Legal/Ethical issues in nursing

The biggest ethical dilemma (IMO) facing nurses in their everyday practice is the conflict of interest that exists for the RN.

It is the duty of the RN to act in the best interest of the patient and NOT the employer. Therefore, we must often object to unsafe assignments or float positions for which we are not qualified for.

Duty requires that we refuse these assignments even if it means the boss threatens to fire or discipline. Unfortunately, I think that many nurses forget this duty. However, there are many, many who do not and speak up for their patient.

I will do my best!

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.


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.

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.


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.

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.


Hope this helps

Pat

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.

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.

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.

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

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