ethic ole gal - final

8/2/2019 Ethic Ole Gal - Final

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Bioethics

ETHICS are set of moralprinciples or values that

informally govern individuals inthe society.

Morality is not the same as ethics.

Morality is behavior in accordance with

custom or tradition and usually

reflects personal or religious beliefs.


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Deontology is an ethical theory

that considers the intrinsic

moral significance of the act

itself as the criterion for

determination of good.

For example, health professionals might operate by

a rule that indicates that a moral person never lies.

No matter how much the truth might hurt, the truth

is told.


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UTILITARIANISM. consequences orthe outcomes of the dilemma are

the most important elements toconsider in decision making

Consequentialism

Ethical if: - minimizes pain andsuffering

- maximizes pleasure

- seeks happiness of themajority


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Theories: EGOISM- self-interest of the

doer determines goodness ofthe act.

Ethical decisions are based on

principles such as autonomy,nonmaleficence, beneficence,

justice, veracity, and fidelity.


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RELATIVISM/ SUBJECTIVISM-standard of right or wrong is relativeto people, to time and to place.

SITUATIONALISM- love theory

NATURAL LAW THEORY- work ofcreator

if acts preserves life, it is good; ifrejects life, it is bad.


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Principles: 1. BENEFICENCE- means to do

good and not to do harm. 2.NON- MALEFICENCE- one

ought not to inflict evil or

harm. 3. AUTONOMY- means self-

determination


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4. JUSTICE- refers to the obligation tobe fair to other people.

Types:

1.distributive justice- fairdistribution of responsibilities

2.criminal justice- penaltyproportionate to crime

3.rectificatory justice- justcompensation in civil law

5. VERACITY- refers to telling the truth

or not intentionally deceiving ormisleading patients


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6. STEWARDSHIP- not harm our

body because it is Gods not

ours.

7. FIDELITY- refers to the

obligation to be faithful to the

agreements, commitments andresponsibilities that one has

made to oneself and others


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8. RESPECT- treat all human

beings as persons with rights

9. SHARING AND ALLOCATION

OF RESOURCES- who will

receive particular scarce

resources.


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PATIENTS BILL OF RIGHTS1. Right to considerate andrespectful care - nurse avoids discriminating

acts that tends to bring the

appearance of favoritism

- tender loving care attitude


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2. Right to information aboutdiagnosis, treatment and prognosis3. Right to informed consent - refers to the capacity of the patient

to accept or refuse treatmentoptions offered by the health careprovider.

Elements: voluntariness

information

capacity


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6. Right to confidentiality - all records and

communications held inconfidence

when to divulge information: patient placed in serious

danger

public welfare

legal proceeding


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BIOETHICS- is the study of humanconduct in the area of the life

sciences and health care using

moral values and principles.

Examples: abortion, euthanasia

contraception, art. Insemination

etc.


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7. Right to go over records8. Right to services and to

transfer - referrals

9. Right to know relationship withother health care andeducational institutions

10. Right not to be subjects ofresearch or experimentation


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11. Right to expect reasonablecontinuity of care - follow up consultations12. Right to examine and receivean explanation of his bill, Right

to know what hospital rulesand regulations apply to hisconduct as a patient


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A nurse is brought to a situationprecisely, because the patients statu

quo is not acceptable.

As perceived by the patient, the role othe nurses is to bring about a desiredchange. It is through observation and

analysis that the nurse is expected tobring about change.


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Nurses primary

responsibility is to preserv

health at all cost.

1. Promotion of health

2. Prevention of illness3. Alleviation of

suffering

4. Restoration of health


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Other Issues


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Other Issues

Slander

Death/Birth Certificate

Immorality/Dishonorable Conduct

Telephone Orders Personal Favors

Sexual Advances/Sexual Harassment


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Nursing Practice is affected

by LAWS and ETHICS

LAWS are societys formal rules oconduct or actions, which the

members recognize asenforceable by controllingauthority.

ETHICO-LEGAL IMPLICATIONS OF I V


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ETHICO-LEGAL IMPLICATIONS OF I.V.

THERAPY

I. Republic Act 9173Rule V, Section 28 Scope

Nursing Practice A nurse while in practice of nursing in all settings i

duty-bound/required to:

Observe the code of Ethics for nurses

Uphold standards for safe nursing practice

Maintain competence to be provided by the APO or an

recognized professional nursing organization

II. New Nurses Code of Ethics


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III. Executive Order No. 220Directing the adaptation of the Code of

Good Governance for the Professionals inthe Philippines

Code of Good Governance for theProfessions in the Philippines

Specific Principles:

Service to Others Integrity and Objectivity

Professional Competence

Solidarity and Teamwork

Social and Civic Responsibility

Global Competitiveness

Equality to All Professions


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PHILIPPINES CODE OF

ETHICS FOR NURSES

NURSES AND PEOPLE


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NURSES AND PEOPLE Values, customs and spiritual

beliefs heldby individuals are tobe respected.

Nurses hold in strict confidencepersonal information acquiredin

the process of giving nursing

care.

NURSES AND PRACTICES


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NURSES AND PRACTICES

Nurses are accountable for their own nursin

practice.

Nurses maintain or modify standards of

practice within the reality of any given

situation.

Nurses are the advocates of the patients.

Nurses are aware that their actions have

professional, ethical, moral and legal

dimensions.

NURSES AND CO-


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NURSES AND CO-WORKERS

Nurses maintain collaborative working

relationships with their co-workers and

other membersof the health team.

They recognize their capabilities and

limitations in accepting responsibilities

and those of their co-workerswhen

delegating responsibilities to them.

NURSES AND SOCIETY


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NURSES AND SOCIETY Nurses are contributing members of

society. They assumeresponsibilities inherent in beingmembers and citizens of thecommunity/society in which theylive/work.

Nurses recognize the need forchange and initiate, participate, andsupport activitiesto meet the healthand social needs of the people.


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PROFESSIONAL

VALUES


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What is CARING? is the locus of all attributes

used to describe NURSING. It is

no only the main value of

Nursing but the Essence. It isnot only a nursing act but to

care is human and to be human

is caring.


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5 Cs of CARING:1. Compassion:A way of living born out of an

awareness of ones relationship to all living

creatures; engendering a response ofparticipation in he experiences of another;

sensitivity to pain and brokenness of the

other; quality of presence which allows one

to share.2. Conscience:A state of moral awareness, a

compass directing ones behavior accordin

to the moral fitness of things

3. Competence:The state of having the


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knowledge, judgment, skill, energy,

experience and motivation required to

respond adequately to the demands of

ones professional responsibilities.

4. Confidence:The ability or quality which

fosters trusting relationships

5. Commitment:A complex affective

response characterized by a convergencebetween ones desires and obligations and

by deliberate choice to at in accordance

with them


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MOST FREQUENTALLEGATIONSAGAINST NURSESAND PREVENTIVETIPS


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POINTS TO OBSERVE

IN ORDER TO AVOID

CRIMINAL LIABILTY

1. Be familiar with the Philippine Nursing Law


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pp g

2. Be aware of the laws that affect the nursinpractice.

3. At the start of the employment get a copy othe agencys rules, regulations and policies

4. Upgrade your skills and competence.

5. Develop good interpersonal relationships wyour co-workers, whether they be yoursupervisor, peer or subordinate.

6. Consult your superiors for problems thatmaybe too big for you to handle.

1 A t l h ibilit th t i ithi th


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1. Accept only such responsibility that is within the scopyour employment and your job description.

2. Do not delegate your responsibility to others.

3. Determine whether your subordinates are competent iwork you are assigning with them.

4. The doctors should be informed about the patients

condition, the effects of the medication and treatmentthe patients lack of progress.

5. The nurse is reminded the value and necessity of keepaccurate, adequate and timely record.

6. Patients are entitled to informed consent.


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Documentation


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St d d M th d f


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Standard Methods of

Recording

1. Chronological or conventional

charting is the most commonly

used, where statements,

remarks, and other data arewritten as they occur,

observed or accomplished.

2. Check List Method

Objectives of Nurses


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Objectives of Nurses

Notes1. To keep a current, concise,

and accurate record of the

patients hospitalization.

2. To provide the health teamwith a guide for future care on

the rehabilitation of a

particular patient.


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INCIDENT REPORT

It is a report of any happeningthat is not consistent with the

routine operation of thesection/unit and/or department

of the hospital

Main Purposes of the


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Main Purposes of the

Incident Report

1. Documentation

2. For correction and/or

improvement of in-service

education.

3. For investigative/legal use.

Points to Consider in


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Making an Incident Report1. Record/report incident written within the

required time promptly (24 hours).2. Write the exact hour, day, date, persons

involved

3. Factual report of each person involved

4. If the patient is involved, write themedical findings and management of thephysician

5. IR is not a punitive measurement.

6. IR is a confidential report.


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Telephone Order


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Wrong Telephone Order

Wrong Chart Order

Right Telephone Orde

Wrong Treatment


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Negligence

LiabilityCountersigned Uncountersig

Attending Doctor Nurse

Hospital

Only one situation


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y

where Telephone

order may be

allowed

Life and death situations

e.g. CPR going on

A licensed doctor should

take the telephone order

and write the order

himself on the doctors

order sheet of themedical record

Most Common Issues Raised in


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Most Common Issues Raised in

the Complaints

Health providers attitude

Delayed response time (85%)

Patients awareness as to

information Changes of procedures during

management

Cost of the medical service

Choice of doctors/nurse

DONT attempt to evade being officially notified,either by a process server or by a certified mail.


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either by a process server or by a certified mail.

RESIST the urge to place court papers in a drawerand hope the case will go away.

DONT assume that someone else has notified youinsurer- notify them yourselfimmediately. This letsthe insurer investigators get statements from youand other key witnesses before the informationbecomes stale. Also, the sooner the insurer knows

the sooner your defense can be established and yostress can subside. Finally, failure to report a claimmay jeopardize your coverage.

NOTIFY your employer. Even if you have personalmalpractice coverage, your employer may have

assistance programs to support you emotionally afinancially. Your employer may also be named in thlawsuit.

If you keep a written record or diary of the


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y p yevents, make sure its factual, concise, anavoids blame. Make sure to show your diato your attorney before bringing it to a

deposition or to trial, as you may need toproduce the diary at those times.

DONT attempt to correct or alter the

patients chart; such as falsification ofdocuments can place your nursing licensein serious jeopardy, even if no lawsuitresults. Late entries are acceptable, butmake sure to follow your facilitys policy

and procedure regarding them.

As much as possible, DONT discuss the case withanyone until youve met with your insurer and


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anyone until youve met with your insurer andattorney; then proceed as advised. If you have youown malpractice insurance, your insurer will provian attorney experience in medical malpractice.

DONT speak to any other attorney without speakito your attorney first (the attorney may even contayou first). She may want to be present to protectyour interests. Once youve been represented by aattorney, an attempt by another attorney to contac

you is unethical.

DONT talk about the case with reporters, patientsor staff without first consulting your attorney.

A 7 year child, epileptic and is scheduled for CT scan with contras


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dye. the nurse understand the consent is needed for the this

procedure. Who among the following relatives can give the consen

for the patient first.

a. His 40 year old uncle

b. His 65 year old grandmother

c. His 26 brother

d. 32 year old cousin


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CONSENT

CONSENT


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CONSENT

PatientsRight

Informed

Consent

Qualified to

give Conse

CONSENT.. Who Has The


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CONSENT.. Who Has The

Duty To Explain?

NURSE DOCTOR

NURSING

PROCEDURES

MEDICAL

PROCEDURESPATIENT

ADMITTING

CONSENT


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CONSENT

CONTRACT ETHICSNURSE- PATIENTRELATIONSHIP PRINCIPLE OFSELF-

AUTONOMY

PRINCIPLE OFSELF-DETERMINATION

REQUISITESCONSENT

OBJECT

CONSIDERATION

INFORMED CONSENT


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INFORMED CONSENTBenefits vs. Risks, Complications,

Risks

Language, Education, Visual Effect, TVVideo

Time to decide, Chance to Ask, 2ndOpinion

INFORMATION

COMPREHEN

VOLUNTARINESS

WHO CAN GIVE


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O C G

CONSENT?1. PATIENT2. SPOUSE3. CHILDREN4. PARENTS5. GRANDPARENTS6. SIBLINGS7. NEAREST KIN8. HOSPITAL DIRECTOR

Situations When Consent


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S tuat o s e Co se t

is Not Necessary

1. It is an emergency

2. It is an exercise of a therapeutic

professional discussion

3. There is a waiver on the part of thepatient

4. Patient already had a similar

experience

IMPORTANCE OF


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1. Professional Responsibility & Accountabilit- to describe the nursing care of individualsand families to promote optimal patient car

2. Legal Purposes

- provides pertinent and useful data about tpatients condition, together with the medicand nursing regimen employed in his/hercase.

- proof that care was maintained according

accepted standards of care.

DOCUMENTATION

MEDICAL RECORD


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MEDICAL RECORD

A Medical Record is a legaldocument of pertinent facts

of a patients life history,

including past and presentillnesses and the present

care and treatment.

The medical record can be the nurses best

f i d t I hi h i


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friend or worst enemy. In which scenario ca

it be the nurses worst enemy;

A. its missing B. it voluminous

C. If it is presented in court as evidence in

a lawsuit

D. if its inaccurate, incomplete andinadequate

A 6 year-old girl with a fractured femur is brought tthe ER by her parents. When asked how the injury

occurred her parents stated that she fell from the


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occurred, her parents stated that she fell from the

sofa. On the examination, the nurse finds old and

new lesions on the childs buttock. Which of the

following statements most appropriately reflectshow the nurse should document these findings?

a. Seven lesions noted on buttocks at various

stages of healing.b. Multiple lesions on buttocks due to child

abuse

c. Lesions on buttocks due to unknown caus

d. Several lesions on buttocks caused bycigarettes

The patients medical records


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are the best evidence of care tha

is given to a patient. Medical records should be

complete, accurate and adequat

documentation of the quality of

patient care.


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TIPS ON HOW TO DOCORRECTIONS ON


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CORRECTIONS ON

MEDICAL RECORDS:

If there are wrong entries, merely cross-out the

word with one or two lines, so that the crossed

word can still be discernable.

Avoid blank spaces; if there are blank spaces,

cross them out.

Additions or correction should be properly

counter-signed and dated.

If there are any deviations from


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the normal practice or

procedure, this must be

documented and the reason for

the deviation briefly explained.

HCW should not argue, quarrel,

or criticize each other in the

patients chart.

Incident report is not a part of

the patients medical records.

FUNDAMENTALS OFEFFECTIVE


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EFFECTIVE

DOCUMENTATION Write legibly and neatly always

countersigned your name.

Use proper spelling and grammar.

Choose terms carefully. Be specific andconcise.

Use authorized abbreviations.

If possible write in an active voice rather tha

passive voice


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passive voice.

Place time of event.

Chart promptly. Chart after delivery of nursing care, not befo

Identify late entries correctly.

Correct mistaken entries properly.

Do minimal charting of routine on respective

data.

Make sure the patients name is on every she

Use your nursing judgment

Know when to use direct quotations


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SKILLS KNOWLEDGE ATTITUDE

Documents nursing data A Fundamentals of A Values of the


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Documents nursing dataaccurately using astandard format of the

ff:A. Significant findings/observations/ problemsB. Medical/Nursingintervention madeincluding referrals

C. Evaluation of patientscareOutcomes based onmedical/ nursinginterventions made

A. Fundamentals ofeffectivedocumentation

B. Methods, knowledgeand skills in recordingassessment,interventions andevaluationC. Legal/Ethical

implications ofdocumentation

A. Values of theimportance of beinvigilant on looking o

significant changesevaluation the dailystatus and progress patients.B. Realizes theimportance of prop

and accuratedocumentation ofpatient care.C. Recognizes theimportance of legaimplications indocumentation.


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A 7 year old boy with a compound fracture of the right femu

is being admitted to a pediatric unit. Which of the followin


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actions is best for the nurse to take.

A. Ask the Nursing Aid to obtain VS while the nurseobtains a history from the parents

B. Ask the NA to assess peripheral pulse of the

childs left leg while the nurse completes the

admission forms

C. Ask the NA to stay with the child and his parent

while the nurse obtains phone orders from the

physician

D. Ask the NA to obtain equipment for the childs

care while the nurse talks with the child and his

parents

A woman is admitted to the hospital with a ruptured ectop

pregnancy. A laparotomy is scheduled, Preoperatively,

which of the following goals is most important for the nurs


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which of the following goals is most important for the nurs

to inlcude on the patients plan of care

A. fluid replacement

B. Pain relief

C. Emotional support

D. Respiratory therapy

9. SITUATION; Marco Antonio Manos, 25 yo. Accountant, was admittedcomplaints of fever and gangrenous big toe on the right foot;


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Mark becomes openly hostile when learning thaamputation of gangrenous toe is being. The bindication that the nurses interaction has beetherapeutic would be

a. An increase in physical activityb. A relaxation of tensed musclesc. Absence of further outburstd. A denial that further discussion is necessary

Nonverbal behavio

better is a better

index of feelings

because it is less

likely to beconsciously contro

A 49-year old woman sustains a left femur fracture in avehicular accident. She is placed in a balanced

suspension skeletal traction. The patient tells the nurse

th t h h t ibl i i h l ft thi h Wh t h ld


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that she has terrible pain in her left thigh. What should

the nurse do first

a. Determine that all the weights and ropes free from the

traction apparatus are in line and hanging free

b. Ask the patient for more information about the location

and characteristics of her pain

c. Check the traction and splint if its positioned

appropriately

d. Explain to the patient that pain she is experiencing in the

affected leg is a common occurrence.