ETHICALAND LEGAL ISSUES IN COMMUNITY HEALTH NURSING AND ITS IMPLICATIONS

INTRWUCTIW

‘l’he communlty health nurse experiences and many ethical connlcts are existing h health care delivery
system. Is we began profestonal practice. It Is essential to understand the law that defines the nurse‘s
responslblllty and dutls. Especially the community health nurse must be very careful whl|e doing
services in the community because; there Is a turn of people workmg In the hospital. Whereas, In the
community health nurses are alone and mostof the time she Is In posltbn ofto Implementthe services at
home. So, she must be more careful and she shou|d have enough kmwbdgeon legal issues The purpose
oi this topic is to analyze traditional ethics and profsslonal nursing and apply these princnples to the
practlce ofcommumty health nursing.

DEFINI‘HONS

" Ethu: is a system of moral principles, and rules of conduct recognized in respect to a particulz class of
humm actions or to a particular group of people."

Or

Ethics Is a branchof philosophy dealing wuth vaIues related to human conduct with respect to the
rlghtness mdwrongness ofcertain actions and to the goodness and badnes of the motives and ends of
such actlons.

DEFINITION OF LAW

It Is a standard or ru|es of conduct estabHshed and enforced by the Government These are Intended to
protect the public.

SOURGS (F LAW

1. THE CONSTITUTION: It Is a system of fundamental laws or prlnciples that governs a nation or sonnety.
2. STAYUTB: laws that govern. It Is enacted by the |eglslat|ve body or leglslatlve lu. Laws passed by
council or parliament. For ample, nurse practice act.

3. ADMINISTRATIVE AGENCIES: the Mes and rqulatlons establlshed by executive branch of

thegmernment executive officers, majors are responsible for law enforcement. For example, INC, Board
of Nursing Statd Central level.

4. TORI LAW OR COURT DECISION: Judicial and decision! laws are made by the court to Interpret legal
Issues. Court decisions can be changed, but on» With strong justifications. For example, patients nuns]
measles vacclnatlon.

TYPES OF [AW

1. CRIMINAL LAW: nurses found guilty of intentiondly administering fatal clones of drug tothe patlents.

2. CIVIL LAW: one Individud sues another for money tocompensate the loss. Inczceratlon-czn ls escaped
from prison. For example, malpractice cases can be tried In cMI courts (monitory damages can be
claimed)

3. ADMINISTRATIVE LAW: an indivldual Issued by a state board or muncll In violation of the

musepractlce ant.

SIGNIFICANI’ LEGISIATIVE KT

1. SHEPARD TOWNER ACT 1921: grants In ad or funds to the state for administration of programs to
promote the health andweifare of mother and Infants [grants h aid for pregnant mothers).

2. SOCIAL SECURIW ACT 1935: allocation funds on the basis of PH problem, economic need and need
fortrainim for health personnel.

3. HOSPITAL SURVEY AND CONSIRUCIION ACT 1946: natlomuide health facilities plannlng to the states
for hospnaI/ health centers construction.
4. MCH AMENDMENI’S ACT 1963: openeddoor for Improved servlcs to brim down the perinatal
mortality. (Implementation of MCH program.)

5. NONCOMMUNIABLE DISEASE ACT 1965: comprehensive halth planning for program development. For
example, cancercontrol program

6. HEALTH MANPOWER ACT 1968: Increased supply of health personnel by provldirg federal money to
educational Institution for construction, training and special project;

7. OCCUPATIONAL SAFEW ACT 1970: protection to written against personal injury at Illness resuklm
from hazards working oohdlnon.

LEGALCONCEP‘I’S

I CRIME/YORTS: refers a wrong committed by a person gainst mother personorhls/her W096"!!

O CRIME: It (svblatlon punishable by the state.

I YORT: It Is urns negligence (cg. quuld, Phenol.)

I MISDEMEANOR: less serlous crime punishable with fines Imprisonment for less than 1 year.

0 FELONY: punishable by lmprlsonmentfor morethan lyea'.

LIYEATDN: It Is pmcess of brlnglrg and trying a lawsuit.

PLAINTIFF: person or government bringing 5th against another ls called plaintiff. For example, mother of
terminal» Ill child threatening to bring charges In the hospitaI. Court Is the decmng authority.

DEFENDANTS: one being accused: crime In called defendant.

INTENTIONAI. 0R UNINTENTIONALTORTS

INTENTlmAL TORTS

1.

ASSAULT: It ls a threatoran attemptto make bole contact with another personwllhout that person
consent.

BATTERY: It 3 an asault that Is carried out with willful angry and vlolentor neglbent touching of another
person‘s body or clothes

Examples:

a. Fordny removing patient’s clothes.

I). Injection with force of weapon refused by patient.

c. Pushirg a patient Infloor or in the chair.

DEFAMATION: It Is an Intenuonai tort makes derogatory remarks about another.

a. Slander: oral defamation of character.

b. Libel: written defanatlon (petition)

For example, about patient or coworkers

INVASION OF PRIVACY:
a. All Information should be confidential

b. Interacting with family membels

Avoid unnemssary exposure

Checking ofall gadgets or machines

Carryout research activities

Using tape recorder, video or photos

FALSE IMPRISIONMENT: a personcannot be legaly forced to remain In health centers or hospital.

(unjustified Bntention)

FRAUD: willful and purposeful interpretation or misinterpret": theoutcome of procedure oftreatment.

(license may be prosecuted under the NP act).

‘01?

UNINTENTIONAL TORTS

WM

«999

NEGLIGENCE an act of negiuence may be enact ofomisslonorcomNsslon.

Mabractlce or neglcehce

LIABILITY: It Imoives four elements that must be established to prove that malpractice or negligence has
occurred.

DUTY AND DOCU ME NIATION; execution of safety measure.

BREACH OF DUTY: failure to note and report tohgher authorlty about the seriousness. CAUSAIION:
failure to use appro priate safety measures.

DAMAGES: lengthened hospital stayand need for rehabilitatlon.

COMMON CAUSES G LEGAL ISSUES

Professlonal negligence e. g Imam; the seriousnes. Practicing medicine without license lnmmmunity.

Obtaining nursing Hcense by fraud or alowlng others to use your Ilcense Felony comlctlonfor any
offence.

Participating incriminal abortion, eg. quack.

Not reporting substandard medtclne or nursing care.

Provldlng patient carewhlle under the influence of akohol or drugs. Givmg narcotics without an order.

Falsely holding oneself as family practitioner or nurse practitioners.

PROFESSIONAL AND LEGAL REGUlATION OF NURSING PRACTICE

0 Every state has " nurse practice act” that protects the public define the legal scope. 0 Nurse practlce
actviolation of rule can result in dlscupllnary action. For example, medicatnon, IPPI vials.
0 Standardsgutdellnes Issued by counciIs-quallflcatlon. standards, rules and regulation, ea, unrecognized
courses.

0 Credentialingthe ways In whlch professlonalcompetence Is ensured and maintained

Three processes can be used

a. ACCREDITATION: education program is evaluated and recognized by National Accreditation Board.

I). UCENSURE: the state determines certa'n requirement to practice as nurse. (e5. negligence,
malpractice, wrong treatment and alcoholism)

c. CERTIFICATION: entry level competence. Specific knowledge and experience in

specufied areas needed. All the certlfucates cannot be registered (es. nursing asst course.)

CUEN'IS RIGHTS AND PROFESSDONAI. RESPONSIBILITIES IN COMMUNITY HEALTH CARE CLIENTS RIGHIS

It Is one of the earliest recognnlons of clients rights concernhg health were made by the national
convention of the 1973. Undergoing the theme of basuc human rghts, the Imders ofthe revolution
declared that there shoutd only be one patient to a bed In hospltals and hospital beds were to be placed
at |east 3 feet apart(Annas.1978). This kindof direcmn by a governmentor legislature body In the
recognition and assertion of clients right has condnued to be prominent in consideratuon of thoughtto
health and the ruht to health care as extensions of basic human r&hts such as rights to

mformed consent to refuse treatmentor to privacy have apparently been aided by consumer groups and
health care providers.

BASIC HUMAN RIGHTS RELATED TO HEALTH

American Hospitai Asociation was studied and Issued the results of its study, entitled " the Patient’s bill
of rights." The document says that the traditional physlclarr patient relationshtp takes on a new

dimension whencare is rendered withlnorganizational structure." The basic rights includes the
foHowing:

Considerate and respectful care

Obtain complete medical Information

Receive Information necessary for giving informed consent

Reflne treatment

Consideration of privacy

Gonndentlal treatment of personal information and medical records Request services

Information on other Instltutlon and hdeuaIs relate! to care and treatment Refuse participation ln
research project

10. Expect reasonable continuity of care

11. Examination and explanation of financial changes

12. Know instltutbnal regulations

3°“".“9"P!"!"!"

SOCIETAL OBUGATIMS
The 'Presldents’ commisslon for the study of ethical problems reached several concluslons

concerning current patterns of access to health care and made sknmcant recommendations for changes
Yhe commission ooncluds that:

1. Society has an ethical obligatlon to ensure equitable aoces to health care for all. 2. The societal
obligationls balanced by Indwidualobligatlon.

3. Equimle access to health care requires thatall citizens be able to securean adequate level of 1.

4. When equity occurs through the operationof private forces, there Is no need for government
Involvement, butthe ultimate responslbdlty for ensuring that soclety obligation ls met, thromh a
combination of public and private sector arrangements, rat with the federal govemment.

5. The cost ofachlevlm equitable access to healthcare ought to be shared farm»

6. Efforts to certain nursing health care costs are Important butshould not focus on Ilmltim the
mahment of equitable access for the |east well served portionof the public.

PROFBSIONAL RESPONSIBILITIES

In response to cllent’s rights, health care professionals Incur particular dutles or respomibllltls

whichare supported by professional code of ethic: mdare correlative to bade liberty rights of patienu

PROFBSIONAL CODE OF ETHIG

Professional code of ethics Is statements encompasslrc rules that apply to persons In professional tote
there are some profssiond ethics
Profeslonal etiquette good manners based on loyalty. Knowing the lines of authority and responsibility.
Each person should be treated withdcnlty.

When death occurs, they need empathy, supponand understanding. More practice ls needed In an
Isolated arm.

PP?!"

ShouId know what others are doing and be faithful In supportingeach other. Coordinate with all.

Have partnership and cooperate with phvsIclan.

Goodcommunication based on gIviru and recerirg.

The nurse relates In the community as a worker and to Improve health standards. 10. The nurse relates
In the community as a worker and to improve health standards

9939s"

ETHICAl PRINCIPLES IN CWMUNITV HEALTH Relationships of ethical rula, principles and theories

Rules state that certain actions are to be performed because they are right [or wrong). An example
would be that " nurses always ought to tell the truth to the clients“ Principles are more abstract than
rules and serve as the foundation of rules. For example, the ethical principle of autonomy Is the
foundation forsuch rules as " aways Informed consent“, tell the truth, and protect the privacy etc.
theories howeverare collectIon of principIes and rules They prmlde theoretical foundations for

declding what to do when principles or rules mnfllct. Ethical prinprIes sImply suggst which ethlcd
principle wII mole Iikew to happen generally when moral decisions have to be made.

PRINCIPLE 0F BENE FICIENCE

It states "we ought to do pod and prevmtoravoid doing harm.” It Includes the idea that
beneflcence Is a duty to help others gain what is of benefit to them but does not carry the obligation to
risk one’s own welfare or interiors In helping othe's.

Application of theories Incommunlty health The ptlncipleof beneficence can be appIIed for:

1. Balmcing harms and beme to client populatIon 2. In the use of cost benefit analvsIs In decisIons
affectlng client population

COST BENEFICIAL ANALYSIS

It Is a specinc application of the principle of beneficence. To measure the benefIts and costs of
alternative approaches to a problem or to decIde how to dIstrlbute health program funds.

PRINCIPLES OF AUTONOMY: autonomy refers to heedom of actIon, as chosen by an Individual

person who are autonomers and capable of choosIng and acting on plans they themsewes have decided
on.

Appllcation In communltv health nursing principle 01 autonomy Is applied In community health through
conscderations wlth:

1. RESPECT FOR PERSONS: the client should be given a cholce or even considered in a

treatment Man. The elderly have the right to determlne their Me and health plans as they have the
capacity to do so.