2. The roots of true achievement lie in the will to
become the best that you can become."
MORNING.....
Every Little Smile can touch Somebody's heart
May U find hundreds of reasons to smile today and
May U be the reason for someone else to smile always
Have a nice day....
3. Somashekhar.R.K.
BY
“LEGAL & ETHICLA ISSUES IN
NURSING”
“SDM INSTITUTE OF NURSING SCIENCES, SATTUR
DHARWAD.
Medical & Surgical Nursing
Department
Nursing Administration
Presentation
4. INTRODUCTION
The Consumers are patients with complex needs.
With increased awareness of health care, health care
facilities and Consumer protection Act, patients are
getting aware about their rights. Nurses also have now
the expanded role. Issues which seem not feasible, and
ideal, may become practice with the change of time.
These issues are base for the future trends in care
5. KEY WORDS
LAWS- Law is a system of rules that are created and enforced
through social or governmental institutions to regulate behavior.
VALUES- In ethics, value denotes the degree of importance of
some thing or action, with the aim of determining what actions
are best to do or what way is best to live.
MORAL- It is concerned with the principles of right and wrong
behaviour.
RIGHTS- Rights are legal, social, or ethical principles of
freedom or entitlement
6. ETHICAL SYSTEM
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 is a guideline for performance and standards and
personal responsibility.
-Lillie M S and Juanita Lee
7. 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
8. 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.
9. LEGAL SYSTEM
MEANING OF LEGAL
Established by or founded upon law or official or
accepted rules
• DEFINITION OF LAW
The law us a system of rights and obligations which the state
--Green
10. SOURCES OF LAW
STATUTORY LAW
COMMON LAW
ADMINISTRATIVE
LAW
15. CRMINIAL LAW
Developed to protect society
THERE ARE THREE (3) CATEGORIES:
(1)FELONY (most serious! Includes
violating the nurse practice act)
(2) MISDEMEANOR (lesser offenses, such as a traffic violation)
(3) JUVENILE (crimes committed by those under the age of
eighteen)
16. A nurse may break a
crminial law and be tried in
crminal court!!!!!!!!!!!!
Examples:illegally distributing
controled substances or
altering a patient’s record
17. CIVIL LAW
Law that is administered between citizen
and citizen
Usually involve the violation of one
individual’s rights by another individual
Tort is a type of civil law
18. TORT
A civil/legal wrong committed against a person
or property and is punishable by damages
(monetary) not imprisonment
Negligence is a type of tort (malpractice is the
term for professional negligence!)
19. FOUR LEGAL ELEMENTS OF
NEGLIGENCE
(1) Duty
(2) Breach Of Duty
(3) Causation
(4)Harm All Four Of These
Components Must Be
Involved To Prove
Negligence!!
20. WHAT IS THE NURSE
PRACTICE ACT???????
The nurse practice act is the law!
The administrative rules are how the board of
nursing enforces the law
Know your practice act and rules in any state
that you are licensed and practicing nursing
21. APPLICATION OF THE
NURSE PRACTICE ACT
Sexual harassment
Workplace violence
End of life decisions
Advanced directives
Confidentiality
Informed consent
Malpractice issues
Whistleblower protection
Organ donation
Abandonment
22. SEXUAL HARASSMENT
Laws that prohibit discrimination in the workplace
are based on the fifth and fourteenth amendments to
the constitution!
23. Title vii of the civil rights act of 1964 identified two
forms of sexual harassment
(1) QUID PRO QUO (sexual favors are given in
exchange for job security/benefits)
(2) HOSTILE ENVIRONMENT (harassment is based on
gender and creates an offensive workplace causing the
employee not to be able to effectively discharge the
responsibilities of the job)
24. IF THE NURSE IS A VICTIM OF
SEXUAL HARASSMENT
The ANA Suggests Four Tactics:
(1) Confront The Harasser
(2) REPORT TO THE SUPERVISOR (File A Formal
Complaint)
(3) DOCUMENT THE INCIDENT (Name Any Witnesses)
(4) SEEK SUPPORT FROM FRIENDS,FAMILY, AND
ORGANIZATIONS (Such As The ANA)
25. Nurses who engage in sexual harassment
of others are guilty of intentional torts and civil
rights claims. They are guilty of intentional
infliction of emotional distress. Further, they
have violated the nurse practice act!!!!!!!!!!!!!
26. SEXUAL HARASSMENT
Do not dismiss any sexual
harassment as “just having
fun”!
A response like this can
have serious
consequences!!!!
27. VIOLENCE IN THE
WORKPLACE
Nurses have been identified as a group
at risk for violence from patients, family
members, and other staff members
28. VIOLENCE IN THE WORKPLACE
MAY INCLUDE THE FOLLOWING:
(1) THREATS (making expressions of intent to harm
others) (this may include verbal threats, written threats,
or threatening body language)
(2) PHYSICAL ASSAULTS (slapping, beating, rape,
using weapons)
(3) MUGGINGS ( assaults with the intent to rob)
29. SUGGESTIONS FOR NURSES TO
IMPROVE WORKPLACE SAFETY
PARTICIPATE IN WORKPLACE ASSESSMENTS (identify
unsafe areas as well as factors that might contribute to violent
behaviors)
ALWAYS BE ALERT FOR SUSPICIOUS BEHAVIOR
(threatening body language, drug/alcohol use, a weapon)
MAINTAIN BEHAVIOR THAT DE-FUSES ANGER
(acknowledge the person’s feelings, remain calm)
If the situation cannot be de-fused, quickly leave and call
security
30. If The Nurse Is The Victim Of Workplace
Violence, He/She Should Do The Following:
Report the incident to the supervisor
Call the police
Get medical attention
Contact your state nurses association
Be proactive!!
31. END OF LIFE DECISIONS
DNR (do not resuscitate) orders or no code
orders are a form of withholding treatment
Only physicians can write a DNR, usually after
consulting with the patient (when possible) and
the family. All members of the health care
team are expected to comply with the order!!!
32. DO NOT RESUSCITATE
A DNR permits health care
providers to withhold only
treatment related to
resuscitation. Does not
apply to withholding
nourishment, hydration, or
ivf’s
34. ADVANCED DIRECTIVES
A document that makes one’s wishes
known concerning medical life-support
measures in the event that one is
unable to speak for oneself.
35. THE PATIENT SELF-
DETERMINATION ACT OF 1990
This law was passed to provide guidelines for
developing advanced directives. Healthcare
facilities/agencies are required to ask patients
about advance directives. Most facilities/agencies
will provide the necessary forms for patients to fill
out if they wish to set up advanced directives.
36. ADVANCE DIRECTIVES
the two most common forms:
1.the living will
2.healthcare surrogate (durable power of
attorney)
37. LIVING WILL
A legal document stating an
individual’s wishes regarding
“life support” in the event that
this individual becomes
incompetent in making informed
treatment decisions and is
suffering from a terminal
condition
38. HEALTHCARE SURROGATE/PROXY
(durable power OF attorney)
A document authorizing
another person to act on
one’s behalf. This person
makes known the patient’s
wishes to medical
personnel
39. CONFIDENTIALITY
The act of holding information in
confidence. It is not to be released to
unauthorized individuals!!!!!!!!
All information concerning patients should
be given only in private, secluded areas!!!!
40. CONFIDENTIALITY
Nurses who fail to maintain
confidentiality, are guilty of
violating the nurse practice
act as well as hipaa (health
insurance portability and
accountability act of 1996)
41. INFORMED CONSENT
The patient has given permission either
expressed (orally or written) or implied for the
physician to examine him/her, to perform tests
that aid in diagnosis, and/or to treat for a
medical condition.
42. INFORMED CONSENT IMPLIES THAT THE
PATIENT UNDERSTANDS THE FOLLOWING: (it is
the responsibility of the MD to explain this)
Proposed mode of treatment
Reason treatment is necessary
Risks involved
Alternative modes of treatment
Risks of alternative modes of
treatment
Risks involved if treatment is
refused
43. Nurses are often responsible for getting consent forms
signed!
Nurses must be sure that a patient is considered able or
competent to make informed decisions (competency is
defined differently from state to state)
If the patient does not understand the procedure and/or
treatment or expresses uncertainty, contact the
physician!!!!
44. MALPRACTICE ISSUES (COMMON ACTS
OF NEGLIGENCE)
(1) medication errors
(2) failure to monitor (observe) and take appropriate action
(3) failure to communicate
(4) falls
(5) FOREIGN OBJECTS LEFT IN PATIENTS (post-surgery)
(6) burns
(7) BLOOD ADMINISTRATION (failing to follow proper policies/procedures)
(8)altering a patient’s record
(9) failure to report a co-worker’s negligence
(10)FAILURE TO PROVIDE PROPER EDUCATION (teaching) TO A
PATIENT
(11) defects in equipment
45. WHISTLEBLOWER
STATUTES
This provides protection for nurses from
retaliatory action
Who report their employers, other health
care professionals, or other agencies.
(These statutes differ from state to state)
46. Examples Of Statutes Involving A
Duty To Report:
(1) Evidence of child or adult abuse
(2) Deaths under suspicious circumstances
(3) Injuries caused by violence
(4) Illegal, substandard, unethical, unsafe or
incompetent practice
47. ORGAN DONATION
The uniform anatomical gift act
(1968, 1987) allows people 18
years of age or older and of
sound mind to make a gift of all
or any part of their own bodies
for medical education, research,
or transplantation.
48. ORGAN DONATION
Some patients carry a card they have
signed stating they wish to be an
organ donor
Some have indicated they wish to be
an organ donor on their driver’s
license
Nurses may serve as a witness for
patients consenting to donate organs
Patients may revoke their decision by
(1)destroying the card or (2)orally
retracting their desire to be a donor in
the presence of two witnesses
49. ORGAN DONATION
Nurses are required by law to contact the
alabama organ center and the eye bank when
a patient expires. THESE
ORGANIZATIONS DETERMINE (based
on pre-determined criteria) IF THE
INDIVIDUAL IS A CANDIDATE FOR
ORGAN DONATION. If these
organizations determine that the individual
meets the criteria, then the nurse approaches
the family to discuss the possibility of organ
donation!
50. ABANDONMENT
Acceptance of a patient assignment, thus
establishing a nurse-patient relationship, and
then ending the relationship without giving
reasonable notice to supervisory personnel, so
that others can make arrangements for
continuation of nursing care!!!
51. ABANDONMENT
To be guilty of abandonment is a violation of the
nurse practice act!!!!
52. TAKE HOME MESSAGE
From we were very young we begin to learn what
was right and what wrong behaviour was. We learned this
from our parents, relatives, friends and teachers. By the
time we became adults, we had a personal set of ethics to
guide our behaviour in daily life.
54. CODE OF ETHICS
Within any given profession, a code of ethics serves
as a means of self- regulation and a source of guidelines for
individual behaviour and responsibility.
Professional codes of ethics are a system rules and
principles by which that profession is expected to regulate
its members and demonstrate its responsibility to the
society.
55. NURSING CODE OF ETHICS
Provides values, standards, and
principles to help nursing
function as a profession
The original code was developed
in 1985 by the ANA board of
directors and the congress on
nursing practice
56. ICN CODE OF ETHICS
1. Nurses and people
2. Nurses and practice
3. Nurses and Society
4. Nurses and Co-workers
In India, nurses are following the
international council of Nurses Code for Nurses
1993, revised in 2000 as mentioned above
57. ICN RECOMMENDATION
1) To promote health
2) To prevent illness
3) To restore health
4) To alleviating suffering.
58. 1. Nurses and people
The nurses provides care, values customs and
spiritual beliefs of the individual are respected
Keeps information confidential, and use the
judges in sharing their information.
59. 2. Nurses and practice
The nurse when acting in a professional capacity
should ensure all times maintain standards of
personal conduct which reflect created upon the
profession & practice properly
Nurse should carries personal responsibility for
nursing practice and competence by continuous
learning
60. 3. Nurses and Society
Nurse is also responsible for providing care
keeping in mind needs of the society
The nurse with other citizens the responsibility for
initiating and supporting action to in edit the
health and social needs of the public
61. 4. Nurses and Co-workers
The nurse sustain a co-operative relationship
with co-workers in nursing practice and nursing
education
The nurse is active in developing a care of
professional knowledge
62. American Nurses Association Code of Ethics for Nurses
1911
1. The nurse in all professional relationship practices with
compassion and respect for the inherent dignity, worth
and uniqueness of every individual, economic status
personal attributes or the nature of health problems.
2. The nurse primary commitment is to patient, whether
an individual, family, group or community
3. The nurse promote, advocates for the strives to protect
the health, safety and rights of the patient.
63. CODE OF PROFESSIONAL CONDUCT (FOR NURSES IN
INDIA)
1. Professional responsibility and accountability
2. Nursing Practice
3. Communication and interpersonal relationships
4. Valuing human being
5. Encourages, Respect and supports individual
64. 1.Professional responsibility and accountability
Nurse Maintains standards of personal conduct.
It is accountable for his/her own decisions and
actions.
It is responsible for the continuous improvement
of current practices
65. 2. Nursing Practice
Provide care in accordance with set standards of
practice
Treats all individuals and families with human
dignity. Ensures safe practice
66. 3. Communication and interpersonal
relationships
Establishments and maintains effective interpersonal
relationships with individuals families and communities
Upholds the dignity of team members and maintain
effective interpersonal relationship with them
Cooperates with other health professionals to meet the
needs of individual, families and communities
67. 4. Valuing human being
Encourages, Respect and supports individual in
her right to speak for themselves on issues
affecting health and welfare
Take appropriate action to protect individuals
from harmful unethical practices
Respects and supports made by individuals
68. 5. Management
Proper management of resources is essential for
improving the over all efficiency of the nurse.
Participate in performance appraisal
Participates in evaluation of nursing services
Ensure appropriate allocation and utilization of
available responses
69. 6. Professional advancement
1. Ensure the protection of human rights, while perusing
the advancement of knowledge
2. Participate in determining and implementing quality
care
3. Take responsibility of updating one’s own knowledge
and competencies.
4. Contributing to the core of professional knowledge and
conducting, participating in research.
70. PATIENT CARE ISSUES
Nursing covers a wide range of disciplines and
heal the care
Isues that are always changing and at the
forefront of what guides this career path.
71. MEDICO LEGAL ISSUES
1. DUTY TO SEEK MEDICAL CARE FOR THE PATIENT
It is the legal duty of the nurse to ensure that every patient receives
safe and competent care
If a nurse determine that a patient in any setting needs medical
care, and she does not do everything within power to obtain that
care for the patient, you have breached your duty as a nurse
73. 3. PERMISSION TO TREAT
When people are admitted to hospitals, nursing homes, and
home health services, they sign a document that gives the personnel in
the organization and
permission to treat them
75. 5. NEGLIGENCE
Negligence occurs when a person fails to perform according to the
standards of care person would perform in the same situation. It is the
responsibility of the nurse to monitor the patient.
77. 7. ASSAULT
Assault is the threat of unlawful touching of another, the willful
attempt to harm someone.
Assault can be verbally threatening a patient
78. 8. FALSE IMPRISONMENT
Preventing movement or making a person stay in a place without
obtaining consent is false imprisonment.
79. 9. INVASION OF PRIVACY
Clients have claims for invasion of privacy , e.g.
their private affairs, with which the public has no
concern, have been publicized.
80. PATIENT SATISFACTION
PATIENT- Patients expect their doctors to
keep up the timings, behave co-ordinally,
and communicate in their language. They
expect care, concern, and courtesy in
addition to a good professional job
81. Hospital
Good Telephone service
Good Office appearance
Minimizing Waiting time
More Doctor-patient interaction
Proper Patient education
Feedback
85. ISSUES IN NURSING CURRICULUM
DEVELOPMENT
It includes validation of curriculum or
judgemental process
Providing professional education and
preparation of participants
Updating & upgrading recent knowledge
86. C. EMPLOYMENT ISSUES
1. Issues related to nursing shortage
2. Issues in nursing migration
3. Essential terms and conditions in an employment
contract
4. Unsatisfactory work performance and termination
of employment
6. Misconduct and imposition of Punishment
87. Renewal of nursing registration
Diploma vs degree in nursing for registration to
practice nursing
Specialization in clinical area
88. PATIENT’S RIGHTS
In 1973, the American hospital association
published a statement known as the “patient’s
bill of rights”
It is now known as “your rights as a hospital
patient”
89. “YOUR RIGHTS AS A HOSPITAL PATIENT”
This document reflects the
acknowledgement of the
patient’s right to actively
participate in his/her health
care and to communicate
openly with the health care
team
90. ROLE AND FUNCTIONS OF NURSE MANAGER
IN LEGAL ISSUES.
1. Serves as a role model by providing nursing care that meets or
exceeds accepted standards of care.
2. Reports substandard nursing care to appropriate authorities
3. Practices nursing within the area of individual competence
4. Prioritizes patients right and welfare first in decision making
5. Delegates to subordinates wisely, looking at the managers scope of
practice and that of those they supervise.
91. TAKE HOME MESSAGE
Nurses play an integral role in the healthcare system. This is
why they have been correctly referred to as the heart of healthcare.
Being a nurse is one of the most demanding professions in the
world and needs a lot of dedication and commitment to the job.It is
a nurse’s professional responsibility to remain safe and competent
by being a lifelong learner and provide effective care to patient to
avoid medico legal issues, employment issue can be avoided by
proper recruitment system, staffing & keeping adequate salary.
