environment

HIPAA Compliance in Nursing Practice Examples
Charts shuld be in a secure, nonpublic location; place clipboards face down; printed copies of protected info should not be left unattended; verify number dialed before faxing info; encrypt digital transmissions; limit access to authorized personnel; utilize passwords; post notice of rights to privacy; lower voices to minimize disclosure; stay current with HIPAA regulations

Practice Guidelines: Reporting a Crime, Tort, or Unsafe Practice
Write a clear description of event, make sure statements are factual/complete, make sure you are credible, maintain support from 1 trust worthy person, report the manner starting at the lowest possible level in agency hierarchy, assume responsibility, see problem through once reported

6 Elements of the Incident Report
1) Identify client by name, initials, and hospital/id number; 2)

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