Ethico-Legal in Nursing Leadership

The role of the professional nurse has expanded rapidly in terms of:
 Increased expertise
 Specialization
 Certifications
 Autonomy
 Accountability
 Independent Practice
This has forced nurse managers to increase awareness of the interaction of legal and ethical
principles. This protects the nurse as she performs her task and her patient who expects that
she gets the care she deserves.
 LAWS > are formal rules of conduct that the members comply with and recognize as
enforceable by a controlling body
 ETHICS > are a set of principles or values that govern the individuals’ actions in a
society
Philippine Nurses Association (PNA)
 has set the guidelines on the ethical practice of nurses when it promulgated the Code
of Ethics for Registered Nurses in its Board Resolution #220, Series of 2004
 It described the ethical principles that govern the relationship of the registered nurse
and people, their practice, co-workers, society, environment, and her profession.
Ethical Concerns Confronting Nurses
1. The confidentiality of records
2. The patient’s right to privacy
3. The patient’s right to information regarding medical procedures and their implications
4. The patient’s competent consent to treatment
5. The patient’s right to refuse treatment
6. The quality of service provided to severely disabled elderly or terminally ill patients
7. Termination of treatment
Ethical Principles
1. Autonomy – addresses personal freedom & the right to choose a course of action free
of correction. (Example: Informed Consent)
2. Beneficence- This states that the action one takes should promote a good outcome
3. Non-maleficence- It involves an ethical and legal duty to avoid harming others. It is
based on the Latin maxim, “Primum Non-Nocere” or “First Do No Harm”. This principle
involves areas of healthcare practice including treatment procedures and the rights of
patients.
4. Veracity- Truth should be told
5. Justice- Equal and fair treatment to everyone
6. Paternalism- Allows one to make decisions for another
7. Fidelity- Keeping one’s promises and commitments
8. Respect for others- This principle acknowledges the right of individuals to make
decisions and live them.

FOUR ASPECTS OF ETHICAL DECISION-MAKING

1. Clarifying the Problem
2. Describing the ethical considerations
3. Choosing a solution
4. Implementing and evaluating the choice through the development of an action plan

Guidelines for Ethical Decision-Making

1. Know your values
2. Do not allow your values to be compromised
3. Be familiar with the Code of Ethics for Nurses
4. Do not allow your nursing ethics to be compromised.
5. Do not force your personal values on others
6. Do not be disappointed when some people fail to meet your expectations
7. Remember that the client’s well-being & safety is your ethical responsibility
 ETHICAL CONFLICTS
1. Autonomy vs. Paternalism
Example: If a patient needs a technological therapy that the physicians view as
lifesaving but the patient views as unnatural and unbearable, he or she may make an
informed decision that the benefit does not outweigh the psychological and physical
costs
2. Justice vs. Utilitarianism
Justice demands the people to have an opportunity to obtain the healthcare they need
on an equitable basis. Utilitarianism states that the morally right thing to do is that act
that produces the greatest good (for the greatest number of people or society)
3. Veracity vs. Fidelity
The concept of veracity refers to truth-telling, honesty or integrity, the nurse, as a
professional, has an obligation to tell the truth. Fidelity is related to trust, or to
promises we make. Professional Nurses promise to care for a patient to the best of
their ability
4. Professional Integrity vs. Remaining True to one’s own ethical and moral beliefs
Conflicts between professional integrity and remaining true to one’s own ethical and
moral beliefs occur in various situations. Such conflicts might result in objecting to
delivering certain types of treatment or to caring for certain types of patients.

TECHNOLOGICAL CONCEPTS AND ETHICAL PRACTICE

 The use of technology yields benefits including enhanced communication and
symptom management.
 Use of technology for good (beneficence) shows outcomes ranging from better self-
management of illness to improved patient satisfaction in terms of access to
healthcare.
 Threats to human good include potential consequences if information received is
misunderstood, increased independence on technology, and lack of consistent
evidence demonstrating the effectiveness of ICT in health promotion
 If technology fails, or if privacy and confidentiality are breached, harm might occur
 Threats to autonomy may arise when users do not understand or give their informed
consent; Justice is threatened when similar technology is not available for everyone or
patient has limited ability to use it.
Ethical Considerations in Patient Care
Responsibilities:
* Nurses as moral agents, prevent harm to patients
* Nurses should seek the least harmful and least disruptive methods of ensuring patient
protection
* Nurses who are employed in institutions have a responsibility to make every effort to utilize
internal reporting mechanisms
* Nurses should seek to minimize harm to colleagues

Nursing Administrator/Manager Actions

* Promote a climate in which employees are encouraged to report those situations which may
affect the delivery of quality care.
* Identify practices which may cause to potential harm to the patient
* Establish mechanisms for reporting unethical or illegal practice
* Maintain confidentiality in appropriate circumstances
* Respond to situations which involve unacceptable practices
* Participate in the development of specific procedures for identifying unethical practice

Staff Nurse Action

* Identify & Confront those individuals whose clinical practice clearly represents danger
* Report to appropriate authority the individual whose unethical or unsafe practice has been
confronted without an acceptable solution
* Recognize the necessity of further reporting if problem is not resolved
* Participate in the development of specific procedures for identifying unethical practice.
LEGAL RESPONSIBILITY FOR PATIENT CARE
Philippine Nursing Act of 2002 RA.9173

Legally, nurses are required to perform their duties according to accepted standards and
within the scope of practice as contained in the Philippine Nursing Law

COMMON LIABILITIES THAT NURSES MAY INCUR

NEGLIGENCE
ommision or the commission of an act that a reasonably prudent person would or should not
do under normal circumstances.

ELEMENTS OF NEGLIGENCE:
1. duty 5. incompetence
2. breach 6. malpractice
3. causation
4. damages

RES IPSA LOQUITOR: The thing speaks for itself

3 conditions required to establish negligence under the doctrine:
1.) the injury would not have occurred normally unless someone was negligent
2.) the injury was caused by something within the exclusive control of the defendant
3.) the injured party did not contribute in any way to his own injury
RESPONDEAT SUPERIOR: Let the master answer for the acts of the subordinate

LIABILITY OF SUPERVISING NURSES

Supervising Nurses should likewise utilize competence with corresponding authority as the
basis for delegating responsibilities to subordinates.
LIABILITY OF NURSING ATTENDANTS
Nursing attendants perform selected nursing activities under the direct supervision of nurses
Their responsibilities usually pertain to routine long term care of patients.
If a nurse delegates her function to the nursing attendant and the latter commits a mistake,
the former will be held liable for the mistake
NURSE’S RESPONSIBILITY FOR PATIENT SAFETY
Nurses are responsible for providing self care both physically and psychologically.
Equipment, such as, stretchers, wheelchairs and beds should likewise promote an
environment conducive to recovery
EMERGENCY CARE
When a patient is brought to ER for treatment, it is implied that he/she is consenting to the
measures the physician deems necessary for his/her condition. Nurses should observe and
properly record the patient’s condition and the treatment he/she received.
CONSENT
Patients have the right to choose whether they desire medical care or not. A consent signed
by the patient should be obtained before beginning any treatment or care.
No consent is necessary for emergency cases where a patient’s life is at stake. However, this
should be properly witnessed and the doctor should make the necessary notation of the
chart.
THERAPEUTIC ORDERS
Should be legal, written, clear, timed and signed by the ordering physician. Signing an order is
the legal proof that such an order has been made. If the order is unclear, verify from the
ordering physician.
What is not charted has not been observed, nor administered nor done
Only in an extreme emergency and no other physician is available should a nurse receive
telephone orders.
CAUSES OF MALPRACTICE FOR NURSE MANAGERS AND NURSES
1. Delegation and Supervision
2. Staffing Issues
3. Consent
4. Emergency Care
5. Therapeutic Orders
To avoid legal problem, the nurse must be aware and conscious of observing the rights of the
patients at all times
1. Right to good health
2. Right to information and confidentiality
3. Right to privacy ex. visual and auditory
4. Right to withdraw consent without prejudice to care
5. Right to second opinion