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Legal and Ethical Considerations Within Nursing

The word ethics comes from the Greek word ‘ethos’, which can be loosely translated to the character. Ethical values are incredibly essential in nursing practice and healthcare in general. Similarly, legal considerations provide a framework that helps healthcare providers determine the best way to conduct themselves. Notably, there are several legal and ethical dimensions to nursing practice – this article aims to explore some of these dimensions. Take a look!

Legal considerations in nursing practice

There are several legal issues in nursing to be aware of during nursing practice. Failure to adhere to them can result in dire consequences, such as termination of employment and loss of licensure. Here are the major areas of legal concern:

Negligence or malpractice

A patient can file a malpractice claim against a nursing professional alleging that they did not follow the appropriate standard of care. This can apply to all MSN nursing jobs. Many schools, such as Elmhurst University, now offer the opportunity for non-nurses with previous Bachelor of Science degrees to transition to a career in nursing quickly.

A malpractice claim could stem from a nurse failing to give medication promptly or not following the correct procedure. The patient might also claim that the nurse did not use the medical equipment responsibly. Consider a situation where the nurse doesn’t charge equipment fully before a medical procedure. That equipment might run out of power sooner than expected, leading to negative implications for the patient. That would be a case of negligence. Failure to access or monitor a patient can also cause a nurse to be deemed negligent or reckless.

Usually, in a court of law, the person filing the claim must prove that the nurse failed to do something that a prudent person would have done in a similar situation or something that someone else wouldn’t have done in that situation. The case of malpractice must satisfy these four conditions:

  • Duty
  • Breach of duty
  • Damages
  • Causation

Legal and Ethical

Patient confidentiality

Patient confidentiality is an essential legal and medical obligation in nursing practice. The Hippocrates Oath and the Nightingale Pledge emphasize the importance of nurses upholding patient privacy and confidentiality. Unfortunately, this is not always done well. Research shows that 2.5 instances of breach of confidentiality happen weekly in an 1197-bed hospital. One might wonder: “Why are there that many cases?” Well, some incidents are hard to avoid.

While some of these issues might not lead to official implications, such as a lawsuit, they still disrupt a client’s privacy, so nursing professionals should do everything within their power to maintain patient confidentiality. One way they can do that is by preventing people from listening to conversations. However, that might be hard since some hospitals require patients to share a room. Expanding hospitals to allow every patient to stay in a private room is a rather costly venture, so it might take some time before all hospitals get there.

Nevertheless, even in the case of shared rooms, nurses can still respect patients’ privacy by closing the curtain. Hospitals can also opt for less costly measures, such as installing soundproof dividers instead of fabric curtains. Nurses can also try to speak in a low voice when discussing protected health information. However, that might be a challenge when the patient has hearing problems.

Another way nurses can uphold confidentiality is by keeping protected health information out of sight. That applies to both paper and electronic records. For hard copies, nurses should always ensure that the documents are stored under lock and key. When it comes to electronic records, they should never leave their computers unattended. Nurses are also required only to share confidential patient information with authorized people. Any information must be relevant for them to know.

Defamation

When the conversation of legal issues in nursing practice comes up, most people think of negligence and breach of confidentiality. However, there are other equally important areas of the law that nurses should be aware of. One such area is defamation of character.

Defamation involves false statements presented as facts that have the potential to harm someone’s reputation or character. This may include either libel or slander. In libel, the defamatory statement is made in a visible and permanent form. On the other hand, slander consists of spoken words. Some examples of defamatory activities in nursing practice include:

  • A claim that a nurse released client information that was untrue and defamatory
  • Alleged defamation of character when a parent was questioning a nurse about suspected sexual abuse
  • Defamatory statements about a supervisor in a nurse’s letter of resignation
  • A lawsuit initiated by a nursing student against a nursing instructor alleging negligence

Social media has also introduced a new dimension to defamation in nursing practice. For instance, posting defamatory comments online can have serious consequences for nurses and healthcare workers. A patient can also post comments online that can affect the nurse’s career.

There have been extreme cases of defamation in the past. For instance, in 2014, the jury awarded a plaintiff $1m in damages after she claimed that the New York Times had published false information about her. This decision was affirmed on appeal.

Nurses can avoid being on the wrong side of the law as far as defamation goes by being truthful. If a statement is truthful, it cannot be termed defamatory. It is also essential to be unambiguous.

Medical battery

Medical battery occurs when someone inflicts physical harm on another in a medical setting. This requires intent. If a patient decides to sue, they must prove that the nursing professional intentionally committed the act to cause harm. An example of medical battery is when the nurse performs a substantially different procedure than what the patient consented to.

People tend to confuse medical battery with malpractice. The difference is that the latter is broader, while the medical battery is more specific. The medical battery can lead to economic and non-economic damages. Monetary damages include medical bills and lost wages. On the other hand, non-economic damages can include emotional distress and PTSD.

Ethical dimensions in nursing practice

Nurses are bound to uphold the profession’s foundational moral virtues, duties, and principles. The American Nurses Association established a formal Code of Ethics in the 1950s to establish expectations. However, it can be challenging to not color outside the lines due to the complex moral choices and pressures nurses face every day. Here are some ethical issues that nurses confront in the healthcare environment:

Informed consent

Informed consent might sound like a pretty straightforward issue. However, it is a layered concept that can sometimes pose a dilemma to nursing professionals. These dilemmas can take different forms. For instance, a patient can refuse treatment due to cultural or personal beliefs. In that case, the nurse must respect their decision even when it could lead to negative implications. However, there are exceptions to informed consent. Examples include when the patient is incapacitated or in a life-threatening emergency, and there is no time to obtain proper consent.

Aside from its implicit ethical value, informed consent also has legal implications. Failure to secure informed consent can lead to a medical malpractice lawsuit. The nurse is mandated to explain what is involved with treatment, anticipated benefits, and potential risks and alternatives to the proposed treatment.

Informed consent has benefits beyond avoiding lawsuits. It also improves patient outcomes since they feel more empowered and are more likely to follow a treatment plan diligently.

Shared patient decision-making

Shared decision-making (SDM) is an essential component of patient engagement that nurses should bear in mind. This approach dictates that the healthcare provider collaborates with the patient to make treatment decisions. It has several benefits, such as improved patient and health system outcomes.

However, it can pose an ethical dilemma when the patient fails to understand the treatment. If they disagree, they can fallout with the nursing staff, which can negatively affect outcomes.

Treating conflicts of interest

There is no law prohibiting nurses from treating people they know. However, it can easily lead to a situation of conflict of interest. It can cause the nurse to lose objectivity. For instance, the nurse might feel they must give the patient special treatment. Similarly, the patient might feel awkward and vulnerable. Additionally, the nurse might suffer stronger emotional trauma if something goes wrong.

Confidentiality can also become an issue when a nurse handles a patient they know. Think of a scenario where the patient is a relative. You might want to discuss their case with a mutual family member, which is a breach of confidentiality. Since it can be difficult to draw these lines, it would be best to avoid such a situation altogether.

There are other examples of conflict of interest in nursing, both tangible and intangible. These issues will never disappear entirely for as long as the profession continues. The best thing to do as a nurse is to voice any concerns. It is also essential for nurses to remember that ethically, their obligation is to the patient first.

Inadequate resources and staffing

Nursing is a growing profession, with more and more people studying to become registered nurses. Yet, there is still an acute shortage. The persistent shortage of resources and staffing challenges nurses’ ethical obligations in the United States and beyond. When nurses are understaffed, they experience emotional distress, which can interfere with them providing quality care to their patients. In that case, what comes first? Is it the nurse’s well-being or the needs of the patients?

Staffing shortages also make it hard for nurses to protect patients from any harm. For instance, when a nurse is assigned to care for several patients, they might not adequately meet all the patient’s needs. They might choose to prioritize only mandatory primary care, such as injections and medicine, and forego taking them for a walk or giving them a back rub.

Nurse managers also face a difficult time when there is a shortage of other facilities, such as medical equipment. They must decide which patients will use the available resources, which goes against moral obligations.

Handling ethical dilemmas in the nursing profession

As you’ve read above, ethical dilemmas will always be a part of this profession, so the goal is not to eliminate them. It is learning how to recognize and address them effectively. The most important thing to do is understand the dilemma’s uniqueness. No two patients are alike, so no two dilemmas are alike. A nurse can better understand the situation at hand by gaining insights from all parties involved. From there, they can work with everyone involved to find common ground.

It is also important to constantly refer to the code of ethics. Although it was established several years ago, the document is updated regularly to accommodate emerging challenges. Nurses can also seek ethics education beyond The Code. For instance, they can attend conferences discussing dilemmas in the profession. They can also look for mentors in the field who have most likely experienced a similar situation.

Understandably, some dilemmas can affect the nurse’s emotional health. For instance, a situation can rekindle a past event or might make the nurse question their competency. In that case, the nurse should talk to their supervisor about seeking counseling.

Ethical patient care is a complex concept. It is rooted in rational science, informed decision-making, and critical thinking. It helps to be open-minded and to see each dilemma as an opportunity to learn and become a better nurse.

The link between ethics and the law in nursing

In most cases, there is an overlap between ethics and the law in nursing. When an overlap occurs, the nurse must examine the situation thoroughly. For instance, the government might prohibit certain patients from accessing some medicines. Yet, the nurse knows these medicines will improve the patient’s condition. To reduce the legal risks to their career, they might choose to follow the law. Nurses should constantly interact with legal professionals for guidance on how to act correctly in situations where there might be a divergence. It is also worth noting that nursing is a self-governing profession, so the government must respect and preserve the profession’s integrity and ethics. This can be done by involving nursing professionals when making policies.

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