🩹Professionalism and Research in Nursing Unit 3 – Legal & Ethical Aspects of Nursing

Key Concepts and Definitions

• Ethics involves a system of moral principles and values that guide behavior and decision-making
• Morals refer to personal beliefs about right and wrong, shaped by individual values and cultural norms
• Laws are rules and regulations established by government authorities to maintain order and protect citizens
• Bioethics focuses on ethical issues related to healthcare, medical research, and the life sciences
• Autonomy is the right of individuals to make their own decisions about their health and medical treatment
• Beneficence is the ethical principle of doing good and acting in the best interest of the patient
• Non-maleficence means avoiding harm and ensuring that actions do not cause injury or suffering to others
• Justice in healthcare refers to fair and equitable distribution of resources and access to care

Legal Framework in Nursing

• Nurses are bound by federal and state laws that regulate the practice of nursing and protect patient rights
• The Nurse Practice Act (NPA) defines the scope of nursing practice and establishes licensure requirements for each state
• Nursing licensure ensures that nurses meet minimum standards of education, training, and competency to provide safe patient care
• Malpractice occurs when a healthcare professional fails to provide the standard of care, resulting in patient harm or injury
• Negligence is a failure to exercise reasonable care, leading to unintentional harm or damage
• Nurses have a legal duty to report suspected abuse, neglect, or exploitation of vulnerable populations (children, elderly, disabled)
• Documentation is a legal requirement in nursing practice, providing a written record of patient care and communication among healthcare providers
• Nurses must adhere to privacy laws (HIPAA) that protect the confidentiality of patient health information

Ethical Principles in Healthcare

• Respect for persons acknowledges the inherent dignity and worth of every individual, regardless of their background or circumstances
• Veracity is the ethical principle of truthfulness, requiring healthcare providers to be honest and transparent in their communication with patients
• Fidelity refers to the duty of loyalty and keeping promises, such as maintaining confidentiality and advocating for patient interests
• Paternalism is the practice of making decisions on behalf of patients without their input, based on the belief that the healthcare provider knows best
  • Paternalism can conflict with the principle of autonomy and should be used judiciously in patient care
• Double effect is a principle that recognizes that some actions may have both positive and negative consequences, and the intent behind the action is important in determining its ethical permissibility
• Ethical principles can sometimes conflict with one another, requiring careful consideration and balancing of competing values in decision-making
• Cultural competence is essential for providing ethical care that respects the diverse beliefs, values, and practices of patients from different backgrounds

Patient Rights and Responsibilities

• Patients have the right to receive information about their diagnosis, treatment options, and prognosis in a way they can understand
• The right to refuse treatment allows patients to make informed decisions about their care, even if it goes against medical advice
• Patients have the right to privacy and confidentiality of their personal and medical information
• The right to access medical records enables patients to review and obtain copies of their health information
• Patients are responsible for providing accurate and complete information about their health history and current symptoms
• Patients have a responsibility to follow treatment plans and communicate any concerns or questions to their healthcare providers
• The right to file a complaint or grievance ensures that patients can voice their concerns and seek resolution for problems with their care

Informed Consent and Confidentiality

• Informed consent is the process of providing patients with sufficient information to make a voluntary decision about their medical treatment
  • Elements of informed consent include disclosure of risks, benefits, and alternatives; assessment of patient understanding; and documentation of the patient's decision
• Capacity refers to a patient's ability to understand information and make rational decisions about their care
• Surrogate decision-makers may be appointed to make healthcare decisions on behalf of patients who lack capacity (due to age, mental illness, or unconsciousness)
• Confidentiality is the ethical and legal obligation to protect patient privacy and prevent unauthorized disclosure of personal and medical information
• Exceptions to confidentiality may occur in certain situations, such as reporting communicable diseases or suspected abuse, as required by law
• Nurses must take precautions to maintain the confidentiality of patient information, including secure storage and disposal of records and avoiding discussions in public areas

Professional Boundaries and Conduct

• Professional boundaries are the limits that define the appropriate relationship between nurses and patients, based on therapeutic goals and ethical standards
• Boundary violations occur when nurses cross the line of professional conduct, such as engaging in personal or sexual relationships with patients
• Gifts from patients can blur professional boundaries and should be handled according to organizational policies and ethical guidelines
• Social media use by nurses requires careful consideration of privacy, confidentiality, and professional image
  • Nurses should avoid posting patient information or images online and maintain separate personal and professional profiles
• Interprofessional collaboration is essential for providing comprehensive patient care, but requires clear communication and respect for the roles and expertise of other healthcare team members
• Nurses have a responsibility to report unethical or unsafe behavior by colleagues, following established channels and protocols for addressing concerns
• Professional organizations (ANA) provide guidance and support for ethical nursing practice through codes of ethics, position statements, and educational resources

Ethical Decision-Making Models

• Ethical decision-making models provide a structured approach for analyzing and resolving ethical dilemmas in nursing practice
• The Four-Quadrant Model considers the medical indications, patient preferences, quality of life, and contextual features of an ethical situation
• The MORAL model guides nurses through the steps of Massage the dilemma, Outline options, Review criteria and resolve, Affirm position and act, and Look back and evaluate
• Uustal's Decision-Making Model involves gathering relevant information, identifying ethical principles involved, exploring alternatives, and making a decision based on the nurse's values and moral reasoning
• Ethical frameworks, such as utilitarianism (greatest good for the greatest number) and deontology (adherence to moral rules and duties), can inform decision-making in complex situations
• Nurses should involve patients, families, and other healthcare team members in ethical decision-making processes whenever possible
• Documentation of ethical decision-making is important for transparency, accountability, and continuity of care

Legal and Ethical Challenges in Nursing Practice

• End-of-life care presents ethical challenges related to withholding or withdrawing treatment, advance directives, and assisted dying
• Allocation of scarce resources, such as organ transplants or intensive care beds, requires consideration of fairness, medical necessity, and social justice
• Reproductive health issues, including contraception, abortion, and maternal-fetal conflicts, involve complex ethical and legal considerations
• Genetic testing and precision medicine raise questions about privacy, discrimination, and the right to know or not know one's genetic information
• Research ethics in nursing encompass issues of informed consent, risk-benefit assessment, and protection of vulnerable populations
• Moral distress occurs when nurses face constraints that prevent them from acting in accordance with their ethical beliefs and values
  • Strategies for addressing moral distress include self-care, peer support, and organizational initiatives to create an ethical practice environment
• Nurses have a responsibility to advocate for policies and practices that promote ethical healthcare and address systemic inequities and disparities