12 legal & ethical issues

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Mr.Channabasappa.K.M
PCON
UNIT 12: LEGAL AND ETHICAL ISSUES LAWS AND ETHICS
1. LAWS AND ETHICS, ETHICAL COMMITTEE, CODE OF ETHICS AND
PROFESSIONAL CONDUCT, LAGAL SYSTEM: - TYPES OF LAWS, TORT LAW,
AND LIABILITIES.
INTRODUCTION
From we were very young we began to learn what was right and what wrong behavior was.
We learned this from our parents, relatives, friends and teachers. By the time we became adults,
we had a personal set of ethics to guide our behavior in daily life. We may believe, for example,
that honesty is important and necessary and important. We will try to be honest because we
believe it is right to do so. Being dishonest would then be wrong for us. This is ethical behavior.
TERMINOLOGIES
Competent: adequately qualified.
Judicious: sensible; prudent
Conducive: leading to some end
Collaborate: work in combination
Conscience: moral sense of right and wrong
Contemporary: living or occurring at same time
Deterrent: frightening or hindering
Submissive: surrendering: obedient
Definition
ETHICS
Ethics refers to the moral code for nursing and is based on obligation to service and respect
for human life.
Melanie and Evelyn.
Ethics are the rules or principles that govern right conduct and are designed to protect the
rights of human beings.
Sister Nancy.
CODE OF ETHICS
Definition;
1. A code of ethics is a set of ethical principles that are accepted by all members of a
profession.
Potter and Perry
2 Code of ethics is a guideline for performance and standards and personal responsibility.

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Lillie M S and Juanita Lee
3. Code of ethics provides a frame work for decision making for the profession and should be
oriented
toward the day to day decisions made by members of the profession.
Chitty K K
4. A code of ethics is a set of ethical principle that
A} is shared by members of a group
B} reflects their moral judgments over time
C} serves as a standard for their professional actions.
Barbara Kozier
Nursing Ethics
It‘s a branch of applied ethics that concerns itself with activities in the field of
nursing. Its refers to ethical standards that govern and guide nurses in every day practice
such as ―being truthful with clients ―, ―respecting client confidentiality‖, and advocating
on behalf of the client.
Needfor nursing ethics
Helps the students/ RN to practice ethically
Helps the nurse to identify the ethical issues in her work place
 Protecting patients right and dignity
 Providing care with possible risk to the nurses health
 Staffing patterns that limit the patients access to nursing care
Ethical reasoning
Helps the nurse to respond to ethical conflicts
Helps to differentiate right /wrong behavior
Guide for a professional behavior
Help teachers plan education.
Prevent below standard practice.
Protect a nurse if falsely accused and guide direction for legal action
Key Principles of ethics in health care system

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Autonomy-The right of self determination, independence and freedom. Right to
health care decision.
Justice-Obligation to be fair with all people.
Fidelity- Obligation of an individual to be faithful to the commitment made to
himself, and to others. It is the main support of accountability.
Veracity: - The duty to tell the truth.
Beneficence- Doing good for the client. What exactly is good for one person may
not be the same for others.
Malaeficence- is the requirement that health care providers do no harm to their
client either intentionally or unintentionally
Deontological:-What causes a good outcome is good action.
Situational: - What causes a good outcome is good action.
Thus a profession‘s ethical code is a collective statement about the group‘s expectations
and standards of behavior. The ANA and ICN have established widely accepted codes that
professional nurses attempt to follow.
DEFINITION:-
Ethics:-
Ethics is the study of good conduct, character and motives. It is concerned with
determining what is good or valuable for all people. Act that are ethical often reflect a
commitment to standards beyond personal preference standards on which individuals,
professions and societies agree.
Code of ethics:-
Code of ethics is the providing guidelines for safe and compassionate care. Nurse‘s
commitment to a code of ethics guarantees the public that nurses adhere to professional
practice standards.
CODE OF ETHICS
Within any given profession, a code of ethics serves as a means of self-regulation
and a source of guidelines for individual behaviour and responsibility.

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I.C.N CODE OF ETHICS FOR NURSES(1993)
Ethical concepts applied to nursing:-
The fundamental responsibility of the nurses is of four fold: to promote health, to
prevent illness, to restore health and to alleviate suffering.
Elements of the code:-
Nurses and people
 The nurses primary responsibility is the those people who require nursing care
 The nurses provides care, promotes an environment in which the values customs
and spiritual beliefs of the individual are respected
 The nurses holds confidence, personal information and uses judgment in sharing
their information
Nurses and practice
 The nurse carries personal responsibility for nursing practice and for maintaining
competence by continuous learning
 The nurses maintains the higher standards of nursing care possible within the
reality of a specific situation
 The nurses assess judgment in relation to individual competence when accepting
and delegating responsibilities
 The nurse when acting in a professional capacity should at all times maintain
standards of personal conduct which reflect created upon the profession
Nurses and Society
The nurses with other citizens the responsibility for initiating and supporting action to in
edit the health and social needs of the public
Nurses and Co-workers
 The nurse sustains a co-operative relationship with co-workers in nursing
practice and nursing education
 The nurse is active in developing a care of professional knowledge
 The nurse acting through the professional organization, participants in
establishing and maintaining equitable social and economic working conditions in
nursing.

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AMERICAN NURSES ASSOCIATION CODE OF ETHICS FOR NURSES
 The nurses in all professional relationships practices with compassion and respect for
the inherent dignity, worth and uniqueness of every individual, unrestricted by
considerations if should or economic status personal attributes or the nature of health
problems.
 The nurses primary commitment is to patient, whether an individual, family, group or
community.
 The nurses promote, advocates for the strives to protect the health, safety and rights of
the patient.
 The nurse is responsible and accountable for individual nursing practice and
determines the appropriate delegation of tasks consistent with the nurses obligation to
provide optimum patient care.
 The nurse owns the same duties to self as others including the responsibility to
preserve integrity and safety to maintain competence and to continue personal and
professional growth.
 The nurses participates in establishing, maintaining and improving health care
environments and conditions of employment conducive to the provision of quality
health care and consistent with the values of the profession through individual and
collective action.
 The nurses participates in the advancement of eh profession through contribution to
practice, education, administration and knowledge development.
 The nurses collaborates with others health professional and the public in promoting
community, national and international efforts to met the health needs.
 The profession of nursing as represents by associations and their members, is
responsible for articulating nursing values for maintaining the integral of the
profession and its practice for shaping the social policy.
CANADIAN NURSES ASSOCIATION CODE OF ETHICS FOR NURSING
 Health and Well being: Nurses value health and well being and assist persons to
achieve their optimum level of health in situations of normal health illness, injury
or in the process of dying.
 Choice : Nurses respect and promote the autonomy of clients and them to express
their health needs and values and to obtain the appropriate information and
services
 Dignity : Nurse value and advocate the dignity and self-respect of human beings
 Confidentiality: Nurses safeguard the trust of clients that information learned in
the context of a professional relationship is spread outside the health care team
only with the client‘s mission or as legally required.

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 Fairness : Nurses apply and promote principles of equity and fairness to assist
clients in receiving inhibited treatment and a share of health services and resource
proportionate to their needs
 Accountability : Nurses act on a manner consistent with their professional
responsibilities and standards of practices
 Practice Environment: Conducive to safe, competent and ethical care. Nurses
advocate the practice environments that have the organizational and human support
systems and the resource allocation necessary for safe, competent and ethical
nursing care.
TYPE OF ETHICAL THEORIES
1. Duty-oriented ethical theories
A duty oriented ethical theory is a system of ethical thinking having the concept of
duty or obligation as foundation. Duties are strict obligations that take primary over rights
and goals. Keep in mind however each duty has corresponding rights.
Duty-oriented theories are advantages in homogeneous societies in which each
person hold the service values. A duty oriented theory would work well in a tribal society
because it is easier to share values and therefore beliefs among a small group of people.
A disadvantage of a duty-oriented theory is determining how to rank duties. For
example, a nurse may be form between a duty to support life and a duty to prevent
suffering.
2. Rights-Oriented Ethical theories
A rights-oriented ethical theory is a system of ethical thinking having the concept
of rights as a foundation. Rights-oriented theories assign the highest value to rights, so that
duties and goals flow from rights, from right –oriented perspective, your would first look
to the clients right to privacy flowing from that right to privacy would be your duty to
keep care information confidential to achieve the goal of encouraging clients to
communicate information freely.
Duty Oriented Ethical Theories
Duties
Right
Goals
Rights Oriented Ethical Theories
Right
Duties
Goals
3. Goal-oriented ethical theories

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A goal-oriented ethical theory is a system of ethical thinking having the concept of
maximizing the overall goal as its foundation- goal-related theories suggest that good
choices result from concern with the consequences of actions
In today‘s environment of health care reform nurses might choose to support
changes that will provide basic preventive and treatment services for all. Providing both
prevention and treatment could be viewed as maximizing the welfare of society
Goal-Orienetd Ethical Theories
Goals
Duties Rights
4. Intuitionist ethical theory
An ethical theory is a system of ethical thinking that balances goals, rights and
duties according to the situation. Philosophers espousing this theory argue that humans
innately know good from bad and that through intuition, duties, goals and rights can be
balanced.
Intuitionist Ethical Theories
Duties Goals Rights
ETHICAL PRINCIPLES
Ethical principles actually control professionalism nursing practice much more
than to ethical theories. Principles are the moral norms that nursing, as a profession, both
demands and strives to implement to every day clinical practice. Ethical principles that the
nurses should consider when making decisions are as follows
1. Respect for persons
2. Respect for autonomy
3. Respect for freedom
4. Respect for beneficence (doing good)
5. Respect for non-malfeasance(avoiding harm to others)

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6. Respect for veracity ( truth telling)
7. Respect for justice ( fair and equal treatment)
8. Respect for rights
9. Respect for fidelity ( fulfilling promises)
10. confidentiality ( protecting privileged information )
1. Respect for persons
This principle not only applied to clinical situation, but it applies to all life situations it
directs individuals to treat themselves and other with a respect inherent to main humans.
The respect to person‘s a need to be simplified as not affects nursing practice.
2. Autonomy
Autonomy means that individuals are able to act for themselves to the level of their
capacity. It is the rights of individuals, governing their actions according to their own
purpose and reason.
3. Freedom
Nurses a group believes that patient should be observed freedom of choice within the
nation‘s health care system. This principle should be observed by staff nurses when
planning patient care, by nurse‘s manager when leading subordinates
4. Beneficence: (the ethical principles of upholding doing good)
The beneficence principles states that the actions one takes should promote good. It
requires the balancing the harms and benefits. Benefits promote the clients welfare and
health whereas harms or risks detract from the client‘s health and welfare. In other words,
providing benefits that enhance the other welfare. Whereas balancing the benefits and
harms of intervention made on the others half.
5. Non- Maleficence
The principle of non- maleficence states that one should do no harm. The nurses should
interpret the term harm to mean emotional and social as well as physical injury. Harm is
threading, defeating or setting back one person./s interest through invasive action by
another.
6. Veracity
Veracity concerns truth talking and incorporates the concept that individuals should
always tell the truth. It requires professional care givers to provide with accurate, reality
based information about their health status and care or treatment prospective.
7. Justice
Justice concerns the issue that persons should be treated equally and fairly. This principle
of justice requires treating others fairly and giving persons their due.

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8. Rights
Rights is an entitlement to behave in a certain way under circumstances, such as nurses
entitlement to freely express personal beliefs and preferences by voting in a political
election.
Right is also used to mean agreement with justice, law and morality. So right may be
mental rights or legal rights to respective profession.
9. Fidelity
Fidelity is keeping one‘s promises or committeemen‘s. The principles of fidelity hold that
a person should faithfully fulfill his duties and obligations.
10. Confidentiality
Confidentiality is the duty to respect privileged information. The principle of
confidentiality provides that care-givers should respect a patient need for privacy and by
personal information about him or her only to improve care. Nurses should practice
confidentiality to decrease patient vulnerability and share from widespread knowledge of
personal information divulged during care.
ETHICAL DILEMMAS
A dilemma is defined as a situation requiring a choice between two equally
desirable or undesirable alternatives. In ethical dilemma each alternative course of action
can be justified by two ways in which a person views the course of action based on his or
her value system. Increasingly, staff nurses and nurse managers face difficult decisions
caused by tensions between technological capabilities, budgetary strictures, and quality of
life concerns.
Nurses in all clinical and functional specialties face the following dilemmas.
 Need to ration patient care to conserve scarce resources
 Need to make treatment and care of decisions for terminally ill patients
 Need to obtain patients informed consent for care treatment orders and measures such
as
o Do not requisite order
o With holding/with drawing nutrition and fluids
o Starting / discontinuing life support system
 Responses to patient request for assisted suicide
 Need to balance the patients need for confidentiality and privacy against societies
needs for protection from unreasonable risk
 Need to protect autonomy rights of children and incompetent adults concerning
consent for rese4arch participation

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 Need to protect justice rights of patients who participate in random trails of
experimental treatment.
Decision Making
The nursing process is a system at the step-by –step approach to resolving
problems that deals with a client‘s health and well-being. The chief goal of the ethical
decisions making process is to determine right and wrong in situation.
The following ethical decision-making progress is presented or a tool for resolving ethical
dilemma.
Step – I: Collect, Analyze and interpret the data
Obtain as much information as possible concerning the particular ethical dilemma;
unfortunately such information is sometimes very limited. The clients wishes the clients
family‘s emotional problems carrying the dilemma, the physicians beliefs about health
care and the nurses own orientation to concerning life and death
Step – II: State the Dilemma
After collecting and analysis much information as available the nurses to state the
dilemma as clearly as possible the step. It is important to identify whether the problem is
one that can be resolved only by the client, client‘s family and the physician.
Step – III: Consider the choices of action
After stating the dilemma as early as possible the next step as to attempt to help the
considerations of their consequences all possible covering the action that can be taken to
resolve the dilemma.
Step – IV: Analyze the advantage and disadvantages of each course of action
Some of the courses of action developed during the previous step are more relates readily
evident during this step in the decision making process when the advantages and the
disadvantages of each action are considered in detail. Along with each action the
consequences of taking each course of action must be thoroughly evaluated.
Step– V: Make the decision and act on it.
The most difficult part of the process is actually making the decision following through
with action and the living in the consequences. Decision are often made with no follow
through because nurses are fearful the consequences of their decisions.
Ethical Decision- making
Identify potential ethical dilemma
Collect analyze and interpret data

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State the dilemma
Dilemma cannot be Dilemma can be
Resolved by nurse resolved by nurse
Take no action List potential solutions
Acceptable Unacceptable
Consequences consequences
Ethical decision Take no action
Dilemma resolution
ROLES AND FUNCTIONS OF ADMINISTRATOR IN ETHICAL ISSUES
The leadership roles and management functions of an administrator in ethics as follows
 He or she is self aware regarding own values and basic beliefs about the rights,
duties and goals of human beings
 Accepts that some ambiguity and uncertainty be a part of all ethical decision-
making
 Accepts that negative outcomes occur in ethical decision making despite high
quality problem solving and decision-making
 Demonstrates risk taking in ethical decision making
 Role models ethical decision-making which are congruent with the code of ethics
and inter respective statements
 Actively advocates for clients, subordinates and the profession
 Clearly communicates expected ethical standards of behavior
 Uses a systematic approach to problem-solving or decision making when faced
with management problems with ethical ramifications
 Identify outcomes in ethical decision-making that should always be sought to
avoided
 Uses establishment ethical framework to clarify values and benefits

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 Applies principles of ethical reasoning to define what beliefs or values from a basis
of decision making
 It aware of legal procedures that may guide ethical decision making and is
accountable for possible habitats should they go against the legal precedent.
 Continuously re-evaluate quality of won ethical decision making based on the
present of decision making problem-solving used
 Recognizes and rewards ethical conduct of subordinates
 Takes appropriates actions when subordinates use unethical conduct
PROFESSIONAL CONDUCT
Code of professional conduct (for nurses in India)
1. Professional responsibility and accountability
To maintain professional responsibility and accountability, the nurse
 Appreciates a sense of self-worth and nurtures.
 Maintains standards of personal conduct, reflecting credit upon the profession.
 Carriers out responsibilities within the framework of the professional boundaries
is accountable for maintaining practice standards set by the Indian Nursing
Council.
 Is accountable for his/her own decisions and actions.
 Is compassionate.
 Is responsible for the continuous improvement of current practices
 Provides adequate information to individuals these allows them to make informed
choices.
 Practices healthful behavior.
2. Nursing Practice
In the course of practice of nursing, the nurse
 Provide care in accordance with set standards of practice
 Treats all individuals and families with human dignity in providing the physical,
psychological, emotional , social and spiritual and aspects of care
 Respects individuals and families in the context of traditional and cultural
practicing, promoting healthy practices and discouraging harmful practiced
 Presents realistic practices truthful in all situations for facilitating autonomous
decisions making by individuals and families
 Promote participation and individuals and significant others in the care

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 Ensures safe practice
 Consults, co-ordinates, callboards and follow p approximately when an individuals
care needs exceed the his or her competence
3. Communication and interpersonal relationships
This plays a key role in the interaction of the nurse with his or her clients. To effect
optimal interaction the nurse
 Establishments and maintains effective interpersonal relationships with individuals
families and communities
 Upholds the dignity of team members and maintains effective interpersonal
relationship with them
 Appreciates a and nurtures the professional role of team members
 Co-operates with other health professionals to meet the needs of individuals ,
families and communities
4. Valuing human being
The nurse values human life. He or she
o Takes appropriate action to protect individuals from harmful unethical practices
o Considers relevant facts while taking cons… decisions in the best interest of
individuals
o Encourages and supports individual in heir right to speak for themselves on issues
affecting health and welfare
o Respects and supports choices made by individuals.
5. Management
Proper management of resources and unfortunate is essential for improving the over all
efficiency of the nurse. Hence the nurses
 Ensures appropriate allocation and utilization of available responses
 Participates in supervision and education of students and other formal providers
 Uses judgment in relation to individual competence which accepting and
delegating responsibility
 Facilitates conducive work culture in order to achieve institutional objectives
 Communicates effectively following appropriate channels if communication
 Participates in performance appraisal
 Participates in evaluation of nursing services
 Participates in policy decision, following the principles of equity and accessibility
of service

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 Works individuals to identify the needs and sensitizes policy makers and funding
agencies for resource allocation
Professional Advancement
To escape that he or she is at part with contemporaries in the nursing field the nurse must.
a. Ensures the protection of human rights, while pursuing the advancement of
knowledge
b. Participate in determine and implementing quality
c. Take responsibility for updating one‘s own knowledge and competencies
d. Contribute to the core of professional knowledge and conducting and participating
in research
ICN CODE OF ETHICS FOR NURSES
In 1953 ICN adopted its first code of ethics for nurses and was revised in 2000. The
four principle elements contained within the ICN code involve standards related to nurses and
people, practice, profession and co workers.
ICN recommended that nurses have 4 fundamental responsibilities i.e. to promote
health, to prevent illness, to restore health and to alleviating suffering. And also inherent in
nursing is respect for human rights, like right to life, to dignity and to be treated with respect.
And the care should not be restricted by age, sex, color, creed, culture or nationality.
Nurses and people
The nurse‘s primary responsibility is to those people who require nursing care. The nurse in
providing care promotes an environment in the values, customs, and spiritual beliefs of the
individual are respected .the nurse holds in confidence personal information and use judgement
in sharing this information.
Nurses and practice
The nurse carries personal responsibility for nursing practice and for maintaining
competence by continual learning. The nurse maintains the highest standard of nursing care
possible within the reality of a specific situation. The nurse uses judgement in relation to
individual competence when accepting and delegating responsibilities. The nurse when acting in
professional capacity should at all times maintain standards of personal conduct which credit up
on the profession.
Nurses and co-workers
The nurse maintains a cooperative relationship with coworkers in nursing and other fields. The
nurse takes appropriate action to safeguard the individual when his care is endangered by a co-
worker or

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any person.
Nurses and the profession
The nurses play a major role in determining and implementing desirable standards of
nursing practice. The nursing is active in developing a core of professional knowledge. The nurse
acting through the professional organizations participates in establishing and maintaining
equitable social and economic working conditions in nursing.
FUNCTIONS OF ETHICAL CODES
 To inform the public about the minimum standards of the profession and to help them
understand professional nursing conduct.
 To provide a sign of the profession‘s commitment to the public it serves.
 To outline the major ethical considerations of the profession.
 To provide general guidelines for professional behavior
 To guide the profession in self regulations.
CODE OF PROFESSIONAL CONDUCT
Code of professional conduct (for nurses in India)
1. PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY
To maintain professional responsibility and accountability, the nurse
a. Appreciates a sense of self-worth and nurtures it.
b. Maintains standards of professional conduct, reflecting credit upon the profession.
c. Carries out responsibilities within the frame work of professional boundaries.
d. Is accountable for maintaining practice standards set by the I.N.C.
e. Is accountable for his or her actions.
f. Is compassionate.
g. Practices healthful behavior.
h. Is responsible for continuous improvement of current practices.
2. NURSING PRACTICE
a. In the course of practice of nursing, the nurse
b. Provide care in accordance with set standards of practice.
c. Treats all individual and family with human dignity in providing the physical,
psychological, emotional, social and spiritual aspects of care.
d. Respects individuals and families in the context of traditional and cultural practices,
promoting healthy practices, and discouraging harmful practices.
e. Presents realistic pictures truthful in all situations for facilitating autonomous decisions
making by individuals and families.
f. Promote participation of individuals and significant others in the care.
g. Ensures safe practice.

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3. COMMUNICATION AND INTER PERSONAL RELATIONSHIPS
This plays a key role in the interaction of the nurse with his or her clients. To effect optimal
interaction, the nurse
a. Establishes and maintains effective IPRs with individuals, families and communities.
b. Upholds the dignity of team members and maintains effective IPR with them.
c. Appreciates and nurtures the professional role of team members.
d. Co-operates with other health professionals to meet the needs of the individuals, families
and communities.
4. VALUING HUMAN BEINGS
The nurse values human life. She
a) Takes appropriate action to protect individuals from harmful unethical practices.
b) Considers relevant facts while taking conscientious decisions in the best interest of
individuals.
c) Encourage and supports individual in their right to speak for themselves on issues
affecting health and welfare.
d) Respect and supports choices made by individuals.
5. MANAGEMENT
Proper management of resources and infra structure is essential for improving the overall
efficiency of the nurse. Hence the nurses
a) Ensures appropriate allocation and utilization of available resources.
b) Participates in super vision and education of students and other formal providers.
c) Uses judgment in relation to individual competence while accepting and delegating
responsibility.
d) Communicates effectively following appropriate channels of communication.
e) Participates is performance appraisal.
f) Participates in evaluation of nursing services.
g) Participates in policy decision, following the principles of equity and accessibility of
service.
6. PROFESSIONAL ADVANCEMENT
To ensure that he or she is at par with contemporaries in the nursing field, the nurse must
a. Ensures the protection of human rights, while pursuing the advancement of knowledge
b. Participate in determining and implementing quality care.
c. Take responsibility of updating one‘s own knowledge and competencies.
d. Contribute to the core of professional knowledge and conducting and participating in
research.
e. The nurses ‗responsibility for the patient has been changed to a broader term of people.
This includes respect for culture, customs, religious beliefs and confidential treatment
of personal information. One of our greater adjustments in nursing is accepting
responsibility for our own professional behavior.

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MEANING
Legal
1. LAW
LEGAL SYSTEM
- Established by or founded upon law or official or accepted rules
Law
- The term law is derived from its tentoric root lag which means something which lies
fixed or events
- Law means a body of rules to guide human action
- Law means ―that which is laid down or fixed‖
DEFINITION
1) The law us a system of rights and obligations which the state enforces.
By Green
2) The law constitutes body of principles recognized or enforced by public and regular
tribunals has the administration of justice by pound
3) The law is the body of principles recognized and applied by the state and the
administration of justice by salmaind
4) Law is a rule or standard of human conduct established & enforced by authority, society
or custom
SOURCES OF LAW
 Constitutional law: - it is a judgmental law. Law that governs the state. It
determines structure of state, power and duties.
 Common law:- it is a body of legal principles that evolved from court decisions
 Administrative law: - rules and regulations established by administrative agencies
made by executives of government.
PURPOSES
* To help the nurse to understand that they do have legal responsibilities in nursing
practice.
* To make them understand by which authority these legal responsibilities can be
enforced.

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* To make them understand what areas of nursing practice can mostly create legal
problems.
* To describe and protect the rights of clients and nurses
* Law is there for the protection of nursing practice
* Law is there for the identification of the risk of liability
* Law is there to assist in the decision-making process involved in nursing practice
* Nurses have more responsibility
*another important purposes are
 Safeguarding the public
 Safeguarding the nurse
Safeguarding the public
1) The public safety is guaranteed because the practice of nursing is restricted to those
accredited practitioners who would seek to provide highest possible level of
comprehensive care for the individual and the community taking in to account the
total need
2) The individual is secure to the event of sickness or disability with no fear of
anxiety of being cared for by a competent person
Safeguarding the nurse
1) Licensure:-
All nurses who are in nursing practice have to possess a valid licensure,
issued by the respective state nursing council/Indian nursing council
2) Good Samaritan laws:-
In response to health professionals, fear of malpractice claims, most states
enacted Good Samaritan Laws that exempt doctors and nurses from liability when
they render first during emergency. These laws limit liability and offer legal legal
immunity for people helping in an emergency
3) Good rapport: -
Developing good rapport with the client is very important to prevent
malpractice. The ability to develop good rapport with client is dependent on the nurse
having good interpersonal communication skills e.g. listening
4) Standards of care:-
All professional practicing in the medical field are held to certain standards
when administering care. It is always better to follow standards of care to avoid
malpractice and do not attempt anything beyond the level of competence.
5) standing orders:-

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Although a nurse may not legally diagnose illness or prescribe treatment,
she or he may after assessing patients condition apply standing orders or treatment
guideline that have been established by the physician or doctor as appropriate for
certain problems and conditions
6) consent for operation and other procedures:-
A patient coming in to hospital still retains his rights as a citizen and his entry
only denotes his willingness to undergo an investigation or a course of treatment.
Any investigation or treatment of a serious nature, or an operation in which an
anesthetic is used, requires the written consent of the patient.
7) correct identity:-
The nurse or the midwife has the great responsibility to make sure that all
babies born in the hospital are correctly labeled at birth and to ensure that at no
time they are placed in the wrong cot or handled to the wrong mother.
8) Counting of sponge instrument and needles:-
Nurses advocate that sponge, instrument and needle counts be performed
for all surgical procedures taking place in operation theatre. When an instrument
left in a patient body the nurse will probably t=liable for any patient injury caused
by the presence of foreign body.
9) Contracts:
A contract is a written or oral agreement between 2 people in which goods or
services are exchanged.
10) Documentation:-
Documentation is by far the best once a lawsuit field. The medical record is a
legal document admissible in court as evidence.
LAW AFFECTING NURSES
 Nurse practice laws
Describes and designs the legal boundaries of nurse practice act within each state
 Administrative law
Created by administrative bodies such as state board of when they pass rules and
regulations. Developed by groups who are appointed to governmental administrative
agencies. E.g. Food, Drug & Cosmetic Act; Social Security Act; Nurse Practice Act
 Statutory law
Created by elected legislative bodies such as state legislatures

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 Enacted law
Include all bills passed by legislative bodies whether local, state, and national
LAW IN NURSING
 Common law
Created by judicial decisions made in courts when individual cases are decided
 Felony
Is a crime of serious nature that has a penalty of imprisonment for greater than one
year or even death
 Misdemeanor
Is a less serious crime that has a penalty of a fine or imprisonment of less than one
year
 Civil law
Protects the rights of individual persons within our society and encourage fair and
equitable treatment among people
 Contract Law
It is the enforcement of agreements among private individuals. Employment Contracts is
an example of contract law under civil law
 Criminal law
Prevent harm to society and provides punishment for crimes
Types of law
There are many ways in which a body of law, or the principles of law-making, can be
divided into categories for the purposes of simplification.
- Comparative Law : The comparative lawyer works with international relations in
trade and commerce, travel, government business, and many other areas depending
upon the breadth of his/her knowledge and the needs of his/her employer. The field
of comparative law is one in which there is a great deal of opportunity for
advancement and challenging work.
- Public law : Public law is the body of law that governs the relationship between
the individual and the state, as distinct from civil law (or `private' law) which
governs the relationships between individuals. Public law is often taken to be
divided into `criminal', `constitutional' and `administrative' branches, although
these are not distinct in all jurisdictions.
- Family law: Family law attorneys deal specifically with laws having to do with
family matters. There are multiple facets to each instance of representation
required and knowledge of individuals and their family histories are necessary.
Family law lawyers must interview each family member involved, or mediate for
families so agreements can be made in an amiable or restructuring way. The most

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common family law attorneys are the divorce lawyers, but other aspects of family
law are represented as well. Child support claims and those stipulations, custody
and who gets custody, visitation and length of visitation. Adoption proceedings,
who can adopt, the rights of fathers, mothers, and the different statutes of each
state, paternity and how it is determined, domestic abuse charges, who was abused,
spousal abuse, child abuse, sexual abuse and the court's rulings, annulments of
marriages and what are considered avoidable marriages, are all represented by the
family law attorney. How these cases are decided by the courts and for what
reasons are determined by the knowledge and representation of the family law
attorney.
- Criminal Law : Criminal Law involves just what the label implies - people
accused of crimes. Lawyers who specialize in criminal law may work on either
side of the adversary process - defense or prosecution. There are many more types
of law from which to choose; what you choose will depend upon your present
interests and your interests as they develop in law school. There is no reason to
make your decision before begin.
- Contract law: Contract law covers obligations established by agreement (express
or implied) between private parties. Generally, contract law in transactions
involving the sale of goods has become highly standardized nationwide as a result
of the widespread adoption of the Uniform Commercial Code. However, there is
still significant diversity in the interpretation of other kinds of contracts, depending
upon the extent to which a given state has codified its common law of contracts or
adopted portions of the Restatement (Second) of Contracts. Parties are permitted to
agree to arbitrate disputes arising from their contracts. Under the Federal
Arbitration Act (which has been interpreted to cover all contracts arising under
federal or state law), arbitration clauses are generally enforceable unless the party
resisting arbitration can show unconscionability or fraud or something else which
undermines the entire contract.

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2. TORTS
The word Tort is derived from French word of the same spelling which means
"mischief, injury, wrong, or calamity", from Latin tortus meaning twisted.
Torts a civil wrong made against a person or property. Tort Law is the enforcement
of duties & rights among independent of contractual agreements. 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.
To constitute a tort, it is essential that the following conditions must be satisfied
Act or omission
Wrongful act or omission must be recognized by law
Legal damage
Legal remedy
Categories of torts
Torts may be categorised in a number of ways: one such way is to divide them into
Negligence Torts, and Intentional Torts.
Negligence Torts
Negligence is a tort which depends on the existence of a breaking of the duty of care owed
by one person to another. The tort of negligence provides a cause of action leading to
damages, or to relief, in each case designed to protect legal rights, including those of
personal safety, property, and, in some cases, intangible economic interests. Negligence
actions include claims coming primarily from car accidents and personal injury accidents
of many kinds, including clinical negligence, workers negligence and so forth. Product
liability(warranty stuff) cases may also be considered negligence actions, but there is
frequently a significant overlay of additional lawful content. The elements of negligence
are:
 Duty of care
 Breach of duty in English law|Breach of that duty
 Breach being a proximate cause or not too remote a cause in law
 Causation law Breach causing harm in fact
Intentional Torts
Among intentional torts may be certain torts coming out of the occupation or use
of land. One such is the tort of nuisance, which involves strict liability for a neighbor who
interferes with another's enjoyment of his real property. Trespass allows owners to sue for
entrances by a person (or his structure, for example an overhanging building) on their
land. There is a tort of false imprisonment, and a tort of defamation, where someone

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makes an unsupportable reason for arrest or their speech is not represented to be factual
which damages the reputation of another.
Statutory torts
A statutory tort is like any other, in that it imposes duties on private or public parties,
however they are created by the legislature, not the courts. Liability for bad or not working
products is strict in most jurisdictions. The theory of risk spreading provides support for
this approach. Since manufacturers are the 'cheapest cost avoiders', because they have a
greater chance to seek out problems, it makes sense to give them the incentive to guard
against product defects.
Nuisance
Legally, the term ―nuisance‖ is traditionally used in three ways: (1) to describe an activity
or condition that is harmful or annoying to others (example- indecent conduct, a rubbish
heap or a smoking chimney); (2) to describe the harm caused by the before-mentioned
activity or condition (example- loud noises or objectionable odors); and (3) to describe a
legal liability(responsibility)that arises from the combination of the two. The law of
nuisance was created to stop such bothersome activities or conduct when they
unreasonably interfered either with the rights of other private landowners (example-
private nuisance) or with the rights of the general public (example-public nuisance).
Intentional torts
Intentional torts are any intentional acts that are reasonably foreseeable to cause
harm to an individual, and that do so. Intentional torts have several subcategories,
including torts against the person, including assault, battery, false imprisonment,
intentional infliction of emotional distress, and fraud. Property torts involve any
intentional interference with the property rights of the claimant(plaintiff). Those
commonly recognized include trespass to land, trespass to chattels(personal property), and
conversion.
Economic torts
Economic torts protect people from interference with their trade or business. The area
includes the doctrine of restraint of trade and has largely been submerged in the twentieth
century by statutory interventions on collective labour law and modern antitrust or
competition law. The "absence of any unifying principle drawing together the different
heads of economic tort liability has often been remarked upon."

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1. Liability (financial accounting)
Definition
An obligation that legally binds an individual or company to settle a debt. When
one is liable for a debt, they are responsible for paying the debt or settling a wrongful act
they may have committed. [www.investorwords.com]
Types of liability
Product liability
Product liability is the area of law in which manufacturers, distributors, suppliers,
retailers, and others who make products available to the public are held responsible for the
injuries those products cause. Although the word "product" has broad connotations,
product liability as an area of law is traditionally limited to products in the form of
tangible personal property. Products Liability distinguishes between three major types of
product liability claims:
 manufacturing defect,
 design defect,
 a failure to warn (also known as marketing defects).
Strict liability
In law, strict liability is a standard for liability which may exist in either a
criminal or civil context. A rule specifying strict liability makes a person legally
responsible for the damage and loss caused by his or her acts and omissions regardless of
culpability (including fault in criminal law terms, typically the presence of mens rea).
Strict liability is prominent in tort law (especially product liability), corporations law, and
criminal law.Rather than focus on the behavior of the manufacturer (as in negligence),
strict liability claims focus on the product itself. Under strict liability, the manufacturer is
liable if the product is defective, even if the manufacturer was not negligent in making that
product defective.
Vicarious liability
The word 'vicarious' derives from the Latin word for 'change' or 'alternation' or
'stead' and in tort law refers to the idea of one person being liable for the harm caused by
another, because of some legally relevant relationship.
Public liability
Public liability is part of the law of tort which focuses on civil wrongs. An
applicant (the injured party) usually sues the respondent (the owner or occupier) under
common law based on negligence and/or damages. Claims are usually successful when it
can be shown that the owner/occupier was responsible for an injury, therefore they
breached their duty of care.

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The duty of care is very complex, but in basic terms it is the standard by which one
would expect to be treated whilst one is in the care of another.
Once a breach of duty of care has been established, an action brought in a common
law court would most likely be successful. Based on the injuries and the losses of the
applicant the court would award a financial compensation package.
Classification of accounting liabilities
 Current liabilities
These liabilities are reasonably expected to be liquidated within a year. They usually
include payables such as wages, accounts, taxes, and accounts payables, unearned revenue
when adjusting entries, portions of long-term bonds to be paid this year, short-term obligations
(e.g. from purchase of equipment). Current liabilities are the financial obligations payable
within a short period of time, normally within one year. It is a balance sheet item, which is
equal to the sum of dues within one year and all the money indebted to the establishment.
Current liabilities are the short-term financial obligations.
Some of the distinguishable examples of current liabilities include accrued expenses as
wages, taxes and due interest payments.
 Long-term liabilities
Long-term liabilities — these liabilities are reasonably expected not to be
liquidated within a year. They usually include issued long-term bonds, notes payables,
long-term leases, pension obligations, and long-term product warranties. Long-term
liabilities are liabilities with a future benefit over one year, such as notes payable that
mature longer than one year. In accounting, the long-term liabilities are shown on the
right wing of the balance-sheet representing the sources of funds, which are generally
bounded in form of capital assets.
ETHICAL COMMITTEE
Hospital Ethics Committee
Introduction
Most Indian hospitals have instituted such a committee principally for the purpose of
checking whether proposals submitted for research meet established guidelines. Once this
has been established, the researcher is permitted to proceed with his work and the
committee turns to subsequent proposals. This approach make a very limited usage of the
personnel recruited on such a committee. Much more can be done to improve not only the
quality of research undertaken by the institution but also the care of patients in the
institution.

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‘Mission statement of the committee’
The committee must start with an open statement on its aims and objectives. These
should be circulated throughout the institution and feedback sought on how this can be
improved. It is also necessary to review this mission statement periodically and revise it
when necessary.
The following could form the heads under which details can be entered:
 Care of the patient in this institution.
 Research.
Education of the staff on biomedical ethics.
How should the committee function?
At the helm, There must be at least two senior persons complementing and supplementing
each other. They should, preferably, belong to different disciplines.
Who should be a member?
The obvious answer is anyone with a deep commitment to medical ethics. It is
important not to skew membership by having several persons from the same discipline. It
is also essential to ensure representatives of:
 administration
 clinicians - medical, surgical, other disciplines
 basic sciences
 social workers
 nurses
 rehabilitation personnel
 priests/philosophers
 lawyers
 statisticians
Subcommittees?
If the ethics committee is charged with three principal goals: patient care, research and
education of faculty and other personnel, it is logical to entrust each of these to a
subcommittee. Monthly meetings of a large, single committee once a month over an hour
and a half or two hours are unlikely to do justice to these goals.
Frequency of meetings
This will depend on the goals set for the committee. If the committee is only to
restrict itself to processing applications for research, the number of such proposals will
govern the dates on which meetings are to be held. Most ethics committees meet at least
once a month in order to ensure that no research proposal is held up at the level of the
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Each member must attend at least 75% of all meetings.
Structure of each meeting
Silverman (1) suggests that no more than half an hour at the start of each meeting
be devoted to ‗business issues‘: reading the minutes of the previous meeting, reports from
subcommittees, new issues. The remaining time must be used to discuss and explore the
different moral values within the institution. This is where free discussion on ethics is
encouraged and decisions sought on this basis. He suggests that discussions on specific
cases, their reports having been prepared and circulated in advance, are most likely to
yield results. Such cases could be selected with a view to provoking discussions on
informed consent, the means by which diagnosis is disclosed to the patient and relations,
expenditure incurred by patients, the rationale and justification for expensive tests or
therapies, relevance of research being undertaken within the institute...
He also recommends that time be spent at each meeting on reviewing relevant papers on
medical ethics published in recent issues of journals, the focus being on how these can be
used to improve standards in the institution.
Research
All research proposals must conform to standard scientific and ethical guidelines.
These must be scrutinised by a designated member of the committee to ensure that there is
no glaring deficiency. (In case of such a deficiency, the proposal should promptly be
returned to the researcher with a note on what is needed.)
All proposals received before a stipulated date must be discussed at the next meeting.
The committee must pay special attention to:
- Will the study add substantially to existing knowledge?
- Is the study scientifically, statistically and ethically valid?
- Is it relevant?
- Are the results of this study likely to prove harmful? Pilgaokar (1) points out that we
have a moral responsibility to desist from any inquiry as soon as it becomes clear that it is
likely to endanger mankind.
- If experiments on animals form an essential component, are humane practices built into
the project?
- If human subjects are involved, special attention must be paid to how truly informed
consent is obtained, what measures have been provided in case of complications that may
harm the subjects and how those defaulting from the study will be followed up if a drug or
implant with medium or long term action is being used. Pilgaokar (2) has summed up the
requirements of truly informed consent, listing the various kinds of information that must
be conveyed to subjects.

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Care of patients
Is the institution providing the best possible medical care? This could be considered
under the following heads:
 The art of bedside medicine
 Relief of suffering
 Cure of disease
 Iatrogenic disease: incidence, trend over time
 Cost to patient: tests, drugs, other costs. Can these be lowered?
 Prompt attention to needs of the patient.
 Care of the seriously ill
 Dying patients
 The dead patient
Education of the staff within the institution
This could cover all aspects of patient care and research. Other activities of an ethics
committee
Silverman (2) also recommends that the committee:
 produces guidelines on a broad range of topics. Disclosure of diagnosis, diagnosis
of brain death,requesting permission to harvest organs for trans-plantation,truly
informed consent are some examples.
 sets up and ensures proper functioning of a forum for redressal of complaints from
patients and fami-lies. This forum must receive complaints in writing, helping
illiterate patients to prepare such documents. Complaints, proceedings of hearings
on them, decisions and action taken must be kept on record.
 produces a document for the benefit of patients and their families informing them
of services provided by the institution, rights of patients and relatives, their
responsibilities, means by which they may seek redressal for any harm that may be
done to them...
 surveys practices within the institution on a continuing basis: standards of patient
care, unnecessary expenditure enforced on patients, obtaining truly informed
consent. Patients and relatives could be polled on deficiencies/ malpractice
witnessed by them and their suggestions for improvement.
 obtains feedback from faculty, other staff on the functioning of the ethics
committee; perceived deficiencies and suggestions on how it might function more
effectively. It may be necessary to permit anonymity of those making observations
in order to safeguard them from victimisation and encourage free and frank
observations.

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 conducts seminars/ workshops/ mini- conferences on biomedical ethics, better
research...
Why do some ethics committees fail?
Committee set up for the wrong reasons: Such reasons include
a) an attempt at avoiding prosecution under the heads: Consumers Protection Act;
b) ensuring that research proposals made by members of the faculty sail smoothly through
national and international agencies that offer grants and require clearance by a local ethics
committee before they will take up the proposal for scrutiny;
c) to form yet another power group within the institution that can hold the rest of the
faculty to ransom.
Goals that are too ambitious: Silverman (1) refers to the phase when ethics committees,
like infants, ‗fail to thrive.' When formed, there is much enthusiasm and activity by
members of the committee. A little later, a feeling of frustration emerges as unrealistic
goals set for the committee are not achieved. He refers to plans to educate the entire
faculty and resident staff on medical ethics (including those in research) in a short while as
an example of such a goal.
Lack of support by the institution:If all research protocols and matters of ethical concern
are not placed before the committee and if the recommendations of the committee are
flouted by the administration, demoralisation is inevitable.
The committee must also be provided adequate infrastructure for its deliberations,
inquiries, follow up studies and maintenance, analysis of records. It will be necessary for
the committee to enter into correspondence with other experts and groups, record
proceedings of its meetings, circulate the minutes, interact with experts on other ethics
committees, funding agencies and similar groups.
Funds and secretarial help are mandatory for the proper functioning of such a committee.
The entire institution must want and welcome the formation of such a committee, seeing it
as a means for improving standards, providing better care to patients and carrying out
research of the highest standards.
Poor selection of members on the committee:If these individuals are already short of
time, it is unlikely that they will pay much attention to the tasks to be attended to on behalf
of the committee. Cursory inspection of documents, little or no follow up action and
frequent absences from meetings of the committee are expected consequences.
The members must possess a strong motivation for improving the conditions under which
patients are treated and research practiced. They should have already devoted some time
and energy in identifying current slip- ups and malpractice and the means to be employed
in correcting them.

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They must also be conversant with current trends in national and international biomedical
ethics. Without continued self- education, they are likely to lapse into rigidity of approach
and dogmatic decisions.
Institutional Ethics Committee
The need for Institutional Ethics Committee (IECs) in medical and research establishments
resulted from the realization that affirms human rights as a prerogative of all members of
society. Individual physicians and research workers may not be able to do what is right in
all instances as evidenced by the number of cases on record.
Institutional ethics committees vary widely in their composition, usually in an attempt to
assure a broad based multi-disciplinary membership. In addition to those with research and
clinical experience, many committees include representation from Pastoral Care, Social
Work, and Law backgrounds, and often a member with a more academic orientation.
Moreover, most committees find it important to include individuals from the lay
community to help provide a patient's and public perspective.
The present medical and research scene in India is rather chaotic and irregular and
therefore vulnerable to unethical practices. With globalization and shift of research focus
from the developed countries to developing countries, the protection of vulnerable
populations in countries like India is of utmost importance and urgency. The apex medical
and research bodies at best have played a passive role till recently on ethical issues by not
making a strong enough stand in public and not being persuasive enough to motivate all
institutions to establish ethics committees. There has been no concerted move to either
educate the public on ethical issues confronting medical practice and research or
importantly, to incorporate bioethics as a subject in the medical, nursing, paramedical and
biotechnology courses.
The Indian Council of Medical Research (ICMR) has published detailed guidelines on the
composition and responsibilities of IECs and established ethical guidelines for biomedical
research on human subjects (Published in 2006). A survey of existing IECs of various
institutions in the country was initiated recently by the ICMR. Unfortunately this effort
received a very unenthusiastic response. This sorry situation reflects an inadequate form of
control and governance in the practice of medicine and research because the overseeing
institutions are not given the necessary authority to take action against offenders, and
society as a whole has not established a sensitive and interactive approach to the whole
question of unethical practices.
What should be our perception of IEC?
When an ethical dilemma occurs, it is not so much a question of "shall I do the wrong
thing or the right thing", it is, "which good that I am trying to achieve is the better good?"
An IEC is not a scientific review board - working as a gatekeeper and a regulator for
experimental research and clinical trials. An IEC does not have that kind of a mandate -
nor does it wish to.

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It is not a morals police force going around looking for research workers doing something
unethical.
It is not a quality review board or risk management committee who is supposed to cover
the institution's legal situation.
Then what should it be?
The IIT-IEC should function like a preventive medicine department (preventing problems
from arising) and concentrate its efforts on conflict resolution.
IIT-IEC must bear in mind that it is a porous bi-layered membrane facing creative research
on one side and maintaining society's human rights on the other.
Composition of IEC
IEC will have a chairman, the member secretary and members nominated by the Director.
IEC will have minimum eight (8) members including
 2 medical/ non medical scientists
 All members of the IEC should be non-institutional except the member secretary
 The chair should be an outsider
 The secretary should be a staff of this institution
 There should be at least 2 lady members in the committee
 There should be at least 5 members for a quorum
 No senior administrative officer of the institution should be a member
 An office and office staff should be available for the secretary of the IEC
 No outside member of the IEC should be connected with the institution or research
project in any way
Some Specific roles the IECs can play are the following
1. Be available through the member secretary for clarifying ethical problems that may
arise from the project and detail the ethical problem for the IEC to debate.
2. Make sure that "informed consent "has been properly obtained. There is a general
belief among doctors and research workers that patients belonging to the lower
socio-economic group are pretty illiterate about medical matters and therefore need
not be told much about their diagnosis, management or prognosis or why a certain
quantity of blood or other specimens are being collected.The findings of a survey
are totally at variance with this observation.
3. Multi-center trials require a uniform protocol and a unified assessment system.
There should be unlimited cross talk between IECs of institutions involved.
4. Periodic follow up should be made by the IEC after an institutional project has
been sanctioned.

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5. Use of laboratory animals in research - additional inputs from physiologist,
pharmacologists and pathologists should be sought by the IEC or a separate
committee should be available.
6. Informed consent obtained from volunteers who are to participate in a field trial
must be meticulously executed. The dangers if any spelt out, what legitimate
safeguards as opposed to enticements can be offered ?what sort of compensation
will be offered if something goes wrong, how will confidentially be maintained ,
can be biological samples obtained from the person be sent to other laboratories in
india and abroad? And the proper disposal of biological samples.
7. Clinical trials of drugs or therapy conducted by clinicians /research workers
attached to this institution and a collaborating one, should not only be assessed by
the IEC ,but it should have a say in the quantum of largesse offered for the person's
services and the final report should be made available to the IEC before it is
submitted to the sponsoring agency. The ethics committee minutes of the
collaborating institution should be available with the institutional PI.
8. Stem cell research. Experts and details mandatory.
Procedure for Ethical Clearance for Projects
1. Clearance by the 'Technical Committee' is needed. In case of experiments
involving animals, clearance from the Animal Experimentation Committee is
required.
2. Submission of the proposal highlighting the Ethical aspects have to be submitted to
the IEC office. Form 1 - must be filled up and attached to the submitted proposal.
Clearance(s) as mentioned in (1) must also accompany the proposal. This must be
submitted to the Member Secretary at least a month before the next meeting of the
Ethics committee.
3. The PI will be informed of the date and time of the IEC meeting when the
presentation has to be made to the IEC.
4. The IEC will issue the clearance certificate subject to all the criteria being met by
the PI for the submitted proposal.
5. Submit 8 hard copies of your proposal to the IEC office with the prescribed forms.
LEGAL ROLE OF THE NURSE
1) Provider of Service
 Ensure that client receives competent, safe, & holistic care
 Render care by ―standards of reasonable, prudent person‖
 Supervise/evaluate that which has been delegated
 Documentation of care
 Maintain clinical competency

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2) Responsibility of appointing and assigning
3) Responsibility in quality control
4) Responsibility for equipment
5) Responsibility for observation and reporting
6) Responsibility to protect public
7) Responsibility for record keeping and reporting
8) Responsibility for death and dying
CONCLUSION
All the ethics aims at safeguarding the rights of life. A nursing practice done with
ethics in mind surely earns respect and preference and acceptability but certain dilemma
are present today regarding each ethic and nurse should try her best to deal with these
dilemma and act according to right need of the hour. The nursing profession has a lot of
challenges in the 21st century. Critical components of the professional practice continue to
expand and be enhanced through technology, synchronous (at the same time) and
asynchronous (at different times).Along with this the nurses should work in a collaborative
way to meet the identified goals.
Bibliography
Jean barrett, ward management and teaching, konark publications
Basavanthappa BT. Nursing administration. 2ed. St Louis (USA): jaypee brothers
medical publishers; 2009. p809-36.
Potter P.A., A.G Perry(2005): fundamentals of nursing(6th edn) Elsevier
publications; New Delhi; pg no:388-392, 404.
Lan E Thompson, Kath M M (2005) Nursing ethics, Church hill living stone,
London: pg no:54-56
Susan Leddy, J Pepper(1998)Conceptual bases of professional nursing (4th
edn)Lippincott, Philadelphia:Pg no:11, 14-16
http://www.iitm.ac.in/iec
http://www.issuesinmedicalethics.org/042ed051.html
http://en.wikipedia.org/wiki/Long-term_liabilities
http://www.economywatch.com/budget/india/liabilities.html
http://www.investorwords.com/2792/liability.html
http://en.wikipedia.org/wiki/Public_liability
http://en.wikipedia.org/wiki/Strict_liability
http://en.wikipedia.org/wiki/Tort
http://en.wikipedia.org/wiki/Product_liability
http://en.wikipedia.org/wiki/Law_of_the_United_States#Types_of_law

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2. TOPIC: LEGAL ISSUES IN NURSING: NEGLIGENCE, MALPRACTICE,
INVASION OF PRIVACY AND DEFAMATION OF CHARACTER.
INTRODUCTION:
As a nurse it has become an important necessity to be aware of the legal aspects
associated with caring and helping people in the health industry today .Unfortunately, the
more and more negligence cases there are the less and less people want to get in to the
health care field fearing legal aspects and the inevitable law suites. The first nursing law
created was that of nursing registration in 1903 and they have only evolved and expanded
over the years to create a thick book which must be studied today by aspiring nurses.
GENERAL OBJECTIVES:
At the end of the class students will gain the knowledge about legal issues in nursing
service and develop desired skills and attitudes while practicing nursing.
TERMINOLOGIES:
Plaintiff: A person who brings a case against someone else in a court of law.
Sued: Take legal action against a person or institution.
Intrusion: The action of coming in to a place or situation where you are unwelcome or
uninvited.
Parole: Temporary or permanent release of a prisoner before the end of a sentence.
Homicide: Killing of person
MEANING OF LAW:
Ordinarily the term law means a body of rules to guide human action.
DEFINITION OF LAW
1. The law is a system of rights and obligations which the state enforces - GREEN
2. The law is the body of principles recognized and applies by the state and the
administration of justice .- SAMAIND
CLASSIFICATION OF LAW:
Law is divided in to civil and criminal components.
CRIMINAL LAW:
Criminal law applies to law that affects the general welfare of the public. A violation of
criminal law is called crime and is prosecuted by the government. On conviction, a crime
may be punished by imprisonment, parole condition and a loss of privilege (such as a
license), a fine or any combination of these. The punishment is intended to deter others
from committing the crime and to punish the violator.
There are three classification of criminal crime:
1. Felony: A felony is a crime of serious nature that carried a penalty of imprisonment for
greater than one year or death.This includes such act as homicide, grand larcency and a
nurse act violation.
2.Misdemeanor: It is a crime of less serious nature and the penalty is usually a fine or
imprisonment for less than a year. Includes lesser offenses such as traffic violation.
3. Juvenile: Crimes carried out by individuals under the age of 18 years, specific age
varies by state and crime.

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CIVIL LAW:
Civil law applies to laws that regulate conduct between private individuals or businesses.
A tort is a violation of a civil law in which another person is wronged. Private individuals
or groups may bring a legal action to court for breach or breaking of civil law.
The judgement of the court results in a plan to correct the wrong and may include a
monetary payment to the wronged party. Nurses may find themselves involved with civil
and criminal laws either separately or within the same situation.
LEGAL ISSUES IN NURSING:
Some legal issues recur frequently in nursing practice. It is wise for the nurse to try to
understand these particular issues as they relate to individual practice.
PERSONAL LIABILITY:
As an educated professional, nurses are always legally responsible or liable for
their action. Thus ,if a physician or supervisor asks you to do something that is contrary to
your best professional judgement and says, ‗I‘ll take responsibility that person is acting
unwisely. The physician and supervisor giving the directions may be liable if harm results
but that would not remove your liability.
Although each person is legally responsible for his or her own actions, there are also
situations in which a person or organization may be held liable for actions taken by others.
EMPLOYER LIABILITY:
The most common situation in which a person or organization is held responsible for
the actions of another is in the employer-employee relationship. In many instances ,an
employer can be held responsible for torts committed by an employee. This is called the
doctrine of respondent superior(let the master respond).The law holds the employer
responsible for hiring qualified personnel, for establishing an appropriate environment for
correct functioning and for providing supervision or direction as needed to avoid errors or
harm. Therefore if a nurse, as an employee of a hospital, is guilty of malpractice, the
hospital may be named in the suit.The employers liability may exist even if the employer
appears to have taken precautions to prevent error.
It is important to understand that this doctrine does not remove any responsibility
from the individual nurse, but it extends responsibility to the employer in addition to the
nurse.
CHARITABLE IMMUNITY:
In some states, non-profit hospitals have charitable immunity.This means that the non
profit hospital cannot be held legally liable for harm done to a patient by its employees.
The employees of that nonprofit hospital are still legally for their own actions.The trend
in legislation is toward the repeal of laws providing for charitable immunity.Those active
in the consumer movement have argued that no institution should be relieved of
responsibility in such a blanket fashion.If you are employed by a non profit institution, it is
important that you know whether the law in your state provides charitable immunity for
the institution.

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SUPERVISORY LIABILITY:
When a nurse is in the role of charge nurse ,head nurse, supervisor or any other role
which involves supervision or direction of other people ,the nurse is potentially liable for
the actions of others .The supervising nurse is responsible for good exercising good
judgement in a supervisory role .This includes making appropriate decisions about
assignments and delegation of tasks .If an error occurs and the supervising nurse is shown
to have exercised sound judgements in all decisions made in that capacity, the supervising
nurse may not be held liable for the error of the subordinate .If poor judgement was used
in assigning an inadequately prepared person to an important task the supervisory nurse
might be liable for resulting harm.
DUTY TO REPORT OR SEEK MEDICAL CARE FOR A PATIENT:
A nurse who is caring for the patient has legal duty to ensure that the patient receives
safe and competent care .This duty requires that the nurse maintain an appropriate
standard of care and also that the nurse take action to obtain an appropriate standard of
care from other professionals when that is necessary. The nurse has a duty to continue all
efforts to obtain appropriate medical care for the patient.
INFORMED CONSENT:
Every person has the right to either consent to or refuse medical treatment. The law
requires that a person give voluntary and informed consent to treatment.This consent may
be either verbal or written.Written consent usually is preferred in health care to ensure that
a record of consent exists.The form should state the specific proposed medical procedure
or test.
A nurse may present a form for a patient to sign and the nurse may sign the form as a
witness to the signature. This does not transfer the legal responsibility for informed
consent for medical care to the nurse .If the patient does not seem well informed, the nurse
should notify the physician so that further information can be provided to the patient. The
nurse has ethical obligations to assist the patient in exercising his or her rights and to assist
the physician in providing appropriate care.
CONSENT FOR NURSING MEASURES:
Nurses must obtain a patient consent for nursing measures undertaken. This does not
mean that exhaustive explanations need to be given in each situation because courts have
held that patients can be expected to have some understanding of usual care. Consent for
nursing measures may be verbal or implied.
The nurse should remember that the patient is free to refuse any aspect of care offered.
However, like the physician, the nurse is responsible for making sure that the patient is
informed before making a decision.
COMPETENCE TO GIVE CONSENT:
A person ability to make judgements based on rational understanding is termed
competence. Dementia, developmental disabilities, head injury , stroke and illness
creating loss of consciousness are common causes of an inability to make judgement.
Determining competence is complex issue. Illness ,age or condition alone do not
determine competence. Legal competence is ultimately determined by the courts. When a
person is legally determined to be incompetent, consent is obtain from legal guardian.
Competence may change from day to day as person physical illness changes.

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WITHDRAWING CONSENT:
Consent may be withdrawn after it is given. People have the right to change their
minds.Therefore, if after one IV infusion a patient decides not to have a second one started
that is his or her right.As a nurse, you have an obligation to notify the physician if the
patient refuses to medical procedure or treatment.
CONSENT AND MINORS:
The consent of minor is usually given by a parent or legal guardian.You should also
obtain the minor consent when he or she is able to give it.Increasingly, courts are
emphasizing that minors be allowed a voice when it concerns matters that they are capable
of understanding.This is especially true for adolescent,but this consideration should be
given to any child who is seven years of age or older.When the minor refuses care and the
legal guardian have authorized that care,you should not proceed until legal clarification is
given.Your nursing supervisor should be consulted.
CONSENT IN EMERGENCY:
If a true emergency exists, consent for care is considered to be implied.The law holds that
if a reasonable person were aware that the situation was life threatening,he or she would
give consent for care. An exception to this made,if the person has explicitly rejected such
as care in advance and any such information may be identified from patient wallet.
FRAUD:
Fraud is deliberate deception for the purpose of personal gain and is usually prosecuted
as crime situations of fraud in nursing are not common.
One example would be trying to obtain a better position by giving incorrect information to
a prospective employer. By deliberately stating(falsly) that you had completed a nurse
practitioner program to obtain a position for which you would otherwise be ineligible,you
are defrauding the employer
This may be prosecuted as a crime because you are also placing members of the
community in danger of receiving sub standard care.You may also commit fraud by trying
to cover up a nursing error to avoid legal action.Courts tend to be more harsh in decision
regarding fraud represents a deliberate attempt to mislead others for your own gain and
could result in harm to those assigned to your care.
MEDICATION ERRORS:
Some errors results from drugs with similar names ,look alike medication containers,
poor systems for communication in which hand writing problems may contribute to lack
of clarity.
When medications errors do occur,fraud or intentional concealment may be charged
and may contribute to the awarding of punitive damages as well as ordinary damages.
TORTS:
Torts are civil wrongs committed by one person against another.The wrong may be
physical harm, psychological harm or harm to reputation, livelihood or some other less
tangible value.

38
CLASSIFICATION OF TORTS:
1. Intentional torts
2. Quasi-intentional torts
3. Unintentional torts
INTENTIOAL TORTS:
Assault:
Assault is any intentional threat to bring about harmful or offensive contact. No actual
contact is necessary .The law protects clients who afraid of harmful contact. It is an assault
for a nurse to threaten to give a client for an X-ray procedure when the client has refused
consent. The key issue is the client consent. In an assault lawsuit, if the clients gives
consent, the nurse is not responsible.
Battery:
Battery is un-consented or unlawful touching of a person. For battery to occur ,the
touching must occur without consent. Remember that consent may be implied rather than
specifically stated. Therefore, if the patient extends an arm for injection, he cannot later
charge battery, saying that he was not asked. But if the patient agreed because of a
thread(assault), the touching would still be considered battery because the consent was not
freely given.
False imprisonment:
The tort of false imprisonment occurs with unjustified restraining of a person without
legal warrant. For example, this occurs when nurses restrain a client in a bounded area to
keep the person from freedom but when it occurs in health care it is most often the basis of
a civil suit rather than a criminal case.
Any time a patient needs to be confined for his or her own safety or well being , it is
best to help the understand and agree to that course of action. If the patient is not
responsible, the guardian or legal representative may give permission. The third alternative
is to objectively document the need in the patients record and obtain a physicians order as
soon as possible .Be sure to follow the policies of the facility.
All persons who have the right to make decisions for themselves, regardless of
consequences you protect yourself by recording your efforts to teach the patient the need
for restrictions and by reporting the patients behaviour to your supervisor and the
physician.
QUASI-INTENTIONAL TORTS
1. Invasion of privacy:
MEANING:
Invasion of privacy n. the intrusion into the personal life of another, without just
cause, which can give the person whose privacy has been invaded a right to bring a lawsuit
for damages against the person or entity that intruded. However, public personages are not
protected in most situations, since they have placed themselves already within the public
eye, and their activities (even personal and sometimes intimate) are considered

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newsworthy, i.e. of legitimate public interest. However, an otherwise non-public
individual has a right to privacy.
Types of invasion of privacy
Invasion of Privacy - Intrusion of Solitude
Intrusion of solitude, seclusion or into private affairs is a subset of invasion of privacy
earmarked by some spying on or intruding upon another person where that person has the
expectation of privacy. The place that the person will have an expectation of privacy is
usually in a home or business setting. People who are out in a public place do not have the
same expectation for privacy, according to most state laws, than do people who are inside
their own homes.
For instance, journalist, investigators, law enforcement and others may not place wiretaps
on a private individuals telephone without his or her consent. However, law enforcement,
may at times circumvent this law by obtaining permission from the courts first. In rare
cases, law enforcement may even obtain permission after-the-fact for the wiretaps.
Opening someone's mail is also considered to be intrusion of solitude, seclusion or private
affairs. The information gathered by this form of intrusion need not be published in order
for an invasion of privacy claim to succeed. Trespass is closely related to the intrusion tort
and may be claimed simultaneously.
Invasion of Privacy - Appropriation of Name, Likeness or Identity
The appropriation of a private person's name, likeness or identity by a person or company
for commercial gain in prohibited under the invasion of privacy laws. This law pertains to
a private figure and not a public figure or celebrity, who have fewer and different privacy
rights.
This law was born from a couple of court decisions in the early 1900's where a private
person's photograph was being used without consent for advertising purposes and without
the person receiving any money for using their pictures in print. The courts recognized the
common law right to privacy including a person's identity had been violated by the
unauthorized commercial use. In later cases, a person's voice was also included.
Public figures, especially politicians do not have the same right to privacy in regards to
appropriation of name, likeness or identity since there is much less expectation of privacy
for public figures. Celebrities may sue for the appropriation of name, likeness or identity
not on grounds of invasion of privacy, but rather on owning their own right to publicity
and the monetary rewards (or damages) that come from using their likeness.

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Invasion of Privacy - Public Disclosure of Embarrassing Private Facts
Public disclosure of embarrassing private facts is an invasion of privacy tort when the
disclosure is so outrageous that it is of no public concern and it outrages the public sense
of decency. In this invasion of privacy tort, the information may be truthful and yet still be
considered an invasion if it is not newsworthy, the event took place in private and there
was no consent to reveal the information. Divorce situations and relationship breakups
may involve this kind of invasion of privacy tort.
LAW OF PRIVACY
Privacy law is the area of law concerned with the protection and preservation of the
privacy rights of individuals. Increasingly, governments and other public as well as private
organizations collect vast amounts of personal information about individuals for a variety
of purposes. The law of privacy regulates the type of information which may be collected
and how this information may be used and stored.
Specific privacy laws
These laws are designed to regulate specific types of information. Some examples include:
 Health privacy laws
 Financial privacy laws
 Online privacy laws
 Communication privacy laws
 Privacy in one's home
 Information privacy law
UNINTENTIONAL TORTS
1. Negligence:
Definition
1. Negligence refers to the act of doing something or refraining from doing
something that any other reasonable medical professional would do or refrain
from doing in a similar situation. It goes without saying that every situation is
different, and that is where the law becomes somewhat cloudy. However, when
reviewing a nursing negligence case, assumptions and circumstantial evidence
are taken into account to determine if there was negligence.
2. The basic and legal definition of negligence means breach of duty or injury.
Standards of care in nursing generally mean those practices that "a reasonably prudent
nurses would use." So a good nurse knows and understands ethics in the medical field and

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strives to provide excellent quality of care in order to avoid negligence. However,
mistakes, which will happen, do not necessarily mean negligence has occurred.
Breach of Duty
Examples of breach of duty, which may be considered negligent under certain
circumstances may include "doing something which a reasonably prudent person
would not do, or the failure to do something which a reasonably prudent person
would do, under circumstances similar to those shown by the evidence. It is the
failure to use ordinary or reasonable care," according to Critical Care Nurse, a
journal for high acuity, progressive and critical care.
Injury
For an injury to be considered caused by negligence, records must show that the
nurse failed to perform her duties with the patient in question. In such cases, the
failure of duty must then be proven as directly related to the injury of the patient.
For example, if a nurse fails to give medications as directed then the patient's
condition worsens or he dies, the nurse may be found negligent.
Performance Failures
Inadequate nursing skills or attention to tasks may result in a suit of negligence
against a nurse who chronically fails to provide approved standards of care. Such
incidents include, but are not limited to, habitual medication errors, failure to
follow protocol or orders and improper use of equipment.
Examples of nursing negligence
Common examples of nursing negligence include malnutrition, inadequate
hydration, physical abuse, medication errors, and mental and emotional abuse. In
nursing homes or other places of long-term care, there are also often injuries due to
bedsores, infections and falls. Malnutrition and dehydration cases come from
leaving a patient unattended for too long, ignoring his needs, or simply refusing to
feed and provide water. Abuse comes in a variety of forms and, in many cases,
nurses do not feel they will be reported, especially if the patient is mentally
handicapped. Medication errors, bedsores, infections and falls are most frequently
the result of carelessness and lack of paying attention to their patients as necessary.
Proof
The legal review of a nursing negligence case requires proof that injury was done,
and that it was the result of the nurse's care or lack thereof. There are five main
elements in a nursing negligence case, and all elements must be proven in order for
a case to be valid. If one or more of the elements is not present, the case may be

42
difficult to pursue--(1) the nurse had a duty to perform, (2) the appropriate care
was apparent in the situation, (3) there was a breach or violation of care, (4) there
was an injury proven to result from the nurse's negligence, and (5) there is proof
that damages occurred as a direct result of the situation.
Avoiding Negligence
It is important for nurses to document their actions very closely and accurately at the
time because sometimes negligence cases come about later when details are difficult to
remember. Charting everything makes it easy to determine the details surrounding
each action or inaction and to find a logical reason as to why it was done. This, in
combination with a nurse who follows the proper scope of practice, will likely keep a
nurse from being prosecuted for nursing negligence.
2. Malpractice:
Definition
Malpractice is defined as improper or negligent practice by a lawyer, physician, or
other professional who injures a client or patient. The fields in which a judgment of
malpractice can be made are those that require training and skills beyond the level of
most people's abilities. Medical malpractice is defined as a wrongful act by a physician,
nurse, or other medical professional in the administration of treatment— or at times,
the omission of medical treatment, to a patient under his or her care. Although dentists,
architects, accountants, and engineers are also liable to malpractice suits, most lawsuits
of this type in the United States involve medical malpractice.
Medical malpractice is professional negligence by act or omission by a health care
provider in which care provided deviates from accepted standards of practice in the
medical community and causes injury or death to the patient. Standards and regulations
for medical malpractice vary by country and jurisdiction within countries. Medical
professionals are required to maintain professional liability insurance to offset the risk
and costs of lawsuits based on medical malpractice
Why Nursing Malpractice is Increasing
Nursing is a profession that‘s critical to the administration of healthcare, and it‘s a
profession that‘s in high demand. But there are not enough qualified nurses (for
instance, registered nurses and licensed practical nurses) to keep up with this demand,
and the result is chronic understaffing and a population of overworked nurses.
While nursing shortages are not a direct cause of nursing malpractice, it does cause a
couple of serious issues:
1. Nurses who work excessively long shifts may suffer from fatigue, making them
more prone to commit an error. In fact, a 2004 report showed that nurses who worked a
shift longer than 12.5 hours were three times more likely to make a mistake.

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2. Hospitals and other healthcare facilities may hire inadequately trained nurses or
unlicensed nurse aides to fill a need. The less training a nurse has, the greater the risk
of a medical error.
In addition, miscommunication and carelessness are not uncommon in the healthcare
setting and may directly cause a potentially life-threatening complication or mistake.
Types of Nursing Malpractice
Nursing malpractice takes many forms, including:
- Medication errors – giving a patient the wrong medication or the wrong dose, or
dispensing medication to the wrong patient
- Failure to follow a physician‘s orders
- Delaying patient care and/or failure to monitor a patient
- Incorrectly performing a procedure, or trying to perform a procedure without training
-Documentation error
-Failure to get informed patient consent
Consequences of Nursing Malpractice
The consequences of nursing malpractice can range from minor to potentially fatal, and
may include:
Medication overdose
 Adverse drug reaction
 Coma
 Brain, heart, kidney or other organ damage
 Infection
 Death
What Constitutes Nursing Malpractice?
Not all unfortunate events in medicine are caused by malpractice. Despite what may be a
common societal belief, not all unexpected, unintended, or even undesired medical results
can be attributed to the fault of the healthcare provider. The law recognizes that much of
nursing care requires clinical judgment. Consequently, a patient must prove 4 requisite
elements to establish a malpractice case.
First, the patient must establish that there was a nurse-patient relationship. It is out
of the nurse-patient relationship that a nurse‘s duty to the patient arises. Rarely can it be
said that a particular nurse had a duty to the patient if such a relationship cannot be shown.
Most often, this element will be satisfied by reliance on the hospital record documenting

44
the nurse‘s involvement with some aspect of patient care. Once this is established, a duty
is created.
Second, the patient must establish the scope of the duty that was owed by the
nurse; this is usually done though an expert witness testifying about the care that was
required.
Third, the patient must establish that there was a departure from "good and
accepted practice." Good and accepted practice is most often defined as care that would
have been provided by the ordinarily prudent nurse practicing in the particular
circumstances. The care need not have been the best care or even optimum care.
Furthermore, when there is more than 1 recognized method of care, a nurse will not be
deemed negligent if an approved method was chosen, even if that method later turns out to
be the wrong choice. As long as the defendant nurse provided care that was consistent with
accepted practice, the nurse will not be found negligent, regardless of outcome.
Lastly, there must be a causal relationship between the act or acts that departed
from accepted nursing care and the patient‘s injury. This link must be established not by
possibility, but by probability; thatis, it must be proved that if the nurse had not been
negligent, then more likely than not, the patient would not have suffered harm. This
element must also be proved by expert testimony.
Other common causes of malpractice cases against nurses include failure to properly
monitor and assess the patient‘s condition and failure to properly supervise a patient
resulting in harm. Typically, negligent monitoring cases arise from a nurse‘s failure to
perform an assessment and notify the treating physician of changes. Thus, a nurse‘s failure
to obtain vital signs and report a patient‘s deteriorating condition was held to constitute
negligence.3 Similarly, when a nurse observed that a patient‘s arm was swollen, black, and
foul-smelling but failed to advise the treating physician of other clinical findings, including
delirium and arm drainage, the nurse was held liable.4 Negligent supervision cases usually
involve a patient who falls while getting out of bed, while ambulating, or while using the
bathroom.
A nurse who concludes that an attending physician has misdiagnosed a condition or
has not prescribed the appropriate course of treatment may not modify the course set by
the physician simply because the nurse holds a different view. To permit that conduct
would allow the nurse to perform tasks of diagnosis and treatment denied to the nurse by
law. However, the nurse is not prohibited from calling on or consulting with nurse
supervisors or with other physicians on the hospital staff concerning those tasks when they
are within the ordinary care and skill required by the relevant standard ofconduct.
Therefore, a nurse has an obligation to advocate on behalf of the patient when
issues arise about the course of care or treatment being provided. Merely documenting in
the chart that the order was discussed and confirmed with the ordering care provider is not

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enough. The issue in these cases is not about allocating the responsibility of healthcare, but
instead arises from the hospital‘s and nurse‘s duty to keep the patient safe.
Is the Hospital Responsible for the Actions of Its Nurses?
Generally speaking, a principal is responsible for the acts of its agents. In law, this
is known as respondeat superior. Therefore, a hospital has vicarious liability for the
negligence of its nurses, which allows a patient to bring a lawsuit against either the nurse
individually, or the hospital as the employer, or both.
In addition to liability arising out of respondeat superior, a hospital may also have
separate institutional or corporate liability. Among its responsibilities, a hospital has a duty
to the patient to ensure the competency of its nursing staff and the physicians who
maintain privileges at its institution. Furthermore, the hospital is responsible for ensuring
that proper drugs and equipment are available for use, and that they are not defective. The
hospital also has a general duty to patients and visitors to maintain the hospital premises in
a reasonably safe condition.
How Can Malpractice Actions Be Avoided?
The simple answer is that they cannot be avoided. However, by utilizing the
nursing process and employing critical thinking, bad outcomes that commonly lead to
malpractice claims can be reduced.
The steps of the nursing process are described as follows:
1. Assessment
2. Problem/need identification
3. Planning
4. Implementation
5. Evaluation
By ensuring that each step is taken and that reflection is given by using critical
thinking, the likelihood of an avoidable adverse medical event occurring is less likely. In
medication administration, the 5 Rs are often cited: right patient, right drug, right route,
right dose, and right time. All too often 1 or more of these "rights" are violated, and a
patient is injured. As with any order, guideline, directive, or principle within the nursing
process, following these steps is only the beginning. To ensure that the clinical
circumstances warrant implementation of the order, critical thinking is essential when
administering any drug.

12 legal & ethical issues

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