ETHICAL & LEGAL

REPOSNIBILTITES
IN NURSING

Prepared By:

DEFINITIONS
Values
Ideal, beliefs, customs, modes of conduct, qualities of goals that are
highly prized or preferred by individuals, groups, or society
Usually not written down

Values Clarification
Refers to the process of becoming more conscious of & naming
what one values or considers worthy.

Values Conflict
Internal of interpersonal conflict that occurs in circumstances
in which personal values are at odds with those of patients,
colleagues or the institution.

DEFINITIONS
CONTINUES
Morals

Standards of right & wrong

Learned & internalized at early age
Society & culture play important role
Moral orientation generally is based on religious beliefs

Moral Values
Preferences reflective of right and wrong, should or should not, in
human behavior.

Moral Integrity
A focal virtue that relates to soundness, reliability, wholeness, and
integration of character & reliability, in adherence to moral norms
sustained over time

DEFINITIONS
CONTINUES
Moral Thought
Individuals cognitive examination of right & wrong, good & bad.

Moral Distress
The reaction to a situation in which there are moral problems that
seem to have clear solutions, yet one is unable to follow ones
moral beliefs because of external restraints; this may be evidenced
in anger, frustration, dissatisfaction & poor performance in the work
setting.

SCENARIO-I
Mr. Anderson , a 92 year old man living in a nursing
home and suffering with Alzheimers disease for over
10 years reaches the stage where he is no longer able
to swallow food effectively. He has been hospitalized
with aspiration pneumonia four times in the last year.
The mans eldest child, who lives in the same town has
a durable power of attorney and visits regularly
instists that a feding tube be inserted. He has the
support of his two siblings. The staff feels that a
feeding tube would be distressing to the patient.
Besides they say he swats away our hands when we
try to hold him down to insert the tube and he always
pulls the tube out

SCENARIO-II
Mr. Ahmad is an 28 years old nursing home resident who has multiple co
morbidities including significant dimensia. He is combative and often kicks or
punches those who attempt to care for him, infact three members of the staff
(two nurses and a nursing assistant) have been treated in the emergency room
for injuries that occur during the course of caring for him. The mans wife refuses
medication to sedate him, saying that she is concerned about the side effects
communicating the consistency and severity of the problem to the doctors, some
of whom are there as consultants and all of whom only see mr. ahmad for brief
intervals is challenging while the nursing staff are not willing to abandon
mr.ahmad they are afraid for their safety and morally distressed because they
feel forced to tolerate physically violance without any power to change the
situation. They know that caring for mr. ahmad safely requires giving him
medication but they are constrained by the fact that the doctors who must write
the prescription do not understand the extent of the problem and Mrs ahmad the
patient power of attorney, opposes any form of sedation. They feel trapped

DEFINITIONS
CONTINUES
Ethic
Declaration of what is right or wrong & what ought to be.
A formal process of making logical and consistent decisions based
upon moral beliefs.

Ethical Principles
Basic & obvious moral truths that guide delibration & action.
Standards of conduct defining the kind of behavior an ethical
person should and should not engage in.

ADVANCE DIRECTIVE
Written instructions recognized under state law relating
to the provision of healthcare when an individual is
incapacitated.
Advance directives may take two forms
Health care proxy- a written directive designation a person to make
health care decisions on behalf of an individual when he becomes
unable to make such decisions.
Living will- a written advance directive in which an individual
specifies choices for medical treatment

CODE OF ETHICS
Written list of a professions value and standards of
conduct
Framework for decision making
Offer guidance
Periodically revised
Not legal enforcable as law but consistant violent
indicate an unwilling by the person to act in a
professional manner and license can be suspended or
revoked.

CODE OF ETHICS AS
APPLIED TO NURSING
The ANA approved these nine provisions of the new
code of ethics for nurses on june 30, 2001.
The nurse in all professional relationship practices with
compassion and respect for the inherit dignity. Worth &
uniqueness of every individual unresticated by
considerations of social or economic status personal
attributes or the nature of health problems.
2. The nurse primary commitment is to the patient as
an individual family group or community.

CODE OF ETHICS CONT..

3. The nurse promotes, advocates for, and strives to
protect the health, safety, and rights of the patient
4. The nurse is responsible and accountable for
individual nursing practice and determines the
appropriate delegation of tasks consistent with the
nurse's obligation to provide optimum patient care.
5. The nurse owes the same duties to self as to others,
including the responsibility to preserve integrity and
safety, to maintain competence, and to continue
personal and professional growth.

CODE OF ETHICS CONT..

6. The nurse participates in establishing,
maintaining, and improving healthcare
environments and conditions of employment
conducive to the provision of quality health care
and consistent with the values of the profession
through individual and collective action.
7. The nurse participates in the advancement of
the profession through contributions to practice,
education, administration, and knowledge
development.

CODE OF ETHICS CONT..

8. The nurse collaborates with other health
professionals and the public in promoting
community, national, and international efforts to
meet health needs.
9. The profession of nursing, as represented by
associations and their members, is responsible for
articulating nursing values, for maintaining the
integrity of the profession and its practice and for
shaping social policy.

KEY
ETHICAL
CONCEPTS

AUTONOMY
self-governing; having the freedom to make independent choices

self-determination
r/t health care deals with professionals
willingness to respect clients rights to
make a free choice given that they
have been provided with all necessary
information & knowledge
not an absolute right except in some
cases

JUSTICE
an ethical principle that relates to fair,
equitable & appropriate treatment in
light of what is due or owed to persons,
recognizing that giving to some will
deny receipt to others who might
otherwise have received these things
obligation to be fair to all people
1st statement in ANA Code of Ethics for
Nurses

FIDELITY
The individuals obligation to be faithful to commitments made
to self & others
In health care, includes the professionals faithfulness or loyalty
to agreements & responsibilities accepted as part of the practice
of the profession
BENEFICENCE
Views the primary goal of health care as doing good for clients
Includes more than just technical competency
Client approached in holistic manner

NON-MALEFICENCE
Requirement that health care providers do no harm
to their clients intentionally or unintentionally
Opposite side of the coin from beneficence
In current health care practice, the principle of nonmaleficence is often violated in the short run in order
to PRODUCE A GREATER GOOD in the LONG TERM TX
of the client
May undergo painful & debilitating surgery to remove a
cancerous growth in order to prolong life in the future

VERACITY
TRUTHFULNESS
Requires the health care provider to tell the truth & not
intentionally deceive or mislead clients
Limitations = in situations where telling clts the truth
would seriously harm (principle of nonmaleficence)
their ability to recover or would produce greater illness
FEELING UNCOMFORTABLE is NOT a good enough
reason to avoid telling clts the truth about their dx, tx
or prognosis
The client has a RIGHT to know this information

STANDARD OF BEST
INTEREST
A decision made about individual clients health care
when they are unable to make an informed decision for
their own care
Very important to consider the individuals expressed
wishes, either formally or what they may have said
Based upon what the HCP &/or family DECIDE is best
for that individual

STANDARD OF BEST
INTEREST
Formal = written, living will, patient advocate
Should be based on the principle of beneficence
PATERNALISM = UNILATERAL DECISION by HCP
which implies that they know what is best,
disregarding the clts wishes

OBLIGATIONS
LEGAL OBLIGATIONS
They have become formal statement of law and are enforcable
under the law; e.g.

MORAL OBLIGATIONS
There is no legal obligation for a nurse on an vacation trip to stop
and help a motor vehicle accident victim

MAKING
ETHICAL
DECISIONS

ETHICAL DECISION
MAKING PROCESS
It provides a method for nurses to answer KEY
QUESTIONS about ethical dilemmas & to
organize their thinking in a more logical &
sequential manner.
Chief goal = determining right from wrong in
situations where clear demarcations do not exist or are
not apparent

WAYS TO INCORPORATE
ETHICS INTO PRACTICE
Encourage patients expressions of desires.
Identify significant others who impact and are
impacted.
Know thyself
Read
Discuss
Form an ethics committee
Share
Evaluate decisions

THANKS