Ethical and Legal Issues in Nursing Over the last several decades, professional nursing has evolved and changed because of the influence of ethical and legal issues. There may be a variety of reasons for the changes. Examples in changes are advances in medical technology, legal changes about abortion and euthanasia, a push toward patient rights and litigation, and ever decreasing resources in which to provide nursing care. With all these influences affecting care, it has become increasingly difficult to have a true understanding of the direction nursing should take when faced with moral, ethical, and legal issues.
Examination of personal moral and ethics along with utilization of available resources will no doubt aid nurses in sorting out feelings, strategizing for the patient and families, and providing guidance to give the best care possible. One resource available is the American Nurses Association, they have developed a code of ethics that should act as a guide in directing care and solving the ethical and legal dilemmas that surface. When applying the code of ethics resource; nurses can assist their patients families in making informed decisions as well as understand their own and their colleague’s responsibilities.
By examining two case scenarios, the first involving end of life decisions, the second involving nursing conduct, the application of the code of ethics, the legal aspects, and the nurses responsibilities would be better understood. It is prudent to begin by examining the legal responsibilities of the nurse in the work setting. A Registered Nurse carries a legal responsibility in the work setting. A nurse has a commitment to the safety of the patient and must be aware of inappropriate practice. All nurses have ethical duties to the patients they serve.
According to the American Nurses Association; a nurse “promotes, advocates for, and strives to protect the health, safety, and rights of the patient” (ANA, 2001, p. 18). If an action is taken that poses harmful effect on a patient’s health this needs to be immediately reported to a higher authority within the workplace or if necessary to a suitable outside authority. A nurse must be accountable for his or her individual nursing practice. The nurse’s duty is to identify anyone with questionable practice.
All workplaces have guidelines set in place for these types of events. A nurse should concern herself about repercussions when reporting unethical practice. A nurse should be familiar and compliant with his or her state’s nurse practice act and his or her workplace policies applicable practice standards of care for each clinical area. In the malpractice exercise the nurse was observed on several occasions violating standards of care. The occurrences were reported immediately through the chain of command which in this case was administration.
After anecdotal notes were kept by the nurse, she should prepare written documentation, including the time and location of the incident and names of any witnesses. Time should be taken to think about the incident and write down all important points that come to mind, who and, when, she notified in administration and what was told to them. This way everything would be in order and accessible if you need to recall when answering questions. Be honest and truthful if there is something you cannot remember you, state that you do not recall.
There should be no disregard during this process, it is the ethical and legal duty of a nurse, as the patient advocate, to stand up, and protect the patient. Every nurse is equally responsible for his or her own actions. Responsibility also carries over to patients not under her direct care, the obligation for all patients. The incident was reported in the correct manner and she kept personal anecdotal records and upheld her ethical duties. Personal and societal views play a major role in the way a nurse views a current ethical situation.
As nurses and as human beings, we each will have our own way of evaluating and assessing different circumstances that we are part of daily. No matter what kind of nursing or nursing experience that you may have, you cannot run from these trying predicaments. “Our ethical framework assists us when we experience serious ethical dilemmas” (Cameron & Salas, 2010, p. 655). In the case regarding Marianne, there are countless ways in which personal and societal values could have played a part.
They could affect how the family would be viewed by society if they did not try everything to save their loved one, or how would it look if they went through with the surgery and it looked as if Marianne was experiencing torture. Ethical dilemmas are never straightforward and never with a right or wrong answer. It is our job as nurses to put aside our feelings and beliefs and to educate the family on all of the potential outcomes that may be expected. We must remember as health care providers, to be non-judgmental.
When reviewing the case of Marianne, the significant legal aspect to consider is the lack of a Healthcare Power of Attorney and Living Will. Not possessing Marianne’s documented wishes creates a legal ethical dilemma and creates family conflict. The responsibility of deciding the future of Marianne’s care will fall on the family with guidance from the hospital’s Ethics Committee. The ANA Code of Ethics provides nurses with guidance in legal and ethical responsibilities. The code describes the obligation of treating patients and families with autonomy.
Lachman describes the role of autonomy in nursing care: “patients have a moral and legal right to determine what will be done with their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed judgment; to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment; to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or penalty; and to be given necessary support throughout the decision-making and treatment process “(Lachman, 2009, p. 55).
Providing autonomous nursing care to Marianne and her family will ensure all the options are presented. The family members place trust in the nurse to provide good care and be supportive, regardless of the decision they make for Marianne’s future. The trust placed on nurses includes responsibility to the patient and the institution ensuring policies are adhered to thus avoiding the possibilities of negligence. With trust, nurses have an obligation to society. Legally we are “responsible to preserve integrity and safety, to maintain competence and to continue personal and professional growth” (ANA, 2001, p. 8). No matter the situation of the patient in regard to age, race, religion, economic status, etc. We are to treat each patient and family member with the same amount of respect. Both case studies The Nurse as the Witness and The Six Caps are unique in different ways. Nurses often have the tendency to develop close relationships with patients. Reminders may be needed often that the purpose of nursing is not friendship but to alleviate suffering, protect the patient, promote wellness, and to help restore the health.
In Marianne’s case the legal responsibility of the nurse is to communicate all possibilities of Marianne’s care. The nurse in this situation has an obligation to provide all the information possible to help the family come to a decision in regard to Marianne’s life. Nurses are to be truthful and never withhold any information. No matter what a family or patient decides, the nurse is to advocate for that decision. Family decisions are not the function of nurse, no matter what the nature. There may be instances when a nurse will be a witness or perhaps a defendant.
Medical professionals see many and unique situations some will have to be reported and investigated. Documentation is a huge legal aspect of nursing. It will be always important to document exactly what you do and see. Opinions and assumptions are not good practice for documentation purposes as this would not hold up in court and may sway decisions. The malpractice case regarding the nurse as the witness is a fine example of the need to be proficient in documentation. Months and years later, what is in writing is what will count. As nurses we know, if it was not documented, it did not happen!
For this particular case study, the nurse was obligated to report exactly what she wrote about the nurse in question. That nurse has an obligation to report any suspicions of abuse and neglect to administration even repeatedly if necessary. In any situation, the nurse has an obligation to act in the best interest of the patient. It may have consequences but, the overall nurse’s responsibility is to keep the patient safe. Summing up, it is clear that nursing practice can be influenced by personal ethics and morals. The American Nurses Association’s code of ethics provides a guide for practice.
When applied to a practical case, such as Marianne and her family, the code of ethics allows the nurse caring for here to remain professional and objective without letting her own feelings influence the family. The nurse has a responsibility to Marianne, her family and the employing institution. Overall, these guidelines extend throughout practice and are set in place to protect society. It becomes a mutual trust and is why nursing is held to such a high standard. References American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements.
Washington, DC: ANA. Blais, K. K. , Hayes, J. S. , Kozier, B. , & Erb, G. (2006). Professional nursing practice. Upper Saddle River, New Jersey: Pearson, Prentice Hall. Cameron, B. L. , & Salas, A. S. (2010). Ethical openings in practical home care practice. Nursing Ethics, 17(5), 655-665. Retrieved from http://web. ebscohost. com. ezproxy. apollolibrary. com Practical use of the nursing code of ethics: part I. Medsurg nursing: official journal of the academy of medical-surgical nurses, 18(1), 55-57. Retrieved from http://EBSCOhost
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