Ethical and Legal Aspects in

Nursing

Prof. Ramanand Chaudhary

Child Health Nursing
 Objectives
At the end of the session participants will be able to:
• Define ethics
• List out its principles
• List out ethical dilemmas in nursing
• Define legal terminologies
• List out the types of laws
• Explain about legal responsibilities in nursing
• Explain about legal safe guard for nurses
 Ethics
• Ethics is the core of nursing practice.

• It is branch of philosophy that concern the distinction

between right and wrong based on body of
knowledge, not just based on opinion.

• In nursing ethical issues raise daily. There is issues such

as death, birth, abortion and human right.

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 Ethical Principles
• Autonomy:- Respect for an individual’s right
to self determination.

• Non-maleficent:- The obligation to do or

cause no harm.

• Beneficence:- Promoting good or maintain a

balance between benefit and harm.

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 Contd…
• Veracity:- The obligation to tell the truth.

• Fidelity:- Be faithful to agreements and

responsibilities one has undertaken.

• Justice:- Fairness the equitable distribution of

potential benefits and task.

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 Ethical Dilemmas
 It occurs when there is conflict between two
or more ethical principles.

 Problem in making a decision because there is

no clear, correct or right choice.

 Having to choose an action that promotes one

principle or value but violates another one.
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 Contd…
Examples:
• Abortion.
• Confidentiality.
• Termination of life sustaining treatment.
 Legal Aspect of Nursing

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 Introduction
Law
• It is defined as a system composed of general
rules, governing conduct and the procedures for
resolving disputes when rules are not followed.

• Laws are binding rules of conduct. When laws

are broken it is punishable by an authority
figure.

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 Types of law
1. Public law:- It is theory of law governing the
relationship between individual, government
agencies.
• Constitutional law (powers of government)
• Administrative law (governmental agencies)
• Criminal law (act against welfare of public)

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 Contd…
2. Private law or civil law:- Body of law that deals with
relationship between private individuals.

• Contract law: Involves the enforcement of agreement

among private individuals and the payments of
compensation for failure to fulfill the agreement
(employee contract).

• Tort law: Defines and enforces duties and right among

private individuals that are not based on contractual
agreement. (negligence, battery, assault, fraud etc)
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 Some Legal Terminology

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 Terminologies
• Informed consent:- An agreement to the performance
of a procedure/ treatment based on knowledge, risk
and alternative.

• Tort :- Wrongful act which produce harm against a

person, his/her rights or property, intentionally or
intentional. It is of three type:
• Intentional tort (assault, battery, fraud, false
imprisonment)
• Negligence torts (negligence, malpractice) and
• Strict Liability torts
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 Contd…
• Assault :- Intentional and unlawful offer to touch a person
in an offensive, insulting or physically intimidating manner.

• Battery :- Touching another person without the person’s

consent.

• Negligence:- Lack of reasonable conduct or care. Omitting

an action expected of a prudent person in a particular
circumstances is considered negligence. It is conduct that
falls below the standard of care.
 Contd…
• Liability:- It is a legal doctrine that makes a
person responsible for the damages and loss
caused by his/acts and omissions regardless of
responsibility.

A nurse is legally responsible for actions that

fail to meet the standard of care or for failing
to act and there by causing harm.
 Contd…
• Defamation (Slander):- Something untrue was
said to ruin the reputation of a person.

• Defamation (Liable):- Something untrue was

written to ruin the reputation of a person.

• Suit:- A case in a law court, legal proceeding.

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 Contd…
• Crime :- Act that is violation of duty or breach of law,
punishable by the state by fine or imprisonment .

• Standard:- The minimal knowledge and conduct

expected from a professional practitioner.

• Bill:- Draft or temporary outline of what the act will

be. Nurses are sometimes involved in draft bill.

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 Contd…
• Act :- Written document which has been formally
passed by government e.g. Nepal nursing council act
at the national level, health act.

• Legal document:- Certain written forms used

regularly by nurse and doctor on the process of
treatment. These forms can be used as evidence in
court if any difficulty arises. These document should
contain factual statement and signed by concerned
personnel and dated. E.g. treatment chart and
consent papers.
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 Function of Law in Nursing
1. It provides a frame work for establishing which nursing
actions in the care of client are legal.

2. It differentiates the nurse’s responsibility from those of

other health professionals.

3. It helps establish the boundaries of independent

nursing actions.

4. It assists in maintaining a standard of nursing practice

by making nurses accountable under the law.
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 Legal Responsibilities of Nurses
1. Careful carrying out physician order:
Nurses responsibilities to clarify ambiguous or
seemingly erroneous orders in prescription.
• Question any order a client questions.
• Question any order if the client’s condition has
changed.
• Question and record verbal order to avoid
miscommunication.
• Question standing order
 Contd…
2. Implementing delegated and independent nursing
intervention.
• Be responsible for the act.
• Informed consent before doing procedure.
• Document and communicate information regarding
client care and response.
• Reveal client confidential information only to appropriate
person.
• Perform act in which she is qualified.
• Restrain client only when necessary.
 Contd…
3. Reporting crimes, torts and unsafe practice.
• Report alcohol, drug abuse, theft unsafe
practice to concern department.
• Incident report should describe observed
behavior only.
• Medico legal case should be registered n
record book.
 Contd…
4. Nurse as witness.
• Nurse can be called to testify in legal action for
variety of reasons.
• Nurse in these situation can take advice from
attorney before providing testimony.
• Attorney for the institution will provide
support and counseling.
 Legal Safeguard in Nursing Practice

• Licensure: All nurse who are in nursing practice have to

possess a valid licensure by the Nepal nursing council.

• Collective Bargaining: A legal process in which

representative of organized employees negotiates with
employers about such matters as wages, hours and
conditions.

• Good Samaritan laws: Render first aid during

emergency.
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 Contd…
• Adequate Staffing: Under staffing is a problem that
results in reduced quality nursing care and may risk
client safety.

• Standing Order: Written orders instead of verbal

orders which is accepted by hospital policy.

• Contracts: Written or oral agreements between two

people in which goods or services are exchanged .

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 Contd…
• Consents: Agreement by client to accept a course of
treatment or procedure after being fully informed to it.
Consent for patient age above 18 years (self consent) and
ascent for patient below 18 years from parents or care
taker.

• Incident Reports: Also called a variance or occurrence

report, is used by healthcare agencies to document the
occurrence of anything out of the ordinary that results in,
or has the potential result in, harm to a patient, employee
or visitor.
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 References
• Taylor C, Lillis C, LeMone C & Lynn P. Fundamentals of Nursing. 6 th
ed. Lippincott publications. 2008.
• Kozier B, Erb G, Berman A, Synder S. Fundamentals of Nursing
Concepts, Process & Practice. New Delhi. 7 th ed. First reprint 2004.
Saurabh Printers Pvt Ltd.
• Deloughery G. Issues and Trends in Nursing. USA. 3rd ed. 1998.
Mosby’s Publications.
• Basavanthappa BT. Nursing Administration. 2003. New Delhi:
JAYPEE.P. 63-76.
• TNAI, Nursing Administration and Management. 2007. New Delhi
India.
• Rai L. Nursing concepts theories and Principles. 2 nd ed. 2011.