NURSING ETHICS

AND LAWS

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LAW
is the system of binding rules of
action or conduct that governs the
behavior of people in respect to
relationship with others and with
government (Guido, 2005)

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 BASIC FUNCTIONS OF LAW IN SOCIETY
 Define relationships among members of society
and to declare which actions are and are not
permitted
 Describe what constraints may be applied to
maintain rules, and by whom they may be
applied
 To furnish solution to problem
 Redefine relationships between people and
groups when circumstances of life change
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BASIC FUNCTIONS OF LAW IN SOCIETY
 Laws ensure the safety of citizens, protect property,
promote non discrimination, and regulate profession…..

 The law establishes rules that define our rights and

obligations, and sets penalties for people who violate
them
 Laws also describe how government will enforce the
rules and penalties

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RELATIONSHIP OF LAW WITH
ETHICS

 Laws reflect moral belief

 Convert morality into social guidelines
 Congruency exists between ethical and
legal issues; which is legal is also ethical
and vice versa (What do you think?)

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 WHY ETHICS & LAW DIFFER SOME TIMES
 Ethical point of view (deontology and
utilitarianism)
 Human behavior & motives are complex
than can be fairly reflected in law as in
moral development
 Law judges actions not motives
 Law changes (abortion, organ transplant)
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 DISTINCTION BETWEEN LAW
AND ETHICS
Concepts Law Ethics

Source External Internal

Concerns Conduct and Motive, attitude,

Actions culture
Interests Society Individual

Enforcements Courts Ethics Committee

and professional
organizations
SOURCES OF LAW:
Constitutional(Nigeria, USA)
Statutory /Legislative(Congress)
Administrative (NMCN)
Common law(Court rules)

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CONSTITUTIONAL
formal set of rules and principles that
describe power of government and
the rights of the people. The
principles laid out in a constitution,
coupled with a description of how
these principles are to be interpreted
and carried out
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Example: Bills of Rights
Citizen’s rights, freedom of speech,
maternity leave, freedom of religion(nurse
must be aware of Bills of Rights of the
country where she lives. constitution are
consistent with ethical principles of
autonomy, confidentiality, respect of
person and veracity)

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 STATUTORY/LEGISLATIVE
 A statute is a rule or formal regulation
established by governmental legislative
authority that appears in writing
 Violation of a statute is legally punishable
 It is published in codes and written down as
specific rules
 E.g., statutory recognition of nurses in advanced
practice (prescriptive authority), health care
legislation
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ADMINISTRATIVE
 The operation of governmental agencies,
national, state and local government set up
administrative agencies to do work of
government
 These agencies regulate such activities as
education, public health, profession
 E.g., state board of nursing or NMCN
 The role of board of nursing is to protect the
public rather than advocate for nurses
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COMMON LAW( CASE LAW)

 are constituting the basis of the judicial

system
 These are known as precedents, over time
take on the force of law
 In the common law, decision are based upon
earlier court ruling in similar cases

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TYPES OF LAW
 Public:Legal problems related to the
relationship between people and the
government

 Private:the problems occurring as a result of

relationships between people

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TYPES OF LAW
 Public law
Define person’s rights and obligations in relation to
government, describe division of government and their
power
 One branch of Public law is criminal law (deals with
crimes which are the actions that considered harmful to
society)

(Criminal law deals with felonies and misdemeanor)

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 Nurses can be accused of crime related to their actual
relationship with government, these include such actions
as falsifying narcotic records, failure to renew licenses

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CRIMINAL LAW
 Branch of public law that deals with crimes that is action
considered harmful to society

 Felonies are serious crimes, that carry significant fines and

jail sentence ( A nurse who unintentionally cause death of pt by
administrating a medication to which pt is allergic)

 Misdemeanor less serious crime, usually punishable by fine or

a short jail sentence or both (nurse slapping pt or given an
injection without consent)

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PRIVATE LAW (CIVIL
LAW)
Determine person’s legal rights and
obligations in many kinds of activities
that involve other people including
everything from borrowing to buying
a home

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 Sixbranches of private law:
• Contract and commercial law
• Tort law (a wrongful act, that
results in injury to another's person, property, reputation
for which the injured party is entitled to compensation)
• Property law
• Inheritance law
• Family law
• Corporation law
 Applicable to nursing practice: contract law and tort law

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CONTRACT LAW
 Deals with rights and obligations of people
who make a contract
 Contract is an agreement between two or more
people that can by enforced by law
 May be either written or oral
 In health care contract may be expressed or
implied

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Expressed contract occur when the two
parties agree explicitly to its terms as in
employment contract
Implied contract occur when there has
been no discussion between the parties,
but the law consider that contract exist
Nurse-patient relationship (implied
contract nurse agree to give competent
care)
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 TORT LAW
 Wrong or injury that person suffers because of
someone else’s action either intentional or
unintentional
 The tortuous action may:
• cause bodily harm
• invade another’s privacy
• damage a person’s property, business, or
reputation
• Make unauthorized use of a person’s property
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 Intentional tort: are willful or intentional acts
that violate another person’s rights or property

 Components:
 The act must be intended to interfere with
plaintiff or his property
 Must be intent to bring about the consequences
 There is no legal requirement that damages or
injury actually result from the act, proof of the
defendant’s intention is sufficient.

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• Intentional : (fraud, assault, invasive privacy,
false imprisonment, defamation(a false
accusation of an offense or a malicious
misrepresentation of someone's words or
actions), slander (The action or crime of making
a false spoken statement damaging to a person's
reputation), libel (A published false statement
that is damaging to a person's reputation; a
written defamation)

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 Many torts are unintentional; accident damage
 Unintentional torts occur when an act or
omission causes unintended injury or harm to
another person
 Most familiar with nurses, The most common
cause of an unintentional tort are:
Negligence
Malpractice

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 Negligence: The omission to do something
that a reasonable and prudent person would do,
or doing something which a reasonable person
would not do.
 E.g., The nurse who ignored that the patient
had nose bleed

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 Malpractice is a type or subset of negligence,
committed by a person in professional capacity

 Any professional misconduct, unreasonable lack of

professional skill or no adherence to the accepted
standard of care causes injury to pt.

 To be held liable for malpractice ,the nurse must fail to

act as other reasonable professional nurse who have the
same knowledge & education would have act under
similar circumstances

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MALPRACTICE…CONT
 Malpractice claims against nurses in studies:
• Inadequate communication with the doctor
• Inadequate nursing assessment
• Medication errors
• Inadequate nursing interventions
• Inadequate care/poor nursing care
• Unsafe environment
• Inadequate infection control
• Improper use of equipment/defective technology
• Failure to protect the patient from poor medical
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care
 Nurse has duty to assess and evaluate / held
liable
 Failure to record a plan of care/ evidence that
the nurse is negligent

 Implementation / beneficence / maintaining

expertise in practice & report dangerous
practice to others
 medication errors are examples of failure to
implement properly.
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Neglecting to remove foreign object like
spongy are left in pt body cavity

Nsg care focuses on person as a whole

( psycho-social-spiritual as physical /
failure to implement care in this area result
in Nsg malpractice) (intentional emotional
distress) e.g., announcing death for close
relative

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COMPONENTS REQUIRED TO
PROVE LIABILITY OF
MALPRACTICE
 Duty owed to the patient
 Breach of standards of care or failure to carry out duty

 Actual harm or injury suffered by the patient

 Causal relationship between the breach of standards of

care or duty and the injury

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 Nursesare responsible for safe and
appropriate administration of medication
regardless of physician order, or workload

 Pt
burns (heating pad) may also be
considered a failure to implement Nsg care

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 FRAUD

 Is deliberate deception for the purpose of

securing an unfair or unlawful gain
 Falsification of information on employment
application, untruthful billing procedure or
falsification of pt records to cover up an
error or avoid legal action

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Right to privacy: right to be left alone
or to be free from unwanted publicity

tort of invasion of privacy

 Intentional

occurs when person's privacy is invaded

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TYPES OF INVASION PRIVACY
 Intrusion on the pt’s physical and mental seclusion
( shutting out or keeping apart from society)
 Public disclosure of private facts

 Publicity that places the pt in a false light in the public

eye
 Appropriation of pt’s name or likeness for the
defendant’s advantage

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Assault: As unjustifiable attempt or threat
to touch person without consent that
result in fear of immediate harm
(touching need not actually occur)

 E.g.,If nurse threaten to give an

injection to a noncompliant adult pt
without consent

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Battery: is unlawful, harmful, unwarranted
touching of another or carrying physical harm
( battery includes any, angry, violent, or
negligent touching of a person's body or
clothes, or any thing held by or attached to the
person)

 E.g., touching without consent, slapping, pinching,

( surgical procedures that are performed without
informed consent ). Also when nurse ignores the
objections of the pt and performs an invasive
procedure
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False imprisonment :Is the unjustifiable detention of a
person within fixed boundaries or an act intended to
result in such confinement without consent and without
authority of law
 E.g., physical restraint of the person, locking pt in room,
detaining pt for payment of bills

Defamation: occurs when one harms person's reputation

and good name, diminishes others value or esteem.
 Defamation only occurs when the words are
communicated to third person

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 FORMS OF DEFAMATION
 Slander: occurs when one defames the reputation of
another by speaking unprivileged or false words.
 ( e.g., by voicing the opinion that pt is uncooperative,
unintelligent, or drug-seeking ,treated for something
while its wrong)

 Libel : consists of printed defamation by written words

and image that injure person's reputation or cause others
to avoid
 E.g. when writing information in pt chart that can be
damaging, judgmental, critical or speculative statement
such as “ the pt is drug-seeking” “the pt is rude”
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REDUCING RISK OF MALPRACTICE
 Maintain good communication
 Maintain expertise in practice

 Maintain autonomy & empowerment

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Maintain good communication by:
 Be courteous, show respect, and take time to
listen attentively.
 Do not make value judgments
 Involve pt in decision making
 Assess pt level of understanding
 Explain in language that pt can understand
 Clarify and verify telephone orders; whenever
possible, avoid accepting telephone orders or
giving advice over telephone.
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Maintain expertise in practice
 Keep up-to-date in both knowledge and skills.
 Do not attempt any task or give any medication
that is unfamiliar
 Be familiar with and follow institutional and
professional standards of care .
 Be attentive to pt changing health status
 Pay attention to details.
 Document objectively, thoroughly, and in timely
fashion

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Maintain autonomy & empowerment
 Questioning physician order (particularly those
by telephone)
 Seek attention for pt with changing heath status

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LIABILITY INSURANCE
 Is an important risk management strategy that
protects, assets and income affords nurses peace
of mind.
 Professional liability insurance provides for
payment of lawyer fees and settlement or jury
awards
 Claims-made policies: provide coverage only
in instances in which both injury and claim are
made during the time in who the policy is effect
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Occurrence –based policy: protect the
nurse when lawsuits are filled after the
policy has expired even when the policy
was not renewed

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 Malpractice policies offer coverage
exclusively for claims of malpractice

 Professional liability insurance offer protection

against various injuries that are not directly
related to malpractice

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 NURSES AS EXPERT WITNESSES
 Honest and give objective opinion to the court
 Involve a complete and extensive process of
examining evidence and reviewing pertinent
nursing literature, giving deposition and
testifying in the court
 Nurse should be familiar with All medical record
during incidence, pertained written policies and
procedure of institution, and nsg care plan
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 The witness must describe the standards of care
to the court.
 Evaluate the nurses actions against them
 Discuss conclusions relative to accusation of
malpractice
 Effectiveness of the expert witness is influenced
by breadth of experience, degree of preparation,
depth of knowledge and confident delivery

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 DISCRIMINATION & HARASSMENT
 Ethically &legally prohibited
 Civil bill of rights protect against work place
discrimination
 Ethical principle of Justice.
 Discrimination or unequal treatment in legislation,
administration
 Exploitation, taking advantage of another person
to gain unfairly
 Making false statement about people or their work
that aren’t fair 49
DISCRIMINATION

It can be
Racial
Disability
Sexual

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 HARASSMENT
 Sexual harassment is unwelcomed sexual
advance, requests for sexual favors and other
verbal, non verbal or physical conduct of sexual
nature
 Hostile work environment, Sexual
harassment ,abusive work environment

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CUES FOR RECOGNIZING HARASSMENT
 Invasion of space
 Lack of respect

 Deliberate nature of behavior

 Power

 Over friendly behavior

 Sexualized work place

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CAUSES OF LICENSE SUSPENSION
 Professional negligence

 Practicing nursing w/o a license

 Obtain license by fraud

 Felony convictions

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 CAUSES OF LICENSE SUSPENSION

Not reporting substandard medical or nursing

care
Providing patient care under the influence of
drugs/alcohol
Giving narcotics w/o order
Falsely portraying self to public or any HCP
as a nurse
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