Introduction to Nursing Profession

(NURS 210)

Nursing: Ethical & Legal concepts

 Learning Outcomes

1. Explain how values, moral frameworks, and codes of ethics affect moral
decisions.
2. Discuss how nurses use knowledge of values to make ethical decisions
and to assist clients in clarifying their values.
3. Identify the ethical decision making process, and the strategies
necessary to enhance it, when presented with an ethical situation.
4. Describe ways nurse practice acts, credentialing, standards of care, and
agency policies and procedures affect the scope of nursing practice.
5. Describe the purpose and essential elements of informed consent.
6. Discriminate between negligence and professional negligence/
malpractice.
7. Discuss the legal responsibilities of nursing students.
What Do You Know
About Ethics
???
 Introduction

• Nurses' decisions and advocacy for client decisions

Need for:
 Sensitivity to ethical dimensions
 Awareness of nurse and client values
 Understand how values influence decisions
 Think about approaching moral problems/issues
 What is the meaning of “Ethics”?

• Ethics has several meanings.

– A method of inquiry that helps people to understand
the morality of human behavior
OR:
– Expected standards of moral behavior of a particular
group as described in the group's formal code of
professional ethics (e.g.: Nursing Ethics)
 What is the meaning of “Morality”?

• Morality
– Private, personal standards of what is right and wrong
in conduct, character, and attitude

Concerned with important values and norms-evoke words such as

good, bad, wrong, should, and ought
 Moral Frameworks

1. Consequence-based (teleological) theories

 Utilitarianism: “Utility”.
2. Principles-based (deontological) theories
3. Relationships-based (caring) theories
 Moral Frameworks (Cont.)

1. Consequence-based (teleological) theories:

look to the outcomes (consequences) of an action in judging
whether that action is right or wrong. They focus on issues of
fairness.
– Utilitarianism: views a good act as one that brings the
most good and the least harm to the greatest number of
people. This is called the principle of “Utility”.
 Moral Frameworks (Cont.)

2. Principles-based (deontological) theories:

• They emphasize individual rights, duties, and obligations.
• The morality of an action is determined by whether it is done
according to an fair, objective principle.

For example, following the rule “Do not lie,” a nurse might believe he or she
should tell the truth to a dying client.
 Moral Principles

Statements about broad, general, philosophic

concepts.

Importance:
1. Provide the basis for specific prescriptions for actions.
2. Useful in ethical discussions.
3. Serve as a basis for the solution acceptable to all parties
 Moral Principles

1. Autonomy: the right to make one’s own decisions.

 the nurse respects a client’s right to make decisions even when those choices
seem to the nurse not to be in the client’s best interest.

2. Nonmaleficence: is the duty to “do no harm.”

 Harm can mean intentionally causing harm, placing someone at risk of harm,
and unintentionally causing harm.

3. Beneficence: means “doing good.”

 Nurses are obligated to do good, that is, to implement actions that benefit
clients and their support persons.
 Moral Principles (Cont.)

4. Justice: is frequently referred to as fairness.

 Nurses often face decisions in which a sense of justice should prevail.

5. Fidelity: means to be faithful to agreements and promises.

 By virtue nurses, as professional caregivers, have responsibilities to clients,
employers, government, and society, as well as to themselves.
 Nurses often make promises such as “I’ll be right back with your pain
medication”.

6. Veracity: refers to telling the truth.

 Nursing Ethics

• Nowadays, it is mandatory to have “Ethics

committees” or similar structure

• Purpose of ethics committees

• To write guidelines and policies
• to provide education, counseling, and support on ethical
issues.
• Ensure that the relevant facts of a client’s case brought out
• Provide a forum to express diverse views, provide support for
caregivers, reduce institution's legal risks
 Figure 5–1 An ethics committee
contemplates all aspects of the case
being considered.
Ghislain & Marie David de
Lossy/Alamy.
 Nursing Code of Ethics

Defined as: “Formal statement of ideals and values”.

• It is a set of ethical principles that:

a) Is shared by members of the group,
b) Reflects common moral judgment over time
c) Serves as a standard for professional actions
d) Usually higher standard than legal standard

Nurses are responsible for being familiar with the code that
governs their practice.
 Purposes of
Nursing Code of Ethics

 Inform the public about the minimum standards of the profession

 Provide a sign of the profession's commitment to the public
 Help the public understand ethical considerations of professional
nursing
 Aid self-regulation among nurses
 Remind nurses of their special responsibilities in caring for the
sick
 Making Ethical Decisions

An important first step in ethical decision making is

to determine whether a moral situation exists.

 Set of criteria may be used to decide whether

there is a moral issue or not
 Criteria used to Make Ethical
Decisions

• Difficult choice exists between actions that conflict with needs of

one or more persons.
• Moral principles exist that can be used to provide some
justification for the action.
• The decision must be freely and consciously chosen.
• The choice is affected by personal feelings and by the particular
context of the situation.
• Whether there is “Moral distress” (i.e., Conflict between client's
interests and nurse's personal beliefs)
Figure: When there is a
need for ethical decisions
or client advocacy, many
different individuals
contribute to the final
outcome.

Photo Network/Alamy.
 Ethical Decision Making Process

1. Identify the moral aspects. (Using criteria determine whether a moral

situation exists).
2. Gather relevant facts that relate to the issue.
3. Determine ownership of the decision. (For example, for whom is the
decision being made? Who should decide and why?)
4. Clarify and apply personal values.
5. Identify ethical theories and principles.
6. Identify applicable laws or hospital policies.
 Ethical Decision Making Process (Cont.)

7. Use competent interdisciplinary resources.

8. Develop alternative actions and project their outcomes on the client
and family.
9. Apply nursing codes of ethics to help guide actions. (Codes of nursing
usually support autonomy and nursing advocacy.)
10.For each alternative action, identify the risk and seriousness of
consequences for the nurse. (Some employers may not support nursing
autonomy and advocacy in ethical situations.)
 Strategies to Enhance Ethical
Decisions and Practice

• Become aware of personal values and ethical aspects of nursing

• Be familiar with nursing code of ethics
• Seek continuing education to remain knowledgeable about
ethical issues in nursing
• Respect values, opinions, and responsibilities of other health
care professionals
• Participate in or establish ethics activities
• Serve on institutional ethics committees
 What Do You Know
About Legal Aspects
???
 Introduction

 It is important for nurses to know the basics of legal concepts,

because nurses are accountable for their professional judgments and
actions.
 Accountability is an essential concept of professional nursing
practice.
 Knowledge of laws that regulate and affect nursing practice is
needed for two reasons:
1. To ensure that the nurse’s decisions and actions are consistent with current
legal principles.
2. To protect the nurse from liability.
 REGULATION OF NURSING PRACTICE

• Protection of the public is the legal purpose for defining

the scope of nursing practice, licensing requirements,
and standards of care.
• Nurses who know and follow their nurse practice act and
standards of care provide safe, competent nursing care.
 Credentialing

• is the process of determining and maintaining competence in

nursing practice.
• The credentialing process is one way in which the nursing
profession maintains standards of practice and accountability for
the educational preparation of its members.
• Credentialing includes:
1. Licensure
2. Certification, and
3. Accreditation.
 LICENSURE
• A license: is a legal permit that a government agency
grants to individuals to engage in the practice of a
profession and to use a particular title.

• Nursing licensure is mandatory for all nurses.

 CERTIFICATION

• is the voluntary practice of validating that an individual

nurse has met minimum standards of nursing
competence in specialty areas such as maternal–child
health, pediatrics, mental health, gerontology, and school
nursing.

• Certification programs are conducted by specialty nursing

organizations.
 ACCREDITATION/APPROVAL OF BASIC NURSING
EDUCATION PROGRAMS

• As a legal requirement, and to ensure that schools preparing nurses

maintain minimum standards of education, nursing educational
programs must be either approved or accredited.
• Nursing programs can also choose to seek voluntary accreditation
from a private organization such as the Accreditation Commission for
Education in Nursing (ACEN)
• Maintaining voluntary accreditation is a means of informing the public
and prospective students that the nursing program has met certain
criteria.
 Standards of Care

• Standards of care are the skills and learning commonly

possessed by members of a profession
(Guido, 2014).
• These standards are used to evaluate the quality of care
nurses provide.
 SELECTED LEGAL ASPECTS OF NURSING
PRACTICE

1. Informed consent.
2. Delegation.
3. Violence, abuse, and negligence (Refer to Chapter).
4. Controlled substances (Refer to Chapter).
 SELECTED LEGAL ASPECTS OF NURSING PRACTICE
1. Informed consent

Informed consent is an agreement by a client to accept a

course of treatment or a procedure after being provided
complete information.

It includes:
a. The benefits and risks of treatment,
b. Alternatives to the treatment, and
c. prognosis if not treated by a health care provider.
 SELECTED LEGAL ASPECTS OF NURSING PRACTICE
1. Informed consent

Obtaining Informed consent for specific medical and surgical

treatments is the responsibility of the person who is going to
perform the procedure.

Generally this person is

the primary care provider (e.g., physician)
 SELECTED LEGAL ASPECTS OF NURSING PRACTICE
1. Informed consent

Informed consent has three major elements:

1. The consent must be given voluntarily (i.e., Client must not feel
coerced).
2. The consent must be given by a client or individual with the
capacity and competence to understand.
3. The client or individual must be given enough information to be
the ultimate decision maker.
 SELECTED LEGAL ASPECTS OF NURSING PRACTICE
1. Informed consent: EXCEPTIONS

Three groups of people cannot provide consent:

1. A minor, person 18 years or younger

2. The unconscious or person injured in such as way that they are
unable to consent
3. A mentally ill person judged by professionals to be incompetent
 Informed Consent: Nurse’s Role

• Nurse's Role
– Client gave consent voluntarily.
– Signature is authentic.
– Client appears competent to give consent.
– Client has right to refuse even after signing consent
form.
– Documentation important aspect
 Figure 4–3
Obtaining informed
consent is the
responsibility of the
individual
performing the
procedure. The
nurse may be asked
to witness the
client's signature on
the consent form.
 SELECTED LEGAL ASPECTS OF NURSING PRACTICE
2. Delegation

Delegation is:
“the process for a nurse to direct another person to perform nursing
tasks and activities”

Nurses must know not only their own scope of practice but also the
scope of practice of others (according to their job description & skill
level).
It is important to the nurse to know that the responsibility for action or
inaction on the part of the nurse or delegatee remains with the nurse.
 Difference between
Negligence and Malpractice

• Negligence: is misconduct or practice that is below the

standard expected of an ordinary, reasonable, and
prudent person. Such conduct places another person at
risk for harm.

• Gross negligence: involves extreme lack of knowledge,

skill, or decision making that the person clearly should
have known would put another person at risk for harm.
 Difference between
Negligence and Malpractice

• Malpractice: is negligence that occurred while the person

was performing as a professional.
• It applies to all professionals (i.e., physicians, dentists,
and generally includes nurses)
 Legal Responsibilities of Students

1. Responsible for own action and liable for their own acts of
negligence
2. Lower standards are not applied to nursing students
3. Function within scope of education, job description and nurse
practice act
4. Follow procedures and policies
5. Ask for additional help or supervision in situations they feel
inadequately prepared
6. If working as an aide, only perform tasks in job description, not
from nursing school.