Académique Documents
Professionnel Documents
Culture Documents
Ethics is about:
Meaning and value
Making choices
Along with rules, laws, a code of
ethics, a set
of principles
Doing right or doing the right thing
Focused on the welfare of others
Active work
Reflect on what is important
meaningful or
valuable
Make choices that support value(s),
make
those values more real and more
COMMON ISSUES
Clinical : patient and family issues
Patient rights
Advance directives
Surrogate decision making
Goals of care
Code status
End of life
Culture and religion
Mediation
COMMON ISSUES
Organisational : Hospital and system
health
Allocation of resources
Conflict resolution
Conflicts of interest
Confidentiality
Research
Public action
PRINCIPLES
Beneficience
~ best interest of pt.
Non-maleficience
~ first do no harm
Respect for autonomy
~ pts right for treatment or refusal of
Rx
Justice
~ fairness & equality
Dignity
Truthfulness & honesty
Emphasis
Maintaining relationship
Maintaining dignity
Collaborative care
Beneficience
this means taking actions that serve the best
interests of patients.
Eg : ~ by ensuring that hot water bag,
given to the patient, is covered
properly, and closed tightly.
~ no smoking zone poster when
the patient is on oxygen.
~ putting railing of bed to prevent fall.
~ health education to an antenatal mother
about
the Antenatal check up and preparation
and
care of new born.
Non-maleficience
that it is more important not to harm
your patient, than to do them good.
that patient understands the risks and
benefits, and that the likely benefits
outweigh the likely risks.
Double effects ~ eg Morphine in dying
pt
Respect of autonomy
Patient enabled to make decisions
about their care
Concept of informed consent
including advance directive
Confidentiality
Truth telling
Informed consent
refers to the idea that a person must be fullyinformed about and understand the potential
benefits and risks of their choice of treatment
Patients can elect to make their own medical
decisions, or can delegate decision-making
authority to another
If the patient is incapacitated ; having a
person appointed by the patient or their
next of kin make decisions for them.
A correlate to "informed consent" is the
concept of informed refusal.
Confidentiality
concept is commonly
known as patientphysician privilege.
Legal protections prevent
physicians from revealing
their discussions with
patients, even under
oath in court.
Should the nurse inform
to the patients spouse
about the HIV positive
status?
Legal Responsibility
Legal responsibility refers to the
ways in which a nurse is expected
to follow the rules and regulations
prescribed for nursing practice.
Licensure ~ insuring basic
competence in nursing practice.
Responsibility of the
nurse
The main responsibilities of a nurse are
to provide care based on nursing
diagnosis, prioritizing the needs;
planning, implementing and evaluating
the nursing care.
provides care to the patient based on
needs, respect, dignity and right without
considering race, nationality, caste,
creed, colour or socio economic status.
NEGLIGENCE AND
MALPRACTICE
Definitions
Malpractice is professional
negligence when the conduct fails to
meet the legal standard of care and
someone is damaged as a result.
any unreasonable lack of skill in
professional duties or illegal or immoral
conduct that result in injury or
death to the client/consumer.
ELEMENTS OF A
LAWSUIT
DUTY - A nurse-client relationship
Examples of negligence
harmful objects left near the patient with
suicidal ideation
not following Five R (Rights) and causing harm
to the patient by giving wrong medicine
causing thermal, chemical, physical injuries to
the patient
fall of patient, under sedation, after operation
recovering from anesthesia, semiconscious
state, and person suffering from dizziness
failure to observe and take appropriate action
failure to inform to the team members about
untoward effect observed in patient
absconding of patient
loss/damage of patients property
foreign object left in patients body during the
surgery due to wrong counting
delay in obtaining help for patient
D AMA(DischargedAgainst
Medical Advice or AOR D/C)
If the patient is in a critical condition, as a Nurse, your
responsibility is to:
1) explain about the critical condition of the patient
to relatives,
2) inform the medical officer, and get it written from
the medical officer that patient can go on LAMA,
3) signature of relative should be taken in which s/he
writes
that s/he is taking full responsibility of taking away the
patient, that the Doctors and nurses have explained the
critical condition, and the risk of taking away the
patient,
4) if it is a hospital policy, the life support system should
not be
withdrawn,
5) all the records should be kept under lock and key.
Absconding
If the patient runs away from the ward/hospital,
it becomes a major responsibility of a nurse. To
avoid this problem you must remember the
following:
Check the number of patients admitted, with
the actual number of patients present in the
ward while handing over, and taking over,
during change of shifts.
Inform immediately the CMO, if any patient is
reported absconded, in writing and get is signed.
Record of absconded patient should be kept
under lock and key.
Examination of Female
Patient