UNIT 4: LEGAL & MORAL ASPECTS OF NURSING Legal Protections in Nursing Practice Good Samaritan Acts These are laws designed to protect health care providers who provide assistance at the scene of an emergency against claims of professional negligence unless it can be shown that there was a gross departure from the normal standard of care or willful wrongdoing on their part. Gross negligence usually involves further injury or harm to the person. For example, an automobile may strike an injured child left on the side of the road when the nurse leaves to obtain help. Nursing Code of Ethics A code of ethics is a formal statement of a group’s ideals and values. It is a set of ethical principles that (a) is shared by members of the group, (b) reflects their moral judgments over time, and (c) serves as a standard for their professional actions. Nurses are responsible for being familiar with the code that governs their practice Nursing Code of Ethics Purposes Inform the public about the minimum standards of the profession and help them understand professional nursing conduct. Provide a sign of the profession’s commitment to the public it serves. Outline the major ethical considerations of the profession. Provide ethical standards for professional behavior. Guide the profession in self-regulation. Remind nurses of the special responsibility they assume when caring for the sick. Moral Principles Autonomy refers to the right to make one’s own decisions. Nonmaleficence is the duty to “do no harm.” Beneficence means “doing good.” Nurses are obligated to do good, that is, to implement actions that benefit clients and their support persons. Justice is frequently referred to as fairness. Fidelity means to be faithful to agreements and promises. Veracity refers to telling the truth. Accountability means “answerable to oneself and others for one’s own actions”. Responsibility refers to “the specific accountability or liability associated with the performance of duties of a particular role. Providing Competent Nursing Care Competent practice is a major legal safeguard for nurses. Nurses need to provide care that is within the legal boundaries of their practice and within the boundaries of agency policies and procedures. Nurses therefore must be familiar with their various job descriptions, which may differ from agency to agency. UNIT 4: LEGAL & MORAL ASPECTS OF NURSING Every nurse is responsible for ensuring that his or her education and experience are adequate to meet the responsibilities delineated in the job description Practice Guidelines Legal Protection for Nurses Function within the scope of your education, job description, and nurse practice act. Follow the policies and procedures of the employing agency. Build and maintain good rapport with clients. Always check the identity of a client to make sure it is the right client. Observe and monitor the client accurately. Communicate and record significant changes in the client’s condition to the primary care provider. Promptly and accurately document all assessments and care given. Be alert when implementing nursing interventions and give each task your full attention and skill. Perform procedures correctly and appropriately. Make sure the correct medications are given in the correct dose, by the right route, at the scheduled time, and to the right client. When delegating nursing responsibilities, make sure that the person who is delegated a task understands what to do and that the person has the required knowledge and skill. Protect clients from injury. Report all incidents involving clients. Always check any order that a client questions. Know your own strengths and weaknesses. Ask for assistance and supervision in situations for which you feel inadequately prepared. Maintain your clinical competence. For students, this demands study and practice before caring for clients. For graduate nurses, it means continued study to maintain and update clinical knowledge and skills. Carrying Out a Physician’s Order Nurses are expected to analyze procedures and medications ordered by the physician or primary care provider. It is the nurse’s responsibility to seek clarification of ambiguous or seemingly erroneous orders from the prescriber. Clarification from any other source is unacceptable and regarded as a departure from competent nursing practice. If the order is neither ambiguous nor apparently erroneous, the nurse is responsible for carrying it out. Several Categories of Orders that Nurses must Question to Protect Themselves Legally Question any order a client questions. For example, if a client who has been receiving an intramuscular injection tells the nurse that the health care provider changed the order from an injectable to an oral medication, the nurse must recheck the order before giving the medication. Question any order if the client’s condition has changed. The nurse is considered responsible for notifying the primary care provider of any significant changes in the client’s condition, UNIT 4: LEGAL & MORAL ASPECTS OF NURSING whether the primary care provider requests notification or not. For example, if a client who is receiving an intravenous infusion suddenly develops a rapid pulse, chest pain, and a cough, the nurse must notify the primary care provider immediately and question continuance of the ordered rate of infusion. If a client who is receiving morphine for pain develops severely depressed respirations, the nurse must withhold the medication and notify the primary care provider. Reporting/Documentation REPORTS: Are oral, written, or audiotaped exchanges of information between caregivers. Common reports: Change-in-shift report, Telephone report Telephone or verbal order – only RNs are allowed to accept telephone orders. Transfer report and Incident report. DOCUMENTATION: Is anything written or printed that is relied on as record or proof for authorized person Principles in Documentation Nursing documentation must be: accurate, comprehensive, and flexible enough to retrieve critical data, maintain continuity of care, track client outcomes, and reflects current standards of nursing practice. Effective documentation ensures continuity of care, saves time and minimizes the risk of error. As members of the health care team, nurses need to communicate information about clients accurately and in timely manner. If the care plan is not communicated to all members of the health care team, care can become fragmented, repetition of tasks occurs, and therapies may be delayed or omitted. Data recorded, reported, or communicated to other health care professionals are all CONFIDENTIAL and must be protected. Confidentiality Nurses are legally and ethically obligated to keep information about clients confidential. Nurses may not discuss a client’s examination, observation, conversation, or treatment with other clients or staff not involved in the client’s care. Only staff directly involved in a specific client’s care have legitimate access to the record. Clients frequently request copies of their medical record, and they have the right to read those records. Nurses are responsible for protecting records from all unauthorized readers. When nurses and other health care professionals have a legitimate reason to use records for data gathering, research, or continuing education, appropriate authorization must be obtained according to agency policy. Maintaining confidentiality is an important aspect of profession behavior. It is essential that the nurse safe-guard the client’ right to privacy by carefully protecting information of a sensitive, private nature. Sharing personal information or gossiping about others violates nursing ethical codes and practice standards. UNIT 4: LEGAL & MORAL ASPECTS OF NURSING It sends the message that the nurse cannot be trusted and damages the interpersonal relationships. Guidelines of Quality Documentation and Reporting Factual - a record must contain descriptive, objective information about what a nurse sees, hears, feels, and smells.-the use of vague terms, such as appears, seems, and apparently is not acceptable because these words suggests that the nurse is stating an opinion. Example: “ the client seems anxious” (the phrase seems anxious is a conclusion without supported facts.) Accurate - The use of exact measurements establishes accuracy. (example: “Intake of 350 ml of water” is more accurate than “ the client drank an adequate amount of fluid”-Documentation of concise data is clear and easy to understand.-It is essential to avoid the use of unnecessary words and irrelevant detail. Complete - The information within a recorded entry or a report needs to be complete, containing appropriate and essential information. Example: The client verbalizes sharp, throbbing pain localized along lateral side of right ankle, beginning approximately 15 minutes ago after twisting his foot on the stair. Client rates pain as 8 on a scale of 0-10. Current - Timely entries are essential in the client’s ongoing care. To increase accuracy and decrease unnecessary duplication, many healthcare agencies use records kept near the client’s bedside, which facilitate immediate documentation of information as it is collected from a client. Organized- The nurse communicates information in a logical order. For example, an organized note describes the client’s pain, nurse’s assessment, nurse’s interventions, and the client’s response. Legal Guidelines in Reporting Draw single line through error, write word error above it and sign your name or initials. Then record note correctly. Do not write retaliatory or critical comments about the client or care by other health care professionals. Enter only objective descriptions of client’s behavior; client’s comments should be quoted. Correct all errors promptly. Errors in recording can lead to errors in treatment. Avoid rushing to complete charting, be sure information is accurate. Do not leave blank spaces in nurse’s notes. Chart consecutively, line by line; if space is left, draw line horizontally through it and sign your name at end. Record all entries legibly and in blank ink. Never use pencil, felt pen. Blank ink is more legible when records are photocopied or transferred to microfilm. If order is questioned, record that clarification was sought. If you perform orders known to be incorrect, you are just as liable for prosecution as the physician is. Chart only for yourself. Never chart for someone else. You are accountable for information you enter into chart. Avoid using generalized, empty phrases such as “status unchanged” or “had good day”. Begin each entry with time, and end with your signature and title. UNIT 4: LEGAL & MORAL ASPECTS OF NURSING Do not wait until end of shift to record important changes that occurred several hours earlier. Be sure to sign each entry. For computer documentation keep your password to yourself. Maintain security and confidentiality. Once logged into the computer, do not leave it unattended.
