LEGAL AND ETHICAL ISSUES

INTRODUTION:The role of the nurse and professional nursing has expended rapidly within
Past ten years to include expertise specialization, autonomy and accountability, both form
legal and ethical perspective, this expansion has forced a new concern among nurses and
a highest awareness of interaction of legal and ethical principles. Areas of concern including
professional nursing practices, legal issues, ethical principles, labor management and
employment.
CIVIL AND COMMAN LAW ISSUES IN NURSING PRACTICE:TORTS:A tort is a civil wrong made against a person or property.torts may be classified as
unintentional or intentional.
INTENTIONAL TORTS: ASSUALT:- it is any intentional threat to bring about harmful or offensive contact. No
actual contact is necessary. the protects client who are afraid of harmful contact. It is
an assault for a nurse to threaten to give a client an injection or to threaten to
restrain a client for an X-Ray procedure when the client has refused consent. in a
lawsuit wherein as Sault is alleged , the clients consent would bar the claim of
assault against a nurse.
BATTERY:-It is any any touching without consent. the contact can be harmful to the
client and cause an injury, or it can merely offensive to the clients personal dignity.
A battery always includes an assaults which is why the terms assault and battery
are commonly combined. in the example of nurse threatening to give a client an
injection without the clients consent, if the nurse actually gives the injection, it is
considered battery . Battery can also result if the health care provider performs a
procedure that exceeds the clients consent. For example, if the client gives consent
for an appendectomy and the physician performs a tonsillectomy, battery has
occurred.
INVASION OF PRIVACY:- The tort of invasion of privacy protects the clients
right to be free from unwanted instrusion into his or her private affair.clients are
entitled to confidential health care. For example, in a classic case ,reporers
published photographs of a female client in her hospital room without her consent. A
claim for invasion of privacy was upheld. Another form of invasion of privacy is the
release of a clients medical information to an unauthorized person, such as a
member of the press or clients employer.
DEFAMATION OF CHARACTER:-Defamation of character is the publication of
false statements that result in damage to a persons reputation.
UNINTENTIONAL TORTS: NEGLIGENCE:-Negligence is conduct that falls the standard of care. The standard
of care is established by law for the protection of others against an unreasonably
great risk of harm. For example, if a driver of a car acts unreasonably in failing to
stop at a stop sign, it is negligence.

MALPRACTICE:- Malpractice is one type of negligence ;it is refere to as

professional negligence. Nursing malpractice results when nursing care falls below
the standard of care. Nurses can be found liable for malpractice if the following
criteria are established:
o The nurse owed duty to the client;
o The nurse did not carry out that duty;
o The client was injured;and
o The nurses failure to carry out the duty caused the injury.

LEGAL SAFEGUARD IN NURSING PRACTISE

LICENSURE:- All nurses who are in nursing practice have to passes a valid license,
issued by the representative nursing council or Indian nursing council. There practice is
controlled educational programme.
GOOD SAMARITAN LAW: - In response to health professional, fear of malpractice
claims, most states enacted Good Samaritan law that exempt doctors and nurses from
liability when they render first aid during emergency.
GOOD RAPPORT:- Developing god rapport with the client is very important to prevent
malpractice. A lawsuit is often circumvented when the nursing staff treats with warrants
and caring. So nurse must never underestimate rapport with the client in malpractice
prevention. The ability to develop good rapport with clients is depends on the nurse
having good interpersonal communication skills. E.g. listening
STANDARD OF CARE:- All professional practicing in the medical field are held to
certain standard when administrating care comes from several sources including laws,
organizational standard and institutional policies and procedures. It is always better to
follow standards to avoid malpractice and do not attempt any thing beyond the level of
competence.
STANDING ORDERS:- Although a nurse legally diagnose illness or prescribe treatment,
he or she may after assessing patients condition, apply standing order or treatment
guideline that have been established doctor as appropriate for the certain problem and
the condition. Nurse do not take chance, if there is any doubt arise, it is always better to
follow written order instead of oral orders.
CONTRACT:- A contract is written or oral agreement between two people in which
goods or services are exchanged. Section 13 to the Indian contract act defines the word
that two or more people are said to consented when they agree upon the same thing in
the same sense. Treating a patient without obtaining proper consent can lead to a
chance of assault.
CONSENT FOR OPERATION AND OTHER PROCEDURE:- A patient coming in to the
hospital still retain his/her right as a citizen and his entry only denotes his willingness to
undergo an investigation or treatment of a serious nature, or an operation which needed
anesthesia, requires the written consent of the patient if he has attain the age of 18
years or is a minor who has attain the age of 16 years.

CORRECT IDENTITY:- All patient in general hospitals wear identity band, in order to
prevent the mistakes. It is very important that correct band is given to each patient and
these are normally checked as the part of the admission procedure. Every patient before
giving pre medication for an operation should be labeled approved by the hospital. The
nurse or midwife has the great responsibility to make sure that all the babies born in the
hospital are correctly labeled at birth and to ensure that no time they are placed in
wrong cot or wrongly handled.
COUNTING OF SPONGE, NEEDLE AND INSTRUMENT:- Nurse advocate that sponge,
instrument and needle count should be performed for all surgical procedures taking
place in operation theater. When an instrument or needle left in patients body, during
surgery the operating room nurse will probably be liable for any patients injury caused
by the presence of foreign body. The nurse have to carry out a final check before the
body cavity is closed.
ACCIDENT OR INJURY: - If a patient sustain injury while in hospital, He may bring an
action against the hospital authority or against a person (member of medical, nursing or
ancillary staff) to whom he/she attributes a injury. An action may be brought away
against the hospital even after the several years the accident occurred. It is therefore,
necessary that at the time of incident an accurate and full record should be made on the
special form provided.
SELF DISCARGE OF THE PATIENT:- When the patient demands to discharge himself,
the duty of nurse is to inform the medical officer concern with his care. It is probable that
that a senior administrative officer the patient and ask him to sign a written statement
that he is leaving against the medical advise. If he refuses it, a note of this effect will
have to be made and signed by two witnesses one of whom is usually a administrative
officer and other is nurse-in charge at that time.
PROFFESIONAL CONFIDENCE:- Guarding the confidence of the patient is an ethical
duty of the medical authority and nurses and it must take that it never should be
discussed personal information received by the nature of their position, except with the
senior members of the staff.
DOCUMENTATION::-Documentation is by far the best one a lawsuit filled. Nurse should
give them selves the credit from care they provide thoroughly documenting in the
medical record. While documenting it is better to use formats of documentation for each
activity specified by the respective institution or government.
REPORTING:- In some situation, nurses have obligation or are required to report certain
communicable diseases or criminal activity such as abuse, gun shot wound, attempted
suicide or rape to the appropriate authority.
Some donts and dos for the nurse are as guideline for their safe practices.
- Do documentation all unusual incidences.
- Do report all unusual incidences.
- Do follow policies and procedures as established by your employing agency.
- Do keep current year license to practice.
- Do perform procedures that you have taught and that are within the standard scope
of your practice.
- Do not accept money or gifts from the patients.

Do not allow the client to leave the hospital unless there is an order or signed
release.
Do not medication advices to friends and neighbors.
Do not give advice that is contrary to doctor
Do not take medication that belongs to patient.
Do not work as a nurse, in a state where you are not licensed.

Legal Responsibility of nurse:

Responsibility of quality control:The nursing administrator and the authority of the
agency at all levels have a legal obligation to ensure nursing care quality. usually
the head nurse or ward in charge is responsible for quality of patient care given by all
personnel including medical on the nursing unit, whether or not these individuals
have direct reporting responsibility to the head nurse.

Responsibility for Equipment:To patient and employees from injury, a nurse manager
must ensure that all patient care equipments are fully functional and that defective
equipment is promptly repaired or replaced.
Responsibility for observation and reporting:Nursing personnel have more frequent and
prolonged patient contact than other care giver. the nurse has a duty to record and
report observations of a patients condition promptly ,so that the physician can base
treatment ,decision on up to date information about the patients health needs.
Responsibility of protect public:The nurse has a legal duty to protect the public from
injury by dangerous patient.
Responsibility for record keeping and reporting:Nurses have legal responsibility for
accurately reporting and recording patient conditions, treatments and responses to
care. the medical record is an information source document that should be used to
plan care, to evaluate care ,allocate costs, educate personnel ,research care
measures, and substantiate legal claim.
Responsibility for death and dying:There are many issues surrounding the events
of death .death occurs when there is an absence of brain function ,despite functions
of other body organs .however ,nurses must be aware of legal definition of death
because they must document all events that ,when the patient is in their care.
Roles and function of nurse manager in legal issues:1. Serves as a role model by providing nursing care that meets or exceeds accepted
standards of care.
2. Reports substandard nursing care to appropriate authorities.
3. Fosters nurse/patient relationships that are respectful, caring and honest ,thus
reducing the possibility of future lawsuits .
4. Practices nursing within the area of individual competence.
5. Priorities patients rights and welfare first in decision making.

6. Is knowledgeable responding sources of law and legal doctrines that affect nursing
practice.
7. Understands and adheres to institutional policies and procedures.
8. Practice nursing within the scope of the state nurse practice act.
9. Provide educational and training opportunities for staff on legal issues affecting
nursing practice.

ETHICAL ASPECTS OF NUSING

Introduction:Ethics is the science relating to moral actions and ones value system. Many
nurses envision ethics are dealing with principles or morality and what is right or wrong.
Ethics are concern with motives and attitudes and the relationships of these attitudes for the
individuals.
Ethics are always been an integral part of nursing. Through out the nursing
one can find the code of ethics, statements of moral principles, maintaining of high ideas,
and recorded decision of moral ethical issues.
Nursing ethics provide the statement of the standard for professional behavior
and is the study of principles of right and wrong conduct for nurses.
CODE OF ETHICS
A code of ethics serves as a mean of self regulation and a source of guideline for individual
behavior and responsibility. Professional codes of ethics are a system of rules and
principles by which that profession is expected to regulate its responsibility to society. Code
of ethics for nurses is as follows:NURSES AND PEOPLE: The nurses primary responsibility to those people who require nursing care.
The nurse provides care, promote an environment in which the values, customs and
spiritual beliefs of the individual.
The nurse holds confidence, personal information and uses judgment in sharing their
information.
NURSES AND PRACTICE:-

The nurse carries personal responsibility for nursing practice and for maintaining
competence.
The nurse uses judgment in relation to individual competence when accepting the
delegating responsibilities.
The nurse when acting a professional capacity should at all time maintaining
standards of professional standard.

NURSES AND SOCIETY: The nurse shares with other citizens and responsibility for initiating and supporting
action to meet the health and social need of the public.
NURSES AND COWORKER: The nurse sustains a co-operative relationship within nursing and other field.
The nurse take appropriate action to safe guard the individual when his/her care
endangered by coworker or any other person.
NURSES AND THE PROFESSION: The nurse plays the major role in determining implementing desirable standards of
nursing practice and nursing education.
The nurse is active in developing a care of professional knowledge.

ETHICAL PRINCIPLES
Ethical principles actually professionalism in nursing practices much more than to ethical
theory. Ethical principles that are the nurses should follow when making decisions are as
follows:1. Respect for persons:-It directs individuals to treat themselves and other ,with a
respect inherent to mans humanness.
2. Respect for autonomy:-Autonomy means that are able to act for themselves to the
level of their capacity. it is the right of individuals, governing their actions according
to their own purpose and reason
3. Respect for freedom:-This principle of individual freedom decreases that patients
be exempt from control by others to select and pursue personal health goal.
4. Respect for beneficence:-the beneficence principle states that the actions one
takes should promote good. it dictates that a person is obliged to help other to
advance their legitimate and important interests.
5. Respect for non mal efficiency:-The corollary beneficence, the principle of non
maleficence states that one should do no harm. the nurse should interpret the term
harm to mean emotional and social as well as physical injury.
6. Respect for veracity:-It requires professional care giver to provide with accurate,
reality based information about their health status and care or treatment prospect
ion.
7. Respect for justice:-This principle of justice requires treating other fairly and giving
their due.
8. Respect for rights:-Right is an entitlement to behave in a certain way under
circumstances, such as nurses entitlement to freely express personal beliefs and
preferences by voting in a political election.

9. Respect for fidelity:-Fidelity is keeping ones promises or commitments. the

principle of fidelity holds that a person faithfully fulfill his duties and obligations.
10. Confidentiality:-It is the duty to respect privileged information.
ROLE AND FUNCTIONS OF NURSE IN ETHICAL ISSUES

Takes appropriate action when subordinates use unethical conduct.

Recognizes and rewards ethical conduct of subordinates.
Actively advocates for clients ,subordinates and the profession.

He or she is self aware regarding own values and basic beliefs about the rights,
duties and goals of human being.
Accept that uncertainly must be a part of all ethical decision making.
Accept that negative outcome occur in ethical decision making.
Actively advocate for clients, subordinates and the profession.
Clearly communicates expected ethical standard of behavior.
Uses a systematic approach to problem solving or the decision making when faced
with management problem.
Clearly communicates expected ethical standards of behavior.

Conclusion:Safe nursing practice includes an understanding of the legal boundaries within which
nurse must function.
Ethics are always been an integral part of nursing. Throughout the nursing one can
find the code of ethics, statements of moral principles, maintaining of high ideas, and
recorded decision of moral ethical issues.

BIBLIOGRAPHY:
1)

Basavanthapa B.T.Nursing administration, legal and ethical issues in nursing,Published

by Jaypess at New Delhi, Page no. 474-510.

2)

Potter and perry ,Fundamental of nursing, legal implication in nursing practice,5 th

edition,page no.422-427,435-438.

3)

Alphosa Jacob, Fundamental of nursing ,Chapter 4,vol. 1,page no.28-29

4)

http://www.ukessays.com/essays/nursing/legal-ethical-professional.php

5)

http://www.docstoc.com/docs/9482486/Legal-and-Ethical-Issues-in-Nursing-andHealthcare.