Lesson 1, Topic 1
In Progress

07-Objectives: Ethical Issues facing Health Care Workers

April 12, 2021

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  1. Telling the Truth
  2. Confidentiality
  3. Right to Die
  4. Allocation of Scarce Resources

[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ align_self=”auto” content_layout=”column” align_content=”flex-start” valign_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” type_medium=”” type_small=”” order_medium=”0″ order_small=”0″ dimension_spacing_medium=”” dimension_spacing_small=”” dimension_spacing=”” dimension_margin_medium=”” dimension_margin_small=”” margin_top=”” margin_bottom=”” padding_medium=”” padding_small=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” hover_type=”none” border_sizes=”” border_color=”” border_style=”solid” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_color=”” gradient_end_color=”” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” render_logics=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no” border_position=”all”][fusion_accordion type=”” boxed_mode=”” border_size=”1″ border_color=”” background_color=”” hover_color=”” divider_line=”” title_font_size=”” icon_size=”” icon_color=”” icon_boxed_mode=”” icon_box_color=”” icon_alignment=”” toggle_hover_accent_color=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””][fusion_toggle title=”Ethical Aspects of Nursing” open=”no” class=”” id=””]

The science of ethics studies the relationships between moral actions and values and how these affect society. The word ethics refers to values that influence a person’s behavior and the individual’s feelings and beliefs about what is right or wrong. Nursing ethics involve moral values and principles that affect personal and professional conduct. As previously mentioned, the LPN/LVN has the responsibility to practice within the legal and ethical boundaries of nursing practice. Nursing ethics propose the duties and obligations of nurses to their patients, other health care professionals, the profession itself, and society.

[/fusion_toggle][fusion_toggle title=”Confidentiality” open=”no” class=”” id=””]

Nurses have a duty to protect information about a patient regardless of how the information is kept. Information should be accessed only on a need-to-know basis. For example, on a patient care unit only those health care personnel directly involved in an individual’s care should be able to access that patient’s information. Failure to maintain patient confidentiality risks legal liability and both civil and criminal filings may result. Employers consider violations of confidentiality an offense that justifies termination. The responsibility of maintaining confidentiality is not limited to the work shift. All matters committed to the nurse’s keeping are to be held in confidence. Securing the materials that contain confidential information is a responsibility of the nurse. These materials include not only the physical chart forms but the technological resources as well. When accessing computerized pat­ient files, the nurse must ensure the appropriate log-out information is entered to prevent others from viewing the records. Written notes and chart forms must be stored in restricted areas. Conversations discussing patients and their personal information should be held in private conference rooms. Discussions away from the patient care areas, such as the elevator or cafeteria, are problematic and should be avoided.

[/fusion_toggle][fusion_toggle title=”Medical Records” open=”no” class=”” id=””]Laws govern the collection, maintenance, and disclosure of information in medical records. Each health care institution also has policies and procedures regarding patient medical records. Medical records are not public documents, and the information they contain must be kept secure. Any breach in the confidentiality of information kept in a patient’s medical record risks legal liability.

In a lawsuit, both parties are permitted to use the patient’s medical record to argue facts of the case. Entries made in the chart often show whether the standards of care were met in a given situation. It is essential that the employing institution’s policies and procedures regarding the patient’s medical record be followed. All entries in the medical record must be permanent, accurate, complete, and legible. Two current trends potentially affect patient confidentiality. Many smaller health care organizations are merging to form large corporations in an effort to save resources while continuing to provide services. Also, computer-based health care records are becoming common.

Together, these two trends have the potential to vastly expand the numbers of people with access to confidential patient information. Those implementing these trends are required to take federal HIPAA pri­vacy standards into consideration and prevent unauthorized disclosure of medical records and patient information.[/fusion_toggle][fusion_toggle title=”Invasion of Privacy” open=”no” class=”” id=””]

The legal concept of invasion of privacy involves a person’s right to be left alone and remain anonymous if he or she chooses. Consent for treatment does not waive the right to privacy. Privacy-related concerns may include the physical exposure or disclosure of patient information to others. When providing care, the nurse should protect the patient from unnecessary exposure with the use of drapes and remember to close the door or use available signage to restrict admission to rooms during procedures as needed. Calls and inquiries concerning the patient should be handled with care. Providing information to callers can result in a breach in confidentiality. Calls should be referred to the charge nurse or available family members. Nurses frequently take notes during change of shift report. These notes should be closely monitored during the shift. Report sheets and communication tools should be destroyed at the end of the shift before the nurse leaves the worksite. Use of any patient information (name, photograph, specific facts regarding an illness, and so on) without authorization is a violation of the patient’s legal rights. Safeguard the patient’s right to privacy at all times.

[/fusion_toggle][fusion_toggle title=”Reporting Abuse” open=”no” class=”” id=””]

There are exceptions to the right to privacy. The law stipulates that the health care professional is required to report certain information to the appropriate authorities. The report should be given to a supervisor or directly to the police, according to agency policy. When acting in good faith to report mandated information (e.g., certain communicable diseases or gun­shot wounds), the health care professional is protected from liability.

In an effort to respond to the growing problem of child abuse, the federal Child Abuse Prevention Treatment Act of 1973 made the reporting of child abuse mandatory. Health care professionals are mandated reporters. Failure to report suspected cases to the appropriate authorities may result in fines or imprisonment. Facilities have procedures in place to assist the nurse when making reports. Withholding medical treatment to an infant born with serious life-threatening handicaps is a form of child abuse. Congress enacted the Child Abuse Amendments in 1984 to protect the rights of these handicapped newborns to proper treatment and care. These regulations make any institution that receives federal funds legally responsible to investigate the withholding of medical treatment to an infant. In general, withholding of lifesaving treatment and care is a form of passive euthanasia (letting a person die) and medical neglect. This act carries the risk of professional neglect (medical malpractice) charges.

Spousal and elder abuse may also be a hidden problem within a family. Populations at increased risk include women and older adults (see Life Span Considerations for Older Adults box). Most states have responded to the issue of spousal and elder abuse by enacting laws to protect victims. Fines, restraining orders that prohibit contact by the abusing person, and even imprisonment are some of the ways often attempted to protect the victims of abuse. Abuse is an underreported crime. Only a portion of abuse cases are ever reported. It is the responsibility of the nurse to know the signs of abuse and the procedures for reporting suspected cases.  Workplace violence is another form of abuse that occurs at times in the health care setting. This form of violence includes verbal abuse, emotional abuse, sexual harassment, physical assault, and threatening behavior. Health care institutions are implementing policies and procedures to promote a safe work environment, and education is an important component of the awareness and prevention measures. Strategies to provide adequate supervision, employ security personnel, monitor work areas, and facilitate reporting of incidents represent efforts to decrease the incidence of workplace violence.

[/fusion_toggle][fusion_toggle title=”Patients’ Rights” open=”no” class=”” id=””]

In 1972, the American Hospital Association (AHA) issued the Patient’s Bill of Rights in an effort to ensure the patient’s fundamental rights for treatment with dignity and compassion were fulfilled. The trailblazing document was revised again in the 1990s and was finally replaced in 2003 when the AHA adopted the Patient Care Partnership (Box 1-2). Under the terms of this document, patients are assured that they can expect high-quality hospital care, a clean and safe.

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Box 1-2 Characteristics, Roles, and Responsibilities of the Practical or Vocational Nurse

  • Is a responsible and accountable member of the health care team
  • Maintains a current license
  • Practices within the scope of the nurse practice act
  • Practices under the supervision of the registered nurse, or physician
  • Supervises other practical/vocational nurses and unlicensed assistive personnel
  • Participates in continuing education activities
  • Uses the nursing process to meet patients’ needs
  • Promotes and maintains health, prevents disease, and encourages and assists in rehabilitation
  • Maintains a professional appearance
  • Subscribes to recognized ethical practices
  • Participates in activities of professional organizations
  • Assists in developing the role of the licensed practical nurse and licensed vocational nurse of tomorrow

environment, involvement in their care and the decision-making process, protection of privacy, help when leaving the hospital, and help with billing concerns (American Hospital Association, 2003). Nursing home patients also have their rights protected. The Resident’s Bill of Rights is a document that has been developed to provide clarity to the needs and rights of the individual who resides in a long-term care environment (Centers for Medicare and Medicaid Services, 2012).[/fusion_text][/fusion_builder_column][fusion_builder_column type=”1_1″ align_self=”auto” content_layout=”column” align_content=”flex-start” valign_content=”flex-start” content_wrap=”wrap” spacing=”” center_content=”no” link=”” target=”_self” min_height=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” sticky_display=”normal,sticky” class=”” id=”” type_medium=”” type_small=”” order_medium=”0″ order_small=”0″ dimension_spacing_medium=”” dimension_spacing_small=”” dimension_spacing=”” dimension_margin_medium=”” dimension_margin_small=”” margin_top=”” margin_bottom=”” padding_medium=”” padding_small=”” padding_top=”” padding_right=”” padding_bottom=”” padding_left=”” hover_type=”none” border_sizes=”” border_color=”” border_style=”solid” border_radius=”” box_shadow=”no” dimension_box_shadow=”” box_shadow_blur=”0″ box_shadow_spread=”0″ box_shadow_color=”” box_shadow_style=”” background_type=”single” gradient_start_color=”” gradient_end_color=”” gradient_start_position=”0″ gradient_end_position=”100″ gradient_type=”linear” radial_direction=”center center” linear_angle=”180″ background_color=”” background_image=”” background_image_id=”” background_position=”left top” background_repeat=”no-repeat” background_blend_mode=”none” render_logics=”” filter_type=”regular” filter_hue=”0″ filter_saturation=”100″ filter_brightness=”100″ filter_contrast=”100″ filter_invert=”0″ filter_sepia=”0″ filter_opacity=”100″ filter_blur=”0″ filter_hue_hover=”0″ filter_saturation_hover=”100″ filter_brightness_hover=”100″ filter_contrast_hover=”100″ filter_invert_hover=”0″ filter_sepia_hover=”0″ filter_opacity_hover=”100″ filter_blur_hover=”0″ animation_type=”” animation_direction=”left” animation_speed=”0.3″ animation_offset=”” last=”no” border_position=”all”][fusion_accordion type=”” boxed_mode=”” border_size=”1″ border_color=”” background_color=”” hover_color=”” divider_line=”” title_font_size=”” icon_size=”” icon_color=”” icon_boxed_mode=”” icon_box_color=”” icon_alignment=”” toggle_hover_accent_color=”” hide_on_mobile=”small-visibility,medium-visibility,large-visibility” class=”” id=””][fusion_toggle title=”Health Care Providers’ Rights” open=”no” class=”” id=””]

The delivery of health care has to be a process of mutual exchange between patients and health care providers. Patients expect their rights as just outlined to be respected, but health care workers have expectations as well. Health care professionals expect that patients will do the following to actively participate in their care as much as possible: take an active role in the planning process, have an understanding of the care and the treatment given, ask questions, follow the treatment plan prescribed, act responsibly with respect to their own conditions, and give health care workers the same respect to which patients are entitled.

[/fusion_toggle][fusion_toggle title=”Ethical Principles in Nursing Practice” open=”no” class=”” id=””]

In health care, several common ethical principles are important for consideration when confronted with an ethical question. The first, most fundamental principle is respect for people. This principle leads us to view all human life as sacred, with each individual having inherent worth as a person. To the nurse, this principle means that no one person is more important than another; each patient has the same worth and is always entitled to respect. Autonomy is another ethical principle; it refers to freedom of personal choice, a right to be independent and make decisions freely. Frequently the patient may ask the nurse for opinions or assistance in making decisions. The nurse does not have the authority to make decisions for the patient. Beneficence means doing good or acting for someone’s good; this principle is one of primary importance to nurses. The nurse has an ethical duty to protect life and promote the well-being of all patients. Another ethical principle is nonmaleficence, which means to do no harm. It is paramount to nursing practice to act in the patient’s best interest and an ethical and legal duty to do nothing that has a harmful effect on the patient. Finally, there is the principle of justice, or the concept of what is fair. In the context of nursing, justice means that all patients have the same right to nursing interventions.

It is a great challenge to the nurse to balance these ethical principles when they seem in conflict. Rarely are options clear or black and white. Decisions often come down to choosing what seems more right and less wrong, more good and less bad.

[/fusion_toggle][fusion_toggle title=”Codes of Ethics” open=”no” class=”” id=””]

As a member of society and the health care community, nurses use both personal and professional ethical principles to govern professional practice. Professional organizations have developed codes of ethics for the nursing profession that serve as a way to regulate the nurses’ actions and give guidelines for ethical behavior. By helping health care practitioners become more competent, trustworthy, and accountable, such codes of ethics help safeguard society. The National Federation of Licensed Practical/Vocational Nurses (NFLPN)

has developed a code for LPN/LVNs. This code specifies what is expected: (1) to know and function within the scope of practice for a licensed LPN/LVN; (2) to maintain patient confidences; (3) to provide health care without discrimination; (4) to maintain a high degree of professional and personal behavior; and (5) to take an active role in the development of the LPN/LVN profession. The ANA and the CNA have also developed codes of ethics that specify the ethical duties required of the nursing professional.

[/fusion_toggle][fusion_toggle title=”Reporting Unethical Behavior” open=”no” class=”” id=””]

Nurses have a duty to report behavior witnessed that does not meet the established standards. Unethical behavior involves failing to perform the duties of a competent caring nurse. When reporting unethical behavior, one should always follow the proper chain of command and explain the facts as clearly as possible. Any documentation of the incident must be objective and accurately state what occurred, when and where it occurred, and any other pertinent facts. Reporting a coworker is never an easy task. Always remember, however, that a nurse’s first duty is to the patient’s health, safety, and well-being.

[/fusion_toggle][fusion_toggle title=”Ethical Issues” open=”no” class=”” id=””]

Ethical issues are difficult for the nurse, as for everyone, because there is no absolutely right or absolutely wrong answer to the question the issue presents. Like many other issues in health care, ethical issues change as society changes. Some of the current ethical issues in nursing include practitioner-assisted suicide (PAS), the right to refuse treatment, the nurse’s right to refuse to provide care, and genetic research.

[/fusion_toggle][fusion_toggle title=”Practitioner-Assisted Suicide” open=”no” class=”” id=””]

Health care professionals and patient advocacy groups on both sides of the issue are debating the ethics of PAS. Also called physician-assisted suicide, this is a form of active euthanasia in which a health care provider takes an active role in ending a patient’s life. Two cases, Vacco v Quill and Washington v Glucksberg, were brought before the U.S. Supreme Court regarding the legality of state bans on assisted suicide. The Supreme Court ruled in 1997 that there is no constitutional right to assisted suicide. This ruling allows each state to decide whether to legalize or ban assisted suicides. The ANA has taken a firm stand on the issue of PAS, holding that PAS is not consistent with the philosophy of nursing. ANA’s specific objections to PAS are based on the principle of nonmaleficence, to do no harm, and beneficence, the duty to protect life.

In 1944, the ANA adopted a position statement concerning PAS. The ANA wrote that such an act is in violation of the Code of Ethics for Nurses and the ethical tradition of the profession. Nurses have an obligation to provide compassionate end-of-life care that includes providing comfort and pain relief. Proponents of PAS, however, cite the ethical principles of the right to autonomy and the right to self-determination in support of their position.

[/fusion_toggle][fusion_toggle title=”Right to Refuse Treatment” open=”no” class=”” id=””]

In the context of health care, competent adults have the right to refuse treatment. This right derives from their right to determine what is done, or not done, to them. Medicine’s technical capacity to sustain life and postpone death further complicates this complex issue. It is the right of the patient to accept or refuse a treatment, even if the refusal has the potential to or is certain to result in death. To exercise the right to refuse treatment, many patients prepare advance directives. Living wills, one kind of advance directive, become effective when patients are incapacitated and are not able to make their own wishes known; these documents specify which lifesaving treatments are acceptable and which are not. Some patients choose to designate a health care proxy (assign durable power of attorney) to make decisions regarding medical treatment in the event that the patient becomes unable to make them. The proxy is another person who will speak for the patient and make decisions regarding the patient’s care. The proxy is obligated to act on the patient’s behalf according to the patient’s expressed wishes. State laws vary on the legalities of the various forms of advance directives, and nurses need to know the applicable laws in their state.

[/fusion_toggle][fusion_toggle title=”Do-Not-Resuscitate Orders” open=”no” class=”” id=””]

The patient is not usually involved directly at the time a do-not-resuscitate (DNR) order is written. Although many people make their wishes regarding DNR status known in an advance directive, at this stage the patient is usually incapacitated with little hope for recovery. The physician, after consultation with the patient’s family, writes the DNR order in the medical record. The physician is responsible for following the applicable policies and procedures for writing DNR orders. When a DNR order is written in the chart, the nurse has the duty to follow the order.

[/fusion_toggle][fusion_toggle title=”Refusal to Treat” open=”no” class=”” id=””]

Refusal to treat is an issue that arises when a patient’s care requires a nurse to do something that conflicts with his or her personal moral beliefs. A typical example of this dilemma involves assisting in or caring for a woman having an abortion. There is a legal right to abortion, but this does not establish whether abortion is morally right or wrong. If the nurse has a strong moral or religious belief regarding abortion, these concerns must be communicated with the appropriate supervisor. Do not abandon the patient; instead, ask for another assignment. Remember that the right to disqualify oneself from assisting with an abortion

does not extend to the complete ability to avoid caring for the patient after the abortion. Disagreement with care decisions made by patients does not allow the nurse to refuse to care for them.

Patient diagnoses and lifestyles do not allow the nurse the legal right to refuse to care for a person. Examples include an infectious disease, such as HIV, or sexual orientation. The rationale is that the need for standard precautions (infection control measures) applies to every patient, and therefore, the nurse is at no greater risk for infection from one patient than from another. The ethical principle of respect for all people without discrimination underlies this issue. The patient has the right to receive care, and the nurse has the responsibility to provide nursing interventions.

[/fusion_toggle][fusion_toggle title=”Conclusion” open=”no” class=”” id=””]

There are no easy quick answers to legal or ethical issues. The nurse has the charge of working to effectively manage difficult situations. Today’s health care system is facing many challenges, as is the profession of nursing. The health care system will continue to undergo changes in response to the enormous problem of containing health care costs while improving quality of care. The nursing profession will be called on to adjust and adapt to these changes. The legal system is also undergoing changes. Members of the legal community and the health care system have to work together to ensure that the legal and ethical rights of all individuals are considered and protected.

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