Any healthcare provider must have ethical values. Ethical values are universal rules of conduct that serve as a practical foundation for determining what types of actions, intentions, and motives are valued.
1) Ethics are moral principles that govern how individuals or groups act or conduct themselves. The emphasis is on right and wrong actions and the decision-making process for determining the ultimate consequences of those actions.
2) Every individual has their own set of personal ethics and morals. Healthcare ethics are important because workers must recognize healthcare dilemmas, make sound judgments and decisions based on their values, and adhere to the laws that govern them. Nurses, like all healthcare professionals, require regulation and guidance within the profession in order to practice competently and with integrity.
3) For this purpose, the American Nurses Association (ANA) created the Code of Ethics.
Nursing ethics can be traced back to the late nineteenth century. At the time, ethics was thought to include virtues such as physician loyalty, moral character, and obedience. Nursing has evolved since then, and nurses are now part of the healthcare team and patient advocates.
In the 1950s, the first formal Code of Ethics to guide the nursing profession was developed. The ANA developed and published it to guide nurses in their daily practice and to establish primary goals and values for the profession. Its purpose is to provide a concise statement of every individual who enters the nursing profession’s ethical obligations and duties. It establishes a non-negotiable ethical standard and reflects nursing’s own understanding of its societal responsibilities.
Over time, the Code of Ethics has been revised. The current version reflects technological advances, societal changes, the expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, as well as the creation and maintenance of healthy work environments. You may visit Nursing papers market for further information or write ups on ethical and legal principles in nursing.
Malpractice and Negligence
Negligence is defined as “conduct lacking in due care, carelessness, and a deviation from the standard of care that a reasonable person would use in a specific set of circumstances.”
1) Malpractice is a more specific term that considers a standard of care as well as the caregiver’s professional status.”
2) To establish negligence or malpractice in a court of law, the following elements must be established:
• Duty owed to the patient
• Breach of duty owed to the patient
• Predictability
• Causation
• Injury
• Damages
3) To avoid being sued for negligence or malpractice, nurses and nursing students must adhere to the scope and standards of practice care established by their state’s Nurse Practice Act, the American Nurses Association, and employer policies, procedures, and protocols.
4) Failure to Assess: Nurses should evaluate all potential nursing problems and diagnoses, not just those directly affected by the medical disease. For example, all patients should be assessed for fall risk, and fall precautions should be implemented.
• Inadequate monitoring: Some conditions, such as fall risk, suicide risk, confusion, and self-injury, necessitate frequent nurse monitoring.
• Communication Failure:
o Inadequate documentation: In a court of law, if an assessment or action is not documented, it is presumed to be uncompleted. In addition to the specific type of patient documentation known as a nursing care plan, nurses must document all assessments and interventions.
o Inadequate provider notification: Changes in patient condition should be communicated to the health care provider as soon as possible based on patient status. Documentation of provider notification should include the date, time, and person notified, as well as the nurse’s follow-up actions.
• Failure to Comply with Protocols: Agencies and states have procedures in place for reporting specific behaviors or concerns. For example, a nurse must report suspicion of a patient, child, or elder abuse based on assessment data.
Confidentiality of Patients
In addition to negligence and malpractice, patient confidentiality is a significant legal consideration for nurses and nursing students. Patient confidentiality refers to an individual’s right to keep personal, identifiable medical information, also known as protected health information (PHI), private. The federal regulations are known as the Health Insurance Portability and Accountability Act protect this right (HIPAA). HIPAA was enacted in 1996 in response to the need to ensure the privacy and security of individual health records and data in an era of electronic medical records and third-party insurance payers.
The Privacy and Security Rule are the two main sections of HIPAA law. The Privacy Rule addresses the use and disclosure of health information about individuals. The Security Rule establishes national standards for the confidentiality, integrity, and accessibility of electronically protected health information.
HIPAA regulations apply to patient information shared with others as well as medical records. As a result, all types of patient information should be shared only with members of the health care team who are actively providing care to them.
What impact do HIPAA regulations have on you as a student nurse? You must follow HIPAA regulations from the moment you begin providing patient care. Nursing students who violate HIPAA may be disciplined or expelled by their nursing program. Nurses who violate HIPAA rules may be sacked or face legal action. below are the common HIPAA violations and how to avoid them.
HIPAA Violations and How to Avoid Them
1) Gossiping in the hallways or discussing patients in public where other people can hear you. It’s natural to be excited about what’s happening when you start working with patients and want to talk about exciting things.
As a student, you will be able to discuss patient care confidentially with your instructor behind closed doors. However, as a health care professional, do not discuss patients in the hallways, elevator, breakroom, or with anyone who is not directly involved with that patient’s care because it is all too easy for others to overhear what you are saying.
2) Mishandling medical records or leaving them unsecured. HIPAA rules can be violated if you leave your computer unlocked for anyone to access or if you leave written patient charts in unsecured locations. Never give out your password to anyone else.
When you step away from a computer, always lock it with a password, and keep paper charts closed and secured in a place where unauthorized people cannot easily access them. NEVER take a facility’s records or include a patient’s name on the paperwork that leaves the facility.
3) Unlawful or unauthorized access to patient files If someone you know is admitted to the unit you are working on, such as a neighbor, coworker, or family member, do not access their medical record unless you are directly caring for them. Facilities can track everything you access in the electronic medical record and hold you accountable for it. This rule applies to employees who previously cared for a patient as students; once your shift as a student is complete, you should no longer have access to that patient’s medical records.
4) Disseminating information to unauthorized individuals. You must have written permission to share medical information with anyone other than the patient. For example, if a husband comes to you and requests his spouse’s lab results, you must first obtain permission from his spouse before sharing that information with him. Simply confirming or denying that a patient has been admitted to a unit or agency is a breach of confidentiality.
5) Information can generally be shared with children’s parents until they reach the age of 18, though there are exceptions if the minor child seeks birth control, an abortion, or becomes pregnant.
As a general rule, whenever you are asked for patient information, check to see if the patient has given permission first.
6) Sending patient information via text or e-mail on an unencrypted device. For e-mailing or faxing protected patient information, only use appropriately encrypted devices that your health care facility has approved. Additionally, ensure that the information is sent to the correct person, address, or phone number.
7) Disseminating information via social media. Never post anything on social media about your patients, the facility where you work or have clinical, or even how your day at the agency went. Nurses and other professionals have been sacked for failing to follow HIPAA regulations on social media.
Social Media Policies as viewed in the ethical and legal principles in nursing
Nursing students, nurses, and other health care team members are obligated to exercise extreme caution when posting to social media sites such as Facebook, Instagram, Twitter, Snapchat, and others. Information about patients, patient care, and/or health care agencies should never be posted on social media; violators of this policy may lose their jobs and face legal action, and students may be disciplined or expelled from their nursing program. The information may become public even if you believe you are posting in a private group.
The American Nurses Association (ANA) has established the following social media guidelines for nurses:
• Nurses must not transmit or post individually identifiable patient information online.
• Nurses must adhere to ethically prescribed professional patient-nurse boundaries.
• Nurses must understand that postings may be viewed by patients, colleagues, organizations, and employers.
• Nurses should use privacy settings to separate personal and professional information online.
• Nurses should bring to the attention of appropriate authorities any content that may jeopardize a patient’s privacy, rights, or welfare. • Nurses should participate in the development of organizational policies governing online behavior.
In addition to these principles, the ANA has provided the following social media tips for nurses and nursing students:
• Keep in mind that professional standards apply in all situations, including online.
• Do not share or post any information or photographs obtained from the nurse-patient relationship.
• Use electronic media within professional boundaries. Contact with patients via the internet blurs this line.
• Even if they are not identified, do not make disparaging remarks about patients, employers, or coworkers.
• Do not use personal devices, including cell phones, to take photos or videos of patients.
• Report any breach of confidentiality or privacy as soon as possible.
Ethical Guidelines
There are several ethical guidelines for nursing care in addition to legal considerations.
There is a distinction between morality, ethical principles, and an ethical code. Morality is “individuals’ personal values, character, or conduct within communities and societies.” An ethical principle is a broad guideline, fundamental truth, or assumption that can be used in conjunction with clinical judgment to determine a course of action.
Beneficence (do good), nonmaleficence (not harm), autonomy (individual control), and justice are four common ethical principles (fairness). A code of ethics is established for a profession and specifies its primary obligations, values, and ideals.
The American Nursing Association’s (ANA) Code of Ethics for Nurses governs nursing practice.
This code serves as a framework for ethical nursing care as well as a decision-making guide.
The Code of Ethics for Nurse’s purpose:
• It is a concise statement of nurses’ ethical values, obligations, duties, and professional ideals individually and collectively.
• It is the profession’s unchangeable ethical standard.
Provisions for the code of ethics for nurses
Provision 1: The nurse practices with compassion and respect for each person’s inherent dignity, worth, and unique characteristics.
The nurse is obligated to a high level of respect for all individuals and allow dignity in care and communication interactions. Patients’ families must be treated with dignity because of their relationship with the patient. Nurses must understand professional communication guidelines and work with colleagues and patient families. Understanding the proper professional relationship to maintain with families and patients is critical. Individuals, whether patients or coworkers have the right to choose whether or not to participate in care and work.
Provision 2: The primary commitment of the nurse is to the patient, whether that patient is an individual, family, group, community, or population.
The patient should always be the first and foremost priority. The nurse must recognize the importance of incorporating the patient’s individual thoughts into care practices. Any conflict of interest, whether belonging to external organizations or the nurse’s habits or ideas that conflict with the act of nursing, should be shared and addressed so that patient care is not jeopardized.
Internal and external teams must collaborate to provide the best possible patient care. Understanding professional boundaries and how they relate to patient care outcomes is critical.
Provision 3: The nurse promotes, advocates for, and protects the patient’s rights, health, and safety.
Nurses must understand all privacy guidelines pertaining to patient care and patient identifiers. Nurses who participate in research must understand all aspects of participation, including informed consent and full disclosure to patients about all aspects of the study. The nurse must understand any institutional standards in place to review their performance, including progress measurements and the need for additional review or study to meet performance standards.
To become a nurse, clinical and documentation skills must be demonstrated. Nursing standards of competence will be maintained in institutions and academic organizations that employ nurses. If a questionable healthcare practice is witnessed or recognized, it is critical that the patient is protected by reporting any misconduct or potential safety concern.
Finally, the nurse will not provide patient care while under the influence of any substance that may impair thought or action, including prescription medication.
Provision 4: The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and acts in accordance with the obligation to provide the best possible patient care.
It is instilled in me as a nurse that accountability for all aspects of care aligns with responsible decision-making. Authority must be used professionally and concerning all aspects of individualism and patient and ethical concerns. Nursing decisions must be carefully considered, planned, and implemented responsibly. Any delegation of nursing activities or functions must be done with consideration for the action and the end result.
Provision 5: The nurse owes the same duties to herself as she does to others, including the responsibility to promote health and safety, to maintain character and integrity, to maintain competence, and to continue personal and professional growth.
A nurse must also care for herself as well as others. An ideal nurse will be self-conscious about healthcare practices and will uphold safe practices in the care setting and at home. Once a nurse enters the profession, she must have high regard for care as an overall inert ability. A character with integrity would become a nurse.
Nurses should be concerned about personal development in terms of continuing professional nursing education. The ability to grow as a nurse as care improves, changes, or trends in care should be adapted to maintain competence and allow the profession to grow.
Provision 6: The nurse establishes, maintains, and improves the ethical environment of the work setting and working conditions that are conducive to safe, quality health care through individual and collective effort.
As a nursing profession, standards should be outlined both within and outside of work institutions that dictate ethical obligations of care and must report any deviations from appropriateness. Understanding the safety, quality, and environmental factors that contribute to the best patient care outcomes is critical.
Provision 7: The nurse advances the profession in all roles and settings by conducting research and scholarly inquiry, developing professional standards, and developing nursing and health policy.
Nurse education should include research principles, and every nurse should understand how to incorporate scholarly work and inquiry into practice standards. Nurse committees and board members are encouraged to make a difference in health policy and professional standards. The ability to maintain professional practice standards should be maintained, changed, and improved as practice evolves over time.
Provision 8 states that the nurse works with other health professionals and the general public to protect human rights, promote health diplomacy, and reduce health disparities.
Maintaining the concept that health is a right for all individuals through collaboration within the discipline will open the channels of best practice possibilities. The nurse recognizes the need to continue to advance care options by committing to ongoing learning and preparation. The nurse’s ability to practice in a variety of healthcare settings may include unusual situations that necessitate ongoing diplomacy and advocacy.
Provision 9 states that the nursing profession, collectively through its professional organization, must articulate nursing values, uphold the profession’s integrity, and incorporate social justice principles into nursing and health policy.
Nurses must continue to form committees and form groups in order to share and evaluate values for the accuracy and survival of the profession. Nurses can unite in strength to advocate for social justice through these organizations. To preserve the integrity of the nursing profession, continued political awareness is required. The ability of nurses to contribute to health policy should be shared among the profession, allowing nurses all over the world to speak with one voice.
All healthcare workers must have ethical values. The ethical practice serves as a foundation for nurses who deal with ethical issues on a daily basis. As nurses care for patients, ethical quandaries arise.
These quandaries may at times contradict the Code of Ethics or the nurse’s ethical values. Nurses are patient advocates who must strike a balance while providing patient care.
There are four major ethical principles:
• Autonomy,
• Beneficence
• Justice
Each patient is free to make choices based on their beliefs and values.
This is referred to as autonomy. The need for autonomy of a patient may conflict with care guidelines or suggestions made by nurses or other healthcare workers. Regardless of the benefit, a person has the right to refuse medications, treatment, surgery, or other medical interventions. If a patient refuses to receive a potentially beneficial treatment, the nurse must respect that decision.
Healthcare workers are responsible for avoiding mistreatment, minimizing harm, and promoting good toward patients.
This duty of specific treatment describes beneficence. Healthcare workers demonstrate this by balancing benefits and risks to the patient. Beneficence can be demonstrated by assisting patients with tasks they cannot complete on their own, maintaining side rails for fall prevention, or providing medications in a timely and efficient manner.
Everyone has the right to be treated fairly and equally by others. Justice is concerned with how people are treated when their interests compete with those of others. The lack of healthcare insurance for some is a current hot topic that addresses this. Another example is patients in rural areas who may not have access to the same healthcare services as those in urban areas.
Patients have the right to be safe. Nurses must avoid causing harm to patients in order to be non-maleficent. [6] This is probably the most challenging principle to uphold. When life support is turned off, or patients refuse to take medication that could save their lives, the nurse is placed in a morally difficult position.
Nurses should be aware of and recognize their own integrity, moral character, and the Code of Ethics for their profession. Nurses must have a fundamental understanding of key ethical principles. The nursing profession must remain faithful to patient care while advocating for patient rights to self-identify needs and cultural norms. Though complex, ethical considerations in nursing represent a proper integration of the art of patient care.
Nurses owe it to themselves, their profession, and their patients to uphold the highest ethical standards. Many organizations have ethics committees in place to address ethical issues. Nurses at all levels of practice should participate in ethics reviews in their chosen specialty area. Advocating for patient care, rights, and ethical practice is critical.
Ethics education should begin in nursing school and continue throughout the nurse’s career.
In conclusion
As the article reviews the ethical and legal principles in nursing, nurses owe it to themselves, their profession, and their patients to uphold the highest ethical standards. Many organizations have ethics committees in place to address ethical issues. Nurses at all levels of practice should participate in ethics reviews in their chosen specialty area. Advocating for patient care, rights, and ethical practice is critical. Ethics education should begin in nursing school and continue throughout the nurse’s career.
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