Ethics

NURSES AND CONTRACTS

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 which the law recognizes as a duty and when that duty is not performed the law provides a remedy (Breach)

KINDS OF CONTRACT Formal- refers to an agreement between parties and is required to be in writing. E.g. marriage contract .. Informal- one in which the law does not require the same to be in writing. Express- the conditions and terms of contract are given orally or in writing by the parties concerned. E.g. PDN under the doctrine of "facio ut des" means I do that you may give.

Implied- one that is concluded as a result of acts of conduct of the parties into a contract. Void- one that is inexistent from the very beginning and therefore may not be enforced. Illegal- one that is expressly prohibited by law Those that are made In protection of the law Consent obtained by fraud; duress; undue influence and material misrepresentation

CONSENT a free and rational act that presupposes knowledge of the thing to which consent is being given by a person who is legally capable to give consent Informed Consent- a written consent should be signed to show that the procedure is the one consented to and that the person understands the nature of the procedure

Nurse’s responsibility regarding informed consent (1) witness the exchange between the client and the physician (2) witnessing the client affix his signature (3) establishing that the client really understood.

Characteristics of a Valid Consent Voluntariness; free from coercion Opportunities to ask questions expalined Treatment explained Understood by the patient Maturity of parties (physically and mentally)

CRITERIA OF GOOD CONSENT Eighteen years old and above Mentally capacitated Proxy consent- <18 and mentally incapacitated Parent Guardian (in order) Physician Guardian ad litem

Exceptions to an Informed Consent Married & mature minors Emancipated minors Emergency cases Minors seeking birth control or pre-natal treatment Over specific age (12 years old & above may give consent for STD, HIV testing, AIDS treatment, drugs & alcohol treatment without parents consent. Sexually abused minors & adolescents

QUESTION The nurse must see to it that the written consent of mentally ill patients must be taken from: A. Doctor B. Social worker C. Parents or legal guardian D. Law enforcement authorities

QUESTION Imang is terminally ill, she speaks to you in confidence. You now feel that Imang’s family could be helpful if they knew what Imang has told you. What should you do first? A. Tell the physician who in turn could tell the family B. Obtain her permission to share the information in the family C. Tell Imang that she has to tell her family what she told you D. Make an appointment to discuss the situation with the family

QUESTION Informed consent is necessary for the treatment for involuntary clients. When this cannot be obtained, permission may be taken from the: A. social worker B. doctor C. next of kin or guardian D. chief nurse

QUESTION The patient has a right to information regarding the operation or other invasive procedure and potential effects. This right is achieved through: A. informed consent B. preoperative visit C. charting D. doctor’s rounds

QUESTION A thumb mark of a comatose patient in the informed consent is considered: A. a misrepresentation B. “nothing” C. not a valid signature D. a valid signature

QUESTION Edward elaborated on the concept of informed consent. He determines that the nurses need more explanation if their response is one of the following: A. the consent should provide a description of alternative treatments or procedures B. the consent should offer a thorough explanation of the procedures to be done and the consequences of it. C. the consent should include the medical diagnosis and explanation of the patient’s condition D. the consent should describe the prognosis if the recommended care is refused.

QUESTION A nurse and a pregnant woman agreed that the nurse will do home delivery for a fee. What type of contract? A. Implied C. Void B. Expressed D. Formal

LEGAL CONSIDERATIONS IN CHARTING PURPOSE OF THE PT’S. CHART Communication and continuity Assurance of quality care Research Legal document Statistics of the disease *The chart is owned by the hospital

DO’S & DONT’S IN CHARTING DO’S Full, factual and objectively accurate Legible Immediate Personal DON’T’S Language or unacceptable words Improper corrections Spaces & skips Abbreviation, not standard

Don’t tamper the medical record by: Adding Rewriting Destroying original record Observe agency’s standards on documentation Complete & Concise Specific & Standard abbreviations

Writing an Incident Report A tool used as a means of identifying and improving client care. They are usually made immediately after its occurrence and validated immediately by co-workers. Purpose: to provide accurate documentation of occurrences affecting the client as to have basis for its intervention.

The following are common situations that require an incident report: MOST OF THEM ARE NEGLIGENT ACTS Falls , burns & medication error Break in the aseptic technique Incorrect sponge count during surgery Failure to report the clients condition Rules in Incident Report Don’t use the word error or include lawful judgment or inflammatory words

QUESTION A main function of the patient’s records is to: A. prepare the nurse for the shift worked B. serve as a record of financial charges C. serve as a vehicle for communication D. ensure that the message is received

QUESTION When the nurse writes in the chart and discovers an error has been made, which is the BEST approach? A. erase the erroneous material B. carefully ink out the erroneous material C. place an asterisk next to the statement, then footnote it D. draw a straight line through the error & initial it.

QUESTION

1. 2. 3. 4. 6.

Which of the following qualities are relevant in documenting patients care? accuracy and consciousness thoroughness and currentness systematic and orderly legibly, properly dated and signed use of locally accepted abbreviation A. 1,3,4 & 5 B. 2,3,4 & 5

C. 1,2,3 & 5 D. 1,2,3,& 4

QUESTION The patient’s medical record can work as a double edged sword. When can the medical record become the doctor’s/ nurse’s worst enemy? A. When the record is voluminous B. When a medical record is subpoenaed in court C. When it is missing D. When the medical record is inaccurate, incomplete, and inadequate

QUESTION Disposal of medical records in government hospitals/institutions must be done in close coordination with what agency? A. Department of Interior and Local Government (DILG) B. Metro Manila Development Authority (MMDA) C. Records Management Archives Office (RMAO) D. Department of Health (DOH)

QUESTION In the hospital, when you need the medical record of a discharged patient for research you will request permission through: A. Doctor in charge B. Hospital director C. The nursing service D. Medical records section

QUESTION Legally, patient’s chart is: A. Owned by the hospital B. Owned by the doctor C. Owned by the gov’t. cause it’s a legal document D. Owned by the patient

QUESTION As a nurse, you can help improve the effectiveness of communication among healthcare givers by: A. Use of reminders of ‘what to do’ B. Using standardized list of abbreviations, acronyms, and symbols C. One-on-one oral endorsement D. Text messaging and e-mail

QUESTION Charting should be legible and include only standard abbreviations. Which of the following is NOT a standard abbreviation? A. PRN C. NNO B. OD D. NPO

NURSES AND WILLS, GIFTS, ADVANCE DIRECTIVES WILLS- legal declaration of a person’s intentions upon death. Called a testamentary document because it takes effect after the death of its maker An act whereby a person is permitted with the formalities prescribed by law, to control a certain degree the deposition of his estate, to take effect after death.

Decedent – a person whose property is transmitted through succession whether or not he left a will Testator – a person who left a will. Testatrix – a woman who is making a will Heir – a person called to succession either by the provision of a will or by operation of law Testate – a person who dies leaving a will Intestate – a person who died without leaving a will Probate – validation of a will in court Administrator – one who administers the provision of the will Estate – the interest a person has in lands or in any other subject to property Attestation Clause- means the clause wherein the witness certifies that the instrument has been executed before them, and the manner of the same.

TYPES OF WILLS Holographic will – a will is written, dated and signed by the testator Nuncupative will or Nuncupation- an oral will

WHO CAN MAKE A WILL? Sound mind Eighteen years old & above Not prohibited by law WHO CAN WITNESS? Sound mind Eighteen years old & above Able to read and write Not blind, deaf or dumb

The Nurses obligation in the Execution of a will Note the soundness of the pt’s mind Ensure there was freedom from fraud or under influence The pt should be above 18 years of age Note the will was signed by the testator and that the witnesses signed the will in the presence of the testator For protection, the nurse must make a notation on the pt’s chart

Gifts Another way of disposing property Four legal requirements for a gift: gift must consist of personal property Intention to make the gift Indication of transfer of control over such property acceptance by the recipient Gifts Causa Mortis or Donation Causa Mortis – Gifts made by a person because of anticipation of death or beliefs in approaching death.

ADVANCE CARE DIRECTIVE a document written or completed by the client and used by a facility or hospital to provide care at a time when client cannot make his own decision SUBJ ECTS: 1. Show risk for early dementia 2. Show risk for stroke 3. Activities- severe head injuries 4. Severe and recurring psychiatric illness 5. Terminally ill

Characteristics of Advance Directives b. Allows clients to participate in choosing health care providers c. Allows also in choosing the type of medical treatment the client desires. c. Allows clients to consent or refuse treatments

TYPES: 1. INSTRUCTIVE DIRECTIVE- specifies lifesustaining treatment to be withheld or withdrawn. LIVING WILL-legal document stating person does not wish to have extraordinary life saving measures when not able to make decisions about his own care. -applicable for life saving treatment only. Example: DNR

2. PROXY OR DURABLE POWER OF ATTORNEY legal document giving designated person authority to make health care decisions on the client’s behalf when the client is unable to do so.

QUESTION Mr. Martin felt better after 5 days but recognizing the severity of his illness, he executes a document authorizing the wife to transact any form of business in his behalf in addition to all decisions relative to his confinement his document is referred to as: A. durable power of attorney B. living will C. informed consent D. medical records

QUESTION While in the ICU, a pt. executes the document that list the medical treatment he chooses to refuse in case his condition becomes severe to a point that he will be unable to make decisions for himself. This document is: A. living will B. informed consent C. last will and testament D. power of attorney

Do not Resuscitate (DNR) Factors in giving order of resuscitation: 1. Client’s will and advance directives 2. Disease prognosis such as cancer or HIV 3. Client’s ability to cope 4. Whether CPR will be given or not

Reasons for refusing to perform resuscitation Epidemic or widespread disease or debilitating condition & that CPR is not beneficial CPR will aggravate or prolong the agony of the client against cultural & religious suffering Advance directives & Will

QUESTION In medical and nursing practice, code means a call for: A. DNR state B. call to order C. clinical case D. cardiopulmonary resuscitation

Organ Donation REQUIREMENTS: Any person 18 years of age or older may become an organ donor by written consent. Informed choice to donate an organ can take place with the use of a written document signed by the client prior to death, a will, or a donor card or an advance directive. In the absence of appropriate documentation, a family member or legal guardian may authorize donation on the descendant’s organs. In case of newborns, they must be full term already (more than 200 grams)

TYPES: 1. Autotransplantation- donor and recipient are one and the same Ex: skin and bones 2. Heterologous- donor and recipient are two different individuals. a. animal to human b. human to human c. cadaver donor d. living donor Types of organs used : 1. Those that regenerate - bone marrow, skin 2. Those that come in pair - kidneys, eyes

Religions that have different views regarding organ donations Russian Orthodox: permits all donations EXCEPT THE HEART. Jehovah’s Witness: DOES NOT ALLOW organ donation and all organ to be transplanted must be drained of blood first. Judaism: They permit organ donation as long as with RABBINICAL CONSULTATION. Islam: will NOT USE ORGAN STORED IN ORGAN BANKS.

NURSING ETHICS

ETHICS Came from the Greek word ETHOS ‘moral duty’ Studies how people make judgment in regard to right or wrong MORALITY It is the right or wrong; good or evil; proper or improper, cruel or benevolent acts

Health Care ethics Division of ethics that relates to human health Bioethics Focuses on moral issues in the field of health care NURSING ETHICS The examination of all ethical and bio-ethical issues from the prospective of nursing theory and practice

PRINCIPLES IN BIOETHICS BENEFICENCE means to do only what’s good NON- MALEFICENCE Principle of “do no harm” AUTONOMY the right to make one’s own decision; self-determination STEWARDSHIP not harm our body because it is God’s not ours

JUSTICE The right to be treated fairly, justly and equally FIDELITY refers to the obligation to be faithful to the agreements, commitments and responsibilities that one has made to oneself and others VERACITY Truthfulness or honesty

RESPECT treat all individuals as persons with rights with or without abnormality. INVIOLABILITY/ SANCTITY OF LIFE No one can violate or destroy life SHARING OR ALLOCATION OF RESOURCES applies when resources are scanty or very limited

Standards of Care Guidelines for determining whether nurses have performed duties in an appropriate manner & guidelines in which the nurse should practice

QUESTION Bioethics in caring for children capitalizes on some important principles. You are expected to know these by heart because nurses care for children as well as adults. What is the principle to hold on when caring for children who have been abandoned and abused? a. consistent assurance b. respect c. allocation of resources d. autonomy

QUESTION The principle that tells children are to be treated accordingly as persons is a. beneficence b. autonomy c. non-maleficence d. respect

QUESTION When a nurse is providing care to her/his patient, s/he must remember that she is duty bound not to do any action that will cause the patient harm. This is the meaning of the bioethical principle: A. Non-maleficence B. Beneficence C. Justice D. Solidarity

QUESTION When the nurse triage patients to render care accordingly, you are using this particular principle a. respect b. allocation of resources c. beneficence d. autonomy

QUESTION In choosing sharp intramuscular needles for injection, you are practicing this principle a. beneficence b. respect c. justice d. non-maleficence

QUESTION In rendering care to a handicapped child, the nurse has many responsibilities, most of all the nurse should be ethical. What principle should a nurse carry when caring for a handicapped child? a. respect b. beneficence c. non-maleficence d. justice

QUESTION Ensuring that there is an informed consent on the part of the patient before a surgery is done, illustrates the bioethical principle of: A. Beneficence B. Autonomy C. Veracity D. Non-maleficence

QUESTION In apportioning candies and other nice goodies among children, what bioethical principle should a nurse observe? a. respect b. beneficence c. non-maleficence d. justice

QUESTION This principle states that a person has unconditional worth and has the capacity to determine his own destiny: A. Bioethics B. Justice

C. Fidelity D. Autonomy

QUESTION A handicapped child like any other child should be loaded with a. care b. food c. toys d. love

QUESTION What ethical consideration is violated in human transplantation? a. Principle of totality b. Stewardship c. Autonomy d. Respect

PATIENT’S BILL OF RIGHTS 1. Right to considerate and respectful care nurse avoids discriminating acts that tends to bring the appearance of favoritism a “ tender loving care attitude” 2. Right to information about diagnosis, treatment and prognosis

3. Right to informed consent refers to the capacity of the patient to accept or refuse treatment options offered by the health care provider. Elements: Voluntariness Informed Competent parties Knowledgable info. provided Signed prior to pre-op meds

4. Right to an advance care directive 5. Right to Privacy 6. Right to confidentiality all records and communications held in confidence when to divulge information: 1. patient placed in serious danger 2. public welfare 3. legal proceeding

7. Right to go over records 8. Right to services and to transfer Referral 9. Right to know relationship with other health care and educational institutions 10. Right not to be subjects of research or experimentation 11. Right to expect reasonable continuity of care follow up consultations 12. Right to know what hospital rules and regulations apply to his conduct as a patient

MORAL PRINCIPLES The golden rule Do unto others what you would like others do unto you

The two fold effect May have bad and good effect Must be morally good Good effect must be willed and the bad effect merely allowed Good effect must not come from an evil action Good effect must be greater than the bad effect

The Principle of Totality The whole is greater than any of its parts

Epikia Exception to the general rule

One who acts through an agent is himself responsible Ex. Nurse recommends patient to another clinic for abortion but does not want to perform

No one is obliged to betray himself/herself No one can force any person to answer a question if such will incriminate him/her

The end does not justify the means Giving sleeping tablets to someone who has chronic illness

Defects of nature may be corrected Corrected by plastic surgery

If one is willing to cooperate in the act, no injustice is done to him/her With patient’s consent

A little more or less does not change the substance of an act Stealing

The greatest good for the greatest number Have more good effects for more people than a smaller group

No one is held to the impossible Do not promise impossible things

The morality of cooperation Formal cooperation is an evil act and never allowed

Principle relating to the origin and destruction of life Thou shall not kill

PATIENT’S RESPONSIBILITIES Providing information Complying with instructions Informing the physician of refusal to treatment Paying hospital charges Following hospital rules and regulations Showing respect and consideration

NURSES’ BILL OF RIGHTS Registered nurses promote and restore health Prevent illness Protect the people entrusted to their care Alleviate suffering Provide services that maintain respect for human dignity

QUESTION The Patient’s Bill of rights helps practitioners provide more effective patient care. Which of the following should NOT be included in the list? A. be informed of administrative and policies and practices B. considerate and respectful care C. confidentiality of communications and records D. relevant current and understandable information concerning diagnosis, treatment diagnosis, specific procedures treatment and risks involved.

QUESTION You inform the patient about his rights which include the following EXCEPT: A. Right to expect reasonable continuity of care B. Right to consent to or decline to participate in research studies or experiments C. Right to obtain information about another patient D. Right to expect that the records about his care will be treated as confidential

QUESTION Which document addresses the patient’s right to information, informed consent and treatment refusal? A. Code for Nurses B. Nursing Practice Act C. Patient’s Bill of Rights D. Standard of Nursing Practice

Board Resolution # 220

CODE OF ETHICS FOR REGISTERED NURSES

Four basic ethical principles: 1. Fundamental responsibility of the nurse is four-fold 2. Nurse renders service regardless of race, creed, nationality or political belief. 3. Nurse protects life and respects the dignity of man. 4. Nurse works in collaboration with members of the health team

REGISTERED NURSES AND PEOPLE Ethical Principles: Values, customs and spiritual beliefs shall be respected Individual freedom to make decisions Personal information acquired must be held in confidence

Guidelines to be observed: a. individuality and totality of patients b. respect c. uphold the rights of individuals d. take into consideration culture and values in the event of conflict, welfare and safety take precedence

REGISTERED NURSES AND PRACTICE Ethical Principles a.Human life is inviolable b.Quality and excellence in the care of patients c.Accurate documentation- nursing accountability

Guidelines to be observed: a. know the definition and scope of nursing practice b. be aware of duties and responsibilities c. acquire and develop competence in knowledge, skills and attitude d. optimum standard of safe nursing practice e. be morally and legally responsible f. patient’s records considered confidential

RN’S are aware that their actions have professional, ethical, moral and legal dimensions Guidelines to be observed: 1. Duties in conformity with law 2. Not allow to be used in advertisements that demean image of the profession 3. Decline any gift, favor or hospitality from patient 4. Not demand and receive any commission, fee for recommendations made 5. Avoid any abuse of relationship

REGISTERED NURSES AND THE PROFESSION Ethical Principles: 1. Maintain loyalty 2. Compliance with by laws of accredited professional organizations 3. Commitment to continual learning 4. Contribute to the improvement of the socio-economic conditions and welfare of nurses

Guidelines to be observed: a. Be a member of accredited prof organization (PNA) b. Strictly adhere to nursing standards c. Strive to secure equitable working conditions through appropriate legislation and other means d. Assert for the implementation of labor and work standards

QUESTION Based on the Code of Ethics for Filipino Nurses, what is regarded as the hallmark of nursing responsibility and accountability? A. Human rights of clients, regardless of creed and gender B. The privilege of being a registered professional nurses C. Health, being a fundamental right of every individual D. Accurate documentation of actions and outcomes

QUESTION A basic structure against which competent care is objectively measured is which of the following? a. principles b. standards c. laws d. codes

QUESTION Which of the following nurse’s behavior is regarded as a violation of the Code of Ethics of Filipino Nurses? A. A nurse withholding harmful information to the family members of a patient B. A nurse declining commission sent by a doctor for her referral C. A nurse endorsing a person running for congress. D. Nurse Reviewers and/or nurse review center managers who pays a considerable amount of cash for reviewees who would memorize items from the licensure exams and submit these to them after the examination.

QUESTION The purpose of having a nurses’ code of ethics is: A. Delineate the scope and areas of nursing practice B. Identify nursing action recommended for specific health care situations C. To help the public understand professional conduct expected of nurses D. To define the roles and functions of the health care givers, nurses, clients

-GET MOTIVATED! -BELIEVE THAT YOU WILL PASS! -HAVE FAITH IN HIM! God bless you!!!