1 29 August 2009

LAW & ETHICS

IN NURSING

29 August 2009 2
MEANING OF LAW

The term law is derived from tentoric root
, Lag which means something which lies
fixed or events.

Law means body of rules to guide
human action.
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DEFINITION OF LAW
1 Law can be defined the sum total of
rules and regulations by which a society
is governed.
( Guido, 2001.p.2 )
2. The law is a system of rights and
obligations which the state enforces.
( Green )
3. The law is the body of principles
recognized and applied by the state and
the administration of justice .
( Salmaind )
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MEANING -
The study of doing right is called ethics.
DEFINITION -
Ethics may be defined as the system or
code of conduct and morals advocated by
a particular individual or group.



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BIOETHICS
MEANING
A situation that requires an individual to
make a choice between two equally
unfavorable alternatives.

e.g. Conflicts between one individuals
rights and those of another.

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NURSING ETHICS
Philosophical analysis of moral phenomena in
the Practice of nursing.

Nursing ethics are the professional standard
of conduct practiced by nurse practitioners
related to or in accordance with approved
moral behavior in rendering health care
services.
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FUNCTIONS OF
LAW IN NURSING

1. It provides a framework for establishing the
legal nursing activities.

2. It helps in establishing the boundaries of
independent nursing activity.

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FUNCTIONS OF LAW IN NURSING
CONTD ..

3. It differentiates the nurses responsibilities
among the health professionals.

4. It assists in maintaining the standard of
nursing practice which is accountable under
the law.

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TYPES OF LAWS
CIVIL CRIMINAL
CONTRACTS TORTS
INTENTIONAL UNINTENTIONAL
ASSAULT
BATTERY
INVASION OF
PRIVACY
DEFAMATION OF
CHARACTER
FALSE
IMPRISONMENT
NEGLIGENCE MALPRACTICE
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TYPES OF LAW

I - Criminal Law :

1. Criminal law prevent harm to society and
provide punishment for crimes.
( Black , 1999 )

2. A crime is an act committed in violation of
criminal Law and punishable by a fine or
imprisonment. A crime does not have to be
intended in order to be a crime.

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TYPES OF LAW contd..
Crimes are classified as felonies and misdemeanor.

FELONY - Is a crime of a serious nature that has
a penalty of imprisonment for greater than one
year or even death. e.g. murder.

MISDEMEANOR - Is a serious crime that has a
penalty of a fine or imprisonment for less than one
year.
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TYPES OF LAW
contd..

II Civil Law

It protects the rights of individual persons
within our society and encourage fair
and equitable treatment among people.
( Black, 1999 )
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Contract Law
Contract Law
Involves the enforcement of agreements
among private individuals or payment of
compensation for failure to fulfill the
agreements.

Tort Law
A tort is a civil wrong made against a person
or property.



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Types of Torts
Intentional
Are willful acts that violate anothers rights.
They are deliberate or willful actions in which
the intend is to cause injury to a person ( or )
Property.
Unintentional
These are accidents that cause injury to another
person or property. it involves failure or breach of
nursing duties that lead to harm.
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Types of Torts contd.
Intentional Unintentional

1 Assault 1 Negligence
2 Battery 2 Malpractice
3 Invasion of Privacy
4 Defamation of character
5 False imprisonment
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Intentional Torts
1. Assault - can be described as an attempt or
threat to touch another person unjustifiably.
Assault is any intentional treat to bring about
harmful or offensive Contact.

Example A nurse may threaten to give a
client an injection or restrain the client for any
procedure when client has refuse consent
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Intentional Torts
contd

2. Battery - Is any intentional touching
without consent. Battery always includes an
assault.
Example A nurse threatening to give a client
an injection without clients consent, if the nurse
actually gives the injection it
is called Battery.
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Intentional Torts
contd

3. Invasion of privacy -
The tort of invasion of privacy protects the
clients right to be free from unwanted intrusion
into his/ her private affairs.
1. Use of clients name
2 Unreasonable intrusion
3 Public disclosure of private facts
4 Putting a person in a false light

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Intentional Torts
contd

4 Defamation of character
Is the publication of false statements that result
in damage to a persons reputation.
It is communication that is false, or made with a
careless disregard for the truth, and results in
injury to the reputation of a person.
Example - Loss of Client Property, such as
jewelry, money, eyeglasses and dentures is a
constant concern to hospital personnel.
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Intentional Torts
contd
5 False imprisonment
False imprisonment is the unjustifiable
detention of a person without legal warrant to
confine the person
( Guido, 2001, p.98)
False imprisonment accompanied by forceful
restraint or threat of restraint is battery.
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Unintentional
Torts

Negligence and malpractice are examples
of unintentional torts that may occur in
the health care setting.

Negligence - Is misconduct or practice
that is below the standard of care.
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Unintentional Torts
contd..
Malpractice Is negligence committed by a
professional such as nurse or physician.
Nurses are liable for malpractice in the following
criteria.
1. The nurse owed a duty to the client.
2. The nurse did not carry out that duty.
3. The client was injured.
4. The nurses failure to carry out the duty
caused the injury.
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Measures to be taken by
nurse to avoid liability
for negligence and
malpractice.

1 Follow standard of cares.
2 Give competent health care.
3 Communicate with other health care providers.
4 Develop a caring rapport with the client.
5 Document assessments, interventions &
evaluations.
6 Should know the current nursing literature in
their areas of practice.
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Measures contd
..contd.
7. Should know and follow the policies and
procedures of the institution in which they work.
8 Should be sensitive to common sources of client
injury such as falls and medication errors.
9 Must communicate with the client.
10 Explain patients the tests concerns about the
treatment
11 Any significant changes in clients condition must
be reported to physician & documented in the
chart.
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SOURCES
OF
LAW
Constitutional
Law

Legislative
Law
Administrative
Law


Common
Law


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SOURCES OF LAW

1 Constitutional Law

The constitution creates legal rights and
responsibilities and foundation of a system
of justice. e.g. the constitution ensures
each U.S. citizen the right to due process
of law.
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SOURCES OF LAW CONTD..
2. Legislation ( Statutory Law )
Laws enacts by any legislative body are
called statutory laws.
3. Administrative Law
When a state legislature passes a
statute, an administrative agency is given
authority to create rules and regulations
to enforce the statutory laws.
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SOURCES OF LAW
CONTD..

4.Common Law

Laws evolving from court decisions are
referred to as common law.
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CATEGORY.EXAMPLES.
Constitutional


Statutory
- Due Process
- Equal protection

- Nurse Practice Act
- Good Samaritan Act
- Child and Adult Abuse Act
- Living Wills
- Sexual Harassment Laws
- American Disability Act
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CATEGORY.EXAMPLES.
Criminal






Contract
Homicide
Manslaughter
TheftActive
Eucanthesia
Sexual assault
Illegal possession of control drugs

Nurse and client
Nurse and employer
Nurse and insurance
Client and agency
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CATEGORY.EXAMPLES.
Torts Negligence / Malpractice
Libel and slander
Invasion of privacy
Assault and battery
False imprisonment
Abandonment
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AREAS OF
LIABILITY IN
NURSING
Crime
A crime is an act committed in violation
of public ( criminal ) law and
punishable be a fine or imprisonment.

A crime does not have to be intended
in order to be a crime.

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AREAS OF LIABILITY IN
NURSING contd


Torts -A tort is a civil wrong committed
against a person or a persons property.

Duty - The nurse must have ( or should have
had) a relationship with the client that involves
providing care and following an acceptable
standard of care.

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AREAS OF LIABILITY IN NURSING
contd.
Breach of duty - There must be a standard of
care that is expected in the specific situation but
that the nurse did not observe.

Foreseeability - A link must exist between the
nurses act and the injury suffered.

Causation - It must be proved that the harm
occurred as a direct result of the nurses failure
to follow the standard of care.
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AREAS OF LIABILITY IN NURSING
contd.
Harm of injury - The client or plaintiff
must demonstrate some type of harm or
injury ( physical, financial or emotional )
as a result of the breach of duty owed the
client.
Damages- If malpractice caused the
injury, the nurse is held liable for damages
that may be compensated.
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AREAS OF LIABILITY IN NURSING
contd.
Intervention Errors - Failing to
Document all nursing interventions understand the
medications being administered.
Always monitor the client as the condition warrants and as
ordered.
Document the frequency of client monitoring and client
status.
Promptly bring distressing symptoms and changes in client
status to the attention of the physician.
Document the time and content of all telephone
conversations with the physician.
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1. Informed Consent
Is the authorization by the patient and
based upon legal capacity, voluntary
action and compensation voluntary action
and comprehension. It is the persons
agreement to allow something to happen
based on full disclosure of facts needed to
make an intelligent decision.
SELECTED LEGAL
ASPECTS OF
NURSING PRACTICE
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
1. Explaination of treatment procedure.

2 The purpose of the treatment

3. What the client can expect to feel or
experience
4 The intended benefits of the treatment
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SELECTED LEGAL
ASPECTS OF NURSING
PRACTICE
5 Possible risks or negative outcomes of the
treatment
6 Advantages and Disadvantages of possible
alternatives to the treatment ( including
no treatment )
7.Name of the persons performing the
procedure.
8.Statement that patient may withdraw his
consent at anytime.
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
There are three major elements of informed
consent.
1. The consent must be given voluntarily.
2. The consent must be given by a client or
individual with a capacity and competence to
understand.
3. The client or individual must be given enough
information to be the ultimate decision maker..

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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
2. Delegation
Definition by The National Council of State
Boards of Nursing (1995) defines delegation
as, Transferring to a competent individual
the authority to perform a selected nursing
task in a selected situation.
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
3. Violence, Abuse and Neglect
Violent behavior can include domestic
violence, child abuse, elder abuse and
sexual abuse. Neglect is the absence of
care necessary to maintain the health and
safety of a vulnerable individual such as a
child or elder.
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
4. Sexual Harassment
Sexual Harassment is a violation of the
individuals rights and a form of discrimination.
The Equal Employment Opportunity Commission
( EEOC) defines sexual harassment as
Unwelcome sexual advances, requests for sexual
favors, and other verbal or physical conduct of a
sexual nature.
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
5. Abortions
Abortion Law provide specific guidelines for
nurses about what is legally permissible. In
1973, when the Roe V. Wade and Doe V. Bolton
cases were decided, the Supreme Court of the
United States held that the constitutional rights
of privacy gives a woman the right to control her
own body to the extend that she can abort her
fetus in the early to the extent that she can
abort her fetus in the early stages of pregnancy.
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE

6. Death and related Issues

Legal issues associated with death include
advance directives, euthanasia, do not
resuscitate ( DNR ) orders, certification of
death, autopsy, inquest, and organ
donation.
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SELECTED LEGAL ASPECTS OF
NURSING PRACTICE
8. Loss or damage to patients property

The nurse is held responsible if she handles the
patients property carelessly and as a result the
property is lost. e.g. Handing of patients jewelry
to patients nearest relative after written consent.
Money, eyeglasses and dentures is a another
concern of loss in the hospital personnel.
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LEGAL PROTECTION IN
NURSING PRACITCE
I. LICENSURE
1. All nurses in the nursing practice must possess a
valid licensure issued to the state council.
2. This license is to practice with ones own
authority.
3. The licensure on one hand is to secure society
the benefits which comes from the services of
skilled growth.
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LEGAL PROTECTION IN
NURSING PRACITCE
II GOOD RAPPORT
1. Developing good rapport with the patient is very
important to prevent malpractice.

2.Nurses must never underestimate a rapport with
the client in malpractice prevention.

3. Good rapport with the client depends on good
IPR. Communication skills e.g. listening.
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GOOD SAMARITAN ACTS
Good Samaritan acts are laws designed to
protect the healthcare providers who
provide assistance at the scene of an
emergency against claims of malpractice
unless it can be shown that there was a
gross departure from the normal standard
of care or willful wrongdoing on their part.
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PROFESSIONAL LIABILITY
INSURANCE

Because of the increase in the number
of malpractice lawsuits against
health professionals, nurses are
advised to carry their own liability
insurance.
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PROVIDING COMPETENT
NURSING CARE

Complete 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.
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RECORD KEEPING
The clients medical record is a legal
document and can be produced in court
as an evidence. Often, the record is used
to remind a witness of events surrounding
a lawsuit, because several months or
years usually elapse before the suit goes
to trail.
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ETHICS IN NURSING
Ethics is derived from the word, Ethos .
It is a tradition or sharing of customs and
commitment to a particular system of values.

Ethics refers to the science of moral duty,
ideal character and moral principles of a
practice of a profession.
( Bernard Harding )
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IMPORTANCE OF
ETHICS IN NURSING

Ethics has always been an integral part of nursing.

Caring for, comforting the sick, and protecting the
suffering is human activity and it should be seen
how society views directly affect the morals,
customs and beliefs of human kind.

Nursing ethics provide the standards for
professional behavior.
29 August 2009 55
INTERNATIONAL COUNCIL FOR
NURSES CODE OF ETHICS

Within any given profession , a code of ethics
serve as a means of self regulation and a source
guidelines for individuals behavior and
responsibility.

Code of ethics is an inclined contact through
which the profession informs society the
principles and rules by which it functions.

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NURSES AND PEOPLE
The nurses primary responsibility is to those
people who require nursing care.

The Nurse holds confidence, personal
information and uses Judgment in sharing their
information.

The Nurse provides care, promotes good
environment in which the values, customs and
spiritual beliefs of the individuals are respected
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NURSES AND PRACTICE
The nurse carries personal responsibilities for
nursing practice and for maintaining competency
by continuously learning.

The nurse maintains the higher standards of
nursing care possible with in the reality of the
specific situation.

The nurse uses judgment in relation to individual
competence when accepting and delegating
responsibilities
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NURSE AND SOCIETY

The nurse shares with other citizens the responsibility for
initiation and supporting action to meet the health and
social needs of public.

NURSES AND COWORKERS
The nurse sustains a cooperative relation with coworkers in
nursing and other fields.

The nurse takes appropriate action to safeguard the
individual when his care endangered by a coworker or any
other person
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NURSES AND THE PROFESSION
The nurse plays a major role in delivering and
implementing desirable standards of nursing
education.

The nurse is active in developing a care of
professional knowledge.

The nurse acting through the professional
organization in establishing and maintaining
equitable social and looking for condition in
nursing
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ETHICAL DECISION MAKING

Nurses decisions are increasingly constrained by
ethical issues. Ethical decision making involves
reflection on the following. Who should make
the choice, possible option or courses of action,
available options, consequences, both good or
bad, of all possible options, desired
outcomes.
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ETHICAL PRINCIPLES
Respect for person.
Respect for autonomy
Respect for freedom
Respect for beneficence ( doing good )
Respect for non-malfeasance (avoiding harm to
others )
Respect for veracity ( truth telling )
Respect for justice ( Fair and equal treatment )
Respect for rights
Respect for fidelity.( Fulfilling promises )
Respect for confidentiality (Protecting privileged
information)

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ETHICAL DECISION MAKING
M- Massage the dilemma. Identify and
define the issues in the dilemma. Consider
the options of all the major players in the
dilemma as well as their value system.

O- Outline the options. Examine all
options including those less realistic and
conflicting. Three stages are designed only
for considering options and not for making
final decision.
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ETHICAL DECISION MAKING
....Contd
R- Resolve the dilemma. Review the issues and
options, applying the basic Principles of ethics to
each option. Decide the best option based upon
the views of all those concerned in dilemma.
A- Act by applying chosen option. This step is
usually the most difficult as it requires actual
implementation. While the previous steps had
only allowed for dialogue or discussion.
L- Look back and evaluate the entire process
including the implementation.
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ETHICAL DILEMMA

A dilemma is defined as a situation
requiring a choice between two equally
desirable or undesirable alternatives.
In ethical dilemma each alternative
course of action can be justified by two
in which a person views a course of
action based on his/her value based
system.
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ETHICAL COMMITTEE
The members are - Physicians, Nurses, Clergy
and ethicists.
Functions are The committees analyze
situations.
Help to clarify issues.
Identify the options available.
Influence policy making
Teach staff and clients about ethical rights and
ethical decision making.
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ROLE AND FUNCTIONS OF NURSE /
ADMINISTRATOR / MANAGER IN LEGAL &
ETHICAL ISSUES.
PROVIDER OF SERVICE
EMPLOYEE OR CONTRACTOR FOR
SERVICE
RESPONSIBILITY IN QUALITY
CONTROL
RESPONSIBILITY FOR EQUIPMENT
RESPONSIBILITY FOR OBSERVATION
AND REPORTING

29 August 2009 67
LEGAL ROLES OF NURSES
Provider of Service
Employee or contractor for Service
Citizen
29 August 2009 68

THANK YOU