ETHICO-MORAL ASPECTS IN NURSING

Ethos - comes from Greek work w/c means character/culture - Branch of Philosophy w/c determines right and wrong Moral - personal/private interpretation from what is good and bad. Ethical Principles: 1. Autonomy the right/freedom to decide (the patient has the right to refuse despite the explanation of the nurse) Example: surgery, or any procedure 2. Nonmaleficence the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social) 3. Beneficence- for the goodness and welfare of the clients 4. Justice equality/fairness in terms of resources/personnel 5. Veracity the act of truthfulness 6. Fidelity faithfulness/loyalty to clients Moral Principles: 1. Golden Rule 2. The principle of Totality The whole is greater than its parts 3. Epikia There is always an exemption to the rule 4. One who acts through as agent is herself responsible (instrument to the crime) 5. No one is obliged to betray herself You cannot betray yourself 6. The end does not justify the means 7. Defects of nature maybe corrected 8. If one is willing to cooperate in the act, no justice is done to him 9. A little more or a little less does not change the substance of an act. 10. No one is held to impossible Law rule of conduct commanding what is right and what is wrong. Derived from an Anglo-Saxon term that means that which is laid down or fixed Court -body/agency in government wherein the administration of justice is delegated. Plaintiff complainant or person who files the case (accuser) Defendant accused/respondent or person who is the subject of complaint Witness individual held upon to testify in reference to a case either for the accused or against the accused. Written orders of court 1. Writ legal notes from the court A. Subpoena

1. Subpoena Testificandum a writ/notice to an individual/ordering him to appear in court at a specific time and date as witness. 2. Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all important documents Summon notice to a defendant/accused ordering him to appear in court to answer the complaint against him Warrant of Arrest - court order to arrest or detain a person Search warrant court order to search for properties. Private/Civil Law body of law that deals with relationships among private individuals Public law body of law that deals with relationship between individuals and the State/government and government agencies. Laws for the welfare of the general public. Private/Civil Law : 1. Contract law involves the enforcement of agreements among private individuals or the payment of compensation for failure to fulfill the agreements Ex. Nurse and client nurse and insurance Nurse and employer client and health agency - an agreement between 2 or more competent person to do or not to do some lawful act. - it maybe written or oral= both equally binding Types of Contract: 1. Expressed when 2 parties discuss and agree orally or in writing the terms and conditions during the creation of the contract. Example: nurse will work at a hospital for only a stated length of time (6 months),under stated conditions (as volunteer, straight AM shift, with food/transportation allowance) 2. Implied one that has not been explicitly agreed to by the parties, but that the law considers to exist. Example: Nurse newly employed in a hospital is expected to be competent and to follow hospital policies and procedures even though these expectations were not written or discussed. Likewise: the hospital is expected to provide the necessary supplies, equipment needed to provide competent, quality nursing care.

Feature/Characteristics/Elements of a lawful contract: 1. Promise or agreement between 2 or more persons for the performance of an action or restraint from certain actions. 2. Mutual understanding of the terms and meaning of the contract by all. 3. A lawful purpose activity must be legal 4. Compensation in the form of something of value-monetary Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant 1. Tort law is a civil wrong committed against a person or a persons property. - person/persons responsible for the tort are sued for DAMAGES - Is based on : ACT OF COMMISSION something that was done incorrectly or ACT OF OMMISION something that should have been done but was not. Classification of Tort 1. Unintetional a. Negligence misconduct or practice that is below the standard expected of ordinary, reasonable and prudent person - failure to do something due to lack of foresight or prudence - failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance. - An act of omission or commission wherein a nurse fails to act in accordance with the standard of care. Doctrines of Negligence: 1. Res ipsa loquitor the thing speaks for itself the injury is enough proof of negligence 2. Respondeat Superior let the master answer command responsibility 3. Force majuere unforeseen event, irresistible force b. malpractice stepping beyond ones authority

6 elements of nursing malpractice: 1. duty the nurse must have a relationship with the client that involves providing care and following an acceotable standard of care. 2. breach of duty the standard of care expected in a situation was not observed by the nurse -is the failure to act as a reasonable, prudent nurse under the circumstances -something was done that should not have been done or nothing was done when it should have been done 3. foreseeability a link must exist between the nurses act and the injury suffered 4. causation it must be proved that the harm occurred as a direct result of the nurses failure to follow the standard of care and the nurse should or could have known that the failure to follow the standard of care could result in such harm. 5. harm/injury physical, financial, emotional as a result of the breach of duty to the client Example: physical injury, medical cost/expenses, loss of wages, pain and suffering 6. damages amount of money in payment of damage/harm/injury II. Intentional Tort Unintentional tort do not require intent bur do require the element of HARM Intentional tort the act was done on PURPOSE or with INTENT - No harm/injury/damage is needed to be liable - No expert witnesses are needed

1. Assault an attempt or threat to touch another person unjustifiably Ex.: A person who threatens someone with a club or closed fist. Nurse threatens a client with an injection after refusing to take the meds orally. 1. Battery willful touching of a person, persons clothes or something the person is carrying that may or may not cause harm but the touching was done without permission, without consent, is embarrassing or causes injury. Example: a nurse threatens the patient with injection if the patient refuses his medsorally. If the nurse gave the injection without clients consent, the nurse would be committing battery even if the client benefits from the nurses action. 1. False Imprisonment unjustifiable detention of a person without legal warrant to confine the person - occurs when clients are made to wrongful believe that they cannot leave the place Example: Telling a client no to leave the hospital until bill is paid Use of physical or chemical restraints False Imprisonment Forceful Restraint=Battery 1. Invasion Of Privacy intrusion into the clients private domain -right to be left alone Types of Invasion the client must be protected from: a. use of clients name for profit without consent using ones name, photograph for advertisements of HC agency or provider without clients permission b. Unreasonable intrusion observation or taking of photograph of the client for whatever purpose without clients consent. c. Public disclosure of private facts private information is given to others who have no legitimate need for that. d. Putting a person in a false/bad light publishing information that is normally considered offensive but which is not true. 1. Defamation communication that is false or made with a careless disregard for the truth and results in injury to the reputation of a person

Types: a. Libel defamation by means of print, writing or picture Example: writing in the chart/nurses notes that doctor A is incompetent because he didnt respond immediately to a call a. Slander defamation by the spoken word stating unprivileged (not legally protected) or false word by which a reputation is damaged Example: Nurse A telling a client that nurse B is incompetent - person defamed may bring the lawsuit - the material (nurses notes) must be communicated to a 3rd party in order that the persons reputation maybe harmed Public Law: 1. Criminal Law deals with actions or offenses against the safety and welfare of the public. a. b. c. d. e. f. homicide self-defense arson- burning or property theft stealing sexual harassment active euthanasia illegal possession of controlled drugs

Homicide killing of any person without criminal intent may be done as self-defense Arson willful burning of property Theft act of stealing

Professional Adjustment/Negligence
Professional Negligence refers to the commission or omission of an act, pursuant to a duty, that a reasonably person in the same or similar circumstance would or would not do, and acting or the non-acting of which is the proximate cause of injury to another person or his property Elements of Professional Negligence

Existence of a duty on the part of the person charged to use due care under circumstances Failure to meet the standard of due care The foreseeability of harm resulting from failure to meet standard The fact that the breach of this standard resulted in an injury to the plaintiff

Specific Examples of Negligence 1. Failure to report observations to attending physicians. 2. Failure to exercise the degree of diligence which the circumstances of the particular case demands. 3. Mistaken identity. 4. Wrong medicine, wrong concentration, wrong route, wrong dose. 5. Defects in equipments that may result in injuring the patients. 6. Errors due to family assistance. 7. Administration of medicine without a doctor prescription. The Doctrine of Res Ipsa Loquitor 1. The thing speaks for itself. 2. It means that the nature of the wrongful act or injury is suggestive of negligence 3. Three conditions are required to establish a defendants negligence without proving specific conduct.

That the injury was of such nature that it would not normally occur unless there was a negligent act on the part of someone. That the injury was caused by an agency within the control of the defendant That the plaintiff himself did not engage in any manner that would tend to bring about the injury.

Malpractice

you do things beyond your scope of practice also denotes stepping beyond ones authority with serious consequences.

Doctrine of Force Majeure

It means an irresistible force, one that is unforeseen or inevitable. you cannot stop it from happening circumstances such as floods, fire, earthquakes and accidents fall under this doctrine

Doctrine of Respondeat Superior

let the master answer for the acts of the subordinate the liability is expanded to include the master as well as the employee and not a shift of liability from the subordinate to the master this doctrine applies only to those actions performed by the employee within the scope of his employment

Incompetence

is the lack of ability, legal qualifications or fitness to discharge the required duty. Although a nurse is registered, if in the performance of her duty she manifests incompetency, there is ground for revocation or suspension of her certificates of registration.

Liability of Nurses for the Work of Nursing Aides

Nursing aides perform selected nursing activities under the direct supervision of nurses. Nurses should not delegate their functions to nursing aides since the Philippine Nursing Act specifies the scope of nursing practice of professional nurses. If a nurse delegates, he is responsible.

Liability for the Work of Nursing Students

Under the Philippine Nursing Act of 2002, nursing students do not perform professional nursing duties. They are to be supervised by their Clinical Instructors.

Assumption of Risk

A nurse cannot bring suit against the patient if she gets hurt or contacts the disease since upon accepting the case, the nurse agreed to assume the risk of harm or infection.

Consent

Is defined as a free and rational act that presupposes knowledge of the thing which consent is being given by a person who is legally capable to give consent. It is the NURSE who actually secures the consent of the patient upon admission.

Informed Consent

it is established principle of law that every human being of adult years and sound mind has the right to determine what shall be done with his on body Essential elements of Informed Consent 1. 2. 3. 4. 5. Diagnosis and explanation of the condition A fair explanation of the procedures to be done and used and the consequences A description of alternative treatment or procedures A description of benefits to be expected Material rights if any

6. The prognosis, if the recommended care, procedure, is refused. Proof of Consent

A written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of procedure A signed special consent is necessary before any medical or surgical treatment is don such as x-rays etc.

Who Must Consent

Normally the patient himself is the one who gives the consent, If he is incompetent (minors or mentally ill) or physically unable, consent must be taken from another who is authorized to give it in his behalf.

Consent of Minors

Parents, or someone standing in their behalf If emancipated minor consent is signed by them.

Consent of Mentally Ill

They cannot legally give consent. Parents or guardians.

Emergency Situation

When an emergency situation exists, no consent is necessary because inaction at such time may cause greater injury.

Refusal to Consent

Patients other than those who are incompetent to give consent can refuse consent. If refuses to sign, this should be noted in his chart

Consent for Sterilization

Is the termination of the ability to produce offspring. The husband and wife must consent to the procedure if the operation is primarily to accomplish sterilization. If its medically necessary or an incidental result, the patient alone is sufficient.

Medical Records

As a record of illness and treatment, it saves duplication in future cases and aids in prompt treatment It serves as a legal protection for the hospital, doctor, and nurse by reflecting the disease or condition of patient and its management. If it was not charted, it was not observed or done. Nurses have the responsibility of keeping the patients right to confidentiality.

Permission has to be taken from the Medical Records Division of the Hospital.

Intentional Wrongs

nurse may be held liable for intentional wrongs

Torts

is a legal wrong, committed against a person or property, independent of a contract which renders the person who commits it liable for damages in a civil action. The person who has been wronged seeks compensation for injury or wrong he has suffered

Examples of Torts are: 1. Assault and Battery

Assault is the imminent threat of harmful or offensive bodily contact; banta Battery is an intentional, unconsented touching of another person.

1. False Imprisonment or Illegal Detention

Unjustifiable detention of a person without legal warrant within the boundaries fixed by the defendant by an act or violation of duty intended to result in such confinement

1. Invasion of Right to Privacy and Breach of Confidentiality.

The right to privacy is the right to be left alone, the right to be free from unwarranted publicity and exposure to public view

1. Defamation

Character assassination, be in written or spoken Slander is oral defamation of a person by speaking unprivileged or false words by which his reputation is damaged. Libel is defamation by written words, cartoons or such representations that cause a person to be avoided, ridiculed or held in contempt or tend to injure him in his work.

NURSING AS A PROFESSION
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Profession is a calling that requires special knowledge, skill and preparation. An occupation that requires advanced knowledge and skills and that it grows out of societys needs for special services. Criteria of Profession:

1. To provide a needed service to the society. 2. To advance knowledge in its field. 3. To protect its members and make it possible to practice effectively.
Characteristics of a Profession:

1. A basic profession requires an extended education of its members, as well as a basic 2. 3. 4. 5.

liberal foundation. A profession has a theoretical body of knowledge leading to defined skills, abilities and norms. A profession provides a specific service. Members of a profession have autonomy in decision-making and practice. The profession has a code of ethics for practice.

NURSING >is a disciplined involved in the delivery of health care to the society. >is a helping profession >is service-oriented to maintain health and well-being of people. >is an art and a science. NURSE - originated from a Latin word NUTRIX, to nourish. Characteristics of Nursing:

1. Nursing is caring. 2. Nursing involves close personal contact with the recipient of care. 3. Nursing is concerned with services that take humans into account as physiological, 4. 5. 6.
psychological, and sociological organisms. Nursing is committed to promoting individual, family, community, and national health goals in its best manner possible. Nursing is committed to personalized services for all persons without regard to color, creed, social or economic status. Nursing is committed to involvement in ethical, legal, and political issues in the delivery of health care.

Personal Qualities of a Nurse:

1. Must have a Bachelor of Science degree in nursing. 2. Must be physically and mentally fit. 3. Must have a license to practice nursing in the country.
A professional nurse therefore, is a person who has completed a basic nursing education program and is licensed in his country to practice professional nursing. Roles of a Professional

1. Caregiver/ Care provider

the traditional and most essential role functions as nurturer, comforter, provider mothering actions of the nurse provides direct care and promotes comfort of client activities involves knowledge and sensitivity to what matters and what is important to clients show concern for client welfare and acceptance of the client as a person

2. Teacher

provides information and helps the client to learn or acquire new knowledge and technical skills encourages compliance with prescribed therapy. promotes healthy lifestyles interprets information to the client

3. Counselor

helps client to recognize and cope with stressful psychologic or social problems; to develop an improve interpersonal relationships and to promote personal growth provides emotional, intellectual to and psychologic support focuses on helping a client to develop new attitudes, feelings and behaviors rather than promoting intellectual growth. encourages the client to look at alternative behaviors recognize the choices and develop a sense of control.

4. Change agent

initiate changes or assist clients to make modifications in themselves or in the system of care.

5. Client advocate

involves concern for and actions in behalf of the client to bring about a change. promotes what is best for the client, ensuring that the clients needs are met and protecting the clients right. provides explanation in clients language and support clients decisions.

6. Manager

makes decisions, coordinates activities of others, allocate resource evaluate care and personnel plans, give direction, develop staff, monitors operations, give the rewards fairly and represents both staff and administrations as needed.

7. Researcher

participates in identifying significant researchable problems participates in scientific investigation and must be a consumer of research findings must be aware of the research process, language of research, a sensitive to issues related to protecting the rights of human subjects.

Expanded role as of the nurse 1 Clinical Specialists- is a nurse who has completed a masters degree in specialty and has considerable clinical expertise in that specialty. She provides expert care to individuals, participates in educating health care professionals and ancillary, acts as a clinical consultant and participates in research. 2. Nurse Practitioner- is a nurse who has completed either as certificate program or a masters degree in a specialty and is also certified by the appropriate specialty organization. She is skilled at making nursing assessments, performing P. E., counseling, teaching and treating minor and self- limiting illness. 3. Nurse-midwife- a nurse who has completed a program in midwifery; provides prenatal and postnatal care and delivers babies to woman with uncomplicated pregnancies. 4. Nurse anesthetist- a nurse who completed the course of study in an anesthesia school and carries out pre-operative status of clients. 5. Nurse Educator- A nurse usually with advanced degree, who beaches in clinical or educational settings, teaches theoretical knowledge, clinical skills and conduct research. 6. Nurse Entrepreneur- a nurse who has an advanced degree, and manages health-related business. 7. Nurse administrator- a nurse who functions at various levels of management in health settings; responsible for the management and administration of resources and personnel involved in giving patient care. Fields and Opportunities in Nursing

1. Hospital/Institutional Nursing a nurse working in an institution with patients Example: rehabilitation, lying-in, etc. 2. Public Health Nursing/Community Health Nursing usually deals with families and communities. (no confinement, OPD only) Example: brgy. Health Center 3. Private Duty/special Duty Nurse privately hired 4. Industrial/Occupational Nursing a nurse working in factories, office, companies 5. Nursing Education nurses working in school, review center and in hospital as a CI. 6. Military Nurse nurses working in a military base. 7. Clinic Nurse nurses working in a private and public clinic. 8. Independent Nursing Practice private practice, BP monitoring, home service. - Independent Nurse Practitioner.