we are going to be reviewing the concept of ethical and legal practice ethics uh and legal practice are integral to nursing so they work to ensure patient safety that we're upholding professional Integrity um it facilitates legal compliance it can mitigate risk for us promote accountability work to enable patient advocacy um and also it just contributes to the delivery of high quality patient care um patient safety and well-being usually includes respect for patient autonomy maintaining confidentiality um and that we provide care that's in the best interest of the patient ethical Behavior can really be fundamental to earning and maintaining the trust of our patients our colleagues the public and another piece of that is the legal compliance which requires that we understand legal regulation and practice in accordance um with those laws is absolutely necessary to avoid potential um malpractice suit or or legal issues for the presentation we're going to of course go over some relevant definitions attributes of the concepts antecedents subconcepts are nursing interventions positive and negative outcomes or Consequences and our related Concepts so ethical and legal practice is defined as the necessity to follow a system of laws and moral principles or standards to govern professional practice so ethics is essentially the standard of right and wrong that influences human behavior we're going to talk about these a little bit further in the next couple of slides but but knowing that ethical and legal practice means we follow a system of laws and we follow a system of moral principles or standards and those govern professional practice so for ethics ethics is defined as a system of moral principles or standards that govern behaviors and relationships so again these are going to be the standards of right and wrong that influence our behavior um usually ethics are based on different types of framework so those can come from a number of different places um those are going to be like religious teaching philosophy theories philos philosophical theories cultural traditions and Professional Standards so for nursing we're looking at the Prof nursing professional code of ethics but if you look at anything like if we're looking at some other ones we've got religious teaching so that could be something like the Ten Commandments but what you want to keep in mind with ethics is that it is a framework it's something that is established and agreed upon by a group of people um and that agree agement means that that we have a structure in place to help us determine you know what our next step should be or what what what things are right and wrong so what are the differences between these different words that you hear so we hear ethics values morals laws we want to be able to know what the differences are in those things and we've identified that ethics is um what influences what's right and wrong in human behavior uh when we look at values those are going to provide the foundation on which um either an individual or a group's ethical standards are built so personal beliefs those are going to be like personal beliefs about what is true or right and then of course if we want to define the word belief it's an interpretation or a conclusion that someone accepts as true when we look at morals those are something different those are going to be private personal so on a on a on a singular person level that's how a an individual decides what is right and wrong within their conduct character and attitude so that morals is on an individual level and those are based on cultural norms religious teaching family values and individual experiences and those can be really subjective and they vary between individuals and in between cultures and then we talk about law laws reflect the moral values of a society and they can they can offer guidance to us in determining what is moral but a really good question that I usually like to ask you guys is do we think that all laws are moral do we think that all laws are ethical and those are those are interesting ideas to sort of evaluate um because usually the answer is no and if all of our laws aren't a reflection of either our current or past ethics um values morality then what steps do we need to take as individuals and as professional nurses to sort of advocate for that to make sure that they match so you know how are these things related because we've identified how it is that they're different right overall ethics values morals laws they're all interrelated or interconnected Concepts that influence human behavior and societal Norms so while they have common elements and they overlap in certain areas um each plays a unique role in shaping individual and Collective conduct ethics and morals provide guidance on what's right and wrong values shape our priorities and beliefs and laws establish formal rules and regulations for behaviors within a society some values that are essential for professional for professional nursing or for a professional nurse nurse and that's going to be altruism so altruis altruism is the concern for the welfare or the well-being of others in practice altruism is reflected in a nurse's concern for the welfare of patients the their concern for other nurses and for other Healthcare Providers we talk about autonomy a lot but autonomy is the right to self-determination professional practice um reflects autonomy when the nurse respects a patient's rights to make decisions about their own Healthcare human dignity is going to refer to the inherent Worth or uniqueness of individuals and populations a nurse that values and respects all patients and colleagues shows respect for human dignity Integrity is when we act in accordance with the code of ethics or the accepted standards of practice and we can see this in professional practice if a nurse is honest and provid care based on an ethical framework that's accepted within the profession so we talked about the code of ethics it's usually Thea code of ethics but any profession is going to have these type of standards and social justice is an interesting one so we learn about justice as an ethical principle which we will talk about um but social justice refers to the upholding of Justice or what's fair on a social scale nurses act in accordance with social justice by treating all of their patients equally without regard to economic status ethnicity age gender religion citizenship Etc um but when we think about when we use the word justice usually that's on an an individual to individual level social justice is on a macro level which means applied to larger groups or populations our nursing code of ethics so with this PowerPoint anything that is um in a different color and underlined is something that you can click and access this link on here will take you to the nursing code of ethics but the nursing profession has developed a formal code of ethics to guide nurses in their work i' I've referenced this a few times but any any ethical principles or ethical standards are going to be a framework that helps you with decision- making um a code of ethics is a general guide for the professions member ship and it's also a social contract with the public so it isn't just standards that we apply to ourselves but it also tells the public that we interact with what it is that they can expect from us what standards we have and and how they should expect their interactions with us to go so the Ana code of ethics for nurses serves as a statement nurses ethical obligations and duties it's it's considered a non-negotiable standard but it is something that we re-evaluate every couple of years as as a group and if there are changes that feel like they're necessary then we agree to go ahead and do those transitioning from our discussion on the ethics of nursing looking at the legal issues legal issues in nursing are the um rights responsibilities and the scope of nursing practice as defined by state nurse practice acts um additionally by criminal law civil law so you guys would have talked previously about the nurse Practice Act and those are specific to each state all all of us and the I think the District of Colombia uh all of them are going to have their own nurse Practice Act safe practice um acknowledges or requires that requires knowledge of Regulation institutions um payment systems and federal and state laws and then we talk about malpractice which of course would be not adhering to the safe practice guidelines or to these established laws but it's conduct that deviates from the standard standard of practice dictated by a profession so some types of laws that we have and their sources statutory laws uh are are usually going to come from the legislative branches of the US so that's going to come from US Congress state legislator legis isure city or county government um but nursing laws nursing practice acts are examples of statutory law administrative law are policies and procedures that come from administrative bodies so our legislative branch makes statutes right and then they delegate responsibility for enforcement to administrative agencies and then those administrative agencies come up with policies and procedures um to implement the statutes from the legislative branch criminal law is something that we're all pretty familiar with but it include things it can include things like manslaughter theft arson but criminal law is an area of law that deals with conduct that is harmful to another individual or to Society at large and criminal law or violation of criminal law can be punishable by fines or imprisonment and our civil law which is the one that you will most often deal with with regard to malpractice but civil law deals with the rights or the duties of private individuals or citizens and it's most often enforced by lawsuits so a type of civil law would um or a violation of civil law would be called a tort t o r t a tort is a wrong that's committed against an individual or an individual's property to professional misconduct or a breach of Duty by the healthcare provider and there are four pieces that are necessary for malpractice to be established you have to have a duty to the patient which means you have a legally enforcable obligation to adhere to a particular standard of care you have to have a breach of Duty which means um that you deviate from the standard of care owed to the patient uh and then you have causation so we have to be able to say that the the the direct result of a professional breech of Duty uh is related to what another another piece of this is our injury and harm or an or an act or event that causes damage harm loss of functioning so the easiest way to think about this would be you have a duty to the patient which essentially means you've been assigned to the patient's care and you've accepted care of that patient then in order from out practice to occur you have to have a breach of Duty so you have to violate that somehow and then you have to we have to be able to establish that there's been an injury or harm to the patient and that can look like a lot of different things and then you have to have causation which means we can directly relate the injury or harm that happened back to the breach of Duty by the healthcare provider with intentional Tor this usually feels a little bit more straightforward so intentional implies um willful action so we've got things like assault which means that we created an environment enironment um that was offensive insulting or physically injurious assault doesn't have to include physical injury um but it does have to mean that we uh created a threatening environment and battery is the piece where we actually have physical contact so battery is the willful touching of another individual where that touching is unwanted embarrassing or unwarranted something that we didn't need to do or that the patient asked us not to do that we did anyway and then we have things like false imprisonment and invasion of privacy which has to do with our our HIPPA laws the standards of care which I talked about a couple of times now um but standards of care are the skills and learning that are common to um to a profession or and specifically for us common to the nursing profession those are usually defined as the guidelines that are used to determine what a nurse should or shouldn't do these are established by our nurse practice acts administrative rules our job description that we agree to when we accept a position agency policies and National nursing standards so some attributes of our concept is going to our defining our attributes of course which are our defining characteristics of ethical and legal practice is going to be that we adhere to laws to the Texas Bo rules and regulations to the American Nurses Association standards and their code of ethics so then the Joint Commission standards the national patient safety goals which if we haven't already talked about them we will National patient safety goals are re-evaluated by The Joint Commission every year and they they send those out to the hospitals and they say these are the things that we're trying to accomplish or these are the things that we've identified as a problem that we want to try and improve and the Inc code of ethics and an additional attribute would be um advocacy both patient advocacy and professional our antecedents are going to be the the pieces that are necessary that come before for our um ethical and legal practice to take place and those are going to be our society demands um changes to practice negligent acts ethical principles dilemas um values and advocacy the subconcepts of ethical and legal practice we have six of them so legal risks responsibilities and quality legal risks respon remind nurses to follow the rules um our responsibilities mean nurses have to do their jobs well and take care of patients and then our quality is about doing a good job to help patients stay healthy and happy all of these things uh together make sure that nurses are doing their best to help people feel better and stay safe when we talk about applicable laws those are going to be the ones that um are rules that nurses have to follow to do their job safely and correctly these laws can be really important because they help nurses to know what they can and can't do when taking care of patients an example laws might say how medicines should be given how to keep patients information private um or what to do in emergencies accountability accountability means taking responsibility for what it is that you do in nursing it's super important because nurses are trusted to take care of people's Health when a nurse follows the rules and does their job well it shows that they're accountable if a patient gives a nurse the wrong medicine the nurse or being accountable would mean that the admitting that they had made a mistake fixing it if that's an option and learning from the mistake to avoid making it again in the future it essentially it's saying I messed up but I'll do better next time advocacy which we talk about quite a bit but advocacy means that we're standing up for someone and speaking up for what's right in nursing advocacy is about making sure patients get the best care possible nurses are essentially champions for our patients we listen to what the patients need we make sure their voices are heard and we help to get them the care that they deserve if a patient is um too shy or uninformed to ask questions about their treatment a nurse can speak up for them and make sure that all their concerns are addressed ethical and legal decision-making those kind of make sense within this concept and then ethical and legal reasoning as well some strategies to prevent um incidents of professional negligence we want to make sure that we're maintaining patient safety and there are a number of different ways that we can do that one of them is that we utilize evidence-based practice and making sure that we're up to the most current standards on what it is that we need to do to keep them as safe as possible to to help them to get healthy making sure that we are communicating effectively and that looks like a lot of different things effective communication is um standardized care handoff it's going to be professional communication so managing the way that we interact with other people it's going to be how we communicate with our patients cultural competency making sure that we adjust our language when we talk to them to reduce the likelihood of professional negligence we also want to minimize the risk of medication errors we call these medication errors but they aren't limited to Medicine a med error is anything that occurs in healthcare that's outside the standard operating practice and and we can minimize our our risks for that by adhering to our agency policies by adhering to State national laws and regulation to your nurse Practice Act um and by being proactive in your care of patients and then we want to obtain professional liability insurance most facilities offer a liability insurance through them I would recommend that when you begin profession practicing professionally that you have individual professional liability insurance to protect you in the event that you're caught up in some kind of litigation and the hospital um ultimately decides that it was that the mistake wasn't relate related to anything systemic and that you are ultimately the individual responsible so some positive outcomes related to effective ethical and legal practice we're going to have things like conflict resolution we're going to be able to manage ethical issues across the lifespan of a patient um appropriate due process fairness risk management which is an element of quality improvement we'll cover a little bit later our patients rights are going to be respected and as a nurse you're going to be protected from litigation so alternatively our negative outcomes is going to include things like litigation malpractice suits conflict moral distress moral dist moral distress is an interesting idea um it's where a lot of times where your expectations of yourself and the things that you're actually able to accomplish are um disperate or they're they're not the same and what happens when we have expect like you guys can think about this in terms of school you have an expectation of yourself about how you think you should be performing and then in reality maybe you aren't doing as well in school or in your personal life as you would want to that type of expectation of yourself is going to create a moral distress and those can be hard to resolve substandard or negligent care disciplinary action or even up to loss of license the related Concepts to ethical and legal practice are going to include um diversity so diversity means that everyone is different in their own you know unique way so in nursing diversity can be really important because patients come from all different types of backgrounds culture Lifestyles having an understanding of diversity helps nurses to give better care so some M some patients might have different beliefs about how medicine different beliefs about medicine or different Customs for how they'd like to be treated and nurses who understand and respect those differences can provide care that meets the patient's needs and preferences related to legal and ethical nursing diversity reminds nurses to treat every patient with fairness and respect um no matter who they are it's about making sure that everybody gets the same highquality care without regard to their background or identity um diversity is really closely connected to being a good nurse uh who cares for all patients equally relating health and legal practice health is about how well our bodies and minds are doing um in nursing taking care of people's health is one of our main jobs nurses help people to feel better when they're sick they help people to stay healthy um and essentially help them to live their best the best version of their lives legal and ethical nursing practice means doing the job in the right way uh following the rules and treating everybody fairly for example nurses have to make sure they give the right medicine to the right person at the right time um we also have to keep patients information private to protect their privacy so health is really important in nursing because it's what nurses work to improve every day following the rules and being fair and caring helps nurses to do their best um to keep people healthy and happy discussing clinical judgment it helps to kind of Define some of these things clinical judgment is like using your best judgment or decision-making skills to figure out what's going on with a patient and what interventions we need to help them in nursing this means thinking really carefully about a patient's symptoms their medical history and What treatments might work best for them relating that to legal and ethical nursing practice clinical judgment um of course is important nurses need to make sure that they're making the right decisions based on what's best for the patient following the rules and guidelines and um being honest for example if a nurse thinks that a patient needs more tests or a different treatment they need to be able to speak up and make sure that the patient gets the care that they need professionalism in nursing means that we are acting responsibly and respectfully it's about following rules doing your job well um making sure that we treat everybody uh with you know adher to ethical principles of fairness and beneficence or not fairness Justice and beneficence relating that to legal and ethical nursing practice professionalism means that nurses have to make sure that we're doing everything the right way following the rules and the laws and putting the patients first being professional means things like showing up on time being respectful to patients and co-workers being honest about our mistakes professionalism is closely related to legal and ethical practice because it's about being a good nurse who follows the rules treats everybody with respect and does their best to help patients stay happy and to stay healthy excuse me we haven't had an opportunity much to discuss informatics but a brief description of that informatics is in nursing is about using technology and information to help patients it is using computers and other devices to keep track of patient information like their medical medical history treatments test results connecting that to legal and ethical practice informatics um means that nurses need to make sure that they're using technology in the right way so we're following privacy rules we're keeping patients information safe and confidential and that we're that we're using informatics to improve patient care nurses have to be careful about who they share patient information with and make sure that it's only used for the right reasons so that has to do with ethics and legality right informatics is is related to legal and ethical nursing practice because it's about using technology responsibly to help patients while following the rules and keeping their information safe