Prepared by: MA. ARNIE C. PULGA, RM, RN.

Ethos - comes from Greek work w/c means character/culture

- Branch of Philosophy w/c determines right and wrong

Moral - personal/private interpretation from what is good and bad.

Ethical PrinciplesAutonomy – the right/freedom to decide (the patient

has the right to refuse despite the explanation of the nurse) Example:  surgery, or any procedure

Nonmaleficence – the duty not to harm/cause harm or inflict harm to others (harm maybe physical, financial or social)

Beneficence- for the goodness and welfare of the clients

Justice – equality/fairness in terms of resources/personnel

Veracity – the act of truthfulnessFidelity – faithfulness/loyalty to clients

Moral PrinciplesMoral PrinciplesGolden Rule

The principle of Totality – The whole is greater than its parts.

Epikia – There is always an exemption to the rule.

One who acts through as agent is herself responsible – (instrument to the crime)

No one is obliged to betray herself – You cannot betray yourself

The end does not justify the means.

Defects of nature maybe corrected.

If one is willing to cooperate in the act, no justice is done to him.

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

No one is held to impossible.

Legal TerminologiesLegal TerminologiesLaw – rule of conduct commanding what is right and

what is wrong. Derived from an Anglo-Saxon term that means “that which is laid down or fixed”

Court -body/agency in government wherein the administration of justice is delegated.

Plaintiff – complainant or person who files the case (accuser).

Defendant – accused/respondent or person who is the subject of complaint

Witness – individual held upon to testify in reference to a case either for the accused or against the accused.

Written Orders of CourtWritten Orders of Court1. Writ – legal notes from the court SubpoenaSubpoena

1. Subpoena Testificandum – a writ/notice to an individual/ordering him to appear in court at a specific time and date as witness.

2. Subpoena Duces Tecum- notice given to a witness to appear in court to testify including all important documents

Summon – notice to a defendant/accused ordering him to appear in court to answer the complaint against him

Warrant of Arrest - court order to arrest or detain a person.

Search warrant – court order to search for properties.

Private/Civil Law – body of law that deals with relationships among private individuals.

Public law – body of law that deals with relationship between individuals and the State/government and government agencies. Laws for the welfare of the general public

Private/Civil Law :Contract law – involves the enforcement of

agreements among private individuals or the payment of compensation for failure to fulfill the agreements

Ex. Nurse and client nurse and insurance Nurse and employer client and health

agency.

an agreement between 2 or more competent person to do or not to do some lawful act.

it maybe written or oral= both equally binding.

Types of Contract1.  Expressed – when 2 parties discuss and agree

orally or in writing the terms and conditions during the creation of the contract.

Example:nurse will work at a hospital for only a stated length of time (6 months),under stated conditions (as volunteer, straight AM shift, with food/transportation allowance)

2. Implied – one that has not been explicitly agreed to by the parties, but that the law considers to exist.

Example:Nurse newly employed in a hospital is expected to be competent and to follow hospital policies and procedures even though these expectations were not written or discussed.

Likewise: the hospital is expected to provide the necessary supplies, equipment needed to provide competent, quality nursing care.

Feature/Characteristics/Elements of a lawful contract:

1. Promise or agreement between 2 or more persons for the performance of an action or restraint from certain actions.

2. Mutual understanding of the terms and meaning of the contract by all.

3. A lawful purpose – activity must be legal.4. Compensation in the form of something of value-

monetary.5. Persons who may not enter into a contract: minor,

insane, deaf, mute and ignorant

1. Tort law – is a civil wrong committed against a person or a person’s property.

person/person’s responsible for the tort are sued for DAMAGES

Is based on : ACT OF COMMISSION –something that was done incorrectly or

ACT OF OMISSION – something that should have been done but was not.

Classification of Tort1. Unintentional

a. Negligence – misconduct or practice that is below the standard expected of ordinary, reasonable and prudent person- failure to do something due to lack of foresight or prudence.- failure of an individual to provide care that a reasonable person would ordinarily use in a similar circumstance.- an act of omission or commission wherein a nurse fails to act in accordance with the standard of care.

Doctrines of Negligence1. Res ipsa loquitor – the thing

speaks for itself – the injury is enough proof of negligence.

2. Respondeat Superior – let the master answer command responsibility.

3. Force majuere – unforeseen event, irresistible force

b. Malpractice – stepping beyond one’s authority. 6 elements of nursing malpractice:1. DUTY – the nurse must have a relationship with the

client that involves providing care and following an acceptable standard of care.

2. BREACH OF DUTY – the standard of care expected in a situation was not observed by the nurse

- is the failure to act as a reasonable, prudent nurse under the circumstances.

- something was done that should not have been done or nothing was done when it should have been done.

3. FORSEEABILITY – a link must exist between the nurse’s act and the injury suffered.

4. CAUSATION – it must be proved that the harm occurred as a direct result of the nurse’s failure to follow the standard of care and the nurse should or could have known that the failure to follow the standard of care could result in such harm.

5. HARM / INJURY –physical, financial, emotional as a result of the breach of duty to the client.

Example: physical injury, medical cost/expenses, loss of wages, pain and suffering.

6. DAMAGES – amount of money in payment of damage/harm/injury

The high risk areas for malpractice are: 1. Safety issues 2. Medication errors 3. Nursing assessment 4. Competent knowledge regarding medical

procedures 5. Use of equipment 6. Communication 7. Documentation 8. Failure to follow established health system’s policies

and procedures

Substantial injuries caused by breach of the standards of care that satisfy the "damages" element of a medical malpractice claim include:

Death Disability Deformity Additional hospitalization or surgery to correct a

medical error Severe and prolonged pain

Six ix Major Categories of Negligence That Result in Malpractice Lawsuits

1. Failure to follow standards of care, including failure to:

perform a complete admission assessment or design a plan of care.

adhere to standardized protocols or institutionalpolicies and procedures (for example, using an improper injection site).

follow a physician’s verbal or written orders.

2. Failure to use equipment in a responsible manner, including failure to:

follow the manufacturer’s recommendations foroperating equipment.

check equipment for safety prior to use. place equipment properly during treatment. learn how equipment functions.

3. Failure to communicate, including failure to: notify a physician in a timely manner when

conditions warrant it. listen to a patient’s complaints and act on them. communicate effectively with a patient (for example, inadequate or ineffective communication of

dischargeinstructions).

seek higher medical authorization for a treatment.

4. Failure to document, including failure to note in the patient’s medical record:

a patient’s injuries. a patient’s progress and response to treatment. pertinent nursing assessment information (for

example, drug allergies). a physician’s medical orders. information on telephone conversations with

physicians, including time, content of communicationbetween nurse and physician, and actions taken.

5. Failure to assess and monitor, including failure to: complete a shift assessment. implement a plan of care. observe a patient’s ongoing progress. interpret a patient’s signs and symptoms.

6. Failure to act as a patient advocate, including failure to:

question discharge orders when a patient’s conditionwarrants it.

question incomplete or illegible medical orders. provide a safe environment.

The following can help nurses reduce potential liability

Maintain open, honest, respectful relationships and communication with patients and family members.

Maintain competence in your specialty area of practice. Know legal principles and incorporate them into everyday

practice. Practice within the bounds of professional licensure. Know your strengths and weaknesses.

II. Intentional Tort Unintentional tort – do not require intent to do,

require the element of HARM.

Intentional tort – the act was done on PURPOSE or with INTENT

- No harm/injury/damage is needed to be liable

- No expert witnesses are needed.

1. ASSAULT – an attempt or threat to touch another person unjustifiably.

Ex.: A person who threatens someone with a club or closed fist.

- Nurse threatens a client with an injection after refusing to take the meds orally.

2. BATTERY – willful touching of a person, person’s clothes or something the person is carrying that may or may not cause harm but the touching was done without permission, without consent, is embarrassing or causes injury.

Example:a nurse threatens the patient with injection if the patient refuses his meds. orally.  If the nurse gave the injection without client’s consent, the nurse would be committing battery even if the client benefits from the nurse’s action.

3. FALSE IMPRISONMENT – unjustifiable detention of a person without legal warrant to confine the person- occurs when clients are made to wrongful believe that they cannot leave the place.

Example:a. Telling a client not to leave the hospital until bill is paid.b. Use of physical or chemical restraints.

False Imprisonment Forceful Restraint = Battery

4. INVASION OF PRIVACY – intrusion into the client’s private domain.- right to be left alone.

Types of Invasion the client must be protected from:

Use of client’s name for profit without consent – using one’s name, photograph for advertisements of HC agency or provider without client’s permission.

Unreasonable intrusion – observation or taking of photograph of the client for whatever purpose without client’s consent.

Public disclosure of private facts – private information is given to others who have no legitimate need for that.

Putting a person in a false/bad light – publishing information that is normally considered offensive but which is not true.

2. DEFAMATION – communication that is false or made with a careless disregard for the truth and results in injury to the reputation of a person.

Types:a. LIBEL – defamation by means of print, writing

or picture.

Example: writing in the chart/nurse’s notes that doctor A is incompetent because he didn’t respond immediately to a call.

b. SLANDER – defamation by the spoken word stating unprivileged (not legally protected) or false word by which a reputation is damaged.

Example: Nurse A telling a client that nurse B is incompetent.

person defamed may bring the lawsuit the material (nurse’s notes) must be

communicated to a 3rd party in order that the person’s reputation maybe harmed

Public Law1. CRIMINAL LAW– deals with actions or

offenses against the safety and welfare of the public.

a. homicide – self-defenseb. arson- burning or propertyc. theft – stealingd. sexual harassmente. active euthanasiaf. illegal possession of controlled drugs

2. Homicide – killing of any person without criminal intent may be done as self-defense.

3. Arson – willful burning of property.

4. Theft – act of stealing