Clinical Judgment,

Nursing Ethics & Law

NUR2349
 objectives
By the end of this module you should be able to:
•Discuss the rationale for evidence-based practice.
•Define evidence-based practice.
•Describe common ethical issues that might concern nurses
caring for their patients in different health care settings.
•Explain how the nursing process influences clinical
judgment while care for your patient across the lifespan.
Ethics in Nursing Practice
Overview

•Clinical ethics
•Ethical issues and dilemmas
Principles of Clinical Ethics

• Respect for autonomy

• Liberty
• Nonmaleficence
• Beneficence
• Justice
 Professional Ethics

• American Nurses Association (ANA) Code of Ethics

• Patient’s Bill of Rights
• Organizational ethics
 Nurse’s Role in Ethics

• Intermediary
• Moral distress
• Patient advocacy
 Confidentiality

• Health Insurance Portability and

Accountability Act (HIPAA)
 Advance Directives

• Elderly considerations
• Living will
• Durable power of attorney for health care
(DPAHC)
• Verbal advance directive
• Surrogate decision-maker
 Evidence-Based Practice (EBP)

• Knowledge bases for clinical decisions

• Definition
• Research evidence
• Clinical expertise
• Patient preference
• Sociopolitical forces in quality of care
Process of EBP
 Applying Evidence-Based Concept

• EBP
• Effectiveness of care improves when
research guides care
• EBP in nursing
• Process of moving research into practice
• Improves patient care
 Evidence-based Practice

•Star model
• Definition of knowledge transformation
• Underlying premises of knowledge
transformation
 Star Model
• Stages
• Point 1: Discovery
• Point 2: Evidence Summary
• Point 3: Translation
• Point 4: Integration
• Point 5: Evaluation
 Major Features of EBP

• Interdisciplinary
• Evidence summary
• Translation to clinical practice guidelines
• Provider and organizational factors guide integration
• Evaluation
 Major Features of EBP

Steps in conducting systematic review

• Formulate question
• Locate relevant studies
• Select and appraise studies
• Summarize and synthesize results
• Interpret findings
• Update regularly
 Major Features of EBP

• Review of literature
• Sources of evidence for clinical practice
• Sources of evidence summaries
• Clinical practice guidelines
• Priority health topics
Legal Aspects
 Laws
• Established to protect society
• Nursing practice guided by legal principles
• Purpose of laws
• Protect clients/society
• Define scope of nursing practice
• Identify minimum level of care to be
provided
 Federal Laws Guiding Nursing
Practice

• Bill of Rights
• Emergency Medical Treatment and Active Labor Act
• Americans With Disabilities Act
• Patient Self-Determination Act
• Health Insurance Portability and Accountability Act
(HIPAA)
 State Laws Guiding Nursing Practice

• Mandatory reporting laws • Nurse Practice Acts

• Communicable • Credentialing
disease
• Abuse • Licensing
• Good Samaritan laws • Discipline
• Differ by state
 Standards of Practice
•What a reasonable and prudent nurse would do in a
given situation
•Nurse Practice Acts (mandatory standards)
•Professional organizations (voluntary)
•Joint Commission
•ANA
•Institutional polices and procedures
•Nursing Codes of Ethics
•Patient Care Partnership
•ANA Bill of Rights for Nurses
 Criminal Law

• Federal or state government prosecutes

• Offense against society
• Can lead to a fine, imprisonment, or death
• Misdemeanor
• Minor crime; DUI
• Felony
• Homicide
 Civil Law

• Allows for resolution of dispute between

private parties
• May result in monetary compensation
• Plaintiff: person bringing suit
• Defendant: person being sued
 Types of Civil Law

• Contract law
• Dealing with agreements between individuals
• Explicit or implicit
• Tort law
• Dealing with duties and rights among individuals
• Involves claims for damages
 Torts and Nursing Practice

Quasi-Intentional Torts
Defamation
• False communication to a third person
Slander
• Oral defamatory statements
Libel
• Written defamatory statements
 Torts and Nursing Practice
Intentional Torts
Assault and battery
• Performing a procedure
without consent
False imprisonment
• Restraining a client against her/his will
Fraud
• Failing to provide essential information for informed consent
Invasion of privacy
• Breach of confidentiality
 Torts and Nursing Practice

Negligence

• Failure to perform as a reasonable, prudent

person would
• Failure to follow standards of practice
• No intent to harm is present
 Torts and Nursing Practice

Malpractice

• Professional form of negligence

• Four elements necessary to collect damages
• Existence of a duty
• Breach of the duty
• Causation
• Damages
 Common Malpractice Claims

• Failure to assess and

diagnose
• Failure to plan
• Failure to implement a plan
of care
• Failure to evaluate
 Minimizing Malpractice Risk

• Observe mandatory standards of care

• Use nursing process; follow professional
standards
• Avoid medication and treatment errors
• Report and document accurately
• Obtain informed consent
• Attend to client safety
 Minimizing Malpractice Risk

 Maintain client confidentiality

 Provide education and counseling
 Delegate, assign, and supervise properly
 Accept appropriate assignments
 Participate in continuing education
 Observe professional boundaries
 Observe mandatory reporting regulations
 Be aware of legal safeguards for nurses
 References:

Treas, L. S. & Wilkinson, J. M. (2014). Basic

nursing: Concepts, skills, & reasoning.