Ethical committee

ethical committee, needs of nursing ethics, code of ethics, purposes of code of ethics, laws , types of laws, torts , laws in nursing , responsibility of nurses in law , classification of torts

1. Presented by: shagun rana M.Sc. (n) 2 nd year Shimla nursing college Ethical committee, Code of ethics, professional conduct , legal system & legal issues in nursing

2. Index SR. No. TOPICS 1. Ethical committee 2. Code of ethics 3. Legal system 4. Legal issues in nursing 5. Conclusion 6. Summary 7. Bibliography

3. Ethical committee

4. Ethics committee Hospital Ethics Committee INTRODUCTION Most Indian hospitals have instituted a committee for the purpose of checking whether proposals submitted for research meet established guidelines. It improve not only the quality of research undertaken by the institution but also the care of patients in the institution.

5. committee Administration Clinicians- medical, surgical, other disciplines Social workers Nurses Rehabilitation personnel Priests/philosophers Lawyers Statisticians

6. Subcommittees Monthly meetings of a large, single committee once a month over an hour and a half or two hours. Frequency of meetings will depend on the goals set for the committee. Most ethics committees meet at least once a month. Each member must attend at least 75% of all meetings.

7. Mission statement of the committee The committee must be start with an open statement on its aims and objectives . These should be circulated throughout the institution and feedback sought on how this can be improved. It is also necessary to review this mission statement periodically and revise it wen necessary.

8. Cntd.. The following could form the heads under which details can be entered: care of the patient in institution research

9. Care of patients The art of bedside medicine Relief of suffering Cure of disease Cost to patient: tests, drugs, other cost. Prompt attention to needs of the patient. Care of the seriously ill Care of the dying patients Care of dead patients.

10. RESEARCH The committee must pay special attention to : Will the study ass substantially to existing knowledge? Is the study scientifically, statistically and ethically valid? Is it relevant?

11. How should the committee function? There must be at least two senior persons complementing and supplementing each other. They should, preferably, belong to different disciplines. Q. Who should be a member? Ans. Anyone with deep commitment to medical ethics.

12. Education of the staff WITHIN THE INSTITUTION Produces guidelines on a broad range of topics. e.g. disclosure of diagnosis, diagnosis of brain death, truly informed consent etc. Sets up of a forum for receiving complaints from patients & families in writing & taking action to solve the problem.

13. produces a document for the benefit of patients & their families informing them about services provided by the institution(rights of patients & relatives, their responsibilities) continuing surveys practices within the institution (standards of patient care, unnecessary expenditure, obtaining truly informed consent) Obtains feedback from faculty, other staff on the functioning of the ethics committee & perceived deficiencies & suggestions on how it might function more effectively. Conduct seminars/workshop/mini-conferences on biomedical ethics & research.

14. WHY DO SOME ETHICS COMMITTEE FAILs? Goals that are too ambitious Lack of support by the institution Poor selection of members on the committee

15. Institutional ethics committee (IEC) Institutional Ethics Committee (IECs) help to strengthen the human rights reserved exclusively for all members of society which the individual physicians and research workers may not be able to do alone.

16. Composition of IEC 1. 2 medical/ non medical scientists. 2. All members should be non-institutional except the secretary. The chairman should be an outsider. 2 lady members. 5 member for a quorum. No senior administrative officer of the institution. Office staff ( for secretary)

17. The roles of IECS 1. Secretary should be available for clarifying ethical problems that may arise from the project. 2. Make sure that “ informed consent” has been properly obtained. 3. Multi-centre trials require a uniform protocol & a unified assessment system. 4. Periodic follow up should be made by the IEC.

18. 5. informed consent obtained from volunteers who are to participate in a filed rial must be properly executed. 6. clinical trials of drugs or therapy conducted by clinicians.

19. Procedure for ethical clearance for projects 1. Clearance by the “technical committee” is needed. In case of experiments involving animals, clearance from the Animal Experimentation Committee is required. 2. Submission of the proposal highlighting the ethical aspects have to be submitted to the IEC office. Form 1 – must be filled up and attached to the submitted proposal. This must be submitted to the Member Secretary at least a month before the next meeting of the Ethics committee.

20. Cntd.. 3. The PI (principal investigator) will be informed of the date and time of the IEC meeting of the ethics committee. 4. The IEC will issue the clearance certificate subjects to all the criteria being met by th PI for the submitted proposal. 5. Submit 8 hard copies of proposal to the IEC office with the prescribed forms.

21. Legal role of the nurse Provide of service ( documentation, holistic care) Ensure that client receives competent, safe, & holistic care. Render care by “ standards of reasonable, prudent person”. Supervision that which has been delegated. Documentation of care Maintain clinical competency

22. 2. Responsibility of appointing and assigning 3. Responsibility for equipment 4. Responsibility for observation and reporting 5. Responsibility to protect public 6. Responsibility for record keeping and reporting 7. Responsibility for death and dying 8. Responsibility of quality control CNTD…

23. Code of ethics and professional conduct

24. Introduction Ethics refers to the moral code for nursing & is based on obligation to service & respect for human life. Melanie and Evelyn Ethics are the rules or principles that govern right conduct & are designed to protect the rights of human beings. Sister Nancy

25. Code of ethics A code of ethics is a set of ethical principles that are accepted by all members of a profession. Potter and Perry Code of ethics is a guideline for performance and standards & personal responsibility. Lillie M S and Juanita Lee

26. PURPOSES OF CODE OF ETHICS Standards for the behaviour of nurse and provide general guidelines for nursing action in ethical dilemmas. The code helps to distinguish between right and wrong. The code enable a correct decision and a uniform decision with in a group. Helps to protect the rights of individuals, families and community and also the right of the nurse.

27. Needs for nursing ethics Helps the students/RN to practice ethically. Helps the nurse to identify the ethical issue in her work place. Protecting patients right & dignity. Provided care with minimum risk to the nurse health. Ethical reasoning. Helps the nurse to respond to ethical conflicts.

28. Helps to differentiate right/wrong. Guide for a professional behaviour. Help teachers to plan education. Prevent below standard practice. Protect a nurse if falsely accused for legal action.

29. Key principles of ethics in health care system

30. 1. Autonomy: the right of self determination, independence and freedom. Right to health care decision. 2. Fidelity: obligation of an individual to be faithful to the commitment made to himself, and to others. It is the main support of accountability. 3. Justice: obligation to be fair with all people. 4. Veracity: the duty to tell the truth. 5. beneficence: doing good for the client. What exactly is good for one person may not be the same for others.

31. Cntd.. 6. Maleficence: is the requirement that health care providers do no harm to their client either intentionally or unintentionally. 7. deontological : what causes a good outcome is good action. 8. Situational: what causes a good outcome is good action.

32. Uses of code of ethics Constitute towards empowerment of individual to become responsible for their health and well being. Contributes to quality of care. Identifies obligation in practice, research and relationship. Inform the individual, families, community and other professionals about expectations of nurse.

33. I.c.n code of ethics for nurses (1993) The fundamental responsibility of the nurses is of four fold: To promote health To prevent illness To restore health To alleviate suffering

34. Elements of code Nurses and people: The nurses primary responsibility is the people who require nursing care. The nurse provides care, promotes an environment in which the values customs and spiritual beliefs of the individual are respected. The nurses holds confidence, personal information and uses judgment in sharing their information.

35. Nurse and practice The nurse carries personal responsibility for nursing practice and for maintaining competence by continuous learning. The nurses maintains the higher standards of nursing care possible within the reality of a specific situation. The nurse assess judgement in relation to individual competence when accepting and delegating responsibilities. The nurse when acting in a professional capacity should at all times maintain standards of personal conduct which reflect created upon the profession.

36. Nurses and society The nurses with other citizens the responsibility for initiating and supporting action to in edit the health and social needs of the public.

37. Nurses and co-workers The nurse sustains a co-operative relationship with co-workers in nursing practice and nursing education. The nurse is active in developing a care of professional knowledge. The nurse acting through the professional organization, participants in establishing and maintaining equitable social and economic working conditions in nursing.

38. American nurses association code of ethics for nurses The nurse in all professional relationships practice with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by considerations. If should or economic status personal attributes or the nature of health problems. The nurses primary commitment is to patient, whether an individual, family, group or community. The nurses promote, advocates for the strives to protect the health, safety and rights of the patient.

39. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with nurses obligation to provide optimum patient care. The nurses collaborates with others health professional and the public in promoting community, national and international efforts to met the health needs. The nurses participates in the advancement of the profession through contribution to practice, education, administration and knowledge development.

40. Canadian nurses association code of ethics for nursing Health and well being : Nurses value health and well being and assist persons to achieve their optimum level of health in situations of normal health illness, injury or in the process of dying. Choice: nurses respect and promote the autonomy of clients and them to express their health needs and values and to obtain the appropriate information and services. Dignity: nurse value and advocate the dignity and self-respect of human beings.

41. Confidentiality: nurses safeguard the trust of clients that information learned in the context of a professional relationship is spread outside the health care team only with the client`s mission or as legally required. Fairness: nurses apply and promote principles of equity and fairness to assist clients in receiving inhibited treatment and a share of health services and resources proportionate to their needs. Accountability: nurses act on a manner consistent with their professional responsibilities and standards of practices.

42. Types of ethical theories 4. Intuitionist ethical theory

43. 1. Duty-oriented ethical theories A duty oriented ethical theory is a system of ethical thinking having the concept of duty or obligation as foundation. Duties are strict obligations that take primary over rights and goals. Keep in mind however each duty has corresponding rights.

44. Advantages: Work well in a tribal society Hold the services values Disadvantages: How to rank duties ( for e.g. a nurse may be form between a duty to support life and a duty to prevent suffering)

45. 2. Rights oriented ethical theories It assign the highest value to rights, so that duties and goals flow from rights, from right-oriented perspective, you would first look to the clients right to privacy flowing from that right to privacy would be your duty to keep care information confidential to achieve the goal of encouraging clients to communicate information freely.

46. Duty oriented ethical theories Rights oriented ethical theories

47. 3. Goal oriented ethical theories It is a system of ethical thinking having the concept of maximizing the overall goal as its foundation-goal-related theories suggest that good choices result from concern with the consequences of actions. Providing both preventive and treatment could be viewed as maximizing the welfare of society.

48. 4. Institutional ethical theory It is a system of ethical thinking that balances goals, rights and duties according to the situation. Philosophers espousing this theory argue that humans innately know good from bad and that through intuition, duties, goals and rights can be balanced.

49. Intuitionist ethical theories Duties Rights Goals

50. Ethical principles

51. International code of nursing ethics The body of code is divided in to 5 sections: 1. Nurses and People 2. Nurses and Practice 3. Nurses and Profession 4. Nurses and Co-workers 5. Nurses and Society

52. Ethical dilemma An ethical dilemma occurs when there is conflict between two or more ethical principles. No correct decisions exists. Need to obtain patients informed consent for care treatment orders & measures such as : With holding/with drawing nutrition & fluids. Starting/discontinuing life support system.

53. the nurse must make a choice between two alternatives that are equally unsatisfactory. Such dilemmas may occur as a result of differences in cultural or religious beliefs. Need to protect autonomy rights of children. Need to make treatment & care of decisions for terminally ill patients.

54. Need for resolving ethical dilemma Step-1: c ollect, analyze and interpret the data. Step-2: s tate the dilemma step.-3: c onsider the choices of action Step-4: Analyze the advantages and disadvantages of each course of action Step-5: Make the decision & act on it.

55. Roles and functions of administrator He or she is self aware regarding own values & basic beliefs about their rights and duties. Be a part of all ethical decision-making. Accepts that negative outcomes occur in ethical decision making & use high quality problem solving and decision-making. Actively advocates for clients, subordinates and the profession.

56. Contd….. Clearly communicates the ethical standards with the health personnel. Uses problem-solving or decision making when faced with management problems. Identify outcomes in ethical decision-making that should always to be avoided. He should aware of legal produces that may guide ethical decisions making and accountable for it.

57. Contd… Continuously re-evaluate quality of ethical decision making based on the present of decision making. Recognizes and rewards ethical conduct of subordinates. Takes appropriates actions when subordinates use unethical conduct.

58. Code of professional conduct for nurses

59. 1. Professional responsibility an accountability Carries out responsibilities within the professional boundaries. Is accountable for maintaining practice standards set by Indian Nursing Council. Is responsible for own decisions and actions. Practices healthful behaviours. Is responsible for continuous improvement of current practices.

60. 2. Nursing practices Provides care in accordance with set standards of practice. Respects individuals and families need to promoting healthy practices and discouraging harmful practices. Treat all individuals and families with human dignity to providing physical, psychological, spiritual, emotional and social aspects of care. Promotes participation of individuals and significant others in the care.

61. 3. Communication and interpersonal relationship Establishes and maintain effective interpersonal relationship with individuals, families and communities. Uphold the dignity of team members and maintains effective interpersonal relationship with them. Co-operates with other health professional to meet the needs of the individuals, families and communities.

62. 4. Valuing human being Takes appropriate action to protect individuals from harmful unethical practice. Encourages and supports individuals in their right to speak for themselves on issues affecting their health and welfare. Respect and supports choices made by individuals.

63. 5. management Ensures appropriate allocation and utilization of available resources. Participates in supervision & education of students. Communicates effectively following appropriate channels of communication. Participates in evaluation of nursing services.

64. 6. Professional advancement Ensures the protection of the human rights while pursuing the advancement of knowledge. Contributes to the development of nursing practice. Contributes to care professional knowledge by conducting and participating in research.

65. Legal system: types of law, tort law and liabilities

66. Legal system Legal is established by or founded upon law or official or accepted rules. DEFINITION: The law is the body of principles recognized and applied by the state and administration of justice. By Salmaind The law is a system of rights and obligation which the state enforces. Acc. to Green

67. Characteristics of laws Laws are generally based on moral principles. It regulate external human conduct where as morality mainly regulate internal conduct. Laws are definite & precise where as morality is variable. Laws are upheld by the coercive power of the state . Morality simply enjoy the support of public opinion & or individual conscience.

68. Sources of law Statutory law: I t is a law that any local, state, or federal legislative body enacts. T hese laws can significantly affect health care providers. 4 .

69. Statutory law: It is created by elected legislative bodies such as Legislated laws enacted by congress (federal statutes). Sate drafted laws (state statute) Laws drafted by cities ( city ordinances, codes, regulations

70. Statutory law is either civil or criminal laws. Civil laws: protects the rights of individual persons within our society & encourage, fair and equitable treatment among people. Criminal laws: prevent harm to society and provide for crimes.

71. There are two classification of crimes: A felony: is a more serious crime that has a penalty of a fine or imprisonment for greater than one year or even death. A Misdemeanor: is a less serious crime that has a penalty of a fine or imprisonment for less than one year. For e.g. of criminal conduct for nurses would be misuse of a controlled substance (pethidine)

72. Statutory law Although each states has its own nurse practice act, they all share common components: Define the scope of practice Establish requirements for licensure & entry into practice Create a board of nursing to oversee nursing practice Identify legal titles for nurses, such as registered nurse & licensed practical nurse. Determine what constitute grounds for disciplinary action.

73. State board of nursing The primary responsibility is to protect the public : Review and approve nursing education program in the state. Form criteria for granting licensure. Overseeing procedures for licensure examinations. Issuing or transferring licenses. Implementing disciplinary procedures.

74. Purposes Law for the protection of nursing practice. Law for the identification of nursing practice Law for the identification of the risk of liability Law to assist in the decision-making process To describe and protect the rights of clients and nurses.

75. Safeguarding the nurse Licensure Good Samaritan laws Good rapport Standards of care Standing orders Consent for operation

76. Cntd. Correct identity Counting pf sponge instrument & needles Contracts Documentation

77. Laws in nursing

78. Types of law Civil law: some civil laws include the right to be left alone, freedom from threats of injury, freedom from offensive contact, & freedom from character attacks.

79. Contract law: it covers obligations established by agreement between private parties. Transactions involving the sales of goods has become highly standardized nationwide as a result of the widespread adoption of the uniform commercial code .

80. Torts The word tort is derived from French word of the same spelling which means “ mischief, Injury, wrong, or calamity ” from Latin tortus meaning twisted. Torts are civil wrongs committed by one person against another.

81. Responsibility of nurse in law Responsibility to appoint and assign. Responsibility to quality control of nursing care. Responsibility in handling equipment. Responsibility for observation and reporting. Responsibility towards public. Responsibility for record keeping & reporting. Responsibility for death & dying.

82. To constitute a tort, it is essential that the following conditions must be satisfies: Act or omission Wrongful act or omission must be recognised by law Legal damage Legal remedy

83. Classification of torts

84. Torts 1. I ntentional torts Assault Battery False imprisonment 2. Q uasi-intentional torts 1. Invasion of privacy 3. U nintentional torts 1. Negligence 2. Mal-practice

85. 1. Intentional torts

86. Assault It is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary The law protects clients who afraid of harmful contact. It is an assault for a nurse to threaten to give a client for an X-ray procedure when the clients has refused consent. The key issues is the client consent.

87. Battery Battery is un-consented or unlawful touching of a person. for battery to occur, the touching must occur without consent. remember that consent may be implied rather than specifically stated. Therefore, if the patient extends an arm injection, he can not later charge battery, saying that he was not asked. But if the patient agreed because of a threat(assault), the touching would still be considered battery because the consent was not freely given.

88. Non consensual physical contact sometimes is justified. When mentally ill or intoxicated clients are endangering their own safety or the safety of others, health professionals may use physical force to subdue them.

89. The nurse must clearly document that the situation required the degree of restraint used. Excessive force never is appropriate when less force would have been just as effective.

90. when recording these incidents, the nurse must document the behavior that resulted in the use of force and the client’s response when the nurse tried lesser forms of restraint first.

91. False imprisonment It occurs with unjustified restraining of a person without legal warrant. For e.g. it occurs when nurses restrain a client in a bounded area keep the person from freedom but when it occurs in health care it is most often the basis of a civil suit rather than a criminal cases.

92. 2. Quasi-intentional torts: 1. Invasion of privacy: all the information of the patient in any form is considered private, confidential & legal. Privacy is a human right to maintain autonomy. Certain actions of nurse can constitute an invasion of privacy, e.g. unnecessary exposing patient while assessing for examination. Specific privacy laws: Health privacy laws Online privacy laws Communication privacy laws Privacy in one`s home Information privacy law

93. 3. Unintentional torts

94. Negligence: The basic & legal definition of negligence means breach of duty or injury. It refers to the act of doing something or refraining from doing something that any other reasonable medical professional would do or refrain from doing in a similar situation. e.g. Patients had fallen due to a slippery or waxed floor. Administration of wrong medication, wrong dose , wrong patient.

95. Malpractice : It is defined as improper or negligent practice by a lawyer, physician, or other professional who injuries a client or patient. The common malpractices in nursing practice can be: Failure to obtain a proper informed consent. Failure to provide patient safety (physical, social) Failure to follow physician`s order Documentation error

96. E.g. If a client sustains a burn from warm soaks, the nurse who failed to check the water temperature could be found liable because he or she violated professional standards by not checking the temp. of the water before applying the soak to the skin.

97. Categories of torts Negligence torts Intentional torts Statutory torts Economic torts

98. Negligence torts: It is a tort which depends on the existence of a breaking of the duty of care owed by one person to another. The elements of negligence are: Duty of care Breach of duty in English law Breach being a proximate cause or not too remote a cause in law Causation law breach causing harm in fact Intentional torts : These are any intentional acts that are reasonably foreseeable to cause harm to an individua, and that do so. It includes several subcategories, assault, battery, false imprisonment & fraud.

99. Statutory torts: It imposes duties on private or public parties, however they are created by the legislature, not the courts. Liability for bad or not working products is strict in most jurisdiction. Economic torts : It protects people from interference with trade or business. The “absence of any unifying principle drawing together the different heads of economic tort liability has often been remarked upon”.

100. Liability (financial accounting) Definition An obligation that legally binds an individual or company to settle a debt. when one is liable for a debt , they are responsible for paying the debt or setting a wrongful act they may have committed.

101. Types of liability Product liability

102. Legal issues in nursing

103. Legal issues in nursing Introduction: the first nursing law created was that of nursing registration in 1903 & they have only evolved and expanded over the years to create a thick book which must be studied today by aspiring nurses. The legal issues is a dispute or a legal question that need to deal in the court for deciding as per civil or criminal law.

104. Legal issues in nursing

105. Negligence The basic & legal definition of negligence means breach of duty or injury. It refers to the act of doing something or refraining from doing something that any other reasonable medical professional would do or refrain from doing in a similar situation. e.g. patients had fallen due to a slippery or waxed floor. administration of wrong medication, wrong dose , wrong patient.

106. Malpractice It is defined as improper or negligent practice by a lawyer, physician, or other professional who injuries a client or patient. The common malpractices in nursing practice can be: failure to obtain a proper informed consent. failure to provide patient safety (physical, social) failure to follow physician`s order documentation error

107. Defamation of character It is an intentional tort or the issuance of a false statement about another person, causing harm to a person. Slander is oral defamation of character & libel is a defamation of character in writing. Defamation of character can be grounded both in criminal or civil law based on the amount of harm done to the plaintiff.

108. Nurses who make false statements about the patient or their co-workers have the risk of being used for slander or libel. Nurses must avoid offering unfounded or exaggerated negative opinions about clients, the expertise of physicians, or other coworkers.

109. INVASION OF PRIVACY Invasion of privacy: all the information of the patient in any form is considered private, confidential & legal. Privacy is a human right to maintain autonomy. Certain actions of nurse can constitute an invasion of privacy, e.g. unnecessary exposing patient while assessing for examination. Specific privacy laws: Health privacy laws Online privacy laws Communication privacy laws Privacy in one`s home Information privacy law

110. Role and functions of nurse manager in legal issues

111. Conclusion Ethics are the rules or principles that govern right conduct & are designed to protect the rights of human beings. The legal issues is a dispute or a legal question that need to deal in the court for deciding as per civil or criminal law.

112. Summarization

113. Recapitulation Define ethical committee? Enlist the legal issues in nursing? Explain the types of law?

114. Bibliography www.slideshare.com . Sujata Mohapatra, viewed on 4-5-21. www.investorwords.com , viewed on 5-5-21 S hebeer p basheer, “a concise textbook of advanced nursing practice”, medical publisher ,page no.9 to 20 www.slideshare.com ,Sweetharry71, viewed on 18-5-21. Anoop .N, Deepak K., A textbook of nursing management page no. 669- 702

115. 6. Vati Jogindra, principles and practices of nursing management & administration, 2 nd edition, jaypee publisher page no.48-50 7. N. Anoop, k. Deepak, A textbook on nursing management, page no. 669- 718