Chapter 4:
Legal and Ethical Aspects of
Nursing
Introduction
❖Laws: formal, written rules of behavior that govern
conduct; enforced by an authority
❖Ethics: philosophic studies that examine actions,
values, and moral principles of human behaviors;
provide fundamental ideas of societal and cultural
values of right versus wrong
❖Ethics and ethical standards evolve
❖Your responsibility: know the legal and ethical
standards before caring for clients
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Legal Issues of Nursing Practice #1
❖Held responsible for maintaining established
standards of nursing care
❖Common sources of law
o Constitutional: Right to free speech
o Statutory: Nurse Practice Acts
o Administrative: State Boards of Nursing
o Criminal: Prosecution of malpractice
o Civil: HIPAA violations of privacy
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Legal Issues of Nursing Practice #2
❖ A few major concerns related to legal and ethical aspects
o Nurse practice acts, nursing standards, nursing licensure
o Nursing practice and medical practice laws
o Client rights and nursing obligations regarding informed
consent, protecting individual’s rights, upholding privacy
standards
o Malpractice, negligence, nursing liability
o Nursing responsibilities in professional versus personal life
o Documentation
o Ethical issues, the law, societal needs, healthcare practices
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Legal Terminology #1
❖Crime
o Wrong committed against a person or property
or public good; law is violated; intention to do
wrong is also present
❖Felony
o Serious crime
❖Misdemeanor
o Crime that is considered not as serious as a
felony but is still serious and may be cause for
revocation of a nursing license
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Legal Terminology #2
❖Liability
o Legal responsibility for one’s actions or failure to
act appropriately; commission or omission
❖Tort
o Injury that occurred because of another person’s
intentional or unintentional actions or failure to
act
❖Negligence
o Harm done to a client as a result of neglecting
duties, procedures, or ordinary precautions
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Legal Terminology #3
❖Malpractice
o Improper, injurious, or faulty treatment that
results in illness or injury; harm result of action
or lack of actions
❖Assault
o Threat or an attempt to do bodily harm including
physical or verbal intimidation
❖Battery
o Physical contact with another person without
that person’s consent
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Legal Terminology #4
❖ Consent for care
o Provided by individual, parent, or guardian if client minor,
intellectual disability, or mentally incompetent
o Inferred consent: assumes client would provide consent in
life-threatening circumstances
❖ Informed consent
o Tests, treatments, medications, outcomes, possible
complications, and alternative procedures are to be
explained, documented, and signed by client
o Usually obtained by physician
o All teaching must be documented
o Emergency consent: provided by two physicians
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Legal Terminology #5
❖ False imprisonment or restraint of movement
o Use of unnecessary restraints or solitary confinement
o May be physical or chemical
❖ Libel
o Written statement or photograph that is false or
damaging
❖ Slander
o Malicious verbal statements that are false or
injurious
o Defamation: act that harms a person’s reputation or
good name
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Legal Terminology #6
❖Abandonment of care
o Prematurely stopped caring for a client
❖Invasion of privacy and confidentiality
o Right to privacy: expect property will be left
alone
o Trespassing, illegal search and seizure
o Need written consent to give out any
information
o Protect private information when using
technology
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Question #1
Is the following statement true or false?
It is acceptable to give an injection to clients if they
refuse, and without their written consent.
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Answer to Question #1
False
Giving an injection that the client refuses amounts to
battery and, hence, is illegal. Moreover, the client or a
legal guardian must understand and sign the consent
form for care and treatment.
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HIPAA and Client Privacy #1
❖ Law protects client information, makes sure information
remains private
❖ “Security rule” deals specifically with PHI/EPHI
o Any information concerning health status
o Any part of medical record or payment history
❖ Requires written privacy procedures, documented supervision
❖ Requires privacy officer
❖ “Need to know”
❖ Contingency plan for emergency data backup
❖ Internal audits
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HIPAA and Client Privacy #2
❖Disciplinary action against violators
❖Severe financial penalties for violations
❖PHI can be released under certain circumstances
❖Title II Act:
o Regulates who can have access to client
information
o Sets standards for storage and transmission of
client information
o Requires policies allowing clients access to their
own personal health information and right to
request correction of any errors
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HIPAA and Client Privacy #3
❖All clients or caregivers sign HIPAA statement on
admission
❖Violation is cause for termination of employment or
student status
▪ Failure to comply may result in civil or
criminal penalties
❖Patient Safety Act
o Voluntary reporting system
o Encourages reporting in confidential manner
without fear of increased liability risk
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Release of Client Information #1
❖ Signed Release of Information (ROI) required from client
before personal information can be given out legally
❖ Ensure person receiving information is authorized to
receive it
❖ Client may not want anyone to know where they are
❖ Ensure within legal limits before releasing any
information
❖ Ensure cannot be overheard from anyone around you
❖ Protect computer screen from others seeing it
❖ Always log off computer when leaving it
❖ Protect client’s confidentiality at all times
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Release of Client Information #2
❖Various options
o “No Information” Status
o The Alias
o The AKA
o John Doe Admissions
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Special Healthcare Concerns
❖Duty to provide treatment
❖Abortion and sterilization
❖Experimentation
❖Release from liability
❖Death in the hospice facility or during the hospice
program at home
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Question #2
❖Is the following statement true or false?
❖It is vitally important for the nurse to ask
permission from the client each time someone asks
for information about the client’s condition.
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Answer to Question #2
❖False
❖The client should have a completed Signed Release
of Information (ROI) in the records which will let the
nurse know who is authorized to receive information
concerning the client’s condition. It is not necessary
for the nurse to go ask the client each time
someone asks. If the individual’s name who is
asking is not on the ROI, then the nurse should not
give out any information.
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Nurse Practice Act
❖The law that defines and regulates the practice of
nursing in the United States is called the Nurse
Practice Act.
❖These laws define the title of “nursing” and regulate
the many aspects of the field of nursing.
❖The law or Nurse Practice Act in each state,
province, or territory defines regulations for
practical and registered nursing.
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State Boards of Nursing
❖ State agency with legislative power to initiate, regulate, and
enforce the provisions of the Nurse Practice Act
❖ Subject to legal parameters, but usually have some leeway in
interpreting aspects of the Nurse Practice Act
❖ In the recent past were responsible for the creation of the
licensing examination, now written by the National Council of
State Boards of Nursing (NCSBN)
❖ Licensing laws vary between states
❖ Goal to establish uniform requirements so license will be
recognized by all states
❖ National nursing license has been proposed
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Major Concepts of Nurse Practice Acts
❖ Definition of practical and registered nursing
❖ Nursing functions protected by the law
❖ Requirements for an approved school of nursing
❖ Establishment of requirements for licensure
❖ Process and procedures for becoming licensed
❖ Procedures for maintaining licensure and continuing
education
❖ Issue and renewal of nursing licenses
❖ Suspension, revocation, and reinstatement of license
❖ Interstate endorsement
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Important Points to Remember
❖Facility has right to limit function of nurse
❖May require additional education in specialized fields
❖Education is a lifelong, continued process
❖Always practice within limits you were taught
❖Use good common sense and judgment
❖Ask questions if unsure
❖Report any errors immediately
❖Report any defective equipment immediately
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Cause for Revoking or Suspending a
License
❖Drug or alcohol abuse
❖Fraud
❖Deceptive practices
❖Criminal acts
❖Previous disciplinary action
❖Gross or ordinary negligence
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The Licensing Examination: The NCLEX
❖ First responsibility after completion of nursing program
is pass NCLEX-PN or NCLEX-RN
❖ Provided by NCSBN to all states, District of Columbia
and U.S. territories
❖ Questions written by practicing clinical nurses and
educators
❖ Revisions occur on regular basis
❖ Not required to retake examination when move to new
state
❖ Continuing education units (CEUs)/continuing education
hours (CEHs)
❖ Must keep accurate records of your own CEUs/CEHs
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Legal Responsibilities in Nursing #1
❖Safeguards for the Nurse and Student
o Personally liable for any harm client suffers as
result of your own act
o Healthcare facilities may also be held liable for
any harm as result of your actions
o Legal actions involving negligent acts may
become malpractice lawsuits
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Legal Responsibilities in Nursing #2
❖Common sense precautions
o Follow accepted procedures
o Be competent in your practice
o Ask for assistance
o Document well
o Do not give legal advice to clients
o Do not accept gifts
o Do not help a client prepare a will
o Consider a malpractice insurance policy
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Legal Responsibilities in Nursing #3
❖Legal Concerns of Emergencies
o Some states require individuals with medical or
nursing education to provide emergency care
outside of medical facility where employed
o Should act within limits of education and
experience
o Good Samaritan Act: protects against liability if
give care within limits of first aid and act in
reasonable and prudent manner in most states
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Question #3
Is the following statement true or false?
In the case of a client who is terminally ill, has no
relatives present, and requests help, a nurse has the
authority to help the client prepare a will or other
legal document.
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Answer to Question #3
False
A nurse should never attempt to help a client prepare
a will or any other legal document. A graduate nurse
may be asked to witness the signing of a will.
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Professional Boundaries
❖Power versus vulnerability
o Do not exploit the power to access private client
information
❖Boundary crossings
o Questionable behavior
❖Boundary violations
o Excessive personal disclosures
❖Professional sexual misconduct
o Seductive, sexually demeaning, or harassing
behavior
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Advance Directives
❖A legal document in which a person either states
choices for medical treatment or names someone to
make treatment choices if they lose decision-making
ability
❖Examples
o Living will
o Directive to healthcare providers
o Durable power of attorney for healthcare
o Mental health advance declaration
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Question #4
Is the following statement true or false?
If a client has a living will kept on file in the
healthcare facility, the nurse is forced to honor the
will in the case of the client being unable to make
their own decisions regarding care.
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Answer to Question #4
True
A living will is a written and legally witnessed
document that requests no extraordinary measures to
be taken to save a person’s life in the event of
terminal illness. Healthcare providers and nurses are
bound by the person’s wishes.
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Vulnerable Persons
❖Can include
o Children and some adults
o Hospitalized individuals
o Mental illness
o Intellectual disabilities
o Older people
o People living in isolation
❖The law protects from injury, abuse, or neglect while
receiving care in a healthcare facility, nursing home,
school, or their own home.
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Definitions of Death #1
❖Traditional definition: absence of respirations and
heartbeat
❖Technology and advanced life support systems has
changed definition
❖Two major definitions of death today:
o Legal death: individual who has sustained loss of
circulation and respiratory function
o Brain death: considers irreversible cessation of
all neurological function of entire brain, including
brain stem
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Definitions of Death #2
❖ Brain death:
o Cessation of breathing after artificial ventilation is
discontinued
o Cessation of heartbeat without external stimuli
o Unresponsiveness to external stimuli
o Complete absence of cephalic reflexes
o Pupils fixed and dilated
o Irreversible cessation of all functions of the brain
o Also termed irreversible coma, vegetative state,
permanent vegetative state
o May be considered organ donor
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Definitions of Death #3
❖ Exceptions:
o Marked hypothermia
o Severe depression of CNS after drug overdose
with CNS depressant
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Ethical Standards of Healthcare #1
❖ Prejudice, Personal Values, and Nursing
o Each individual brings own personal values
o Do not impose your own values on clients
❖ Quality of Life
o Complicated ethical issue
o Can be used to determine who gets treatment
❖ Nurse’s Role Regarding Ethics
o Expected to practice ethically
o May be first to recognize ethical problem exists
o Responsible to report and help in making changes
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Ethical Standards of Healthcare #2
❖Ethical Issues in Treatment
o Organ transplantation
o Criteria and questions
o Refusal of treatment
o Withholding treatment
o Termination of treatment
o Euthanasia
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Ethical Standards of Healthcare #3
❖The Ethics Committee
o May consist of healthcare professionals,
chaplains, social workers, and others
o Chief functions: education, policy-making, case
review, consultation
o Share ideas and concerns to their field
o Act as advocates for clients
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Clients’ Rights and Responsibilities #1
❖Clients’ Rights
o A patient’s Bill of Rights
❖Clients’ Responsibilities
o Healthcare is a partnership
o Provide accurate and up-to-date medical history
o Request additional information and clarification
as needed
o Recognize impact of personal lifestyle choices
o Ensure healthcare institution has copy of written
advance directive
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Clients’ Rights and Responsibilities #2
❖Clients’ Responsibilities (cont.)
o Inform healthcare providers if anticipate
problems following prescribed treatment
o Respect facility’s rule and regulations and
responsibilities to other clients and community
o Provide necessary information and to assist in
the process of payment for services
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Question #5
Is the following statement true or false?
The various laws and ethical standards which are in
place are designed to ensure each client receives the
best healthcare possible.
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Answer to Question #5
True
The various laws and ethical standards set the
standards of practice, identify limits of care which can
be provided by each member of the healthcare team,
identify the various responsibilities of each client,
identify the various roles and responsibilities of each
healthcare facility, and identify the various penalties
which can occur if an infraction occurs, plus other
factors. All these factors together help create the
system which hopefully gives each client the best
healthcare service available.
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