Nurses respect individual’s needs, values, culture and vulnerability in the provision of nursing care. New Zealand and most states of Australia have an Act that allows for the appointment of a person to hold enduring power of attorney. The principle of beneficence requires that nurses act in ways that promote the wellbeing of another person; this incorporates the two actions of doing no harm, and maximising possible benefits while minimising possible harms (non-maleficence).8 It also encompasses acts of kindness that go beyond obligation. Nurses hold in confidence any information obtained in a professional capacity, use professional judgement where there is a need to share information for the therapeutic benefit and safety of a person, and ensure that privacy is safeguarded. Ethics involve principles and rules that guide and justify conduct. (This is different in the case of a person who is legally declared brain dead; see Brain death section. Critical care nurses need to be aware of the relevant policies and procedures to have an understanding of their individual obligations and responsibilities. Some international literature reflects the different ethical reasoning and decision-making frameworks extant between medical staff and nurses. The nurse acts ethically and maintains standards of practice. Much ethically-desirable nursing practice, such as confidentiality, respect for persons and consent, is also legally required.4,10. The critical care nurse are often confronted with ethical & legal dilemmas related to various ethical principles & it has increased dramatically since the early 1990s.• Many dilemmas are byproducts of advanced medical technologies & therapies developed over the past several decades. The thrust of this chapter is to explore research findings about issues that cause ethical concern for critical care nurses in Europe. In general, nurses focus on aspects such as patient dignity, comfort and respect for patients’ wishes, while medical staff tend to focus on patients’ rights, justice and quality of life. • A statement that participation is voluntary, refusal to participate will involve no penalty or loss of benefits to which the subject is otherwise entitled, and the subject may discontinue participation at any time without penalty or loss of benefits, to which the subject is otherwise entitled. The ‘group think’ approach of ‘That’s how we’ve always done it’ requires critical reflection on what is the ethical or ‘right thing to do’. In any given decision-making situation, the participants hold different presumptions about their roles in the process, different frames of reference based on different levels of knowledge, and different amounts of relevant experience. • Discuss ethical principles as they relate to critical care patients. legal and ethical issues in nursing, patient care technicians, social workers, and office personal. The fair, equitable and appropriate distribution of health care, determined by justified rules or ‘norms’, is termed distributive justice.6 There are various well-regarded theories of justice. Söderberg, A. and Norberg, A. Nursing codes of ethics incorporate such an understanding of patient’s rights. Other related ethical concepts include integrity, best interests, informed consent and advance directives. Ethical implications of brain death and organ donation that particularly relate to nursing practice are also reviewed. Less than 10% of doctors and nurses would like their life prolonged by all available means, compared to 40% of patients and 32% of families. Falcó-Pegueroles, A, Lluch-Canut, T, Guàrdia-Olmos, J. Buy Membership for Critical Care Medicine Category to continue reading. (ed.). (1995) ‘Ethical practice in a technological age’. Not logged in Lack of communication creates a potential for patients to undergo burdensome and expensive treatments that they may not desire. Better communication skills among clinicians and more effective educational resources are required to solve these problems. The first stage in this process will be to explore the preparation of critical care nurses to deal with ethical issues and to identify the nature and essence of nursing ethics in relation to the delivery of critical care. Life support includes the provision of any or all of ventilatory support, inotropic support for the cardiovascular system and haemodialysis, to critically ill patients. International Conference on Critical Care Nursing and Ethical Issues scheduled on October 07-08, 2022 at Tokyo, Japan is for the researchers, scientists, scholars, engineers, academic, scientific and university practitioners to present research activities that might want to attend events, meetings, seminars, congresses, workshops, summit, and symposiums. An explanation of whom to contact for answers to pertinent questions about the research and research subjects’ rights, and whom to contact in the event of a research-related injury to the subject. Introduction: Nurses face many legal and ethical issues while providing patient care and it is essential to understand the law and the way it affects the nursing practice. Ricoeur, P. (1984) ‘The model of the text: meaningful action considered as text’. After the physician leaves, the patient, who is visibly shaken, asks the nurse, Couldnt the doctor be wrong? (1993) ‘Intensive care: situations of ethical difficulty’, Timmermann, A.M. (1996) ‘Intensive care: nursing, staffing and training in the EC’, in Tinker, J., Browne, D.R.G. Teaching Ethics. Teresa Lluch-Canut. 4. Individuals commonly want their family to decide for them, although the judgement of intensive care professionals concerning which treatment should be given may well differ from that of patients and families. BMC Med Eth 2013; 14: 1 – 8. Kendrick, K. (1993) ‘Understanding ethics in nursing practice’. How to Write Care Plans; Nursing Diagnoses; Students. Falcó-Pegueroles A(1), Lluch-Canut T(2), Roldan-Merino J(2), Goberna-Tricas J(2), Guàrdia-Olmos J(2). Critical care nurses need to be aware of the relevant policies and procedures to have an understanding of their individual obligations and responsibilities. However, it is incumbent on all critical care nurses, as patient advocates within the critical care areas of ICU, CCU and the emergency department (ED), to be aware of the potential impact and possible outcomes of therapies delivered in the critical care environment. For research involving more than minimal risk, an explanation as to whether any compensation, and an explanation as to whether any medical treatments are available, if injury occurs and, if so, what they consist of, or where further information may be obtained. Interdisciplinary Education on Discussing End-of-Life Care . The use of the basic ethical principles in these administrative issues may be less familiar. Nurses are expected to practise in an ethical manner, through the demonstration of a range of ethical competencies articulated by registering bodies and the relevant codes of ethics (see Boxes 5.1 and 5.2). Each of these types of consent has differing requirements. Quality of life is often used as a means of justifying a particular decision about treatment that results in either cessation of life or continued life-sustaining treatment, and it tends to be expressed as if a shared understanding exists.4. Kendrick, K. (1994b) ‘Towards professional parity’, Kendrick, K. (1995) ‘Ethical pathways in cancer and palliative care’, in David, J. Leavitt, F.J. (1996) ‘Educating nurses for their future role in bioethics’. Bertolini, C.L. A general distinction can be made between civil law jurisdictions, which codify their laws, and common law systems, where judge-made law is not consolidated. )34, In the Ethicus study of 4248 patients who died or had limitations of treatments in 37 ICUs in 17 European countries, life support was limited in 73% of patients. If there is no guardianship order then, strictly speaking, consents for healthcare treatment may be given only by the guardianship authority. Rather, the role of proxy tends to be assumed on the basis of an existing relationship between proxy and patient. In addition, new medication treatment options contribute significant promises of added benefits, and fewer side effects, and are heralded by drug companies and journals across the world. Fenton, M. (1988) ‘Moral distress in clinical practice: implications for the nurse administrator’, Hunt, G. (1991) ‘The concept of moral responsibility’, Paper presented at the Inaugural Conference of the National Centre for Nursing and Midwifery Ethics, Queen Charlotte College, Thames Valley University, cited in: Tschudin, V. and Marks-Maran, D. (eds) 1993). Shared decision making within clinical care reveals a pronounced tension between three competing factors: (1) Paternalistic conservatism about disclosure of information to patients has been eroded by moral arguments now largely accepted by the medical profession; (2) While many patients may wish to be given information about available treatment options, many also appear to be cognitively and emotionally ill equipped to understand and retain it; and (3) Even when patients do understand information about potential treatment options, they do not necessarily wish to make such choices themselves, preferring to leave final decisions in the hands of their clinicians.23. (1986) ‘Do-Not-Resuscitate orders for critically ill patients in the hospital: how are they used and what is their impact’?. People may also have a combination of both. Although the specific detail varies between organisations and jurisdictions, in general ‘consent to medical research documentation’ should include the following:19, • A statement that the study involves research, • An explanation of the purposes of the research, • The expected duration of the subject’s participation, • A description of the procedures to be followed, • Identification of any procedures which are experimental, • A description of any reasonably foreseeable risks or discomforts to the subject, • A description of any benefits to the subject or to others which may reasonably be expected from the research, • A disclosure of appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the subject, • A statement describing the extent, if any, to which confidentiality of records identifying the subject will be maintained. the level to which basic needs are met, such as avoiding harm, and adequate nutrition and shelter). infection, pneumothorax on insertion). All discussions should be recorded in the medical records including the basis for the decision, who has been involved and the specifics of treatment(s) being withheld or withdrawn.34 There are marked differences in the ‘foregoing of life-sustaining treatments’ that occur between countries and in the patient level of care variation even within the same country. Critical care nurses are encouraged to participate in discussion and educational opportunities regarding ethics in order to provide clarity in relation to fulfilment of their moral obligations. Drought, T.S. The nurse justifies public trust and confidence. 1. Many of these guidance documents emphasize the need to protect the public and minimize harm. Managing the critically ill patient in many cases represents a provision of supportive, rather than curative, therapies. 3. However, some persons are in need of extensive protection, depending on the risk of harm and likely benefit of protecting them, and in these cases paternalism may be considered justifiable.6,7, According to the principle of autonomy, critical care patients are entitled to be treated as self-determining. Ethical and Legal Issues in nursing The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). An understanding of the principle of consent is necessary for nurses practising in critical care. Primarily, it is the treating medical officer who is legally regarded as the only person able to inform the patient about any material risks associated with a clinical therapy or intervention. ‘Statements of patients’ rights’ relate to particular moral interests that a person might have in healthcare contexts, and hence require special protection when a person assumes the role of a patient.4 Institutional ‘position statements’ or ‘policies’ are useful to remind patients, laypersons and health professionals that patients do have entitlements and special interests that need to be respected. • be given by a person legally competent to do so. Consent in human research is guided by a variety of different documents. Justice may be defined as fair, equitable and appropriate treatment in light of what is due or owed to an individual. In addition, individual preferences may change over time. (1994) ‘Ethical decision-making in intensive care: a nurse’s perspective’. consider the effects of having or not having the treatment). Personal ethics may be described as a personal set of moral values that an individual chooses to live by, whereas professional ethics refer to agreed standards and behaviours expected of members of a particular professional group. Kendrick, K. (1994a) ‘Building bridges: teaching ward-based ethics’. People may also have a combination of both. Dilemmas arise when there are disparate views within the team as to what constitutes ‘futility’ and with associated decisions regarding the next step or steps when a patient’s outlook is at its most grave. For example, a shortage of intensive care beds may result in critically ill patients having to ‘compete’, in some way, for access to the ICU. There is a risk that nurses may become socialised into a prevailing culture and associated thought processes, such as the particular work group on their shift, the unit where they are based, or the institution in which they are employed. Dilemmas are different from problems, because problems have potential solutions.5. Dimensions of Critical Care Nursing. To establish that trust you must respect patients’ autonomy – their right to decide whether or not to undergo any medical intervention … [They] must be given sufficient information, in a way that they can understand, in order to enable them to make informed decisions about their care.24, In many countries, if patients believe that clinicians have abused their right to make informed choices about their care, they can pursue a remedy in the civil courts for having been deliberately touched without their consent (battery) or for having received insufficient information about risks (negligence). 26 Ethical and Legal Issues in Critical Care Nursing Jayne M. Willis, MSN, RN, NEA-BC Kathy Black, MSN, RN, NE-BC INTRODUCTION Critical care nurses are often confronted with ethical and legal dilemmas related to informed consent, withholding or withdrawing life-sustaining treatment, organ and tissue transplantation, confidentiality, and increasingly, justice in the distribution of healthcare resources. Achetez Ethical Issues in Critical Care Nursing [VHS] : DVD et Blu-ray : Amazon.fr Livraison gratuite possible dès 25€ Nurses appear at times unable to influence the decision-making process.46, Some international literature reflects the different ethical reasoning and decision-making frameworks extant between medical staff and nurses. Doctors daily make judgements regarding their patients’ competency to consent to medical investigation and treatment, and in today’s litigious climate they must face the possibility that, from time to time, these decisions will be examined critically in a court of law. (1993) ‘Commentary on mortality in intensive care patients with respiratory disease: is age important?’. In the US35–37 and Europe38 the majority of doctors have withheld or withdrawn life-sustaining treatments. Nurses accept the rights of individuals to make informed choices in relation to their care. Bergum, V. (1994) ‘Knowledge for ethical care’. When science travels, so does its ethics. 4. Rose, Chrissian; Bonn, Ashley; MacDonald, Kaitlyn; More. pp 216-232 | The nurse justifies public trust and confidence. Examples of statute law in Australia include: • Consent to Medical Treatment and Palliative Care Act 1995 (SA); Further details of these Australian Acts can be found in the Relevant legislation section at the end of the chapter. Unable to display preview. Nurses value environmental ethics and a social, economic and ecologically sustainable environment that promotes health and wellbeing. Observational studies demonstrate that North American health care workers consult families more often than do European workers,39,41 and some seriously ill patients wish to participate in end of life decisions whilst others do not.42, In most cases where there is doubt about the efficacy and appropriateness of a life-sustaining treatment, it may be considered preferable to commence treatment, with an option to review and cease treatment in particular circumstances after broad consultation. Download preview PDF. a partner, child, good friend who must be over 18 years) to make medical decisions on behalf of that person in the situation where the individual becomes incompetent (i.e. Anna Falcó-Pegueroles . Depending on the prevalent culture at any one of these levels, nursing practice may be highly ethical or less ethically justifiable. However, the code cannot and does not give direction in all situations nurses encounter in practice. 1. In the Netherlands and Belgium, active life ending procedures are permitted and performed with the specific intent of causing or hastening a patient’s death. An advance health care directive, also known as a living will, personal directive, advance directive or advance decision, are instructions given by individuals specifying what actions should be taken for their health in the event that they are no longer able to make decisions due to illness or incapacity, and appoints a person to make such decisions on their behalf. Because of the vulnerable nature of the critically ill individual, direct informed consent is often difficult, and surrogate consent may be the only option, particularly in an emergency. In addition, individual preferences may change over time. Consent may relate to healthcare treatment, participation in human research and/or use and disclosure of personal health information. Some states have legislated to allow this authority to be delegated to a ‘person responsible’ or ‘statutory health authority’ without prior formal appointment. Primarily, it is the treating medical officer who is legally regarded as the only person able to inform the patient about any material risks associated with a clinical therapy or intervention.18. Conditions of scarcity and competition result in the predominant problems associated with distributive justice. Quickly memorize the terms, phrases and much more. a living will) or proxy (the appointment of a person(s) with enduring power of attorney to act as surrogate decision maker), or some combination of both. Much of this research arises out of transnational collaborations made up of sponsors in high income countries (pharmaceutical industries, aid agencies, charitable trusts) and researchers and research subjects in low- to middle-income ones. The protections that medical and research ethics offer in these contexts tend to be modelled on a western tradition in which individual informed consent is paramount and are usually phrased in legal and technical requirements. Given the complexity of contemporary healthcare environments, it is vital that nurses are a… 2. Organisations such as the Global Forum for Bioethics in Research, the Forum for Ethical Review Committees in the Asia Pacific Region and the World Health Organization have sought to improve oversight of research projects, refine regulation and guidance, address cultural variation, educate the public about research and strengthen ethical review committee structures according to internationally acknowledged ‘benchmarks’.4,5. Patients that would probably have previously died can now be maintained for prolonged periods on life support systems, even if there is little or no chance of regaining a reasonable quality of life. Ethics involve principles and rules that guide and justify conduct. Current Students; New Nursing Students; Aspiring Students; Vlog; Med Math; iStudentNurse.com | Ethical and Legal Issues in Critical Care. Nurses in all settings and roles are bound by the ANA’s nursing code of ethics, which deals with various areas of patient care and provides guidance in handling the top ethical issues in nursing today, such as the five discussed below. As with formally appointed guardians, the powers of a ‘person responsible’ are limited by statute.19. Hospitals should provide detailed patient admission information, including information regarding ‘patients’ rights and responsibilities’, that usually include a broad explanation of the consent process within that institution. Considerable debate exists regarding ICU access/admission criteria, that may vary across institutions. they must not be impervious to reason, divorced from reality or incapable of judgement after reflection), be able to weigh that information up (i.e. Consent should never be implied, despite the fact that the patient is in a critical care area. A common ethical dilemma found in critical care is related to the opposing positions of ‘maintaining life at all costs’ and ‘relieving suffering associated with prolonging life ineffectively’. However, it is usually recognised that justice does not always require equal sharing of all possible social benefits. Many entities frame their recommendations in terms of ethical principles and articulate similar substantive and procedural norms (9, 10). A comprehensive understanding of current legal and ethical frameworks facilitates the delivery of appropriate skilled nursing care. Medical decisions to withdraw treatment were shown to vary between medical staff and among patients with similar pathologies.43, Because ethical positions are fundamentally based on an individual’s own beliefs and ethical perspective, it may be difficult to gain a consensus view on a complex clinical situation, such as withdrawal of treatment. Obtaining consent is part of the overall duty of care.11, In recent decades, research in the biomedical sciences has been increasingly located in settings outside of the global north. In that event, it is likely that withdrawal of treatment will not occur until concordance is reached. If the courts have appointed a person to be a guardian for an incompetent individual, then the guardian can provide consent on behalf of that individual. 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North American health care professional articulate similar substantive and procedural norms ( 9, ).
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