ETH ICO -MO RAL ASPE CT S IN NU RSING

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.

Written orders of court

Writ – legal notes from the court

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

Warrant of Arrest - court order to arrest or detain a person

Search warrant - court order to search for properties.

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.

Private/Civil Law can be :

Contract law – involves the enforcement of agreements among private individuals or the payment of compensation for
failure to fulfill the agreements

Ex. Nurse and client nurse and insurance

Nurse and employer client and health agency

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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.

Example: Nurse newly employed in a hospital is expected to be competent and to follow

hospital policies and procedures even though these expectations were not written or
discussed.

Likewise: the hospital is expected to provide the necessary supplies, equipment needed to
provide competent, quality nursing care.

Feature/Characteristics/Elements of a lawful contract:

1. Promise or agreement between 2 or more persons for the performance of an action or restraint from certain actions.
2. Mutual understanding of the terms and meaning of the contract by all.
3. A lawful purpose – activity must be legal
4. Compensation in the form of something of value-monetary

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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

b. Malpractice – stepping beyond one’s authority

(6) elements of nursing malpractice:

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

6. Damages – amount of money in payment of damage/harm/injury

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

4. Invasion Of Privacy – intrusion into the client’s private domain

 Right to be left alone

Types of Invasion the client must be protected from:

a. use of client’s name for profit without consent – using one’s name, photograph for advertisements of HC
agency or
provider without client’s permission
b. Unreasonable intrusion – observation or taking of photograph of the client for whatever purpose without client’s
consent.
c. Public disclosure of private facts – private information is given to others who have no legitimate need for that.
d. Putting a person in a false/bad light – publishing information that is normally considered offensive but which is
not true.

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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EGB’June09 4
ETHICO-MORAL ASPECTS OF
NURSING PRACTICE
Nurses need to:
• Develop sensitivity to the ethical
dimensions of nursing practice
• Examine their own & client’s value
• Understand how values influence their
decisions
• Think a head about the moral problems
they are likely to face. Ex.: birth, death,
marriage
*Values are important because they influence
decisions & actions, including nurses’ ethical
decisions even though they may be unspoken
questions of values underlie all moral dilemmas
VALUES
- enduring beliefs or attitudes about the
worth of a person, objects, idea or action
- concepts/ ideas that give meaning to
one’s life & provide a framework for one’s
decision
BELIEFS (OPINIONS)
- Interpretations or conclusions that people
hold as true
- Based more on faith that fact & may/ may
not be true
- Beliefs do not necessarily involves values
Ex.: If I study hard, I will get good grade
ATTITUDES
- Mental positions/ feelings toward a person,
object or idea
- Often judged as bad or good, positive or
negative, beliefs are judged as correct or
incorrect.
VALUES
- Are learned through observation &
experience & are heavily influenced by a
person’s sociocultural environment that is
by:
o Societal traditions, cultural, ethical,
religious groups, family or peer
groups
PROFESSIONAL VALUES
- Are acquired during socialization from
nursing experience, from teachers, peers
& code of ethics
*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
about specific issues as abortion/ euthanasia
VALUES CLARIFICATION
- Process by which people identify, examine
& develop their own individual values
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(5) VALUES ESSENTIAL FOR PROFESSIONAL
NURSES
1. Altruism >The concern for the welfare &
well-being of others
2. Autonomy >The right for self- determination
of professional practice
Ex.: When the nurse respects
patient’s right to make decisions
about their health care
3. Human - Respect for the inherent worth &
dignity uniqueness of individual &
populations
Ex.: when the nurse values &
respects all patient’s & colleagues
4. Integrity - Acting in accordance with an
appropriate code of ethics &
standards of practice
Ex.: when the nurse is honest &
provides care based on ethical
framework that is accepted within
profession
5. Social - Upholding moral, legal &
Justice humanistic principles.
Ex.: when the nurse works to
ensure equal treatment under the
laws & equal access to quality
care.
PROFESSIONAL BEHAVIORS ASSOCIATED
WITH 5 VALUES
1. Demonstrate understanding of cultures,
belief & perspectives of others
2. Demonstrates accountability for own
actins
3. Documents accurately & honestly
4. Designs care with sensitivity to individual
patient needs
5. Advocates for patients particularly the
most vulnerable
6. Take risks on behalf of patients &
colleagues
7. Plans in partnership with patients
8. Honors the rights of patient & families to
make decisions about healthcare
9. Provide information so patients can make
informed choices
10. Provide culturally competent & sensitive
care
11. Protects the patients privacy &
confidentiality
12. Provides honest information
13. Promotes universal access
14. Seek to remedy errors made
15. Support fairness
16. Encourage legislation
ETHICS came from the Greek word ETHOS meaning
custom/character or moral duty
 Method of inquiry that assist people to
understand the morality of human
behaviour
 Refers to the expected standards of moral
behavior
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

NURSING ETHICS PROFESSIONAL NURSE

- Refers to the ethical issues that occur in nursing  Completed a basic nursing education
practice program
- Refers to the conduct or behaviour which by reason  Licensed in his/her country or state to
of public approval or practice has become customary practice professional nursing
among professional
NURSING PRACTICE
MORALS/ MORALITY  Primary responsibility promotion of health and
 Greek work MORALIS prevention of illness
 Collaborate with other health care providers
 Refers to private, personal standard of
what is right & wrong in conduct, o Curative
character or attitude
 Nurses should distinguish MORALITY & o Preventive
LAWS.
o Rehabilitative aspects of care
 LAWS – reflect the moral values of
society, they offer guidance in o Restoration of health
determining what is normal
 An action can be moral but not legal, on o Alleviation of suffering
the other hand, an action can be moral
but illegal o Towards a peaceful death
 Morality is what you believe is right and good
 Provide nursing care through the utilization of the
Health Care Ethics nursing process
 Division of ethics that relates to human health
o Therapeutic use of self
 Realm of human values, morals, customs, personal
beliefs and faith o Executing health care techniques and
procedures
MORAL DEVELOPMENT
- The process of learning to tell between o Essential primary health care
right & wrong & of learning what ought not
to be done o Comfort measures
- Complex process that begins in childhood
& continues throughout life o Health teachings
- 2 well known theorist:
o Administration of written prescription for
o Lawrence Kohlberg
treatment
 Rights & formal reasoning

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 o Therapies
o Oral
o Topical
o Parenteral medications
o Internal examination during labour in the
absence of antenatal bleeding and delivery
o Suturing of perineal laceration
 Establish linkages with community resources
 Coordination with the health team
 Provide health education to individuals, families and
communities
 Teach, guide and supervise students in nursing
education programs
 The nurse is required to maintain competence by
continual learning through continuing professional
education
QUALIFICATIONS AND ABILITIES OF A
PROFESSIONAL NURSE
 Professional Preparation
o Have a license to practice
o Bachelor of science degree in nursing
o Be physically and mentally fit
 Personal Qualities and Professional Proficiencies
o Interest and willingness to work and learn
o Warm personality and concern for people
o Resourcefulness and creativity, well
balanced emotional condition
o Capacity and ability to work cooperatively
with others
o Skill in decision making
DEFINITION OF LICENSE
 A legal document given by the government that
permits a person to offer to the public his or her skills
and knowledge in a particular jurisdiction
CONTRACT
 Meeting of minds between two persons whereby one
binds himself, with respect to other, to give
something or to render some service
 A promise or a set of promise which the law
recognizes as a duty and when that duty is not
performed the law provides a remedy
MORAL THEORIES
- Provide framework
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(3) TYPES OF MORAL THEORIES
1. CONSEQUENCE-BASED (Theological
theories)
- Looks to the consequences of an action in
judging whether the action is right of
wrong
- Focus on issues of fairness
- UTILITARIANISM
o Views the good act as one that
bring the most good for the greater
number or the least harm for the
greatest number
- PRINCIPLE OF UTILITY
o From the utilitarian perspective, th
point of morality is to promote
what is intrinsically good by
maximizing benefits & minimizing
harm
TELEOLOGICAL APPROACH
 Greek word TELOS or goal or end
 The right thing to do is the good thing to do
 Act utilitarianism- good resides in the promotion of
happiness or the greatest net increase of pleasure over
pain
 If the act helps people, then it is a good act
 If the act hurts people then it is a bad act
2. PRINCIPLE-BASED (Deontological
theories)
- Involve logical & formal processes &
emphasize individual rights, duties &
obligations
- The morality of an action is determined
not by its consequences but whether it is
done according to an important objective
DEONTOLOGICAL APPROACH OR DUTY
ORIENTED THEORY
 Basic rightness or wrongness of an act depends on
the intrinsic nature rather than upon the situation or
its consequences
 Greek word DEON meaning DUTY
 Immanuel Kant- rational human being with freedom
and social worth
 A person is morally good and admirable if his actions
are done from a sense of duty and reason
3. RELATIONSHIP BASED OR CARING
THEORIES
- Stress courage, generosity, commitment &
need to nurture & maintain relationship
Other Moral Theories:
FLETCHER’S GUIDELINES FOR MAKING ETHICAL
DECISIONS
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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

EGB’June09 8
 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

3. Inviolability of life  NONMALEFICENCE-

 Also proposed sanctity, dignity or
respect for human life 1. To do no harm
 It means choosing life to protect it
 This principle includes measures for the 2. Not assisting in or performing abortion
survival of the human species & the
freedom to have children 3. Not to assist people to commit suicide
 It is be against violence, pollution of
4. Be involved in mercy killing
environment, drug/alcohol addiction,
euthanasia, suicide & capital punishment
 JUSTICE
4. Non-maleficence
 Duty to do NO HARM
1. The right to demand to be treated justly,
fairly and equally
Violations of the Principle
1. Physically harming a person as in
suicide, abortion, infanticide
(person who murder infant),
violence
2. Harming a person’s reputation & CODE OF ETHICS
honor by revealing confidential
information - A set of ethical principle that all member
3. Exposing the person to harm as in of a profession generally accept
subjecting the person to
unnecessary treatment - Sets the group expectation & standard of
behaviour
5. Beneficence
PRINCIPLES UNDERLYING CODE OF ETHICS

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1. Refers to the execution of duties
Responsibility associated with the nurse’s role
2. Ability to answer for your own
Accountability action
3. Requires that those with access
Confidentiality with health information to a 3rd
party without consent
4. Judgement Ability to form opinion or draw
sound conclusions
5. Advocacy >Giving patients information
they need to make decision to
support those decision
>Implies caretaker is drive to
understand & clearly state
patient’s point of view to other
health care provider
others for
whom the
nurse is
responsible
SCOPE OF NURSING
- A person shall deemed to be practicing
nursing when she/he singly or in
collaboration with another which initiates
& performs nursing services to individual,
family, community in any health care
setting
- Nurses are primarily responsible for the
promotion of health prevention illness

ETHICAL DILEMAS - Nurses shall collaborate with other health

- Exist when the right thing to do is not
clear/ members of health care team
cannot agree what the right thing to do
care provider for the curative, preventive,
rehabilitative aspects of care, restoration
of health, alleviation of suffering & when
recovery is not responsible towards a
peaceful death

LEAGL RIGHTS, ROLES & RESPONSIBILITY OF

THE NURSE ROLE

ROLE RESPONSIBIL RIGHT - Expectation about how a person

ITY occupying one position behaves toward a
1. Provider of To provide safe Right to person occupying another position
service care, adequate &
commensurate classified
with the assistance as
RIGHTS
nurses’ necessary
preparation - Privileges or fundamental powers that
experience & individuals poses, unless they are revoke
circumstances or given up voluntarily
2. Employee or >To fulfill the >Right to
contractor of obligations of adequate
service contracted working
service with condition RESPONSIBILITIES
the employer >Right to
>To respect compensation - Obligations associates with rights or state
the right & for services of being accountable
responsibilities rendered
of other >Right to
healthcare reasonable & IT SHALL BE THE DUTY OF THE NURSE TO:
providers prudent
conduct Provide nursing care thru the utilization of the
3. Citizen >Protect the >Right to nurse
right of the respect by
recipients of others of the Establish linkages with community resources
care nurse’s own & coordination with the health team
>To inform role &
Provide health education
clients of the responsibility,
consequences right to Teach, guide & supervise students in nursing
of various physical safety education programs including the
alternative of >Right to administration of nursing services in
outcome of reasonable & varied settings
care prudent
>To provide conduct for Undertake nursing & health human resource
adequate clients development training & research
supervision &
evaluation of

EGB’June09 10
 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

The nurse is required to maintain by PUBLIC LAW

continued learning.
- deals with relationships of between
individuals & government agencies

STANDARD OF CARE

- Skills & learning commonly possessed by CRIME

members of the professional.
- an act in violation of public law &
- Purpose: to protect consumer punishable by a fine or imprisonment

- 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

SELECTED LEGAL ASPECTS OF NURSING

PRACTICE
TORT
LAW
- A civil wrong committed against a person
- A system of principles & processes by or person’s property
which people attend to control human
conduct in an effort to minimize the use of - Classified as:
force
o Unintentional

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

EGB’June09 11
  Failure to comply with the Relationship with a client
standards of due care either by
omission or commission 2. Breach of duty

 A misconduct or practice that is Failure to act as a reasonable

below the standard expected of an prudent
ordinary reasonable & prudent
3. Forseeability
person
Link must exist between the
nurse’s act & injury suffered
Doctrines related to Negligence:
4. Causation
Respondeat Superior or
Must prove that harm
Respondent supervisor occurred that resulted a nurse’s
failure
Let the superior answer
5. Injury/ harm
An employee as well as
the employer is liable for Client must demonstrate
the any failure some type of injury

6. Damages

Res ipsa loquitor The nurse is held liable for

damages to be compensated
Let the thing speak for
itself

Shows sufficient proof on COMMON MALPRACTICE ACT

the person’s duty & his
1. Medication error
neglect to perform it
2. Burning of client

3. FALLS from the bed/ crib

B. MALPRACTICE
4. Ignoring a client complaint
Professional negligence that
occurred while the person was 5. Mistaken identity
performing as a professional

The failure of the professional to

act as a reasonable & prudent II. INTENTIONAL
professional with the same
o The person executed the act with
education & experience would act
purpose or intent
in similar situation
o Classified as:

TYPES OF MALPRACTICE  Assault

1. Failure to make referral to  Battery

provide the patient with
appropriate teaching before  False imprisonment
discharge

2. Learning a foreign object inside

ASSAULT
patient’s abdomen after surgery
An attempt or threat to harm
3. Negligence on supervision of
person unjustifiability
subordinate

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

EGB’June09 12

FALSE IMPRISONMENT
Illegal detention of a person
without his consent
III. QUASI-INTENTION TORT
o Voluntary act that directly cause
injury or distress
o Types:
 Slander (Verbal)
A false oral statement
that unjustly damage a
person’s name
 Libel (written)
A false written or
representational statement
that unjustly damages a
person’s name
 Invasion of Privacy
A violation of the person’s
right against unreasonable,
unwarranted interference
with his personal life
Ex.: Releasing info. About
patient to a 3rd party
allowing unauthorized
person
LEGAL PRECAUTIONS FOR NURSES
- Function within the scope of your
education, job description of area/ scope
of nursing practice
- Follow the procedures & policies of
employing agency
- Observe & monitor client accurately
- Communicate & record significant changes
in the client’s condition to AP
- Check any order that client
asked/questioned
- Modify the client before initiating any
interventions
- Protect the client from falls & preventable
injuries
EGB’June09
PROHIBITIONS IN THE PRACTICE OF
NURSING
Practicing nursing must have certificate of
registration (COR)
Who uses his own license/ COR of another
Who uses expired/ revoke COR
Who gives false evidence to the board of
nursing in order to obtain COR
Who poses as RN that conveyed that he/she is
RN
Who appends BSN/TN to his name without
being confirmed with a degree
Uses names in advertisement
(5) LEGAL PROTECTION
1. Good Samaritan act
• A nurse who renders first aid or treatment
at the scene of an emergency and who
does so within the standard of care, acting
in good faith, is relieved of the
consequences
2. Carrying out physician’s order
3. Provide competent care
4. Record Keeping
5. Incidental report
Components of incidental report
1. Name
2. date, time
3. describe the facts of incidence
4. Client’s account for incident
5. Witnesses of incident
6. Identify equipment, name of doses
7. signature
NURSES’ BILL OF RIGHTS
1. Registered nurses promote and restore
health
2. Prevent illness
3. Protect the people entrusted to their care
4. Alleviate suffering
13
 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

6. Confidentiality of communications and 4. Epikia

records
 Exception to the general
7. Review his records concerning his medical rule
care
5. One who acts through an agent is himself
8. Be informed of business relationship among responsible
the hospital educational institution
 Ex. Nurse recommends
9. Consent or decline to participate patient to another clinic for
experimental research affecting his care abortion but does not want
to perform
10. Reasonable continuity of care when
appropriate and be informed of other care 6. No one is obliged to betray himself/herself
options
 No one can force any person
11. Be informed of hospital polices and to answer a question if such
practices will incriminate him/her

7. The end does not justify the means

LVING WILLS OR ADVANCE DIRECTIVE  Giving sleeping tablets to

someone who has chronic
1. Accept or refuse any treatment, service or illness
procedure used to diagnose or treat physical
or mental condition 8. Defects of nature may be corrected

2. Decision to provide or withhold life-  Corrected by plastic surgery

sustaining measures
9. If one is willing to cooperate in the act, no
3. This living will is signed by the patient injustice is done to him/her

4. Witnessed by two other persons who is not  With patient’s consent

designated as the person’s health care
representative 10. A little more or less does not change the
substance of an act
5. Directive has force of law
 Stealing

11. The greatest good for the greatest number

MORAL PRINCIPLES
 Have more good effects for
1. The golden rule more people than a smaller
group
 Do unto others what you
would like others do unto 12. No one is held to the impossible
you
 Do not promise impossible
2. The two fold effect things

 May have bad and good 13. The morality of cooperation

effect

EGB’June09 14
  Formal cooperation is an
evil act and never allowed
14. Principle relating to the origin and
destruction of life
 Thou shall not kill
CODE OF GOOD GOVERNANCE
• Service to others
o Commitment to a life of sacrifice and
genuine selflessness in carrying out their
professional duties
• Integrity and Objectivity
o Perform their responsibilities with the
highest sense of integrity
• Professional Competence
o Knowledge, technical skills, attitudes and
experience
• Solidarity and teamwork
o Maintain and support one professional
organization
• Social and Civic Responsibility
o Shall always carry out their professional
duties with due consideration of the broader
interest of the public
• Global Competitiveness
o Shall remain open to challenges of a more
dynamic and interconnected world
• Equality of All professions
o Shall treat their colleagues with respect and
strive to be fair in their dealings with one
another
AMENDED CODE OF ETHICS FOR NURSES
Section 3 Republic Act No. 877 known as the Philippine
Nursing Law and Section 6 of P.D No. 223 the amended
Code of Ethics of Nurses
• Article I
o Preamble- health is a fundamental right of
every individual
• Article II
o Values, customs and spiritual beliefs held by
individual shall be represented
EGB’June09
o Consider the individuality and totality of
patients when they administer care
• Article III
o Human life is inviolable
o Quality and excellence in the care of patients
are the goals of the nursing practice
o Accurate documentation of actions and
outcomes of delivered care is the hallmark
of nursing accountability
• Article IV
o The registered nurse is in solidarity with
other members of the healthcare team in
working for the patient’s best interest
• Article V
o Preservation of life, respect for human rights
and promotion of healthy environment
o Promotion in local, national, and
international efforts to meet health and
social needs of the people
• Article VI
o Maintenance of loyalty to the nursing
profession and preservation of its integrity
are ideal
• Article VII
o The certification of registration of the
registered nurse shall either be revoked or
suspended for violation of any provisions of
this code.
DEFINITION AND MEANING OF LAW
• The sum total of rules and regulations by which
society is governed
• Man mad regulates social conduct in a formal and
binding way
• Rule of conduct pronounced by controlling authority
and which may be enforced
o Authority or right to declare that the rule
exists
o Rule is pronounced or expressed
o Source can be defined
o A right to enforce the same must be
provided
• Controlling authority in our system is the government
• Fundaments law of the government is the constitution
• Principal sources of pronouncements
15
 o Constitution
o Statutes or legislations
o Executive branch
o Case decision/judicial opinions
o Presidential decrees
o Letters of instructions
RESONSIBILITY AND ACCOUNTABILITY FOR THE
PRACTICE OF PROFESSIONAL NURSING
• Professional Negligence
o Commission or omission of an act,
pursuant to a duty
 Existence of a duty on the
part of the person charged
to use due care under
circumstances
 Failure to meet the standard
of due care
 The foresee ability of harm
resulting from failure to
meet the standard
 The fact that the breach of
this standard resulted in an
injury to the plaintiff
• Article 19 of the civil code
o One shall act with justice, give
every man his due, observe honest
and good faith
• Article 20
o Those who in the performance of
their obligations through
negligence causes any injury to
another, are liable for damages
• Common acts of negligence
o Burns resulting from hot water
bags, heat lamps, vaporizers, sitz
bath
o Objects left inside the patient’s
body; sponges suction tips, loose
dentures lodged in the patient’s
trachea
o Falls of the elderly; confused,
unconscious, sedated patients
o Falls of children whose bed rails
were not pulled up and locked
o Failure to observe and take
appropriate action
EGB’June09
o Failure to report observations to
attending physicians
o Failure to exercise the degree of
diligence which the circumstances
of the particular case demands
o Mistaken identity- drug given to the
wrong patient
o Wrong medicine, wrong
concentration, wrong route, wrong
dose
o Defects in the equipment
o Errors due to family assistance
o Administration of medicine without
a doctors prescription
Acts of negligence:
(1) THE DOCTRINE OF RES IPSA LOQUITUR
• Injury was of such nature that it would not
normally occur unless there was negligent
act
• Injury was caused by an agency within
control of the defendant
• Plaintiff himself did not engage in any
manner that would tend to bring about the
injury
MALPRACTICE
• The idea of improper or unskilful care of a
patient by a nurse
• Stepping beyond one’s authority with
serious consequences
• Carelessness of professional personnel
• LESNIK- negligent act committed in the
course of professional performance
(2) DOCTRINE OF FORCE MAJEURE
• Irresistible force; unforeseen or inevitable
• No person shall be responsible for those events which
cannot be foreseen
• Floods fire, earthquakes
(3) DOCTRINE OF RESPONDEAT SUPERIOR
• Let the master answer for the acts of the subordinate
• The liability is expanded to include the master as well
as the employee
INCOMPETENCE
• Lack of ability, legal qualifications or fitness to
discharge the required duty
16
CONSENT TO MEDICAL AND SURGICAL o Divulge information from patient’s chart to
PROCEDURES improper sources or unauthorized person

• Consent • Defamation

o Free and rational act that presupposes o Character assassination

knowledge of teh thing to which consent is
being given by a person who is legally o Slander-oral defamation
capable to give consent
o Libel-written words
o Signed by the patient or authorized
representative/legal guardian o There must be a third person who hears or
read the comment before it can be
o An authorization by a patient or a person considered defamation
authorized by law to give the consent on the
patient’s behalf

o Nurse secures the consent of the patient CRIMES, MISDEMEANORS, AND

upon admission FELONIES

• Informed Consent

o Established principle law that every human CRIME

being of adult years and sound mind has the
right to determine what shall be done with • An act committed or omitted in violation of
his own body the law

o May choose whether to be treated or not • Two elements

• Proof of Consent o Criminal act

o A written consent should be signed to show o Evil/criminal intent

that the procedure is the one consented to
• Conspiracy to commit a crime
and that the person understands the nature of
the procedure
o Two or more persons agree to
commit a felony
TORTS
 Principals- who take a
• Definition: A legal wrong, committed against
direct plan/part
a person or property
 Accomplices- cooperate in
• Assault and Battery the execution
o Imminent threat of harmful or offensive  Accessories- having
bodily contact knowledge of the
commission of the crime
o Unjustifiable to tough another person or to
threaten to do so • Criminal Actions

• Battery o Acts or offenses against public

welfare
o An intentional, unconsented touching of
another person • Criminal negligence

• False Imprisonment of Illegal Detention o Reckless imprudence- person does

an act or fails to do it voluntarily
o Unjustifiable detention of a person without a
but without malice
legal warrant within boundaries
o Simple imprudence- did not use
• Invasion of Right to Privacy and breach of
precaution and the damage was not
confidentiality
immediate or the impending danger
o Right to privacy is the right to be left alone was not evident or manifest

o Right to be free from unwarranted publicity • Criminal Intent

o Exposure to public view o States of mind of a person at the

time the criminal act is committed
that he/she knows that an act is not

EGB’June09 17
 lawful and still decide to do it
anyway

WILLS

• A legal declaration of a person’s intentions upon

death

• Testamentary document takes effect after the death of

its maker

• Decedent- person whose property is transmitted

through the succession whether or not he left a will

• If he left a will he is called a testator

• Woman is testatrix

• Heir- called to succession either by the provision of a

will or by operation of law

• A person who dies leaving a will is said t have died

testate

• One who dies without will is said to have died

intestate

• Validation of the will in a court is known as probate

• A will which is written, dated and signed by the

testator is called holographic will

• An oral will is called nuncupative will or

nuncupation- made during the person’s last illness,
that it be done in the place in which he died, one or
more witnesses to the will

• Testator must have the expressed intention of making

a will

• Must be right of age

• Under 18 cannot make a will

• Required to have sound mind

• Think clearly ability at the time of its execution

NURSES OBLIGATIONS IN THE EXECUTION OF A

WILL

• The nurse should note the soundness of the patient’s

mind

• There was freedom from fraud or undue influence

• Make a notation on the patient’s chart of the apparent

mental and physical condition of the patient at the
time of making the will

EGB’June09 18