ETHICAL AND LEGAL ISSUES IN CARDIOVASCULAR AND THORACIC NURSING, nursing

1. COLLEGE OF NURSING
MADRAS MEDICAL COLLEGE,
CHENNAI-03
MEDICAL SURGICAL NURSING-II
EHICAL AND LEGAL ISSUES IN CARDIO VASCULAR
AND THORACIC NURSING
BY
EDWIN JOSE.L
MSC(N) II YEAR,
COLLEGE OF NURSING,
MADRAS MEDICAL COLLEGE,
CHENNAI

2. INTRODUCTION
Ethics have always been an integral part of nursing.
Nurses at all levels/areas of practices experience a range of ethical
issues during the course of their day- to-day work.
Cardiovascular and thoracic care has come to be associated with
high- tech, aggressive & often risk-filled medical care.
The cardiovascular and thoracic care nurse are often confronted
with ethical & legal dilemmas related to various ethical principles
& it has increased dramatically.
Many dilemmas are byproducts of advanced medical technologies
& therapies developed over the past several decades

3. Definition- ethics
Ethics are defined as the moral principles that determine how a
person or group of people will or act or behave in specific situation.
Strong ethics are vital to nursing , as moral dilemmas can frequently
arise while attending to patients.
Nurse and other health care professional must recognize these
ethical problems when they occur and apply the profession’s ethics
and core values in their judgement and decision making.

4. Ethical principles
Principle of Autonomy
Principle of Beneficence
Principle of Nonmaleficence
Principle of Justice
Principle of Veracity
Principle of Fidelity
Principles of totality and integerity

5. Ethical and legal issues
1. Promoting beneficence
2. Preventing and avoiding harm to patients
3. Ensuring informed consent and informed refusal
4. Handling medical errors
5. Addressing refusals of and requests for withdrawal of life-sustaining
treatment
6. Fostering advance care planning
7. Ensuring appropriate surrogate decision making
8. Addressing requests for interventions
9. Maintaining patient confidentiality
10. Bedside allocation of health care resources

6. Promoting Beneficence
Beneficence requires that nurse promote the interests of patients,
which take precedence over the nurse s’ self-interests.
Beneficent nurse maintain clinical competence and strive for
quality, safety, and continuous improvement in nursing practice.
Beneficence requires that, nurse completely and clearly share their
assessments and recommendations with patients and ensure that
patients understand them.
 Recommendations should not be presented as a menu of choices,
but as a hierarchy of options based on efficacy, safety, and patients’
health care–related values, preferences and goals.

7. Preventing and Avoiding Harm to Patients
The principle of nonmaleficence is closely coupled with the
principle of beneficence.
Weighing the potential benefits versus the potential harms of a
diagnostic or therapeutic intervention is common in nursing practice.
 Nurses should prevent or minimize harms associated with any
intervention.
Conflicts of interests should not compromise nurses’ nonmaleficence
duties

8. Ensuring Informed Consent and Informed Refusal
 Consent problems arises because patients experiencing acute, life threatening
illness that interfere with their ability to make decisions on treatment.
 The informed consent is based on the principle of autonomy.
 Consent denotes voluntary agreement, permission or compliance. It implies to
permission by the patient to perform an act on his body either for diagnosis or
therapeutic procedure.
 The four elements of consent are;
 voluntariness
 capacity
 knowledge
 Decision making.

9. CONT……
If patient is not mentally capable (critical patients) informed consent
should be obtained from surrogate or legal next of kin.
It should be given by a person of sound mind & above the age of 18
years.
Requires the disclosure of basic information considered necessary
for decision making.
 Patients providing consent should be free from pain & depression.

10. Handling medical errors
The ethical rationale for disclosing errors to patients is strong.
First, nurse should act in the best interests of the patient.
Nondisclosure does not serve the patient and damages trust
because many patients eventually learn of errors.
Second, respect for patient autonomy requires that nurse disclose
errors to patients to allow for informed decision-making.
Third, justice requires that patients be given what is due to them,
including information about their medical condition and
compensation if appropriate (e.g., for injury).
Finally, nurses should participate in efforts to prevent errors.

11. Addressing refusals of and requests for withdrawal of life-sustaining
treatment
 based on patient’s principle of autonomy
 A patient also has the right to refuse previously consented
treatments if their health care–related values, preferences, and goals
have changed.
Dying patients (or their surrogates) may refuse or request the
withdrawal of life-sustaining treatments (e.g., mechanical
ventilation, hemodialysis, artificially administered hydration and
nutrition, device therapies) that are perceived by the patients (or
surrogates) as burdensome.
Withdrawal of life-sustaining treatments from dying patients who
no longer want the treatment is widely practiced.

12. Fostering advance care planning
 Advance care planning is a process in which patients, working with their nurse
and loved ones, articulate their values, preferences, and goals regarding future
health care decisions
 One form of advance care planning is the do not resuscitate (DNR) order.
 cardiopulmonary resuscitation (CPR) is the default standard of care for cardiac
arrest unless a DNR order has been written for the patient. Advance care
planning also includes completion of an advance directive.
 ADs are health care instructions used when a patient lacks decision-making
capacity.
 The AD should be regarded as an extension of the autonomous patient.

13. Ensuring appropriate surrogate decision making
 Patients who lack decision-making capacity are incapable of being
autonomous.
 For these patients, the nurse must rely on surrogate decision-makers to make
decisions for patients.
 If the patient's AD names a surrogate, this choice should be honored.
 If the patient does not have an AD, the ideal surrogate is one who best
understands the patient's health care values, preferences, and goals.

14. Addressing requests for interventions
Many patients (or their surrogates) make requests for specific
diagnostic and therapeutic interventions.
Many requests are reasonable and within standards of care. The
nurse generally should grant these requests.
However, clinicians or nurse are not obligated to grant requests for
interventions that are ineffective or violate their consciences.

15. Maintaining patient confidentiality
 The ethics principle of respect for patient autonomy requires that the nurse
maintain patient confidentiality.
 The nurse need access to patients’ medical information, ask sensitive
questions and conduct thorough physical examinations to assess and treat
patients properly.
 Patients should trust that their personal and medical information will be kept
confidential.

16. Bedside allocation of health care resources
 The ethics principle of justice requires that the nurse treat patients fairly.
 Injustice occurs when health care–related decisions are based on patient-
specific factors such as gender, ethnicity, and religion, not on medical need.

18. introduction
 In recent times, there has been a gradual transformation in the way in which
health care is delivered, with a shift from a system focusing on individual
expertise to one that is based on a common body of scientific knowledge.
 This body of knowledge is the evidence that informs the many decisions that
guide practice.
 This shift to a practice based on the best available evidence has been fueled by
such things as the growing expectations of consumers, rising costs of service
delivery, the many new health technologies and the significant developments
in information technology.
 At the same time, there has been a growing awareness of the limitations of
existing research evidence and recognition of the difficulties of implementing
change in health care.

19. Evidence based nursing is the conscientious, explicit, and
judicious use of current best evidence in making decisions about the
care of individual patients.
The practice of evidence based nursing means integrating
individual clinical expertise with the best available external evidence
from systematic research

20. EBNP VENN DIAGRAM/components

21. the need for change
The changing nature of modern society has placed additional
expectations on health systems struggling to keep pace with demand. The
pressure from many interrelated factors has increased the complexity of health
care decision-making, and fuelled interest in EBP.
 Consumer factors
 Health service delivery factors
 Public scrutiny
 Increased complexity of health care
 Volume of literature
 Poor quality research
 Internet
 Research literacy
 Implementing change

22. Evidence based practice process

25. Barriers of EBNP
 Lack of knowledge about EBP.
 Lack of knowledge about library and online resources.
 Inconvenient/inaccessible library/internet.
 Misperceptions or negative views of research.
 Devotion to traditional care
 Overwhelming patient care load.
 Voluminous amounts of literature.
 Difficult patient care situations.
 Organizational constraints.
 Inadequate information in nursing program.
 Laziness/lack of motivation/ burnout.

26. conclusion
 The ethical & legal responsibility of nurse working in cardiovascular and
thoracic nursing care areas has increasing.
 Nurses must maintain & continually update their knowledge base & clinical
competence.
 Failure to do so could not only cause harm to patients but could also put
nurses & their employer at risk for allegations & professional negligence.
 As a registered nurse working within the health care industry it is important to
consider all sides of the ethical debate & to always act within the law & with
the best interests of the client in mind.