45786975 Ethico Legal Nursing
Content
ETHICO LEGAL NURSING Teresita a. Cada RN MAN Civil Laws
They are laws that regulate disputes between individuals & between individuals and groups. Common sources are judicial or common laws. It includes laws relating to contracts and ownership of property.
A common feature is that a monetary award is provided for damages or as compensation when another person causes injury. Torts
It is a civil wrong committed by one person against another or that person’s property.
It may be intentional- ( when the injury suffered by the victim was intended by the wrongdoer. Examples are: Fraud, Defamation, False Imprisonment, Assault or Battery and invasion of privacy. Fraud This is false representation of some facts example is when a nurse falsely represents herself as being certified as a specialist in nursing; or to claim false statements about past employment or about academic credentials or professional activities on a résume' for the purpose of deceiving an employer. Defamation This is a false communication or careless disregard for the truth that result in damage to one’s reputation. 1. Libel – occurs through printing, writing or use of pictures. Forms:
2. Slander – this is spoken defamation, ex. Telling a patient that a certain nurse is incompetent False Imprisonment It involves restraining a person with or without force against a person’s wishes. Ex. Keeping patients from leaving the hospital. Exemptions are cases of impaired judgment as in Alzheimer’s disease.
Example. Use of restraints without permission. It violates rights & dignity. Assault & Battery Assault is an attempt or threat to touch another person unjustly. Battery is the actual or willful touching of another person that may or may ot cause harm. An assault precedes battery, example; A nurse who threatens a client of injection or catheterization could be found guilty of assault.
If a nurse performs a procedure without permission or does a procedure in a way that causes harm or embarrassment is guilty of battery. If a nurse gives injection despite the patient’s objection, it constitutes battery. Invasion or Privacy When the nurse unreasonably intrudes on the clients private affairs. Example: 1. soliciting information not required for the client’s care or discussing client’s information with people who are not entitled to that information. The nurse should exercise prudence in using or sharing information to protect the patient’s privacy. 2. Unnecessary exposing patient during transport or procedures, photographs or videos without permit. Unintentional Torts
NEGLIGENCE This occurs when harm or injury is caused by an act of omission or commission by a lay person. It results from failure to use the kind of care a reasonably prudent lay person would use in similar situation. Ex. Carelessly failing to lock the brakes of a wheelchair when transporting a client.
Another example is leaving an infant on the examination table without taking precautions to prevent falling, or failure to take vital signs of clients with untoward signs. Malpractice This is an act of negligence by a professional person compared to the action of another professional in similar circumstance. Liability
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Legal obligation for which the nurse can be held liable and accountable. There are 4 elements that must be proven;
1. Duty – involves the obligation of the nurse to use due care; that is to exercise due care to which a prudent nure would do. 2. Breach of Duty – the failure to meet the standard of care. 3. Causation – when the failure to meet the standard of care resulted to harm to the patient.
4. Damages – the patient must have suffered actual harm or injury Standards of Care These are derived from: Professional standards Legal regulation of nursing practice
Employer’s expectation for nursing practice. Terminologies Plaintiff – the person bringing a lawsuit, alleges facts and outcomes. Defendant – the person against whom the lawsuit is filed. Duty –(obligation) example – the nurse is responsible for accurate assessment & timely reporting of changes in a client’s condition Breach of duty – when the nurse fails to note that a client’s thumb is warm to toucch, red & swollen & painful.
Causation – failure to note the signs and symptoms of an infection leading to disarticulation of the thumb.
Damage – the loss of the thumb seriously limits the client’s use of his hand Forms of Settlement of legal action 1. Parties may negotiate out of court. This does not mean that the nurse is guilty of negligence or malpractice. However the cost of litigation and the potential liability may suggest “out-of court settlement” as the best action. 2. Case is settled in court When both parties attempt to persuade the court to rule in their favor. 3. To present the case to an arbitration panel. Contracts A contract is an agreement between two or more individuals that creates certain rights and obligations in exchange for goods or services
A crime is an act that violates the duties we owe to the community. Ex of criminal acts:
Larceny Homicide Manslaughter Burglary Kidnapping Arson Drug/human trafficking
THEORIES OF NURSING
•
Florence Nightingale Five Environmental Factors
Fresh Air Pure water Efficient drugs Cleanliness Light (sunlight)
•
She stressed keeping the patient warm, noise free-environment and attending to patients’ die Henderson 1955 Maintaining body temperature within normal range by adjusting clothing & modifying environment. Keeping the body clean and well-groomed to protect integument. Avoiding dangers in the environment & avoiding injuring others. Communicating with others in expressing emotions, needs, fears or opinions. Working in such a way that one feels a sense of accomplishment. Praying or participating in various forms of recreation. Worshipping according to one’s faith. Learning, discovering or satisfying the curiosity that leads to normal development & using available health
facility.
•
Martha Rogers (Science of Unitary Human Beings)
To Rogers UNITARY MAN is: An irreducible four-dimensional energy field identified by pattern. (he has unique identifying behaviors or qualities & characteristics) Manifest characteristics different from the sum of the parts. Interacts continuously & creatively with his environment. Behaves as a totality. As a sentient being, participates creatively to change. Orem’s Self-Care deficit
•
Self-care of dependents is learned behaviors that individuals initiate to perform on their own behalf to maintain life, health and well-being. Nursing systems form when nurses prescribe & provide nursing care that regulates the individual self-care abilities like:
Wholly compensatory – systems are required for individuals unable to control & monitor their environment and process information. Partially compensatory – systems designed for individuals who are unable to perform some (but not all) self-care activities. Supportive – educative (developmental) system designed for persons who need to learn to perform self-care measures & need assistance to do so. SYSTEMS THEORY (INTERRELATED PARTS FUNCTIONING TOGETHER TO FORM A WHOLE)
•
Roy’s Adaptation Model
Roy focuses on the individual a biopsychosocial adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an on-going purposive response Adaptive response contributes to health and the process of being and becoming integrated. Ineffective process or maladaptive responses do not contribute to the process of being and becoming
integrated.
•
1. King’s Goal Attainment Theory
There are three (3) dynamic interacting systems Personal System- perception, self body image, growth and development, space and time. Interpersonal system – interaction, communication, transaction, role and stress. Social system – organization, authority, power status and decision making. 3. Neuman’s Health Care System Model Nursing interventions are carried out on 3 Preventive Levels: Primary prevention – identifies risk factors, attempts to eliminate the stressors & focuses on protecting the normal line of defense & strengthening the flexible line of defense. A reaction has not yet occurred but the degree of risk is known. Secondary prevention – relates to interventions or active treatment initiated after symptoms have occurred. The focus is to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors. Tertiary Prevention – it is focused on relation & stability that favors return to wellness following treatment. 4. Johnson’s Behavioral Systems Model Attachment affiliative – provides survival and security. Its consequences are social inclusion, intimacy and the formation and maintenance of social bond. Dependency subsystem – promotes helping behavior that calls for nurturing process. Ingestive subsystem – satisfies appetite. It is concerned with social and psychological considerations as well as biologic. The eliminative subsystem – excretes body wastes. Sexual subsystem functions dually for procreation and gratification. Achievement subsystem – attempts to manipulate the environment. It controls or masters an aspect of the self or environment to some standard of excellence. The aggressive subsystem – protects and preserves the self & society within the limits imposed by society. Each of these subsystems has the functional requirements: protection, nurturance & stimulation. The subsystem’s responses are developed through motivation, experience & learning and are influenced by biopsychosocial factors. Interpersonal Caring Theories These theories seek to develop the nurses’ skill in relationship with clients, compassion, the helping process and caring.
Peplau’s Psychodynamic nursing theory Leininger”s transcultural care theory Watson’s philosophy & science of caring Benner’s primary nursing
•
Peplau’s Psychodynamic Nursing Theory
Orientation – During this phase, the patient seeks help and the nurse assist the patient to understand the problem and the extent for the need for help. Identification – At this phase, the patient assumes role of dependence, interdependence or independence in relation to the nurse. (Relatedness) the nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the patient’s situation. Exploitation – In this phase, the patient uses available services on the basis of self-interest and needs Power shifts from the nurse to the patient. Resolution – In this phase, old needs and goals are put aside and new ones are adopted. Once older needs are resolved, newer and more mature ones emerge.
•
Leininger’s Transcultural Care theory
She postulates that caring and culture are intrinsically linked. She states that care is the essence of nursing and the dominant, distinctive and unifying feature of nursing. She further said that there could be no cure without care, but there may be caring without curing, and that Human Caring varies among culture.
•
Watson’s Philosophy & Science
Caring is central to nursing, the unifying focus for nursing. Nursing interventions related to human care are called “Carative Factors” such as: Forming a humanistic – altruistic system of values; giving of self. Instilling faith & hope – (optimism, hope & trust) Developing a helping trust relationship Expressing positive and negative feeling Cultivating sensitivity to oneself and others Using a creative problem-solving caring process
Promoting transpersonal teaching and learning
Providing a supportive, protective or corrective mental physical, socio-cultural & spiritual environment. Assisting with gratification of human needs Being sensitive to existential-phenomenologic spiritual force.
MAJOR ETHICAL PRINCIPLES
Beneficence/nonmaleficence Autonomy (Respect for Person) Confidentiality Veracity Justice
They are laws that regulate disputes between individuals & between individuals and groups. Common sources are judicial or common laws. It includes laws relating to contracts and ownership of property.
A common feature is that a monetary award is provided for damages or as compensation when another person causes injury. Torts
It is a civil wrong committed by one person against another or that person’s property.
It may be intentional- ( when the injury suffered by the victim was intended by the wrongdoer. Examples are: Fraud, Defamation, False Imprisonment, Assault or Battery and invasion of privacy. Fraud This is false representation of some facts example is when a nurse falsely represents herself as being certified as a specialist in nursing; or to claim false statements about past employment or about academic credentials or professional activities on a résume' for the purpose of deceiving an employer. Defamation This is a false communication or careless disregard for the truth that result in damage to one’s reputation. 1. Libel – occurs through printing, writing or use of pictures. Forms:
2. Slander – this is spoken defamation, ex. Telling a patient that a certain nurse is incompetent False Imprisonment It involves restraining a person with or without force against a person’s wishes. Ex. Keeping patients from leaving the hospital. Exemptions are cases of impaired judgment as in Alzheimer’s disease.
Example. Use of restraints without permission. It violates rights & dignity. Assault & Battery Assault is an attempt or threat to touch another person unjustly. Battery is the actual or willful touching of another person that may or may ot cause harm. An assault precedes battery, example; A nurse who threatens a client of injection or catheterization could be found guilty of assault.
If a nurse performs a procedure without permission or does a procedure in a way that causes harm or embarrassment is guilty of battery. If a nurse gives injection despite the patient’s objection, it constitutes battery. Invasion or Privacy When the nurse unreasonably intrudes on the clients private affairs. Example: 1. soliciting information not required for the client’s care or discussing client’s information with people who are not entitled to that information. The nurse should exercise prudence in using or sharing information to protect the patient’s privacy. 2. Unnecessary exposing patient during transport or procedures, photographs or videos without permit. Unintentional Torts
NEGLIGENCE This occurs when harm or injury is caused by an act of omission or commission by a lay person. It results from failure to use the kind of care a reasonably prudent lay person would use in similar situation. Ex. Carelessly failing to lock the brakes of a wheelchair when transporting a client.
Another example is leaving an infant on the examination table without taking precautions to prevent falling, or failure to take vital signs of clients with untoward signs. Malpractice This is an act of negligence by a professional person compared to the action of another professional in similar circumstance. Liability
•
Legal obligation for which the nurse can be held liable and accountable. There are 4 elements that must be proven;
1. Duty – involves the obligation of the nurse to use due care; that is to exercise due care to which a prudent nure would do. 2. Breach of Duty – the failure to meet the standard of care. 3. Causation – when the failure to meet the standard of care resulted to harm to the patient.
4. Damages – the patient must have suffered actual harm or injury Standards of Care These are derived from: Professional standards Legal regulation of nursing practice
Employer’s expectation for nursing practice. Terminologies Plaintiff – the person bringing a lawsuit, alleges facts and outcomes. Defendant – the person against whom the lawsuit is filed. Duty –(obligation) example – the nurse is responsible for accurate assessment & timely reporting of changes in a client’s condition Breach of duty – when the nurse fails to note that a client’s thumb is warm to toucch, red & swollen & painful.
Causation – failure to note the signs and symptoms of an infection leading to disarticulation of the thumb.
Damage – the loss of the thumb seriously limits the client’s use of his hand Forms of Settlement of legal action 1. Parties may negotiate out of court. This does not mean that the nurse is guilty of negligence or malpractice. However the cost of litigation and the potential liability may suggest “out-of court settlement” as the best action. 2. Case is settled in court When both parties attempt to persuade the court to rule in their favor. 3. To present the case to an arbitration panel. Contracts A contract is an agreement between two or more individuals that creates certain rights and obligations in exchange for goods or services
A crime is an act that violates the duties we owe to the community. Ex of criminal acts:
Larceny Homicide Manslaughter Burglary Kidnapping Arson Drug/human trafficking
THEORIES OF NURSING
•
Florence Nightingale Five Environmental Factors
Fresh Air Pure water Efficient drugs Cleanliness Light (sunlight)
•
She stressed keeping the patient warm, noise free-environment and attending to patients’ die Henderson 1955 Maintaining body temperature within normal range by adjusting clothing & modifying environment. Keeping the body clean and well-groomed to protect integument. Avoiding dangers in the environment & avoiding injuring others. Communicating with others in expressing emotions, needs, fears or opinions. Working in such a way that one feels a sense of accomplishment. Praying or participating in various forms of recreation. Worshipping according to one’s faith. Learning, discovering or satisfying the curiosity that leads to normal development & using available health
facility.
•
Martha Rogers (Science of Unitary Human Beings)
To Rogers UNITARY MAN is: An irreducible four-dimensional energy field identified by pattern. (he has unique identifying behaviors or qualities & characteristics) Manifest characteristics different from the sum of the parts. Interacts continuously & creatively with his environment. Behaves as a totality. As a sentient being, participates creatively to change. Orem’s Self-Care deficit
•
Self-care of dependents is learned behaviors that individuals initiate to perform on their own behalf to maintain life, health and well-being. Nursing systems form when nurses prescribe & provide nursing care that regulates the individual self-care abilities like:
Wholly compensatory – systems are required for individuals unable to control & monitor their environment and process information. Partially compensatory – systems designed for individuals who are unable to perform some (but not all) self-care activities. Supportive – educative (developmental) system designed for persons who need to learn to perform self-care measures & need assistance to do so. SYSTEMS THEORY (INTERRELATED PARTS FUNCTIONING TOGETHER TO FORM A WHOLE)
•
Roy’s Adaptation Model
Roy focuses on the individual a biopsychosocial adaptive system. Both the individual and the environment are sources of stimuli that require modification to promote adaptation, an on-going purposive response Adaptive response contributes to health and the process of being and becoming integrated. Ineffective process or maladaptive responses do not contribute to the process of being and becoming
integrated.
•
1. King’s Goal Attainment Theory
There are three (3) dynamic interacting systems Personal System- perception, self body image, growth and development, space and time. Interpersonal system – interaction, communication, transaction, role and stress. Social system – organization, authority, power status and decision making. 3. Neuman’s Health Care System Model Nursing interventions are carried out on 3 Preventive Levels: Primary prevention – identifies risk factors, attempts to eliminate the stressors & focuses on protecting the normal line of defense & strengthening the flexible line of defense. A reaction has not yet occurred but the degree of risk is known. Secondary prevention – relates to interventions or active treatment initiated after symptoms have occurred. The focus is to strengthen internal lines of resistance, reduce the reaction, and increase resistance factors. Tertiary Prevention – it is focused on relation & stability that favors return to wellness following treatment. 4. Johnson’s Behavioral Systems Model Attachment affiliative – provides survival and security. Its consequences are social inclusion, intimacy and the formation and maintenance of social bond. Dependency subsystem – promotes helping behavior that calls for nurturing process. Ingestive subsystem – satisfies appetite. It is concerned with social and psychological considerations as well as biologic. The eliminative subsystem – excretes body wastes. Sexual subsystem functions dually for procreation and gratification. Achievement subsystem – attempts to manipulate the environment. It controls or masters an aspect of the self or environment to some standard of excellence. The aggressive subsystem – protects and preserves the self & society within the limits imposed by society. Each of these subsystems has the functional requirements: protection, nurturance & stimulation. The subsystem’s responses are developed through motivation, experience & learning and are influenced by biopsychosocial factors. Interpersonal Caring Theories These theories seek to develop the nurses’ skill in relationship with clients, compassion, the helping process and caring.
Peplau’s Psychodynamic nursing theory Leininger”s transcultural care theory Watson’s philosophy & science of caring Benner’s primary nursing
•
Peplau’s Psychodynamic Nursing Theory
Orientation – During this phase, the patient seeks help and the nurse assist the patient to understand the problem and the extent for the need for help. Identification – At this phase, the patient assumes role of dependence, interdependence or independence in relation to the nurse. (Relatedness) the nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the patient’s situation. Exploitation – In this phase, the patient uses available services on the basis of self-interest and needs Power shifts from the nurse to the patient. Resolution – In this phase, old needs and goals are put aside and new ones are adopted. Once older needs are resolved, newer and more mature ones emerge.
•
Leininger’s Transcultural Care theory
She postulates that caring and culture are intrinsically linked. She states that care is the essence of nursing and the dominant, distinctive and unifying feature of nursing. She further said that there could be no cure without care, but there may be caring without curing, and that Human Caring varies among culture.
•
Watson’s Philosophy & Science
Caring is central to nursing, the unifying focus for nursing. Nursing interventions related to human care are called “Carative Factors” such as: Forming a humanistic – altruistic system of values; giving of self. Instilling faith & hope – (optimism, hope & trust) Developing a helping trust relationship Expressing positive and negative feeling Cultivating sensitivity to oneself and others Using a creative problem-solving caring process
Promoting transpersonal teaching and learning
Providing a supportive, protective or corrective mental physical, socio-cultural & spiritual environment. Assisting with gratification of human needs Being sensitive to existential-phenomenologic spiritual force.
MAJOR ETHICAL PRINCIPLES
Beneficence/nonmaleficence Autonomy (Respect for Person) Confidentiality Veracity Justice
