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Complete this document either in Word. All of this information is found in the PowerPoint presentations

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Chapter 4—Ethical Issues

Compare and contract legal and ethical issues.
What determines how a person approaches and solves ethical dilemmas
Define moral indifference—provide an example
Define moral uncertainty—provide an example from your own healthcare experience
Moral distress—provide an example from your own health care experiences
What is an ethical dilemma? Give an example
Describe deontological approach to ethical decision making? What does this mean?
Describe a teleological approach to ethical decision making? What does this mean?
Compare and contrast the 4 different frameworks for ethical decision making
What is autonomy—give an example from your experience
Define the following terms—how have you used/understood these principles in your nursing practice?
Beneficence
Paternalism
Utility
Justice
Veracity
Fidelity
Confidentiality
What is the MORAL decision-making model—how does this work?
Name important strategies to promote ethical behavior in healthcare.
Chapter 5—Legal and Legislative Issues

Define civil law and what is involved in civil cases
What are the reasons that nurses are at increased risk for legal liability in nursing practice?
What does the term Standard of Care mean in nursing? Why is this so important?
Define malpractice and the term professional negligence (the 5 criteria needed to fulfill this definition)….provide examples of each criteria to deepen your understanding
What does the term “under ordinary circumstances” means as it relates to professional negligence?
Define these legal terms that are pertinent to nursing practice—be sure you can relate these term to nursing practice
Stare decisis
Liability
tort
respondeat superior
vicarious liability
product liability
res ipsa loquitur
Define intentional torts and give as many examples as you can related to nursing practice
What are some common reasons nurses are sued (claims filed against them)
BON—Board of Nursing—what is their responsibility to the public?
Define the Nurse Practice Act and its role in your ability to practice nursing?
Define, compare and contrast the three forms of consent:
Informed consent
Implied consent
Express consent
What is HIPAA and what is its importance to healthcare/your nursing practice?
What are the parameters of Good Samaritan Immunity?
Describe the Patient Self-Determination Act (PSDA) of 1991 and how it changed healthcare
List the common causes of nursing license revocation

Chapter 4 Ethical Issues

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Learning Objectives

1. Define ethics and ethical dilemmas (ATI p 47) (Text 85-86)

2. Compare and contrast the utilitarian, duty-based, rights based and intuitionist frameworks for ethical decision making (Text p 88)

3. Identify and define nine different principles of ethical reasoning (ATI p 47) (Text p 89)

4. Use a systematic problem solving or decision-making model to determine appropriate action for select ethical problems (ATI p 47-48) (Text p 99)

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Learning Objectives

5. Describe how differences in personal, organizational, subordinate and patient obligations increase the risk of intrapersonal conflict in ethical decision making. (Text p 94)

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Ethical Issues

In an era of markedly limited physical, human, and fiscal resources, nearly all decision making by nurse-managers involves some ethical component. Multiple advocacy roles and accountability to the profession further increase the likelihood that managers will be faced with ethical dilemmas in their practice.

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Legal and Ethical Are Not the Same! #1

Legal EthicalIllegal Ethical
Legal UnethicalIllegal Unethical

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Legal and Ethical Are Not the Same! #2

Sometimes, it is very difficult to separate legal and ethical issues, although they are not the same. Legal controls are generally clear and philosophically impartial. Ethical controls are much more unclear and individualized.

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Ethics #1

The systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment

The justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are

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Ethics #2

Nurses are often placed in situations where they are expected to be agents for patients, physicians, and the organization simultaneously, all of which may have conflicting needs, wants, and goals.

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Ethics #3

The way a person approaches and solves ethical dilemmas is influenced by his or her values and basic beliefs about the rights, duties, and goals of all human being

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Moral Issues Faced by Nurses

Moral indifference: an individual questions why morality in practice is even necessary

Moral uncertainty: an individual is unsure which moral principles or values apply and may even include uncertainty as to what the moral problem is

Moral distress: occurs when the individual knows the right thing to do but organizational constraints make it difficult to take the right course of action

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Ethical Dilemma #1

Defined as making a choice between two or more equally undesirable alternatives

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Ethical Dilemma #2

Self-awareness is a vital leadership role in ethical decision making, just as it is in so many other aspects of management.

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Two Common Approaches to Ethical Decision Making

Deontological—duty-focused normative approach centered on rules from which all action is derived

Teleological—outcome-focused approach that places emphasis on results and protects the interest of the majority

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Frameworks for Ethical Decision Making

Utilitarianism

Duty-based reasoning

Rights-based reasoning

Intuitionism

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Principles of Ethical Decision Making

Autonomy

Beneficence

Paternalism

Utility

Justice

Truth telling (veracity)

Fidelity

Confidentiality

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Autonomy

Promotes self-determination/freedom of choice

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Beneficence (Doing Good)

The actions one takes should be done in an effort to promote good.

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Paternalism

One individual assumes the right to make decisions for another.

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Justice

Seeks fairness

Treats “equals” equally

Treats “unequals” according to their differences

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Veracity

The obligation to tell the truth

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Fidelity

The need to keep promises

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Confidentiality

Keeping privileged information private

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Utility

The good of the many outweighs the wants/needs of the individual.

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To Make Appropriate Ethical Decisions

The nurse must use a professional approach that eliminates trial and error and focuses on proven decision-making models or problem-solving processes.

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Sample Ethical Problem-Solving Processes

Traditional problem-solving process

Nursing process

MORAL decision-making model

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The MORAL Decision–Making Model (Crisham, 1985) #1

M—Massage the dilemma.

O—Outline options.

R—Review criteria and resolve.

A—Affirm position and act.

L—Look back. Evaluate the decision making.

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The MORAL Decision–Making Model (Crisham, 1985) #2

A common error made by managers in ethical problem solving is using the outcome of the decision as the sole basis for determining the quality of the decision making.

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The MORAL Decision–Making Model (Crisham, 1985) #3

If a structured approach to problem solving is used, data gathering is adequate, and multiple alternatives are analyzed, even with a poor outcome, the manager should accept that the best possible decision was made at that time with the information and resources available.

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The MORAL Decision–Making Model (Crisham, 1985)

Perhaps the most important thing a manager can do to create an ethical work environment is to role model ethical behavior.

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Professional Codes of Ethics

A code of ethics is a set of principles, established by a profession, to guide the individual practitioner.

The first code of ethics for nurses was adopted by the American Nurses Association in 1950 and has been revised six times since then (most recently in 2015).

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Professional codes of ethics do not have the power of law. They do, however, function as a guide to the highest standards of ethical practice for nurses.

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Strategies to Promote Ethical Behavior as the Norm

Separate legal and ethical issues.

Collaborate through ethics committees.

Use institutional review boards appropriately.

Foster an ethical work environment.

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Chapter 5 Legal and Legislative Issues

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Learning Objectives

1. Identify the primary sources of law and how each affects nursing practice (ATI p 42) (Text 111-112)

2. Describe the types (criminal, civil, and administrative) of legal cases nurses may be involved in and differentiate between the burden of proof and the potential consequences for rule breaking in each (ATI p 42) (Text p 111-115)

*Federal Regulations (ATI p 42) (Text 125, 127)

*State Laws (ATI p 42) (Text p 129-30)

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Learning Objectives

3. Identify specific doctrines used by the courts to define legal boundaries for nursing practice (ATI p 42) (Text p 114)

4. Describe the five elements that must be present for a professional to be held liable for malpractice (ATI p 43) (Text p. 114-118)

5. Identify strategies nurses can use to reduce their likelihood of being sued for malpractice (Text p. 118)

6. Identify types of intentional torts as well as strategies nurses can use to reduce their likelihood of being sued (ATI p 42) (Text p 121)

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Learning Objectives

7. Describe appropriate nursing actions to ensure informed consent (ATI p 36-37) (Text p 123)

8. Describe the need for patient and family education regarding treatment and end-of-life issues as part of the Patient Self-Determination Act (Text p 125)

9. Describe conditions that must exist to receive liability protection under the Good Samaritan laws. (ATI p 43) (Text p 127)

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Learning Objectives

10. Recognize his or her legal imperative to protect patient confidentiality in accordance with the Health Insurance Portability and Accountability ac Act of 1995 (Text p 127)

11. Identify the role State Boards of Nursing play in professional licensure and discipline (ATI p 43 (Text p 129-30)

* Standards of Care (Practice) (ATI p 44) (Text p 115-116, 122, 129, 138, 147,315,625)

* Advance Directives (ATI p 38) (Text p 125)

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Learning Objectives

Confidentiality—Privacy Rule (ATI p 40) (Text p 127)

* Confidentiality and Information Security (ATI p 40) (NCSBN)

* Use of Social Media (ATI p 41) (NCSBN)

* Reporting Incidents (ATI p 69-71) (Text p 121)

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Types of Law

Criminal law

Civil law

Administrative law

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Civil Cases (Typically Including Malpractice)

One individual sues another monetarily to compensate for a perceived loss.

Burden of proof required to be found guilty is a preponderance of the evidence.

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Two Types of Negligence

Ordinary negligence

Professional negligence (also called malpractice)

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Nurses Risk Increased Legal Liability Due to: #1

More authority and independence in decision making

Increased legal accountability for decision making

Doing more things that used to be in the realm of medical practice

Making more money

More are carrying malpractice insurance

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Nurses Risk Increased Legal Liability Due to: #2

Nurses need malpractice insurance not only because of their expanded roles but also because they incur a greater likelihood of being sued if they have malpractice insurance since injured parties will always seek damages from as many financial resources as possible.

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Standard of Care

A minimal level of expertise that may be delivered to a patient

The conduct of a reasonably prudent nurse in similar circumstances

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Malpractice

The failure of a person with professional training to act in a reasonable and prudent manner—also is called professional negligence.

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Five Components Necessary for Professional Negligence #1

A standard of care is in place.

There is a failure to meet the standard of care.

Foreseeability of harm must exist.

There must be a provable correlation between care and harm.

Actual patient injury must occur.

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Five Components Necessary for Professional Negligence #2

Being ignorant is not a justifiable excuse, but not having all the information in a situation may impede one’s ability to foresee harm.

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Under Ordinary Circumstances

The question of whether a nurse acted with reasonable and prudent care is determined by the testimony of expert nursing witnesses.

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Being Sued for Malpractice

“Just following physician orders” is not a defense for malpractice.

Nurses have an independent responsibility to take appropriate steps to safeguard patients.

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Other Legal Terms

Stare decisis

Liability

Tort

Respondeat superior

Vicarious liability

Product liability

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Stare Decisis

Means “to let the decision stand” (use precedents)

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Respondeat Superior

Means “the master is responsible for the acts of his servants”

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Res Ipsa Loquitur

Latin term meaning ”the thing speaks for itself”

Harm is obviously the result of negligence.

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Intentional Torts #1

Assault and battery

False imprisonment

Invasion of privacy

Defamation of character

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Intentional Torts #2

The use of physical restraints has led to claims of false imprisonment.

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Frequent Causes of Claims Against Nurses #1

Inadequate charting

Inadequate communication with physician or supervisors about changes in patient conditions

Leaving potentially harmful items within patient reach

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Frequent Causes of Claims Against Nurses #2

Unattended patient falls

Inaccurate counting of operative instruments and sponges

Misidentifying patients for medications, surgeries, tests

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The Board of Registered Nursing Protects Citizens by: #1

RN licensing

Monitoring of RN educational standards

RN continuing education

Disciplining RNs

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The Board of Registered Nursing Protects Citizens by: #2

Boundaries for practice are defined in the Nurse Practice Act of each state.

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RN Licensure #1

Remember that nursing licensure is a privilege and not a right.

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RN Licensure #2

Since the first mandatory Nurse Practice Act passed in New York in 1938, nursing has been legislated, directed, and controlled to some extent.

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Nurse Practice Act

The Nurse Practice Act is a legal instrument that defines what the functions of nursing shall be and sets standards for licensure.

It grants a nurse the authority to carry out those functions.

Each state has its own Nurse Practice Act, but all must be consistent with provisions or statutes established at the federal level.

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Types of Consents

Informed consent

Implied consent

Express consent

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Informed Consent

Obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure and only if the patient understands the potential benefits and risks associated with doing so.

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Medical Records

Although the patient owns the information in the medical record, the actual record belongs to the facility that originally made the record and is storing it.

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Health Insurance Portability and Accountability Act (HIPAA) of 1996

Protects the privacy of health information and improves the portability and continuity of health insurance coverage.

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Good Samaritan Immunity

Generally, a nurse is not liable for injury that occurs as a result of emergency treatment, provided that:

Care is provided at the scene of the emergency.

The care is not grossly negligent.

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Patient Self-Determination Act (PSDA)

Required health-care organizations that received federal funding (Medicare and Medicaid) to provide education for staff and patients on issues concerning treatment and end-of-life issues

Includes the use of advance directives (ADs), written instructions regarding desired end-of-life care

Also likely includes durable power of attorney for health care (health-care proxy)

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Legal Responsibilities of the Nurse-Manager

Reporting dangerous understaffing

Checking staff credentials and qualifications

Carrying out appropriate discipline

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Common Causes of Professional Nursing License Suspension or Revocation #1

Professional negligence

Practicing medicine or nursing without a license

Obtaining a nursing license by fraud or allowing others to use your license

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Common Causes of Professional Nursing License Suspension or Revocation #2

Felony conviction for any offense substantially related to the function or duties of an RN

Participating professionally in criminal abortions

Not reporting substandard medical or nursing care

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Common Causes of Professional Nursing License Suspension or Revocation #3

Providing patient care while under the influence of drugs or alcohol

Giving narcotic drugs without an order

Falsely holding oneself out to the public or to any health-care practitioner as a “nurse practitioner”

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