Primary relationship between legal and ethical issues in nursing

Ethical Considerations in Emergency Nursing | Nursing

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The use of computers and communication technologies will impact more lives in the 21st century than any other technology, including stem cells, transplants, and nanomedicine Goodman, As indicated in the case scenario and the study findings, the use of the EHR can result in a unique set of ethical and legal challenges.

Nurses must be prepared to face these challenges and recognize the requirements of state and federal law, workplace policies, and obligations of the profession. A study in revealed that nurses spent a majority of indirect nursing time documenting in the EHR, demonstrating the critical necessity of proper usage to satisfy quality of patient care Kim, Documentation must be clear and accurate to provide a basis for the contribution of nurses to patient outcomes and the viability of healthcare organizations ANA, Documentation that fails to meet these principles can result in undesirable outcomes for the nurse, patients and families, or for the healthcare organization ANA, Nursing documentation, electronic or handwritten, are legal documents that can, under some circumstances, be used in legal proceedings.

Nurses maintain competence regarding the legal significance of documentation and therefore must demonstrate legible and comprehensive reporting Larsen, Once documentation has been electronically recorded and signed by the nurse, the liability of that acknowledgement is not clear. The copy and paste functionality includes copying, pasting, cloning, auto-filling, carrying forward, replicating data and reusing content from one section to another within the EHR Scruth, The copy and paste phenomenon has caused significant debate from those who argue its necessity for time efficiency weighed against the significant risk of inaccuracy and patient safety errors Harrington, These practices can result in timeliness issues or time-related accuracy of documentation in any EHR.

EHRs are designed to facilitate easier provider order entry and have been shown to reduce prescription errors Scruth, They have tremendous potential to improve efficiency of healthcare delivery and improvement of quality patient care. However, healthcare providers have experienced notable challenges to balance necessary time for patient care with computer entry McBride et al. Historically, it was assumed that all standards of care were met unless documented otherwise.

However, with the introduction of the EHR, complete documentation requires charting of all clinical assessments, care plans, interventions, and outcomes requiring more time for documentation de Ruiter et al. Additionally, alert fatigue and clinical information overrides must be addressed within the organization.

Overriding content in what is often an undesirable system design can result in misinformation in charting that can have detrimental effects on the nurse, patient, and healthcare organization. For example, a false entry into an EHR can follow a patient for years. The patient is likely unaware of the false entry, but subsequently applies for health or life insurance.

The patient may be denied insurance coverage based on a one-time false entry that was replicated over time. Recommendations and Call to Action We conclude with a call to action for interprofessional teams, associations, industry, and others to collaboratively address these issues on behalf of the health and safety of the nation, and equally as important, the health and well-being of the healthcare workforce.

To do that, the authors suggest the following recommendations to address challenges with EHRs. These recommendations may help mitigate ethical and legal issues arising as a result of the massive uptake of technology that has resulted in the digital age of healthcare delivery. Support Nurses must have a seamless mechanism for reporting EHR challenges Nurses face time constraints, overstaffing, and unfamiliarity with EHR systems on a daily basis.

Healthcare organizations must have structures in place at the unit, management, and administrative levels to facilitate effective use of EHRs in nursing practice.

Nurses must have a seamless mechanism for reporting EHR challenges e. This type of support could potentially mitigate the moral distress noted in the case scenario.

Culture of Safety Nurse managers and executives have a particular obligation to ensure that direct care nurses are empowered to identify and engage in ethical situations associated with EHRs. Nurse managers and executives have a particular obligation to ensure that direct care nurses are empowered to identify and engage in ethical situations associated with EHRs.

Nurses in administrative roles should promote a culture of safety in their settings that include reducing the risk of harm arising from inadequate EHR design, and usability ANA, This emphasizes the need for continuing education for novice and expert nurses in EHR management and documentation.

Informatics specialty nurses and advanced practice nurses can serve as leaders to assess and research documentation for timeliness and accuracy, along with providing continuing education on a frequent basis Scruth, Education about principles of documentation and competence in specific EHR system usage is needed to foster nurse mastery and development to successfully improve health outcomes Goodman, The American Health Information Management Association AHIMA, Code of Ethics has 11 principles with interpretive statements, referred to as guidelines, that seem to underscore the importance of practices that stand in stark contrast to the experiences of nurse participants in the Texas nursing research McBride et al.

This computational capacity may establish EHR information as authoritative, potentially displacing work processes critical to nurse-patient interaction. Systems and technologies such as EHRs that assist in clinical practice are adjunct to, not replacements for, nurse knowledge and skill ANA, Most importantly, the EHR must not substitute for a current and accurate clinical assessment, and appropriate intervention.

Finally, as reflected in the Texas study and clinical scenario, current technology in the healthcare industry often presents challenges with usability, design, implementation, and failure to adequately support clinical teams.

Concepts Unwrapped - Legal Rights & Ethical Responsibilities

This results in ethical situations often associated with feelings of moral distress. Application of the FCM can assist clinical teams to explore and potentially resolve these issues.

Legal, ethical and professional aspects of duty of care for nurses

Additionally, the authors recommend further research into the moral distress noted in emerging evidence, including the TNA-TONE statewide study and the case scenario presented. As such, the healthcare industry has an imperative to identify and address ethical issues with use of EHRs. From the beginning in when the TNA Board of Directors resolution was passed, the two organizations created the partnership that provided cumulative guidance, funding, and dissemination efforts throughout the years.

Specifically, we would like to acknowledge the staff of these organizations, the dozens of volunteer committee members who have served, and the report writing sub-committee of Susan McBride, Mary Anne Hanley, Cindy Zolnierek, Laura Thomas, Mari Tietze, and Huaxin Song. Finally, we acknowledge the many subject-matter experts who, through numerous focus groups, helped yield the final surveys. McBride is a Professor at the Texas Tech University Health Sciences Center School of Nursing whose research focus is on methods development for implementing, evaluating and utilizing health information technology to address patient safety, quality and population health.

She is a professor with teaching responsibilities supporting graduate courses in statistics, informatics, and epidemiology.

Research focus is telehealth with a telemedicine, remote management and mobile health component. She has taught ethics at the undergraduate and graduate levels and conducted research on moral distress and ethical climate among other issues. She worked for several years as a critical care nurse and later received her law degree. She worked as a consultant for the D. Board of Nursing interpreting professional ethics provisions and recently completed her masters in bioethics.

Her leadership is demonstrated through various charitable roles. Weber is a nurse attorney and Clinical Assistant Professor at the University of Minnesota School of Nursing, where she teaches ethics, leadership, and public policy in the context of a continuum of interprofessional healthcare.

Identifying and Addressing Ethical Issues with Use of Electronic Health Records

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primary relationship between legal and ethical issues in nursing

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Legal & Ethical Issues that Health Care Professionals Face |

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primary relationship between legal and ethical issues in nursing

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Refusal of Care Ethically patients have the right to refuse care. It is the responsibility of the ED nurse to ascertain if the patient has enough information to make an informed decision regarding refusal of care.

If the reasoning for the decision is irrational, the nurse is responsible for ensuring that the patient has all necessary information. It is the responsibility of the nurse to make sure the patient has more information by which they can make a better informed decision.

Surrogates and family members that are making decisions must also have enough information in order to ensure the best care for the patient.

Discharge against medical advice is a decision made by the patient to leave the ED prior to the physician recommending discharge. In such cases it is incumbent upon nurses to determine the capacity of the patient, evaluate the quality of the delivered information including risks and benefits, and a full documentation of the process.

Ethical Problems An ethical problem is one in which no clear answer exists for all. Although algorithms are available to guide care in cases of cardiac arrest and trauma, each patient and situation is unique, and deviations from protocol may be indicated.

Like clinical problems, ethical problems require action for resolution. In most clinical settings, there is adequate time to identify and discuss the relevant ethical issues before decisions are made.

However, this is often not the case in the ED, where ethical problems may require immediate resolution. To promote ethical decision making in these situations, a system to quickly analyze ethical concerns should be in place. This system can include consideration of the following issues: Who are the stakeholders? What is the chronology of events? What medical, social, and legal information is required to facilitate decision making?

What is the best communication pathway to follow? What family values must be considered? Is there any consensus that exists with any of the person involved?

Public Guardians The ED is unique from all other specialties in healthcare, and presents in a unique environment with distinct moral challenges. In order to respond appropriately to these ethical challenges, ED nurses are required to have knowledge of moral concepts and principles, and specialized moral reasoning skills.

It becomes import then to identify and promote the moral attributes of those nurses in the ED. ED nurses have a duty not only to their patients, but to the society in which they live. The nurse is responsible for informing the public, assisting in the allocation of resources in a just manner, opposing violence and promoting public health.

It then becomes the responsibility of the ED nurse to participate in helping craft legislative, regulatory, institutional and educational pursuits that promote the safety of the patient and improve the quality of care. Mission Statements and Code of Ethics.

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Legal & Ethical Issues that Health Care Professionals Face

The relationship between law and medical ethics. Retrieved May 11,from http: Retrieved June 1,from Ethics in Medicine Web site: Discharges Against Medical Advice.

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