ETHICAL AND LEGAL ISSUSE

IN NURSING PRACTICEV
Prepared by : kafi al_shmary
Hanan al_ jehany
Supervised by : Dr nazik
NOV_2_22

Objective

;Uponcompletionofthissessionyouwillbeableto
. Definethekeyterms
Illustrateethicalprincipalrelatedtonursing.
HealthcareEthicsApproachess
Discusspurpose&elements&applicationofthecodeof
.ethics
.DiscussEthicalDilemma&decisionmakingprocess
>>
Identifyourcesoflow.
Illustrate!actorsaffectinglegaldecisions&
"lassificationoflaws.
E#plain$egalissuescommoninnursing&
!actorthatcontributetomalpracticeclaims.

%re&entingmalpracticeclaims.
DiscussElementsoflegalaction.
Outline
Definitionoffollowingterms'ethics(&alues(moral(
.')laws
.%urposeofcodeofethics
Elementsofthecodeofethics&applyingelementof
.I"*
organi+ationalethics&healthcareethics
.approach
.principleofcodeofethics
ApproachtoEthicalDilemma&decisionmaking
.process
.thekeyethicaltheoriesorsystemcanbeused
.,lossaryoftermusedinI"*codeofethicsfornurses
>>
ourcesoflow.
!actorsaffectinglegaldecisions.
"lassificationoflaws.
$egalissuescommoninnursing.
!actorthatcontributetomalpracticeclaims.

%re&entingmalpracticeclaims.
Elementsoflegalaction.
.INTRODUCTION
Every newspaper contains reports of sensational
cases being decided in our courts.
Concerns about lawsuits and liability are voiced in
every business. Health care
remains at the forefront of professions where legal
issues constitute a major area of
concern. The wise nurse considers legal issues
before a crisis arises and uses sound
information to help guide action in situations
.where questions arise
>>

*ursesareconstantlyfacedwiththechallengeof
makingdifficultdecisionregardinggoodande&il
.orlife&deathorallissues
*ursesmustknowthelegal&ethicalissue
.regardingcareofpatient

;Keydefinition
.-alues
Areidealsorconceptthatgi&emeaningtoanindi&idual
.life
;.oral
Arethefundamentalstandardsofrightandwrongthatan
indi&iduallearnsandinternali+es(usuallyintheearly
.stagesofchildhoodde&elopment
;$aws
Aregenerallydefinedasrulesofsocialconductde&isedby
peopletoprotectsociety.lawarebasedonconcernsfor
.fairnessand/ustice
:Ethics

Ethicsaresystemsof&aluedbeha&iors
andbeliefsthatgo&ernproperconduct
toensuretheprotectionofan
.indi&idual0srights
>
Aredeclarationofwhatisrightandwhatiswrong(
.systemof&aluedbeha&iorsandbeliefs
Ethicsareassociatedwithsociety
CodeofEthics

.Ethicscode
Anethicsisawrittenlistofprofessions&aluesand
(standardsofconduct
Anethicscodepro&idesaframeworkfordecision
making
NursinCodeofEthics :
1hecodeofethicsforregisterednursesisa
statementofethicalcommitmentsofnursesto
thosetheyser&e.*ursesha&ede&elopeditfor
nursesandsetforththeethicalstandardsby
whichnursesaretoconducttheirnursing
practice.'"*Acodeofethics(2332
.The!ur!oseofthiscodeofethics

Identifythefundamentalmoralcommitmentsof
.theprofession
%ro&idenurseswithabasisforprofessionalandself
.reflectiononethicalconduct
.Actasaguidetoethicalpractice
Indicatetothecommunitythemoral&alueswhich
.nursescanbee#pectedtohold
.Ele"entsofthecodeof
.*ursesandpeople
.*ursesandpractice
.*ursesandprofession
.*ursesandco4workers
.Nurses pe!ple

The nurses Primary responsibility is to people who
.need nursing care
The nurse, in providing care ,promotes an
environment in which the values ,customs, and
.spiritual beliefs of individual are respect
The nurse hold in confidence personal information
.and uses judgment sharing this information
.Nurses#!r$ctice
1henursecarriesresponsibilityfornursingpracticeand
formaintaincompetencebycontinuallearning.the
nursemaintainedthehigheststandardofnursing
.carepossiblewithintherealityofaspecificsituation
1henurseuses/udgmentinrelationtoindi&idual
competencewhenacceptinganddelegating
.responsibility
1henursewhenactinginaprofessionalcapacity
shouldatalltimesmaintainsstandardsofpersonal
.conductwhichreflectcreditupontheprofession
.Nurses "he pr!fessi!n
1henurseplaysthema/orroleindeterminingand
implementingdesirablestandardsofnursing
.practiceandnursingeducation
1henurseisacti&einde&elopingacoreof
.professionalknowledge
1henurse(actingthroughtheprofessional
organi+ation(participatesinestablishingand
maintaininge5uitablesocialandeconomic
.workingconditionsinnursing
.Nurses#co%&or'ers

1henursesustainsacooperati&erelationshipwith
.co6workerinnursingandotherfield
1henursetakesappropriateactiontosafeguard
theindi&idualwhenhiscareisendangeredbya
.co6workeroranyotherperson
(!!lyinele"entofICNCodeofethics
.fornurses
fourelementgi&eaframeworkforthestandardsof
.conduct
.tudythestandardsundereachelement 7
reflectonwhateachstandardmeanstoyou.thank7
;abouthowcanapplyethicsinnursingdomain
.practice(education(researchormanagement
.Identifyhowyouwouldresol&ethedilemma 7
8orkingrouptoclarifyethicaldecisionmakingand7
.reachaconsensusonstandardsofethicalconduct
"ollaboratewithyournationalnursesassociation(co67
workersandotherincontinuousapplicationof
.ethicalstandardsinnursingdomain
Or$ni)$tion$lEthics
!ocusontheworkplace
Ethicalculturemakesadifference
eniorleadershipmustpromoteanethicalculture
OR*(NI+(TION(,ET-IC.
;%ublicaccountability
publicin&ol&ement6
complaintsprocess6
9Inter6professional%rocedures
standards6
codes6
committees6
researchethics6

-e$lthc$reEthics
(!!ro$ches
%rescripti&e
'"ommandstructure'hierarchy6
$aw6
:egulatorybodies6
Ethics"odes6
Ethicscommittees
:eligion(culturalnorms
>>
%articipati&e(e#ploratory
a;!ramework
e.g.:ightsand<bligations
e.g.%ublicAccountabilityframework
e.g.Decision6makingframework
b;%rocess
e.g.opendiscussionfrominitial5uestion
Ethic$l/rinci!les
utonomy
.:espect
*onmaleficence
=eneficence
>ustice
!idelity
"onfidentiality
-eracity
Accountability
(utono"y

1hefreedomtomakedecisionsabout
.themsel&es
*ursesneedtorespectclients0rightstomake
choicesabouthealthcare
Res!ect
:eferstotreatingpeopleasuni5ue(e5ualand
responsiblemoralagent
0eneficence

1hisprinciplemeans?doinggood@forothers
*ursesneedtoassistclientsinmeetingalltheir
needs
=iological
%sychological
ocial
Non"$leficence
:e5uiresthatnoharmbecausedtoanindi&idual(
eitherunintentionallyordeliberately
1hisprinciplere5uiresnursestoprotectindi&iduals
whoareunabletoprotectthemsel&es
1ustice
E&eryindi&idualmustbetreatede5ually
1hisre5uiresnursestobenon/udgmental
#ideli"y $!yal"y

1hepromisetofulfillallcommitments
1hebasisofaccountability
%!nfiden"iali"y

Anythingstatedtonursesorhealth6carepro&idersby
clientsmustremainconfidential

91heonlytimesthisprinciplemaybe&iolatedare
Ifclientsmayindicateharmtothemsel&esorothers
Iftheclientgi&espermissionfortheinformationtobe
shared
Vera&i"y
@1hisprincipleimplies?truthfulness
*ursesneedtobetruthfultotheirclients
-eracityisanimportantcomponentofbuilding
trustingrelationships
(ccount$bility

Indi&idualsneedtoberesponsiblefortheirown
actions
*ursesareaccountabletothemsel&esandtotheir
colleagues
'"hi&al Dilemmas
Isasituationthatre5uiresanindi&idualtomakea
choicebetweentwoe5uallyunfa&orable
.alternati&e
<ccurwhenaprobleme#istsbetweenethical
principles
Decidinginfa&orofoneprincipleusually&iolates
another
=othsidesha&e?goodness@and?badness@
associatedwiththem
ResolvinEthic$lDile""$s

Usingthe*ursing%rocess
Assessment
%lanning
Implementation
E&aluation

(ppr!a&h "! '"hi&al Dilemma
W h a t V a l u e s a r e i n c o n f l i c t
C o l l e c t
t h e f a c t s
A m I i n v o l v e d
A s s e s s m e n t
L i s t a n d
R a n k t h e o p t i o n s
I d e n t i f y
D e c i s i o n - M a k e r s
D e t e r m i n e g o a l s
o f t r e a t m e n t
l a n n i n g
! s e o f
d i s c u s s i o n a n d
n e g o t i a t i o n
W o r k t o " a r d s
a m u t u a l l y
a c c e p t a # l e d e c i s i o n
I m p l e m e n t a t i o n
R e - e v a l u a t e a s n e c e s s a r y
D e t e r m i n e
" h e t h e r d e s i r e d
o u t c o m e s h a v e # e e n
r e a c h e d
$ v a l u a t i o n
A p p r o a c h
2iveste!ethic$ldecision"$'in
!rocess$stoolforresolvin
.ethic$ldile""$s
."ollect(Analy+e(andInterprettheData6A
.tatethedilemma62
."onsiderthechoicesofaction6B
Analy+ethead&antages&disad&antages6C
.ofeachaction
..akethedecision6D
Ethic$lTheories

;Deontology
Isasystemofethicsthatisbasedonunchanging
.principles
1hissystemparallelsthelegalandmoralsystem
.mostpeoplefollowgrowingupintodayEsworld
>>
1eleological
Utilitarianismisasystemofethicsthatis
basedontheprincipleofgreatestgood.asa
system(maynotbeappropriateforsome
.healthcaredecision
!"#$CE! "% &'
!tatute law
Astatuteisaruleorformal
regulationestablishedby
go&ernmentallegislati&eauthority
$egulatory &aw

Regulatory law (referred to as
executive or administrative law)
includes the rules and
regulations established by al agencies
to carry out enacted law.
Common &aw
"ommonlawderi&esfromcommonusage(
custom(and/udiciallaw
FACTORS AFFECTING LEGAL
DECISIONS
dministrative rulings
:eferredtoasanad&isoryopinion(made
by
astateboardor
byanattorneygeneralpro&idesaguideline
basedonaninterpretationoftheenacted
andregulatory
lawrelati&etoaspecificsituation(andis
notafinallegaldecision.
$ights and $esponsibilities in
Health Care
:ightsandresponsibilitiesha&ebothlegaland
ethicalaspects.1heserightsprotecttheindi&idual
from
go&ernmentalinterferenceinbasicareasoflife.A
protocolorprocedurepro&idesspecificguidelines
onperformingatask.1hepurpose
ofprotocolsandproceduresistoensurethatthere
isconsistent(soundpracticeinan
institution.
(nstitutional Policies and
Protocols
Institutionalpoliciespro&ideguidancein
theproperactionstobetakeninspecific
situations(
andidentifytheindi&idualsresponsiblefor
takingaction.
CLASSIFICATION OF LAWS

Criminal &aw
Addressesthegeneralwelfareofthepublic.A
&iolationofcriminallawiscalled
acrimeandisprosecutedbythego&ernment.<n
con&iction(acrimemaybepunishedby
imprisonment(paroleconditions(alossof
pri&ilege'suchasalicense;(afine(orany
combination
ofthese.
CRIMINAL LAW AND NURSING
) . 1he*urse%racticeActre5uiresthatactions
'suchasadministeringdrugs;beperformed
onlyunderthedirectionofaphysician(
* . A&iolationofaprofessionalpracticeact
maybeprosecutedasacrimee&enifnoactual
harmoccurredtothepatient.
+ . =yfindingminorerrorsthecriminalaction
couldresultinthelossofa/obandintheloss
ofalicensetopracticenursing..

,,
- . -iolationoflawsrelatedtothecareand
distributionofcontrolledsubstancesisalso
acrime.
..Alteringorchangingnarcoticrecordsisa
crimee&enifnodi&ersionofdrugsoccurred.
/.*urseswhocommitfeloniessuchastheft(
abuse(ordeliberateharmtoapatientare
alwayschargedunderbothcriminallawsandthe
.lawsregulatingnursingpractice

Civil &aw
:egulatesconductbetweenpri&ateindi&idualsor
businesses(andisenforcedthroughthecourtsas
damagesormoneycompensation.Atortisa
&iolationofaci&illawinwhichanotherpersonis
wronged.

C(0(& &' 12 1#$!(13

Torts
Areci&ilwrongscommittedbyone
personagainstanotherpersonora
.person0sproperty
1egligence
Isageneraltermthatreferstoconduct
thatdoesnotshowduecare.
A.Harmmustha&eoccurredtoan
indi&idual.
2.1henegligentpersonmustha&ebeenin
asituationwhereheorshehadaduty
towardthepersonharmed.
B.1hepersonmustbefoundtoha&efailed
tofulfillhisorherduty.
4alpractice
Isatermreferstothenegligence
speciallytrainedoreducatedperson
intheperformanceofhisorher/ob.
Italsousedtodescribenegligenceby
nursesintheperformanceof
theirduties.
&E3& (!!#E! C"44"1 (1 1#$!(13
2uty to $eport or !ee5 4edical Care for a
Patient
Anursewhoiscaringforapatienthasalegal
dutytoensurethatthepatientrecei&essafeand
competentcare.1hisdutyre5uiresthatthenurse
maintainanappropriatestandardofcareand
thatthenursetakeactiontoobtainan
appropriatestandardofcarefromother
professionals
whenthatisnecessary.
Confidentiality and $ight to
Privacy
"onfidentialityandtherighttopri&acy
withrespecttoone0spersonallifearebasic
concernsinoursociety.
2efamation of Character
(nyti"eth$tsh$redinfor"$tionis
detri"ent$lto$!erson3sre!ut$tion4the
!ersonsh$rin
theinfor"$tion"$ybeli$blefor
def$"$tionofch$r$cter.
(.5rittendef$"$tionisc$lledlibel.
0.Or$ldef$"$tionisc$lledsl$nder.
Privileged Communication
:eferstoinformationsharedbyan
indi&idualwithcertainprofessionals
thatdoesnotneedtobere&ealed.
(nformed Consent
E&erypersonhastherighttoeither
consent'agree;toortorefusehealthcare
treatment.
C"1!E1T %"$ 1#$!(13
4E!#$E!
C"4PETE1CE T" 3(0E
C"1!E1T
Aperson0sabilitytomake/udgments
basedonrationalunderstandingis
termedcompetence.
'(TH2$'(13 C"1!E1T
"onsentmaybewithdrawnafteritis
gi&en.%eopleha&etherighttochange
theirminds.
C"1!E1T 12 4(1"$!
1heparentorlegalguardianusually
pro&idesconsentforcareofaminor.
2" 1"T $E!#!C(TTE "$2E$!
?Donotresuscitate@'D*:;or?*o
"ode(@meaningthatnoresuscitation
effortsofanykindaretobemade.
1herewouldbeno"%:(no
resuscitati&e
drugs(andno&entilatorsupport.
!uit6Prone Patients
uit6pronepatientsusuallyare
identifiedbyo&ertbeha&iorinwhich
theyarepersistent
fault6findersandcriticsofpersonnel
andofallaspectsofcare.
!uit6Prone 1urses
A.*urseswhoareinsensiti&etothe
patient0scomplaints(
2.whodonotidentifyandmeetthe
patient0semotionalneeds(orwhofail
torecogni+eandacceptthe
limitsoftheirownpracticemay
contributetosuitsinstitutednotonly
againstthenursebut
alsoagainsttheemployerandthe
physician.
%CT"$! THT C"1T$(7#TE T"
4&P$CT(CE C&(4!

!ocial %actors
Healthcareisabigbusiness(and
patientscomplainincreasinglyofnot
beingacceptedand
respectedasindi&iduals.
dapting Proposed ssignments
*ursesmayfindthemsel&esassigned
tounitswheretheyha&elittle
ornoe#periencewiththetypesof
patientproblemstheywillencounter.
%ollowing Policies and
Procedures
%oliciesareoftendesignedtopro&ide
legaldirection.
Changing Policies and Procedures
"hangesareneededinpolicies(
procedures(andprotocols.%artof
yourresponsibility
asaprofessionalistoworktoward
keepingtheseuptodate.
2ocumentation
Documentationintherecordof
obser&ationsmade(decisionsreached(
actionstaken(andthee&aluationofthe
patient0sresponseareconsideredmuch
moresolide&idence
than&erbaltestimony(whichdependson
one0smemory.
Documentationneedstobefactual(
legible(andclearlyunderstandable.<nly
appro&edabbre&iationsshouldbeused.
E&E4E1T! "% &E3& CT("1
2iscovery
In&ol&esgatheringinformation
throughdocuments'suchaspre&ious
medicalrecordsandresultsofmental
andphysicale#aminations;(
interrogatories
'written5uestionsansweredunder
oath;(anddepositions.
Testimony
:eferstoanindi&idual0s&erbalorwritten
accountofasituation.
deposition
(s a formal proceeding in which each
attorney has an opportunity to
question
.a witness outside of court
$esearch finding related 8.
.1wohundredandforty6ninedeathsowingto
substanceo&erdosewerereportedtothe.edico6
$egal"entre(Dammam(audiArabiaintheF
yearperiodfromAGG3toAGGH.Allcaseswere
sub/ecttoafullforensicautopsywith
to#icologicalandhistologicalstudies.1he
o&erallmale9femaleratiowasH.G9Aandmales
predominatedinallagegroups.audis
outnumberedothernationalitiesandaccounted
forAGA'HHI;ofthecases.!ourmaincategoriesof
o&erdosefatalitieswereidentified9opiates(
prescribedmedication(alcoholandcarbon
.mono#ide
JJ
<piatesaccountedforAAK'CHI;ofallo&erdosedeaths(
althoughsuchfatalo&erdosesha&ebeendecreasingsince
AGGB..edically6prescribeddrugsaccountedforD3'23I;
ofthefatalities'2Adeathsfromantidepressants(AGfrom
tran5uilli+ers(fi&efromhypnotics(threefrom
paracetamolandtwofromamphetamines;.Ethylalcohol
accountedfor2Hdeaths'AAI;andcarbonmono#idefor2K
deaths'A3.DI;.1hisstudyshowsasharpfallino&erdose
fatalitiesineasternaudiArabiaduringthelastDyears(
whichprobablyreflectstheinfluenceofacombined
policyofstrictlegislationsagainstdrugtraffickingand
tightcontrolo&erprescriptionofdrugs
Conclusion
.References
.The ICN of Ethics for Nurses. ICN,2000
Toi! "!"r#, A. $200%&Le'!( , ethic!( )o(itic!( issue i Nursi' .2
"

.e".UAS.F.A.D!*is co+)!#
htt),,fs) .or' .s! ,e ,i"e- .ht+
.our!( of c(iic!( foresic +e"icie *o(u+e / , issue 0 ,M!rch 0111 ,)!'e 20
32%
.Ri"er , .4 E.$2002&.Nursi' i to"!# 5or" tre"s, issue4 +!!'e+et
0 esseti!( of ursi' (e!"ershi)4+!!'+et,% E"itio
L!c!ster.$0111&.Nursi' Issues i (e!"i' !" +!!'e+et ch!'e. USA6
.Mos7#