Nursing Jurisprudence

Nelia B. Perez RN, MSN

Northeastern College

Santiago City

LAW

• Etymology : lex• A set of rules established by a

governing power to guide actions, regulate conduct of the people and impose sanctions for violation or non-compliance thereof.

• Obligatory upon the people because it commands the people to do right and prohibits them to do wrong.

Branches of Law

• Divine Law : promulgated by our Creator.

• Human Law

* General / Public Law : includes international law and religious law

* Individual or private law : consists of civil law, mercantile and procedural law.

Jurisprudence

• Etymology : juris (oral legal tradition and to functional applications of Law, to and in particular sets of facts ans circumstances); prudentia (one who behaves prudently or wisely because he has knowledge of the possible consequences of a particular action).

Jurisprudence (cont)

• Denotes or pertains to the judicial precedent or the course or established decisions of the Supreme Court.

Ethics

• Etymology : ethos (custom or particular behavior)

• Practical science dealing with morality of the human acts or conduct.

ETHICS DEFINED• Ethics is a study of good conduct,

character, & motives & is concerned with determining what is good or valuable for all people. It goes beyond personal preferences to establish norms & standards upon which individuals, professions & societies agree.

NURSING ETHICS• Within nursing, specific values &

moral requirements are necessary to maintain the integrity of the profession. An ethical nurse will act & treat others in specific ways that are consistent with nursing norms & will be guided by more than personal preferences or values.

NURSING ETHICS (cont’d)

• To become mature professionals who are able to participate effectively in the ethical dimensions of their practice, nurses must continue to develop a strong sense of their moral identity, seek support from professional resources & expand their knowledge and skill in the area of ethics.

NURSING ETHICS (cont’d)

• A nurse assumes responsibility and accountability for nursing care provided.

RESPONSIBILITY• Refers to the execution of duties

associated with the nurse’s particular role. A nurse who acts in a responsible manner gains the trust of clients & other professionals. A responsible nurse remains competent in knowledge & skills & demonstrates a willingness to perform within the ethical guidelines of the profession.

RESPONSIBILITY (example)• When administering medications,

the nurse is responsible for assessing clients’ need for the drugs, giving them safely & correctly, and evaluating the responses.

ACCOUNTABILITY• Being answerable for one’s own

actions. A nurse is accountable to self, the client, the profession, the employer, and society

ACCOUNTABILITY (example)• If a wrong dose of medication is

given, the nurse is accountable to the client who received it, the physician who ordered it, the nursing service that set standards of expected performance, & society which demands professional excellence.

ACCOUNTABILITY (example cont’d)• Thus, when an error is made, the

nurse reports it and initiates care to prevent further injury. Accountability calls for an evaluation of a nurse’s effectiveness in practice.

ACCOUNTABILITY PURPOSE

• 1. To evaluate new professional practices & reassess existing ones.

• 2. To maintain standards of health care.

• 3. To facilitate personal reflection, ethical thought, & personal growth on the part of health care professionals.

• 4. To provide a basis for ethical decision making.

VARIABLES AFFECTING ETHICAL DECISIONS• Because ethical problems occur

in situations involving people who have different approaches to “moral reasoning”, it is helpful if the nurse can sort through the various factors that influence a persons’ thinking.

VARIABLES (cont’d)• Emotions

• Legal considerations

• Cultural diversity

• Religious/Spiritual convictions

• Education level

• Past life experiences

• Developmental level

VARIABLES (cont’d)• Societal changes

• Race

• Gender

• Class

• Economic level

• Sexuality orientation

• Current state of “health”

ETHICAL DECISION MAKING METHODS• Each ethical situation or dilemma

will be different, but the nurse in any setting can use the following guidelines for ethical processing and decision making.

METHODOLOGY (cont’d)• Presume good will• Identify all important persons• Gather relevant information• Identify important ethical

principles• Propose alternative courses of

action• Take action

SENSITIVE ETHICAL SITUATIONS

• Bio-technology• Surrogate Pregnancy Contracts• Adoption• Abortion• Substance Abuse• AIDS/HIV• Death & Dying• Living Wills/Health Care Surrogates• Organ Donations

Ethico-Moral Aspects of

Nursing

THE CODE OF ETHICS FOR FILIPINO NURSES • First approved in 1982, 5 decades

after it was formed in 1922.

• March 21, 1984: PRC adopted the ICN Code of Ethics and subsequentle was approved by the Board on March 21, 1984 pursuant to RA No. 877 and PD No. 223.

THE CODE OF ETHICS FOR FILIPINO NURSES (cont)• Unanimously approved through BON

Resolution No. 633 on March 21, 1984.

THE ICN CODE OF ETHICS FOR NURSESAn international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2005.

PREAMBLENurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. Nurses render health services to the individual, the family and the community and co-ordinate their services with those of related groups.

1. NURSES AND PEOPLE The nurse’s primary professional responsibility is to people requiring

nursing care.• In providing care, the nurse promotes an environment in which the

human rights, values, customs and spiritual beliefs of the individual, family and community are respected.

• The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.

• The nurse holds in confidence personal information and uses judgement in sharing this information.

• The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations.

• The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.

2. NURSES AND PRACTICE • The nurse carries personal responsibility and

accountability for nursing practice, and for maintaining competence by continual learning.

• The nurse maintains a standard of personal health such that the ability to provide care is not compromised.

• The nurse uses judgement regarding individual competence when accepting and delegating responsibility.

• The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence.

• The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people.

3. NURSES AND THE PROFESSION

• The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education.

• The nurse is active in developing a core of research-based professional knowledge.

• The nurse, acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing.

4. NURSES AND CO-WORKERS • The nurse sustains a co-operative

relationship with co-workers in nursing and other fields.

• The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a coworker or any other person.

Morals• Closely associated with the

concept of ethics is that of morals.

Morals

• The word morals is derived from the Latin mores, which means custom or habit.

• Morals are the basic standards for what we consider right and wrong.

• Morals or standards are often based on religious beliefs and, to some extent, social influence and group norms.

Ethics & Morals

• Together, the two words ethics and morals form constructs related to conduct, character, and motives for action.

Ethics & Morality

• “Ethics seems to pertain to an individual’s character, whereas morality speaks to relationships between human beings.” - Thiroux, 1998

Good (Ethical)

• In either case, we typically describe the behavior we observe as good, right, desirable, honorable, fitting, or proper.

• Bad (Unethical) or, we might describe the behavior as bad, wrong, improper, irresponsible, or evil.

Good / Ethical = Values

• Quickly you will realize that such perceptions are based on values, and that each of us (and each society) has a differing set of values.

Values

• “ . . . values are abstract standards that give a person a sense of what is right and wrong and establish a code of conduct for living.” - Videbeck, 2001

What are Values?

Examples of Values

• hard work

• honesty

• sincerity

• genuineness and

• being clean.

Values

• Values are most commonly derived from societal norms, religion, and family orientation

• Our Values Provide the framework for making decisions about the actions we take every day.

Values Conflict

• This occurs when we must choose between two things, both of which are important to us.

Values Conflict

• For example, if you are a new mother, you probably would like to spend all of your time with your child; however, if you also must help provide support for the family, and that requires leaving the child to go to work, you have a values conflict.

Values Conflict

• Most of the time we don’t think about our values—we just accept them.

• We are most likely to think about them when we have a difficult decision to make, when something goes wrong, or when we find ourselves in a conflict because of differing values.

Values & Nursing

• In nursing we work with a diverse patient population and therefore are exposed to a variety of values and ethical standards.

• The need to give conscientious care to all patients often forces us to examine our own values.

Values Clarification

• The process of becoming more conscious of and naming what one values or considers worthy is known as values clarification

• We examine what we believe is good, bad, beautiful, worthy, meaningful, and so forth, and explore the process of determining our personal values.

Values Clarification (cont)

• This increases our self-awareness or understanding of ourselves and assists us in making choices.

• Clarification It facilitates decision-making, because we have a better grasp of our own value systems.

Ethical Dilemna

• Having a good understanding of yourself will be helpful when you are faced with an ethical dilemma.

Ethical Dilemma

• An ethical dilemma occurs when an individual must choose between two unfavorable alternatives.

Ethical Dilemma

• Ethical dilemmas usually have no perfect solution, and those making decisions may find themselves in the position of having to defend their decisions.

Ethical Dilemma

• Although there are times when a difference in values and decisions can be accepted, at other times differences put people into direct conflict.

CRITICAL THINKING ACTIVITY

• Identify situations you might confront in nursing in which your personal religious or philosophic values would be involved.

• What would be the consequences of following the dictates of your value system?

• Do conflicts exist between your value system and actions required by the situation? If so, how will you recognize the differences and how will you deal with them?

• Are there any other alternatives? What might they be?