Ethical Issues in Nursing

Luceno Michelle Ilagan Hannah Melissa

Values and ethics

Values

and ethics are inherent in all nursing acts. A value is a strong personal belief; an ideal that a person strives to uphold. Your values reflect cultural and social influences, relationships and personal needs. Vary among people and develop and change over time.

What is Ethics?
Branch

of philosophy concerned with determining right and wrong in relation to peoples decisions and actions. Morals and ethics are often used interchangeably but morals are often stated as private, personal standards of what is right and wrong, ethics reflect a commitment to standards beyond personal preferences.

Nursing Ethics
An expression of how nurses ought to

conduct themselves. Refers to ethical standards that govern and guide nurses in everyday practice such as being truthful with clients respecting client confidentiality and advocating on behalf of the client.

What does a code of ethics do?

Gives guidance for decision making about

ethical matters by providing a set of values that are basic to nursing practice.

The Code of Ethics

Provide rules of ethical or moral behavior for

every circumstance. Offer guidance about which values should take priority or how they can be balanced in practice.

Values and The Code of Ethics

Primary values that are central to ethical nursing practice. The 7 values include: 1. Providing safe, 2. Compassionate competent and 3. Ethical care, 4. Promoting health and well-being, 5. Promoting and respecting informed decision-making, 6. Maintaining privacy and confidentiality, 7. Promoting justice and being accountable

Definition of Nursing Standards

Describes

the desirable and achievable level of performance expected of registered nurses in their practice against which performance can be measured Benchmark for assessing the professional conduct of all registered nurses.

Legal Implications in Nursing Practice

Law
The sum total of rules & regulations by which a society is governed. As such, law is created by people & exists to regulate all persons
GUIDO, 2001

Functions of the Law in Nursing

It provides a framework for establishing

which nursing actions in the care of clients are legal. It differentiates the nurses responsibilities from those of other health professionals. It helps establish the boundaries of independent nursing action. It assist in maintaining a standard of nursing practice by making nurses accountable under the law.

Sources of Law
Constitutional law Legislation law (Statutory law) Administrative law Common law

Constitutional Law The supreme law of a country. Creates legal rights & responsibilities and a foundation of a system of justice. Legislation law (Statutory law) Enacted by any legislative body The regulation of nursing is a function of state law

Administrative law It creates rules & regulations to enforce the statutory laws. Common Law Laws evolving from court decisions. Interpreting & applying the constitutional or statutory law.

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:
1. 2. 3.

There is a need to protect the publics 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

Patient Safety Goals:

1. 2. 3. 4. 5. 6. 7. 8. 9.

Improve the process of Patient Identification Eliminate wrong-site, Wrong Patient & Wrong Procedure Surgery Improve the effectiveness of Communication among Caregiver Improve the Safety of High Alert Medications Improves Safety in Infusions Pumps Improve the effectiveness of Clinical Alarm systems Reduce the risk of healthcare-acquired infections Accurately & completely reconcile medications across the continuum of care Reduce the risk of patient harm resulting from falls

Nursing Documentation
Your License may depend on it!

"if it's not documented it was not done"

To avoid litigation, health care providers

must comply with established standards of care. care

Prudent Nurse
Knowledge Skill Care Diligence

Documenting This Process

Record

events and observations in the patients medical record in an objective and clear manner. Document the specific facts, and carefully record the time of each entry as accurately as possible. Avoid finger pointing and personal attacks on the physician.

The Basics
Chronology: Date and Time Client History Interventions: Medical, Social and Legal Observations: Objective and Subjective Outcomes Client and Family Response Authorship: Your Signature and Credentials

Legibility
Hand written
Cursive Print

Computerized
Typed notes Clicks

Date & Time

Sequence of Events Lapse in Time Late Entries Blocked Time Military vs Standard Time

Subject & Objective

See Hear Feel Think

Changes in Health Status

Your actions Clients response Client outcomes

Your Signature
Full name Credentials Job title Initials

Client Education
Family Significant Other

Phone Calls
Phone Record Phone Orders Pager Response Documentation Facility Policy

Read Back
Date and time of call Physician's name and "T/O" to indicate order Verbal order, written word-for-word Documentation that you've read back the order, to be sure you heard it correctly Documentation that you've transcribed it according to your facility's policy Your name

Computerized Documentation
Easier form of communication Legible As legal as when you manually chart

Make Documentation Easier

The Dos The Donts

The Dos
Correct Chart Reflect the Nursing Process Write Legibly Permanent Black Ink Complete / Concise / Accurate Medications
Route Clients response

Precautions / Preventive Measures

Side rails Restraints

Nursing Procedures
Name of procedure When it was performed Who performed it How it was performed How well the client tolerated it Adverse reactions

Phone calls Health Care Team visits Dont wait to Chart Client refusals Clients subjective data

DOs
Medication omission Late Entry Not Applicable Charting Frequency
Facility P&P / Standards

Approved abbreviations & symbols Discharge instructions Commonly misspelled words Look-a-Like / Sound-a-Like

The Don'ts
Complaints Opinions Altering the Record Adding Information Dating the entry
Dates / Times conflict

Inaccurate Information. Destroying records

Chart for someone else Chart Opinions Use Negative Language Leave empty lines / spaces Write in the margins Make reference to incident reports

When you make a Mistake

White out / Eraser The word Error Correct the Entry Oops Sad Faces