LEGAL, ETICHAL & SOCIAL ISSUES

IN NURSING
LEADERSHIP & MANAGEMENT

SR. MARIA BERNADETE SEA, SPC

 Understanding Organization

 Critical for all nurses, especially managers &

leaders.
 Legal and ethical issues are intertwined in many
ways, but the two entities are distinct bodies of
thought and practice.

RIGHT/ WRONG
GOOD/ BAD

LEGAL
ETHICS
A. Definition of Laws

 Laws means those rules that control social

conduct in a formal and legally binding
manner.

 Set down by the state or federal governments,

administrative agencies, or courts.
Sources of Law
1. The Constitution

 The Constitution is legal basis of a country.

 These laws define and limit the power of the
government and protect citizens’ freedom of speech,
freedom of assembly, religious freedom, freedom of the
press.
Indonesian Laws concerning Nursing

1. Law Number 38 of 2014 concerning Nursing

2. Health Minister Regulation No.49 of 2013 concerning
the Nursing Committee.
3. Decree of the Minister of Health Number 647 / Minister
of Health / Decree / IV / 2001 concerning Regression
and Practice of Nurses.
4. Code of Ethics and Nursing Discipline Issued by The
Indonesian National Nurses Association.
2. Administrative Law

 Agencies that have been given the responsibility for

administering healthcare- related laws.
Ex.: Department of Health and Human Services
Department of Labor, etc.
 At the state level are the departments of health and
mental health and the licensing boards.
Ex.: The state nursing board receives the authority to
issue and revoke licenses from specific statutory
laws.
Types of Laws

1. Criminal Law
 Criminal laws were developed to protect
society from actions that threaten its
existence.

 The perpetrator of the act is punished, and

the victim receives no compensation for
injury or damages.
There are 3 categories of criminal law:
a. Felony is the most serious category and includes
such acts as homicide, grand larceny, and violating a
nurse practice act.
b. Misdemeanors are lesser offenses such as traffic
violations or shoplifting of a small dollar amount (A
nurse who illegally distributes controlled
substances).
c. Juvenile crimes are carried out by individuals under
the age of 18 ( teen fighting between schools).
2. Civil Law

 Civil laws usually involve the violation of

one person’s rights by another person.
 Areas of civil law that particularly affect
nurses are:
- Tort law
- Contract law
- Employment discrimination
- Labor laws
Tort

 A tort is a legal or civil wrong committed by

one person against the person or property of
another.
 Tort law recognizes that individuals in their
relationships with each other have a general
duty not to harm others.
 Nurses have a duty to deliver care are not
harmed the consumer.
Types of torts:

1. Unintentional Torts:
- Negligence: is the failure to act as a reasonable or
prudent person would act in the same or similar
circumstances.
- Malpractice is a form of negligence committed by a
professional, such as a nurse, by which professional
misconduct, unreasonable lack of professional skills,
and/or noncompliance with accepted standards of
care causes injury to the client.
2. Intentional Torts
 Are willful or intentional acts that violate another
person’s rights or property.
 Intentional torts include:
- Fraud
- Assault and Battery
- False imprisonment
- Invasion of privacy
- Slander and libel.
a. Fraud
 Fraud is deliberate deception to gain unfair or
unlawful advantage of a situation.
 Ex: A nurse falsifies her employment record or any
records at her disposal.
b. Assault
 Civil assault is a threat to touch an individual
without consent and causing an immediate fear
of harm.
 The touch does not have to take place; the
individual just has to be fearful that it will
take place.
 Ex: “If you don’t stop pushing that call bell, I’ll
give you this injection with the biggest needle
I can find’’.
c. Battery

 Battery is the actual and unlawful touching of

the individual’s body or clothes or anything
attached to the individual without informed
consent.
 Ex : Holding down the patient roughly and
against their will and injecting a sedative.
d. False Imprisonment

 False imprisonment is the unjustifiable and

unlawful detention of a client within fixed
boundaries or an act with the intention to
keep the individual in such a confinement.
 Ex: Detaining unwilling clients in an
institution when they desire to leave.
e. Invasion of Privacy

 Invasion of privacy is the right to be left alone or

free from unwanted publicity.
 Nurse leaders and managers must make sure that
a client’s privacy is not invaded during their care.
 Ex: Publish photos of patients without permission
f. Slander and Libel

 Slanders: Making a false statement about a

client’s condition.
 Ex: Stating that a client who had blood drawn
for drug testing has a substance abuse
problem, when in fact the client does not
carry that diagnosis.

 Liebel: Putting a false statement into writing

Other Laws Relevant To Nursing Practice

Good Samaritan Laws

 Protect nurses and physicians when
administering emergency care from civil
liability.
 When they assisting during an emergency
nurses must still observe professional
standards of care.
Standards of Practice

 Concern for the quality of care is a major part of

nursing’s responsibility to the public.
 The nursing profession is accountable to the
consumer for the quality of its services.
 Nursing standards were established as guidelines for
the profession to ensure acceptable quality of care.
1. Informed Consent
 Without consent, many of the procedures
performed on client may be considered battery.
 Client’s consent: give healthcare personnel the
right to deliver care and perform specific
treatments without fear of prosecution.
 The physician’s responsibility to give information to
a client about a specific treatment or medical
intervention.
 Nurses may be asked to obtain the signatures on
the informed consent form.
2. Appropriate Documentation

 The old adage “not documented, not done” holds true

in nursing.
 According to the law, if something is not documented,
then the responsible party did not do whatever
needed to be done.
 Nursing documentation needs to be legally credible:
an accurate accounting of the care the client received.
 It also indicates the competence of the individual who
delivered the care.
 Staying Out Of Court: Prevention

 Unfortunately, the public’s trust in the medical

profession has declined over recent years.
 Consumers are better informed and more assertive in
their approach to health care. They demand good and
responsible care.
 If clients and their families feel that behaviours are
uncaring or that attitudes are impersonal, they are
more likely to sue for what they view as errors in
treatment.
 Nurses who involve clients and their families in
decisions about care reduce the likelihood of a lawsuit.
B. Definition of Ethics
 Ethics is a branch of philosophy
that involves clarification of the
“should” and “ought” of individuals
and society.
 Why an action is reprehensible or
not reprehensible.

Guidelines in behaving in society:

related to the nature of “good and
bad”.
Ethical Principles…

1.Autonomy
 Involves the right to self-determination and to make
independent personal decisions regarding care.
 Described as respect for autonomy.
 An example in health care is the patient’s right to
refuse treatment.
 The only restriction on autonomy that may preclude
this right would be a communicable disease, in which
case the patient’s autonomy would be restricted.
Ethical Principles…

2.Beneficence
 Beneficence is a principle that speaks to deeds of
charity, mercy, and kindness toward the individual.
 Promoting the welfare of others or doing good.
Nurses, by the nature of nursing practice, perform
beneficent acts.
Ethical Principles…

3.Nonmaleficence
 Nonmaleficence literally means to not harm the patient.
 Nonmaleficence is the other side of beneficence
 Nurses may sometimes violate this principle in the short
term in order to give a positive long-term result.
 An example is chest compressions in the event of heart
stoppage in an elderly patient; ribs may be broken,
and/or sternal fractures may occur that are harmful,
but recovering the patient’s life takes precedence over
the harm.
Ethical Principles…

4.Justice
 It refers to the right to be treated justly, fairly, and
equally.
 Nurses should be aware that when indigent patients
arrive in the emergency department, they must be
treated in an equitable way.
 And that if persons require emergency service due to
trauma, nurses must proceed to deliver the service
as deemed appropriate.
Ethical Principles…

5.Fidelity
 Fidelity focuses more on the delivery of health care and
literally means keeping one’s promises or obligations to an
individual.
 Keeping these commitments becomes of paramount
importance when considering patient care standards that
are to be met by the nurse.
 Ethical Principles…

6.Veracity
 The nurse certainly has an obligation to tell the
truth.
 Ex.: A cancer patient asks the nurse how long he
might live.
 The nurse not to take hope away from the patient
(no one is able to predict death/ there is always
hope in life).
Ethical Principles…
7.Sanctity of Life
 Is a part of ethical decisions when it comes to
withholding or withdrawing life-sustaining treatments
or assisting suicide.
 Is defined as the obligation not to take human life.
 The ANA implies that nurses caring for patients should
direct their care toward the relief and prevention of
the suffering that is often associated with the process
of dying.
 Nurses must continue to give good care and educate
client family members about the dying process and
provision of comfort measures.
Ethical Decision Making…

 Nurses must learn how to make ethical decisions.

 Nurse managers/leaders must direct and guide nurses in making
such decisions.

MORAL Model of Ethical Decision Making

M Massage the dilemma
O Outline the options
R Resolve the dilemma
A Act by applying the chosen option
L Look back and evaluate the entire process, including
the implementation
Essential Values & Behaviours…

1. Altruism

 Altruism is a concern for the welfare and well-

being of others.
 Altruism is reflected by the nurse’s concern for the
welfare of patients, other nurses, and other
health-care providers.
Essential Values & Behaviours…

2. Human dignity

 Human dignity is respect for the inherent worth

and uniqueness of individuals and populations.
 Is reflected when the nurse values and respects
all patients and colleagues.
 Example: Protecting patient’s privacy
Essential Values & Behaviours…

3. Integrity
 is reflected in professional practice when the nurse
is honest and provides care based on an ethical
framework that is accepted within the profession.
 The professional behaviours involved with this
essential value include:
- Providing honest information to patients / public
- Documenting care accurately and honestly
Essential Values & Behaviours…
4. Social justice
 is upholding moral, legal, and humanistic principles.
 This value is reflected when the nurse works to ensure equal
treatment under the law and equal access to quality health
care.
 The professional behaviours involved with this essential value
include:
-Supporting fairness & non discrimination in health care.
- Promoting universal access to health care.
End of Life Decisions

 When a heart ceases to beat, a client is in a state of

cardiac arrest.
 Both in modern healthcare institutions and in the
community, it is common to begin cardiopulmonary
resuscitation when cardiac arrest occurs.
DNR Orders

 A DNR order is a specific directive to healthcare

personnel not to initiate cardiopulmonary
resuscitative measures.
 Only physicians can write a DNR order, usually
after consulting with the client or family.
 Other members of the healthcare team are
expected to comply with the order.
Tips to Avoid Legal problems

1. Keep yourself informed regarding new research findings

related to your area of practice.
2. Insist that the health care institution keep personnel
apprised of all changes in policies and procedures and in
the management of new technological equipment.
3. Always follow the standards of care or practice for the
institution.
4. Delegate tasks and procedures only to appropriate
personnel.
Tips to Avoid Legal problems

5. Identify patients at risk for problems such as falls or the

development of decubiti.
6. Establish and maintain a safe environment.
7. Document precisely and carefully.
8. Write detailed incident reports and file them with the
appropriate personnel or department.
9. Recognize certain patient behaviors that may indicate
the possibility of a lawsuit.
 Reference

Jones, Rebecca A. P. (2010). Nursing Leadership and

Management; Theories, Processes and Practice. F.A.
Davis Company. Philadelphia. Page 58-66

Tappen, R.M., Wiss, S.A., Whitehead, D.K. (2001).

Essentials of Nursing Leadership and Management. F. A.
Davis Company. Philadelphia. Page 162-172
Thank You