ETHICO -MORAL ASPE CTS IN NU RSING

Ethics
- Ethos - comes from Greek work w/c means character/culture
- Branch of Philosophy w/c determines or study morality (right and wrong)
- Systematic inquiry into principles of right, from good e!il as they relate to conduct
Moral - personal/pri!ate interpretation from what is good and "ad#
TYPES OF ETHICS
$hose of particular concern to the nurse are%
1. B&'($)&*S - branch of ethcs that studes mora vaues n the bomedca scences
2. *+&,&*-+ ($)&*S . concerned wth ethca probems at the bedsde that arse wthn the context of
carng for actua patents
(/#% &nformed consent how one ought to respond to requests for assisted suicide
3. ,01S&,G ($)&*S . study of ethca ssues that arse n the day practce of nursng & of the anayss
used by nurses to make ethca |udgement
(/#%cost-containment, "reaches of patient2s confidentiality, illegal practices of colleagues
Ethical Principles:
1. Autonomy . the right/freedom to decide (the patient has the right to refuse despite the e/planation of the nurse) Example:
surgery, or any procedure
2. Nonmaleicence . the duty not to harm/cause harm or inflict harm to others (harm may"e physical, financial or social)
3. !eneicence - for the goodness and welfare of the clients
4. "ustice . equality/fairness in terms of resources/personnel
5. #eracity - the act of truthfulness
6. Fi$elity . faithfulness/loyalty to clients
Moral Principles:
3# Golden 1ule
4# $he principle of $otality . $he whole is greater than its parts
5# (pikia . $here is always an e/emption to the rule
6# 'ne who acts through as agent is herself responsi"le . (instrument to the crime)
7# ,o one is o"liged to "etray herself . 8ou cannot "etray yourself
9# $he end does not :ustify the means
;# <efects of nature may"e corrected
=# &f one is willing to cooperate in the act, no :ustice is done to him
># - little more or a little less does not change the su"stance of an act#
3?# ,o one is held to impossi"le
%a& - rule of conduct commanding what is right and what is wrong# <eri!ed from an -nglo-Sa/on term that means @that which
is laid down or fixedA
Court -"ody/agency in go!ernment wherein the administration of :ustice is delegated#
Plainti . complainant or person who files the case (accuser)
'een$ant . accused/respondent or person who is the su":ect of complaint
(itness . indi!idual held upon to testify in reference to a case either for the accused or against the accused#
(ritten or$ers o court
Writ . legal notes from the court
Su"poena
1. Subpoena Testificandum . a writ/notice to an indi!idual/ordering him to appear in court at a specific time and
date as witness#
2. Subpoena Duces Tecum- notice gi!en 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 - "ody of law that deals with relationships among pri!ate indi!iduals
Public law - "ody of law that deals with relationship "etween indi!iduals and the State/go!ernment and go!ernment agencies# +aws
for the welfare of the general pu"lic#
Pri!ate/*i!il +aw can "e %
Contract law . in!ol!es the enforcement of agreements among pri!ate indi!iduals or the payment of compensation for
failure to fulfill the agreements
Ex. Nurse and cent nurse and nsurance
Nurse and empoyer cent and heath agency
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- An agreement between 2 or more competent person to do or not to do some
awfu act.
- It maybe wrtten or ora = both equay bndng
(4) $ypes of *ontract%
3# Expressed . when 4 parties discuss and agree orally or in writing the terms and conditions during the creation of the
contract#
Example: Nurse w work at a hospta for ony a stated ength of tme (6 months), under
stated condtons (as vounteer, straght AM shft, wth food/transportaton aowance)
4# Implied . one that has not "een e/plicitly agreed to "y the parties, "ut that the law considers to e/ist#
Example: Nurse newy empoyed n a hospta s expected to be competent and to foow
hospta poces and procedures even though these expectatons were not wrtten or
dscussed.
Lkewse: the hospta s expected to provde the necessary suppes, equpment needed to
provde competent, quaty nursng care.
Feature)Characteristics)Elements o a la&ul contract:
3# Promise or agreement "etween 4 or more persons for the performance of an action or restraint from certain actions#
4# Butual understanding of the terms and meaning of the contract "y all#
5# - lawful purpose . acti!ity must "e legal
6# *ompensation in the form of something of !alue-monetary
///
Persons who may not enter into a contract% minor, insane, deaf, mute and ignorant
TORT LAW . is a ci!il wrong committed against a person or a person2s property#
- Person/person2s responsi"le for the tort are sued for <-B-G(S
- &s "ased on%
-*$ 'C *'BB&SS&', .something that was done incorrectly or
-*$ 'C 'BB&S&', . something that should ha!e "een done "ut was not#
*lassification of $ort
1. Unintentional
a. Negligence . misconduct or practice that is "elow the standard e/pected of ordinary, reasona"le and prudent person
- Cailure to do something due to lack of foresight or prudence
- Cailure of an indi!idual to pro!ide care that a reasona"le person would ordinarily use in a similar circumstance#
- -n act of omission or commission wherein a nurse fails to act in accordance with the standard of care#
<octrines of ,egligence%
1. *es ipsa lo+uitor . the thing speaks for itself . the in:ury is enough proof of negligence
2. *espon$eat Superior . let the master answer command responsi"ility
3. Force ma,uere . unforeseen e!ent, irresisti"le force
b. Malpractice . stepping "eyond one2s authority
(9) elements of nursing malpractice%
3# 'uty . the nurse must ha!e a relationship with the client that in!ol!es pro!iding care and following an acceota"le standard
of care#
4# !reach o $uty . the standard of care e/pected in a situation was not o"ser!ed "y the nurse
-is the failure to act as a reasona"le, prudent nurse under the circumstances
-something was done that should not ha!e "een done or nothing was done when it should ha!e "een done
5# Foreseea-ility . a link must e/ist "etween the nurse2s act and the in:ury suffered
6# Causation . it must "e pro!ed that the harm occurred as a direct result of the nurse2s failure to follow the standard of care
and the nurse should or could ha!e known that the failure to follow the standard of care could result in such harm#
7# Harm)in,ury . physical, financial, emotional as a result of the "reach of duty to the client
(/ample% physical in:ury, medical cost/e/penses, loss of wages, pain and suffering
9# 'ama.es . amount of money in payment of damage/harm/in:ury
2. Intentional Tort
0nintentional tort . do not require intent "ur do require the element of )-1B
&ntentional tort . the act was done on P01P'S( or with &,$(,$
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- ,o harm/in:ury/damage is needed to "e lia"le
- ,o e/pert witnesses are needed
1. Assault . an attempt or threat to touch another person un:ustifia"ly
Example: (1) A person who threatens someone wth a cub or cosed fst.
(2) Nurse threatens a cent wth an n|ecton after refusng to take the meds oray.
2. Battery . wilful touching of a person, person2s clothes or something the person is carrying that may or may not cause harm "ut
the touching was done without permission, without consent, is em"arrassing or causes in:ury#
Example: (1) a nurse threatens the patent wth n|ecton f the patent refuses hs medsoray. If
the nurse gave the n|ecton wthout cents consent, the nurse woud be commttng battery
even f the cent benefts from the nurses acton.
3. False Imprisonment . un:ustifia"le detention of a person without legal warrant to confine the person
. 'ccurs when clients are made to wrongful "elie!e that they cannot lea!e the place
Example: (1) Teng a cent no to eave the hospta unt b s pad
(2) Use of physca or chemca restrants
(3) Fase Imprsonment Forcefu Restrant=Battery
4. Invasion Of Privacy . intrusion into the client2s pri!ate domain
1ight to "e left alone
$ypes of &n!asion the client must "e protected from%
a# use of cents name for proft wthout consent . using one2s name, photograph for ad!ertisements of )*
agency or
pro!ider without client2s permission
"# Unreasonabe ntruson . o"ser!ation or taking of photograph of the client for whate!er purpose without client2s
consent#
c# Pubc dscosure of prvate facts . pri!ate information is gi!en to others who ha!e no legitimate need for that#
d# Puttng a person n a fase/bad ght . pu"lishing information that is normally considered offensi!e "ut which is
not true#
5. Defamation . communication that is false or made with a careless disregard for the truth and results in in:ury to the
reputation of a person
(4) $ypes%
%i-el >defamaton by means of prnt, wrtng or pcture
Exampe:
3# writing in the chart/nurse2s notes that doctor - is incompetent "ecause he didn2t respond
immediately to a call
Slan$er >defamaton by the spoken word statng unprveged (not egay protected) or
fase word by whch a reputaton s damaged
Exampe:
3# ,urse a telling a client that nurse B is incompetent
4# Person defamed may "ring the lawsuit
5#$he material (nurse2s notes) must "e communicated to a 5
rd
party in order that the person2s
reputation may"e harmed
///
Public Law:
Criminal %a& . deals with actions or offences against the safety and welfare of the pu"lic#
)'B&*&<( D Eilling of any person without criminal intent may "e done as self-defense
-1S', D Burning of property
$)(C$ D Stealing
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ETHICO-MORAL ASPECTS OF
NURSING PRACTICE
Nurses need to:
Deveop senstvty to the ethca
dmensons of nursng practce
Examne ther own & cents vaue
Understand how vaues nfuence ther
decsons
Thnk a head about the mora probems
they are key to face. Ex.: brth, death,
marrage
*Vaues are mportant because they nfuence
decsons & actons, ncudng nurses ethca
decsons even though they may be unspoken
questons of vaues undere a mora demmas
VALUES
- endurng beefs or atttudes about the
worth of a person, ob|ects, dea or acton
- concepts/ deas that gve meanng to
ones fe & provde a framework for ones
decson
BELIEFS (OPINIONS
- Interpretatons or concusons that peope
hod as true
- Based more on fath that fact & may/ may
not be true
- Beefs do not necessary nvoves vaues
Ex.: If I study hard, I w get good grade
ATTITUDES
- Menta postons/ feengs toward a person,
ob|ect or dea
- Often |udged as bad or good, postve or
negatve, beefs are |udged as correct or
ncorrect.
VALUES
- Are earned through observaton &
experence & are heavy nfuenced by a
persons sococutura envronment that s
by:
o Soceta tradtons, cutura, ethca,
regous groups, famy or peer
groups
PROFESSIONAL VALUES
- Are acqured durng socazaton from
nursng experence, from teachers, peers
& code of ethcs
*Nurses & nursng students need to examne
the vaues they hod about fe, death &
ness. One strategy for ganng awareness of
persona vaues s to consder ones atttude
about specfc ssues as aborton/ euthanasa
VALUES !LARIFI!ATION
- Process by whch peope dentfy, examne
& deveop ther own ndvdua vaues
(" VALUES ESSENTIAL FOR PROFESSIONAL
NURSES
1. Atrusm >The concern for the wefare &
we-beng of others
2. Autonomy >The rght for sef- determnaton
of professona practce
Ex.: When the nurse respects
patents rght to make decsons
about ther heath care
3. Human
dgnty
- Respect for the nherent worth &
unqueness of ndvdua &
popuatons
Ex.: when the nurse vaues &
respects a patents & coeagues
4. Integrty - Actng n accordance wth an
approprate code of ethcs &
standards of practce
Ex.: when the nurse s honest &
provdes care based on ethca
framework that s accepted wthn
professon
5. Soca
|ustce
- Uphodng mora, ega &
humanstc prncpes.
Ex.: when the nurse works to
ensure equa treatment under the
aws & equa access to quaty
care.
PROFESSIONAL BE#AVIORS ASSO!IATED
WIT# " VALUES
1. Demonstrate understandng of cutures,
beef & perspectves of others
2. Demonstrates accountabty for own
actns
3. Documents accuratey & honesty
4. Desgns care wth senstvty to ndvdua
patent needs
5. Advocates for patents partcuary the
most vunerabe
6. Take rsks on behaf of patents &
coeagues
7. Pans n partnershp wth patents
8. Honors the rghts of patent & fames to
make decsons about heathcare
9. Provde nformaton so patents can make
nformed choces
10. Provde cuturay competent & senstve
care
11. Protects the patents prvacy &
confdentaty
12. Provdes honest nformaton
13. Promotes unversa access
14. Seek to remedy errors made
15. Support farness
16. Encourage egsaton
ETHICS came from the Greek word ($)'S meaning
custom/character or moral duty
Method of nqury that assst peope to
understand the moraty of human
behavour
Refers to the expected standards of mora
behavor
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)ow people make :udgement in regard to right or
wrong
*ritical reflection a"out morality and rational
analysis a"out it
H'),S$',- e/amination of all ethical and "io-
ethical issues from the prospecti!e of nursing theory
and nursing ethics
G(1*'( - the fields of nursing ethics "e focused on
the needs and e/periences of practicing nurses, the
e/ploration of its meaning and that of ethical practice
in terms of the perception of these nurses
!IOETHICS
Aso known as apped or practca ethcs
Specific domain of ethics that focuses on moral
issues in the field of health care
1esult of life and death dilemmas faced "y health
care practitioners
Systematic study of human "eha!iour in the field of
life science and health care in the light of moral
!alues and principles
N/*SIN0 ETHICS
- 1efers to the ethical issues that occur in nursing
practice
- 1efers to the conduct or "eha!iour which "y reason
of pu"lic appro!al or practice has "ecome customary
among professional
MO*A%S) MO*A%ITY
Greek work B'1-+&S
Refers to prvate, persona standard of
what s rght & wrong n conduct,
character or atttude
Nurses shoud dstngush MORALITY &
LAWS.
LAWS - refect the mora vaues of
socety, they offer gudance n
determnng what s norma
An action can be moral but not legal, on
the other hand, an action can be moral
but illegal
Borality is what you "elie!e is right and good
Health Care Ethics
<i!ision of ethics that relates to human health
1ealm of human !alues, morals, customs, personal
"eliefs and faith
MO*A% 'E#E%OPMENT
- The process of earnng to te between
rght & wrong & of earnng what ought not
to be done
- Compex process that begns n chdhood
& contnues throughout fe
- 2 we known theorst:
o Lawrence Kohberg
Rghts & forma reasonng
o Caro Ggan
Emphaszes care &
responsbty
N/*SIN0
-n occupation requiring a unique body of
knowledge and skills and whch serves
society
Is nursin. a proession1
YES. It s a cang, vocaton, occupaton based on
scentfc body of knowedge whch needs tranng both
n theory and practce guded by a Code of Nursng
Ethcs, governed by the Nursng Act of 2002, to SERVE
manknd for a FEE or FREE.
P*OFESSION
An occupaton or cang requiring advance
training
Experence n some specfc or specialized
body of knowledge
Provdes service to society n that speca
fed
The term professon s honorc and shoud
be carred wth prde and honor
P*OFESSIONA% N/*SE
Competed a basc nursng educaton
program
Lcensed n hs/her country or state to
practce professona nursng
N/*SIN0 P*ACTICE
Primary responsi"ility promotion of health and
pre!ention of illness
*olla"orate with other health care pro!iders
o *urati!e
o Pre!enti!e
o 1eha"ilitati!e aspects of care
o 1estoration of health
o -lle!iation of suffering
o $owards a peaceful death
Pro!ide nursing care through the utiliIation of the
nursing process
o $herapeutic use of self
o (/ecuting health care techniques and
procedures
o (ssential primary health care
o *omfort measures
o )ealth teachings
o -dministration of written prescription for
treatment
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o $herapies
o 'ral
o $opical
o Parenteral medications
o &nternal e/amination during la"our in the
a"sence of antenatal "leeding and deli!ery
o Suturing of perineal laceration
(sta"lish linkages with community resources
*oordination with the health team
Pro!ide health education to indi!iduals, families and
communities
$each, guide and super!ise students in nursing
education programs
$he nurse is required to maintain competence "y
continual learning through continuing professional
education
2/A%IFICATIONS AN' A!I%ITIES OF A
P*OFESSIONA% N/*SE
Proessional Preparation
o )a!e a license to practice
o Bachelor of science degree in nursing
o Be physically and mentally fit
Personal 2ualities an$ Proessional Proiciencies
o &nterest and willingness to work and learn
o Jarm personality and concern for people
o 1esourcefulness and creati!ity, well
"alanced emotional condition
o *apacity and a"ility to work cooperati!ely
with others
o Skill in decision making
'EFINITION OF %ICENSE
- legal document gi!en "y the go!ernment that
permits a person to offer to the pu"lic his or her skills
and knowledge in a particular :urisdiction
CONT*ACT
Beeting of minds "etween two persons where"y one
"inds himself, with respect to other, to gi!e
something or to render some ser!ice
- promise or a set of promise which the law
recogniIes as a duty and when that duty is not
performed the law pro!ides a remedy
MO*A% THEO*IES
- Pro!ide framework
345 TYPES OF MO*A% THEO*IES
1. !ONSE$UEN!E%BASED (T&eolo'i(al
t&eorie)
- Looks to the consequences of an acton n
|udgng whether the acton s rght of
wrong
- Focus on ssues of farness
- UTILITARIANISM
o Vews the good act as one that
brng the most good for the greater
number or the east harm for the
greatest number
- PRINCIPLE OF UTILITY
o From the uttaran perspectve, th
pont of moraty s to promote
what s ntrnscay good by
maxmzng benefts & mnmzng
harm
TE%EO%O0ICA% APP*OACH
Greek word $(+'S or goal or end
$he right thing to do is the good thing to do
-ct utilitarianism- good resides in the promotion of
happiness or the greatest net increase of pleasure o!er
pain
&f the act helps people, then it is a good act
&f the act hurts people then it is a "ad act
2. PRIN!IPLE%BASED (Deontolo'i(al
t&eorie)
- Invove ogca & forma processes &
emphasze ndvdua rghts, dutes &
obgatons
- The moraty of an acton s determned
not by ts consequences but whether t s
done accordng to an mportant ob|ectve
'EONTO%O0ICA% APP*OACH O* '/TY
O*IENTE' THEO*Y
Basic rightness or wrongness of an act depends on
the intrinsic nature rather than upon the situation or
its consequences
Greek word <(', meaning <0$8
&mmanuel Eant- rational human "eing with freedom
and social worth
- person is morally good and admira"le if his actions
are done from a sense of duty and reason
*. RELATIONS#IP BASED OR !ARIN+
T#EORIES
- Stress courage, generosty, commtment &
need to nurture & mantan reatonshp
Other Mora Theores:
F%ETCHE*6S 0/I'E%INES FO* MA7IN0 ETHICA%
'ECISIONS
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1. *onsideration for people as human beings
2. *onsideration of consequences
3. Proportionate good to come from the choices
4. Propriety of actual needs over ideal or potential
needs
5. - desire to enlarge choices and reduce chance
6. - courageous acceptance of the consequence of the
decision
(8' *OSS- P*IMA FACIE '/TIES- (HAT ONE
SHO/%' 'O (HEN OTHE* *E%E#ANT FACTO*S IN
A SIT/ATION A*E NOT CONSI'E*E'
<uties of fidelity- telling the truth, keeping promises
<uties of reparation- righting the wrong we ha!e
done to others
<uties of gratitude- recogniIing the ser!ice others
ha!e done for us
<uties of :ustice- pre!enting distri"ution of pleasure
or happiness that is not in keeping with the merit of
people in!ol!ed
<uties of "eneficence-helping to "etter the condition
of other "eings
<uties of self impro!ement- "earing oursel!es with
respect to !irtue or intelligence
<uties of nonmaleficence- a!oiding or pre!enting
in:ury to others
#I*T/E ETHICS APP*OACH
-1($&*, Greek word -1($(, heart of the person
performing the act
$raits and !irtues of a good person, courage,
temperance, wisdom, and :ustice
'I#INE COMMAN' ETHICS
Supreme or di!ine that sets down rules to
pro!ide guidance to moral decisions
(" ATTRIBUTES OF !ARIN+
1. Compasson - sorrow for the sufferng or
troube of another, wth an urge to HELP.
2. Competence - condton n quafcaton of
beng abe to perform accordng to STANDARD.
3. Commtment - DEDICATION to a ong-term
course of acton, engagement or nvovement.
4. Confdence - beef n ones own abtes, to fee
CERTAIN.
5. Conscentous - dong thngs accordng to what
s rght, showng care and precson, HONEST
(hed n respect, HONORABLE)
,ORAL PRIN!IPLES
- Broad genera concepts such as autonomy
& |ustce, they provde the foundaton for
mora vaues
PRI!IPLES
- usefu n ethca decsons because even f
peope dsagree about whch acton s rght
n stuaton, they may be abe to agree on
the prncpe that appy
(" BASI! ET#I!AL PRIN!IPLES
1.
Stewardshp
>Our bodes, our fe, our human
nature & everythng n ths earth
are gfts we have domnon over
>Ths means we are responsbe
for them. We shoud not harm
them, but rather mprove & care
for them
>Ex.: Carng for ones body s a
sgn of good stewardshp
2. Totaty >Refers to the whoe. Every
person must deveop, use for &
preserve a hs parts & functons
for themseves as we as the good
of the whoe
3. Doubt
Effect
>When an act s foreseen to have
both good & bad effects, the
prncpe of doube effect s
apped.
>In order that such act be
permssbe the foowng
condtons shoud be met:
1. The acton tsef must be good
or at east neutra
2. The good effects s the one
drected ntended by agent & not
the ev effect
3. The good effect s not produced
by means of the ev effect
4. The foreseen benefca effect
must be equa to or greater than
the foreseen harmfu effect
4.
Cooperaton
>The partcpaton of one agent
wth another agent to produce a
partcuar effect or |ont effect
>Cooperaton becomes a probem
when the acton of the prmary
agent s moray wrong
>Cooperaton may be:
1. FORMAL
When the 2
nd
agent wngy
partcpates as when one agrees,
advce, counses, promotes or
condones
2. MATERIAL
When the 2
nd
agent does not
wngy partcpate
5. Sodarty >Means to be one wth others. In
the provsons of heath care, t s
mportant for the provder to be n
sodarty wth the patent when
seekng the atters best nterest
>Ths s most mportant when
deang wth the poor,
dsadvantaged & margnazed
>Ex.: Shoud the strong hep the
weak?
,A-OR BIOET#I!AL PRIN!IPLES
1. Respect for person
a. The recognton of the equaty
possessed by every human beng
as unque, worthy, ratona, sef
determnng creature havng the
EGB|une09 8
capacty & the rght to decde what
s best for hmsef
b. Responsbty of a to treat persons
as an end never as a means
c. The respect for persons autonomy
(sef governance). The person
shoud be aowed to determne hs
own destny, to choose accordng
to hs own vaues to act accordngy
d. Best practced n the prncpe of
free & nformed consent
e. The roe of autonomy s refusa,
confdentaty & veracty
!ONSENT
1. Imped - ndcates agreement/
nonverba
2. Expressed - verba
(* !om.onent) of informe/ (on)ent
1. Must be gven vountary
2. The consent must be gven to a cent
wth
capacty to understand
3. Gven enough nformaton to be the
utmate
decson maker
E0(e.tion) in 'i1in' (on)ent
1. Mnor
a. Adut who have menta
capacty of a chd
b. Marred who are mnors
c. Pregnant mnors
d. Parents & members of the
mtary
2. Severey n|ured
3. Mentay ed person
2. |ustce
Aso termed farness, means to gve to
each one what the deserves or what s due
Means to treat equas equay
3. Invoabty of fe
Aso proposed sanctty, dgnty or
respect for human fe
It means choosng fe to protect t
Ths prncpe ncudes measures for the
survva of the human speces & the
freedom to have chdren
It s be aganst voence, pouton of
envronment, drug/acoho addcton,
euthanasa, sucde & capta punshment
4. Non-maefcence
Duty to do NO HARM
Violation) of t&e Prin(i.le
1. Physcay harmng a person as n
sucde, aborton, nfantcde
(person who murder infant),
voence
2. Harmng a persons reputaton &
honor by reveang confdenta
nformaton
3. Exposng the person to harm as n
sub|ectng the person to
unnecessary treatment
5. Benefcence
Means to do we, provde a beneft
Brngng the acton & choosng the most
beneft & east harm
PRICIPLE UTILITY
Crcumstances/ Issues Invovng
Maefcence
- Stuatons where n not proongng fe s
aowed
- Obgatory or optona treatment
- Euthanasa
/NI#E*SA% P*INCIP%ES OF !IOME'ICA% ETHICS
$o determine right or wrong in regard to !alue issues
Autonomy-
3# Greek word -0$'S meaning self and
nomos meaning go!ernance
4# Self determination
5# Creedom to choose and implement one2s
decision
6# &nformed consent
7# -llowing the patient to refuse treatment if he
decides so
9# $he person making the decision must "e
deemed competent, intellectual capacity,
legal age
#eracity
)ealth care pro!iders are "ound to tell the
truth
!eneicence
Promotes the doing acts of kindness and
mercy that directly "enefit the patient
NONMA%EFICENCE-
3# $o do no harm
4# ,ot assisting in or performing a"ortion
5# ,ot to assist people to commit suicide
6# Be in!ol!ed in mercy killing
"/STICE
3# $he right to demand to "e treated :ustly,
fairly and equally
!ODE OF ET#I!S
- A set of ethca prncpe that a member
of a professon generay accept
- Sets the group expectaton & standard of
behavour
PRIN!IPLES UNDERL2IN+ !ODE OF ET#I!S
EGB|une09 9
1.
Responsbty
Refers to the executon of dutes
assocated wth the nurses roe
2.
Accountabty
Abty to answer for your own
acton
3.
Confdentaty
Requres that those wth access
wth heath nformaton to a 3
rd
party wthout consent
4. |udgement Abty to form opnon or draw
sound concusons
5. Advocacy >Gvng patents nformaton
they need to make decson to
support those decson
>Impes caretaker s drve to
understand & ceary state
patents pont of vew to other
heath care provder
ET#I!AL DILE,AS
- Exst when the rght thng to do s not
cear/ members of heath care team
cannot agree what the rght thng to do
LEA+L RI+#TS3 ROLES 4 RESPONSIBILIT2 OF
T#E NURSE
ROLE RESPONSIBIL
IT2
RI+#T
1. Provder of
servce
To provde safe
care,
commensurate
wth the
nurses
preparaton
experence &
crcumstances
Rght to
adequate &
cassfed
assstance as
necessary
2. Empoyee or
contractor of
servce
>To fuf the
obgatons of
contracted
servce wth
the empoyer
>To respect
the rght &
responsbtes
of other
heathcare
provders
>Rght to
adequate
workng
condton
>Rght to
compensaton
for servces
rendered
>Rght to
reasonabe &
prudent
conduct
3. Ctzen >Protect the
rght of the
recpents of
care
>To nform
cents of the
consequences
of varous
aternatve of
outcome of
care
>To provde
adequate
supervson &
evauaton of
>Rght to
respect by
others of the
nurses own
roe &
responsbty,
rght to
physca safety
>Rght to
reasonabe &
prudent
conduct for
cents
others for
whom the
nurse s
responsbe
S!OPE OF NURSIN+
- A person sha deemed to be practcng
nursng when she/he sngy or n
coaboraton wth another whch ntates
& performs nursng servces to ndvdua,
famy, communty n any heath care
settng
- Nurses are prmary responsbe for the
promoton of heath preventon ness
- Nurses sha coaborate wth other heath
care provder for the curatve, preventve,
rehabtatve aspects of care, restoraton
of heath, aevaton of sufferng & when
recovery s not responsbe towards a
peacefu death
ROLE
- Expectaton about how a person
occupyng one poston behaves toward a
person occupyng another poston
RI+#TS
- Prveges or fundamenta powers that
ndvduas poses, uness they are revoke
or gven up vountary
RESPONSIBILITIES
- Obgatons assocates wth rghts or state
of beng accountabe
IT SHALL BE THE DUTY OF THE NURSE TO:
Provde nursng care thru the utzaton of the
nurse
Estabsh nkages wth communty resources
& coordnaton wth the heath team
Provde heath educaton
Teach, gude & supervse students n nursng
educaton programs ncudng the
admnstraton of nursng servces n
vared settngs
Undertake nursng & heath human resource
deveopment tranng & research
EGB|une09 10
The nurse s duty bound to observe the code
of ethcs for nurses & uphod the standard
of safe nurse practce
The nurse s requred to mantan by
contnued earnng.
STANDARD OF !ARE
- Sks & earnng commony possessed by
members of the professona.
- Purpose: to protect consumer
- The standards are used to evauate the
gravty of care of nurses & therefore
become ega gudene for nursng
practce
STANDARD OF PROFESSIONAL
PERFOR,AN!E
Ouaty of care
Performance Apprasa
Educaton
Coegaty
Ethcs
Coaboraton
Research
Resource utzaton
SELECTED LEGAL ASPECTS OF NURSING
PRACTICE
LAW
- A system of prncpes & processes by
whch peope attend to contro human
conduct n an effort to mnmze the use of
force
F5n(tion) of LAW in N5r)in'6
Provde a framework for estabshng whch
nursng acton n the care of the cent are
ega
It dfferentates the nurse responsbtes
from those of other heath professonas
It heps estabsh boundares of ndependent
nursng acton
Assst n mantanng a standard of nursng
practce by makng nurses accountabe
under the aw
T2PES OF LAWS PERTINENT TO NURSES
PUBLI! LAW
- deas wth reatonshps of between
ndvduas & government agences
!RI,E
- an act n voaton of pubc aw &
punshabe by a fne or mprsonment
- Crmes may be cassfed as:
o FELONY
Crme of serous nature such
as murder, 1 2
nd
degree
murder caed mansaughter
(kng of another person)
Ex.: Patent who ded due to
ncompatbe bood
transfuson or drug dose
o MISDEMEANOUR
An offence of ess serous
nature & punshabe by a
fne or short term |a
sentence or both
!IVIL LAW
- Comprses of aws that affect the
ndvdua rather the whoe socety
TORT
- A cv wrong commtted aganst a person
or persons property
- Cassfed as:
o Unntentona
o Intentona
o Ouas-ntenson tort
I. UNINTENTIONAL
Act commtted aganst person or hs
property
Cassfed as:
A. NEGLIGENCE
EGB|une09 11
Faure to compy wth the
standards of due care ether by
omsson or commsson
A msconduct or practce that s
beow the standard expected of an
ordnary reasonabe & prudent
person
Doctrnes reated to Neggence:
Respondeat Superor or
Respondent supervsor
Let the superior answer
An empoyee as we as
the empoyer s abe for
the any faure
Res psa oqutor
Let the thing speak for
itself
Shows suffcent proof on
the persons duty & hs
negect to perform t

B. MALPRACTICE
Professona neggence that
occurred whe the person was
performng as a professona
The faure of the professona to
act as a reasonabe & prudent
professona wth the same
educaton & experence woud act
n smar stuaton
TYPES OF MALPRACTICE
1. Faure to make referra to
provde the patent wth
approprate teachng before
dscharge
2. Learnng a foregn ob|ect nsde
patents abdomen after surgery
3. Neggence on supervson of
subordnate
(6) ELEMENTS OF HOW TO PROVE
MALPRACTICE
1. Duty
Reatonshp wth a cent
2. Breach of duty
Faure to act as a reasonabe
prudent
3. Forseeabty
Lnk must exst between the
nurses act & n|ury suffered
4. Causaton
Must prove that harm
occurred that resuted a nurses
faure
5. In|ury/ harm
Cent must demonstrate
some type of n|ury
6. Damages
The nurse s hed abe for
damages to be compensated
COMMON MALPRACTICE ACT
1. Medcaton error
2. Burnng of cent
3. FALLS from the bed/ crb
4. Ignorng a cent compant
5. Mstaken dentty
II. INTENTIONAL
o The person executed the act wth
purpose or ntent
o Cassfed as:
Assaut
Battery
Fase mprsonment
ASSAULT
An attempt or threat to harm
person un|ustfabty
BATTER2
Wfu touchng of a person or
somethng the person s carryng
that may or may not cause harm
EGB|une09 12
FALSE I,PRISON,ENT
Iega detenton of a person
wthout hs consent
III. OUASI-INTENTION TORT
o Vountary act that drecty cause
n|ury or dstress
o Types:
Slan/er (Ver7al
A fase ora statement
that un|usty damage a
persons name
Li7el (8ritten
A fase wrtten or
representatona statement
that un|usty damages a
persons name
In1a)ion of Pri1a(9
A voaton of the persons
rght aganst unreasonabe,
unwarranted nterference
wth hs persona fe
Ex.: Reeasng nfo. About
patent to a 3
rd
party
aowng unauthorzed
person
LE+AL PRE!AUTIONS FOR NURSES
- Functon wthn the scope of your
educaton, |ob descrpton of area/ scope
of nursng practce
- Foow the procedures & poces of
empoyng agency
- Observe & montor cent accuratey
- Communcate & record sgnfcant changes
n the cents condton to AP
- Check any order that cent
asked/questoned
- Modfy the cent before ntatng any
nterventons
- Protect the cent from fas & preventabe
n|ures
PRO#IBITIONS IN T#E PRA!TI!E OF
NURSIN+
Practcng nursng must have certfcate of
regstraton (COR)
Who uses hs own cense/ COR of another
Who uses expred/ revoke COR
Who gves fase evdence to the board of
nursng n order to obtan COR
Who poses as RN that conveyed that he/she s
RN
Who appends BSN/TN to hs name wthout
beng confrmed wth a degree
Uses names n advertsement
(" LE+AL PROTE!TION
1. Good Samartan act
A nurse who renders frst ad or treatment
at the scene of an emergency and who
does so wthn the standard of care, actng
n good fath, s reeved of the
consequences
2. Carryng out physcans order
3. Provde competent care
4. Record Keepng
5. Incdenta report
Components of ncdenta report
1. Name
2. date, tme
3. descrbe the facts of ncdence
4. Cents account for ncdent
5. Wtnesses of ncdent
6. Identfy equpment, name of doses
7. sgnature
NURSES BILL ! RI"#$S
3# 1egistered nurses promote and restore
health
4# Pre!ent illness
5# Protect the people entrusted to their care
6# -lle!iate suffering
EGB|une09 13
7# Pro!ide ser!ices that maintain respect for
human dignity
PA$IEN$S BILL ! RI"#$S
3# *onsiderate and respectful care
4# 1ele!ant, current and understanda"le
information
5# Bake decisions regarding his care plan
6# )a!e ad!ance directi!e (li!ing will)
7# (!ery consideration of his pri!acy
9# *onfidentiality of communications and
records
;# 1e!iew his records concerning his medical
care
=# Be informed of "usiness relationship among
the hospital educational institution
># *onsent or decline to participate
e/perimental research affecting his care
3?# 1easona"le continuity of care when
appropriate and "e informed of other care
options
33# Be informed of hospital polices and
practices
%#IN0 (I%%S O* A'#ANCE 'I*ECTI#E
3# -ccept or refuse any treatment, ser!ice or
procedure used to diagnose or treat physical
or mental condition
4# <ecision to pro!ide or withhold life-
sustaining measures
5# $his li!ing will is signed "y the patient
6# Jitnessed "y two other persons who is not
designated as the person2s health care
representati!e
7# <irecti!e has force of law
%RAL PRINCIPLES
98 The .ol$en rule
Do unto others what you
woud ke others do unto
you
:8 The t&o ol$ eect
May have bad and good
effect
Must be moray good
Good effect must be wed
and the bad effect merey
aowed
Good effect must not come
from an ev acton
Good effect must be greater
than the bad effect
48 The Principle o Totality
The whoe s greater than
any of ts parts
;8 Epi<ia
Excepton to the genera
rue
=8 One &ho acts throu.h an a.ent is himsel
responsi-le
Ex. Nurse recommends
patent to another cnc for
aborton but does not want
to perform
>8 No one is o-li.e$ to -etray himsel)hersel
No one can force any person
to answer a queston f such
w ncrmnate hm/her
?8 The en$ $oes not ,ustiy the means
Gvng seepng tabets to
someone who has chronc
ness
@8 'eects o nature may -e correcte$
Corrected by pastc surgery
A8 I one is &illin. to cooperate in the actB no
in,ustice is $one to him)her
Wth patents consent
9C8 A little more or less $oes not chan.e the
su-stance o an act
Steang
998 The .reatest .oo$ or the .reatest num-er
Have more good effects for
more peope than a smaer
group
9:8 No one is hel$ to the impossi-le
Do not promse mpossbe
thngs
948 The morality o cooperation
EGB|une09 14
Forma cooperaton s an
ev act and never aowed
9;8 Principle relatin. to the ori.in an$
$estruction o lie
Thou sha not k
CO'E OF 0OO' 0O#E*NANCE
SerDice to others
o *ommitment to a life of sacrifice and
genuine selflessness in carrying out their
professional duties
Inte.rity an$ O-,ectiDity
o Perform their responsi"ilities with the
highest sense of integrity
Proessional Competence
o Enowledge, technical skills, attitudes and
e/perience
Soli$arity an$ team&or<
o Baintain and support one professional
organiIation
Social an$ CiDic *esponsi-ility
o Shall always carry out their professional
duties with due consideration of the "roader
interest of the pu"lic
0lo-al CompetitiDeness
o Shall remain open to challenges of a more
dynamic and interconnected world
E+uality o All proessions
o Shall treat their colleagues with respect and
stri!e to "e fair in their dealings with one
another
AMEN'E' CO'E OF ETHICS FO* N/*SES
Section 5 1epu"lic -ct ,o# =;; known as the Philippine
,ursing +aw and Section 9 of P#< ,o# 445 the amended
*ode of (thics of ,urses
Article I
o Pream"le- health is a fundamental right of
e!ery indi!idual
Article II
o Galues, customs and spiritual "eliefs held "y
indi!idual shall "e represented
o *onsider the indi!iduality and totality of
patients when they administer care
Article III
o )uman life is in!iola"le
o Kuality and e/cellence in the care of patients
are the goals of the nursing practice
o -ccurate documentation of actions and
outcomes of deli!ered care is the hallmark
of nursing accounta"ility
Article I#
o $he registered nurse is in solidarity with
other mem"ers of the healthcare team in
working for the patient2s "est interest
Article #
o Preser!ation of life, respect for human rights
and promotion of healthy en!ironment
o Promotion in local, national, and
international efforts to meet health and
social needs of the people
Article #I
o Baintenance of loyalty to the nursing
profession and preser!ation of its integrity
are ideal
Article #II
o $he certification of registration of the
registered nurse shall either "e re!oked or
suspended for !iolation of any pro!isions of
this code#
'EFINITION AN' MEANIN0 OF %A(
$he sum total of rules and regulations "y which
society is go!erned
Ban mad regulates social conduct in a formal and
"inding way
1ule of conduct pronounced "y controlling authority
and which may "e enforced
o -uthority or right to declare that the rule
e/ists
o 1ule is pronounced or e/pressed
o Source can "e defined
o - right to enforce the same must "e
pro!ided
*ontrolling authority in our system is the go!ernment
Cundaments law of the go!ernment is the constitution
Principal sources of pronouncements
EGB|une09 15
o *onstitution
o Statutes or legislations
o (/ecuti!e "ranch
o *ase decision/:udicial opinions
o Presidential decrees
o +etters of instructions
*ESONSI!I%ITY AN' ACCO/NTA!I%ITY FO* THE
P*ACTICE OF P*OFESSIONA% N/*SIN0
Professional ,egligence
o Commsson or omsson of an act,
pursuant to a duty
Exstence of a duty on the
part of the person charged
to use due care under
crcumstances
Faure to meet the standard
of due care
The foresee abty of harm
resutng from faure to
meet the standard
The fact that the breach of
ths standard resuted n an
n|ury to the pantff
-rticle 3> of the ci!il code
o One sha act wth |ustce, gve
every man hs due, observe honest
and good fath
-rticle 4?
o Those who n the performance of
ther obgatons through
neggence causes any n|ury to
another, are abe for damages
*ommon acts of negligence
o Burns resutng from hot water
bags, heat amps, vaporzers, stz
bath
o Ob|ects eft nsde the patents
body; sponges sucton tps, oose
dentures odged n the patents
trachea
o Fas of the edery; confused,
unconscous, sedated patents
o Fas of chdren whose bed ras
were not pued up and ocked
o Faure to observe and take
approprate acton
o Faure to report observatons to
attendng physcans
o Faure to exercse the degree of
dgence whch the crcumstances
of the partcuar case demands
o Mstaken dentty- drug gven to the
wrong patent
o Wrong medcne, wrong
concentraton, wrong route, wrong
dose
o Defects n the equpment
o Errors due to famy assstance
o Admnstraton of medcne wthout
a doctors prescrpton
Acts o ne.li.ence:
(1) THE DOCTRINE OF RES IPSA LOQUITUR
In|ury was of such nature that t woud not
normay occur uness there was neggent
act
In|ury was caused by an agency wthn
contro of the defendant
Pantff hmsef dd not engage n any
manner that woud tend to brng about the
n|ury
MA%P*ACTICE
The dea of mproper or unskfu care of a
patent by a nurse
Steppng beyond ones authorty wth
serous consequences
Careessness of professona personne
LESNIK- neggent act commtted n the
course of professona performance
(2) DOCTRINE OF FORCE MAJEURE
&rresisti"le forceL unforeseen or ine!ita"le
,o person shall "e responsi"le for those e!ents which
cannot "e foreseen
Cloods fire, earthquakes
(3) DOCTRINE OF RESPONDEAT SUPERIOR
+et the master answer for the acts of the su"ordinate
$he lia"ility is e/panded to include the master as well
as the employee
&,*'BP($(,*(
+ack of a"ility, legal qualifications or fitness to
discharge the required duty
EGB|une09 16
CONSENT TO ME'ICA% AN' S/*0ICA%
P*OCE'/*ES
*onsent
o Cree and rational act that presupposes
knowledge of teh thing to which consent is
"eing gi!en "y a person who is legally
capa"le to gi!e consent
o Signed "y the patient or authoriIed
representati!e/legal guardian
o -n authoriIation "y a patient or a person
authoriIed "y law to gi!e the consent on the
patient2s "ehalf
o ,urse secures the consent of the patient
upon admission
&nformed *onsent
o (sta"lished principle law that e!ery human
"eing of adult years and sound mind has the
right to determine what shall "e done with
his own "ody
o Bay choose whether to "e treated or not
Proof of *onsent
o - written consent should "e signed to show
that the procedure is the one consented to
and that the person understands the nature of
the procedure
TORTS
<efinition% A ega wrong, commtted aganst
a person or property
-ssault and Battery
o &mminent threat of harmful or offensi!e
"odily contact
o 0n:ustifia"le to tough another person or to
threaten to do so
Battery
o -n intentional, unconsented touching of
another person
Calse &mprisonment of &llegal <etention
o 0n:ustifia"le detention of a person without a
legal warrant within "oundaries
&n!asion of 1ight to Pri!acy and "reach of
confidentiality
o 1ight to pri!acy is the right to "e left alone
o 1ight to "e free from unwarranted pu"licity
o (/posure to pu"lic !iew
o <i!ulge information from patient2s chart to
improper sources or unauthoriIed person
<efamation
o *haracter assassination
o Slander-oral defamation
o +i"el-written words
o $here must "e a third person who hears or
read the comment "efore it can "e
considered defamation
!RI,ES3 ,ISDE,EANORS3 AND
FELONIES
CRIME
-n act committed or omitted in !iolation of
the law
$wo elements
o *riminal act
o (!il/criminal intent
*onspiracy to commit a crime
o $wo or more persons agree to
commit a felony
Principals- who take a
direct plan/part
-ccomplices- cooperate in
the e/ecution
-ccessories- ha!ing
knowledge of the
commission of the crime
*riminal -ctions
o -cts or offenses against pu"lic
welfare
*riminal negligence
o 1eckless imprudence- person does
an act or fails to do it !oluntarily
"ut without malice
o Simple imprudence- did not use
precaution and the damage was not
immediate or the impending danger
was not e!ident or manifest
*riminal &ntent
o States of mind of a person at the
time the criminal act is committed
that he/she knows that an act is not
EGB|une09 17
lawful and still decide to do it
anyway
WILLS
- legal declaration of a person2s intentions upon
death
$estamentary document takes effect after the death of
its maker
<ecedent- person whose property is transmitted
through the succession whether or not he left a will
&f he left a will he is called a testator
Joman is testatri/
)eir- called to succession either "y the pro!ision of a
will or "y operation of law
- person who dies lea!ing a will is said t ha!e died
testate
'ne who dies without will is said to ha!e died
intestate
Galidation of the will in a court is known as pro"ate
- will which is written, dated and signed "y the
testator is called holographic will
-n oral will is called nuncupati!e will or
nuncupation- made during the person2s last illness,
that it "e done in the place in which he died, one or
more witnesses to the will
$estator must ha!e the e/pressed intention of making
a will
Bust "e right of age
0nder 3= cannot make a will
1equired to ha!e sound mind
$hink clearly a"ility at the time of its e/ecution
N/*SES O!%I0ATIONS IN THE EEEC/TION OF A
(I%%
$he nurse should note the soundness of the patient2s
mind
$here was freedom from fraud or undue influence
Bake a notation on the patient2s chart of the apparent
mental and physical condition of the patient at the
time of making the will
EGB|une09 18