ETHICO-MORAL ASPECTS IN NURSING

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 & evil as they relate to conduct
Moral - personal/private interpretation from what is good and bad.

TYPES OF ETHICS
Those of particular concern to the nurse are:
1. BIOETHICS - branch of ethics that studies moral values in the biomedical sciences
2. CLINICAL ETHICS – concerned with ethical problems “at the bedside” that arise within the context of caring for actual
patients
Ex.: Informed consent & how one ought to respond to requests for assisted suicide
3. NURSING ETHICS – study of ethical issues that arise in the daily practice of nursing & of the analysis used by nurses to
make ethical judgement
Ex.:cost-containment, breaches of patient’s confidentiality, illegal practices of colleagues

Ethical Principles:
1. Autonomy – the right/freedom to decide (the patient has the right to refuse despite the explanation of the nurse) Example:
surgery, or any procedure
2. Nonmaleficence – the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social)

3. Beneficence - for the goodness and welfare of the clients

4. Justice – equality/fairness in terms of resources/personnel

5. Veracity - the act of truthfulness

6. Fidelity – faithfulness/loyalty to clients

Moral Principles:
1. Golden Rule
2. The principle of Totality – The whole is greater than its parts
3. Epikia – There is always an exemption to the rule
4. One who acts through as agent is herself responsible – (instrument to the crime)
5. No one is obliged to betray herself – You cannot betray yourself
6. The end does not justify the means
7. Defects of nature maybe corrected
8. If one is willing to cooperate in the act, no justice is done to him
9. A little more or a little less does not change the substance of an act.
10. No one is held to impossible

Law - rule of conduct commanding what is right and what is wrong. Derived from an Anglo-Saxon term that means “that which
is laid down or fixed”
Court -body/agency in government wherein the administration of justice is delegated.
Plaintiff – complainant or person who files the case (accuser)
Defendant – accused/respondent or person who is the subject of complaint
Witness – individual held upon to testify in reference to a case either for the accused or against the accused.

Written orders of court

Writ – legal notes from the court

Subpoena
1. Subpoena Testificandum – a writ/notice to an individual/ordering him to appear in court at a specific time and
date as witness.
2. Subpoena Duces Tecum- notice given 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 - body of law that deals with relationships among private individuals
Public law - body of law that deals with relationship between individuals and the State/government and government agencies. Laws
for the welfare of the general public.

Private/Civil Law can be :

Contract law – involves the enforcement of agreements among private individuals or the payment of compensation for
failure to fulfill the agreements

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 Ex. Nurse and client nurse and insurance
Nurse and employer client and health agency
- An agreement between 2 or more competent person to do or not to do some
lawful act.
- It maybe written or oral = both equally binding
(2) Types of Contract:
1. Expressed – when 2 parties discuss and agree orally or in writing the terms and conditions during the creation of the
contract.

Example: Nurse will work at a hospital for only a stated length of time (6 months), under
stated conditions (as volunteer, straight AM shift, with food/transportation allowance)

2. Implied – one that has not been explicitly agreed to by the parties, but that the law considers to exist.

Example: Nurse newly employed in a hospital is expected to be competent and to follow

hospital policies and procedures even though these expectations were not written or
discussed.

Likewise: the hospital is expected to provide the necessary supplies, equipment needed to
provide competent, quality nursing care.

Feature/Characteristics/Elements of a lawful contract:

1. Promise or agreement between 2 or more persons for the performance of an action or restraint from certain actions.
2. Mutual understanding of the terms and meaning of the contract by all.
3. A lawful purpose – activity must be legal
4. Compensation in the form of something of value-monetary

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Persons who may not enter into a contract: minor, insane, deaf, mute and ignorant
TORT LAW – is a civil wrong committed against a person or a person’s property.
- Person/person’s responsible for the tort are sued for DAMAGES
- Is based on:
ACT OF COMMISSION –something that was done incorrectly or
ACT OF OMMISION – something that should have been done but was not.

Classification of Tort
1. Unintentional
a. Negligence – misconduct or practice that is below the standard expected of ordinary, reasonable and prudent person
- Failure to do something due to lack of foresight or prudence
- Failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance.
- An act of omission or commission wherein a nurse fails to act in accordance with the standard of care.

Doctrines of Negligence:
1. Res ipsa loquitor – the thing speaks for itself – the injury is enough proof of negligence
2. Respondeat Superior – let the master answer command responsibility
3. Force majuere – unforeseen event, irresistible force

b. Malpractice – stepping beyond one’s authority

(6) elements of nursing malpractice:

1. Duty – the nurse must have a relationship with the client that involves providing care and following an acceotable standard
of care.

2. Breach of duty – the standard of care expected in a situation was not observed by the nurse
-is the failure to act as a reasonable, prudent nurse under the circumstances
-something was done that should not have been done or nothing was done when it should have been done

3. Foreseeability – a link must exist between the nurse’s act and the injury suffered

4. Causation – it must be proved that the harm occurred as a direct result of the nurse’s failure to follow the standard of care
and the nurse should or could have known that the failure to follow the standard of care could result in such harm.

5. Harm/injury – physical, financial, emotional as a result of the breach of duty to the client
Example: physical injury, medical cost/expenses, loss of wages, pain and suffering

6. Damages – amount of money in payment of damage/harm/injury

2. Intentional Tort

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 Unintentional tort – do not require intent bur do require the element of HARM
Intentional tort – the act was done on PURPOSE or with INTENT
- No harm/injury/damage is needed to be liable
- No expert witnesses are needed
1. Assault – an attempt or threat to touch another person unjustifiably
Example: (1) A person who threatens someone with a club or closed fist.
(2) Nurse threatens a client with an injection after refusing to take the meds orally.

2. Battery – wilful touching of a person, person’s clothes or something the person is carrying that may or may not cause harm but
the touching was done without permission, without consent, is embarrassing or causes injury.
Example: (1) a nurse threatens the patient with injection if the patient refuses his medsorally. If
the nurse gave the injection without client’s consent, the nurse would be committing battery
even if the client benefits from the nurse’s action.

3. False Imprisonment – unjustifiable detention of a person without legal warrant to confine the person
– Occurs when clients are made to wrongful believe that they cannot leave the place
Example: (1) Telling a client no to leave the hospital until bill is paid
(2) Use of physical or chemical restraints
(3) False Imprisonment Forceful Restraint=Battery

4. Invasion Of Privacy – intrusion into the client’s private domain

 Right to be left alone

Types of Invasion the client must be protected from:

a. use of client’s name for profit without consent – using one’s name, photograph for advertisements of HC
agency or
provider without client’s permission
b. Unreasonable intrusion – observation or taking of photograph of the client for whatever purpose without client’s
consent.
c. Public disclosure of private facts – private information is given to others who have no legitimate need for that.
d. Putting a person in a false/bad light – publishing information that is normally considered offensive but which is
not true.

5. Defamation – communication that is false or made with a careless disregard for the truth and results in injury to the
reputation of a person

(2) Types:
Libel >defamation by means of print, writing or picture
Example:
1. writing in the chart/nurse’s notes that doctor A is incompetent because he didn’t respond
immediately to a call
Slander >defamation by the spoken word stating unprivileged (not legally protected) or
false word by which a reputation is damaged
Example:
1. Nurse a telling a client that nurse B is incompetent
2. Person defamed may bring the lawsuit
3.The material (nurse’s notes) must be communicated to a 3rd party in order that the person’s
reputation maybe harmed

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Public Law:

Criminal Law – deals with actions or offences against the safety and welfare of the public.

HOMICIDE > Killing of any person without criminal intent may be done as self-defense
ARSON > Burning of property
THEFT > Stealing
SEXUAL HARASSMENT
ACTIVE EUTHANASIA
ILLEGAL POSSESSION OF
CONTROLLED DRUGS

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EGB’June09 4
ETHICO-MORAL ASPECTS OF NURSING PRACTICE
Nurses need to:
 Develop sensitivity to the ethical dimensions of nursing practice
 Examine their own & client’s value
 Understand how values influence their decisions
 Think a head about the moral problems they are likely to face. Ex.: birth, death, marriage

*Values are important because they influence decisions & actions, including nurses’ ethical decisions even
though they may be unspoken questions of values underlie all moral dilemmas

VALUES
- enduring beliefs or attitudes about the worth of a person, objects, idea or action
- concepts/ ideas that give meaning to one’s life & provide a framework for one’s decision

BELIEFS (OPINIONS)
- Interpretations or conclusions that people hold as true
- Based more on faith that fact & may/ may not be true
- Beliefs do not necessarily involves values
Ex.: If I study hard, I will get good grade

ATTITUDES
- Mental positions/ feelings toward a person, object or idea
- Often judged as bad or good, positive or negative, beliefs are judged as correct or incorrect.

VALUES
- Are learned through observation & experience & are heavily influenced by a person’s sociocultural
environment that is by:
o Societal traditions, cultural, ethical, religious groups, family or peer groups

PROFESSIONAL VALUES
- Are acquired during socialization from nursing experience, from teachers, peers & code of ethics

*Nurses & nursing students need to examine the values they hold about life, death & illness. One
strategy for gaining awareness of personal values is to consider one’s attitude about specific issues as
abortion/ euthanasia

VALUES CLARIFICATION
- Process by which people identify, examine & develop their own individual values

(5) VALUES ESSENTIAL FOR PROFESSIONAL NURSES

1. Altruism >The concern for the welfare &
well-being of others
2. Autonomy >The right for self- determination
of professional practice
Ex.: When the nurse respects
patient’s right to make decisions
about their health care
3. Human - Respect for the inherent worth &
dignity uniqueness of individual &
populations
Ex.: when the nurse values &
respects all patient’s & colleagues
4. Integrity - Acting in accordance with an
appropriate code of ethics &
standards of practice
Ex.: when the nurse is honest &
provides care based on ethical
framework that is accepted within
profession
5. Social - Upholding moral, legal &
Justice humanistic principles.
Ex.: when the nurse works to
ensure equal treatment under the
laws & equal access to quality

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 care.

PROFESSIONAL BEHAVIORS ASSOCIATED WITH 5 VALUES

1. Demonstrate understanding of cultures, belief & perspectives of others
2. Demonstrates accountability for own actins
3. Documents accurately & honestly
4. Designs care with sensitivity to individual patient needs
5. Advocates for patients particularly the most vulnerable
6. Take risks on behalf of patients & colleagues
7. Plans in partnership with patients
8. Honors the rights of patient & families to make decisions about healthcare
9. Provide information so patients can make informed choices
10. Provide culturally competent & sensitive care
11. Protects the patients privacy & confidentiality
12. Provides honest information
13. Promotes universal access
14. Seek to remedy errors made
15. Support fairness
16. Encourage legislation

ETHICS came from the Greek word ETHOS meaning custom/character or moral duty
 Method of inquiry that assist people to understand the morality of human behaviour
 Refers to the expected standards of moral behavior
 How people make judgement in regard to right or wrong
 Critical reflection about morality and rational analysis about it
 JOHNSTON- examination of all ethical and bio-ethical issues from the prospective of nursing theory and nursing ethics
 VERCOE- the fields of nursing ethics be focused on the needs and experiences of practicing nurses, the exploration of its
meaning and that of ethical practice in terms of the perception of these nurses

BIOETHICS

 Also known as “applied or practical ethics”

 Specific domain of ethics that focuses on moral issues in the field of health care
 Result of life and death dilemmas faced by health care practitioners
 Systematic study of human behaviour in the field of life science and health care in the light of moral values and principles

NURSING ETHICS
- Refers to the ethical issues that occur in nursing practice
- Refers to the conduct or behaviour which by reason of public approval or practice has become customary among professional

MORALS/ MORALITY
 Greek work MORALIS
 Refers to private, personal standard of what is right & wrong in conduct, character or attitude
 Nurses should distinguish MORALITY & LAWS.
 LAWS – reflect the moral values of society, they offer guidance in determining what is normal
 An action can be moral but not legal, on the other hand, an action can be moral but illegal
 Morality is what you believe is right and good

Health Care Ethics

 Division of ethics that relates to human health
 Realm of human values, morals, customs, personal beliefs and faith

MORAL DEVELOPMENT
- The process of learning to tell between right & wrong & of learning what ought not to be done
- Complex process that begins in childhood & continues throughout life
- 2 well known theorist:
o Lawrence Kohlberg
 Rights & formal reasoning
o Carol Gilligan
 Emphasizes care & responsibility

NURSING
 An occupation requiring a unique body of knowledge and skills and which serves society

Is nursing a profession?

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YES. It is a calling, vocation, occupation based on scientific body of knowledge which needs training both in theory and
practice guided by a Code of Nursing Ethics, governed by the Nursing Act of 2002, to SERVE mankind for a FEE or
FREE.

PROFESSION
 An occupation or calling requiring advance training
 Experience in some specific or specialized body of knowledge
 Provides service to society in that special field
 The term profession is honoric and should be carried with pride and honor

PROFESSIONAL NURSE
 Completed a basic nursing education program
 Licensed in his/her country or state to practice professional nursing

NURSING PRACTICE
 Primary responsibility promotion of health and prevention of illness
 Collaborate with other health care providers
o Curative
o Preventive
o Rehabilitative aspects of care
o Restoration of health
o Alleviation of suffering
o Towards a peaceful death
 Provide nursing care through the utilization of the nursing process
o Therapeutic use of self
o Executing health care techniques and procedures
o Essential primary health care
o Comfort measures
o Health teachings
o Administration of written prescription for treatment
o Therapies
o Oral
o Topical
o Parenteral medications
o Internal examination during labour in the absence of antenatal bleeding and delivery
o Suturing of perineal laceration
 Establish linkages with community resources
 Coordination with the health team
 Provide health education to individuals, families and communities
 Teach, guide and supervise students in nursing education programs
 The nurse is required to maintain competence by continual learning through continuing professional education

QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE

 Professional Preparation
o Have a license to practice
o Bachelor of science degree in nursing
o Be physically and mentally fit
 Personal Qualities and Professional Proficiencies
o Interest and willingness to work and learn
o Warm personality and concern for people
o Resourcefulness and creativity, well balanced emotional condition
o Capacity and ability to work cooperatively with others
o Skill in decision making

DEFINITION OF LICENSE
 A legal document given by the government that permits a person to offer to the public his or her skills and knowledge in a
particular jurisdiction

CONTRACT
 Meeting of minds between two persons whereby one binds himself, with respect to other, to give something or to render some
service
 A promise or a set of promise which the law recognizes as a duty and when that duty is not performed the law provides a
remedy

MORAL THEORIES
- Provide framework

(3) TYPES OF MORAL THEORIES

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1. CONSEQUENCE-BASED (Theological theories)
- Looks to the consequences of an action in judging whether the action is right of wrong
- Focus on issues of fairness
- UTILITARIANISM
o Views the good act as one that bring the most good for the greater number or the least
harm for the greatest number
- PRINCIPLE OF UTILITY
o From the utilitarian perspective, th point of morality is to promote what is intrinsically good
by maximizing benefits & minimizing harm

TELEOLOGICAL APPROACH

 Greek word TELOS or goal or end

 The right thing to do is the good thing to do
 Act utilitarianism- good resides in the promotion of happiness or the greatest net increase of pleasure over pain
 If the act helps people, then it is a good act
 If the act hurts people then it is a bad act

2. PRINCIPLE-BASED (Deontological theories)

- Involve logical & formal processes & emphasize individual rights, duties & obligations
- The morality of an action is determined not by its consequences but whether it is done according to
an important objective

DEONTOLOGICAL APPROACH OR DUTY ORIENTED THEORY

 Basic rightness or wrongness of an act depends on the intrinsic nature rather than upon the situation or its consequences
 Greek word DEON meaning DUTY
 Immanuel Kant- rational human being with freedom and social worth
 A person is morally good and admirable if his actions are done from a sense of duty and reason

3. RELATIONSHIP BASED OR CARING THEORIES

- Stress courage, generosity, commitment & need to nurture & maintain relationship

Other Moral Theories:

FLETCHER’S GUIDELINES FOR MAKING ETHICAL DECISIONS

1. Consideration for people as human beings

2. Consideration of consequences
3. Proportionate good to come from the choices
4. Propriety of actual needs over ideal or potential needs
5. A desire to enlarge choices and reduce chance
6. A courageous acceptance of the consequence of the decision

W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE SHOULD DO WHEN OTHER RELEVANT FACTORS IN A
SITUATION ARE NOT CONSIDERED

 Duties of fidelity- telling the truth, keeping promises

 Duties of reparation- righting the wrong we have done to others
 Duties of gratitude- recognizing the service others have done for us
 Duties of justice- preventing distribution of pleasure or happiness that is not in keeping with the merit of people involved
 Duties of beneficence-helping to better the condition of other beings
 Duties of self improvement- bearing ourselves with respect to virtue or intelligence
 Duties of nonmaleficence- avoiding or preventing injury to others

VIRTUE ETHICS APPROACH

 ARETIC, Greek word ARETE, heart of the person performing the act
 Traits and virtues of a good person, courage, temperance, wisdom, and justice

DIVINE COMMAND ETHICS

 Supreme or divine that sets down rules to provide guidance to moral decisions

(5) ATTRIBUTES OF CARING

1. Compassion – sorrow for the suffering or trouble of another, with an urge to HELP.
2. Competence – condition in qualification of being able to perform according to STANDARD.
3. Commitment – DEDICATION to a long-term course of action, engagement or involvement.
4. Confidence – belief in ones own abilities, to feel CERTAIN.
5. Conscientious – doing things according to what is right, showing care and precision, HONEST (held in
respect, HONORABLE)

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MORAL PRINCIPLES
- Broad general concepts such as autonomy & justice, they provide the foundation for moral values
PRICIPLES
- useful in ethical decisions because even if people disagree about which action is right in situation,
they may be able to agree on the principle that apply

(5) BASIC ETHICAL PRINCIPLES

1. >Our bodies, our life, our human
Stewardship nature & everything in this earth
are gifts we have dominion over
>This means we are responsible
for them. We should not harm
them, but rather improve & care
for them
>Ex.: Caring for one’s body is a
sign of good stewardship
2. Totality >Refers to the whole. Every
person must develop, use for &
preserve all his parts & functions
for themselves as well as the good
of the whole
3. Doubt >When an act is foreseen to have
Effect both good & bad effects, the
principle of double effect is
applied.
>In order that such act be
permissible the following
conditions should be met:
1. The action itself must be good
or at least neutral
2. The good effects is the one
directed intended by agent & not
the evil effect
3. The good effect is not produced
by means of the evil effect
4. The foreseen beneficial effect
must be equal to or greater than
the foreseen harmful effect
4. >The participation of one agent
Cooperation with another agent to produce a
particular effect or joint effect
>Cooperation becomes a problem
when the action of the primary
agent is morally wrong
>Cooperation may be:
1. FORMAL
When the 2nd agent willingly
participates as when one agrees,
advice, counsels, promotes or
condones
2. MATERIAL
When the 2nd agent does not
willingly participate
5. Solidarity >Means to be one with others. In
the provisions of health care, it is
important for the provider to be in
solidarity with the patient when
seeking the latter’s best interest
>This is most important when
dealing with the poor,
disadvantaged & marginalized
>Ex.: Should the strong help the
weak?

MAJOR BIOETHICAL PRINCIPLES

1. Respect for person
a. The recognition of the equality possessed by every human being as unique, worthy, rational,
self determining creature having the capacity & the right to decide what is best for himself
b. Responsibility of all to treat persons as an end never as a means
c. The respect for person’s autonomy (self governance). The person should be allowed to
determine his own destiny, to choose according to his own values to act accordingly
d. Best practiced in the principle of free & informed consent

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 e. The role of autonomy is refusal, confidentiality & veracity

CONSENT
1. Implied – indicates agreement/ nonverbal
2. Expressed – verbal

(3) Components of informed consent

1. Must be given voluntary
2. The consent must be given to a client with
capacity to understand
3. Given enough information to be the ultimate
decision maker

Exceptions in giving consent

1. Minor
a. Adult who have mental capacity of a child
b. Married who are minors
c. Pregnant minors
d. Parents & members of the military
2. Severely injured
3. Mentally illed person

2. Justice
 Also termed fairness, means to give to each one what the deserves or what is due
 Means to treat equals equally

3. Inviolability of life
 Also proposed sanctity, dignity or respect for human life
 It means choosing life to protect it
 This principle includes measures for the survival of the human species & the freedom to have
children
 It is be against violence, pollution of environment, drug/alcohol addiction, euthanasia, suicide &
capital punishment

4. Non-maleficence
 Duty to do NO HARM

Violations of the Principle

1. Physically harming a person as in suicide, abortion, infanticide (person who murder infant),
violence
2. Harming a person’s reputation & honor by revealing confidential information
3. Exposing the person to harm as in subjecting the person to unnecessary treatment

5. Beneficence
 Means to do well, provide a benefit
 Bringing the action & choosing the most benefit & least harm
”PRICIPLE UTILITY”

Circumstances/ Issues Involving Maleficence

- Situations where in not prolonging life is allowed
- Obligatory or optional treatment
- Euthanasia

UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS

 To determine right or wrong in regard to value issues
 Autonomy-
1. Greek word AUTOS meaning self and nomos meaning governance
2. Self determination
3. Freedom to choose and implement one’s decision
4. Informed consent
5. Allowing the patient to refuse treatment if he decides so
6. The person making the decision must be deemed competent, intellectual capacity, legal age
 Veracity
Health care providers are bound to tell the truth
 Beneficence
Promotes the doing acts of kindness and mercy that directly benefit the patient
 NONMALEFICENCE-
1. To do no harm
2. Not assisting in or performing abortion
3. Not to assist people to commit suicide
4. Be involved in mercy killing
 JUSTICE

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 1. The right to demand to be treated justly, fairly and equally

CODE OF ETHICS
- A set of ethical principle that all member of a profession generally accept
- Sets the group expectation & standard of behaviour
PRINCIPLES UNDERLYING CODE OF ETHICS

1. Refers to the execution of duties

Responsibility associated with the nurse’s role
2. Ability to answer for your own
Accountability action
3. Requires that those with access
Confidentiality with health information to a 3rd
party without consent
4. Judgement Ability to form opinion or draw
sound conclusions
5. Advocacy >Giving patients information
they need to make decision to
support those decision
>Implies caretaker is drive to
understand & clearly state
patient’s point of view to other
health care provider

ETHICAL DILEMAS
- Exist when the right thing to do is not clear/ members of health care team cannot agree what the
right thing to do

LEAGL RIGHTS, ROLES & RESPONSIBILITY OF THE NURSE

ROLE RESPONSIBIL RIGHT

ITY
1. Provider of To provide safe Right to
service care, adequate &
commensurate classified
with the assistance as
nurses’ necessary
preparation
experience &
circumstances
2. Employee or >To fulfill the >Right to
contractor of obligations of adequate
service contracted working
service with condition
the employer >Right to
>To respect compensation
the right & for services
responsibilities rendered
of other >Right to
healthcare reasonable &
providers prudent
conduct
3. Citizen >Protect the >Right to
right of the respect by
recipients of others of the
care nurse’s own
>To inform role &
clients of the responsibility,
consequences right to
of various physical safety
alternative of >Right to
outcome of reasonable &
care prudent
>To provide conduct for
adequate clients
supervision &

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 evaluation of
others for
whom the
nurse is
responsible

SCOPE OF NURSING
- A person shall deemed to be practicing nursing when she/he singly or in collaboration with another
which initiates & performs nursing services to individual, family, community in any health care
setting
- Nurses are primarily responsible for the promotion of health prevention illness
- Nurses shall collaborate with other health care provider for the curative, preventive, rehabilitative
aspects of care, restoration of health, alleviation of suffering & when recovery is not responsible
towards a peaceful death

ROLE
- Expectation about how a person occupying one position behaves toward a person occupying
another position

RIGHTS
- Privileges or fundamental powers that individuals poses, unless they are revoke or given up
voluntarily

RESPONSIBILITIES
- Obligations associates with rights or state of being accountable

IT SHALL BE THE DUTY OF THE NURSE TO:

Provide nursing care thru the utilization of the nurse
Establish linkages with community resources & coordination with the health team
Provide health education
Teach, guide & supervise students in nursing education programs including the administration of
nursing services in varied settings
Undertake nursing & health human resource development training & research
The nurse is duty bound to observe the code of ethics for nurses & uphold the standard of safe nurse
practice
The nurse is required to maintain by continued learning.

STANDARD OF CARE
- Skills & learning commonly possessed by members of the professional.
- Purpose: to protect consumer
- The standards are used to evaluate the gravity of care of nurses & therefore become legal guideline
for nursing practice

STANDARD OF PROFESSIONAL PERFORMANCE

Quality of care
Performance Appraisal
Education
Collegiality
Ethics
Collaboration
Research
Resource utilization

SELECTED LEGAL ASPECTS OF NURSING PRACTICE

LAW
- A system of principles & processes by which people attend to control human conduct in an effort to
minimize the use of force

Functions of LAW in Nursing:

Provide a framework for establishing which nursing action in the care of the client are legal
It differentiates the nurse’ responsibilities from those of other health professionals
It helps establish boundaries of independent nursing action
Assist in maintaining a standard of nursing practice by making nurses accountable under the law

TYPES OF LAWS PERTINENT TO NURSES

PUBLIC LAW
- deals with relationships of between individuals & government agencies

CRIME
- an act in violation of public law & punishable by a fine or imprisonment
- Crimes may be classified as:

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 o FELONY
 Crime of serious nature such as murder, 1 2nd degree murder called manslaughter
(killing of another person)
 Ex.: Patient who died due to incompatible blood transfusion or drug dose
o MISDEMEANOUR
 An offence of less serious nature & punishable by a fine or short term jail sentence or
both

CIVIL LAW
- Comprises of laws that affect the individual rather the whole society

TORT
- A civil wrong committed against a person or person’s property
- Classified as:
o Unintentional
o Intentional
o Quasi-intension tort

I. UNINTENTIONAL
 Act committed against person or his property
 Classified as:
A. NEGLIGENCE
 Failure to comply with the standards of due care either by omission or commission
 A misconduct or practice that is below the standard expected of an ordinary reasonable &
prudent person

Doctrines related to Negligence:

Respondeat Superior or
Respondent supervisor
Let the superior answer
An employee as well as the employer is liable for the any failure

Res ipsa loquitor

Let the thing speak for itself
Shows sufficient proof on the person’s duty & his neglect to perform it

B. MALPRACTICE
Professional negligence that occurred while the person was performing as a professional
The failure of the professional to act as a reasonable & prudent professional with the same
education & experience would act in similar situation

TYPES OF MALPRACTICE
1. Failure to make referral to provide the patient with appropriate teaching before discharge
2. Learning a foreign object inside patient’s abdomen after surgery
3. Negligence on supervision of subordinate

(6) ELEMENTS OF HOW TO PROVE MALPRACTICE

1. Duty
Relationship with a client
2. Breach of duty
Failure to act as a reasonable prudent
3. Forseeability
Link must exist between the nurse’s act & injury suffered
4. Causation
Must prove that harm occurred that resulted a nurse’s failure
5. Injury/ harm
Client must demonstrate some type of injury
6. Damages
The nurse is held liable for damages to be compensated

COMMON MALPRACTICE ACT

1. Medication error
2. Burning of client
3. FALLS from the bed/ crib
4. Ignoring a client complaint
5. Mistaken identity

II. INTENTIONAL
o The person executed the act with purpose or intent
o Classified as:
 Assault
 Battery
 False imprisonment

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 ASSAULT
An attempt or threat to harm person unjustifiability

BATTERY
Willful touching of a person or something the person is carrying that may or may not cause
harm

FALSE IMPRISONMENT
Illegal detention of a person without his consent

III. QUASI-INTENTION TORT

o Voluntary act that directly cause injury or distress
o Types:
 Slander (Verbal)
A false oral statement that unjustly damage a person’s name
 Libel (written)
A false written or representational statement that unjustly damages a person’s
name
 Invasion of Privacy
A violation of the person’s right against unreasonable, unwarranted interference
with his personal life
Ex.: Releasing info. About patient to a 3rd party allowing unauthorized person

LEGAL PRECAUTIONS FOR NURSES

- Function within the scope of your education, job description of area/ scope of nursing practice
- Follow the procedures & policies of employing agency
- Observe & monitor client accurately
- Communicate & record significant changes in the client’s condition to AP
- Check any order that client asked/questioned
- Modify the client before initiating any interventions
- Protect the client from falls & preventable injuries

PROHIBITIONS IN THE PRACTICE OF NURSING

Practicing nursing must have certificate of registration (COR)
Who uses his own license/ COR of another
Who uses expired/ revoke COR
Who gives false evidence to the board of nursing in order to obtain COR
Who poses as RN that conveyed that he/she is RN
Who appends BSN/TN to his name without being confirmed with a degree
Uses names in advertisement

(5) LEGAL PROTECTION

1. Good Samaritan act
 A nurse who renders first aid or treatment at the scene of an emergency and who does so within
the standard of care, acting in good faith, is relieved of the consequences
2. Carrying out physician’s order
3. Provide competent care
4. Record Keeping
5. Incidental report

Components of incidental report

1. Name
2. date, time
3. describe the facts of incidence
4. Client’s account for incident
5. Witnesses of incident
6. Identify equipment, name of doses
7. signature

NURSES’ BILL OF RIGHTS

1. Registered nurses promote and restore health
2. Prevent illness
3. Protect the people entrusted to their care
4. Alleviate suffering
5. Provide services that maintain respect for human dignity

PATIENT’S BILL OF RIGHTS

1. Considerate and respectful care
2. Relevant, current and understandable information
3. Make decisions regarding his care plan

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 4. Have advance directive (living will)
5. Every consideration of his privacy
6. Confidentiality of communications and records
7. Review his records concerning his medical care
8. Be informed of business relationship among the hospital educational institution
9. Consent or decline to participate experimental research affecting his care
10. Reasonable continuity of care when appropriate and be informed of other care options
11. Be informed of hospital polices and practices

LVING WILLS OR ADVANCE DIRECTIVE

1. Accept or refuse any treatment, service or procedure used to diagnose or treat physical or mental condition
2. Decision to provide or withhold life-sustaining measures
3. This living will is signed by the patient
4. Witnessed by two other persons who is not designated as the person’s health care representative
5. Directive has force of law

MORAL PRINCIPLES
1. The golden rule
 Do unto others what you would like others do unto you
2. The two fold effect
 May have bad and good effect
 Must be morally good
 Good effect must be willed and the bad effect merely allowed
 Good effect must not come from an evil action
 Good effect must be greater than the bad effect
3. The Principle of Totality
 The whole is greater than any of its parts
4. Epikia
 Exception to the general rule
5. One who acts through an agent is himself responsible
 Ex. Nurse recommends patient to another clinic for abortion but does not want to
perform
6. No one is obliged to betray himself/herself
 No one can force any person to answer a question if such will incriminate him/her
7. The end does not justify the means
 Giving sleeping tablets to someone who has chronic illness
8. Defects of nature may be corrected
 Corrected by plastic surgery
9. If one is willing to cooperate in the act, no injustice is done to him/her
 With patient’s consent
10. A little more or less does not change the substance of an act
 Stealing
11. The greatest good for the greatest number
 Have more good effects for more people than a smaller group
12. No one is held to the impossible
 Do not promise impossible things
13. The morality of cooperation
 Formal cooperation is an evil act and never allowed
14. Principle relating to the origin and destruction of life
 Thou shall not kill

CODE OF GOOD GOVERNANCE

 Service to others
o Commitment to a life of sacrifice and genuine selflessness in carrying out their professional duties
 Integrity and Objectivity
o Perform their responsibilities with the highest sense of integrity
 Professional Competence
o Knowledge, technical skills, attitudes and experience
 Solidarity and teamwork
o Maintain and support one professional organization
 Social and Civic Responsibility
o Shall always carry out their professional duties with due consideration of the broader interest of the public
 Global Competitiveness
o Shall remain open to challenges of a more dynamic and interconnected world
 Equality of All professions
o Shall treat their colleagues with respect and strive to be fair in their dealings with one another

AMENDED CODE OF ETHICS FOR NURSES

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 Section 3 Republic Act No. 877 known as the Philippine Nursing Law and Section 6 of P.D No. 223 the amended Code of Ethics
of Nurses
 Article I
o Preamble- health is a fundamental right of every individual
 Article II
o Values, customs and spiritual beliefs held by individual shall be represented
o Consider the individuality and totality of patients when they administer care
 Article III
o Human life is inviolable
o Quality and excellence in the care of patients are the goals of the nursing practice
o Accurate documentation of actions and outcomes of delivered care is the hallmark of nursing accountability
 Article IV
o The registered nurse is in solidarity with other members of the healthcare team in working for the patient’s best
interest
 Article V
o Preservation of life, respect for human rights and promotion of healthy environment
o Promotion in local, national, and international efforts to meet health and social needs of the people
 Article VI
o Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal
 Article VII
o The certification of registration of the registered nurse shall either be revoked or suspended for violation of any
provisions of this code.

DEFINITION AND MEANING OF LAW

 The sum total of rules and regulations by which society is governed

 Man mad regulates social conduct in a formal and binding way
 Rule of conduct pronounced by controlling authority and which may be enforced
o Authority or right to declare that the rule exists
o Rule is pronounced or expressed
o Source can be defined
o A right to enforce the same must be provided
 Controlling authority in our system is the government
 Fundaments law of the government is the constitution
 Principal sources of pronouncements
o Constitution
o Statutes or legislations
o Executive branch
o Case decision/judicial opinions
o Presidential decrees
o Letters of instructions

RESONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF PROFESSIONAL NURSING

 Professional Negligence
o Commission or omission of an act, pursuant to a duty
 Existence of a duty on the part of the person charged to use due care under
circumstances
 Failure to meet the standard of due care
 The foresee ability of harm resulting from failure to meet the standard
 The fact that the breach of this standard resulted in an injury to the plaintiff
 Article 19 of the civil code
o One shall act with justice, give every man his due, observe honest and good faith
 Article 20
o Those who in the performance of their obligations through negligence causes any injury to
another, are liable for damages
 Common acts of negligence
o Burns resulting from hot water bags, heat lamps, vaporizers, sitz bath
o Objects left inside the patient’s body; sponges suction tips, loose dentures lodged in the
patient’s trachea
o Falls of the elderly; confused, unconscious, sedated patients
o Falls of children whose bed rails were not pulled up and locked
o Failure to observe and take appropriate action
o Failure to report observations to attending physicians
o Failure to exercise the degree of diligence which the circumstances of the particular case
demands
o Mistaken identity- drug given to the wrong patient
o Wrong medicine, wrong concentration, wrong route, wrong dose
o Defects in the equipment
o Errors due to family assistance

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 o Administration of medicine without a doctors prescription

Acts of negligence:

(1) THE DOCTRINE OF RES IPSA LOQUITUR

 Injury was of such nature that it would not normally occur unless there was negligent act
 Injury was caused by an agency within control of the defendant
 Plaintiff himself did not engage in any manner that would tend to bring about the injury

MALPRACTICE

 The idea of improper or unskilful care of a patient by a nurse

 Stepping beyond one’s authority with serious consequences
 Carelessness of professional personnel
 LESNIK- negligent act committed in the course of professional performance

(2) DOCTRINE OF FORCE MAJEURE

 Irresistible force; unforeseen or inevitable

 No person shall be responsible for those events which cannot be foreseen
 Floods fire, earthquakes

(3) DOCTRINE OF RESPONDEAT SUPERIOR

 Let the master answer for the acts of the subordinate

 The liability is expanded to include the master as well as the employee

INCOMPETENCE

 Lack of ability, legal qualifications or fitness to discharge the required duty

CONSENT TO MEDICAL AND SURGICAL PROCEDURES

 Consent
o Free and rational act that presupposes knowledge of teh thing to which consent is being given by a person who is
legally capable to give consent
o Signed by the patient or authorized representative/legal guardian
o An authorization by a patient or a person authorized by law to give the consent on the patient’s behalf
o Nurse secures the consent of the patient upon admission
 Informed Consent
o Established principle law that every human being of adult years and sound mind has the right to determine what
shall be done with his own body
o May choose whether to be treated or not
 Proof of Consent
o A written consent should be signed to show that the procedure is the one consented to and that the person
understands the nature of the procedure

TORTS

 Definition: A legal wrong, committed against a person or property

 Assault and Battery
o Imminent threat of harmful or offensive bodily contact
o Unjustifiable to tough another person or to threaten to do so
 Battery
o An intentional, unconsented touching of another person
 False Imprisonment of Illegal Detention
o Unjustifiable detention of a person without a legal warrant within boundaries
 Invasion of Right to Privacy and breach of confidentiality
o Right to privacy is the right to be left alone
o Right to be free from unwarranted publicity
o Exposure to public view
o Divulge information from patient’s chart to improper sources or unauthorized person
 Defamation
o Character assassination
o Slander-oral defamation
o Libel-written words
o There must be a third person who hears or read the comment before it can be considered defamation

CRIMES, MISDEMEANORS, AND FELONIES

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 CRIME
 An act committed or omitted in violation of the law
 Two elements
o Criminal act
o Evil/criminal intent
 Conspiracy to commit a crime
o Two or more persons agree to commit a felony
 Principals- who take a direct plan/part
 Accomplices- cooperate in the execution
 Accessories- having knowledge of the commission of the crime
 Criminal Actions
o Acts or offenses against public welfare
 Criminal negligence
o Reckless imprudence- person does an act or fails to do it voluntarily but without malice
o Simple imprudence- did not use precaution and the damage was not immediate or the impending danger
was not evident or manifest
 Criminal Intent
o States of mind of a person at the time the criminal act is committed that he/she knows that an act is not
lawful and still decide to do it anyway

WILLS

 A legal declaration of a person’s intentions upon death

 Testamentary document takes effect after the death of its maker
 Decedent- person whose property is transmitted through the succession whether or not he left a will
 If he left a will he is called a testator
 Woman is testatrix
 Heir- called to succession either by the provision of a will or by operation of law
 A person who dies leaving a will is said t have died testate
 One who dies without will is said to have died intestate
 Validation of the will in a court is known as probate
 A will which is written, dated and signed by the testator is called holographic will
 An oral will is called nuncupative will or nuncupation- made during the person’s last illness, that it be done in the place in
which he died, one or more witnesses to the will
 Testator must have the expressed intention of making a will
 Must be right of age
 Under 18 cannot make a will
 Required to have sound mind
 Think clearly ability at the time of its execution

NURSES OBLIGATIONS IN THE EXECUTION OF A WILL

 The nurse should note the soundness of the patient’s mind

 There was freedom from fraud or undue influence
 Make a notation on the patient’s chart of the apparent mental and physical condition of the patient at the time of making the
will

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