NCM 103 LECTURE – FINALS competently fulfill their scope of practice A SAMPLE OF YOUR FUTURE WHEN YOU

and standards of care. It may include BECOME A NURSE

LIFELONG LEARNING formal or informal educational
• Is the "ongoing, voluntary, and self- opportunities such as: Enrolling in
motivated" pursuit of knowledge for either traditional or online degree programs.
personal or professional reasons.
Therefore, it not only enhances social THREE GREAT BENEFITS OF LIFELONG
inclusion, active citizenship, and personal LEARNING FOR NURSES:
development, but also self-sustainability, as 1. Coping with the fast-coping world
well as competitiveness and employability. 2. Greater paychecks by giving job
• Lifelong learners are motivated to learn opportunities
and develop because they want to: it is a 3. Enriching and fulfilling the life
deliberate and voluntary act. Lifelong
learning can enhance our understanding of → “To continually upgrade your services
the world around us, provide us with more in this competitive world.”
and better opportunities and improve our → Keep
quality of life. → Educating
→ Yourself
WHAT DOES THIS MEAN FOR NURSES? • How will you proceed or pursue your
• Lifelong learning helps nurses build and CONTINUING PROFESSIONAL nursing career in the near future? Finding
maintain their clinical competency. DEVELOPMENT (CPD) your specialty: different types of nurses
• Continuing education gives nurses fresh • It refers to the process of tracking and • Pursuing specific field of nursing somehow
information that can be implemented to documenting the skills, knowledge and it can take a long process or may also be
improve patient outcomes experience that you gain both formally not so depending on the path you take as
• Nurses don't practice the same standards and informally as you work, beyond any your search and learn what is really your
they did 20 years ago or even 5 years initial training. calling in the practice of the nursing
ago profession
• It's important for nurses to make an effort
to stay informed of impending changes to BSN DIPLOMA (BACHELOR OF SCIENCE IN
their nursing practice NURSING) → STAFF NURSE → HOSPITAL-
BASED, COMMUNITY-BASED, COMPANY,
WHAT IS LIFELONG LEARNING? OTHERS
• Nurses continue to learn throughout their
careers to gain knowledge so they can

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MASTER/DOCTORAL DEGREE IN NURSING NURSE SALARY BY EDUCATION LEVEL
MANAGEMENT TRACK
(MANAGEMENT)
• Hospital administrator
• Provincial/ regional and national nursing
director
RESEARCH TRACK
• Nurse supervisor / head nurse
• Training officer / assistant chief nurse
• Chief nursing director THE GENDER PAY GAP IN NURSING
CLINICAL TRACK
• Clinical instructor
• Assistant college dean
• College dean
• Principal nurse educator
EDUCATION TRACK
• Nurse epidemiologist • Male nurses receives higher pay over
• Nurse researcher female nurses
TOP PAYING NURSE CAREER

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 ETHICO-MORAL &LEGAL approaches therapeutic use of self  practice provided that this section shall
CONSIDERATIONSIN THE PRACTICE OF executing health care techniques not apply to nursing students who
NURSING and procedures essential primary perform nursing functions under the direct
health care comfort measures health supervision of a qualified faculty
• RA 9173 teachings and administration of provided further that in the practice of
• Philippine Nursing Act of 2002 written prescription for treatment nursing in all settings the nurse is duty-
therapies oral, topical, and bound to observe the code of ethics for
ARTICLE VI parenteral medications nurses and uphold the standards of safe
NURSING PRACTICE  In turn, examination during labor in nursing practice
SEC.28 Scope of Nursing the absence of antenatal bleeding  The nurse is required to maintain
• A person shall be deemed to be practicing and delivery so in case of competence by continual learning
nursing within the meaning of this Act when saturating of perennial laceration through the continuing professional
he/she singly or in collaboration with special training shall be provided education to be provided by the
another, initiates and performs nursing according to protocol established accredited professional organizations or
services to individuals, families and b) Establish linkages with community any recognized professional nursing
communities in any healthcare setting. It resources and coordination with the organization
includes, but not limited to, nursing care health team; • Provided, finally, That the program and
during conception, labor, delivery, infancy, c) Provide health education to individuals, activity for the continuing professional
childhood, toddler, pre-school, school age, families and communities; education shall be submitted to and
adolescence, adulthood and old age. d) Teach, guide and supervise students in approved by the Board.
 As independent practitioners, nurses are nursing education programs including
primarily responsible for the promotion the administration of nursing services in CODE OF ETHICS FOR NURSES
of health and prevention of illness. varied settings such as hospitals and • Code of Ethics for Nurses in the Philippines
 As members of the health team nurses clinics; undertake consultation services; was devised as a guide for carrying out
shall collaborate with other health care engage in such activities that require nursing responsibilities which would tackle
providers for the curative preventive the utilization of knowledge and difficult issues and decisions that a
and rehabilitative aspects of care, decision-making skills of a registered profession might be facing, and give clear
restoration of health elevation of nurse; and instruction of what action would be
suffering and when recovery is not e) Undertake nursing and health human considered ethical or right in the given
possible towards a peaceful death resource development training and circumstance.
a) Provide nursing care through the research, which shall include, but not
utilization of the nursing process. limited to, the development of advance ETHICS
nursing practice
 Nursing care includes but not limited • A code upon which a person bases actions
to traditional and innovative and decisions.

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• The process of determining right from decisions about their care is now standard FIDELITY
wrong, good and bad. practice • Agreement to keep promises
• Decisions are guided by beliefs and • Providers are obligated to inform patients • Refers to the unwillingness to abandon
values. about risk and benefits of treatment plans patients regardless of the circumstances
• Moral truths that guide thought process and and then to ensure that they understand even when personal beliefs differ as they
actions. and agree with their plan may when dealing with drug dealers,
• Respect for provider autonomy refers to members of the gay community, women
INTERNATIONAL COUNCIL OF NURSES (ICN) provider relationships to institutions who receive an abortion or prisoners
• First adopted the code of ethics on 1953 BENEFICENCE
AMERICAN NURSES ASSOCIATION (ANA) • Taking positive actions to help others PROFESSIONAL NURSING CODE OF ETHICS
• First to adopt the code of nurses on 1950 • The agreement to act with beneficence Code of Nursing Ethics
implies that the best interests of the patient  A code of ethics can be defined as a
remain more important than self-interest collective statement about the group's
• The Code of Ethics for Registered Nurses in
NONMALEFICENCE expectations and standards of behavior
the Philippines is promulgated by the
• Avoidance of harm or hurt  ANA reviews and revises the code of
Board of Nursing (BON) and was consulted
regularly to reflect changes in practice
with accredited professional organizations • Non-maleficence is the avoidance of harm
like the Philippine Nurses Association. It or hurt → A set of guiding principles that all
also coincides with the ideals of Republic members of a profession accept
• In healthcare, ethical practice involves not
Act No. 9173 or the "Philippine Nursing Act only the will to do good but an equal → Helps professional groups settle
of 2002." commitment to do no harm questions about practice or behavior
 the code of ethics for Filipino nurses was JUSTICE → Includes advocacy, responsibility,
made after a consultation on October 23, • Being fair accountability, confidentiality
2013 at Iloilo city after accredited • refers to fairness it is used most often in • Advocacy
professional organizations decided to discussions about access to health care ➢ Refers to the support of a particular
adapt a new code of ethics under the RA resources including the just distribution of cause as a nurse you advocate for the
19173 resources health safety and rights of the patients
• The term “just culture” refers to the including the right to privacy and their
BASIC TERMS IN HEALTH ETHICS right to refuse treatment
promotion of open discussion without fear
AUTONOMY • Responsibility
of recrimination whenever mistakes
• Commitment to include patients in decisions especially those involving adverse events ➢ Refers to willingness to respect
about all aspects of care as way of occur or nearly occur obligations and to follow through on
acknowledging and protecting a patient's promises
• As a nurse, you keep promises by following
independence involving patients in ➢
through on your actions and interventions

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 • Accountability emotionally, psychologically, and becomes the key to the resolution of
➢ accountability refers to the ability to spiritually ethical dilemmas
answer for one's own actions standards ➢ As a nurse you agree to provide care ➢ Identifying values as sometimes or
are set by the Joint commission and the to your patients solely on the basis of something separate from facts can help
American Nurses Association their need for your services you find tolerance for others even
➢ So healthcare facilities have ➢ As a nurse you will need to respect when differences among you seem
compliance officers who are your own values even as you try to worlds apart
responsible for making sure that the respect those of others whose values Value
institution remains in compliance with differ from yours • A value is a personal belief about the
standards and regulations ➢ To negotiate differences of value, it is worth of a given idea, attitude, custom, or
• Confidentiality important to be clear about your own object that sets standards that influence
➢ the concept of confidentiality is well values what you value, why and how behavior.
established the Health Insurance you respect your own values even as Values clarification
Portability And Accountability Act of you try to respect those of others • Ethical dilemmas almost always occur in the
1996 or the HEPAA mandates whose values differ from yours presence of conflicting values.
protection of the patient's personal ➢ The values that an individual holds • To resolve ethical dilemmas, one needs to
health information reflect cultural and social influences distinguish among values, facts, and opinion
➢ Social networks can be a supportive and these values vary among people
source of information about patient and develop over time ETHICS AND PHILOSOPHY
care or professional nursing activities ➢ Sometimes people have such strong ➢ Historically healthcare ethics
➢ The risk to patient privacy is great values that they consider them to be constituted a search for fixed
posting a photo with no identifier facts not just opinion standards that would determine right
should not be practiced as sometimes ➢ Sometimes people are so passionate actions ethics has grown into a complex
the patient can still be identified, about their values that they become field of study more flexible than fix
becoming friends with patients may judgmental in a way that intensifies filled with differences of opinion and
cloud your ability to remain objective, conflict deeply meaningful efforts to
workplace policies will guide your ➢ Clarifying values your own, your understand human interaction
decisions in engaging with social media patients, your co-workers is an ➢ These philosophies or theories on ethics
Social Networking important and effective part of ethical provide a foundation for developing
→ Presents ethical challenges for nurses discourse strategies to use when an ethical
VALUES ➢ In the process of values clarification, dilemma occurs
➢ Nursing practice requires you to be in you learn to tolerate differences in a
contact with patients physically, way that often, although not always, DEONTOLOGY
• Defines actions as right or wrong

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 • Proposes a system of ethics that is power is unequal or in which a point of • As a strategy for solving dilemmas,
perhaps most familiar to healthcare view has become ignored or invisible consensus building promotes respect and
practitioners • Writers with a feminist perspective tend to agreement rather than a particular
• Deontology defines actions as right or concentrate more on practical solutions philosophy or moral system itself
wrong based on the right making than on theory
characteristics such as fidelity to promises, • Feminist ethicist proposed that the natural NURSING POINT OF VIEW
truthfulness and justice human urge to be influenced by • All patients in healthcare systems interact
• Deontology depends on a mutual relationships is a positive value with nurses at some point and they
understanding of justice, autonomy and ETHICS OF CARE interact in ways that are unique to nursing
goodness, but it still lives from leaves • Emphasizes the importance of • they are involved in intimate physical acts
room for confusion to surface understanding relationships, especially as such as bathing, feeding, and special
UTILITARIANISM they are revealed in personal narratives procedures. As a result patients and
• Proposes that the value of something is • The ethics of care and feminist ethics are families may feel more comfortable in
determined by its usefulness closely related. Both promote a revealing information that always shared
• This philosophy is also known as philosophy that focuses on understanding with physicians or other healthcare
consequentialism because its main relationships especially personal providers
emphasis is on the outcome or narratives • Your ability to shape your care on the
consequences of an action • An early proponent of the ethics of care basis of this special knowledge provides
• A term associated with this philosophy is use the term the “one caring to identify an indispensable contribution to the
teleology from the Greek word telos the individual who provides care” and the overall care of your patient
meaning end or the study of ends or final “cared for” refer to the patients • The care of any patient involves the
causes • In adopting this language, the author collaboration of many disciplines,
• The greatest good for the greatest hoped to emphasize the role of feelings managers and administrators from many
number of people is the guiding principle different professional backgrounds
for determining right action in this system CASUISTRY contribute to ethical discourse with their
FEMINIST ETHICS • Care-based reasoning knowledge of systems, distribution of
• Focuses on the inequality between people • Turns away from conventional principles resources, financial possibilities and
of ethics as a way to determine best limitations
• Critics conventional ethics such as
deontology and utilitarianism actions and focuses instead on an intimate • Nurses generally engage with patients
understanding of particular situations over longer periods of time than other
• It looks to the nature of relationships to
• This approach to ethical discourse disciplines.
guide participants in making difficult
decisions especially relationships in which depends on finding consensus more than • Patients may feel more comfortable
an appeal to philosophical principle revealing information to nurses

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 PROCESSING AN ETHICAL DILEMMA • For the institutional resources healthcare • His or her ability to contribute to society in
Step 1: Ask if this is an ethical dilemma. institutions establish ethics committees to a gainful way and other nuances or
Step 2: Gather all relevant information. process ethical dilemmas measures of quality still a definition
Step 3: Clarify values. • Nurses provide insights about ethical remains deeply individual and difficult to
Step 4: Verbalize the problem. problems at family conferences at staff predict
Step 5: Identify possible courses of action. meetings and even in one-on-one meetings • The question of quality of life is central to
Step 6: Negotiate the outcome. • Many ethical problems begin when people discussions about quality of care, outcomes
Step 7: Evaluate the action. feel misled or not aware of their options measures, care at the end of life, futile
• Dilemmas cause distress for patients and and do not know when to speak up about care, cancer therapy and healthcare
caregivers also their concerns provider assisted suicide
• Resolving an ethical dilemma is similar to • Ethics committees serve to complement • The national movement to respect the
the nursing process in its methodical relationships within the workplace and the abilities of all regardless of their functional
approach to a clinical issue. It differs in community and offer a valuable resource status has inspired a reconsideration of the
that it requires negotiation of differences for strengthening these relationships definition of quality of life
of opinion and clarify about situations that • Process for resolving ethical dilemmas that • Anti-discrimination laws enhance the
are confusing and not easily solved by respects differences of opinion and all economic security of people with physical,
appealing to the usual ethical principles participants equally helps healthcare mental, or emotional challenges the
• A process for resolving ethical dilemmas providers resolve conflict about right capabilities approach begins with a
that respects differences of opinion and actions commitment to the equal dignity of all
all participants equally helps healthcare people whatever their class, religion, caste,
providers resolve conflict about right ISSUES IN HEALTHCARE ETHICS race or gender and it's completed to the
actions • Ethical issues change as society and attainment for all of lives that are worthy
technologies change but common of that equal dignity
INSTITUTIONAL RESOURCES denominators remain. The basic process • Difficult emotional and spiritual challenges
• Ethics committees are usually used to address the issues and your resulting in moral distress can characterize
multidisciplinary and serve several responsibility to deal with them the management of care at the end of life.
purposes: education, policy • this professional ethical or bioethical issues The term “futile” refers to something that is
recommendation, and case consultation. will influence you and the care you give hopeless or serves no useful purpose. Tn
• Any person involved in an ethical dilemma, your patients quality of life genetic healthcare discussions the term refers to
including nurses, physicians, health care screening and care at the end of life interventions unlikely to produce benefit for
providers, patients, and family members, • the quality of life it measures may take into a patient. If a patient is dying of a
can request access to an ethics committee. account the age of a patient the patient's condition with little or no hope of recovery
ability to live independently almost any intervention beyond symptom
management and comfort measures is seen

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 as futile. In this situation an agreement to • As patient care practice innovations and ➢ Civil law
label an intervention as futile can help new health care technologies, emerge the  Civil laws protect the right of
providers families and patients turn to principles of negligence and malpractice individuals and provide for fair and
palliative care measures as a more liability are being applied to challenging equitable treatment when civil wrongs
constructive approach to the situation new situations. Nurses should practice or violations occur the consequences of
• The legislation also incorporates a nursing armed with the skills that are the civil law violations are damages in the
promotion of wellness by proposing outcomes of informed critical thinking form of fines or specific performance of
changes in payment for services and by good work such as public service
rewarding practices that reduce harm and LEGAL LIMITS OF NURSING  Nursing negligence or malpractice is an
promote quality of outcomes • Sources of law: example of a civil law violation
QUALITY OF LIFE: → Statutory law (Nurse Practice Act) → Regulatory law (administrative law)
• Central to discussions about end-of-life ➢ Criminal law (felonies or misdemeanors)  Regulatory law also known as
care, cancer therapy, physician-assisted  Criminal laws are meant to prevent administrative law defines your duty to
suicide, and Do Not Resuscitate (DNR) harms to society and to provide report incompetent or unethical nursing
DISABILITIES: punishment for crimes so these are conduct to the board of nursing
• Antidiscrimination laws enhance the categorized as felonies or → Common law (judicial decisions)
economic security of people with physical, misdemeanors  Common law results from judicial
mental, or emotional challenges  A felony is a serious offense that results decision concerning individual cases so
CARE AT THE END OF LIFE: in significant harm to another person or most of these revolve around negligence
• Interventions unlikely to produce benefit for society in general and malpractice
the patient  Felony crimes carry penalties of
HEALTH CARE REFORM: monetary restitution imprisonment for • Standards of care
• Facilitated access to care for millions of greater than one year or death  The standards reflect the knowledge
uninsured Americans  Examples of nurse practice act and skill ordinarily possessed and used
violations that may carry criminal by nurses actively practicing in the
LEGAL ASPECTS OF NURSING CARE penalties include misuse of a controlled profession the Philippine Nurses
• A PRECURSOR TO RA 9173 substance or practicing without a license Association develops standards for
• Safe and competent nursing practice  A misdemeanor is a crime that although nursing practice policy statements and
requires clinical reasoning and an injuries does not inflict serious harm similar resolutions. These standards
understanding of the legal framework of  Example parking in a no parking zone outline the scope function and the role
health care, the specific state nurse is a misdemeanor violation of traffic of the nurse in practice
practice act, and the scope and the laws a misdemeanor usually has a  In a malpractice lawsuit a nurse's actual
standards of nursing care penalty of a monetary fine forfeiture or conduct is compared to nursing
brief imprisonment standards of care to determine whether

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 the nurse acted as any reasonably FEDERAL STATUTORY ISSUES IN NURSING  In addition to patient refusal of
prudent nurse would act under the same PRACTICE treatment the nurse frequently
or similar circumstances • Advance directives encounters a do not resuscitate or DNR
 Nurse practice acts define the scope of → Living wills or no code DNR order. Documentation
nursing practice distinguishing between  Durable power of for health care to be that the healthcare provider has
nursing and medical practice and enforced so the patient must be consulted with the patient and or
establishing education and licensure declared legally incompetent or lack family is required before attaching a
requirements for nurses the capacity to make decisions DNR order to the patient's medical
 In a lawsuit for malpractice or regarding his or her own health care record
negligence, a nursing expert may testify treatment  Cardiopulmonary resuscitation or CPR
to the jury about the standards of  Be familiar with the policies of your is an emergency treatment provided
nursing care as applied to the facts of institution that comply with the PSDA, with outpatient consent. Healthcare
the case. Nurse experts base their likewise check the state laws to see if a providers perform CPR on an
opinions on existing standards of state honors and advanced directive appropriate patient unless there is a
practice established by the nurse that originates in another state DNR order in the patient's chart
practice acts federal and state hospital  represent written documents that direct
licensing laws treatment in accordance with a STATE STATUTORY ISSUES IN NURSING
→ Legal guidelines for defining nursing patient's wishes in the event of a PRACTICE
practice and identifying the minimum terminal illness or condition • Nurses act as a Good Samaritan when
acceptable nursing care → Health care proxies or durable power of providing care at the scene of an
→ Best known comes from the American attorney for health care accident
Nurses Association (ANA)  DPAHC is a legal document that • All states or countries have Good
→ Set by state and federal laws that govern designates a person or people of once Samaritan acts provisions may vary
where nurses work choosing to make healthcare decisions among states or places however these
→ Joint Commission requires policies and when the patient is no longer able to laws limit liability and offer legal
procedures (P&Ps). make decisions on his or her own immunity for nurses who help at the scene
 The patient self-determination act or behalf of an accident
PSDA enacted in 1991 requires  This agent makes health care treatment • At least two states we have like for
healthcare institutions to provide decisions on the basis of the patient example we have Minnesota and
written information to patients wishes Vermont require nurses to stop and help
concerning their rights under state law  In addition to federal statutes the in an emergency so if you perform a
to make decisions, including the right to ethical doctrine of autonomy ensures procedure exceeding your scope of
refuse treatment and formulate that the patient the right to refuse practice and for which you have no
advance directives medical treatment

9
 training you are liable for injury that CIVIL AND COMMON LAW ISSUES IN False imprisonment requires that the
may result from that act NURSING PRACTICE patient be aware of the confinement
• If you leave the patient without properly • Torts  Typically, invasion of privacy is the
transferring or handling him or her after  Tort is a civil role made against a person release of a patient's medical information
a capable person you may be liable for or property to an unauthorized person such as a
patient abandonment and responsible  They are classified as intentional quasi- member of the press, the patient's
for any injury suffered after you leave intentional or unintentional employer, the patient's family or online so
him or her  Intentional torts are willful acts that violate the information that is in a patient's
• It is important for you to understand another's rights. These include assault medical record is a confidential
public health laws under the health code battery and false imprisonment communication that may be shared with
state legislatures enact statutes that  Assault it is an intentional threat toward healthcare providers for the purpose of
describe the reporting for communicable another person that places the person in a medical treatment only
diseases specify necessary school reasonable fear of harmful imminent or  Do not disclose the patient's confidential
immunizations and mandate other unwelcome contact. No actual contact is medical information without his or her
measures that promote health and required for an assault to occur consent
reduce health risks in communities  Attempt or threat to touch another person  A patient must authorize the release of
• Public health laws protect populations, unjustifiably so the act that causes the information
advocate for the rights of people, person to believe a battery is about to  the defamation of character is the
regulate health care and health care occur. For example, a nurse who threatens publication of false statements that result
financing and ensure professional the client with injections after the client in damage to a person's reputation
accountability for care provided refuses to take oral medications  Slander occurs when one speaks falsely
• Any health care professionals who does  Battery is an intentional offensive touching about another
not report suspected child abuse or without consent or lawful justification the  Libel is the written defamation of
neglect may be liable for civil or criminal contact can be harmful to the patient and character
legal action cause an injury or it merely can be  Negligence is conduct that falls below the
• Advanced directives are written offensive to the patient's personal dignity. generally accepted standard of care of a
documents that outlay the patient's wishes Battery also results if the healthcare reasonably prudent person
should he or she become incapacitated provider performs a procedure that goes  Malpractice is one type of negligence and
beyond the scope of the patient's consent often referred to as a professional
• Licensure
 The Tort of false imprisonment occurs negligence certain criteria are necessary
• Good Samaritan Laws to establish nursing malpractice such as the
with unjustified restraint of a person
• Public Health Laws without a legal reason. This occurs when nurse or defendant owed a duty of care
nurses restrain a patient in a confined to the patient or plaintiff. The nurse did
area to keep the person from freedom. not carry out or breach that duty the

10
 patient was injured and the nurse's failure • The act that causes the person to believe results in injury to the reputation of the
to carry out the duty caused the injury so a battery is about to occur. person.
the best way for nurses to avoid • e.g. a nurse who threatens the client with LIBEL
malpractice is to follow standard of care. injections after the client refuses to take • Defamation by means of print, writing or
Give competent health care and oral meds pictures. Eg. When a nurse writes in the
communicate with other health care nurses notes that a physician does not
providers, you are accountable for timely INTENTIONAL respond immediately to a call
reporting of any significant changes in the • Willful touching of a person that may or SLANDER
patient's condition to the healthcare may not cause harm. • Defamation by a spoken word, stating
provider and documenting these changes unprivileged or false words by which a
• Consent is required before the procedure.
in the medical record. reputation is damaged. eg. Telling a client
 If records are lost or incomplete there is a • Battery exists when there is no consent,
even if the plaintiff was not asked for that another nurse is incompetent
presumption that the care was negligent
and therefore the cause of the patient's consent.
UNINTENTIONAL TORTS
injuries • Determination of competency to give
NEGLIGENCE
informed consent is made through court
hearings. • Conduct that falls below the standard of
• Intentional care.
→ Assault • May be an act of commission or and act of
FALSE IMPRISONMENT
→ Battery omission.
• “unjustifiable detention of a person without
→ False imprisonment legal warrant to confine the person MALPRACTICE
• Quasi-intentional torts • False imprisonment + forceful • Professional negligence.
→ Invasion of privacy restraint/threat = BATTERY • A deviation in the standard of care.
→ Defamation of character a. The nurse owed duty to a client.
 Slander INVASION OF PRIVACY b. Nurse did not carry out that duty.
 Libel • Direct wrong of a personal nature. c. Client was injured.
1. Unintentional torts d. Nurse’s failure to carry out duty causes
• The right to privacy is the right of
 Negligence injury.
individuals to withhold themselves and their
 Malpractice lives from public scrutiny.
CONSENT
-includes the right to be alone
ASSAULT • A patient signed consent form is necessary
• Attempt or threat to touch another person DEFAMATION for admission to health care agency
unjustifiably.  Communication that is false or made with invasive procedures such as intravenous
a careless disregard for the truth and central and insertion surgery some

11
 treatment programs such as chemotherapy 6. The patient knows that he or she may TERMINATION OF PREGNANCY OR
and participation in research studies so refuse the procedure or treatment even ABORTION ISSUES
• Nurses need to know the law in their states after the procedure has begun • 1973 Roe v. Wade
and be familiar with the policies and  Patients deny understanding or you → U.S. Supreme Court ruled that there is a
procedures of their employing agency suspect that they do not understand fundamental right to privacy
regarding consent so informed consent notify the healthcare provider or
creates a legal duty for the health care nursing supervisor • 1989 Webster v. Reproductive Health
provider to disclose material facts in terms  Healthcare providers must inform a Services
that the patient is able to understand to patient refusing surgery or other
→ Some states require viability tests if the
make an informed choice medical treatments about any harmful fetus is more than 28 weeks’ gestational
• Inform consent is a part of healthcare consequences of refusal age.
provider patient relationship it must be  Parents are usually the legal guardians
→ During the first trimester a woman could
obtained and witnessed when the patient is of pediatric patients therefore they
end her pregnancy without state
not under the influence of medication such typically are the people who sign
regulation because the risk of natural
as opioids it is not the nurse responsibility consent forms for treatment
mortality for abortion or from abortion is
get informed consent  Patients with mental illnesses must also
less than with normal childbirth
• The key elements of responsibility for the give consent so they retain the right to
refuse treatment until a court has → During the second trimester the state has
healthcare provider include the following: an interest in protecting maternal health
1. The patient receives an explanation of the determined legally that they are
incompetent to decide for themselves and the state enforces regulations
procedure or treatment regarding the person performing the
2. The patient receives the names and • Consent form
abortion and the abortion facility
qualifications of people performing and → Must be signed
→ During third trimester when the fetus
assisting in the procedure • Informed consent becomes viable the state's interest is to
3. The patient receives a description of the → Agreement to allow care based on full protect the fetus thus the state prohibits
serious harm including death that may disclosure of risks, benefits, alternatives, abortion except when necessary to save
occur as a result of the procedure and and consequences of refusal the mother
anticipated pain and or discomfort → The nurse’s signature as a witness to the
4. The patient receives an explanation of consent means that the patient NURSING STUDENTS
alternative therapies to the proposed voluntarily gave consent, the patient’s
procedure or treatment and the risk of • You are liable if your actions cause harm
signature is authentic, and the patient to patients, as is your instructor, hospital,
doing nothing appears to be competent to give
5. The patient knows that he or she has the and college/university
consent • You are expected to perform as a
right to refuse the procedure or treatment
without discontinuing other supportive care professional when rendering care

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• You must separate your student nurse role • Euthanasia NURSING RESPONSIBILITY
from your work as a certified nursing • Inquest • Loss of Client Property
assistant (CNA) • Loss of Client Property • Potential Malpractice
 When students work as a nursing • Good Samaritan Act • Post Mortem Care–requires
assistant or during their OGTs or nurses pronouncement of death by the
• Unprofessional Conduct
aids when not attending classes, they physician.
should not perform tasks that do not • Organ Donation–Requires consent from
NURSING CONSIDERATION
appear in a job description for a nurse the client. If the client is dead, the family
ABORTION
aide or assistant may authorize organ donation
 If someone requests that a student • Legally and morally wrong.
employed in the agency as a nurse's ADVANCE DIRECTIVE
• document the individual completes when MALPRACTICE INSURANCE
aide performed task that he or she is
competent outlining the care desired to • A contract between the nurse and the
not prepared to complete safely, the
receive in the future; are followed if insurance company
student employee needs to bring this
information to the supervisor's attention decision making powers are altered and • Provides a defense when a nurse is in a
provides guidance to the health care lawsuit involving negligence or malpractice
so the task can be assigned to an
appropriate healthcare professional team • Nurses covered by institution’s insurance
AUTOPSY while working
GENERAL AREAS OF LIABILITY • Requires consent from significant other  The insurance company pays for cost
DNR ORDER attorneys fees and settlement and other
• For the clients in terminal or irreversible related fees generated in the
illness representation of the nurse
• Should be clearly documented  Nurses employed by healthcare agencies
generally are covered by insurance
• Requested by the client significant other
provided by the agency however it is
EUTHANASIA (MERCY KILLING)
important to remember that the lawyer is
• Legally and morally wrong representing your employer and not to
INQUEST
you
• Legal inquiry into the cause of death  The insurance provided by the employing
NURSING CONSIDERATIONS: • Consult institutional policy agency only covers nurses while they are
• Abortion • Medical records are summoned in court working within the scope of their
• Advanced Health Care Directives not directly released by nurses for legal employment
• Autopsy purposes  Nurses are also investigated by the state
• DNR Order of board of nursing or nursing commission

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 to determine whether the alleged breach 6. The nurse clinical judgment is impaired as a RISK MANAGEMENT AND QUALITY
in care is a violation of civil regulations result of fatigue resulting in a safety risk of ASSURANCE
associated with their nursing license the patient • A system of ensuring appropriate nursing
 Without individual insurance coverage  when refusing an assignment it is care that attempts to identify potential
the nurse will be required to personally important to give your immediate hazards and eliminate them before harm
pay all costs and attorney fees incurred supervisor specific reasons for the occurs
by him or her in the defense against refusal and determine for other • Steps involved:
these claims alternatives such as reassignment are → Identify possible risks
available
→ Analyze risks
ABANDONMENT AND ASSIGNMENT ISSUES  in junction with professional nursing
SHORT STAFFING → Act to reduce risks
organizations has opposed federal
• Legal problems occur if an inadequate legislations titled the registered nurse → Evaluate steps taken
number of nurses will provide care safe staffing act so which requires
FLOATING medicare certified facilities to establish MALPRACTICE VS NEGLIGENCE
• Based on census load and patient acuities. staffing committees comprised of 55% • Medication Error
HEALTH CARE PROVIDERS’ ORDERS direct care nurses so nurses who float • Sponge Count Error
• Nurses follow orders unless they believe an must inform the supervisor of any lack of • Burning a Client
order is given in error or is harmful. experience in caring for the type of • Client falls
patients on the nursing unit • Failure to observe and take appropriate
A nurse may refuse an assignment when  They should request and receive an actions
1. The nurse lacks the knowledge or skills to orientation to the unit • Mistaken Identity
provide competent care  Nurses follow healthcare providers
• Loss/damage of client property.
2. Care exceeding the nurse practice act is orders unless they believe that the
orders are in error, violate agency • Failure in reporting crimes, torts and unsafe
expected practice
3. Health of the nurse or her and born child is policy or are harmful to the patient
 if the healthcare provider confirms an  The rationale for risk management and
directly threatened by the type of quality improvement programs is the
assignment order and you still believe that it is
inappropriate use the agency chain of development of an organizational system
4. Orientation to the unit has not been of ensuring appropriate quality
completed and safety is at risk command to inform your direct
supervisor. Make sure that all the healthcare by identifying potential
5. The nurse clearly states and documents a hazards and eliminating them before
consensus objection on the basis of moral healthcare provider orders are in
writing so dated and timed harm occurs
ethical or religious grounds  Both quality improvement and risk
appropriately and transcribed correctly
management require thorough
documentation

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