Ethics and legal aspect of nursing

Mr Yogendra Mehta
Lecturer
TU IoM
• Introduction of Ethics
• ICN code of ethics
• Ethical principles
• Ethical issues and dilemmas
– Role conflict
– Euthanasia
– Termination of Life-Sustaining Treatment
– Confidentiality
– Care of client living with HIV/AIDS, Hepatitis
– Nurse Patient ratio
– Holistic concept of health care
– Different value system
• Ethical responsibilities of nurses
• Definition of law
• Types of law
• Legal Terminology
• Informed consent
• Liability
• Negligence
• MalPractices
• Defamation
• Assult
• Battery
• Bill
• Act
• Crime
• Tort
• Responsibility
• Accountability
• Clients right
• Consumer right
• Nurses bill of right
• Collective bargaining
• Regulation of nursing practice
– Health act of nepal
– Nepal nursing council
• Licensing
• Credentialing
– Nursing practice act
• Areas of potential liability in Nursing
– Crime
– Tort
– Negligence
– Malpractice
– Unprofessional conduct
• Legal protection for Nurses
– Good Samaritan Law
– Record Keeping
– Incident report
• Legal role, rights and responsibilities of Nurses
• A review of professional organizations
– NAN
– NNC
– ICN
 INTRODUCTION
• Laws are those rules made by humans which
regulate social conduct in a formally prescribed in
legally binding manner.
• Laws are based upon concerns for fairness and
justice.
• Laws prohibit extremes of behavior so that
individuals can live without fear for their person
or their property.
 INTRODUCTION
• As a nurse it has become an important necessity
to be aware of the legal aspects associated with
caring and helping people in the health industry
today

• The legal aspects of nursing are taught and

expected to be kept up on throughout every
nurse's career.
 Types of law
1. Public Law
• Constitutional Law
• Administrative Law
• Criminal Law
2. Civil Law
• Contracts
• Torts
• Protective Reporting Law
 1. Public Law
• One type of law is Public Law which deals with
an individual’s relationship to the state.

• Sources include Constitutional, Administrative

and Criminal.
• These Sources occur on both the Federal and
State level.
 Constitutional Law
• Set of basic laws that defines and limits the
powers of government.
• Constitutional Rights, Civil Rights, State
Constitution.
 Administrative Law
• Developed by groups who are appointed to
governmental administrative agencies. Food,
Drug and Cosmetic Act; Social Security Act;
Nurse Practice Act.
 Criminal Law
• Acts or offences against the welfare or safety
of the public. Controlled Substance Act;
Criminal Codes.
 2. Civil Law
The second type of law is Civil Law which deals
with crimes against a person or persons in
such legal matters as:
• Contracts
• Torts
• Protective Reporting Law
 Contract Law
• It is the enforcement of agreements among
private individuals and payment of
compensation for failure to fulfill the
agreement. Employment Contracts is an
example of contract law under civil law
 TORT LAW
• It is a legal wrong committed against a
person, his or her rights or property,
intentionally or willfully committed
without just cause.
 Tort Law
2 kinds of torts:
Unintentional negligence and malpractice
(Malpractice is professional negligence)
Intentional – assault and battery, invasion of
privacy, false imprisonment, Defamation,
Fraud
 Examples of Tort Law include:
• Negligence and Malpractice
• Assault and Battery
• False Imprisonment
• Invasion of Privacy
• Defamation
• Fraud
 Protective Reporting Law
• Protective/Reporting Laws are sometimes
considered criminal laws based on state
classification.
Client right
 Consumer Right
Patient Rights Under The Consumer Protection Act:
• Right to be protected from hazardous goods and
services.
• Right to be informed about the quality and
performance of goods and services.
• Right to free from choice of goods and services.
• Right to be heard in decision making process
concerning consumer interests.
• Right to consumer education.
 Nurses Bill of right
• Nurses have the right to practice in a manner that
fulfills their obligations to society and to those who
receive nursing care. 
• Nurses have the right to practice in environments
that allow them to act in accordance with
professional standards and legally authorized
scopes of practice. 
• Nurses have the right to a work in an environment
that supports and facilitates ethical practice, in
accordance with the Code of Ethics for Nurses. 
 Nurses Bill of right
• Nurses have the right to freely and openly advocate
for themselves and their patients, without fear of
retribution. 
• Nurses have the right to fair compensation for their
work, consistent with their knowledge, experience
and professional responsibilities. 
• Nurses have the right to a work environment that is
safe for themselves and for their patients.
• Nurses have the right to negotiate the conditions of
their employment, either as individuals or collectively,
in all practice settings.
Collective Bargaining
 LEGAL TERMINOLOGIES
• Informed Consent: It is an agreement by a
client to accept a course of treatment and
procedure after complete information,
including the risks of treatment and facts
relating to it, has been provided by the
physician.
• Liability: Quality or state of being legally
responsible for one's obligations and actions
and to make financial restitution for wrongful
acts.
 LEGAL TERMINOLOGIES
• Negligence: is a

• Malpractice:.
 LEGAL TERMINOLOGIES
• Defamation: A false statement either spoken or
written, or is published or intended to be read
by others, which can cause harm to a person's
reputation is called defamation. If a statement is
published it is libel and if the statement is
spoken, it is slander.
• Defamation (slander): Something untrue was
said to ruin (damage) the reputation of a
person.
• Defamation (Libel): Something untrue was
written to ruin the reputation of a person.
 LEGAL TERMINOLOGIES
• ASSAULT is a mental or physical threat;
knowingly threatening or attempting to do
violence to another without touching the
person e.g. forcing a medication on a
person who does not want it.

• BATTERY is the touching or wounding a

person in an offensive manner with or
without intent to do harm.
 LEGAL TERMINOLOGIES
• Bill: A draft of a proposed law which has
been presented before a legislative body for
approval. An approved bill is enacted as law.
• Act: T.
• Crime:
• Tort:
 LEGAL TERMINOLOGIES
• Accountability: answerable for one own
actions
• Responsibility: dependable role
performance
 FUNCTIONS OF LAW IN NURSING
1. It provides a framework for establishing which
nursing actions in the care of client are legal.
2. It differentiates the nurse's responsibilities from
those of other health professional.
3. It helps establish the boundaries of independent
nursing action.
4. It assists in maintaining a standard of nursing
practice by making nurses accountable under the
law.
REGULATION OF
NURSING PRACTICE
Health Act of Nepal
 CREDENTIALING

• Process of determining and maintaining

competence in nursing practice.
• one way in which the nursing profession
maintains standard of practice and
accountability for the educational preparation
of its members is credentialing which includes
licensure registration certification and
accreditation.
LICENSURE
 LICENSURE
• Is a legal permit that a government agency grants to
individuals to engage in the practice of a profession & to use
a particular title.
• Nursing Licensure is mandatory.

For a profession or occupation to obtain the right to license

its members, it generally must meet
3 criteria:
• There is a need to protect the public’s safety or welfare
• The occupation is clearly delineated as a separate, distinct
area of work.
• There is a proper authority to assume the obligations of the
licensing process e.g. board of nursing.
Grounds for Revocation of license
• Incompetent nursing practice
• Professional misconduct
• Conviction to a crime
 
 REGISTRATION
• Registration is the listing of an individual’s
name and other information on the official
roster of a government or non-governmental
agency.
Nurses who are registered are permitted to use
the title Registered Nurse.
Nurse must appear and pass the exam according to
country and state board of nursing
 NURSE PRACTICE ACT
• These are the laws in the each state that are
instrumental in defining the scope of nursing
practice and also protect public health, safety
and welfare.
• It controls the nursing practice through
licensing.
• Most important piece of legislation related to
nursing practice.
Area of potential liability in
nursing
• Crime is an act committed in violation of public
law and punishable by a fine or imprisonment
 Neglect
 Abortions
 Death and related issues
 Sexual harassments
– Crime
– Tort
– Negligence
– Malpractice
– Unprofessional conduct
EXAMPLES OF TORT LAW INCLUDE:

• Malpractice refers to the behavior of a

professional person’s wrongful conduct,
improper discharge of professional duties, or
failure to meet the standards of acceptable
care which result in harm to another person.

• Negligence (breach of duty) is the failure of an

individual to provide care that a reasonable
person would ordinarily use in a similar
circumstance
• In order to prove that negligence or malpractice
has occurred, circumstances must be present &
must be proven in a court of law these are:
• Harm must have occurred to the individual
• One person must be in a situation where he had
duty towards the person harmed
• The person must be found to have failed to
fulfill his/her duties
• The harm must be shown to have been caused
by the breach of duty.
 LEGAL NEGLIGENCE OF NURSE
• Failure to use equipment in a responsible manner.
• Failure to assess and monitor and failure to
communicate .
• Failure to document .
• Failure to act as a patient advocate.
 LEGAL MALPRACTICE IN NURSING

• Delegation.
• Early discharge .
• Nursing shortage.
• Advances in technology .
• Increased autonomy and responsibility.
• Better-informed consumers .
• Expanded legal definitions of liability.
• Unprofessional Misconduct
LEGAL PROTECTION IN NURSING

• Nurses are protected from some laws,

activities and principles by legal charge
such as good Samaritan laws.
 GOOD SAMARITAN LAWS
• It protects health professionals from claims of
malpractice when they provide assistance at
the scene of an emergency, provided that there
is no willful wrong doing or gross departure
from normal standards of care.
• Its purpose is to keep people from being
reluctant to help a stranger in need for fear of
legal repercussion if they were to make some
mistake in treatment.
• RECORD KEEPING.
The client’s medical record is a legal
document and can be produced in court
as evidence
 INCIDENT REPORT
• Incident report is an agency record of an
accident or incident.

• This report is used to make all the facts

about an accident available to agency
personnel. Incident are reviewed by an
agency committee, decides whether to
investigate the incident further.
SELECTED LEGAL ASPECT OF NURSING

• Nurse face legal issue daily.

• Issues in connection to Negligence,
administrating medication and advocating for
the patient.
• The nurse practice act lists all of the duties and
roles of a nurse except the legal and ethical
roles.
• If these duties are not followed, the nurse is at
risk of losing his license and facing a
malpractice suit
 INFORMED CONSENT
• It is an agreement by a client to accept a course
of treatment and procedure after complete
information, including the risks of treatment and
facts relating to it, has been provided by the
physician.
• It is a phrase often used in law to indicate the
consent a person gives.
EXAMPLES admission agreement, BT consent,
surgical consent, research consent, special
consent like autopsy, organ donation,
photography, restraints
• Major elements of Informed consent
 It must be voluntarily
 Must be given by an individual with the
capacity and competence to understand.
 The client must be given enough
information to the ultimate decision
maker
 RESPONSIBILITIES OF NURSES DURING CONSENT

• Witnessing the exchange between the client

and the physician.
• Establishing that the client really did
understand, that is, was really informed.
• Witnessing the client's signature
 DELEGATION
• Delegation is the assignment of the authority
and responsibility to another person.
• However the accountability is still held by the
person who delegated work.
• It should be according to scope of practice and
agency policy.
 VIOLENCE
• It is the expression of physical or verbal force
against self or others .
• Worldwide it is an important area of concern
for law and culture which attempts to
suppress and stop it.
 ABUSE
• It is an improper usage or treatment for bad
purpose often to unfairly or improperly gain
benefit .
• It can come in many forms e.g physical or
verbal maltreatment, injury, sexual assault,
rape, wrongful practice or custom.
Legal role, rights and responsibilities of Nurses
• Practice in accordance with standards of the profession.
• Practice within the scope of professional practice after
obtaining license.
– Independent interventions: Nurse initiated actions based on the
nurse's body of knowledge and scope of practice that do not
require a physician's order (e.g. teaching, assessment, meeting
hygienic needs).
– Dependent interventions: Physician initiated interventions or
physician established protocols that require specific nursing
responsibilities and technical knowledge (e.g. administration of
medications, tube feedings, and dressing changes).
– Collaborative interventions: Actions the nurse performs that
require interaction and coordination with other health
 Legal role, rights and responsibilities of
Nurses
• Intervene to protect clients from incorrect, unethical/illegal actions by
any person delivering health care.
• Participate in and promote the growth of the profession and own
competence.
• Report any suspected child abuse to the appropriate authority, this
reporting is mandatory.
• Code of ethics guides professional practice and reflects moral values of
the group. (e.g. American nurses association (ANA) code of ethics for
nurses).
• Code of ethics is broader and more universal than laws but cannot
override laws.
• Ethical issues become legal issues through court case decisions or
legislative enactment.
• Obtain professional liability insurance.
LEGAL RESPONSIBILITIES IN NURSING

Common-Sense precautions
• Follow accepted procedures. Protect from
possible lawsuits by always performing
procedures as taught and as outlined in
the procedure manual of healthcare
facility. If these policies are incorrect or
inadequate, work to improve them
through the proper channels.
 Contd………………….
Be competent in practice
• Always responsible for own behaviour. Refuse
to perform procedures for which have not
been prepared.
• Neither will lack of sleep or overwork be
accepted as a legal reason for carelessness
about safety measures or mistakes.
 Contd………………….
Ask for Assistance
• Always ask for help if unsure about how to
perform a procedure. Do not assume
responsibilities beyond those of level.
Admitting that do not know how to perform a
procedure is always better than attempting to
do it and injuring someone. Also question any
physician’s order that do not understand,
cannot read, or an error exists.
 Contd………………….
Document well
• The health record is the written and legal
evidence of treatment. The record is to
reflect facts only, not personal judgments.
Careful and accurate documentation is
vital for each client’s welfare.
• Careful documentation is perhaps the
most important thing can do to protect
against an unjustified lawsuit.
 Contd………………….
Do not give legal advice to clients
• The laws governing personal and property
rights of an individual are many and complex.
Never attempt to advise a client on legal rights
or financial matters. Encourage clients to
confer their families and to consult an
attorney.
 Contd……
Do not accept gifts
• Accepting gifts from the client is unwise for several
reasons. Some clients are considered vulnerable adults
(e.g., mentally ill, retarded, or confused individuals)
exchange of gifts could compromise professional
position, and could be accused of coercing the client.
 
THANK YOU!!!!