Beruflich Dokumente
Kultur Dokumente
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.
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
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.
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- 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.
Likewise: the hospital is expected to provide the necessary supplies, equipment needed to
provide competent, quality nursing care.
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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
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
2. Intentional Tort
Unintentional tort – do not require intent bur do require the element of HARM
Intentional tort – the act was done on PURPOSE or with INTENT
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- 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
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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ETHICO-MORAL ASPECTS OF (5) VALUES ESSENTIAL FOR PROFESSIONAL
NURSES
NURSING PRACTICE
1. Altruism >The concern for the welfare &
Nurses need to:
well-being of others
• Develop sensitivity to the ethical 2. Autonomy >The right for self- determination
dimensions of nursing practice of professional practice
• Examine their own & client’s value Ex.: When the nurse respects
• Understand how values influence their patient’s right to make decisions
decisions about their health care
• Think a head about the moral problems 3. Human - Respect for the inherent worth &
they are likely to face. Ex.: birth, death, dignity uniqueness of individual &
marriage populations
Ex.: when the nurse values &
*Values are important because they influence respects all patient’s & colleagues
decisions & actions, including nurses’ ethical 4. Integrity - Acting in accordance with an
decisions even though they may be unspoken appropriate code of ethics &
questions of values underlie all moral dilemmas standards of practice
Ex.: when the nurse is honest &
VALUES provides care based on ethical
- enduring beliefs or attitudes about the framework that is accepted within
worth of a person, objects, idea or action profession
5. Social - Upholding moral, legal &
- concepts/ ideas that give meaning to
Justice humanistic principles.
one’s life & provide a framework for one’s
Ex.: when the nurse works to
decision
ensure equal treatment under the
laws & equal access to quality
BELIEFS (OPINIONS)
care.
- Interpretations or conclusions that people
hold as true
PROFESSIONAL BEHAVIORS ASSOCIATED
- Based more on faith that fact & may/ may
WITH 5 VALUES
not be true
1. Demonstrate understanding of cultures,
- Beliefs do not necessarily involves values
belief & perspectives of others
Ex.: If I study hard, I will get good grade
2. Demonstrates accountability for own
actins
ATTITUDES
3. Documents accurately & honestly
- Mental positions/ feelings toward a person,
4. Designs care with sensitivity to individual
object or idea
patient needs
- Often judged as bad or good, positive or
5. Advocates for patients particularly the
negative, beliefs are judged as correct or
most vulnerable
incorrect.
6. Take risks on behalf of patients &
colleagues
VALUES
- Are learned through observation &
7. Plans in partnership with patients
experience & are heavily influenced by a 8. Honors the rights of patient & families to
make decisions about healthcare
person’s sociocultural environment that is
by: 9. Provide information so patients can make
informed choices
o Societal traditions, cultural, ethical,
10. Provide culturally competent & sensitive
religious groups, family or peer
care
groups
11. Protects the patients privacy &
confidentiality
PROFESSIONAL VALUES
12. Provides honest information
- Are acquired during socialization from
13. Promotes universal access
nursing experience, from teachers, peers
14. Seek to remedy errors made
& code of ethics
15. Support fairness
16. Encourage legislation
*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 ETHICS came from the Greek word ETHOS meaning
about specific issues as abortion/ euthanasia custom/character or moral duty
Method of inquiry that assist people to
VALUES CLARIFICATION understand the morality of human
- Process by which people identify, examine behaviour
& develop their own individual values Refers to the expected standards of moral
behavior
EGB’June09 5
How people make judgement in regard to right or o Carol Gilligan
wrong Emphasizes care &
responsibility
Critical reflection about morality and rational
analysis about it
NURSING
JOHNSTON- examination of all ethical and bio-
ethical issues from the prospective of nursing theory An occupation requiring a unique body of
and nursing ethics knowledge and skills and which serves
society
VERCOE- the fields of nursing ethics be focused on
the needs and experiences of practicing nurses, the Is nursing a profession?
exploration of its meaning and that of ethical practice YES. It is a calling, vocation, occupation based on
scientific body of knowledge which needs training both
in terms of the perception of these nurses
in theory and practice guided by a Code of Nursing
Ethics, governed by the Nursing Act of 2002, to SERVE
BIOETHICS
mankind for a FEE or FREE.
Also known as “applied or practical ethics”
PROFESSION
Specific domain of ethics that focuses on moral An occupation or calling requiring advance
issues in the field of health care training
Experience in some specific or specialized
Result of life and death dilemmas faced by health body of knowledge
care practitioners
Provides service to society in that special
Systematic study of human behaviour in the field of field
life science and health care in the light of moral The term profession is honoric and should
values and principles be carried with pride and honor
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o Therapies
(3) TYPES OF MORAL THEORIES
o Oral 1. CONSEQUENCE-BASED (Theological
theories)
o Topical
- Looks to the consequences of an action in
judging whether the action is right of
o Parenteral medications
wrong
o Internal examination during labour in the - Focus on issues of fairness
absence of antenatal bleeding and delivery - UTILITARIANISM
o Views the good act as one that
o Suturing of perineal laceration bring the most good for the greater
number or the least harm for the
Establish linkages with community resources greatest number
- PRINCIPLE OF UTILITY
Coordination with the health team o From the utilitarian perspective, th
point of morality is to promote
Provide health education to individuals, families and
what is intrinsically good by
communities
maximizing benefits & minimizing
Teach, guide and supervise students in nursing harm
education programs
TELEOLOGICAL APPROACH
The nurse is required to maintain competence by
continual learning through continuing professional Greek word TELOS or goal or end
education
The right thing to do is the good thing to do
QUALIFICATIONS AND ABILITIES OF A
PROFESSIONAL NURSE Act utilitarianism- good resides in the promotion of
happiness or the greatest net increase of pleasure over
Professional Preparation pain
o Have a license to practice If the act helps people, then it is a good act
o Bachelor of science degree in nursing If the act hurts people then it is a bad act
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1. Consideration for people as human beings - Broad general concepts such as autonomy
& justice, they provide the foundation for
2. Consideration of consequences moral values
PRICIPLES
3. Proportionate good to come from the choices - useful in ethical decisions because even if
people disagree about which action is right
4. Propriety of actual needs over ideal or potential in situation, they may be able to agree on
the principle that apply
needs
(5) BASIC ETHICAL PRINCIPLES
5. A desire to enlarge choices and reduce chance 1. >Our bodies, our life, our human
Stewardship nature & everything in this earth
6. A courageous acceptance of the consequence of the are gifts we have dominion over
decision >This means we are responsible
for them. We should not harm
W.D ROSS- PRIMA FACIE DUTIES- WHAT ONE them, but rather improve & care
SHOULD DO WHEN OTHER RELEVANT FACTORS IN for them
A SITUATION ARE NOT CONSIDERED >Ex.: Caring for one’s body is a
sign of good stewardship
Duties of fidelity- telling the truth, keeping promises 2. Totality >Refers to the whole. Every
person must develop, use for &
Duties of reparation- righting the wrong we have preserve all his parts & functions
done to others for themselves as well as the good
of the whole
Duties of gratitude- recognizing the service others 3. Doubt >When an act is foreseen to have
Effect both good & bad effects, the
have done for us
principle of double effect is
applied.
Duties of justice- preventing distribution of pleasure >In order that such act be
or happiness that is not in keeping with the merit of permissible the following
people involved conditions should be met:
1. The action itself must be good
Duties of beneficence-helping to better the condition or at least neutral
of other beings 2. The good effects is the one
directed intended by agent & not
Duties of self improvement- bearing ourselves with the evil effect
respect to virtue or intelligence 3. The good effect is not produced
by means of the evil effect
Duties of nonmaleficence- avoiding or preventing 4. The foreseen beneficial effect
must be equal to or greater than
injury to others
the foreseen harmful effect
4. >The participation of one agent
VIRTUE ETHICS APPROACH
Cooperation with another agent to produce a
particular effect or joint effect
ARETIC, Greek word ARETE, heart of the person
>Cooperation becomes a problem
performing the act when the action of the primary
agent is morally wrong
Traits and virtues of a good person, courage, >Cooperation may be:
temperance, wisdom, and justice 1. FORMAL
When the 2nd agent willingly
DIVINE COMMAND ETHICS participates as when one agrees,
advice, counsels, promotes or
Supreme or divine that sets down rules to condones
provide guidance to moral decisions 2. MATERIAL
When the 2nd agent does not
willingly participate
5. Solidarity >Means to be one with others. In
(5) ATTRIBUTES OF CARING the provisions of health care, it is
1. Compassion – sorrow for the suffering or important for the provider to be in
trouble of another, with an urge to HELP. solidarity with the patient when
2. Competence – condition in qualification of seeking the latter’s best interest
being able to perform according to STANDARD. >This is most important when
3. Commitment – DEDICATION to a long-term dealing with the poor,
course of action, engagement or involvement. disadvantaged & marginalized
4. Confidence – belief in ones own abilities, to feel >Ex.: Should the strong help the
CERTAIN. weak?
5. Conscientious – doing things according to what
is right, showing care and precision, HONEST MAJOR BIOETHICAL PRINCIPLES
(held in respect, HONORABLE) 1. Respect for person
a. The recognition of the equality
MORAL PRINCIPLES possessed by every human being
as unique, worthy, rational, self
determining creature having the
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capacity & the right to decide what Means to do well, provide a benefit
is best for himself Bringing the action & choosing the most
b. Responsibility of all to treat persons benefit & least harm
as an end never as a means ”PRICIPLE UTILITY”
c. The respect for person’s autonomy
(self governance). The person Circumstances/ Issues Involving
should be allowed to determine his Maleficence
own destiny, to choose according - Situations where in not prolonging life is
to his own values to act accordingly allowed
d. Best practiced in the principle of - Obligatory or optional treatment
free & informed consent - Euthanasia
e. The role of autonomy is refusal,
confidentiality & veracity UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS
To determine right or wrong in regard to value issues
CONSENT
1. Implied – indicates agreement/ Autonomy-
nonverbal
2. Expressed – verbal 1. Greek word AUTOS meaning self and
nomos meaning governance
(3) Components of informed consent
1. Must be given voluntary 2. Self determination
2. The consent must be given to a client
with 3. Freedom to choose and implement one’s
capacity to understand decision
3. Given enough information to be the
ultimate 4. Informed consent
decision maker
5. Allowing the patient to refuse treatment if he
Exceptions in giving consent decides so
1. Minor
a. Adult who have mental 6. The person making the decision must be
capacity of a child deemed competent, intellectual capacity,
b. Married who are minors
legal age
c. Pregnant minors
d. Parents & members of the
Veracity
military
2. Severely injured
3. Mentally illed person Health care providers are bound to tell the
truth
2. Justice
Also termed fairness, means to give to Beneficence
each one what the deserves or what is due
Means to treat equals equally Promotes the doing acts of kindness and
mercy that directly benefit the patient
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1. Refers to the execution of duties others for
Responsibility associated with the nurse’s role whom the
2. Ability to answer for your own nurse is
Accountability action responsible
3. Requires that those with access
Confidentiality with health information to a 3rd
party without consent SCOPE OF NURSING
4. Judgement Ability to form opinion or draw
sound conclusions - A person shall deemed to be practicing
5. Advocacy >Giving patients information nursing when she/he singly or in
they need to make decision to collaboration with another which initiates
support those decision & performs nursing services to individual,
>Implies caretaker is drive to family, community in any health care
understand & clearly state setting
patient’s point of view to other
health care provider - Nurses are primarily responsible for the
promotion of health prevention illness
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The nurse is duty bound to observe the code
of ethics for nurses & uphold the standard
of safe nurse practice TYPES OF LAWS PERTINENT TO NURSES
STANDARD OF CARE
- The standards are used to evaluate the - Crimes may be classified as:
gravity of care of nurses & therefore
o FELONY
become legal guideline for nursing
practice
Crime of serious nature such
as murder, 1 2nd degree
murder called manslaughter
STANDARD OF PROFESSIONAL (killing of another person)
PERFORMANCE
Ex.: Patient who died due to
Quality of care incompatible blood
transfusion or drug dose
Performance Appraisal
o MISDEMEANOUR
Education
An offence of less serious
Collegiality
nature & punishable by a
Ethics fine or short term jail
sentence or both
Collaboration
Research
CIVIL LAW
Resource utilization
- Comprises of laws that affect the
individual rather the whole society
o Intentional
Functions of LAW in Nursing:
o Quasi-intension tort
Provide a framework for establishing which
nursing action in the care of the client are
legal I. UNINTENTIONAL
It differentiates the nurse’ responsibilities
Act committed against person or his
from those of other health professionals
property
It helps establish boundaries of independent
Classified as:
nursing action
A. NEGLIGENCE
Assist in maintaining a standard of nursing
practice by making nurses accountable
under the law
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Failure to comply with the Relationship with a client
standards of due care either by
omission or commission 2. Breach of duty
6. Damages
BATTERY
(6) ELEMENTS OF HOW TO PROVE
MALPRACTICE Willful touching of a person or
something the person is carrying
1. Duty
that may or may not cause harm
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PROHIBITIONS IN THE PRACTICE OF
NURSING
FALSE IMPRISONMENT
Practicing nursing must have certificate of
Illegal detention of a person registration (COR)
without his consent
Who uses his own license/ COR of another
Libel (written)
(5) LEGAL PROTECTION
A false written or
1. Good Samaritan act
representational statement
that unjustly damages a • A nurse who renders first aid or treatment
person’s name at the scene of an emergency and who
does so within the standard of care, acting
Invasion of Privacy
in good faith, is relieved of the
consequences
A violation of the person’s
right against unreasonable, 2. Carrying out physician’s order
unwarranted interference
with his personal life 3. Provide competent care
1. Name
LEGAL PRECAUTIONS FOR NURSES
2. date, time
- Function within the scope of your
3. describe the facts of incidence
education, job description of area/ scope
of nursing practice 4. Client’s account for incident
4. Alleviate suffering
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5. Provide services that maintain respect for Must be morally good
human dignity
Good effect must be willed
and the bad effect merely
allowed
PATIENT’S BILL OF RIGHTS
Good effect must not come
1. Considerate and respectful care from an evil action
2. Relevant, current and understandable
Good effect must be greater
information
than the bad effect
3. Make decisions regarding his care plan
3. The Principle of Totality
4. Have advance directive (living will)
The whole is greater than
5. Every consideration of his privacy any of its parts
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Formal cooperation is an o Consider the individuality and totality of
evil act and never allowed patients when they administer care
Section 3 Republic Act No. 877 known as the Philippine o Authority or right to declare that the rule
Nursing Law and Section 6 of P.D No. 223 the amended exists
Code of Ethics of Nurses
o Rule is pronounced or expressed
• Article I
o Source can be defined
o Preamble- health is a fundamental right of
o A right to enforce the same must be
every individual
provided
• Article II
• Controlling authority in our system is the government
o Values, customs and spiritual beliefs held by
• Fundaments law of the government is the constitution
individual shall be represented
• Principal sources of pronouncements
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o Constitution o Failure to report observations to
attending physicians
o Statutes or legislations
o Failure to exercise the degree of
o Executive branch diligence which the circumstances
of the particular case demands
o Case decision/judicial opinions
o Mistaken identity- drug given to the
o Presidential decrees
wrong patient
o Letters of instructions o Wrong medicine, wrong
concentration, wrong route, wrong
RESONSIBILITY AND ACCOUNTABILITY FOR THE
dose
PRACTICE OF PROFESSIONAL NURSING
o Defects in the equipment
• Professional Negligence
o Errors due to family assistance
o Commission or omission of an act,
pursuant to a duty o Administration of medicine without
a doctors prescription
Existence of a duty on the
part of the person charged Acts of negligence:
to use due care under
circumstances (1) THE DOCTRINE OF RES IPSA LOQUITUR
Failure to meet the standard • Injury was of such nature that it would not
of due care normally occur unless there was negligent
act
The foresee ability of harm
resulting from failure to • Injury was caused by an agency within
meet the standard control of the defendant
The fact that the breach of • Plaintiff himself did not engage in any
this standard resulted in an manner that would tend to bring about the
injury to the plaintiff injury
o One shall act with justice, give • The idea of improper or unskilful care of a
every man his due, observe honest patient by a nurse
and good faith
• Stepping beyond one’s authority with
• Article 20 serious consequences
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CONSENT TO MEDICAL AND SURGICAL o Divulge information from patient’s chart to
PROCEDURES improper sources or unauthorized person
• Consent • Defamation
• Informed Consent
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lawful and still decide to do it
anyway
WILLS
• Woman is testatrix
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