Ethics
Advance directives: take effect when client is unable to speak for him/herself due to mental incapacity.
 Aphasia: inability to express thoughts and comprehend language due to brain dysfunction. Includes both verbalizing and writing.
 Coma (GCS score ≤7) or with expressive aphasia would need an advance directive because they cannot directly express their wishes.
 Alzheimer disease: encourage to make advance directives in early stages while they can make informed decisions.
Advance directive: makes clear a client's health care wishes (DNR). Advocate for client by ensuring that expressed wishes are communicated
in advance directive and medical record. Encourage client to share this information with appointed health care proxy. Copies are given to
health care proxies. Two witnesses are required, other than health care proxies listed.
2 most common forms of advance directives: living wills and durable power of attorney (health care surrogate/proxy). These take effect
when the client cannot self-advocate.
 Living will: represents client's wishes regarding actions to be taken in specific situations.
 Durable power of attorney: individual who decides actions to situations according to an understanding of client's wishes. Medical
power of attorney (an individual appointed when clients are unable to speak for themselves). The client's wishes should be honored.
Clients have the right to declare any individual they trust as their agent with medical POA, and that individual becomes the final
decision maker.
Professional boundaries: maintaining a relationship that benefits the client, not the nurse, and to which the nurse would not be reluctant to
admit. It is generally not appropriate to socialize with a current client after hours, ask for a financial investment/loan, or accept a valuable
gift. Sending sympathy card, praying, occasional visit is okay.
underage client whose parents or guardians cannot be contacted and who needs emergency care should receive all necessary medical care
until a parent or guardian can be reached to provide consent.
The nurse should be cautious of discussing a client's obstetric history in front of the client's partner or family to avoid breaching
confidentiality. Clarification or further questioning about the client's history should take place when the client is alone. Clients' health
information should be discussed only with health care team members directly involved in those clients' care. Not transport, unit clerk
Discussing suspected child abuse with caregiver: empathetic and maintain a neutral, nonaccusatory manner. Parent needs to be told that safety
and well-being of child are primary concerns, certain types of injuries or situations must be reported to appropriate CPS agencies by law.
Waste of controlled substances (opioids) must be witnessed by 2 licensed nurses to comply with facility policy and government regulations.
Contacts the health care provider (HCP), regardless of the time of day
 Falls, deteriorates significantly or dies (right sided upper or lower extremity drift)
 Has critical laboratory results (serum sodium 124)
 Needs a prescription that requires clarification (heparin before surgery)
 Leaves against medical advice or runs away, Refuses key treatments in a relevant period
The person who witnesses an unusual occurrence or event must file an incident report in the institution's computer documentation system,
using an electronic form. The nurse should not document that the incident report was filed or refer to it in the medical record.
Assault: act that threatens the client, causing the client to fear harm without the client being touched.
Battery: touching that is legally defined as unacceptable or occurs without consent.
False imprisonment: restraining a competent client without the client's permission.
Nurse is required to report impaired coworker, a suspicious death, and elder abuse to appropriate authorities. The nurse is legally prohibited
from sharing health information with employers or family members without the client's permission.
After an adverse event, nurse should document objective, specific assessments, and interventions. These include signs/symptoms indicating a
lack of client harm and any corrective actions taken. “Will continue to monitor” is meaningless.
Client safety is the first priority when a medication error occurs. The nurse should assess the client and inform the HCP about the error before
reporting to nursing management and completing an incident report. Assess client first!
A DNR order requires the nurse to withhold resuscitation in event of a cardiac or respiratory arrest. If an event occurs, nurse should assess for
breathing and check the central or apical pulse. After performing these actions, the nurse should call the HCP to confirm the death.
Justice: treating every client equally regardless of gender, sexual orientation, religion, ethnicity, disease, or social standing
Accountability: accepting responsibility for one's actions and admitting errors
Nonmaleficence: doing no harm. Protecting clients who are unable to protect themselves due to their physical or mental condition. Ex:
infants/children, clients under the effects of anesthesia, and clients with dementia
Autonomy: freedom for competent client to make decisions for oneself, even if the nurse or family does not agree (informed consent, advanced
directive). Respect the client's decisions.
Confidentiality means that information shared with nurse is kept in confidence unless permission is given to share or it is required by law to be
shared to protect the client or community (infectious diseases). Suicidal ideation reported to protect the client from self-harm.
Beneficence: nurse's duty to promote good and do what is best for the client.
Paternalism: type of beneficence whereby clients are treated as children.
Veracity: duty to tell the truth.
Fidelity: exhibiting loyalty and fulfilling commitments made to oneself and others.
A nurse who is impaired by alcohol cannot be given client responsibility. The recognizing nurse should notify the supervisor, document the
incident, and not give client responsibility to the impaired nurse. Do not confront nurse or discipline
Providing care establishes a legal caregiver obligation/relationship between nurse and a visitor. In event of a visitor emergency, nurse should
refrain from actions that establish this relationship and instead implement facility protocol to help get the visitor promptly to the emergency
department. (Visitor has heart attack move her to ER. Do not start care in room)
The client must be legally competent to leave against medical advice. Disqualifications for legal competency include impairment by drugs or
alcohol, altered consciousness, and mental illness (a danger to self or others).
Incident/occurrence reports: used to document clinical and safety issues, events that pose actual or potential risk to the health or safety of
clients, visitors, or employees. Examples: assault and injury; delay or omission of treatment; and equipment failure.
Mature minors: adolescents between age 14-18 who can give independent consent for limited conditions such as STIs, family planning, drug
and alcohol abuse, blood donation, and/or mental health care.
All client deaths are reported to local organ procurement services, per hospital protocol. Life support is continued until a decision for organ
donation is reached so that organs and tissues continue to receive perfusion and oxygenation.
Nurse offenses reportable to state board of nursing: criminal acts (theft)- stealing narcotics, practicing outside scope, falsification of
records (documenting something that was not preformed, administering without prescription), and client abandonment
Nursing documentation should be factual, descriptive, and contain objective information that the nurse sees, hears, feels, or smells. It must
include direct observation and measurement. Voided x 1- not descriptive enough, too vague
Good Samaritan laws: prevent civil action if a nurse stops to assist after an accident, as long as nurse acts competently (apply pressure to
artery), continues care until another appropriate caregiver takes over, and does not accept money.
Infants do not start rolling until age 4 months and normally roll front to back at 5 months. This explanation for the injury does not fit the
growth capacity of the child. Because lethargy is present, head injury must be ruled out.
Informed consent is required before any nonemergency procedure. If the need for an additional procedure is discovered during surgery, the
client's medical power of attorney, legal guardian, or next of kin should be contacted to provide consent.
Failure to stop an erroneous code on a client with an advance directive in a timely fashion may result in legal action.
The Health Insurance Portability and Accountability Act and the Personal Information Protection and Electronic Documents Act
requirements related to protected health information include not giving results to a spouse without permission or telling a client diagnosis to an
employee who does not need to know it. It is not a violation to call clients by their names, have information overheard inadvertently, or
indicate well wishes.
Hospital administration will obtain legal protective custody of a minor child if the parents are deciding against life-saving measures for
their child or when there is child abuse/neglect. The parents will not be allowed to take this child out of the hospital against medical advice as it
will endanger the child's life. It does not matter that it is a religious reason for the desired Against Medical Advice) AMA.