LEGAL–ETHICAL ASPECTS of

NURSING
RGN REVISION
Legal Aspects of Nursing
o Law can be defined as those rules made by humans who regulated
social conduct in a formally prescribed and legally binding manner.
Laws are based upon concerns for fairness and justice.

o Types of Law
n Public Law- Constitutional , Administrative , Criminal
n Civil Law - Contracts, Torts, Protective Reporting Law
Functions of Law in Nursing
1. It provides a framework for establishing which nursing actions in the
care of client are legal.

2. It differentiates the nurse's responsibilities from those of other health

professional.

3. It helps establish the boundaries of independent nursing action.

4. It assists in maintaining a standard of nursing practice by making

nurses accountable under the law.
 Functions of the Law in Nursing
o It scrutinizes nursing actions and omissions in light of the fact
that healthcare is experiencing a storm of litigation

o Knowledge of legal principles is necessary for nurses to assist

in making ethical decisions. Nurses and other health workers
need to be able to identify potential or real legal implications
of their actions
Types of Law
o Public law
n Constitutional law: state constitution, human rights, etc.

n Administrative Law: Nurse Practice Acts, FDA, NMC, etc

n Criminal law: criminal codes, DDA, etc

Types of Law (cont’d)
o Civil Law (deals with issues / crimes against people in
matters of agreements)

n Contracts

n Torts
Types of Laws- cont’d
o Private Laws/ Civil Laws
The body of law that deals with relationships among private
individuals

1. Contract law involves the enforcement of agreements among

private individuals or the payment of compensation for failure
to fulfill agreements

1. Tort law defines and enforces rights among private

Tort Law
o A tort is a civil wrong committed against a person or a person’s
property.

o It is a civil wrong committed on a person or property stemming

from either a direct invasion of some legal right of the person,
infraction of some public duty, or the violation of some private
obligation by which damages accrue to the person

o Whenever a nurse fails to practice safe and standardized care

and steps out of her legal boundaries, she commits a wrong act
known as torts.
Intentional vs. Unintentional Torts
o Unintentional torts are negligence & malpractice.
Unintentional torts occur when the wrongdoer does not
intend to cause harm, but harm nevertheless results due to an
accident caused by negligence.

o Intentional torts include assault, invasion of privacy and

defamation, etc. This occurs when the individual
intentionally commits an act which inflicts harm on the other
person
o Examples of Tort Law include:
Negligence and Malpractice
Assault and Battery
False Imprisonment
Restraints or Seclusion
Invasion of Privacy
Defamation
Fraud
Torts- intentional and unintentional

o Unintentional
o Negligence and malpractice

Intentional
o Assault and Battery
o False Imprisonment
o Restraints or Seclusion
o Invasion of Privacy
o Defamation
o Fraud
Negligence

o Negligence is a failure to exercise the care that a reasonably

prudent person would exercise in like circumstances.

o In tort law, negligence applies to harm caused by carelessness,

not intentional harm. Failure to exercise the care that a
reasonably prudent person would exercise in like
circumstances
 NEGLIGENCE

The commission of the act in particular circumstances in

standard of care, to which a nurse is legally bound, and
would not do under similar circumstances.

Negligence (breach of duty) is the failure of an individual

to provide care that a reasonable person would ordinarily
use in a similar circumstance
Proof of Liability in Negligence
o Duty: the defendant had a duty /obligation to the plaintiff

o Breach of duty: the defendant breached this duty

o Injury: the defendant has suffered harm

o Causation: the harm suffered by the plaintiff was a direct result of this
breach of duty

o Damages: damages being sought are directly related to harm caused

n Special damages, general damages, punitive damages
Problems for which nurses are often found negligent in duties

o Failure to use aseptic technique where required.

o Leaving a foreign object in a patient’s body during surgery, i.e. errors

in sponge, instrument or needle count in surgical cases.
Negligence (cont’d)

o Failing to protect an ill

patient from failing, falls
resulting injuries to patients.

o Administering wrong medication to a patient.

Negligence (cont’d)

o Administering a medication inappropriately, i.e.

intravenous therapy, errors resulting infiltration or
phlebitis.

o Administering care in such a manner that a patient

suffers injury, e.g. improper handling of hot water bag,
burns to clients.
Malpractice
o Malpractice is a type of negligence; it is often called "professional
negligence".

o It occurs when a licensed professional (like a doctor, lawyer or

accountant) fails to provide services as per the standards set by the
governing body ("standard of care"), subsequently causing harm to
the plaintiff.

o Malpractice refers to the behaviour of a professional person’s

wrongful conduct, improper discharge of professional duties, or
failure to meet the standards of acceptable care which result in harm
to another person.
 DEFINITION OF MALPRACTICE
o Malpractice is a negligence or carelessness by a
professional person.

o So, it concerns professional actions and is failure

of a person, with professional education and
skills to act in a reasonable and prudent manner.
MALPRACTICE
TYPES OF NURSING MALPRACTICE

q Medication error
q Failure to follow a Physician’s orders
q Delaying patient care and/or failure to monitor a patient
q Incorrectly performing a procedure, or trying to perform
a procedure without training
q Documentation error
q Failure to get informed patient consent.
 Assault and Battery (Intentional Tort)
Assault is any wilful attempt or threat to harm another,
coupled with the ability to actually harm the person. The
victim believes that harm has been caused as a result of
threat. Assault may be subtle.

Battery is the crime of touching an individual which

results in harm. It is an act of violence against an
individual, unlawful physical attack with or without injury
EXAMPLES

o involvement of nurse in handling an uncooperative client in

the casualty room.

o it is an assault for a nurse to threaten to give a client an

injection or to threaten to restrain the client for X-ray
procedure when a client has refused consent.
 INVASION OF PRIVACY

o Clients have claims for ‘invasion of privacy’, e.g. their private

affairs, with which the public has concern, have been publicised.

o Clients are entitled to confidential health care. All aspects of care

should be free from unwanted publicity or exposure to public
scrutiny.

o The precaution should be taken in times when an individual’s right

to privacy may conflict with public’s right to information.
 EXAMPLES

o To pull the client's information onto the computer screen

where other clients can see it.

o Give out any information about a client without his or her

written consent.
 DEFAMATION

o Defamation is communication that is false or made

with careless disregard for the truth, and result in injury
to the reputation of a person.

o The act of damaging the good reputation of an

individual
 TYPES OF DEFAMATION
There are two types of defamation:-

o Slander defamation: is in the form of spoken words for, e.g.

if a nurse tells a client that his doctor is incompetent, for
which nurse could be held liable for slander.

o Libel defamation: is in form of written words, e.g. the nurse

who writes such a comment could be charged for libel.
How can the nurse protect him/herself from
legal liability?
 LEGAL SAFEGUARDS IN NURSING
PRACTICE

o Licensure
o Good Rapport
o Standards of Care
o Standing Orders
o Consent for Operation & Other Procedures
o Knowledge about laws governing health issues
 Ethics
o Ethics is concerned with the study of social morality and
philosophical reflection on society’s norms and practices

o It is the practical application of moral philosophy

o Ethics offer structural guidelines, but it does not tell us what we

ought to do. We must decide for ourselves
Ethical theories

o Teleological Theories- consequence-based

o Deontological Theories -principles-based

o Caring Theories- relationships-based

 Ethical Principles
o Ethical issues are commonly examined in terms of a number
of ethical principles

o Ethical principles are basic and obvious moral truths that

guide deliberation and action

o Major ethical theories utilize many of the same principles,

though the emphasis or meaning may be somewhat different in
 Ethical Principles
o It is vital for nurses to understand ethical principles and
be very skilful at applying them in a meaningful and
consistent manner

o Consistent attention to the ethical principles is an

important basis for ethical practice in nursing
 Fundamental Ethical Principles
o Principle of Respect for Persons
n Duty to respect the rights, autonomy and dignity of
other people

n Duty to promote their wellbeing and autonomy

n Duty of truthfulness, honesty, and sincerity

 Fundamental Ethical Principles
o Respect for persons- autonomy, dignity
o Justice- fairness and equity
o Beneficence and non-maleficence
o Fidelity- faithfulness and keeping promises
o Veracity
o Paternalism
o Confidentiality
o Privacy
 Ethical dilemmas
o An ethical dilemma is defined as a complex situation
in which there is a mental conflict between choosing
two different courses of action.

o The conflict is ethical in nature and involves having to

compromise either your personal or professional ethics
in favour of one course of action
 For an ethical dilemma to exist:
o A decision has to be made about which course of action is ‘best’

o There must be different courses of action to choose from in the

decision

o Irrespective of which course of action is taken, an ethical principle is

compromised. In other words, there will be no ‘right’ or ‘perfect’
solution
o
 Some Ethical Issues in Nursing
o Reproductive rights
o Dealing with issues surrounding minors
o Client personal beliefs vs. nurse’s beliefs
o Patient freedom vs. Nurses’ control
o Honesty vs. selective information
o Religion vs. Medicine
o Resource Distribution