LEGAL AND ETHICAL ISSUES

Introduction
Many key legal concepts are important for nurses to understand. As
nursing practice evolves, these fluid concepts are refined and changed.
The legal concepts are apply to all areas of nursing practice and are not
restricted to any specific segment.
Safe nursing practice includes an understanding of the legal boundaries
with in which nurse practice. As with all aspects of nursing, an
understanding of the implications of the law supports critical thinking on
the nurse part. Nurses need to understand the law to protect themselves
from liability and to protect their clients rights.
ETHICAL COMMITTEE
Hospital Ethics Committee
Introduction
Most Indian hospitals have instituted such a committee principally for the
purpose of checking whether proposals submitted for research meet
established guidelines. Once this has been established, the researcher is
permitted to proceed with his work and the committee turns to
subsequent proposals. This approach makes a very limited usage of the
personnel recruited on such a committee. Much more can be done to
improve not only the quality of research undertaken by the institution but
also the care of patients in the institution.
Mission statement of the committee
The committee must start with an open statement on its aims and
objectives. These should be circulated throughout the institution and
feedback sought on how this can be improved. It is also necessary to
review this mission statement periodically and revise it when necessary.
The following could form the heads under which details can be entered:
Care of the patient in this institution.
Research.
Education of the staff on biomedical ethics.
Functions of the committee

At the helm, there must be at least two senior persons complementing

and supplementing each other. They should, preferably, belong to
different disciplines.

Members of the committee

The obvious answer is anyone with a deep commitment to medical
ethics. It is important not to skew membership by having several persons
from the same discipline. It is also essential to ensure representatives of:
Administration
Clinicians - medical, surgical, other disciplines
Basic sciences
Social workers
Nurses
Rehabilitation personnel
Priests/philosophers
Lawyers
Statisticians
Frequency of meetings
This will depend on the goals set for the committee. If the committee is
only to restrict itself to processing applications for research, the number
of such proposals will govern the dates on which meetings are to be held.
Most ethics committees meet at least once a month in order to ensure
that no research proposal is held up at the level of the committee. Each
member must attend at least 75% of all meetings.

INSTITUTIONAL ETHICS COMMITTEE

The need for Institutional Ethics Committee (IECs) in medical and
research establishments resulted from the realization that affirms human
rights as a prerogative of all members of society. Individual physicians
and research workers may not be able to do what is right in all instances
as evidenced by the number of cases on record.
Institutional ethics committees vary widely in their composition, usually
in an attempt to assure a broad based multi-disciplinary membership. In
addition to those with research and clinical experience, many committees

include representation from Pastoral Care, Social Work, and Law

backgrounds, and often a member with a more academic orientation.
Moreover, most committees find it important to include individuals from
the lay community to help provide a patient's and public perspective.
The present medical and research scene in India is rather chaotic and
irregular and therefore vulnerable to unethical practices. With
globalization and shift of research focus from the developed countries to
developing countries, the protection of vulnerable populations in
countries like India is of utmost importance and urgency. The apex
medical and research bodies at best have played a passive role till
recently on ethical issues by not making a strong enough stand in public
and not being persuasive enough to motivate all institutions to establish
ethics committees.
The Indian Council of Medical Research (ICMR) has published
detailed guidelines on the composition and responsibilities of IECs and
established ethical guidelines for biomedical research on human subjects
(Published in 2006). A survey of existing IECs of various institutions in the
country was initiated recently by the ICMR. Unfortunately this effort
received a very unenthusiastic response. This sorry situation reflects an
inadequate form of control and governance in the practice of medicine
and research because the overseeing institutions are not given the
necessary authority to take action against offenders, and society as a
whole has not established a sensitive and interactive approach to the
whole question of unethical practices.
Some Specific roles the IECs can play are the following
1. Be available through the member secretary for clarifying ethical
problems that may arise from the project and detail the ethical problem
for the IEC to debate.
2. Make sure that "informed consent "has been properly obtained. There
is a general belief among doctors and research workers that patients
belonging to the lower socio-economic group are pretty illiterate about
medical matters and therefore need not be told much about their
diagnosis, management or prognosis or why a certain quantity of blood or

other specimens are being collected. The findings of a survey are totally
at variance with this observation.
3. Multi-center trials require a uniform protocol and a unified assessment
system. There should be unlimited cross talk between IECs of institutions
involved.
4. Periodic follow up should be made by the IEC after an institutional
project has been sanctioned.
5. Use of laboratory animals in research - additional inputs from
physiologist, pharmacologists and pathologists should be sought by the
IEC or a separate committee should be available.
6. Informed consent obtained from volunteers who are to participate in a
field trial must be meticulously executed. The dangers if any spelt out,
what legitimate safeguards as opposed to enticements can be offered?
What sort of compensation will be offered if something goes wrong, how
will confidentially be maintained , can be biological samples obtained
from the person be sent to other laboratories in India and abroad? And
the proper disposal of biological samples.
7. Clinical trials of drugs or therapy conducted by clinicians /research
workers attached to this institution and a collaborating one, should not
only be assessed by the IEC ,but it should have a say in the quantum of
largesse offered for the person's services and the final report should be
made available to the IEC before it is submitted to the sponsoring agency.
The ethics committee minutes of the collaborating institution should be
available with the institutional PI.
8. Stem cell research. Experts and details mandatory.

CODE OF ETHICS
INTRODUCTION
Health care delivery system has undergone notable changes during the
last few decades, including increased client participation, shorter hospital
stays and restructuring services to provide care in settings such as
outpatient clinics, short-stay units and long-term care and in home-care.
For nurses, these changes have contributed to the development of new
clinical environment and expanded practice. Nurses today frequently
encounter difficult situations involving decisions about the best course of
are action. Nurses are obligated to provide ethical and legal client care
that demonstrates respect for others. Both fundamental principles of

health care ethics and laws governing the scope of nursing guide nursing
practice in all situations.

CODE OF ETHICS
Code - A code may be defined as conventionalized set of rules or
expectations devised for a specific purpose.
Ethics-Word ethics is derived from the word Ethos. It is a Greek word
and meaning of this word is customs, character or conduct. It may be
related to a person or a profession or a professional body. When we study
beliefs and assumptions it is moral philosophy and principles of morality
tell us how human beings should behave with each other.
Ethics is the branch of philosophy that examines the difference between
right and wrong. Ethics are meant for holistic development of a
professional.
The term refers to the consideration of standards of conduct or the study
of philosophical ideals of right and wrong behaviour.
-American Heritage Dictionary, 2007
Code of Ethics-A specific set of professional behaviours and values the
professional interpreter must know and must abide by, including
confidentiality, accuracy, privacy, integrity.
What professionals ought or ought not to do, how they ought to comport
themselves, what they, or the profession as a whole, ought to aim at.
-Litchenberg 1996
An ethical code is adopted by an organization in an attempt to assist
those in the organization called upon to make a decision (usually most, if
not all) understand the difference between 'right' and 'wrong' and to
apply this understanding to their decision.
TYPES OF ETHICS
The code of ethics links to and gives rise to a code of conduct for
employees.
1. Employee Ethics
2. Professional Ethics
A code of ethics often focuses on social issues. It may set out general
principles about an organization's beliefs on matters such as mission,
quality, privacy or the environment. It may delineate proper procedures

to determine whether a violation of the code of ethics has occurred and if

so, what remedies should be imposed. The effectiveness of such codes of
ethics depends on the extent to which management supports them with
sanctions and rewards. Violations of a private organization's code of
ethics usually can subject the violator to the organizations remedies. The
code of ethics links to and gives rise to a code of conduct for employees.
1. Code of practice (professional ethics)
A code of practice is adopted by a profession or by a governmental or
non-governmental organization to regulate that profession. A code of
practice may be styled as a code of professional responsibility,
which will discuss difficult issues, difficult decisions that will often
need to be made and provide a clear account of what behaviour is
considered "ethical" or "correct" or "right" in the circumstances. In a
membership context, failure to comply with a code of practice can
result in expulsion from the professional organization.
2. Code of conduct (employee ethics)
A code of conduct is a document designed to influence the behaviour
of employees. They set out the procedures to be used in specific
ethical situations, such as conflicts of interest or the acceptance of
gifts and delineate the procedures to determine whether a violation of
the code of ethics occurred and, if so, what remedies should be
imposed. The effectiveness of such codes of ethics depends on the
extent to which management supports them with sanctions and
rewards. Violations of a code of conduct may subject the violator to the
organization's remedies which can under particular circumstances
result in the termination of employment.
CODE OF ETHICS FOR NURSES
Ethics gives the professionals various guidelines that how should they
behave with each other, with the public and with governments. These are
guideline which the professional should follow when they are dealing with
their clients or patients. Ethics also tell the public that what they can
expect from a professional and tells the professionals that what the public
expects from them. Ethics are needed for every profession so that
nobility and respect of that profession remains undiminished.
Nursing ethics refers to ethical issues that occur in nursing
practice
Nursing is a great profession, giving a healing touch to patients along
with taking care of their diseases and maintaining their health. This

profession is held in high esteem but this esteem varies in different

countries. This difference is not without reasons. In some countries the
associations of nurses have their own code of ethics. These associations
lay stress on the following of ethical codes. Strict following of the codes in
some countries leads to credibility of that profession and esteem of that
profession rises automatically. This leads us to believe that there is no
alternative to following of the codes of ethics. Ethics are needed both for
the nurses as well as the nursing students. For nurses in India the Indian
Nursing Council (INC) has laid down code of ethics and professional
conduct.
CODE OF ETHICS AND PROFESSIONAL CONDUCT (INC)
INTRODUCTION
The code of professional conduct for nurses is critical for building
professionalism and accountability. Ethical considerations are vital in any
area dealing with human beings because they represent values, rights
and relationships. The nurse must have professional competence,
responsibility and accountability with moral obligations. Nurse is obliged
to provide services even if it is in conflict with her/his personal beliefs and
values.
PURPOSE
The purpose of professional conduct is to inform both the nurse and the
society of the minimum standard for professional conduct. It provides
regulatory bodies a basis for decisions regarding standards of
professional conduct.
The code of ethics helps to protect the rights of individuals, families and
community and also the rights of the Nurse.
THE USE OF THE CODE
Acknowledges the rightful place of Individuals in health care delivery
system.
Contributes towards empowerment of individuals to become
responsible for their health and well-being.
Contributes to quality care.
Identifies obligations in practice, research and relationships.
Informs the individuals, families, community and other professionals
about expectations of a nurse.

CODE OF ETHICS AND PROFESSIONAL CONDUCT (INDIAN

NURSING COUNCIL)
KEY WORDS
a. Assurance: A promise that you will definitely do something
b. Health: A state of dynamic balance of an individuals ability to
perform personally
c. Valued roles and responsibilities, to deal and cope with physical,
biological, psychological and social stresses and challenges
throughout the life while continuing to maintain a sense of wellbeing.
d. Nurse: Nurse is a person who has completed prescribed course in
Nursing from an institution recognized by Indian Nursing Council and
registered herself/himself under the State Nursing council as Nurse
and midwife.
e. Nursing: Nursing is a professional service for enabling a person to
maintain and sustain health and wellbeing.
f. Performance criteria: Selected behaviours which illustrate how
the standard is achieved.
g. Practice standards: Set of Activities expected from professional
group of workers.
h. Personal etiquettes: Being polite & soft spoken, honest, sincere,
cheerful, dignified, affectionate, compassionate and courteous.
i. Professional etiquettes: Being attentive listener, keen observer,
objective, non-judgmental, empathetic, confident, assertive,
disciplined, prompt and efficient.
j. Professional body or Regulatory body: Indian Nursing Council /
State Nursing Council is statutory body which regulates the Nursing
Education and practice in India.
k. Professional Worker: A person who confirms to a level of practice
that is expert and ethical after completing an authorized educational
programme.
l. Provider: Same as nurse
m.
Quality Nursing Practice: Quality of nursing practice is
achieved when organizations processes and activities are designed
and implemented to meet the needs and expectations of the
receiver on a competent, consistent and continuous basis.
n. Quality Assurance in Nursing: Quality Assurance is a program for
formal guarantee for provision of quality nursing care against set
standards.
o. Rationale: Reasoning for the standards.

p. Receiver: Receiver(s) refer to those individual persons/ families/

groups/communities who are in need of assistance from Nurse to
maintain and sustain their health and well-being.
q. Standards: Level of performance required for obtaining a specified
desired outcome.
r. Vulnerable: vulnerable persons are those who are disadvantaged
due to physical, emotional and social and economic reasons. For
example
Mentally and physically challenged person.
Emotionally traumatized persons.
Women, children, marginalized groups.
s. Well Being: It is an active state of a person with maximum
potential by maintaining balance and is at peace with inner and
outer world.
CODE OF ETHICS FOR NURSES IN INDIA (INC)
1. The nurse respects the uniqueness of individual in provision of
care
Nurse
1.1 Provides care for individuals without consideration of caste,
creed, religion, culture, ethnicity, gender, socio-economic and
political status, personal attributes, or any other grounds
1.2 Individualizes the care considering the care considering the
beliefs, values and cultural sensitivities.
1.3 Appreciates the place of the individual in family and
community and facilitates participation of significant others in the
care.
1.4 Develops and promotes trustful relationship with individual(s).
1.5 Recognizes uniqueness of response of individuals to
interventions and adapts accordingly.
2. The nurse respects the rights of individuals as partner in care
and helps in making informed choices
Nurse
2.1 Appreciates individuals right to make decisions about their
care and therefore gives adequate and accurate information for
enabling them to make informed choices.
2.2 Respects the decisions made by individual (s) regarding their
care
2.3 Protects public from misinformation and misinterpretations.
2.4
Advocates
special
provisions
to
protect
vulnerable
individuals/groups.

3. The nurse respects individuals right to privacy, maintains

confidentiality, and shares information judiciously
Nurse
3.1 Respects the individuals right to privacy of their personal
information.
3.2 Maintains confidentiality of privileged information except in life
threatening situations and uses discretion in sharing information.
3.3 Takes informed consent and maintains anonymity when
information is required for quality assurance/academic/legal
reasons.
3.4 Limits the access to all personal records written and
computerized to authorized persons only.
4. Nurse maintains competence in order to render Quality
Nursing Care
Nurse
4.1 Nursing care must be provided only by registered nurse.
4.2 Nurse strives to maintain quality nursing care and upholds the
standards of care.
4.3 Nurse values continuing education, initiates and utilizes all
opportunities for self development.
4.4 Nurse values research as a means of development of
nursing profession and participates in nursing research adhering
to ethical principles.
5. The nurse is obliged to practice within the framework of
ethical, professional and legal boundaries
Nurse
5.1 Adheres to code of ethics and code of professional
conduct for nurses in India developed by Indian Nursing council.
5.2 Familiarizes with relevant laws and practices in accordance with
the law of the state.
6. Nurse is obliged to work harmoniously with the members of
the health team.
Nurse
6.1 Appreciates the team efforts in rendering care.
6.2 Cooperates, coordinates and collaborates with the members
of the health team to meet the needs of the people.
7. Nurse commits to reciprocate the trust invested in nursing
profession by society
Nurse

7.1 Demonstrates personal etiquettes in all dealings.

7.2 Demonstrates professional attributes in all dealings.
CODE OF PROFESSIONAL CONDUCT FOR NURSES IN INDIA (INC)
1. Professional Responsibility and accountability
Nurse
1.1 Appreciates sense of self-worth and nurtures it.
1.2 Maintains standards of personal conduct reflecting credit upon
the profession.
1.3 Carries out responsibilities within the framework of the
professional boundaries.
1.4 Is accountable for maintaining practice standards set by Indian
Nursing Council
1.5 Is accountable for own decisions and actions
1.6 Is compassionate
1.7 Is responsible for continuous improvement of current practices
1.8 Provides adequate information to individuals that allows them
informed choices
1.9 Practices healthful behaviour
2. Nursing Practice
Nurse
2.1 Provides care in accordance with set standards of practice
2.2 Treats all individuals and families with human dignity in
providing physical, psychological, emotional, social and spiritual
aspects of care
2.3 Respects individual and families in the context of
traditional and cultural practices and discouraging harmful
practices
2.4 Presents realistic picture truthfully in all situations for facilitating
autonomous decision-making by individuals and families
2.5 Promotes participation of individuals and significant others in
the care
2.6 Ensures safe practice
2.7
Consults,
coordinates,
collaborates
and
follows
up
appropriately when individuals care needs exceed the nurses
competence.
3. Communication and Interpersonal Relationships
Nurse
3.1
Establishes
and
maintains
effective
interpersonal
relationship with individuals, families and communities

3.2 Upholds the dignity of team members and maintains

effective interpersonal relationship with them
3.3 Appreciates and nurtures professional role of team members
3.4 Cooperates with other health professionals to meet the
needs of the individuals, families and communities
4. Valuing Human Being
Nurse
4.1 Takes appropriate action to protect individuals from harmful
unethical practice
4.2 Consider relevant facts while taking conscience decisions in the
best interest of individuals
4.3 Encourage and support individuals in their right to speak for
themselves on issues affecting their health and welfare
4.4 Respects and supports choices made by individuals
5. Management
Nurse
5.1 Ensures appropriate allocation and utilization of available
resources
5.2 Participates in supervision and education of students and other
formal care providers
5.3 Uses judgment in relation to individual competence while
accepting and delegating responsibility
5.4 Facilitates conducive work culture in order to achieve
institutional objectives
5.5 Communicates effectively following appropriate channels of
communication
5.6 Participates in performance appraisal
5.7 Participates in evaluation of nursing services
5.8 Participates in policy decisions, following the principle of equity
and accessibility of services
5.9 Works with individuals to identify their needs and sensitizes
policy makers and funding agencies for resource allocation
6. Professional Advancement
Nurse
6.1 Ensures the protection of the human rights while pursuing the
advancement of knowledge
6.2 Contributes to the development
6.3 Participates in determining and implementing quality care
6.4 Takes responsibility for updating own knowledge and
competencies

6.5 Contributes to the core of professional knowledge by conducting

and participating in research.

LEGAL SYSTEM
MEANING OF LAW
a) Legal
- Established by or founded upon law or official or accepted rules
b) Law
- The term law is derived from its tentoric root lag which means
something which lies fixed or events
- Law means a body of rules to guide human action
- Law means that which is laid down or fixed.
DEFINITIONS
1) The law us a system of rights and obligations which the state enforces.
-Green
2) The law constitutes body of principles recognized or enforced by public
and regular tribunals have the administration of justice.
-Pound
3) The law is the body of principles recognized and applied by the state
and the administration of justice.
-Salmaind
4) Law is a rule or standard of human conduct established & enforced by
authority, society or custom

SOURCES OF LAW
a) Constitutional law: - it is a judgmental law. Law that governs the
state. It determines structure of state, power and duties.
b) Common law : - it is a body of legal principles that evolved from
court decisions
c) Administrative law: - rules and regulations established by
administrative agencies made by executives of government.

PURPOSES
To help the nurse to understand that they do have legal
responsibilities in nursing practice.
To make them understand by which authority these legal
responsibilities can be enforced.
To make them understand what areas of nursing practice can mostly
create legal problems.
To describe and protect the rights of clients and nurses
Law is there for the protection of nursing practice
Law is there for the identification of the risk of liability
Law is there to assist in the decision-making process involved in
nursing practice
Nurses have more responsibility another important purposes are
a) Safeguarding the public
b) Safeguarding the nurse
a) SAFEGUARDING THE PUBLIC
1) The public safety is guaranteed because the practice of nursing is
restricted to those accredited practitioners who would seek to
provide highest possible level of comprehensive care for the
individual and the community taking in to account the total need
2) The individual is secure to the event of sickness or disability with
no fear of anxiety of being cared for by a competent person
b) SAFEGUARDING THE NURSE
1) Licensure:- All nurses who are in nursing practice have to
possess a valid licensure, issued by the respective state nursing
council/Indian nursing council
2) Good Samaritan laws:- In response to health professionals,
fear of malpractice claims, most states enacted Good Samaritan
Laws that exempt doctors and nurses from liability when they render
first during emergency. These laws limit liability and offer legal
immunity for people helping in an emergency

3) Good rapport: - Developing good rapport with the client is very

important to prevent malpractice. The ability to develop good
rapport with client is dependent on the nurse having good
interpersonal communication skills. Eg: Listening
4) Standards of care:- All professional practicing in the medical
field are held to certain standards when administering care. It is
always better to follow standards of care to avoid malpractice and
do not attempt anything beyond the level of competence.
5) Standing orders:- Although a nurse may not legally diagnose
illness or prescribe treatment, she or he may after assessing
patients condition apply standing orders or treatment guideline that
have been established by the physician or doctor as appropriate for
certain problems and conditions
6) Consent for operation and other procedures:- A patient
coming in to hospital still retains his rights as a citizen and his entry
only denotes his willingness to undergo an investigation or a course
of treatment. Any investigation or treatment of a serious nature, or
an operation in which an aesthetic is used, requires the written
consent of the patient.
7) Correct identity:- The nurse or the midwife has the great
responsibility to make sure that all babies born in the hospital are
correctly labelled at birth and to ensure that at no time they are
placed in the wrong cot or handled to the wrong mother.
8) Counting of sponge instrument and needles:- Nurses
advocate that sponge, instrument and needle counts be performed
for all surgical procedures taking place in operation theatre. When
an instrument left in a patient body the nurse will probably liable for
any patient injury caused by the presence of foreign body.
9) Contracts:- A contract is a written or oral agreement between 2
people in which goods or services are exchanged.

10) Documentation:- Documentation is by far the best once a

lawsuit field. The medical record is a legal document admissible in
court as evidence.

LAW AFFECTING NURSES

a. Nurse practice laws: Describes and designs the legal boundaries
of nurse practice act within each state
b. Administrative law: Created by administrative bodies such as
state board of when they pass rules and regulations. Developed by
groups who are appointed to governmental administrative agencies.
Eg: Food, Drug & Cosmetic Act; Social Security Act; Nurse Practice
Act
c. Statutory law: Created by elected legislative bodies such as state
legislatures
d. Enacted law: Include all bills passed by legislative bodies whether
local, state, and national
LAW IN NURSING
a. Common law: Created by judicial decisions made in courts when
individual cases are decided
b. Felony: Is a crime of serious nature that has a penalty of
imprisonment for greater than one year or even death
c. Misdemeanour: Is a less serious crime that has a penalty of a fine
or imprisonment of less than one year
d. Civil law: Protects the rights of individual persons within our society
and encourage fair and equitable treatment among people
e. Contract Law: It is the enforcement of agreements among private
individuals. Employment Contracts is an example of contract law
under civil law

f. Criminal law: Prevent harm to society and provides punishment for

crimes

TYPES OF LAW
There are many ways in which a body of law, or the principles of lawmaking, can be divided into categories for the purposes of simplification.
Comparative Law: The comparative lawyer works with international
relations in trade and commerce, travel, government business, and many
other areas depending upon the breadth of his/her knowledge and the
needs of his/her employer. The field of comparative law is one in which
there is a great deal of opportunity for advancement and challenging
work.
Public law: Public law is the body of law that governs the relationship
between the individual and the state, as distinct from civil law (or
`private' law) which governs the relationships between individuals. Public
law is often taken to be divided into `criminal', `constitutional' and
`administrative' branches, although these are not distinct in all
jurisdictions.
Family law: Family law attorneys deal specifically with laws having to do
with family matters. There are multiple facets to each instance of
representation required and knowledge of individuals and their family
histories are necessary. Family law lawyers must interview each family
member involved, or mediates for families so agreements can be made in
an amiable or restructuring way. The most common family law attorneys
are the divorce lawyers, but other aspects of family law are represented
as well. Child support claims and those stipulations, custody and who
gets custody, visitation and length of visitation. Adoption proceedings,
who can adopt, the rights of fathers, mothers, and the different statutes
of each state, paternity and how it is determined, domestic abuse
charges, who was abused, spousal abuse, child abuse, sexual abuse and
the court's rulings, annulments of marriages and what are considered
avoidable marriages, are all represented by the family law attorney. How
these cases are decided by the courts and for what reasons are

determined by the knowledge and representation of the family law

attorney.
Criminal law: Criminal Law involves just what the label implies - people
accused of crimes. Lawyers who specialize in criminal law may work on
either side of the adversary process - defence or prosecution. There are
many more types of law from which to choose; what you choose will
depend upon your present interests and your interests as they develop in
law school. There is no reason to make your decision before begin.
Contract law: Contract law covers obligations established by agreement
(express or implied) between private parties. Generally, contract law in
transactions involving the sale of goods has become highly standardized
nationwide as a result of the widespread adoption of the Uniform
Commercial Code. However, there is still significant diversity in the
interpretation of other kinds of contracts, depending upon the extent to
which a given state has codified its common law of contracts or adopted
portions of the Restatement (Second) of Contracts. Parties are permitted
to agree to arbitrate disputes arising from their contracts. Under the
Federal Arbitration Act (which has been interpreted to cover all contracts
arising under federal or state law), arbitration clauses are generally
enforceable unless the party resisting arbitration can show unconscious
ability or fraud or something else which undermines the entire contract.
TORTS
The word Tort is derived from French word of the same spelling which
means "mischief, injury, wrong, or calamity", from Latin tortus meaning
twisted. Torts a civil wrong made against a person or property. Tort Law is
the enforcement of duties & rights among independent of contractual
agreements. It is a civil wrong committed on a person or property
stemming from either a direct invasion of some legal right of the person,
infraction of some public duty, or the violation of some private obligation
by which damages accrue to the person.
To constitute a tort, it is essential that the following conditions must be
satisfied
Act or omission
Wrongful act or omission must be recognized by law
Legal damage
Legal remedy

Categories of torts
Torts may be categorised in a number of ways: one such way is to divide
them into
Negligence Torts and Intentional Torts.
1. Negligence Torts
Negligence is a tort which depends on the existence of a breaking of the
duty of care owed by one person to another. The tort of negligence
provides a cause of action leading to damages, or to relief, in each case
designed to protect legal rights, including those of personal safety,
property and, in some cases, intangible economic interests. Negligence
actions include claims coming primarily from car accidents and personal
injury accidents of many kinds, including clinical negligence, workers
negligence and so forth. Product liability (warranty stuff) cases may also
be considered negligence actions, but there is frequently a significant
overlay of additional lawful content. The elements of negligence are:
Duty of care
Breach of duty in English law Breach of that duty
Breach being a proximate cause or not too remote a cause in law
Causation law Breach causing harm in fact
2. Intentional Torts
Among intentional torts may be certain torts coming out of the
occupation or use of land.
One such is the tort of nuisance, which involves strict liability for a
neighbour who interferes with another's enjoyment of his real property.
Trespass allows owners to sue for entrances by a person (or his structure,
for example an overhanging building) on their land. There is a tort of false
imprisonment, and a tort of defamation, where someone makes an
unsupportable reason for arrest or their speech is not represented to be
factual which damages the reputation of another.
3. Statutory torts
A statutory tort is like any other, in that it imposes duties on private or
public parties; however they are created by the legislature, not the
courts. Liability for bad or not working products is strict in most
jurisdictions. The theory of risk spreading provides support for this

approach. Since manufacturers are the 'cheapest cost avoiders', because

they have a greater chance to seek out problems, it makes sense to give
them the incentive to guard against product defects.
Nuisance
Legally, the term nuisance is traditionally used in three ways:
(1) to describe an activity or condition that is harmful or annoying to
others (example- indecent conduct, a rubbish heap or a smoking
chimney);
(2) to describe the harm caused by the before-mentioned activity or
condition (example: Loud noises or objectionable odours);
(3) to describe a legal liability (responsibility) that arises from the
combination of the two. The law of nuisance was created to stop such
bothersome activities or conduct when they unreasonably interfered
either with the rights of other private landowners (example- private
nuisance) or with the rights of the general public (example-public
nuisance).
4. Intentional torts
Intentional torts are any intentional acts that are reasonably foreseeable
to cause harm to an individual, and that do so. Intentional torts have
several subcategories, including torts against the person, including
assault, battery, false imprisonment, intentional infliction of emotional
distress, and fraud. Property torts involve any intentional interference
with the property rights of the claimant (plaintiff). Those commonly
recognized include trespass to land, trespass to chattels (personal
property), and conversion.
5. Economic torts
Economic torts protect people from interference with their trade or
business. The area includes the doctrine of restraint of trade and has
largely been submerged in the twentieth century by statutory
interventions on collective labour law and modern antitrust or
competition law. The "absence of any unifying principle drawing together
the different heads of economic tort liability has often been remarked
upon."

LIABILITY (FINANCIAL ACCOUNTING)

Definition
An obligation that legally binds an individual or company to settle a debt.
When one is liable for a debt, they are responsible for paying the debt or
settling a wrongful act they may have committed.
-www.investorwords.com
Types of liability
1. Product liability
Product liability is the area of law in which manufacturers, distributors,
suppliers, retailers and others who make products available to the public
are held responsible for the injuries those products cause. Although the
word "product" has broad connotations, product liability as an area of law
is traditionally limited to products in the form of tangible personal
property. Products Liability distinguishes between three major types of
product liability claims:
Manufacturing defect
Design defect
A failure to warn (also known as marketing defects).
2. Strict liability
In law, strict liability is a standard for liability which may exist in either
a criminal or civil context. A rule specifying strict liability makes a person
legally responsible for the damage and loss caused by his or her acts and
omissions regardless of culpability (including fault in criminal law terms,
typically the presence of mens area). Strict liability is prominent in tort
law (especially product liability), corporations law, and criminal law.
Rather than focus on the behaviour of the manufacturer (as in
negligence), strict liability claims focus on the product itself. Under strict
liability, the manufacturer is liable if the product is defective, even if the
manufacturer was not negligent in making that product defective.
3. Vicarious liability
The word 'vicarious' derives from the Latin word for 'change' or
'alternation' or 'stead' and in tort law refers to the idea of one person

being liable for the harm caused by another, because of some legally
relevant relationship.
4. Public liability
Public liability is part of the law of tort which focuses on civil wrongs. An
applicant (the injured party) usually sues the respondent (the owner or
occupier) under common law based on negligence and/or damages.
Claims are usually successful when it can be shown that the
owner/occupier was responsible for an injury, therefore they breached
their duty of care. The duty of care is very complex, but in basic terms it
is the standard by which one would expect to be treated whilst one is in
the care of another.
Once a breach of duty of care has been established, an action brought in
a common law court would most likely be successful. Based on the
injuries and the losses of the applicant the court would award a financial
compensation package.
Classification of accounting liabilities
1. Current liabilities
These liabilities are reasonably expected to be liquidated within a year.
They usually include payables such as wages, accounts, taxes, and
accounts payables, unearned revenue when adjusting entries, portions of
long-term bonds to be paid this year, short-term obligations (Eg: From
purchase of equipment). Current liabilities are the financial obligations
payable within a short period of time, normally within one year. It is a
balance sheet item, which is equal to the sum of dues within one year
and all the money indebted to the establishment. Current liabilities are
the short-term financial obligations.
Some of the distinguishable examples of current liabilities include
accrued expenses as wages, taxes and due interest payments.
2. Long-term liabilities
Long-term liabilities these liabilities are reasonably expected not to be
liquidated within a year. They usually include issued long-term bonds,
notes payables, long-term leases, pension obligations, and long-term
product warranties. Long-term liabilities are liabilities with a future
benefit over one year, such as notes payable that mature longer than one

year. In accounting, the long-term liabilities are shown on the right wing
of the balance-sheet representing the sources of funds, which are
generally bounded in form of capital assets.

LEGAL AND ETHICAL ISSUES

INTRODUCTION
From we were very young we began to learn what was right and what
wrong behavior was. Welearned this from our parents, relatives, friends
and teachers. By the time we became adults, we had apersonal set of
ethics to guide our behavior in daily life. We may believe, for example,
that honesty isimportant and necessary and important. We will try to be
honest because we believe it is right to do so.Being dishonest would then
be wrong for us. This is ethical behavior.

LEGAL ISSUES IN NURSING

Introduction
Nursing practice is governed by many legal concepts. It is important for
nurses to know the basics of legal concepts, because nurses are
accountable for their professional judgments and actions.
Laws are rules or standards of human conduct established by
government through legislative bodies and interpreted by court to protect

the rights of the citizens.

FUNCTIONS OF LAW IN NURSING
It provides a framework for establishing which nursing actions in the
care of clients are legal.
It differentiates nurses responsibilities from those of other
professionals.
It helps establish boundaries of independent nursing action.
It assists in maintaining a standard of nursing practice by making
nurses accountable under the law.
SOURCES OF LAWS
Three kinds of laws have the potential to affect nursing practice:
1. Civil law generally governs actions by one individual or corporation
against another. Eg: A client or family member sues the nurse or
nurses employer for malpractice because of a claim of client injury
caused by nursing care.
2. Criminal law involves actions by the state against an individual by
the state against an individual for violations of criminal statutes. Eg:
Drug diversion, client assault, mercy killing etc.
3. Administrative law involves actions by state administrative
agencies against individuals or organizations. Eg: Administrative
agencies govern the practice of nursing through boards or
commissions of nursing in each state.
DEFINITION:Ethics:Ethics is the study of good conduct, character and motives. It is
concerned with
determining what is good or valuable for all people. Act that are ethical
often reflect a
commitment to standards beyond personal preference standards on
which individuals,
professions and societies agree.
Code of ethics:Code of ethics is the providing guidelines for safe and compassionate
care. Nurses
commitment to a code of ethics guarantees the public that nurses adhere
to professional practice

standards.
CODE OF ETHICS
Within any given profession, a code of ethics serves as a means of selfregulation and a
source of guidelines for individual behaviour and responsibility.
I.C.N CODE OF ETHICS FOR NURSES(1993)
Ethical concepts applied to nursing:The fundamental responsibility of the nurses is of four fold: to promote
health, to prevent
illness, to restore health and to alleviate suffering.
Elements of the code:Nurses and people
h The nurses primary responsibility is the those people who require
nursing care
h The nurses provides care, promotes an environment in which the
values customs and
spiritual beliefs of the individual are respected
h The nurses holds confidence, personal information and uses judgment
in sharing their
information
Nurses and practice
h The nurse carries personal responsibility for nursing practice and for
maintaining
competence by continuous learning
h The nurses maintains the higher standards of nursing care possible
within the reality of a
specific situation
h The nurses assess judgment in relation to individual competence when
accepting and
delegating responsibilities
h The nurse when acting in a professional capacity should at all times
maintain standards of
personal conduct which reflect created upon the profession

Nurses and Society

The nurses with other citizens the responsibility for initiating and
supporting action to in edit the
health and social needs of the public
Nurses and Co-workers
h The nurse sustains a co-operative relationship with co-workers in
nursing practice and
nursing education
h The nurse is active in developing a care of professional knowledge
h The nurse acting through the professional organization, participants in
establishing and
maintaining equitable social and economic working conditions in nursing.

PROFESSIONAL CONDUCT
Code of professional conduct (for nurses in India)
1. Professional responsibility and accountability
To maintain professional responsibility and accountability, the
nurse
Appreciates a sense of self-worth and nurtures.
Maintains standards of personal conduct, reflecting credit upon the
profession.
Carriers out responsibilities within the framework of the professional
boundaries
is accountable for maintaining practice standards set by the Indian
Nursing
Council.
Is accountable for his/her own decisions and actions.
Is compassionate.
Is responsible for the continuous improvement of current practices
Provides adequate information to individuals these allows them to
make informed
choices.
Practices healthful behavior.
2. Nursing Practice

In the course of practice of nursing, the nurse

Provide care in accordance with set standards of practice
Treats all individuals and families with human dignity in providing the
physical,
psychological, emotional , social and spiritual and aspects of care
Respects individuals and families in the context of traditional and
cultural practicing,
promoting healthy practices and discouraging harmful practiced
Presents realistic practices truthful in all situations for facilitating
autonomous decisions
making by individuals and families
participation and individuals and significant others in the care
Ensures safe practice
Consults, co-ordinates, callboards and follow p approximately when an
individuals care
needs exceed the his or her competence
3. Communication and interpersonal relationships
This plays a key role in the interaction of the nurse with his or her clients.
To effect optimal
interaction the nurse
X Establishments and maintains effective interpersonal relationships
with individuals
families and communities
X Upholds the dignity of team members and maintains effective
interpersonal relationship
with them
X Appreciates a and nurtures the professional role of team members
X Co-operates with other health professionals to meet the needs of
individuals , families
and communities
4. Valuing human being
The nurse values human life. He or she
o Takes appropriate action to protect individuals from harmful unethical
practices
o Considers relevant facts while taking cons decisions in the best
interest of individuals

o Encourages and supports individual in heir right to speak for

themselves on issues
affecting health and welfare
o Respects and supports choices made by individuals.
5. Management
Proper management of resources and unfortunate is essential for
improving the over all
efficiency of the nurse. Hence the nurses
Ensures appropriate allocation and utilization of available responses
Participates in supervision and education of students and other formal
providers
Uses judgment in relation to individual competence which accepting
and delegating
responsibility
Facilitates conducive work culture in order to achieve institutional
objectives
Communicates effectively following appropriate channels if
communication
Participates in performance appraisal
Participates in evaluation of nursing services
Participates in policy decision, following the principles of equity and
accessibility of
service
Works individuals to identify the needs and sensitizes policy makers
and funding
agencies for resource allocation
Professional Advancement
To escape that he or she is at part with contemporaries in the nursing
field the nurse must.
a. Ensures the protection of human rights, while pursuing the
advancement of knowledge
b. Participate in determine and implementing quality
c. Take responsibility for updating ones own knowledge and
competencies
d. Contribute to the core of professional knowledge and conducting and
participating in
research

ICN CODE OF ETHICS FOR NURSES

In 1953 ICN adopted its first code of ethics for nurses and was revised in
2000. The four
principle elements contained within the ICN code involve standards
related to nurses and people,
practice, profession and co workers.
ICN recommended that nurses have 4 fundamental responsibilities i.e. to
promote health, to
prevent illness, to restore health and to alleviating suffering. And also
inherent in nursing is respect for
human rights, like right to life, to dignity and to be treated with respect.
And the care should not be
restricted by age, sex, color, creed, culture or nationality.
Nurses and people
The nurses primary responsibility is to those people who require nursing
care. The nurse in
providing care promotes an environment in the values, customs, and
spiritual beliefs of the individual
are respected .the nurse holds in confidence personal information and
use judgement in sharing this
information.
Nurses and practice
The nurse carries personal responsibility for nursing practice and for
maintaining competence
by continual learning. The nurse maintains the highest standard of
nursing care possible within the
reality of a specific situation. The nurse uses judgement in relation to
individual competence when
accepting and delegating responsibilities. The nurse when acting in
professional capacity should at all
times maintain standards of personal conduct which credit up on the
profession.
Nurses and co-workers

The nurse maintains a cooperative relationship with coworkers in nursing

and other fields. The nurse
takes appropriate action to safeguard the individual when his care is
endangered by a co-worker or
any person.
Nurses and the profession
The nurses play a major role in determining and implementing desirable
standards of nursing
practice. The nursing is active in developing a core of professional
knowledge. The nurse acting
through the professional organizations participates in establishing and
maintaining equitable social and
economic working conditions in nursing.
FUNCTIONS OF ETHICAL CODES
To inform the public about the minimum standards of the profession
and to help them
understand professional nursing conduct.
To provide a sign of the professions commitment to the public it
serves.
To outline the major ethical considerations of the profession.
To provide general guidelines for professional behavior
To guide the profession in self regulations.
CODE OF PROFESSIONAL CONDUCT
Code of professional conduct (for nurses in India)
1. PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY
To maintain professional responsibility and accountability, the nurse
a. Appreciates a sense of self-worth and nurtures it.
b. Maintains standards of professional conduct, reflecting credit upon the
profession.
c. Carries out responsibilities within the frame work of professional
boundaries.
d. Is accountable for maintaining practice standards set by the I.N.C.
e. Is accountable for his or her actions.
f. Is compassionate.

g. Practices healthful behavior.

h. Is responsible for continuous improvement of current practices.
2. NURSING PRACTICE
a. In the course of practice of nursing, the nurse
b. Provide care in accordance with set standards of practice.
c. Treats all individual and family with human dignity in providing the
physical, psychological,
emotional, social and spiritual aspects of care.
Respects individuals and families in the context of traditional and cultural
practices,
promoting healthy practices, and discouraging harmful practices.
e. Presents realistic pictures truthful in all situations for facilitating
autonomous decisions
making by individuals and families.
f. Promote participation of individuals and significant others in the care.
g. Ensures safe practice.
3. COMMUNICATION AND INTER PERSONAL RELATIONSHIPS
This plays a key role in the interaction of the nurse with his or her clients.
To effect optimal
interaction, the nurse
a. Establishes and maintains effective IPRs with individuals, families and
communities.
b. Upholds the dignity of team members and maintains effective IPR with
them.
c. Appreciates and nurtures the professional role of team members.
d. Co-operates with other health professionals to meet the needs of the
individuals, families and
communities.
4. VALUING HUMAN BEINGS
The nurse values human life. She
a) Takes appropriate action to protect individuals from harmful unethical
practices.
b) Considers relevant facts while taking conscientious decisions in the
best interest of individuals.

c) Encourage and supports individual in their right to speak for

themselves on issues affecting
health and welfare.
d) Respect and supports choices made by individuals.
5. MANAGEMENT
Proper management of resources and infra structure is essential for
improving the overall efficiency
of the nurse. Hence the nurses
a) Ensures appropriate allocation and utilization of available resources.
b) Participates in super vision and education of students and other formal
providers.
c) Uses judgment in relation to individual competence while accepting
and delegating
responsibility.
d) Communicates effectively following appropriate channels of
communication.
e) Participates is performance appraisal.
f) Participates in evaluation of nursing services.
g) Participates in policy decision, following the principles of equity and
accessibility of service.
6. PROFESSIONAL ADVANCEMENT
To ensure that he or she is at par with contemporaries in the nursing field,
the nurse must
a. Ensures the protection of human rights, while pursuing the
advancement of knowledge
in determining and implementing quality care.
c. Take responsibility of updating ones own knowledge and
competencies.
d. Contribute to the core of professional knowledge and conducting and
participating in
research.
e. The nurses =responsibility for the patient has been changed to a
broader term of people. This
includes respect for culture, customs, religious beliefs and confidential
treatment of personal

information. One of our greater adjustments in nursing is accepting

responsibility for our
own professional behavior.
ETHICS
Definition
Ethics refers to the moral code for nursing and is based on obligation to
service and respect for human life.
-Melanie and Evelyn.
Ethics are the rules or principles that govern right conduct and are
designed to protect the rights of
human beings. - Sister Nancy.
CODE OF ETHICS
Definition;
1. A code of ethics is a set of ethical principles that are accepted by all
members of a profession.
-Potter and Perry
2 Code of ethics is a guideline for performance and standards and
personal responsibility.
-Lillie M S and Juanita Lee
3. Code of ethics provides a frame work for decision making for the
profession and should be oriented
toward the day to day decisions made by members of the profession.
- Chitty K K
4. A code of ethics is a set of ethical principle that
A} is shared by members of a group
B} reflects their moral judgments over time
C} serves as a standard for their professional actions.
-Barbara Kozier
Nursing Ethics
Its a branch of applied ethics that concerns itself with activities in the
field of nursing. Its
refers to ethical standards that govern and guide nurses in every day
practice such as being
truthful with clients , respecting client confidentiality., and advocating
on behalf of the client.

Need for nursing ethics

Helps the students/ RN to practice ethically
Helps the nurse to identify the ethical issues in her work place
Protecting patients right and dignity
Providing care with possible risk to the nurses health
Staffing patterns that limit the patients access to nursing care
Ethical reasoning
Helps the nurse to respond to ethical conflicts
Helps to differentiate right /wrong behavior
Guide for a professional behavior
Help teachers plan education.
Prevent below standard practice.
Protect a nurse if falsely accused and guide direction for legal action
Key Principles of ethics in health care system
Autonomy-The right of self determination, independence and freedom.
Right to health
care decision.
Justice-Obligation to be fair with all people.
Fidelity- Obligation of an individual to be faithful to the commitment
made to himself,
and to others. It is the main support of accountability.
Veracity: - The duty to tell the truth.
Beneficence- Doing good for the client. What exactly is good for one
person may not be
the same for others.
Malaeficence- is the requirement that health care providers do no harm
to their client
either intentionally or unintentionally
Deontological:-What causes a good outcome is good action.
Situational: - What causes a good outcome is good action.
Thus a professions ethical code is a collective statement about the
groups expectations and
standards of behavior. The ANA and ICN have established widely
accepted codes that
professional nurses attempt to follow.