Professional Documents
Culture Documents
BS NURSING / FIRST
YEAR
Session # 2
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can:
Charitable Immunity
Cardozo Decision of 1914
A. Informed consent
a. Informed Consent: the right to full disclosure; the right to make one’s own decisions
B. Right to self-determination
a. Right to self-determination: the right to protect one’s own body and to determine how it shall be
treated
• Informed consent, which is a basic tenet of ethical thought, was established in the courts as early as 1914 by
Justice Benjamin Cardozo
• Cardozo determined that every adult of sound mind has a right to protect his or her own body and to determine how it
shall be treated.
• Although the Cardozo decision was of considerable magnitude, governmental interest in the bioethical underpinnings of
human rights in the delivery of healthcare services did not really surface until after World War II.
• Over the years, legal authorities such as federal and state governments maintained a hands-off posture when it came to
issues of biomedical research or physician–patient relationships.
• However, human atrocities committed by the Nazis in the name of biomedical research during World War II shocked
the world into critical awareness of gross violations of human rights
1. AUTONOMY is derived from the Greek words auto (“self”) and nomos (“law”) and refers to the right of self-
determination. Laws have been enacted to protect the patient’s right to make choices independently
Patient Self-Determination Act (PSDA) requires, either at the time of hospital admission or prior to the initiation of care or
treatment in a community health setting, “that every individual receiving health care be informed in writing of the right under
state law to make decisions about his or her health care, including the right to refuse medical and surgical care and the right to
initiate advance”
• The nurse’s responsibility to ensure informed decision making by patients, which includes but is certainly not limited
to advance directives (e.g., living wills, durable power of attorney).
• Documentation of such instruction must appear in the patient record, which is the legal document validating that such
instruction took place.
• Another example of autonomy is the development and use of patient decision aid interventions that are designed to assist
patients in making informed treatment choices.
• These patient decision aids, which include printed materials, videos, and interactive web-based tutorials, provide patients
with information about specific health issues, diagnoses, treatment risks and benefits, and questionnaires to determine
whether they need more information.
While three of the four elements might be satisfied (for example, that the client is of sound mind, that sufficient information has
been provided to enable the client to make an informed decision, and that he or she has the capacity to fully understand the
information being explained) the client might still decide to reject the “treatment of choice.”
• This decision could be due to the exorbitant cost of a treatment or to certain personal or religious beliefs
• Whatever the case, it must be recognized by all concerned that a competent, informed client cannot be forced to accept
treatment as long as he or she is aware of the alternatives as well as the consequences of any decision
A final dimension of the legality of truth telling relates to the role of the nurse as expert witness.
Professional nurses who are recognized for their skill or expertise in a particular area of nursing practice may be called on to
testify in court on behalf of either the plaintiff (the one who initiates the litigation) or the defendant (the one being sued)
Regardless of the situation, the nurse must always tell the truth and the client (or his or her health proxy) is always entitled to
the truth.
3. Confidentiality refers to personal information that is entrusted and protected as privileged information via a social contact,
healthcare standard or code, or legal covenant.
As a consequence, the nurse may not disclose information acquired in a professional capacity from a patient without the consent
of the patient “unless the patient has been the victim or subject of a crime, the commission of which is the subject of legal
proceeding in which the nurse is a witness”
This discussion of confidentiality gives rise to the need to distinguish between the concepts of what is private, what is
privileged, and what is confidential.
The diagnosis of acquired immune deficiency syndrome (AIDS) readily lends itself to the clarification of these concepts. Despite
its communicability, the person with a diagnosis of AIDS is protected by laws promulgated by federal and various state
governments. Within this context, AIDS is considered to be private information.
It need not be disclosed in the workplace, the home, or other social settings. By federal mandate (and in some states), this
information is considered to be highly personal, the privacy of which is regarded as a fundamental right of the person.
AIDS is further considered to be privileged information. Such information is “owned” by the patient alone and is subject to
disclosure only at his or her individual discretion. Once this information is shared between the nurse and the client, it cannot be
shared with other health professionals unless authorized by the client.
The diagnosis of AIDS is also protected by law as confidential. Thus anyone not involved in a client’s care has no right to
private or privileged information regarding the health status of the client.
4. Nonmaleficence is defined as “do not harm” and refers to the ethics of legal determinations involving negligence and/or
malpractice
Negligence is define as “conduct which falls below the standard established by law for the protection of others against
unreasonable risk of harm”
Professional Negligence “involves the conduct of professionals that falls below a professional standard of due care”
Due care is “the kind of care healthcare professionals give patients when they treat then attentively and vigilantly so as to avoid
mistakes”.
For negligence to exist, there must be a duty between the injured party and the person whose actions (or nonactions)
caused the injury.
A breached of that duty must have occurred, it must have been the immediate cause of the injury, and the injured party must
have experienced damages from the injury.
Malpractice “refers to limited class of negligent activities committed within the scope of performance by those pursuing a
particular profession involving highly skilled and technical services”
Malpractice has been specifically defined as “negligence, misconduct, or breach of duty by a professional person that results in the
injury or damage to the patient”
Thus, malpractice is limited in scope to those whose life work requires special education and training as dictated by specific
educational standards.
In contrast, negligence refers to all improper and wrongful conduct by anyone arising out of any activity.
Adherence to these various professional performance criteria and principles, including adequate and current patient education,
speaks to the nurse’s commitment to acting in the best interest of the patient. Such behavior emphasizes patient welfare and
deemphasizes the provision of quality care under threat of litigation.
6. Justice speaks to fairness and equal distribution of goods and services. The
law is the “Justice System.”
• The focus of the law is the protection of society; the focus of health law is the protection of the consumer Decision
making for the fair distribution of resources includes the following criteria as define by Tong (2007):
1. To each, an equal share
2. To each, according to need
3. To each, according to effort
4. To each, according to contribution
5. To each, according to merit
6. To each, according to the ability to pay
These five criteria can assist the teacher in being fully honest with himself or herself regarding the appropriateness of
counselling the student and can serve as an extremely useful guide in uncertain situations.
Students are autonomous agents. If they choose to follow the prescribed course of study and are successful, they will develop
professional autonomy, attain their professional goals, achieve professional competence, and be equipped to develop
relationships with colleagues and patients.
Students are responsible for speaking up when they experience problems with or obstacles to their learning. Otherwise, their teachers
may make overly ambitious demands on and have unrealistic expectations for students in the learning process.
Just as students have the right to expect honesty from their teachers, so they have a reciprocal duty to be truthful – such as when they
have not done an assignment or prepared for a class activity or have made mistake.
Taking responsibility for one’s missteps as a student reveals the students commitment to honesty, the primacy of patient welfare and
trustworthiness.
Caring is not only essential for the physical and psychological well-being of the patients but caring also requires getting involved in a
network of relationships to meet patient’s needs.
Legal and Financial Implications of Documentation
• A Patient’s Bill of Rights
• Joint Commission (JC)
• State Regulations
•
Patient’s Bill of Rights
Financial Terminology
• Direct Costs
Fixed Costs
Variable Costs
• Indirect Costs
Hidden Costs
• Cost Savings, Cost Benefit, and Cost Recovery (Revenue Generation)
Direct Costs: those that are tangible and predictable, such as rent, food, heating, etc.
Fixed Costs: those that are stable and ongoing, such as salaries, mortgage, utilities, durable equipment, etc. Variable Costs:
those related to fluctuation in volume, program attendance, occupancy rates, etc.
Indirect Costs: those that may be fixed but not necessarily directly related to a particular activity, such as expenses of heating,
lighting, housekeeping, maintenance, etc.
Cost Savings: money realized through decreased use of costly services, shortened lengths of stay, or fewer complications
resulting from preventive services or patient education
Cost Benefit: occurs when the institution realizes an economic gain resulting from the educational program, such as a drop in
readmission rates
Cost Recovery: occurs when revenues generated are equal to or greater than expenditures
Revenue Generation: income earned that is above the costs of the programs offered
• Cost-Benefit Analysis: the relationship (ratio) between actual program costs and actual program benefits, as measured
in monetary terms, to determine if revenue generation was realized
• Cost-Effectiveness Analysis: refers to determining the economic value of an educational offering by making a comparison
between two or more programs, based on reliable measures of positive changes in the behaviors of participants as well as
evidence of maintenance of these behaviors, when a real monetary value cannot be assigned to the achievement of program
outcomes
Multiple Choice
1. Which of the following Ethical Principles refer to personal information that is entrusted and protected as privileged
information via a social contact, healthcare standard or code, or legal covenant.
A. Autonomy C. Confidentiality
B. Veracity D. Non-maleficence
RATIO: Private details that is confided and secured as privileged information by a social interaction, healthcare norm or code, or legal
covenant is referred to as confidentiality.
3. It is also known as “ truth telling” and is closely linked with informed decision making and informed consent.
A. Autonomy C. Confidentiality
B. Veracity D. Non-maleficence
RATIO: Veracity or truth telling, is closely linked with informed decision making and informed consent. A person's fundamental right
to make decisions regarding his or her own body is unalienable. This decision established a legal foundation for patient education or
instruction about invasive medical procedures, including the truth about the dangers and advantages of these procedures.
5. Which “refers to limited class of negligent activities committed within the scope of performance by those pursuing a particular
profession involving highly skilled and technical services”
A. Negligence C. Non-maleficence
B. Malpractice D. Justice
RATIO: Malpractice is defined as a "limited class of negligent acts committed within the scope of performance by those pursuing a
particular profession involving highly skilled and technical services by those pursuing a particular profession including highly skilled
and technical services."
7. Which documents define a profession and were developed to protect the public from unqualified practitioners and to protect
the professional’s title.
A. Ethics C. Legal rights and duties
B. Moral D. Practiced Acts
RATIO: Practice Acts define a profession and were intended to protect the public and the professional's title from unqualified
practitioners.
8. Which is an ethical belief system that stresses the importance of doing one’s duty and following the rules.
A. Morality C. Beneficence
B. Deontology D. Non maleficence
RATIO: Deontology is a combination of the Greek words deon, which means "duty," and logos, which means "science" or "study." It is
an ethical belief system that stresses the importance of doing one’s duty and following the rules.
9. Informed consent, which is a basic tenet of ethical thought, was established in the courts as early as 1914 by:
A. Immanuel Kant C. Justice Benjamin Cardozo
B. John Stuart Mill D. American Nurses Association
RATIO: Justice Benjamin Cardozo established informed consent as a basic tenet of ethical thought in the courts as early as 1914.
11. Money realized through decreased use of costly services, shortened lengths of stay, or fewer complications resulting from
preventive services or patient education
A. Cost Savings
B. Cost Benefit
C. Cost Recovery
D .Indirect Costs
RATIO: Cost Savings are the money realized through decreased use of costly services, shortened lengths of stay, or fewer
complications resulting from preventive services or patient education.
12. Those that may be fixed but not necessarily directly related to a particular activity, such as expenses of heating, lighting,
housekeeping, maintenance, etc.
A. Cost Savings
B. Cost Benefit
C. Cost Recovery
D. Indirect Costs
RATIO: Heating, lighting, housekeeping, maintenance, and etc., are examples of indirect costs that are fixed but not always directly tied
to a specific activity.
13. Occurs when revenues generated are equal to or greater than expenditures
A. Cost Savings
B. Cost Benefit
C. Cost Recovery
D. Indirect Costs
RATIO: When revenues generated equal or exceed expenditures, cost recovery occurs.
14. Those are stable and ongoing, such as salaries, mortgage, utilities, durable equipment, etc.
A. Fixed Costs
B. Cost-Benefit Analysis
C. Cost-Effectiveness Analysis
D. Variable Costs
RATIO: Fixed costs are those that are consistent and continuing, such as salaries, mortgages, utilities, durable equipment, and etc.
15. Those related to fluctuation in volume, program attendance, occupancy rates, etc.
A. Fixed Costs
B. Cost-Benefit Analysis
C. Cost-Effectiveness Analysis
D. Variable Costs
RATIO: Variable costs are those that are affected by changes in volume, program participation, occupancy rates, and so on.
You are done with the session! Let’s track your progress.
Ethics – guiding behavioral principles In this Session this topics was enumerated
Ethical – societal behavior standards and differentiated. Terms was defined and
Moral Values – internal belief system explained well. The modules also described
Legal Rights and Duties – rules governing behavior, enforceable by law and discussed how these terms important in
Practice acts – documents defining a profession nursing practice.
Evolution in Ethical and Legal Principles in Health Care
A. Informed Consent
B. Right to self-determination
Financial Terminology
Direct Costs
Fixed Costs
Variable Costs
Indirect Costs
Hidden Costs
Cost Savings, Cost Benefit, and Cost Recovery (Revenue Generation)