Unit 5.

Ethico-legal bases of
Nursing and the Law

May-2023

April 26, 2025 1

 Outline
General Legal Concepts:
1. Functions of the Law in Nursing
2. Sources of Law
3. Kinds of Legal action
4. Civil Judicial process
5. Nurses as expert witness

April 26, 2025 2

 Learning Objectives
1. Describe general legal concepts as they apply in Nursing.
2. Describe ways, standards of care affecting nursing
practice.
3. Identify nursing code of ethics at the International and
the national level.
4. Identify areas of potential liabilities in nursing incident
report.

April 26, 2025 3

 Cont.. Objectives
5. Describe the purpose and essential elements of
informed consent.
6. Recognize the importance of record keeping
7. List information that needs to be included in

April 26, 2025 4

 Unit-5:-Legal Aspects
and the Law in Nursing
1. General Legal Concepts
Law can be defined as those rules made by humans who
regulated social conduct in a formally prescribed and
legally obligatory manner.
 Laws are based upon concerns for fairness and justice.

April 26, 2025 5

2. Functions of the Law in Nursing:
The law serves a number of functions in nursing:-
1. It provides a framework for establishing guidance
which nursing actions in the care of client are legal.
2. It differentiates the nurse's responsibilities from those
of other health professional.
3. It helps establish the boundaries of independent
nursing action.
4. It assists in maintaining a standard of nursing
practice by making nurses accountable under the
law.

April 26, 2025 6

 Laws and Nursing today
• Nurses today needs to be more aware of laws of acts
than ever of the laws for nursing practice.
• Laws are rules or standards of human conduct
established by government through legislative bodies
and interpreted by courts to protect the rights of
citizens.
• Professional liability cases (charge) can be brought
against all healthcare providers, including nurses. and
the case outcomes affects the way that healthcare is
delivered.

April 26, 2025 7

 Cont..
• In addition, issues such as consent and refusal of
treatment, which used to be handled (felt) among the
patient, nurse, physician, and family today are the often
subject of legislation and court actions.
• Nurses must be aware of the legal guidelines that
govern their particular area of practice, and also
recognize that myths flourish/a bound.
(Ganzini,Volicer,Nelson, Fox, & Derse, 2004;Mahon, 2010).
Source: Sharon ,et al.Fundamentals of N.213 p. 107-114.

April 26, 2025 8

 3- Sources of Law

• The legal system in most of the United States has its

foundation in the English common law system.
The primary sources of law are:-
1. Constitutions,
2. Legislative statutes (acts, orders), and
3. Common law.
1. Constitutions:- are the foundation of the system of
justice.
• In the U.S. Constitution is a supreme constitutional
law that establishes the organization of the federal
government and grants power.
April 26, 2025 9
 3- Sources of Law…cont.

2. Legislative statutes:- are laws (acts) derived from a

legislative body.
Examples:-
 Nurse practice acts and
Adult or Child abuse laws are of legislative statutes.
3. Common law:- evolves from decisions of courts.
• These decisions are ones that cannot be supported by
statutory or constitutional law alone.

April 26, 2025 10

 3- Sources of Law…cont.

• As a society changes its values, laws generally

evolve/change to correspond with current thinking
and societal values.
 At any time, societal and patient values may not
conform to the previously existing law.
• As a result, the law alone may not provide specific
answers to difficult health care dilemmas.
• Nurses have a responsibility to understand the current
legal and ethical guidelines that govern patient care.

April 26, 2025 11

 4-Types of Laws
Laws can be classified as:
1. Civil laws or
2. Criminal laws.
1). Civil law:- is also referred to as private law.
• It is the body of law that deals with relationships
between private individuals.
can be subdivided into:-
1. Contract law
2. Torts law.
2). Criminal law:- is a type of public law that deals with
the public’s safety and welfare.
April 26, 2025 12
 Cont..
Criminal law is divided into:
1. Felonies and
2. Misdemeanors.
Examples:- these includes:-
• homicide,
• manslaughter, and
• theft.
(manslaughter = murder, assassination).

April 26, 2025 13

( Sharon F.N. see the Figs. P.107 ).

April 26, 2025 14

April 26, 2025 15
 Differences Between Crimes and
Torts
1. Crime:
• Results in prison term, a jail tenure or fine sentence to
punish the offender.
• Two type Felony and Misdemeanor
a) Felony
i. Premeditated killing (first-degree murder)
ii. Impulsive or unintentional killing (second-degree
murder)

16
April 26, 2025
 Cont..
• manslaughter
• rape
• Arson (torching)
• kidnapping
• bribery (corruption, paying off)
• child abuse
• drug trafficking
• Fraud (deception, fake)
• Terrorism.

April 26, 2025 17

 FRAUD

• Fraud is willful action of deception.

• It is a purposeful misrepresentation of self or an act
that may cause harm to a person or property.
Eg.:A nurse who misrepresents his or her qualifications
or bills (notices) for care not given may be committing a
fraud.

April 26, 2025 18

 Crimes and Torts
I) Intentional Felony
• Assault /attack, beating, stabbing etc.
• Defamation of character (Insult)
• Fraud (deception, dishonesty ,trickery)
• Invasion of privacy (conquest)
• False imprisonment (custody)

April 26, 2025 19

ii)- Unintentional Felony
• 1) Negligence - mistake or failure to be prudent (failure
to be careful)
• 2) Malpractice - mistakes in the practice of a profession
responsibility.
Eg.:- Failure to assess a significant change in condition of a
client.
• Failure to act appropriately in treating a patient:-
o error in sponge counts
o causing a burn
o Failure to use aseptic techniques
o Pts falls etc..

April 26, 2025 20

 Differences Between Crimes and
Torts….cont.
b) Misdemeanor form of crime:
• An offense punishable by imprisonment of less than 1
year or a fine of less than $1,000.
• Does not amount to a felony.
2. Tort
• Results in civil trial to assess compensation for plaintiff
(accuser, challenger)

April 26, 2025 21

 Kinds of Legal Actions

There are two kinds of Legal actions: legal actions

(engagement):-
1. Civil or private acts.
2. Criminal acts.

April 26, 2025 22

 Kinds of Legal Actions.. Cont..

1. Civil actions:-
• Deals with the relationships between individuals in a
society:
Example: a man may file a suit against a person whom
he believes cheated him.
2. Criminal actions:-
• Deals with disputes between an individual and the
society as a whole.
Example:- if a man shoots a person, society brings him
to a trial/court martial.

April 26, 2025 23

 KEY CONCEPTS
• Values are standards for decision making that endure
for a significant time in one’s life.
 To understand ethics as it pertains to nurses or other
clinicians, it is important to distinguish professional
ethics from personal morality and personal values.
 And also distinguish the professional ethics, and
institutional policies, or legal obligations one from the
other.

April 26, 2025 24

 KEY CONCEPTS… cont..
 The major principles of healthcare ethics that are
important to uphold includes:
• beneficence
• non-maleficence
• autonomy
• justice.

April 26, 2025 25

 KEY CONCEPTS…cont..
• Rights and ethical rules of professionals to
client relationships includes:-
• veracity
• fidelity
• privacy
• confidentiality.

April 26, 2025 26

 KEY CONCEPTS…cont.
 Each State or Provincial/Territorial:-Nurse practice acts
provide some guidance for standards of nursing:-
 Following the current standard of nursing care as
evidenced in statutes and regulations, standards of
professional organizations accordingly.
 Following current literature helps to minimize the
risk of legal problems.

April 26, 2025 27

 KEY CONCEPTS…cont.
 Unintentional felony:…..cont.
 The 4 elements of Negligence of duty are:-
• breach of duty/(responsibility, obligation),
• Malpractice
• damages
• proximate cause
• Nurses need to obtain professional liability -
insurance to protect their best interests, should their
practice be called into question through legal action.
• Clear, accurate documentation will substantiate care
provided to patients.
April 26, 2025 28
 INVASION OF PRIVACY

• The nurse is bound to limit discussion about a patient to

appropriate parties.
• Disclosing confidential information to an inappropriate
third party can subjects the nurse to liability for invasion
of privacy, even if the information is true.
• The nurse should discuss the patient with others only
when the discussion is necessary for treatment and
care or when the patient consents for disclosure of the
information.

April 26, 2025 29

 INVASION OF PRIVACY… cont..

 E.g.: in USA:-
• Congress passed the Health Insurance Portability and
Accountability Act (HIPAA) in 1996.
• The Department of Health and Human Services
publicized the final privacy rule in late 2000.
• Hospitals and other agencies have developed policies
to meet strict provisions regarding the handling of
medical records and healthcare information.
• Nurses should carefully review and follow the
agency policies.

April 26, 2025 30

 Damages.
 Generally Damages include:
 pain and suffering,
 disfigurement and disability.
• For a plaintiff to prevail in a malpractice suit, the
plaintiff must have suffered damages.
• The purpose of the suit is to compensate for these
damages.

April 26, 2025 31

 Cont..
• Special damages are for losses and expenses related
to the injury, such as medical expenses and lost
wages.
• Punitive damages (disciplinary), rarely seen in
nursing cases, but are imposed when there is
reckless, indifferent or malicious /hateful/uncaring
conduct .( Weld &Garmon Bibb, 2009 ).

April 26, 2025 32

 TRENDS IN NURSING MALPRACTICE

• In the past, nurses generally were not named in

malpractice suits b/c it was considered better to sue
(prosecute )the person or institution with the most
money or insurance.
• Today, however, nurses are increasingly named in
malpractice litigation (trial) b/c of the availability of
insurance and their increasing autonomy.
• Patients still accuse nurses for:
- medication errors
- falls
- retained sponges etc.
April 26, 2025 33
 TRENDS IN NURSING MALPRACTICE

• During the past few decades, medical care has seen

dramatic advances in knowledge about disease
processes and technology for diagnosis and treatment
for illnesses. but,
• The number of malpractice suits has increased as a
result of these highly complex and advanced methods
of delivering healthcare.
• The result has aimed at higher need of standards of care
for nurses, with a corresponding increase in liability.
(Hamric & Blackhall, 2007 ).

April 26, 2025 34

 Liability

• Liability denotes legal responsibility to pay damages.

• When the four elements of negligence are proven (i.e.
when the nurse’s breach of a duty owed to the patient
was the proximate cause of injury to the patient), the
nurse can be found liable.
• The hospital, clinic, or community nurse service may be
held responsible for a nurse’s negligence under the
doctrine of responded at superior (“let the master
answer”).

April 26, 2025 35

 Liability… cont..
• This notion of vicarious liability, or liability assigned to an
employer by way of the terms of employment, can be
applied whenever the nurse is acting within the scope
of employment. Rarely, the employer may attempt to
prove that the nurse was not acting within the scope of
employment when the negligent act occurred.
• This is one reason individual liability insurance is
recommended.

April 26, 2025 36

 Liability… cont..
• Nurses are generally covered by vicarious liability
when they are acting under their employer’s control.
It is important to remember that this means both the
employer and the nurse are responsible.
• The employer cannot make the nurse immune from
liability.
• General areas of liability are summarized in.

April 26, 2025 37

 Legally Sensitive Areas

Legally Sensitive Areas of Nursing Practice:-

• There are many legally sensitive areas of nursing
practice.
• Common areas of which nurses should be aware
include the following:
1. Controlled substances.
• In 1970, the Comprehensive Drug Abuse
Prevention and Control Act was passed in the
United States.

April 26, 2025 38

 Legally Sensitive Areas… cont.
• In most states, nurses may administer controlled
substances (opioids, depressants, stimulants, and
hallucinogens) given
• only under the direction of a physician or other
authorized provider,
• unless the substances are authorized under
advanced practice licenses.

April 26, 2025 39

 Legally Sensitive Areas.. cont.
2. Death and dying.
• Death occurs either when there is irreversible cessation
of heart and lung functions or an irreversible loss of all
functions of the entire brain.
• It is the nurse’s duty to recognize cardiovascular death.
In most states, the physician has the legal responsibility
of pronouncing the person dead.
• Diagnosing brain death in patients with mechanical
ventilators is a medical determination requiring specific
tests and examinations (John, Reyes, Thachil, Flaherty, &
Emmett, 2007).
April 26, 2025 40
 Assisted suicide
• Assisted suicide is defined as providing the patient with
the means to end his or her life but not providing the
direct action that results in death.
• It is important for nurses to know what care they are to
provide to patients requesting assisted suicide.
• Physician or nurse caused death (active euthanasia) is
defined as deliberately hastening a person’s death and
is considered murder in all states and almost all
countries.

April 26, 2025 41

 Cont..
• Actions that constitute deliberate hastening of death
include:
- injecting a bolus of potassium or
- overdose of insulin.
• Actions that do not constitute hastening death
include:
- Ex - tubating a mechanically ventilated patient
with the informed consent of the patient or
surrogate and then by a physician’s order

April 26, 2025 42

 Terminal sedation
3. Terminal sedation.
• Terminal sedation is not considered euthanasia.
• Rather, it is an infrequently used method of pain
management provided in response to a dying patient’s

persistent and unremitting pain and suffering.

April 26, 2025 43

 Cont..
• In these cases, it is considered legally and ethically
permissible to provide analgesia to a level that
produces light sedation, even though this is likely to
hasten death somewhat secondary to resulting
immobility.
• Terminal sedation is considered an option of last
resort for ensuring that patients can die comfortably
and with dignity ( Randall & Downie, 2010 ).

April 26, 2025 44

 Resuscitation
• Resuscitation:- Nurses must always know the code
status of their patients regarding resuscitation ,
verify the code status on the patient’s order sheet,
and follow agency policy.
• Orders not to provide resuscitation in the event of a
cardiopulmonary arrest are frequently referred to as
no code order or do not resuscitate (DNR) orders .
• Most recently, some experts are calling for a new
name - allow natural death (AND).

April 26, 2025 45

 Good Samaritan laws
Good Samaritan laws.
Good Samaritan laws offer legal immunity for healthcare
professionals who assist in an emergency and render
reasonable care under such circumstances.
• Because most states and provinces do not require
nurses or citizens to aid the distressed, such assistance
becomes an ethical, rather than legal, duty.
• Although these laws limit liability for the nurse, he or
she may be liable for gross negligence.

April 26, 2025 46

 Good Samaritan laws… cont..
• A nurse who helps is obligated to remain until additional
assistance is obtained.
E.g. The nurse should then relinquish (give-up) care to
official rescue personnel unless asked to remain.
Because emergency assistance is generally outside the
scope of the nurse’s employment, the employer’s
malpractice insurance will not provide coverage.
• This is another reason for nurses to carry their own
insurance.

April 26, 2025 47

 Protecting Yourself Legally
• Nurses may minimize the risk of legal problems,
including malpractice, in several ways as:-
1. First, nurses should keep current with advances in
practice.
2. Continuing education is absolutely essential to stay
knowledgeable about general and specialized care.
3. Likewise, nurses should be familiar with regulations
governing nursing practice.

April 26, 2025 48

 Professional Practice

Professional Practice:- policy development:

• Nurses involved in the development of policies,
procedures, protocols, or standardized nursing plans of
care should be sure to make them realistic for their own
practices, for an agency, or both.
• Such standards should be evidence based and
practicable with the resources available.
• Staffing and equipment to conform to these guidelines
must be available at all times.

April 26, 2025 49

 Professional Practice…cont.

• Those who develop standards to apply to various

practice settings should keep in mind the differences
in resources and facilities of different sizes, acuity, and
geographic area.
• Those involved in policy making need to continue to
update policies in a timely and sensible manner in
accordance with nursing’s demands.

April 26, 2025 50

 Professional Practice… cont..

1. New knowledge must be applied.

2. Policies, procedures, and protocols must be followed.
3. Propounding/advocating unrealistic policies and
procedures and those then not following them is an
invitation to malpractice suits.
4. The patient’s condition must be monitored, and
observations must be documented.

April 26, 2025 51

 Professional Practice… cont.
5. Whether the patient is in:
• a hospital recovering from surgery,
• in home care coping with a chronic illness, or
• in a setting where direct observation is limited
(e.g., as a telephone triage nurse), assessment of
the patient must be recorded.

April 26, 2025 52

 Professional Practice… cont.

6. Significant changes in the patient’s condition need to be

reported to a physician or other professional in a timely
manner.
7. The report to the physician also must be documented.
8. When physicians do not follow up with assessment or
intervention, the nurse needs to challenge the physician’s
care.
• Hospitals and nurses may be liable when nurses do
not challenge physicians in the face of obvious
negligence.

April 26, 2025 53

 Professional Practice…cont..
• Professional Liability Insurance
• In the 2006 national malpractice payment reports,
professional nurses accounted for 2 out of every 100
reports.
• These reports view specialized nurses from non-
specialized nurses, with all types of professional nurses
responsible for 6,208 malpractice payments (2.1% of all
payments) since the beginning of the National
Practitioner Data Bank.

April 26, 2025 54

 Professional Practice…cont..
• Registered nurses without a specialization account for 61.6%
of the malpractice payments made for nurses.
• Nurse anesthetists (19%),
• Nurse practitioners (9.6%),
• Nurse midwives (9.6%), and advanced nurse practitioners
(0.2%) .
account for the nurses malpractice payments as described in
the 2006 Annual Report of the National Practitioner Data Bank.
(available from www.npdb-hipdb.hrsa.gov/
resources/reports/2006NPDBAnnualReport.pdf; accessed June
10, 2011 ).

April 26, 2025 55

 Professional Practice…cont.
• Because a nurse may be sued for some act related to
nursing but outside the limits of her or his employment,
each nurse also should have her or his own insurance.
 Nursing students generally are covered for their student
clinical experiences as long as they are registered
students and are practicing under appropriate
supervision.
(To obtain information about nursing malpractice
insurance carriers, visit your state’s association of nursing
home page or search the Internet).

April 26, 2025 56

 Documentation

Documentation:- Should be:-

1. accurate
2. Complete
3. contemporaneous with care given.
4. Avoid pre-charting or documenting events before
they occur; this is the easiest way for nurses to put
themselves at risk for lawsuits ( Singh, 2010 ).
5. Documentation should include normal findings in the
form of a flow sheet, checklist, or narrative.

April 26, 2025 57

 Documentation…cont.

6. Assess and record vital signs in accordance with the

agency’s policy and the patient’s condition.
7. When critical events occur, note the precise time and
event in the records.
8. Documentation should be objective.
- Criticisms and negative comments about other
providers, patients, or family members have no place in
the medical record.

April 26, 2025 58

 Documentation…
9. Never obliterate an entry by erasing it or using
correction fluid.
10. The presumption will be that the matter erased or
covered up is more damaging than whatever was actually
written.
11. Correct charting errors by marking a line through the
error and recording the nurse’s initials.

April 26, 2025 59

 Documentation… cont..

Incident Reporting:
• If a specific incident, such as a fall or medication
error, occurs, follow these principles:-
1. Maintain rapport with the patient .
2. Do not avoid communication with the patient who is
experiencing stress and uncertainty.
3. Offer simple explanations if you can do so honestly, calmly, and
without blaming anyone.
4. Document the incident in the progress notes and on the
appropriate forms of your institution .
5. Incident reports are useful to remind you of the events
surrounding the incident. And to enhance continuous quality
improvement.
April 26, 2025 60
 REFERENCES

1. American Nurses Association. (2001). Code of ethics with interpretative statements.

2. Kansas City, MO: Retrieved June 12, 2011, from http://nursingworld.org/
3. MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-
4. Ethics.aspx .
5. Annual Report, National Practitioner Data Bank. (2006). United States Department
of Health and Human Services (US HHS). Retrieved June 10, 2011, from
6. www.npdb-hipdb.hrsa.gov/resources/reports/2006NPDBAnnualReport. pdf
7. Beauchamp , T. L. , & Childress , J. F. ( 2008 ). Principles of biomedical ethics ( 6th
ed. ). New York, NY : Oxford University Press .
8. Brink , P. J. ( 1984 ). Values orientation as an assessment tool in cultural diversity
Nursing Research , 33 , 198 – 203 .

….///…..

April 26, 2025 61

 Unit 6-Legal Issues

Legal Issues
In Nursing

April 26, 2025 62

 Legal issues in nursing
1. Nursing Practice Act:
Nursing practice act /Act for professional Nursing practice,
regulates the practice of nursing.
• Legally define and describe the scope of nursing
practice, which the law seeks to regulate,
• there by protecting the public wellbeing.
• It protects the professionals by encouraging to build
their capacity.

April 26, 2025 63

 Legal issues in nursing…
• Each country may have different acts, but they all have
common purpose like:-
• To protect the public.
• It grants the public a mechanism to ensure minimum
standards for entry in to the profession and to
• distinguish the unqualified Acts.

April 26, 2025 64

 Legal issues in nursing…
2. Standard of Practice:
 A standard of practice is a means to ensure that its
practitioners are:
• competent and
• Safe to practice through the profession

April 26, 2025 65

 Cont..
• The responsibility of the profession are inherent in
establishment and implementing of standards of
practice.
• The Establishing and implementing standards of
practice are major functions of professional
organizations.

April 26, 2025 66

 Functions of Standard of Practice
1. They establish, maintain, and improve standards .
2. Hold members accountable for using standards.
3. Educate the public to appreciate/rise the (use) of
standard.
4. Protect the public from individuals , who are not will
fully to follow the standards.
5. Safeguard individual members of the profession.

April 26, 2025 67

 criterion areas of Standard of
Practice
 Standard of nursing practice covers 3 criterion areas:-
1. The nature of helping relationship b/n the of client -
nurse interaction.
2. Nurse to fulfill responsibilities as professional.
3. Effective use of nursing process.

April 26, 2025 68

 Standard of nursing practice
• 3 areas of standard of Nursing Practice are:
1. Helping relation ship b/n client and the nurse
2. Professional responsibility and accountability.
3. Effective application of Nursing process practice.

April 26, 2025 69

 Standard of Practice- summary
Standards of nursing practice help to describe the
responsibilities which nurses are accountable.
These standards helps to:-
1. Reflect the values in the practices of the nursing
profession
2. Provide direction for professional nursing practice ,
3. Provide a frame work for the evaluation of nursing
practice.

April 26, 2025 70

 Standard of Practice- summary
4. Standards defines the profession’s / responsibility,
accountability to the public and the client
outcomes for which nurses are responsible.
5. Nursing standard clearly reflect the specific functions
and activities that nurses provide indifferent to the other
health workers.
• The professions maintains standards in practice through
appropriate Admittance (Administrative and controlling
body).= professional orga.

April 26, 2025 71

 Standard of Practice- summary
 When standards of professional practice are established
and implemented they serve as a yardsticks (measure)
for the:
o licensure,
o certification,
o accreditations,
o quality assurance,
o peer review, and
o public policy

April 26, 2025 72

 Standards of Care
3. Standards of care:- Comprise the expected level of
performance or practice as established by :
• guidelines,
• authority, or
• custom,
• They are important to control malpractice and
licensing cases.
• Each nurse practice Act provides one set of guidelines
for the standards that nursing care should meet.
• These guidelines vary as to how specifically they
govern the practice.
April 26, 2025 73
 Standards of Care…cont.
 The Joint Commission accredits healthcare facilities and
sets nursing standards for some aspects of care: such as
documentation.
• Institutions or agencies usually have their own policies
and procedures that define their standards for nursing
care.
• Standardized nursing plans of care or protocols also
reflect the care expected for a specific patient or group
as the standard.

April 26, 2025 74

 Standards of Care…cont.
• The care provided by each nurse also is measured
against the expected behavior of a nurse with a similar
level of expertise and experience.
 Nurses involved in setting standards, so they should be
certain that standards are realistic in light of available
resources
(Moniz, 1992).

April 26, 2025 75

 Standards of Care…cont.
• Standards that an agency sets should be updated
frequently to reflect technologic changes.
• Nurses must familiarize themselves with the standards.
• When circumstances prevent compliance with
standards, nurses should document the reasons for the
deviation. ……..///…...

April 26, 2025 76

 Credentialing
Credentialing:- is the process of determining and
maintaining competence-nursing practice.
Credentials includes:-
a. Certification
b. Registration
c. Licensure
d. Accreditation

April 26, 2025 77

 Credentialing….cont.
a. Licensure:-
 It is legal permit a government agency grants to
individuals to engage in the practice of a profession and
to use particular title.
 It generally to meets three :-
1. There is a need to protect the public's safety or
welfare.
2. The occupation is clearly delineated with a separate,
distinct area of work.
3. There is a proper authority to assume the obligation of
the licensing process.
April 26, 2025 78
 Credential/Licensure?
Credential = qualification , diploma, Recommendation
Licensure = authorization, certificate,( license)
warrant, permit.
(The terms work as synonymous in many articles.)

April 26, 2025 79

 Credentialing….cont./A. Nursing Licensure

• Licensure is the legal ability to practice as a nurse in a

certain state.
• Licensure is mandatory for nursing to practice as a
nurse, a person must be licensed as a nurse.
• Each state or territory has a nurses’ practice act,
Generally nurse Practice Acts helps in:-
1. define nursing,
2. describe the scope and
3. describe the expectations of nursing practice.
4. outline the criteria for nursing education.

April 26, 2025 80

 Nursing Licensure…cont.
• In all states, there are exceptions for those who provide
uncompensated nursing care to the sick by friends or
family members without license.
 Almost all states and provinces recognize advanced
registered nurse practitioners (in USA) have the most
prescriptive authority.

April 26, 2025 81

Liability for licensing arises-in several areas:-
 Care given below nursing standards can result in
liability to the Board of Nursing as a malpractice.
 In addition, the Board of Nursing is concerned with
nurses practicing beyond the scope of their license,
even when the practice meets quality standards

April 26, 2025 82

 Nursing Licensure…cont.
 For example:-
• 1. a nurse without an advanced practice license who decides to
suture wounds or prescribe medicine may be liable for practice beyond
his or her scope in accordance with the nurse Acts of practice
• 2. Drug diversion or abuse gives rise to several licensing actions,
although many states provide an alternative program that promotes
treatment and rehabilitation rather than discipline.
• 3. Patient abuse and sexual contact with patients constitute an
increasing area of liability in licensing cases.
- Sex with a current patient is never acceptable.
- Particularly in psychiatric nursing, sexual contact even with former
patients will undoubtedly violate disciplinary standards.
• 4. Violation of other statutes or regulations also gives rise to
licensing action practice .
…………..///……………
April 26, 2025 83
 Credentialing….cont.
B. Registration:
• Registration Is listing of an individual's name and other
information on the official roster of a governmental
agency.
• Nurses who are registered are permitted to use the title
as “Registered Nurses“.

April 26, 2025 84

 Credentialing….cont.
C. Certification:-
It is the voluntary practice of validating that an individual
nurses met minimum standards of nursing competence in
specialty areas: such as:-
• pediatrics,
• mental health,
• gerontology and
• school health Nursing.

April 26, 2025 85

 Credentialing….cont.
D. Accreditation:
Accreditation is a process by which a voluntary
organization or governmental agency upraises and grants
accredited status to institutions and/or programs.
The purpose of accreditation of programs in nursing
includes:-
1. To foster the continuous development and
improvement in quality of education in nursing.
2. To evaluate nursing programs in relation to the state
outcomes and to the established criteria for
accreditation.

April 26, 2025 86

 Credentialing….cont.
3.To bring together:
o practitioners of :
o , administrators
o faculty, and
o students ,
• …in an activity directed towards improving
educational preparation for nursing practice and
• …To provide an external peer review process.
….. ///….

April 26, 2025 87

 Nursing Code of Ethics
• It is formal statement of a group’s ideas and values that
serve as a standards and guidelines to the professional
actions.
• It informs the public about its commitment.
• Codes of ethics are usually higher than legal standards,
and they can never be less than legal standards of the
profession.

April 26, 2025 88

Purposes of Nursing code of ethics:
.

1. To inform the public about the minimum standards of

profession.
2. To help them understand professional nursing conduct.
3. To provide a sign of the profession’s commitments to the
public it serves.
4. To outline the major ethical considerations of the profession.
5.To provide general guidelines for professional behavior.
6. To guide the profession in self regulation.
7. To remind nurses of the special responsibility they assume
when caring for the sick.

April 26, 2025 89

 ICN CODE OF ETHICS
ICN CODE OF ETHICS:-
(International Nursing Council ICN )
• The need for nursing is Universal.
• The Inherent value in nursing is:
• respect for life, dignity, and rights of man.
• It is unrestricted by considerations of:
• nationality,
• race, color
• faith,
• age, sex,…

April 26, 2025 90

 Cont..
• Nurses render health services to the individual, the
family, and the community and coordinate their
services with those of related groups.

April 26, 2025 91

 Responsibility & Accountability
 The fundamental Responsibility of the nurse is in the
four categories:-
1. To promote health,
2. Prevent illness,
3. Restore health and
4. To alleviate suffering

April 26, 2025 92

 Responsibility & Accountability…cont .

 Nurses should work in accordance to:-

 Dependent.
 Independent.
 Interdependent.
 Collaborative manner of practices.
 Nurses carefully handle nursing practice on specific
ethical issue and resolve the ethical problems
systematically. b/c of they are accountable for their
professional judgment and actions.

April 26, 2025 93

 Nurses and people
A. Nurses and people:
• The nurse’s primary responsibility is to those people
who require nursing care.
• The nurse should promote in their care provision an
environment in which the:
1. values
2. customs
3. Spiritual beliefs of the individual are respected.
4. The nurse holds confidential in the personal
information and uses judgment in sharing this
information to others.
April 26, 2025 94
 Nurses and people...cont.

B. Nurse and Society

• The nurse shares with other citizens the responsibility
for initiating and supporting actions to meet the health
and social needs of the public.
• The nurses acting in a professional capacity should
always maintain standards of personal conduct which
reflects credit upon the profession.

April 26, 2025 95

 Responsibility & Accountability…cont.

C. Nurse and Co-workers

• The nurse should bears a cooperative relationship with
coworkers in nursing and other fields.
• The nurse’s takes appropriate action to safeguard the
individual when his care is endangered by a co-worker
or any other health personnel.

April 26, 2025 96

 Responsibility & Accountability…cont.

D. Nurse and the Profession

• The nurse must plays the major role in determining and
implementing desirable standards of nursing practice
and nursing education.
• The nurse is active in developing a core of professional
knowledge.
• The nurse, acting through the professional organization,
participates in establishing and maintaining equitable

social and economic working condition in nursing.

…….///……
April 26, 2025 97
 Nursing code of ethics in Ethiopia
• The Ethiopian nurses association (ENA) code of ethics
for registered nurses comprises key elements of the
code.
It includes:-
• values,
• responsibility statements, and
• levels of guidance or actions.

April 26, 2025 98

 Nursing code of ethics in Ethiopia…cont.
1. Accountability and responsibility
• The fundamental responsibility of the nurse is four fold:
1. to promote health,
2. prevent illness,
3. restore health and
4. to alleviate suffering
• Nurses act in a manner consistent with their
professional responsibilities and standards of practice
• Nurses advocate practice of environment to be
conducive to safe, Competent and ethical care.

April 26, 2025 99

 Nursing code of ethics in Ethiopia. cont..
• Nurses work in accordance with:
• dependent,
• Independent
• interdependent and collaborative functions of
nursing.
• Nurses carefully handle nursing practice on specific
ethical issue and resolve the ethical problems
systematically.
• b/c Nurses are accountable for their professional
judgment and action.

April 26, 2025 100

Nursing code of ethics in Ethiopia…cont.
2. Respect right and dignity
1. The nurse in providing care, unrestricted by
consideration of nationality, race, creed, color, age, sex,
politics, religion or social statues.
2. The nurse respects the value, customs and spiritual
beliefs of individual.

April 26, 2025 101

 Nursing code of ethics in Ethiopia…cont.
3. The nurse identifies health needs of the client, helps
them to express their concern and obtains appropriate
information and service.
4. Nurses apply and promote principles of equity and
fairness to assist clients in receiving un biased
treatment and share of health services and resources
proportional to their health needs

April 26, 2025 102

Nursing code of ethics in Ethiopia…cont.
3. Confidentiality
• Nurses safeguard the trust of clients that information
and health records in the context of professional
relationship is shared outside the health care team only
with the clients permission or as legally required.
• Nurses maintain privacy during therapeutic and
diagnostic procedures.

April 26, 2025 103

Nursing code of ethics in Ethiopia…cont.
4. Advocacy:-
• Nurses sustain a cooperative relation ship with other
health workers in the team work.

• Nurses value health and well being and assist persons to

achieve their optimum level of health in situation of
normal health, illness, injury or in the process of dying.

April 26, 2025 104

 Nursing code of ethics in Ethiopia…
cont.
• Nurses promote safety prevent intentional or
unintentional harm and take appropriate action to
safeguard the individuals when his care is endangered
by a coworker or any other person.

• The Nurse respects acceptance or refusal right of the

patient during therapeutic and diagnostic procedures or
research and learning situation up on clients.

April 26, 2025 105

 Nursing code of ethics in Ethiopia…
cont.
5. Professional development
• The nurse plays the major role in determining and
implementing desirable Standards of nursing practice and
nursing education.

• The nurse should develop professionally through formal and

non- formal continuing education.

• The nurse should participate in professional organizations

and advocates equitable social and economic working
conditions.

April 26, 2025 106

Specific ethical issues and the Responsibilities of nurses

1. Patient’s Bill of rights

Ethical Issues related pts.’ Rights in the health care:-
a. Right to truth
b. Right to refuse treatment
c. Informed Consent
d. Human Experimentation
e. Behavior control

April 26, 2025Right to refuse

treatment 107
 Specific ethical issues

1. Patient’s Bill of rights:-

• Statement on a patient’s bill of rights was approved by the
House of Delegates in February 6, 1973 USA.

• The American Hospital Association (AHA)presents a

patient’s bill of rights with the expectation that observance
of these rights will contribute to more effective patient care
and greater satisfaction for the patients, and the hospital
organization.

• The traditional physician- patient relationship takes a new

dimension when care is rendered within an organizational
structure.
April 26, 2025 108
 Specific ethical issues and the Responsibilities…cont.

• Legal precedent has established that the institution

itself also has responsibility to the patient.
• It is in recognition of these factors that these rights
are affirmed.
The patient’s rights are as follows:-
1. The patient has a right to considerate and respect
full care.
2. The patient has a right to obtain from his physician
complete current and information concerning his :
• diagnosis, treatment and prognosis in terms
the patient can understand. 109
 Specific ethical issues and the Responsibilities…cont.

• When it is not medically advisable to give such

information to the patient, information should be
made available to an appropriate person on his behalf.

• He has the right to know by name the physician

responsible for coordinating his care.

April 26, 2025 110

 Specific ethical issues and the Responsibilities…cont.

3. The patient has the right to receive information

necessary from his physician to give informed consent
prior to the start of any procedure and / or treatment.
Except in CASE OF emergencies.
 Information for informed consent should include:
a. the medically significant risks involved, and
b. the probable and duration of incapacitation.

April 26, 2025 111

 Specific ethical issues and the
Responsibilities
c. Where medically significant alternatives for care or
treatment exist, or when the patient requests information
concerning medical alternatives, then patient has the right
to such information.
4. The patient has the right to refuse treatment to the
extent permitted by Law and to be informed of the medical
consequences of his action.

April 26, 2025 112

 Specific ethical issues and the
Responsibilities…cont.
5. The patient has the right to Privacy & every
consideration of:-
• his privacy concerning his own medical care program.
• Case dissociation, consultation, examination, and
treatment are confidential and should be conducted
discreetly.
• Those not directly involved in his care must have the
permission of the patient to be present.

April 26, 2025 113

 Specific ethical issues and the
Responsibilities…cont.
6. The patent has the right to confidentiality: expect that
all communications and records pertaining to his care
should be treated as confidential,
7. The patient has the right to expect that within its
capacity, that a hospital must make reasonable response
to the request of a patient for their services.
• The hospital must provide evaluation, service, and/ or
• referral as indicated by the urgency of the case

April 26, 2025 114

 Specific ethical issues and the
Responsibilities…cont.
• Transfers to another facility is only after pt. has received
complete information and explanation concerning the
needs for and alternatives to such a transfer.
• It should be confirmed about institution to which the
patient is to be transferred must first have accepted the
patent for transfer.

April 26, 2025 115

 Specific ethical issues and the
Responsibilities…cont.
8. The patent has a right to obtain information about any
relationship of his hospital to other health care and
educational institutions as far as his care is concerned.
 The patient has the right to obtain information as to
the existence of any professional relationships among
individuals, by name, who is treating him.

April 26, 2025 116

 Specific ethical issues and the
Responsibilities
9. The patient has the right to be advised if the hospital
proposes to engage in and perform human,
experimentation affecting his care or treatment.
• The patient has the right to refuse to participate in such
Research projects.
10. The patient has the right to expect reasonable
continuity of care.
• He has the right to know in advance to discharge, what
appointment times and physicians are available and
where.

April 26, 2025 117

 Specific ethical issues and the
Responsibilities…
• The patient has the right to expect that the hospital will
inform pt. by his physician or by a delegate that patient’s
continuing health care requirements following
discharge.
11. The patient has the right to examine and receive an
explanation of his bill regardless of the source of payment.
12. The patient has the right to know what hospital
rules and regulations apply to his conduct as a
patient.

April 26, 2025 118

 Ethical Issues related
to Pts. Right
Right to truth
• The right of patients to know the truth about their
condition, prognosis, and treatment is an issue between
the physician and the patient.
• The current trend is towards more frankness on the part of
physicians.
• In the past, the moral obligation to disclose the truth
because the patient has the right to know and adjust to was
often overcome by the professional need to protect the
patient from potential physical or emotional harm that could
be caused by knowledge of a critical or terminal condition.
April 26, 2025 119
 Right to Truth…cont.
• Because of there extended contacts with patients, nurses
often find it difficult to accept a physician’s.
• Because of the conflict between physicians’ decisions
and nurses’ personal feelings, it may be advisable for the
health care team to meet in order to resolve the
problem and to devise a consistent approach to the
patient. …///….

April 26, 2025 120

2. Right to Refuse Treatment
• Because of knowledge they have to themselves patient
may refuse treatment even though lack of treatment
may result in their death.
• The question of refusal of treatment may have to be
decided in court.
• Many times, the courts rule that patents cannot be
forced to accept treatment.

April 26, 2025 121

• In the case of minorities like children, however, the
courts can rule that parents cannot withhold treatment
from a child for any reason.
• The child is usually made a temporary ward of the court
and treatment is allowed to begin.
• A patient’s decision to die rather than to accept
treatment may be difficult for a nurse to understand.
• Nurses must recognize a patients’ right to individual
and personal attitudes

April 26, 2025 122

• Pt. beliefs do not allow personal feelings to interfere
with patient care.
• If nurses cannot reconcile their ethical values with those
of patients, they should ask to be taken off the case in
the interest of the patient. ………///…

April 26, 2025 123

 3. Informed Consent

 The issue of informed consent applies to many health

care institutions in both legal and ethical ways.
 Patients have the right to be given accurate and
sufficient information about procedures, both major
and minor,
• so that their consent to undergo those procedures is
based on realistic expectations.
• The responsibility for imparting information about
major surgery or complicated medical procedures lies
with medical professionals.

April 26, 2025 124

• Nurses should inform their patients; in terms the
patients can understand, about all even simple nursing
procedures before the procedures are started.
• This includes answering questions that patients may
have.
• Failure to obtain informed, written consent to perform a
procedure could involve nurses and other health care
professional in legal action or subject to disciplinary
action by state regulatory agencies.

April 26, 2025 125

• Because nurses spend considerable periods of time with
patients, they are likely to be most aware of their
patients’ questions and concerns.
• Many times, these concerns should be brought to the
attention of attending physicians who, because they see
the patients’ less frequently than nurses
.................///………………

April 26, 2025 126

 4. Human experimentation

• Research and human experimentation are primarily

concerns of the scientific and medical professionals.
• However, if nursing care is required for the subjects
involved for such experimental projects, then nurses
became involved.

April 26, 2025 127

 4. Human experimentation…cont.
• In these cases, nurses’ Responsibilities and Ethical decisions
related are:-
1. to making sure that informed consent is given for
participation in the research experiments and
2. the safety of their patients is protected.
• The nurses’ role, along considered to be a patient
advocate, may place them in to dire conflict with :
1. research staffs and
2. sponsoring agencies as well as
3. human subjects and
4. the research the committees.
…………….///…………..
April 26, 2025 128
 5. Behavior control
1. The issue of informed consent is critical question in any
form of behavioral control:-
Eg. 1. the use of drugs or
2. psychosurgery further complicates a highly
complex topic.
2. Controversy persists over the rights of society to decide
what is or is not desirable or acceptable behavior.
• The issue involves both personal and public behavior

April 26, 2025 129

 5. Behavior control…cot
 Moreover, it also Concerns whether:-
• individuals have the right to decide for themselves, and
what is suitable personal behavior ??

• or whether others can decide for them on bases of some

other concept of suitable personal behavior.

• In this regard, one of the ethical questions that may be

confronted by nurses involves informed consent for
treatments that are intended to control behavior.

April 26, 2025 130

 5. Behavior control…cot
 Nurses may question whether:-
• who involves as candidates for drug therapy or
psychotherapy
• are able and competent , to give informed consent,
and
• whether these patients, too have informed about
their right to refuse treatment.
…….///……..

April 26, 2025 131

 Health related Legal issues in
Ethiopia:
Patients’ Bill of rights, In Ethiopia:-
• Shown below are certain health related issues
commonly seen in Ethiopia.

April 26, 2025 132

 Health related Legal issues in
Ethiopia:…cont.
1. Abortion:
• The nurse shall assist the physician if she/he is
sure that an abortion is performed for the
purpose of saving the endangered life or
health of women.
• The nurse shall not attempt or carry out
abortion

April 26, 2025 133

 6.2.9. Health related Legal issues in
Ethiopia: Abortion..cont
• • It is mandatory for the nurse to treat a
patient
who is suffering from the effect of a
criminal abortion induced by others where
there is no physician in the health
institution.

April 26, 2025 134

 6.2.9. Health related Legal issues in
Ethiopia:… Abortion cont
• • The nurse shall report to the
concerned authorities of criminal
abortion in the absence of physician.
• The nurse has all the right not to
participate in all procedures of criminal
abortion
………///……
April 26, 2025 135
 6.2.9. Health Related Legal Issues Ethiopia…cot.

2. Euthanasia:

The nurse shall never assist; collaborate in taking life as: an act
of mercy even at the direct request of the patient
or patient's relatives.

3. Death:
• The nurse shall note the exact cessation of vital signs and notify the
attending physician to pronounce death.
• The nurse shall give due respect to the deceased taking in to
consideration religion and cultural aspects.
• A nurse shall participate I n or assist a medical team in taking
out organ from a cadaver provided there is
written consent of a patient or relatives.
April 26, 2025 136
 4. Suicide

4. Suicide:-
• • A nurse who is taking care of a patient with a
suicidal tendency shall remove all items that
facilitate suicide such as;
– sharp instruments,
– ropes, belts,
– drugs and
– make sure that the outlets are graded.
• The nurse should not leave a suicidal patient
alone.
April 26, 2025 137
 5. Organ Transplantation
• The nurse shall involve in any organ transplantation
procedure provided that the donor and recipient
have clear written agreement, the donor gives
informed consent and he/she is not mentally ill at
the time of consent.
• The nurse shall advocate the declaration of human
rights in the organ transplantation procedure.
• • The nurse shall have moral and professional
rights to make ethical decisions to resolve the
dilemma that arises from the procedure.
April 26, 2025 138
 6. Fertility Matter
Fertility Matter: The nurse shall respect autonomy
of the client for contraception and other fertility
matter including artificial fertilization.
• • The nurse shall have moral and
professional right to make ethical decision
in a situation of dilemma for the same.
• • The nurse shall have responsibility to give
information about the case.

April 26, 2025 139

 6.2.10. Areas of potential
liabilities in nursing
1. Crimes and Torts:
• A crime is an act committed in violation of public (criminal)
law and punishable by a fine and/ or imprisonment.
• A crime does not have to be intended in order to be a
crime.
E.g: a nurse may accidentally give a client an additional and lethal
dose of narcotic to relive discomfort.
• Crimes could be felonies and / or misdemeanors.
1. Felonies: a crime of a serious nature such as
– murder, armed robbery, second degree murder.
– A crime is punished through criminal action by the state.
April 26, 2025 140
2. A misdemeanor: is an offense of a
less serious nature and is usually
punished a fine or short term jail
sentence or both.
• e.g.:, a nurse who slaps a client’s
face could be charged with a
misdemeanor

April 26, 2025 141

A TORT :
• Tort Is a civil wrong committed against a person or a person’s
property.
Torts are usually litigated in court by civil action between individuals.
• Tort may be classified as intentional or unintentional:
1. Intentional tort includes fraud, invasion ofmprivacy, libel and slander
assault and battery and ,false imprisonment.
2. Fraud: false presentation of some fact with the intention that it will
be acted up on by another person.
E.g:, it is fraud for a nurse applying to a hospital for employment to fail
to list two past employers for deceptive reasons when asked for five
previous employers.
3. False imprisonment: is “unlawful restraint or detention of
another person against his or her wishes” To avoid charges of malpractice, nurses
need to recognize those nursing situation in which negligent actions are most likely to
occur and
April 26, to take measures to prevent them
2025 142
 The most common malpractice situations are
.

1. Medication error:
Which resulted from:
1. Failing to read the medication label.
2. Misunderstanding or incorrectly calculating the dose.
3. Failing to identify the client correctly.
4. Preparing the wrong concentration or
5. Administration by wrong route (e.g.
6. Intravenously instead of intramuscularly)
7. Some errors are serious and can result in death.
April 26, 2025 143
For example
a. Administration of Demrol to a client
recently returned from surgery could cause
the client to have hemorrhage.
b. Sponges or other small items can be left
inside a client during an operation.
c. Burning a client: May be caused by hot
water bottle, heating pads, and solutions
that are too hot for applications.

April 26, 2025 144

4. Clients falling Accident to pts’: As a result of:
• a nurse left the bedrails down or
• leaves a baby unattended on a bath table.
5. Ignoring a clients complaints
6. Incorrectly identifying clients
7. Loss of client’s property:
• jewelry,
• money,
• eye glasses
• dentures etc.
April 26, 2025 145
 6.2.11- MEASURES TO PREVENT THE ABOVE
MALPRACTICE SITUATIONS.
1. A nurse always needs to check and recheck medications
very carefully before administering a drug.
2. The surgical team should count correctly before the
surgeon closes the incision
3. Reporting crimes, torts and unsafe practice
• A nurse may need to report nursing colleagues or other
health professionals for practices that endanger the
health and safety of a client.
E.g: Alcohol and drug use theft from a client or agency, and
unsafe nursing practice.
April 26, 2025 146
Guidelines for Reporting a crime, tort or
unsafe practices are:
• Write a clear description of a situation you believe you should
report.
• Make sure that your statements are accurate
• Make sure you are credible / credible
• Obtain support from at least one trust worth person before filing
the report
• Report the matter starting at the lowest possible level in the
agency hierarchy.
• Assume responsibility for reporting the individual
by being open about it, sign your name on the letter.
• follow the problem through once you have reported it.
April 26, 2025
…………..……///…………………… 147
 6.2.12. Record Keeping
Reporting and Documenting
• Reporting: oral or written explanation of
patient status; between members of health
care team.
• Report should be :-
– clear,
– concise, and
– comprehensive.

April 26, 2025 148

• Documenting: patient record/chart provides
written documentation of patient’s status and
treatment.
Purpose:
1. continuity of care,
2. legal document,
3. research,
4. statistics,
5. education,
6. audits
April 26, 2025 149
What to document:
• assessment,
• plan of care,
• nursing interventions (care, teaching, safety
measures),
• outcome of care,
• change in status,
• health care team
• communication,

April 26, 2025 150

Characteristics of documentation:
• brief,
• concise,
• comprehensive,
• factual,
• descriptive,
• objective,
• relevant/appropriate,
• legally prudent (sensible).

April 26, 2025 151

 Record keeping
• Health records are the means by which information is
communicated about clients and means of ensuring
continuity of care.
• The clients medical record is legal document and
can be produced in a court as evidence.
• Records are used as risk management tools and
for research purpose.
• Often the record is used to remind a witness of
events surrounding a lawsuit, because several months or
years usually elapse before the suit goes to trial (court
martial, hearing).
April 26, 2025 152
 Record keeping…cont.
• The effectiveness of record depends up on
accuracy and completeness of the record.
• Nurses need to keep accurate and complete
records of nursing care provided to clients.
• Insufficient or inaccurate
documentation can constitute:
• Negligence and be the basis for tort liability.
• Hinders proper diagnosis and treatment and
• Result injury to the client.
April 26, 2025 153
Accurate Record keeping
1. • Routine nursing assessment and intervention
should be documented properly.
2. Use pen rather than pencil during
documentation.
3. When making correction do not raise the
previous draw one line on an old and add
correction, So the previous remained legible
because correction is not for changing.
 Write legibly.
 Document all information.
April 26, 2025 154
Accurate Record keeping…cont.
4. Add time, date, name and other
important information.
5. Document all medically related
conditions.
6. Use specific terms.
7. Statements should not be biased.
April 26, 2025 155
 THE INCIDENT REPORT

THE INCIDENT REPORT writing:

• An incident report is an agency record of an accident or incident.
• Whenever a patient is injured or has a potential injury there exist a
possibility of a lawsuit, so that a report must be recorded.
• An incidental report may be written for situations involving a
patient, visitors, or employee.
 The incident report is used to:
1. To make all the facts about an accident available to personnel.
2. To contribute to statistical data about accidents or incidents.
3. To help health personnel to prevent future accidents.
4. N.B. the reports should be completed as soon as possible,
i.e., Within 24 hours of the incident and filed according to
agencies policy
April 26, 2025 156
Information to include in Incident
Report
1. Identify the client by name and hospitals
2. Give date and time of the incident.
3. Avoid any conclusions or blame.
4. Describe the incident as you saw it, even if your
impressions differ from those of others.
5. Identify all witnesses to incident
6. Identify any equipment by number and any medication
by name and number.
7. Document any circumstance surrounding the incident.
E.g:- that another client is experiencing cardiac arrest. 157
April 26, 2025
WILLS (pt’s Will of Right)
• A will is a declaration by a person about how the person‘s
property or cash is to be disposed/ distributed after death.
• In order for a will to be valid the following conditions must be
met:
1. The person making the will should be mentally conscious
2. The person should not be unduly influenced by any one else.
3. A nurse may be required to witness a will.
4. A will must be signed in the presence of two witnesses.
5. When witnessing a will, the nurse attests /proves ,that the client signed a
document that is stated to be the client’s last will.
6. Attests that the client appears to be mentally sound and
appreciates the significance of their action.
7. If a nurse witnesses a will, the nurse should record on clients card that the
will was made and patients physical and mental condition.
April 26, 2025 158
Purposes of Recording the Pts’ Wills of Right:-
1. Provides accurate information for later use.
2. May be use full if the will is contested/
disputed.

• N.B. if a nurse does not wish to act as a

witness. For example, if a nurse’s opinion
undue influence has been brought on the
client- then, it is nurse’s right to refuse to act in
this capacity.

April 26, 2025 159

 EUTHANASIA:
• It is the act of pennilessly putting to death persons suffering from
incurable or distressing diseases.
• It is commonly referred as “mercy killing”

Types of Euthanasia:
• 1. Active Euthanasia: Is a deliberate attempt to end life. e.g. a)
Deprivation of oxygen supply,
b) Administering an agent that would result in death.
• 2. Passive Euthanasia: allowing death by withdrawing
or withholding of treatment.
• No special attempt will be made to revive the patient
• All forms of euthanasia are illegal except in states where right to
die status and living will exist.
April 26, 2025 160
 Review questions

1. Define Ethics and identify its relation and difference with

that of morality.
2. What are the common principles of ethics and their
similarity and deference?
3. What is nursing practice act, standard of practice, and
code of ethics?
4. When and how nurses hold the confidence and privacy
of any information obtained during their professional
performance ??
5. What is the basic characteristics and advantage of
documentation?
April 26, 2025 161
Sources:
1.Sharon ,Fundamentals of
Nursing ,2013.P
2.EPHIT, Amsal et al., 2005
P.87-125.
……………….///………………..

April 26, 2025 162