Legal/Ethical issues in nursing

patwil73 · Oct 12, 2008

Hi everyone! I am currently a nursing student taking an ethics course for anyone going into a health or human resource field. I am currently working on a paper about how some of the issues we disscused in class are handled in the nursing field. I have interviewed some nurses (who didn't seem to want to talk about it too much...) and done some reading...but if anyone could add any comments to these questions that would be great!

I will do my best!

1. How is confidentiality (of their medical file,etc.) explained/presented to your patients? Are there any limits to their cofidentiality?

When a patient is admitted to or hospital one of the questions we ask is whether they want to be a confidential patient or not. If they elect to be a confidential patient we give absolutely no information out to callers or visitors unless they know the password established by the visitor - we don't even say if they are a patient here.

Now if they don't elect to be a confidential patient, then if someone calls and asks for them we can say they are in the hospital and if they are doing "ok". Anything else we need specific permission from the patient.

I approach it with the patient this way: "Do you wish to be a confidential patient and keep all mention that you are here from anyone who might call or visit unless you have pre-approved them?" They will then ask what it entails and if they should so I ask "Is there anyone who might want to call that you don't want to talk to? and Is there anyone who might visit that you don't want to see?" If the answer to both is negative they usually don't need to be confidential.

Now as to there chart. At our facility patients actually have the right to read their chart if they want. They can't make copies, but can go over it. We try to have someone in the room to explain what different things mean (usually a doctor), but they can read it without if they wish.

We don't often explain that others won't be viewing the chart unless the patient asks.

2. What do you have priviledge in knowing about a patient?

I can look up any of their records as long as it pertains to the care I am providing. Anything that has been documented before is ok as long as is relevant to their care now. So I might look up old stress tests for my CP patient, but would not peruse their OB charts from last years delivery.

3. What would you do if your nursind records/charts were supoenoaed?

Flee to Canada! Just kidding, actually not much. I doubt I would even know unless I was called to testify or the hospital grapevine was working OT that week.

4. How are the right's of minors treated differently?

MInors with certain exceptions don't have the right to consent for their care, so a legal guardian must be involved. They also can't refuse a treatment although the guardian can. One interesting twist is that a 16 year old can't consent to her own care but if she is a mother she can consent for her child.

5. What ethical dilemas do you face in your everyday nursing practice?

1) How long do we continue to utilize life-saving measures on someone who didn't wish for them (but family does) and will not benefit from them in any way? Continuing to perform CPR on the demented, 98 y.o. COPD'er whose every waking moment was a struggle to breathe just because family can't let go is ethically difficult. Morally I believe that it wrong to not honor the wishes of the patient, but legally we have little choice.

2) Keeping suicidal patients locked up. I might be different than a lot of people on this one, but I have a deep sense that the personal freedoms of individuals should not be compromised unless they can harm others. A person in full control over his faculties locked up because s/he decides that they don't want to continue with their life is morally wrong to me.

3) Watching a baby die because the mother refuses a C-section. I am pro-choice and believe that for those who believe they can't raise, care, and love a baby abortion is a viable option. But once that baby is developed enough to survive on his own, I feel we have a moral obligation to do things to keep him alive and not do things we know will kill him.

4) Deciding on a course of action when a physician fails to order treatment. Does the welfare of the patient justify moving up the chain of command here or is the issue non-urgent enough to adopt a wait and see approach.

Thanks to anyone who shares their ideas/experiences!!

Hope this helps

Pat

patwil73 · Oct 12, 2008

This is the same thing we are studying in my class. It is interesting to read your answers.
I am told confidentiality is taken so lighly at the hosptials and patients sign away on forms they have no idea what they are and they are not informed consent at all.

I actually find that people are much more educated about their illness and often ask very good questions. Where I think we tend to fail is when our language is not the patient's primary language. Because often it can be time consuming and difficult to get a translator or hear over the phone, people tend to turn to family and friends to do this. Or the patient understands some of what you say and just agrees because of the stress or culture or whatever.

How do you declare a person dead? In my class we learned the "higher brain" declaration of dead and the "whole brain" declaration of dead. Basically one is that the patient is still alive even if they are breathing by a breathing machine and others believe if only their brain stem is working- ie breathing and they are not a person anymore then they are dead.

In our hospitals it is actually the residents who usually determine death. 1 minutes of listening for heart tones or breath - without it, they call time of death.

Technicaly you are alive as long as you have a heart beat and breath - although with families who are wondering I often try to explain the difference between the body being alive and the person being alive.

how long do you say people should be on life support for? a week? month? year? If they are in a persistant vegitative State and they are never going to regain consciousness isn't that the same as being "Dead?"

Depends. Is there a realistic chance of survival and quality of life afterwards? And quality of life must be as the patient defines it, not what we define it as. If the patient things living in a bed being fed through a tube is ok with them, then we must respect that.

I thought minors could not make decisions till they were 18 as they do not understand so they would not have complete autonomy. Their parents would make the decisions.

Depends on the decision being made and whether or not they are emancipated.

Why is it that the advanced directive is always ignored? If that is what the patient wanted it should be more important. I read somewhere that only 30% of advanced directives are even carried out. If they do resusitate couldn't the victim sue? If the family does if the doctor doesn't resusitate isn't that a bad situation either way? That would be a tough decision to make.
If they do not follow the advanced directives why bother having one?
Tigger100S, I hope you did well on your paper!
-Danielle

It is not always ignored. It just often seems to turn out badly when it is. Often people don't know the advanced directive. Sometimes people argue that it was made under duress or in an altered state of mind. I do wish as a society we could come to some firm agreement on the validity of advanced directives and that they should be followed above any decision by family - but it might actually take someone who was resucitated when they didn't want to be suing for it to happen.

Hope this helps

Pat