NCM 108 HEALTH ETHICS

MIDTERM MODULE 2
Nursing Roles and Responsibilities
Roles of a Nurse
The primary role of a nurse is to advocate and care for individuals and support them
through health and illness. However, there are various other responsibilities of a nurse
that form a part of the role of a nurse, including to:
• Record medical history and symptoms
• Collaborate with teams to plan for patient care
• Advocate for the health and wellbeing of patients
• Monitor patient health and record signs
• Administer medications and treatments
• Operate medical equipment
• Perform diagnostic tests
• Educate patients about management of illnesses
• Provide support and advice to patients
NURSE AS A CAREGIVER
Patient care
A nurse is a caregiver for patients and helps to manage physical needs, prevent illness,
and treat health conditions. To do this, they need to observe and monitor the patient,
recording any relevant information to aid in treatment decision-making.
Throughout the treatment process, the nurse follows the progress of the patient and acts
accordingly with the patient’s best interests in mind. The care provided by a nurse extends
beyond the administration of medications and other therapies. They are responsible for the
holistic care of patients, which encompasses the psychosocial, developmental, cultural,
and spiritual needs of the individual.
NURSE AS AN ADVOCATE
The patient is the first priority of the nurse. The role of the nurse is to advocate for the
best interests of the patient and to maintain the patient’s dignity throughout treatment and
care. This may include making suggestions in the treatment plan of patients, in
collaboration with other health professionals.
This is particularly important because patients who are unwell are often unable to
comprehend medical situations and act as they usually would. It is the role of the nurse to
support the patient and represent the patient's best interests at all times, especially when
treatment decisions are being made
NURSE IN PLAN OF CARE
A nurse is directly involved in the decision-making process for the treatment of patients.
It is important that they are able to think critically when assessing patient signs and
identifying potential problems so that they can make the appropriate recommendations
and actions.
As other health professionals, such as doctors or specialists, are usually in charge of
making the final treatment decisions, nurses should be able to communicate information
regarding patient health effectively. Nurses are the most familiar with the individual
patient situation as they monitor their signs and symptoms on an ongoing basis and
should collaborate with other members of the medical team to promote the best patient
health outcomes.
NURSE AS AN EDUCATOR
Nurses are also responsible for ensuring that patients are able to understand their health,
illnesses, medications, and treatments to the best of their ability. This is of the essence
when patients are discharged from hospital and need to take control of their own
treatments.
A nurse should take the time to explain to the patient and their family or caregiver what to
do and what to expect when they leave the hospital or medical clinic. They should also
make sure that the patient feels supported and knows where to seek additional
information.
Vicarious Liabilities of Nurses Towards their Subordinates
• Subordinate nursing staff (SNS) usually performs selected activities and procedures
under the direct supervision of a registered nurse. Delegated activities to SNS are
usually characterized as standard unchanging procedures.
• It is the primary responsibility of a nurse to screen his SNS, provide proper
instructions and tools needed, inform the scope of their duties and evaluate the
result of tasks performed.
• A nurse should not delegate to subordinates (non-nursing personnel) any procedures
which are exclusively within the scope of nursing practice.
• Subordinates should work under the supervision of a R.N.
• Nurses delegating any task to a SNS should keep in mind the principle of
"Respondeat Superior“.
• Task assigned should be within the level of competencies of his subordinate &
Proper orientation and data provision on the task and area where they will be
assigned.
• Open channels of communication between subordinates and a nurse. •
Proper assessment and evaluation of their performance.

Responsibilities of Nurses Towards Charting/Documentation

1. The acceptable rule provides that whatever was not put into writing is
considered as not having been given, assessed or provided at all to the patient.
2.Medical records serves as a legal document for all client's activities initiated by
health care providers. It can vindicate or convict a nurse or any member of the
 health care team from liabilities arising from the care of any patient. It also
protects the patient if there be any court case to be filed against erring medical
practitioners including nurses.
3. Characteristics of proper documentation includes using proper grammar and
spelling, legible and neat, logical, accurate, updated, confidential, factual, utilizes
only authorized abbreviation and well-organized.
4. Medical records are confidential matters which all hospitals are bound to keep
against any unauthorized person. Its content can be divulged only upon patient's
consent or court order. The patient's chart is owned by the hospital or health
institution.
5. In any court proceedings involving a nurse, patient and health practitioners,
courts will rely only with original written documents such as the records of the
patient. It can support any claims or defense arising from the care of the patient
and the resulting liability if any. It has more weight than oral evidence. Written
evidence is the best evidence. If a medical record or chart is within the custody of
a private party or hospital administrator, the court may order for its presentation
before the court (subpoena duces tecum).
Purposes of Charting or Documentation
• Systematically communicates patient's condition and care.
• Research purposes.
• Future reference and statistical purposes.
• Legal evidence.
• Assures continuous care from care providers.
• Demonstrate the decision making of the nurse.
• Provides a dynamic, logical and systematic manner of communicating
information as determined by standards and policies.
• Basis for future claims or reimbursements from insurance companies and
similar institutions.
• Basis for any investigation or professional liabilities.
Incident Report
It is a document stating a report of a sudden unusual risk or occurrence. It is also a
comprehensive, specific, detailed and accurate report on any unexpected or unusual
occurrence that affects or may potentially affect a patient, his family and other members
of the health care team.
The purpose of submitting an incident report after an observed or witnessed occurrence is
not to punish erring caregivers, but as a means to protect the client and for the immediate
management of any probable or actual risk.
The following are common situations that requires an incident
report: • break in the aseptic technique
 • sudden abnormalities in the vital signs
• accidental fall resulting to patient's injury
• neglect or omission to report a change of patient's condition
• if the client refuses a medication
• improper equipment count in the O.R. g. patient who suffered burns due to
negligence of the nurse
• medication error
BIOETHICS
AND RESEARCH
Back in the 19th century, there was no specific ethic devised for the use of human
subjects in research. There was a total lack of consumer regulations, food and drug
administration (FDA) and institutional review board (IRB). The history of ethics in
medical sciences and research on human subjects started after 1906. IRB devised several
codes of ethics and a manual in order to protect research methods.
From 1906 onwards, ethics have been designed, conducted and reviewed for safe clinical
practices. The modern code of ethics started after the end of World War II in order to deal
with war crimes trials in Nuremberg.
Nuremberg Code
Introduction
The Nuremberg Code was introduced in 1947 after doctors’ trial in World War II. It has
served as a foundation in clinical research. This code was introduced after criminal
experiments of Nazi physicians and researchers on human subjects in concentration
camps came to light. The Nuremberg code comprised of ten basic points related to ethics
in human research.
1. The consent of the human subject in absolute legal capacity is required.
2. The aim of the research should be to create a positive impact on society.
3. It should be based on any previously approved experiment in order to extend the
ongoing research process.
4. The research procedure should not cause any physical or mental injuries or any
harm to people.
5. It should never be conducted where the risk of death of any participant or member
of society is evident.
6. The risk associated with the research process should be correlated with the benefits
associated with it for social wellbeing.
7. Proper arrangements and facilities should be arranged before conducting the
research process in order to limit the risk of harm to subjects.
8. The researchers and staff members involved in the research should be properly
trained and scientifically qualified.
9. In case human subjects feel at risk of death or injury during an experiment, they
 can quit at any moment.
10. If risks in a research process become so evident that it may cause harm to human
subjects, the researchers should immediately stop the process.
The Declaration of Helsinki
The world medical association adopted a new set of ethical rules and regulations
regarding human experimentation in 1964. It was upgraded in 2013 and termed as a
cornerstone document related to human research ethics. This declaration ties together the
Nuremberg code and the declaration of Geneva. It is not a binding document and is not
enforced under international law. The major points of this declaration included respect
decisions of capable people, autonomy, and respect for vulnerable people.
Beneficence emphasized good deeds by researchers, non-maleficence to avoid bad acts,
justice to treat each ethical issue differently and the best interest to act in the best interest
of the patients.
Pillars of Ethical Research
• Autonomy: It states that all patients have the right to decide on their own whether
or not to be joining in a certain research or study
• Beneficence: The doctors and researchers should aim at doing their best in the
interest of people whether they are patients or society on the whole. The risk
associated with the research process should be correlated with the benefits
associated with it for their social wellbeing.
• Non-Maleficence: Any kind of bad acts and deeds should be avoided in any case in
order to ensure the safe treatment to patients. In case human subjects feel at risk
of death or injury during an experiment, they can quit at any moment. If risks in a
research process become so evident that it may cause harm to human subjects, the
researchers should immediately stop the process.
• Justice: The doctors and researchers should do justice for the conduct of research.
Any impediment like disease, gender, race, sexual orientation etc. to intervene
between duties as a doctor or researcher should be avoided.
• Acting in the best interest of patients: A physician and doctor should act in the
best interest of a patient. The consent of a human subject in absolute legal capacity
is required.
• Fidelity: A researcher should be morally an ethical person and should be bound to
fidelity.
• Trustfulness: A physician should be truthful to its patients in order to help them to
overcome their problems and issues.
• Confidentiality: A researcher should take care of their patient’s secrets even after
the patient’s death.
Informed consent
The common factor in all principles or pillars of ethics of research is ‘Informed consent’
of a patient. It includes communicating all risks associated with the research process,
along with benefits. It should avoid any coercion or intimidation to obtain consent. The
permission of medical research is mandatory for safe practices. There are several
challenges associated with taking informed consent of patients including consent received
half-heartedly, a lack of proper understanding of a medical subject and researcher, and a
lack of legal documents of informed consent leading to legal issues.
Elements of Valid Consent
The core elements of a valid consent include:
• Disclosure or risks associated with a research process to the subject.
• The subject should be educated and capable to deal with lingual, emotional and
intellectual problems.
• Coercion should never be practiced to obtain consent.
The Belmont Report
This report was issued after a famous Tuskegee Syphilis Study which was conducted from
1932-1972. This report was created to codify the protection of human subjects. It was
issued on 30th September 1978 during a conference of the Howard Community College in
the Belmont Conference Center. It was named after the location where it was conducted.
The core principles of this report included:
• Respect for persons
• Beneficence
• Justice
• Informed consent
• Assessment of risks and benefits associated with the research process •
Selection of subject
Tuskegee syphilis study, official name Tuskegee Study of Untreated Syphilis in the Negro
Male, American medical research project that earned notoriety for its unethical
experimentation on African American patients in the rural South.
The project, which was conducted by the U.S. Public Health Service (PHS) from 1932 to
1972, examined the natural course of untreated syphilis in African American men. The
research was intended to test whether syphilis caused cardiovascular damage more often
than neurological damage and to determine if the natural course of syphilis in black men
was significantly different from that in whites. In order to recruit participants for its study,
the PHS enlisted the support of the prestigious Tuskegee Institute (now Tuskegee
University), located in Macon county, Alabama. A group of 399 infected patients and 201
uninfected control patients were recruited for the program. The subjects were all
impoverished sharecroppers from Macon county. The original study was scheduled to last
only six to nine months.
The subjects were not told that they had syphilis or that the disease could be transmitted
through sexual intercourse. Instead, they were told that they suffered from “bad blood,” a
local term used to refer to a range of ills. Treatment was initially part of the study, and
some patients were administered arsenic, bismuth, and mercury. But after the original
study failed to produce any useful data, it was decided to follow the subjects until their
deaths, and all treatment was halted. Penicillin was denied to the infected men after that
drug became available in the mid-1940s, and it was still being withheld from them 25
years later, in direct violation of government legislation that mandated the treatment of
venereal disease. It is estimated that more than 100 of the subjects died of tertiary
syphilis. The Tuskegee syphilis study finally came to an end in 1972 when the program
and its unethical methods were exposed in the Washington Star.