Nursing Ethics and the Law

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Nursing Ethics and the Law
How to protect yourself and your
patients!
Values, Morals, Ethics and Law
• VALUES:
– Worth you assign to an idea or an action or a
person
– The perceptions or ideals that help shape a
person’s life and provide it with meaning.
– Are made about God, family, truth, love, work, sex
and pleasure
– In nursing: altruism, human dignity, truth, justice,
freedom, equality, esthetics
Values, Morals, Ethics and Law
• Morals:
– Concerned with dealing with right or wrong
behavior (conduct) and character
– Customs of society
– Ethical habits of a person
– Shaped from what you value
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Values, Morals, Ethics and Law
• Values and Morals together make up your VALUES
SYSTEM:
– An individual’s collection of inner beliefs that guides the
way a person acts and helps determine the choices made
in life.
– Influences the nurse-patient relationship because the
values of each determines the behaviors of each
– We expect that you will assimilate the nursing values into
your own value system; HANDBOOK:
– Understanding your own values system will help decrease
inner conflict
Values, Morals, Ethics and Law
• Ethics:
– A system or code of behavior; usually considered
to be a list or rules of good conduct for members
of a particular group
– System of standards or moral principles
– Rules of conduct for society
– Knowledge of “right” and “wrong”
– Change as you change and grow
Your personal ethics are the basis
of your nursing ethics
That’s why it is important to know and
learn the nursing values—for the safety
of your patient and your practice!
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Ethics
• In general, “good” nursing lends to “good”
nursing ethics and those ethical values
become the basis for nursing law.
Nursing Ethics
• “the values and ethical principles governing nursing
practice, conduct and relationships”—Miller-Keane
• Deals with the relationships of a nurse to a patient,
family, staff and people in general
• Helps nurse in making decisions
• Codes provide guidelines for what the nurse should
do
• Handbook:
NAPNES/NFLPN
• To guide nurses, these groups adopted Codes
of Ethics that are now considered the codes
for nurses to follow
• You are expected to follow the code of ethics
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YOU
• Ultimately choose what your personal code of
ethics will be
• If personal ethics conflict with law, as a nurse,
you are obligated to follow the law
• You CANNOT refuse to give care if your
personal ethics are in conflict OR you cannot
give care selectively
Ethics and the Nurse
Nurses recognize that the patient is a
WHOLE person, not just a disease
Ethical Responsibilities of Nurses
• Patient Advocacy
• Accountability—you are answerable to
yourself, to your patient, to instructor; you are
accountable for all actions that you perform
• Peer reporting—report peers for behaviors
that are potentially harmful to patients
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Principles of Ethics
• Nonmaleficence
• Beneficence
• Autonomy
• Fidelity
• Justice
Nonmaleficence-primum non
nocere-first do no harm
• Basis of many “rules” in nursing
• Sometimes it is question of how to do the least
amount of harm when something good is expected
(like giving an injection)
• Never knowingly participate in any action that will
deliberately harm the patient (nurses pledge)
• This is reason for practicing procedures in lab,
preparing for patient care, knowing meds
Beneficence—do good
• Basis of trust in nursing
• Involves preventing harm and removing harm
• Put the patient interest first!
• Place the good of the patient before your
needs
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Autonomy—free to choose
Thinking thru all facts
Deciding on basis of an independent thinking process
Acting based on a personal decision
Undertaking a decision voluntarily without pressure
• It does NOT mean free to do anything you want, but
respects rights of others
Includes privacy
Includes the medical record
Privacy
• Permission to observe a procedure—this is
not a peep show!
• Do not expose your patient needlessly
• Knock before you enter the room!
Fidelity—Be True
• Be faithful to the charge of acting in the
patient’s best interest
• Must differentiate between your feelings and
choice on an issue and the feelings and wishes
of the patient
• Includes confidentiality
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Justice—fair to all
• Give each patient his/her due
• Treat each patient fairly
• Means treating each patient with respect and
dignity, not giving them all the same things!
OBLIGATION!
• As a nurse you will be obligated to care for the
patient
• What is an obligation? It is something you
“owe” to someone else
• In other words, nursing isn’t about “me”—it is
about the patient and what I “owe” that
patient by becoming a nurse
Standards of Care
• A measurement
• Minimal levels of expertise
• A level of performance expected by custom or
law as a model, criterion or rule for
comparison or measurement
• Where are our standards? Course syllabus
and student handbook
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AS A NURSE. . .
• You have an ETHICAL COMMITMENT to fulfill
the obligation of nursing and to meet the
standards of care
The basis for this commitment and
obligation. . .
• A strong belief in the right of people to be
treated and respected as human beings!
Ethical Dilemma
• A situation in which there is conflict or opposition
between personal values, moral principles, laws,
personal and professional obligations and the rights
of the individual and society
• Sometimes the values are equally strong on both
sides of the issue
• There may not be one right or wrong answer
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To make ethical decisions:
• Collect the facts
• Ask: what is the action of a reasonably
prudent nurse?
• Refer to someone with more experience in the
area (as a student, you should ALWAYS refer to
your instructor; as a LVN, follow your chain of
command)
Ethics Committees
• A committee dedicated to trying to make the
best decision related to bio-ethical situations
• All hospitals have them
• Made up of physicians, attorneys, nurses,
administrators
You are responsible and
accountable for nursing care!
• Responsible—reliable and trustworthy
• Accountable—responsible for the outcomes
related to decisions and actions for your
behaviors as a nurse
• Not only must you learn the necessary skills of
nursing, you must also accept responsibility
for yourself.
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Reasonable and prudent nurse
• One who acts and performs as others at the
same level, with the same amount of
education and/or experience
• One who behaves in accordance with what
can be established as the standard for nursing
practice
• One who upholds and performs to the
standards of care
LAW
Regulations that control the practice
of nursing, based on ethical values
Nurse Practice Act
• Define the duties and functions that nurses can
perform
• Define what nursing is, what it is not, and under
what circumstances it can be practiced for
compensation
• Provides rules and regulations for nurses to function
• Nurses must limit what they do as defined by the
practice act—the scope of practice
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