ETHICO-MORAL & LEGAL FOUNDATIONS OF CLIENT EDUCATION

A Differentiated View of Ethics, Morality & the Law

 Ethics- guiding principles of behavior
 Ethical- norms or standards of behavior
 Moral- internal value system( the moral fabric of one’s being)
 Morality- expressed externally through ethical behavior
 Ethical principles- deals with intangible moral values, not enforceable by law & neither are these
principles laws in and of themselves
 Legal rights & duties- refers to rules governing behavior or conduct that are enforceable under threat of
punishment or penalty, such as fine, imprisonment or both
 Practice acts- documents that define a profession, describe that profession’s cope of practice & provide
guidelines for state professional boards regarding entry into a profession via licensure & disciplinary
actions that can be taken when necessary. It was developed to protect the public form unqualified
practitioners & to protect the professional title

Evolution of Ethical & Legal Principles in Health Care

 Inform consent- a basic tenet of the ethical practice of health care-was established in the courts as early
as 1914 by Justice Benjamin Cardozo- determined that every adult of sound mind has a right to protect
his or her own body & to determine how it shall be treated
 In 1975,the American Hospital Association (AHA) disseminated a document title A Patient’s Bill of Rights,
which was revised in 1992-a copy of these patient rights is framed and posted in a public place in every
healthcare facility
 In 1950, the American Nurses Association ( ANA) developed and adopted an ethical code for professional
practice that has since been revised and updated several times (ANA-1976,1985,2001)
 The latest revision of the ANA’s Code, now titled the Code of Ethics for Nurses with Interpretive
Statements, was released in 2001 for implementation in the new millennium

 This Code of ethics represents an articulation of 9 provisions for professional values & moral obligations in
relation to the nurse-patient relationship & in support of the profession & its mission outlines these
provisions & further clarifies the nursing role in each provision:

I. Honor the human dignity of all patients & co-workers

II. Establish appropriate nurse-patient boundaries & focus on interdisciplinary collaboration
III. The nurse-patient relationship is grounded in privacy & confidentiality
IV. The nurse is accountable for the personal actions & the behaviors of those persons to whom the
nurse has delegated responsibilities
V. The nurse is responsible for maintaining competence, preserving integrity & safety, &
continuing personal growth
VI. The nurse has a responsibility to deliver quality care to patients
VII. The nurse contributes to the advancement of the profession
VIII. The nurse participates in global efforts for health promotion & disease prevention
IX. Involvement in professional nursing organizations supports the development of social policy

Application of Ethical Principles to Patient Education

 Various theories & traditions can frame a health professional’s understanding of the ethical dimensions in
the healthcare setting.
 In considering the ethical & legal responsibilities inherent in the process of patient education, nurses and
nursing students can turn to a framework of six major ethical principles:
 Autonomy
 Veracity
 Confidentiality
 Nonmaleficence
 Beneficence
 Justice
 Autonomy
 Derived from the Greek words auto (self) & nomos (law) & refers to the right of self-determination

 Laws have been enacted to protect the patient’s right to make choices independently

 The Patient-Self Determination Act (PSDA) which was passed by Congress in 1991, is a clear example of
principle of autonomy enacted to law.

 Any healthcare facility, including acute and long-term institutions , surgery centers, HMOs, hospices or
home care, that receives Medicare and Medicaid funds must comply with the PSDA.

 The law requires that either at the time of hospital admission or prior to the initiation of care or treatment
in a community health setting, “ every individual receiving health care and the right to initiate advance
directives”

 Although ultimate responsibility for discussion treatment options & a plan of care & obtaining inform
consent rests with the physician, the nurse responsibility is to ensure informed decision making by
patients not limited to advance directives

EXAMPLE: AUTONOMY RATIONALE

 A 26-year-old male has been involved in a high-speed collision,  Even though the best interests of this
in which he sustained blunt force trauma to his head as his patient would be served by undergoing a
head hit the front windscreen of his car. He did not lose CT scan and having sutures,  he is an
consciousness, he is fully responsive and has no indications of adult with full mental capacity, and so we
neurological damage. He does, however, have a significant must respect his autonomy in choosing
head wound that is bleeding continuously. This patient has to leave the Department. We cannot
refused treatment on the grounds that he feels “fine” and is prevent him from leaving, and if we did it
refusing to have sutures to close his head wound. He would like would be unlawful detainment.
to leave the Department.

Veracity
 Truth-telling, is closely linked to informed decision making and inform consent
 4 elements making up the notion of informed consent that are such vital aspects of patient education:
I. Competence-capacity of the patient to make a reasonable decision
II. Disclosure of information- requires sufficient information regarding risks & alternative treatment-
including no treatment at all- be provided to the patient to enable him or her to make a rational decision
III. Comprehension - individual’s ability to understand/grasp intellectually the information being provided.
For an adequate inform consent conversation, all options must be expressed in a language the patient can
understand & in lay terms
IV. Voluntariness- patient has made a decision without coercion or force from others

5 Reasons Why Veracity Is Important In Nursing

1. Veracity demonstrates respect for patients. Veracity is one of the basic ethical and moral societal principles.
When nurses practice veracity, they demonstrate respect for their patients and their right to be treated equally
and fairly.

2. Nurses who practice veracity promote the patient’s right to autonomy. Patient autonomy is the right of
competent adults to make decisions about their medical care. When nurses are honest, they give patients the
information they need to choose their care. Exercising patient autonomy helps patients feel more confident in
their decision-making abilities. They feel in control of their rights to choose treatment plans, physicians, and make
educated decisions.

3. Honesty strengthens nurse-patient relationships, which positively impacts patient outcomes. Patients who have
strong relationships with their nurses are more likely to be open about questions, concerns, or issues related to
their illness or treatment plans. Their openness makes it easier for nurses to gauge what is or is not working for
patients and modify their care plans if needed, which can improve the patient's health outcome.

4. Veracity in nursing practice promotes honesty from patients. Veracity binds and strengthens nurse-patient
relationships and is essential as patients and healthcare teams seek to establish achievable treatment goals. When
 patients feel nurses are honest with them, it encourages honesty from the patient to the nurse, which makes it
easier to determine a patient’s status and set realistic goals to promote positive outcomes.

5. Veracity in nursing practice is essential for strong team building. No matter what profession a person pursues,
professional relationships are stronger when honesty and integrity are demonstrated. Nursing is no different. In
fact, the strongest nursing teams demonstrate veracity with patients and one another.

EXAMPLE: VERACITY
1. Admitting mistakes
It is natural to want others to see our good deeds and hope our misgivings or mistakes are not evident. However,
veracity in nursing means being willing to admit our shortcomings and face the consequences of mistakes. Most
mistakes are not intentional. However, when we do not own up to them, mistakes can become a pattern of
purposeful, poor behavior.

2. Helping patients face difficult health challenges

As nurses, it is natural for us to want to “fix things.” The nurturing instinct of nurses leans toward telling a patient
everything is going to be okay even when we know their prognosis is poor or their treatment options are limited. It
is essential for nurses to understand the importance of veracity, even when veiling the truth a bit seems like the
kinder option. Veracity in nursing is demonstrated when nurses acknowledge the patient is facing a challenging
health issue and, instead of trying to make things easier by avoiding the truth, they answer questions honestly and
offer support to the patient and their loved ones.

3. Maintaining accurate charts

Honesty in documentation is another example of veracity in nursing. It is essential for effective patient care,
proper billing, and to avoid legal ramifications. Nurses can demonstrate veracity by documenting pertinent patient
information, being thorough, and using documentation to maintain continuity of care among interdisciplinary
team members.

4. Asking for help when you need it

Nurses may be hailed as the frontline heroes, and for good reason. However, the best heroes know it takes
teamwork to get things done. Nurses can practice veracity by remembering the patient first, which sometimes
means admitting an assignment is too much to handle alone. When you ask for help, you demonstrate a patient-
centered approach that leaves no room for pride or envy among team members. The result is better patient care
and improved patient outcomes.
5. Demonstrating accuracy in patient care
Veracity in nursing practice involves honesty, which can be demonstrated by providing high-quality, accurate
nursing care. While anyone can cut corners or do a job halfway, dedicated nurses strive to do jobs completely and
as accurately as possible.

6. Informed Consent
Informed consent occurs when communication between nurses, patients, and other healthcare team members
results in the patient’s authorization to undergo medical treatments or intervention. True informed consent only
occurs when patients are presented with thorough, accurate, and honest information necessary to make
knowledgeable decisions.

7. Be honest with patient loved ones and family.

It is normal to want to ease the emotional pain family and friends experience when patients are given a poor
prognosis or when treatment plans are failing. Veracity in nursing requires nurses to be forthcoming about
accurate information instead of shielding loved ones from the truth. Keep in mind veracity does not mean you
have the right to violate a patient's right to privacy. If your patient has authorized you to disclose information to
certain people, you may do so with the utmost dignity and respect. In the event your patient has not given
permission for you to share any of their information with others, you can still demonstrate veracity in nursing by
explaining to the friend or loved one that you understand their concern and assuring them you are available to
discuss any concerns that do not violate your patient's privacy.
 8. Answering hard questions, even when you don’t like the answers.
Sometimes the right thing to do is the hardest thing to do. As a nurse, you will be faced with situations when
patting a patient’s shoulder or holding their hand simply isn’t enough. Nurses must learn to balance empathy and
compassion with the ability to tell the truth. Illness and disease can be frightening, and patients need nurses to be
honest with them. Skilled nurses learn the art of demonstrating veracity in nursing while expressing empathy,
concern, and hope.

9. Acting as a patient advocate regardless of your personal feelings or how others may view you.
One of the most significant acts a nurse can perform is to advocate for patients. Advocacy means representing a
patient's desires and avoiding allowing one's personal values to influence decisions. When nurses practice veracity
in advocacy, they speak the truth in representing patient wishes, even if team members disagree.

10. Giving accurate reports at the end of your shift

End of shift reporting is one of the most effective ways to promote teamwork and continuity of care. Nurses must
be intentional about reporting events that occurred with their patients during their shifts. Patient symptoms and
responses to treatment are essential information to share in the report. Nurses must also practice veracity when
reporting the interventions they implemented. Veracity in nursing related patient care provided is essential to
quality care and errors of omission.

5 Consequences Of Lack Of Veracity In Nursing

1. Loss of credibility with other team members:
  The role of nurses is to provide high-quality patient care, and it takes teamwork to get things done. When
nurses are dishonest, it creates an unhealthy work environment including a loss of respect and credibility.
Unfortunately, the loss of credibility among team members affects the level of care patients receive and
can negatively impact patient outcomes.
2. Difficulty establishing solid nurse-patient relationships:
  Illness and disease can leave patients feeling vulnerable. In addition to having a strong non-medical
support system, patients need to establish trusting relationships with nurses and other healthcare
members. When there is a lack of veracity in nursing, patients often question whether nurses genuinely
care for them and have their best interests at heart. As patients examine motives and intent, it can result
in the deterioration of otherwise strong nurse-patient relationships.
3. Miscommunication and misunderstanding about important patient information:
  When nurses withhold essential information or cloak the truth about a patient's status with medical
jargon the patient or family does not understand, it can lead to patients making misinformed decisions
about healthcare.
4. Lack of veracity in nursing practice demonstrates a lack of respect for a patient's autonomy.
  Veracity is a foundation of truthfulness founded on respect for a patient's individuality and autonomy.
When nurses fail to practice veracity, there is a breakdown in the patient's right to independent decision-
making, negatively impacting nurse-patient relationships and patient outcomes.
5. Poor patient outcomes:
  The lack of veracity in nursing can have far-reaching consequences related to patient care and outcomes.
Patients who feel nurses are not forthcoming or are withholding pertinent information find it difficult to
trust, creating communication barriers. Poor communication often leads to improper or incomplete
nursing care plans and failed patient compliance, which leads to poor patient outcomes.

Confidentiality
 Personal information that is entrusted & protected as privileged information via a social contract, health
care standard or code or legal covenant
 When this information is acquired in a professional capacity from a patient, healthcare providers may not
disclose without consent of the patient
 Only under special circumstances maybe secrecy be ethically broken, such as:
 Patient has been a victim/ subject of a crime to which the nurse/ doctor is a witness
 Child/elder abuse
 Narcotic use
 Legally reportable communicable diseases
  Gunshot/knife wounds
 Threat of violence toward someone

Nonmaleficence
 Nonmaleficence is an ethical principle that obliges one to not inflict intentional harm.
 Nonmaleficence requires four things:
1. An act is not intrinsically wrong
2. A good effect is intended
3. The good effect isn't a by-product of a bad effect
4. The good outweighs the bad
An example of nonmaleficence: If an incompetent, or chemically impaired, health care practitioner is taking care of
patients, a nurse should report the abuse to protect the patient.

Beneficence
 This is the core principle of doing good and patient advocacy. To have compassion, take positive actions
to help others and follow through on the desire to do good. Nurses concentrate on ensuring that their
clients receive the best treatment to achieve optimal results. Nurse’s commitment to acting in the best
interest of the patient. Such behavior emphasized patient welfare & deemphasizes the provision of
quality care under threat of litigation

An example of beneficence: If a nursing home patient falls and fractures his hip, a nurse should provide him pain
medication as quickly as possible.

Justice
 All clients must be treated fairly and equally. Nurses face issues of justice every day as they organize
care for their clients: They must decide how much time they have to spend with each client, taking
patient needs into consideration, and then fairly distributing the resources accordingly.

An example of justice: If a hospital organization decides to donate no-cost eye exams and hearing tests to 10
elementary schoolchildren each month, a fair, unbiased method must be used to determine which children receive
these services.

Legality of Patient Education & Information

The patient’s right to adequate information regarding his or her physical condition, medications, risks and access to
information alternative treatments is specifically spelled out in the Patient’s Bill of Rights

Patient’s Bill of Rights:

 Right to Appropriate Medical Care & Humane Treatment
 Right to Informed Consent
 Right to Privacy & Confidentiality
 Right to Information
 The Right to Choose Healthcare Provider & Facility
 Right to Self-Determination
 Right to Religious Belief
 Right to Medical Records
 Right to Leave
 Right to Refuse Participation in Medical Research
 Right to Express Grievances
 Right to be Informed of His Rights and Obligations as a Patient

CODE OF ETHICS

ARTICLE I
SECTION I
 The Filipino registered nurse, believing in the worth and dignity of each human being, recognizes the
primary responsibility to preserve health at all cost
SECTION II
 To assumed this responsibility, registered nurses have to gain knowledge and understanding of man’s
cultural, social, spiritual, physiological, psychological and ecological aspects of illness, utilizing the
therapeutic process
SECTION III
 The desire for the respect and confidence of clientele, colleagues, co-workers and members of the
community provides the incentives to attain and maintain the highest possible degree of ethical
conduct

ARTICLE II
SECTION 4
Ethical Principles
 Values, customs and spiritual beliefs held by individuals shall be respected
 Individual  freedom to make rational and unconstrained decisions shall be respected
 Personal information acquired in the process of giving nursing care shall be held in strict confidence
SECTION 5
REGISTERED NURSES MUST
a. Consider the individuality and totality of patients when they administer care
b. Respect the spiritual beliefs and practices of patients regarding diet and treatment
c. Uphold rights of individuals
d. Take into consideration the culture and values of patients in providing nursing care

ARTICLE III
SECTION 6
ETHICAL PRINCIPLES
 Human life is inviolable
 Quality and excellence in the care of patients are goals in nursing practice
 Accurate documentation of actions and outcomes of delivered care is hallmark of nursing accountability
SECTION 7
REGISTERED NURSES MUST
a. Know the definition and scope of nursing practice which are in the provisions of R.A. 9173
b. Be aware of their duties and responsibilities in the practice of their profession as defined in the “
Philippine Nursing Act of 2002”
c. Acquire and develop necessary competence in knowledge, skills and attitude to effectively render
appropriate nursing services through varied situations
d. See to it quality nursing care and practice meet the optimum standard of safe nursing practice
e. Ensure patient’s records shall be available only if they are to be issued to those professionally and directly
involved in their care and when they are required by law
SECTION 8 
ETHICAL PRINCIPLE
Registered nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and
privileges

REGISTERED NURSES MUST

a. Respect the “Patient’s Bill of Rights” in the delivery of nursing care
b. Provide patients or families with all pertinent information except those which may be deemed harmful to
their well-being
c. Uphold patient’s rights when conflict arises regarding management of their care

ARTICLE IV
SECTION 11
ETHICAL PRINCIPLES
  Registered nurses is in solidarity with other members of the health care team in working for the patient’s
best interest
 The registered nurses maintains collegial and collaborative working relationship with colleagues and other
health care providers
SECTION 12
REGISTERED NURSES MUST
a. Maintain professional role/identity while working with other members of the health team
b. Conform with group activities as those of a health team should be based on acceptable ethico-legal
standards
c. Contribute to professional growth and development of other members of health team
d. Actively participate in professional organization 
e. Not act in any manner prejudicial to other profession
f. Honor and safeguard the reputation and dignity of members of nursing and other professions, refrain
from making unfair and unwarranted comments or criticisms on their competence, conduct and
procedures 
g. Respect rights of co-workers

ARTICLE V
SECTION 13
ETHICAL PRINCIPLES
 Preservation of life, respect for human rights and promotion of healthy environment shall be a
commitment of a Registered Nurse
 Establishment of linkages with the public in promoting local, national and international efforts to meet
health and social needs of the people as a contributing member of the society is a noble concern of a
Registered nurse
SECTION 14
REGISTERED NURSES MUST
 Be conscious of their obligations as citizens and be involved in community concerns
 Be equipped with knowledge of health resources within the community and take active roles in primary
health care
 Actively participate in programs, projects and activities that respond to the problems of society
 Lead their lives in conformity with principles of right conduct and proper decorum
 Project an image that will uplift the nursing profession at all times
SECTION 15
ETHICAL PRINCIPLES
 Maintenance of loyalty to the nursing profession and preservation of its integrity are ideal
 Compliance with the by-laws of accredited professional organization(PNA) and other professional
organizations of which the Registered nurse is a member is a lofty duty
 Commitment to continual learning and active participation in the development and growth of the
profession are commendable obligations
 Contributions to improvement of socio-economic conditions and general welfare of nurses through
appropriate legislation is a practice and a visionary mission
SECTION 16
REGISTERED NURSES MUST
 Be members of the Accredited Professional Organization (PNA)
 Strictly adhere to the nursing standards
 Participate actively in the growth and development of the nursing profession
 Strive to secure equitable socio-economic and work conditions in nursing through appropriate legislation
and other means
 Assert for the implementation of labor and work standards