“LEGAL AND ETHICAL ISSUES”

INTRODUTION:-

The role of the nurse and professional nursing has expended rapidly within Past ten years to include expertise specialization, autonomy and accountability, both form legal and ethical perspective, this expansion has forced a new concern among nurses and a highest awareness of interaction of legal and ethical principles. Areas of concern including professional nursing practices, legal issues, ethical principles, labor management and employment.

CIVIL AND COMMAN LAW ISSUES IN NURSING PRACTICE:-TORTS:-

A tort is a civil wrong made against a person or property.torts may be classified as unintentional or intentional.

INTENTIONAL TORTS:- ASSUALT:- it is any intentional threat to bring about harmful or offensive contact.

No actual contact is necessary. the protects client who are afraid of harmful contact. It is an assault for a nurse to threaten to give a client an injection or to threaten to restrain a client for an X-Ray procedure when the client has refused consent. in a lawsuit wherein as Sault is alleged , the client’s consent would bar the claim of assault against a nurse.

BATTERY:-It is any any touching without consent. the contact can be harmful to the client and cause an injury, or it can merely offensive to the client’s personal dignity. A battery always includes an assault’s which is why the terms assault and battery are commonly combined. in the example of nurse threatening to give a client an injection without the client’s consent, if the nurse actually gives the injection, it is considered battery . Battery can also result if the health care provider performs a procedure that exceeds the client’s consent. For example, if the client gives consent for an appendectomy and the physician performs a tonsillectomy, battery has occurred.

INVASION OF PRIVACY:- The tort of invasion of privacy protects the client’s right to be free from unwanted instrusion into his or her private affair.clients are entitled to confidential health care. For example, in a classic case ,reporers published photographs of a female client in her hospital room without her consent. A claim for invasion of privacy was upheld. Another form of invasion of privacy is the release of a client’s medical information to an unauthorized person, such as a member of the press or client’s employer.

DEFAMATION OF CHARACTER:-Defamation of character is the publication of false statements that result in damage to a person’s reputation.

UNINTENTIONAL TORTS:- NEGLIGENCE:-Negligence is conduct that falls the standard of care. The standard

of care is established by law for the protection of others against an unreasonably great risk of harm. For example, if a driver of a car acts unreasonably in failing to stop at a stop sign, it is negligence.

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MALPRACTICE:- Malpractice is one type of negligence ;it is refere to as professional negligence. Nursing malpractice results when nursing care falls below the standard of care. Nurses can be found liable for malpractice if the following criteria are established:

o The nurse owed duty to the client;o The nurse did not carry out that duty;o The client was injured;ando The nurse’s failure to carry out the duty caused the injury.

LEGAL SAFEGUARD IN NURSING PRACTISE

LICENSURE:- All nurses who are in nursing practice have to passes a valid license, issued by the representative nursing council or Indian nursing council. There practice is controlled educational programme.

GOOD SAMARITAN LAW: - In response to health professional, fear of malpractice claims, most states enacted ‘Good Samaritan law’ that exempt doctors and nurses from liability when they render first aid during emergency.

GOOD RAPPORT:- Developing god rapport with the client is very important to prevent malpractice. A lawsuit is often circumvented when the nursing staff treats with warrants and caring. So nurse must never underestimate ‘rapport’ with the client in malpractice prevention. The ability to develop good rapport with clients is depends on the nurse having good interpersonal communication skills. E.g. listening

STANDARD OF CARE:- All professional practicing in the medical field are held to certain standard when administrating care comes from several sources including laws, organizational standard and institutional policies and procedures. It is always better to follow standards to avoid malpractice and do not attempt any thing beyond the level of competence.

STANDING ORDERS:- Although a nurse legally diagnose illness or prescribe treatment, he or she may after assessing patients condition, apply ‘standing order’ or treatment guideline that have been established doctor as appropriate for the certain problem and the condition. Nurse do not take chance, if there is any doubt arise, it is always better to follow written order instead of oral orders.

CONTRACT:- A contract is written or oral agreement between two people in which goods or services are exchanged. Section 13 to the Indian contract act defines the word that two or more people are said to consented when they agree upon the same thing in the same sense. Treating a patient without obtaining proper consent can lead to a chance of assault.

CONSENT FOR OPERATION AND OTHER PROCEDURE:- A patient coming in to the hospital still retain his/her right as a citizen and his entry only denotes his willingness to undergo an investigation or treatment of a serious nature, or an operation which needed anesthesia, requires the written consent of the patient if he has attain the age of 18 years or is a minor who has attain the age of 16 years.

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CORRECT IDENTITY:- All patient in general hospitals wear identity band, in order to prevent the mistakes. It is very important that correct band is given to each patient and these are normally checked as the part of the admission procedure. Every patient before giving pre medication for an operation should be labeled approved by the hospital. The nurse or midwife has the great responsibility to make sure that all the babies born in the hospital are correctly labeled at birth and to ensure that no time they are placed in wrong cot or wrongly handled.

COUNTING OF SPONGE, NEEDLE AND INSTRUMENT:- Nurse advocate that sponge, instrument and needle count should be performed for all surgical procedures taking place in operation theater. When an instrument or needle left in patient’s body, during surgery the operating room nurse will probably be liable for any patients injury caused by the presence of foreign body. The nurse have to carry out a final check before the body cavity is closed.

ACCIDENT OR INJURY: - If a patient sustain injury while in hospital, He may bring an action against the hospital authority or against a person (member of medical, nursing or ancillary staff) to whom he/she attributes a injury. An action may be brought away against the hospital even after the several years the accident occurred. It is therefore, necessary that at the time of incident an accurate and full record should be made on the special form provided.

SELF DISCARGE OF THE PATIENT:- When the patient demands to discharge himself, the duty of nurse is to inform the medical officer concern with his care. It is probable that that a senior administrative officer the patient and ask him to sign a written statement that he is leaving against the medical advise. If he refuses it, a note of this effect will have to be made and signed by two witnesses one of whom is usually a administrative officer and other is nurse-in charge at that time.

PROFFESIONAL CONFIDENCE:- Guarding the confidence of the patient is an ethical duty of the medical authority and nurses and it must take that it never should be discussed personal information received by the nature of their position, except with the senior members of the staff.DOCUMENTATION::-Documentation is by far the best one a lawsuit filled. Nurse should give them selves the credit from care they provide thoroughly documenting in the medical record. While documenting it is better to use formats of documentation for each activity specified by the respective institution or government.

REPORTING:- In some situation, nurses have obligation or are required to report certain communicable diseases or criminal activity such as abuse, gun shot wound, attempted suicide or rape to the appropriate authority.

Some “don’ts” and “do’s” for the nurse are as guideline for their safe practices.- Do documentation all unusual incidences.- Do report all unusual incidences.- Do follow policies and procedures as established by your employing agency.- Do keep current year license to practice.- Do perform procedures that you have taught and that are within the standard scope

of your practice.- Do not accept money or gifts from the patients.

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- Do not allow the client to leave the hospital unless there is an order or signed release.

- Do not medication advices to friends and neighbors.- Do not give advice that is contrary to doctor- Do not take medication that belongs to patient.- Do not work as a nurse, in a state where you are not licensed.

Legal Responsibility of nurse: Responsibility of quality control:- The nursing administrator and the authority of the agency at all levels have a legal obligation to ensure nursing care quality. usually the head nurse or ward in charge is responsible for quality of patient care given by all personnel including medical on the nursing unit, whether or not these individuals have direct reporting responsibility to the head nurse.

Responsibility for Equipment:- To patient and employees from injury, a nurse manager must ensure that all patient care equipments are fully functional and that defective equipment is promptly repaired or replaced. Responsibility for observation and reporting:- Nursing personnel have more frequent and prolonged patient contact than other care giver. the nurse has a duty to record and report observations of a patient’s condition promptly ,so that the physician can base treatment ,decision on up to date information about the patient’s health needs. Responsibility of protect public:- The nurse has a legal duty to protect the public from injury by dangerous patient. Responsibility for record keeping and reporting:- Nurses have legal responsibility for accurately reporting and recording patient conditions, treatments and responses to care. the medical record is an information source document that should be used to plan care, to evaluate care ,allocate costs, educate personnel ,research care measures, and substantiate legal claim. Responsibility for death and dying:- There are many issues surrounding the events of death .death occurs when there is an absence of brain function ,despite functions of other body organs .however ,nurses must be aware of legal definition of death because they must document all events that ,when the patient is in their care.

Roles and function 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. Fosters nurse/patient relationships that are respectful, caring and honest ,thus

reducing the possibility of future lawsuits .4. Practices nursing within the area of individual competence.5. Priorities patient’s rights and welfare first in decision making.6. Is knowledgeable responding sources of law and legal doctrines that affect nursing

practice.

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7. Understands and adheres to institutional policies and procedures.8. Practice nursing within the scope of the state nurse practice act.9. Provide educational and training opportunities for staff on legal issues affecting

nursing practice.

ETHICAL ASPECTS OF NUSING

Introduction:- Ethics is the science relating to moral actions and one’s value system. Many nurses envision ethics are dealing with principles or morality and what is right or wrong. Ethics are concern with motives and attitudes and the relationships of these attitudes for the individuals. Ethics are always been an integral part of nursing. Through out the nursing one can find the code of ethics, statements of moral principles, maintaining of high ideas, and recorded decision of moral ethical issues. Nursing ethics provide the statement of the standard for professional behavior and is the study of principles of right and wrong conduct for nurses. CODE OF ETHICSA code of ethics serves as a mean of self regulation and a source of guideline for individual behavior and responsibility. Professional codes of ethics are a system of rules and principles by which that profession is expected to regulate its responsibility to society. Code of ethics for nurses is as follows:-

NURSES AND PEOPLE:- The nurse’s primary responsibility to those people who require nursing care. The nurse provides care, promote an environment in which the values, customs and

spiritual beliefs of the individual. The nurse holds confidence, personal information and uses judgment in sharing their

information.

NURSES AND PRACTICE:- The nurse carries personal responsibility for nursing practice and for maintaining

competence.

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The nurse uses judgment in relation to individual competence when accepting the delegating responsibilities.

The nurse when acting a professional capacity should at all time maintaining standards of professional standard.

NURSES AND SOCIETY:- The nurse shares with other citizens and responsibility for initiating and supporting

action to meet the health and social need of the public.

NURSES AND COWORKER:- The nurse sustains a co-operative relationship within nursing and other field. The nurse take appropriate action to safe guard the individual when his/her care

endangered by coworker or any other person.

NURSES AND THE PROFESSION:- The nurse plays the major role in determining implementing desirable standards of

nursing practice and nursing education. The nurse is active in developing a care of professional knowledge.

ETHICAL PRINCIPLESEthical principles actually professionalism in nursing practices much more than to ethical theory. Ethical principles that are the nurses should follow when making decisions are as follows:-

1. Respect for persons:-It directs individuals to treat themselves and other ,with a respect inherent to man’s humanness.

2. Respect for autonomy:-Autonomy means that are able to act for themselves to the level of their capacity. it is the right of individuals, governing their actions according to their own purpose and reason

3. Respect for freedom:-This principle of individual freedom decreases that patients be exempt from control by others to select and pursue personal health goal.

4. Respect for beneficence:-the beneficence principle states that the actions one takes should promote good. it dictates that a person is obliged to help other to advance their legitimate and important interests.

5. Respect for non mal efficiency:-The corollary beneficence, the principle of non maleficence states that one should do no harm. the nurse should interpret the term harm to mean emotional and social as well as physical injury.

6. Respect for veracity:-It requires professional care giver to provide with accurate, reality based information about their health status and care or treatment prospect ion.

7. Respect for justice:-This principle of justice requires treating other fairly and giving their due.

8. Respect for rights:-Right is an entitlement to behave in a certain way under circumstances, such as nurses entitlement to freely express personal beliefs and preferences by voting in a political election.

9. Respect for fidelity:-Fidelity is keeping one’s promises or commitments. the principle of fidelity holds that a person faithfully fulfill his duties and obligations.

10. Confidentiality:-It is the duty to respect privileged information.

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ROLE AND FUNCTIONS OF NURSE IN ETHICAL ISSUES

Takes appropriate action when subordinates use unethical conduct. Recognizes and rewards ethical conduct of subordinates. Actively advocates for clients ,subordinates and the profession.

He or she is self aware regarding own values and basic beliefs about the rights, duties and goals of human being.

Accept that uncertainly must be a part of all ethical decision making. Accept that negative outcome occur in ethical decision making. Actively advocate for clients, subordinates and the profession. Clearly communicates expected ethical standard of behavior. Uses a systematic approach to problem solving or the decision making when faced

with management problem. Clearly communicates expected ethical standards of behavior.

Conclusion:-Safe nursing practice includes an understanding of the legal boundaries within which

nurse must function.Ethics are always been an integral part of nursing. Throughout the nursing one can

find the code of ethics, statements of moral principles, maintaining of high ideas, and recorded decision of moral ethical issues.

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BIBLIOGRAPHY:

1) “Basavanthapa B.T.”Nursing administration”, legal and ethical issues in nursing,Published by Jaypess at New Delhi, Page no. 474-510.

2) Potter and perry ,Fundamental of nursing, legal implication in nursing practice,5 th

edition,page no.422-427,435-438.

3) Alphosa Jacob, Fundamental of nursing ,Chapter 4,vol. 1,page no.28-29

4) http://www.ukessays.com/essays/nursing/legal-ethical-professional.php

5) http://www.docstoc.com/docs/9482486/Legal-and-Ethical-Issues-in-Nursing-and-Healthcare.

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