Ethics, Values & Legal
Accountability
Chapters 43 & 44
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Morals and Ethics
Morals
 Private, personal, or group standards of right
and wrong
 Moral behavior, in accordance with custom,
reflects personal moral beliefs
 Ethics
 Systematic study of right and wrong conduct
 Formal process for making consistent moral
decisions
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Ethics
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Ethics is the branch of philosophy that deals with
the values of human conduct (rightness or
wrongness of actions).
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A set of rules or values that govern right behavior.
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Ethical theories are sets of principles used to decide
what is morally right or wrong.
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Answers the question, “What should I do in a given
situation?”
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Factors in Ethical Decision Making
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Values
 Belief about the worth of something
 Highly prized ideals, customs, conduct, goals
 Freely chosen
 Learned through observation and experience
 Vary from person to person
 Can change
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Ethical Principles
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Autonomy - right to self-determination, independence
Beneficence - duty to benefit others or promote good,
to act in the best interest of our patients
Nonmaleficence - requirement to “do no harm”
Justice – fairness, all clients treated fairly and equally,
regardless of race, age , gender, diagnosis, economic
level……
Veracity - honesty, truthfulness
Fidelity - obligation to honor commitments, contracts
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Whistleblowing
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A whistleblower is a person who reveals information
about practices of others that are perceived as wrong,
fraudulent, corrupt, illegal, or a detriment to the health,
safety, and welfare of their clients.
Can have harmful and long-lasting effects on the nurses’
personal & professional lives- loss of employment, fear of
physical violence, or rejection of colleagues
Involves risks – nurses must weigh their ethical
obligations to advocate for their clients against their
obligations to the employer. THINK before you act
Pg. 1635
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2
Ethical Dilemmas
Ethical dilemma
 Conflict of ethical principles
 No one clear course of action
 A choice must be made between two equally
undesirable actions
Many dilemmas in healthcare
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Abortion
Advance Directives (DNR status)
Confidentiality & privacy (child or elder abuse)
Euthanasia
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Professional Guidelines for Ethical
Decision Making
Codes of Ethics for Nurses
International Council of Nurses
 American Nurses Association
 Standards of care
 Patient Care Partnership
 The Joint Commission
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Patient’s Bill of Rights
Nurses and hospitals are considered
responsible for upholding the rights of
patients.
 NLN and American Hospital Association have
established guidelines of patient’s rights.
 Patient’s Bill of Rights is concerned with
respect, privacy, and continuity of care.
 Patients have the right to be informed about
benefits, treatment options, confidentiality,
non-discrimination, etc…..
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Federal Laws Guiding Nursing Practice
▪ Health Insurance Portability and
Accountability Act (HIPAA)
▪ Emergency Medical Treatment and Active
Labor Act (EMTALA)
▪ Health Information Technology for Economic
and Clinical Health (HITECH)
▪ Patient Self-Determination Act (PSDA)
▪ Americans with Disabilities Act (ADA)
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Advance Directives
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2 types of legal written advance directives
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Living Will – prepared by a competent individual &
gives direction about a person’s wishes related to
life-sustaining treatments.
Durable Power of Attorney – identifies a person
(surrogate decision maker) who will make
healthcare decisions in the event a client is unable
to do so.
A DNR (Do not Resuscitate) status is a type
of advance directive
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State Laws Guiding Nursing Practice
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Mandatory reporting laws
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Good Samaritan laws
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Communicable disease
Abuse
Differ by state
Designed to protect from liability those who provide
emergency care to someone injured
Nurse practice acts
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Credentialing
Licensing
Discipline
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4
Nursing Liability
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Responsibile for providing safe, competent, legal, ethical care
Because we are legally responsible for our actions as nurses,
we need to know what is contained in the Nurse Practice
Act.
Meeting standards of care developed from:
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ANA’s Code of Ethics for Nurses with Interpretive Statements
ANA’s Scope and Standards of Psychiatric-Mental Health Nursing
Practice
State Nurse Practice Acts/federal agency regulations
Agency policies and procedures/job descriptions
Civil, criminal laws
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Laws
 Established
to protect society
practice guided by legal principles
 Purpose of Laws
 Protect clients/society
 Define scope of nursing practice
 Identify minimum level of care to be provided
 Nursing
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Nurse Practice Act
 Legal
framework for practice in a given
state.
 Regulates
practice through licensing
procedures and disciplinary actions.
 Identifies limits and scope of practice.
 Caregivers are legally responsible for
their actions.
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Liability
 Liability
means that a person is financially
or legally responsible for something.
 Nurses are legally responsible for their
own actions and this legal responsibility
cannot be delegated – this is the basis for
liability in nursing practice
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Torts – Potential Liability
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Wrongful act resulting in injury, loss or damage
May be intentional or unintentional Unintentional torts
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Negligence - failing to do what a reasonable & prudent person
would do, failure to follow standards of practice. No intent to
harm is present
Malpractice – professional form of negligence
Elements to prove malpractice
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Duty
Breach of duty
Injury or damage
Causation
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Torts – Potential Liability
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Intentional torts
 Assault/Battery
 False imprisonment
 Invasion of Privacy
 Fraud
3 elements to prove liability
 Willful voluntary act
 Intention to bring about consequences or injury
 Act as substantial factor in injury or consequences
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6
Least Restrictive Environment
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Short term use of restraints and seclusion
Permitted only when client is aggressive & dangerous to
self or others, & all other means of calming client have
been unsuccessful.
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Face-to-face evaluation in 1 hour, every 8 hours thereafter
(every 4 hours for children)
Physician’s order every 4 hours (every 2 hours for children)
Documented assessment by nurse every 1-2 hours
Staff must monitor restrained clients continuously on 1:1 basis
Close supervision of client
Monitoring of client’s skin condition, blood circulation in
hands/feet must be documented.
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Avoiding Liability
Practice proper documentation.
Observe standards of practice.
 Use nursing process; follow professional
standards.
 Avoid medication and treatment errors.
 Report and document accurately.
 Obtain informed consent.
 Attend to client safety.
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Avoiding Liability
Maintain client confidentiality.
Provide education and counseling.
 Delegate, assign, and supervise properly.
 Accept appropriate assignments.
 Participate in continuing education.
 Observe professional boundaries.
 Observe mandatory reporting regulations.
 Be aware of legal safeguards for nurses.
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Self-Awareness Issues
Talk to colleagues or seek professional
supervision.
 Spend time thinking about ethical issues,
determine your values and beliefs regarding
situations before they occur.
 Be willing to discuss ethical concerns with
colleagues or managers.
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