CCN 2258 Fundamental Concepts of Health and Nursing

The Conceptual basis of Nursing practice Ethical and legal consideration

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Ethical and legal consideration

After completing this lecture, you will be able to:

Describe the purpose and essential elements of informed consent Understand the privacy, organ donation and legal termination of pregnancy briefly Identify the code of ethics for nurses in Hong Kong

Informed consent

Purpose

Provides client with complete information prior to obtaining agreement by client to accept a course of treatment or procedure

Express Consent

Oral or written agreement

Individuals nonverbal behavior indicates agreement Medical emergency when a person cannot express content because of physical condition

Implied Consent

Informed consent
Three

major elements

must be given voluntary must be given by client or individual with capacity to understand must be given enough information to be the ultimate decision maker

Informed consent
Three

groups of people cannot provide informed consent

a person 18 years or younger (provided by a parent or guardian) the unconscious or person injured in such as way that they are unable to consent (by provided necessary care for the clients emergency condition) a mentally ill person judged by professionals to be incompetent (by an appointed guardian) Hong Kong Statutory law Section 59ZB(2) Part IVC of Mental Health Ordinance (Cap 136) A mentally incapacitated person is incapable of giving such consent if that person is incapable of understanding the general nature and effect of the treatment or special treatment. Statute (Hong Kong)

Informed consent

Important to consider the problem of illiteracy and other language barriers The consent must be read to the client or an interpreter appropriately used to be certain client understands Nurses Role

Client gave consent voluntarily Signature is authentic Client appears competent to give consent Remind client they have the right to refuse after signature on form continues after signing consent

Privacy

Hold in confidence personal information obtained in a professional capacity

The nurse ensures that the information given by the clients in confidence will only be used for the purposes for which it was given The nurse protects the information obtained in the course of professional practice and discloses only with the patients/clients consent, or in exceptional circumstances, such as where a court is made for disclosure When personal information is required for teaching, research or quality assurance procedures, the nurse takes care to protect the patients/clients anonymity and privacy

Some examples of laws of HK related to nursing practice

Antibiotics Ordinance Births and Deaths Registration Ordinance Coroners () Ordinance Dangerous Drug Ordinance Defamation () Ordinance Hong Kong Bill of Rights Ordinance Hospital Authority Ordinance Hospitals, Nursing Homes and Maternity Homes Registration Ordinance Human Organ Transplant Ordinance Interpretation and General Clauses Ordinance
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Medical (Therapy, Education and Research) Ordinance Mental Health Ordinance Midwives Registration Ordinance Nurses Registration Ordinance Occupational Safety and Health Ordinance Offences Against the Person Ordinance Personal Data (Privacy) Ordinance Pharmacy and Poisons Ordinance Prevention of Bribery Ordinance Quarantine () and Prevention of Disease Ordinance

Organ donation
Number of organ / tissue donation & patient waiting for transplantation under H.K. Hospital Authority (1994 2011)

(Department of Health, Hong Kong, 2012)

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(Apple daily, 2013)

Organ donation policy

Opting-in ()

Require individuals to sign the consent to indicate the individuals wishes The consent of the relatives has to be secured before the organ can be retrieved for transplantation United Kingdom, United State, Australia, Taiwan, Japan, Hong Kong Require individuals to sign to indicate objection to the taking of organs by others after death Austria, France, Brazil, Spain, Singapore

Opting-out ()

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Applying for legal Termination of Pregnancy

Section 47 of the Offences Against the Person Ordinance Termination of pregnancy requires two registered medical practitioners to concur that:
continuing the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated; or there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormality as to be seriously handicapped; or the woman is with child before attaining the age of 16; or the woman is the victim of incest, rape, drug rape, intercourse by threats, or intercourse by false pretences, and has made a report to the police within 3 months after the date of such offences

Legal termination of pregnancy must not be performed after the 24th week of pregnancy 12

Several Examples of ethical principles

Respect for autonomy

Right to choose Acting in the patients best interest

Beneficence

Nonmaleficence

Doing no harm to patients

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Code of Ethics for Nurses in Hong Kong

Organized around four broad value statements and seventeen provisions () that represent the morals and ideals of the profession and are regarded as central to ethical nursing practice The four broad value statements are:

1. 2. 3.

4.
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Respect life, and improve quality of life Respect individual rights and dignity Be responsive to societys needs, and work towards a healthy community through partnership Strive for excellence, and assure quality of care

Code of Ethics for Nurses in Hong Kong

The provisions articulated in each value statement are ethical responsibilities that nurses should act upon in order to enact the broad values in practice situations For each of these statements, the scope of responsibilities identified extends beyond individuals to include families, communities and society By upholding these values in practice, it is envisaged that nurses can improve their personal quality, provide quality nursing care and earn the trust of those under their care

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The 4 value statements are based on the following general principles :

People's needs are universal. Nursing service is provided for people throughout their life span Inherent in nursing is the respect for life, dignity and rights of individuals, and improvement in the quality of life Nurses should serve all people irrespective of race, nationality, creed, colour, age, gender, politics or social status The fundamental responsibilities of nurses are to promote health, prevent illness, restore health, and alleviate suffering caused by ill health

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1. Respect Life, and Improve Quality of Life

1.1 Nurses should encourage the individual, the family and the community to improve the quality of life 1.2 Nurses should ensure patient/client safety when delivering nursing services 1.3 Nurses should provide information and consultation in accordance with and adjustable to patients'/clients' and their families capacity and needs 1.4 Nurses should respect the wishes of the dying patients/clients, and ensure that they have peace and dignity at the time of death

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2. Respect Individual Rights and Dignity

2.1 Nurses should respect the individuals spiritual beliefs, values and customs. 2.2 Nurses should hold in confidence patients'/clients' information and be prudent in their use of the information. 2.3 Nurses should respect patients'/clients' and their families wishes, encouraging them to participate in planning and implementing nursing care. 2.4 Nurses should take appropriate action to safeguard the individuals rights and dignity. 2.5 Nurses should value truthfulness and integrity and put oneself in the place of another.
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3. Be Responsive to Societys Needs, and Work towards a Healthy Community Through Partnership
3.1 Nurses should share the responsibility in raising the health consciousness of the community 3.2 Nurses should collaborate with others in initiating and supporting actions that work towards the goal of health for all 3.3 Nurses should use health care resources efficiently and effectively through partnerships with the community 3.4 Nurses should coordinate their services with those of medical and social groups in rendering health services to individuals, families and the community, as appropriate
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4. Strive for Excellence, and Assure Quality of Care

4.1 Nurses should seek truth from facts, and use scientific evidence in finding the best possible ways to provide nursing services for the wellbeing of patients/clients. 4.2 Nurses should maintain the highest standards of nursing care possible, actually seeking improvement on the existing service. 4.3 Nurses should exercise professional judgment in accepting responsibilities and delegating nursing activities to others. 4.4 Nurses should value research and development for the promotion of nursing knowledge and skills.
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References

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Department of Health, Hong Kong. (2012). Statistics ( Milestones of Hong Kong Organ Transplantation ). Retrieved from http://www.organdonation.gov.hk/eng/statistics.html Kozier, B., Berman, A. & Snyder, S. (2012). Kozier & Erb's fundamentals of nursing : concepts, process, and practice (9th ed.). Upper Saddle River, N.J. : Pearson. Legislative Council of the Hong Kong Special Administrative Region of the Peoples Republic of China. (2000). Mental health ordinance (chapter 136). Retrieved from http://www.legco.gov.hk/yr9900/english/bc/bill_81/general/81_brf.pdf The Family Planning Association of Hong Kong. (2013). Unplanned pregnancy. Retrieved from http://www.famplan.org.hk/fpahk/en/template1.asp?style=template1.asp &content=sexual/what.asp The Nursing Council of Hong Kong. (2002). Code of professional conduct and code of ethics for nurses in Hong Kong. Retrieved from http://www.nchk.org.hk/filemanager/en/pdf/conduct_eng.pdf