File Name: ethical and legal issues in nursing .zip
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of ethical practice in order to:. Ethics, simply defined, is a principle that describes what is expected in terms of right and correct and wrong or incorrect in terms of behavior. For example, nurses are held to ethical principles contained within the American Nurses Association Code of Ethics.
In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of legal rights and responsibilities in order to:. Some of the most commonly occurring legal issues that impact on nursing and nursing practice are those relating to informed consent and refusing treatment as previously detailed, licensure, the safeguarding of clients' personal possessions and valuables, malpractice, negligence, mandatory reporting relating to gunshot wounds, dog bites, abuse and unsafe practices, for example, informed consent, documentation, accepting an assignment, staff and client education relating to legal issues, and strict compliance with and adherence to all national, state, and local laws and regulations. All registered and licensed practical, or vocational, nurses must be currently licensed to practice nursing in their state of practice.
By clicking register, I agree to your terms. All rights reserved. Design by w3layouts. No matter how diverse the community or how advanced the healthcare setting, the needs, preferences, and values of the patient and family will continue to be at the core of palliative care.
KEY WORDS: Palliative care, bioethics, end-of-life conflict, nursing codes of ethics A basic knowledge of ethics, relevant federal and state law, and how these intersect with palliative care and end-of-life care provides a necessary framework for oncology nurses working in an increasingly Mary S.
Address correspondence to Mary S. These goals, preferences, and choices form the basis for the plan of care. Co-morbidities are common and symptoms with suffering tend to be cumulative. Sudden deaths, although they do occur, are much less frequent. The combination of advances M. COYLE in science and medical technology, concerns about paternalism, emphasis on patient autonomy, and reluctance to offer a clinical judgment in guiding the decisions of patients and their families have complicated the picture.
Healthcare providers have the means to prolong life, but also the means to prolong the dying process. This double-edge sword has led to both benefits and challenges for society and an implicit responsibility to provide care that is clinically and ethically appropriate. Illness with a long trajectory provides both the opportunity and the obligation for nurses and other healthcare professionals to have ongoing conversations with patients and their families about their desire for present and future healthcare interventions that align with their values, beliefs, and goals.
Presenting the patient and or family with the opportunity to have these conversations for example, at key points in a disease trajectory, such as at time of initial diagnosis or when the disease has progressed and goals of care need to be revisited is an ethical obligation. The need to have these conversations becomes even more urgent when the patient presents with advanced disease. He is not a candidate for chemotherapy or surgery, but radiation therapy is being considered for palliation.
The patient, who is alert but confused, is admitted to the hospital for dyspnea. He has a devoted, extended family that communicates well with each other. His wife is deceased and his two daughters are his healthcare agents. After meeting with the clinical team, the ethics consultant speaks with the daughters and one son-in- law and then meets with the son-in-law who is the Rabbi.
A very extensive discussion is held regarding what needs to be done to fulfill Jewish law and how this could be done without causing the patient any additional suffering. The consultant discusses what can be done to fulfill the spirit of these requirements. It is explained that the patient is at risk for aspiration pneumonia and that oral feeding may no longer be safe.
The risks associated with tube feedings are also explained. The Rabbi does not question this clinical judgment and agrees that the nutrition and hydration requirements can be fulfilled with intravenous fluids, if needed.
The question of intubation without cardiac resuscitation is raised. It is explained that intubation is uncomfortable and that the patient would in all likelihood need to be sedated afterwards. The Rabbi states that he does not want his father-in-law to suffer and that the patient himself had expressed that wish. For example, many cultures do not share the primacy of the value of individualism and individual autonomy. In addition, truth telling in the setting of advanced disease may be seen as doing harm rather than doing good.
The norms of a society evolve and change, however, and multiple subcultures may be present in one society and indeed within one family. In some cultures, societies, and religions, moral distinctions differ from the dominant culture.
A justification for not starting a treatment is also sufficient for stopping it. A person with capacity has the right to refuse any or all treatment. For example, a symptomatic patient at end-of-life may require increasing doses of analgesics to control pain.
Although escalating opioid doses in response to the level of pain or dyspnea does not hasten death in most patients, it may do so in a specific case. To evoke the principle of Double Effect, the act must be morally good or neutral eg, controlling pain or dyspnea the good effect is intended relieving suffering ; the bad effect is merely foreseen as a potential hastening death ; the bad effect is not the means to the good effect intent to kill the patient to relieve the suffering ; and proportionality the good trying to achieve outweighs the bad that might happen — this may vary based on goals of care.
Because of these as well as other factors, there is a natural interface between ethics and palliative care. He began chemotherapy at the facility, but this was stopped because of urinary retention, severe gout, and dehydration. His functional status quickly declined and he became severely debilitated. The patient and his family sought a second opinion at a comprehensive cancer center regarding his treatment options.
An ethics consultation was requested by the team to discuss how best to deal with this situation. The consultant recommended that the physician and office practice nurse first meet with the patient alone to determine his true wishes regarding disclosure of his healthcare information and then discuss his preferences with him, his daughter, and other family members together during an office visit.
This approach allowed the patient to express his preference for full disclosure but with the desire to have his daughter included in important messages and decisions. During the clinic visit, with his daughter present, M. COYLE the patient clearly stated that he wanted full disclosure on all issues. Comment — Respect for autonomy gives the patient the right to receive full disclosure about their medical condition but also the right not to be told this information but to have it directed to another person.
A recent ethnographic study explored the context in which ethically difficult situations arise. This code set out three principles, or prescriptive judgments, that are relevant to both clinical research and clinical care in our Western cultural tradition: respect for persons, beneficence and justice.
Then through the courts, two important cases highlighted the fact that there are limits to physician authority and expanded the concept of surrogate decision-making and the right to refuse treatment. Alongside this movement has been a parallel effort to assure that the rights of patients are protected even when they no longer have the capacity to make healthcare decisions.
Both federal and state laws have continued to focus on protecting these rights. The Patient Self Care Determination Act, passed by Congress in , requires that hospitals and other healthcare institutions provide information about advance healthcare directives to adult patients upon their admission to the healthcare facility.
All but seven states and the District of Columbia currently have or are developing such laws. The lack of a DNR order for a terminally ill patient leads to ethical conflicts for the healthcare team because CPR is almost never successful in these individuals. There can be religious or cultural reasons that patients and their families request resuscitation, but there also may be misunderstandings about what such a procedure entails and whether the DNR restricts other care of the patient.
For some patients and families, they are not making the decision, but rather it is being made by a religious figure who guides the decision-making, thus making it critically important to engage this key figure in the discussion. Family members, in particular, may become distressed when their request for tube feedings are denied in the dying patient, and they may become angry when counseled to not give food or liquids orally to a dying patient at risk of aspiration.
In the first case, the family may wrongly think that the nutrition being denied will prolong survival; in the second case, the family may feel they are being forbidden to perform the one remaining act of caregiving that they can still provide to their loved one.
Both medical and nursing associations, along with palliative care organizations, support the withholding of artificial nutrition and hydration at the end-of-life, except in select patients. However, the application of these statements requires that the nurse is knowledgeable Increasingly, as patients and families are involved in healthcare decisions, value conflicts arise when there are differences in the desired plan of care.
Although these differences are most often attributed to conflicts between clinicians and patients, they may also exist between healthcare providers and healthcare teams. Each of these topics deserves attention and extensive discussion, but two that are particularly relevant to nursing practice are highlighted. COYLE about the risks and benefits of such requested interventions and can explain their being withheld in terms of promoting the good of the patient. The need for nursing is universal.
Most importantly, the professional ideals expressed in these codes must be supported and actualized to be of value. Such actualization can occur in a number of ways, at the individual level, at the unit work level, at the site of healthcare delivery, and at the institutional level.
At all levels, actualization requires ethical analysis and reasoning specific to the situation at hand. One important way in which these values can be actualized is through the function of institutional ethics committees. Such committees are very common in the US and throughout the world, and the need for them reflects the complexity of healthcare today, in particular oncology care.
These committees were first organized in the mid 20th century as institutional efforts to bring a formal ethical perspective to clinical issues. In fact, in , the Supreme Court of New Jersey recommended in its decision in the Karen Ann Quinlan case that hospitals have an ethics committee to deal with termination of life-sustaining treatments. More recently, the Joint Commission on Accreditation of Healthcare Organizations has required since that each healthcare institution have a standing mechanism to address ethical issues and resolve disputes.
To be effective in these two clinical domains of consultation and education, it is critically important that nurses know about and be active members of ethics committees. Because so much of oncology care is provided by multidisciplinary teams, it is not only natural but necessary for nurses to be part of the committee function and to be confident in calling on the ethics committee to assist in clinical situations when ethical issues arise.
However, such confidence and expertise does not arise overnight, it requires the identification and commitment of nursing leadership to encourage and even request committee participation, if need be, and to support nurses who speak up about clinical situations where there is ethical conflict. But what is driving this need for ethics consults?
For one thing, the healthcare system has become incredibly complex and our approach with patients is to engage them in joint decision-making and have them more actively involved in their care. More than ever before, patients and families face choices that are difficult to understand and they are asked to make decisions they often feel unprepared to make.
In addition, the coordination of care among providers is often lacking because each specialist is focused on a limited set of medical problems and communication with the primary care provider may be quite limited. Patients also have less wellestablished relationships with their physicians and these physicians have less time to spend with their patients at a time when clear, understandable communication is essential. But communication and coordination problems are not the sole and inevitable causes of ethics consults.
There can also be real disagreements about what constitutes medically beneficial care, especially as our country becomes increasingly diverse.
A number of nursing-led forums can be practically and effectively instituted. For example, nurses on a particular unit or practice site can take the lead in setting up multidisciplinary debriefings after a TABLE 1.
Whom do they involve? Staff issues Is there disagreement about medical management? Is some other interstaff conflict being played out? Joint issues What is the relationship between the staff and the patient and family?
What is the understanding of goals of care by different participants? Ethical issues Is there an ethical dilemma? A true conflict of values that cannot be reduced to any other problem or misunderstanding?
Are there cultural or religious issues at play here? Legal issues Are there laws or regulations, federal, or state that impact the case? What is the nature of that conflict? Adapted and reprinted with permissions from Lederberg.
It can be more than peer support with particular focus on the ethical issues at play, how they were addressed or not , and what would work better in the future.
For example, a debriefing centered on a case where the family was requesting that the patient not receive pain medication at the end of life, despite the assessment by the nurses that the patient was in significant pain, could focus on the professional obligation to relieve suffering, as well as the legal and clinical issues of the case.
By clicking register, I agree to your terms. All rights reserved. Design by w3layouts. No matter how diverse the community or how advanced the healthcare setting, the needs, preferences, and values of the patient and family will continue to be at the core of palliative care. KEY WORDS: Palliative care, bioethics, end-of-life conflict, nursing codes of ethics A basic knowledge of ethics, relevant federal and state law, and how these intersect with palliative care and end-of-life care provides a necessary framework for oncology nurses working in an increasingly Mary S. Address correspondence to Mary S.
Explain key protections. • within the Americans with Disabilities Act. KEY CONCEPT AND TERMS. Advance directive. American Nurses Association. Code of Ethics.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Neonatal nurses regularly face complex legal and ethical dilemmas. This article discusses the hypothetical case of Jack, a two-day-old infant diagnosed with trisomy 13 syndrome , a life-limiting condition. Jack's prognosis is poor, and he is not expected to live past two weeks of age.
Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal.
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Но колокольный звон растекался по улочке, призывая людей выйти из своих домов. Появилась вторая пара, с детьми, и шумно приветствовала соседей.
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