Legal and Ethical Issues in Maternal/Newborn and Women’s Health Developed by D. Ann Currie, R.N., M.S.N.

Legal and Ethical Issues in Legal and Ethical Issues in Maternal/Newborn and Maternal/Newborn and

Women’s HealthWomen’s Health

Developed by Developed by

D. Ann Currie , R.N. , M.S.N.D. Ann Currie , R.N. , M.S.N.

LEGAL CONSIDERATIONSLEGAL CONSIDERATIONS

GENERAL LEGAL CONCEPTSGENERAL LEGAL CONCEPTS ARENAS FOR CONSIDERATIONARENAS FOR CONSIDERATION LITIGATIONLITIGATION RISK MANAGEMENTRISK MANAGEMENT QUALITY ASSURANCEQUALITY ASSURANCE DOCUMENTATIONDOCUMENTATION CLINCAL EXAMPLES OF COMMON CLINCAL EXAMPLES OF COMMON

LEGAL ISSUESLEGAL ISSUES

GENERAL LEGAL CONCEPTSGENERAL LEGAL CONCEPTS

LAW CAN BE DEFINED AS”THOSE LAW CAN BE DEFINED AS”THOSE RULES MADE BY HUMANS WHICH RULES MADE BY HUMANS WHICH REGULATE SOCIAL CONDUCT IN A REGULATE SOCIAL CONDUCT IN A FORMALLY PRESCRIBED AND FORMALLY PRESCRIBED AND LEGALLY BINDING LEGALLY BINDING MANNER.”(BERNZWEIG)MANNER.”(BERNZWEIG)

FUNCTIONS OF THE LAW IN FUNCTIONS OF THE LAW IN NURSINGNURSING

THE LAW SERVES A NUMBER OF THE LAW SERVES A NUMBER OF FUNCTIONS IN NURSING:FUNCTIONS IN NURSING:

IT PROVIDES A FRAMEWORK FOR IT PROVIDES A FRAMEWORK FOR ESTABLISHING WHICH NURSING ESTABLISHING WHICH NURSING ACTIONS IN THE CARE OF THE CLIENTS ACTIONS IN THE CARE OF THE CLIENTS ARE LEGALARE LEGAL

IT DIFFERENTIATES THE IT DIFFERENTIATES THE NURSE’SRESPONSIBILITIES FROM THOSE NURSE’SRESPONSIBILITIES FROM THOSE OF OTHER HEALTH PROFESSIONALOF OTHER HEALTH PROFESSIONAL

CONT. FUNCTIONSCONT. FUNCTIONS

IT HELPS ESTABLISH THE IT HELPS ESTABLISH THE BOUNDARIES OF INDEPENDENT BOUNDARIES OF INDEPENDENT NURSING ACTION.NURSING ACTION.

IT ASSISTS IN MAINTAINING A IT ASSISTS IN MAINTAINING A STANDARD OF NURSING PRACTICE STANDARD OF NURSING PRACTICE BY MAKING NURSES ACCOUNTABLE BY MAKING NURSES ACCOUNTABLE UNDER THE LAW.UNDER THE LAW.

SOURCES OF LAWSOURCES OF LAW

CONSTITUTIONCONSTITUTION LEGISLATION (STATUTES)LEGISLATION (STATUTES) COMMON LAWCOMMON LAW

TYPES OF LAWSTYPES OF LAWS

PUBLIC LAW- CRIMINAL LAWPUBLIC LAW- CRIMINAL LAW PRIVATE LAW-CIVIL LAWPRIVATE LAW-CIVIL LAW CONTRACT LAWCONTRACT LAW TORT LAWTORT LAW

ARENAS OF LEGAL ARENAS OF LEGAL CONSIDERATIONCONSIDERATION

PERSONAL PROFESSIONAL PRACTICEPERSONAL PROFESSIONAL PRACTICE CLIENT CARE AND ADVOCACYCLIENT CARE AND ADVOCACY

LEGAL CONSIDERATIONS IN LEGAL CONSIDERATIONS IN PERSONAL PROFESSIONAL PERSONAL PROFESSIONAL

PRACTICEPRACTICE

SCOPE OF PRACTICESCOPE OF PRACTICE STANDARDS OF CARESTANDARDS OF CARE LICENSURELICENSURE COLLECTIVE BARGAININGCOLLECTIVE BARGAINING

SCOPE OF PRACTICESCOPE OF PRACTICE

THE NURSE PRACTICE ACT----THE NURSE PRACTICE ACT---- BROAD DEFINITION OF PERMISSIBLE BROAD DEFINITION OF PERMISSIBLE

BOUNDARIES OF PRACTICE WITHIN A BOUNDARIES OF PRACTICE WITHIN A STATE.STATE.

DISTINGUISHES NURSING PRACTICE DISTINGUISHES NURSING PRACTICE FROM THE PRACTICE OF OTHER FROM THE PRACTICE OF OTHER HEALTH PROFESSIONALSHEALTH PROFESSIONALS

SCOPE OF PRACTICESCOPE OF PRACTICE

EXCLUDES UNTRAINED OR EXCLUDES UNTRAINED OR UNLICENSED INDIVIDUALS FROM UNLICENSED INDIVIDUALS FROM PRACTICING NURSING.PRACTICING NURSING.

RULES AND REGULATIONS RULES AND REGULATIONS PROMULGATED BY STATE BOARDS PROMULGATED BY STATE BOARDS OF NURSING PROVIDE OFFICIAL OF NURSING PROVIDE OFFICIAL INTERPRETATION OF NURSING ACTS.INTERPRETATION OF NURSING ACTS.

SCOPE OF PRACTICESCOPE OF PRACTICE

CORRECT INTERPRETATION AND CORRECT INTERPRETATION AND UNDERSTANDING OF STATE PRACTICE UNDERSTANDING OF STATE PRACTICE ACTS ENABLES THE NURSE: TO PROVIDE ACTS ENABLES THE NURSE: TO PROVIDE SAFE CARE WITHIN THE LIMITS OF SAFE CARE WITHIN THE LIMITS OF NURSING PRACTICE AND TO AVOID THE NURSING PRACTICE AND TO AVOID THE RISK OF BEING ACCUSED OF RISK OF BEING ACCUSED OF PRACTICING MEDICINE WITHOUT A PRACTICING MEDICINE WITHOUT A LICENSELICENSE

READ AND KNOW THE NURSE PRACTICE READ AND KNOW THE NURSE PRACTICE ACT ****.ACT ****.

STANDARDS OF CARESTANDARDS OF CARE

DEFINITION:DEFINITION: MINIMUM CRITERIA FOR MINIMUM CRITERIA FOR

COMPETENT,PROFICIENT DELIVERY OF COMPETENT,PROFICIENT DELIVERY OF NURSING CARE.NURSING CARE.

USED TO EVALUATE THE QUALITY OF USED TO EVALUATE THE QUALITY OF CARE PROVIDEDCARE PROVIDED

FORMULATED FROM SKILLS AND FORMULATED FROM SKILLS AND KNOWLEDGE COMMONLY POSSESSED KNOWLEDGE COMMONLY POSSESSED BY MEMBERS OFBY MEMBERS OF

CONT.CONT.

A PROFESSION….NURSES.A PROFESSION….NURSES. IDENTIFY IDENTIFY

HEALTH,DEMOGRAPHIC,ENIRONMENHEALTH,DEMOGRAPHIC,ENIRONMENTAL,AND PSYCHOSOCIAL TAL,AND PSYCHOSOCIAL PARAMETERS OF CAREPARAMETERS OF CARE

REFLECTS CURRENT KNOWLEDGE IN REFLECTS CURRENT KNOWLEDGE IN THE FIELD,AND,THEREFORE,ARE THE FIELD,AND,THEREFORE,ARE DYNAMIC AND SUBJECT TO CHANGE.DYNAMIC AND SUBJECT TO CHANGE.

USES OF STANDARDS OF USES OF STANDARDS OF CARECARE

CRITERION FOR DETERMINING IF A CRITERION FOR DETERMINING IF A NURSE HAS VIOLATED THE STATE -NURSE HAS VIOLATED THE STATE -NURSE PRACTICE ACT.NURSE PRACTICE ACT.

CRITERION FOR DETERMINING IF A CRITERION FOR DETERMINING IF A NURSE HAS VIOLATED STATE OR NURSE HAS VIOLATED STATE OR CITY CRIMINAL CODESCITY CRIMINAL CODES

CRITERION ELEVATING NURSING CRITERION ELEVATING NURSING PRACTICE TO A PROFESSIONAL PRACTICE TO A PROFESSIONAL LEVEL.LEVEL.

INTERNAL STANDARDS OF INTERNAL STANDARDS OF CARECARE

INDIVDUALINDIVDUAL INSTITUTIONALINSTITUTIONAL SET BY ROLE AND EDUCATION OF SET BY ROLE AND EDUCATION OF

THE NURSE: JOB THE NURSE: JOB DESCRIPTION,EDUCATION,AND DESCRIPTION,EDUCATION,AND EXPERTISEEXPERTISE

SET BY INDIVIDUAL INSTITUTIONS: SET BY INDIVIDUAL INSTITUTIONS: POLICIES AND PROCEDURES.POLICIES AND PROCEDURES.

EXTERNAL OR NATIONAL EXTERNAL OR NATIONAL STANDARDS OF CARESTANDARDS OF CARE

EXTERNAL BECAUSE THEY EXTERNAL BECAUSE THEY SUPERCEDE INDIVIDUAL SUPERCEDE INDIVIDUAL PRACTITIONERS AND INSTITUTIONS.PRACTITIONERS AND INSTITUTIONS.

BROADER THAN LOCALITY RULES: BROADER THAN LOCALITY RULES: STANDARDS OF CARE VEIWED FROM STANDARDS OF CARE VEIWED FROM THE PERSPECTIVE OF CARE WITHIN A THE PERSPECTIVE OF CARE WITHIN A GEOGRAPHIC AREA.GEOGRAPHIC AREA.

CONT. EXTERNAL CONT. EXTERNAL STANDARDS OF CARESTANDARDS OF CARE

BASED ON REASONABLENESS AND BASED ON REASONABLENESS AND AVERAGE DEGREE OF SKILL,CARE, AVERAGE DEGREE OF SKILL,CARE, AND DILIGENCE PRACTICED BY AND DILIGENCE PRACTICED BY MEMBERS OF THE PROFESSION MEMBERS OF THE PROFESSION ACROSS THE NATION.ACROSS THE NATION.

NURSES IN A VARIETY OF SETTINGS NURSES IN A VARIETY OF SETTINGS AND LOCALS MUST MEET THE SAME AND LOCALS MUST MEET THE SAME STANDARDS: HOMES,BIRTHING STANDARDS: HOMES,BIRTHING CENTERS,HOSPITALS ETC.CENTERS,HOSPITALS ETC.

CONT. ETERNAL CONT. ETERNAL STANDARDS OF CARESTANDARDS OF CARE

STANDARDS ESTABLISHED BY:STANDARDS ESTABLISHED BY: STATE BOARDS OF NURSING STATE BOARDS OF NURSING

THROUGH NURSE PRACTCE ACTS OR THROUGH NURSE PRACTCE ACTS OR PROMULGATED RULES AND PROMULGATED RULES AND REGULATIONS.REGULATIONS.

PROFESSIOAL ORGANIZATIONS: PROFESSIOAL ORGANIZATIONS: ANA,ICN,OR CONGRESS FOR ANA,ICN,OR CONGRESS FOR NURSING PRACTICE.NURSING PRACTICE.

CONT. EXTERNAL CONT. EXTERNAL STANDARDS OF CARESTANDARDS OF CARE

SPECIALITY NURSING SPECIALITY NURSING ORGANIZATIONS:AWHONN,NANN, ORGANIZATIONS:AWHONN,NANN, ACNM.ACNM.

FEDERAL ORGANIZATIONS AND FEDERAL ORGANIZATIONS AND GUIDELINE: JCAHO AND MEDICARE GUIDELINE: JCAHO AND MEDICARE RULES.RULES.

STANDARD OF CARE STANDARD OF CARE NEGLIGENCE AND NEGLIGENCE AND

MALPRACTICEMALPRACTICE

NEGLIGENCE- IT IS OMITTING AN ACT NEGLIGENCE- IT IS OMITTING AN ACT OR DEVIATION FROM THE STANDARD OR DEVIATION FROM THE STANDARD OF CARE THAT A REASONABLY OF CARE THAT A REASONABLY PRUDENT PERSON WOULD NOT OMIT PRUDENT PERSON WOULD NOT OMIT OR COMMIT UNDER SIMILAR OR COMMIT UNDER SIMILAR CIRCUMSTANCES.CIRCUMSTANCES.

MALPRACTICE- IT IS A NEGLIGENT MALPRACTICE- IT IS A NEGLIGENT ACTION OF A PROFESSIONALACTION OF A PROFESSIONAL

ELEMENTS OF NEGLIGENCEELEMENTS OF NEGLIGENCE

THERE WAS A DUTY TO PROVIDE THERE WAS A DUTY TO PROVIDE CARE.CARE.

THE DUTY WAS BREACHED.THE DUTY WAS BREACHED. INJURY OCCURRED.INJURY OCCURRED. THE BREACH OF DUTY CAUSED THE BREACH OF DUTY CAUSED

INJURYINJURY

EXAMPLES OF NEGLIGENCEEXAMPLES OF NEGLIGENCE

EXAMPLES OF OMISSION: FAILING TO EXAMPLES OF OMISSION: FAILING TO GIVE A MEDICATION, FAILING TO GIVE A MEDICATION, FAILING TO ASSESS PROPERLY,FAILING TO ASSESS PROPERLY,FAILING TO NOTIFY A PHYSICIAN OF A CHANGE NOTIFY A PHYSICIAN OF A CHANGE IN A CLIENT”S CONDITION OR STAUS.IN A CLIENT”S CONDITION OR STAUS.

EXAMPLES OF COMMISSION:GIVING EXAMPLES OF COMMISSION:GIVING WRONG MEDICATION OR TO WRONG WRONG MEDICATION OR TO WRONG CLIENTCLIENT

CONT.CONT.

PLACING INFANT IN WRONG CRIB OR PLACING INFANT IN WRONG CRIB OR GIVING INFANT TO WRONG MOTHER.GIVING INFANT TO WRONG MOTHER.

CONT.CONT.

NURSES NOT MEETING APPROPRIATE NURSES NOT MEETING APPROPRIATE STANDARDS OF CARE COULD BE STANDARDS OF CARE COULD BE SUBJECT TO ALEGATIONS OF SUBJECT TO ALEGATIONS OF NEGLIGENCE OR MALPRACTICE.NEGLIGENCE OR MALPRACTICE.

NURSE’S RESPONSILITY IN NURSE’S RESPONSILITY IN PREVENTING NEGLIGENCE PREVENTING NEGLIGENCE

AND MALPRACTICEAND MALPRACTICE OBTAIN AND MAINTAIN CURRENT OBTAIN AND MAINTAIN CURRENT

INFORMATION REGARDING THE INFORMATION REGARDING THE STATE NURSE PRACTICE ACT- GET A STATE NURSE PRACTICE ACT- GET A COPY AND READ IT AND KNOW COPY AND READ IT AND KNOW IT..READ PUBLICATION FROM THE IT..READ PUBLICATION FROM THE STATE (BON), VISIT WEB SITE FOR STATE (BON), VISIT WEB SITE FOR BNE INFORMATION AND ATTEND BNE BNE INFORMATION AND ATTEND BNE WORKSHOPS.WORKSHOPS.

CONT. NURSE CONT. NURSE RESPONSIBLITYRESPONSIBLITY

OBTAIN AND MAINTAIN CURRENT OBTAIN AND MAINTAIN CURRENT INFORMATION ON INTERNAL AND INFORMATION ON INTERNAL AND EXTERNAL STANDARDS OF EXTERNAL STANDARDS OF PRACTICE,PRACTICE,

SEEK CONTINUING EDUCATION TO SEEK CONTINUING EDUCATION TO REMAIN CURRENT IN SPECALITY REMAIN CURRENT IN SPECALITY AREASAREAS

USE THE NURSING PROCESS WHEN USE THE NURSING PROCESS WHEN GIVING CLIENT CARE.GIVING CLIENT CARE.

CONT. NURSE’S CONT. NURSE’S RESPONSIBILITYRESPONSIBILITY

DEVELOPE A POSITIVE, EMPOWERING DEVELOPE A POSITIVE, EMPOWERING RELATIONSHIP WITH CLIENTS---SEE RELATIONSHIP WITH CLIENTS---SEE CLIENTS AS AN IMPORTANT MEMBER CLIENTS AS AN IMPORTANT MEMBER OF THE HEALTH TEAM.OF THE HEALTH TEAM.

BE THROUGH IN COMPLETING AND BE THROUGH IN COMPLETING AND REPORTING ASSESSMENTS AND REPORTING ASSESSMENTS AND IMPLEMENTING CARE.IMPLEMENTING CARE.

CONT NURSE’S CONT NURSE’S RESPONSIBLITYRESPONSIBLITY

MAINTAIN CLEAR, CONCISE, MAINTAIN CLEAR, CONCISE, ACCURATE, COMPLETE, AND LEDGIBLE ACCURATE, COMPLETE, AND LEDGIBLE DOCUMENTATION.DOCUMENTATION.

QUESTION APPROPRIATENESS OF QUESTION APPROPRIATENESS OF CARE WHEN HARM CAN BE DONE TO CARE WHEN HARM CAN BE DONE TO CLIENT.CLIENT.

CHECK MEDICAL ORDERS CHECK MEDICAL ORDERS FREQUENTLY.FREQUENTLY.

USE CHAIN OF COMMAND.USE CHAIN OF COMMAND.

LEGAL CONSIDERATIONS LEGAL CONSIDERATIONS FOR CLIENT CAREFOR CLIENT CARE

HEALTHCARE REFORMHEALTHCARE REFORM MANAGED CAREMANAGED CARE SHORTENED HOSPITAL STAYSSHORTENED HOSPITAL STAYS UNLICENSED ASSISTIVE UNLICENSED ASSISTIVE

PERSONNNEL(UAP)PERSONNNEL(UAP) NURSE’S ROLE AS CLIENT NURSE’S ROLE AS CLIENT

ADVOCATE.ADVOCATE.

Healthcare reformHealthcare reform

The USA leads the world in healthcare The USA leads the world in healthcare spending, yet has one of the highest spending, yet has one of the highest infant mortality rates among the infant mortality rates among the industrialized nations……..industrialized nations……..

One of the primary factors related to One of the primary factors related to infant mortality(deaths under one year infant mortality(deaths under one year of age per 1000 live births) is an of age per 1000 live births) is an increase in the delivery of low birth increase in the delivery of low birth weight infants, which is linked to lack of weight infants, which is linked to lack of prenatal care.prenatal care.

Healthcare ReformHealthcare Reform

Barriers to access to prenatal care Barriers to access to prenatal care 1) Costs of health care1) Costs of health care 2) Limited financial resources 2) Limited financial resources 3)Uncoordinated service systems 3)Uncoordinated service systems 4) Individual behaviors and beliefs 4) Individual behaviors and beliefs

concerning health care concerning health care 5)Bureaucratic obstacles, such as 5)Bureaucratic obstacles, such as

complicated, lengthy forms for complicated, lengthy forms for MedicaidMedicaid

HEALTHCARE REFORMHEALTHCARE REFORM

Barriers to prenatal care Barriers to prenatal care 6) Unavailability of maternal services 6) Unavailability of maternal services

in certain parts of the country in certain parts of the country 7) Underfunded and overcrowded 7) Underfunded and overcrowded

publicly supervised clinics publicly supervised clinics 8) Difficulty in recruiting and 8) Difficulty in recruiting and

retaining healthcare providers in retaining healthcare providers in publicly subsidized clinicspublicly subsidized clinics

Healthcare reformHealthcare reform

Barriers to prenatal careBarriers to prenatal care 9) Lack of coordinated services for 9) Lack of coordinated services for

needy individuals needy individuals 10) Inaccessibility to prenatal 10) Inaccessibility to prenatal

services because of transportation, services because of transportation, location, and lack of child care location, and lack of child care facilities.facilities.

11) Other….11) Other….

HEALTHCARE REFORMHEALTHCARE REFORM

Federal and state governments, Federal and state governments, through policies and legislation, have through policies and legislation, have begun to implement strategies to begun to implement strategies to resolve these barriers by:resolve these barriers by:

1) Broadening health insurance 1) Broadening health insurance coverage for childbearing women coverage for childbearing women and infantsand infants

2) Improving coordination and 2) Improving coordination and funding of public programsfunding of public programs

Healthcare ReformsHealthcare Reforms

3) Simplifying bureaucratic procedures 3) Simplifying bureaucratic procedures 4) Increasing the number of maternity 4) Increasing the number of maternity

care providers care providers 5) Establishing a national council on 5) Establishing a national council on

children and healthchildren and health 6) Raising public awareness 6) Raising public awareness

throughout the countrythroughout the country 7) Other…..7) Other…..

HEALTHCARE REFORMHEALTHCARE REFORM

NEED TO CONTINUE to seek reform NEED TO CONTINUE to seek reform to further control costs, improve to further control costs, improve access to healthcare, and improve access to healthcare, and improve quality of healthcarequality of healthcare

MANAGED CAREMANAGED CARE

Private sector solution for decreasing Private sector solution for decreasing healthcare costshealthcare costs

1) Health insurance plans that 1) Health insurance plans that combine: delivery of healthcare combine: delivery of healthcare services, financing of those services, services, financing of those services, controlling the use of services.controlling the use of services.

2) Philosophy of managed care 2) Philosophy of managed care organizations includes:organizations includes:

Managed CareManaged Care

Cont. Health promotion and disease Cont. Health promotion and disease prevention, desire to avoid serious prevention, desire to avoid serious disease and costly treatment services disease and costly treatment services

3)To meet expenses and make a 3)To meet expenses and make a reasonable profits reasonable profits

4) Creates a climate in which providers 4) Creates a climate in which providers have: little time and few resources with have: little time and few resources with which to provide care and financial which to provide care and financial

MANAGED CAREMANAGED CARE

CONT. -DISINCENTIVES FOR CONT. -DISINCENTIVES FOR PROVIDERS TO GIVE ADEQUATE PROVIDERS TO GIVE ADEQUATE SERVICES TO THEIR CLIENTS.SERVICES TO THEIR CLIENTS.

5) CONSEQUENCES : FEWER 5) CONSEQUENCES : FEWER EXPENSIVE TESTS OR COSTLY EXPENSIVE TESTS OR COSTLY PROCEDURS PERFORMED, PROCEDURS PERFORMED, SHORTENED HOSPITAL STAYS AND SHORTENED HOSPITAL STAYS AND INCREASED USE OF UNLICENSED INCREASED USE OF UNLICENSED HEALTHCARE WORKERS.HEALTHCARE WORKERS.

SHORTENED HOSPITAL SHORTENED HOSPITAL STAYSSTAYS

During the early to mid-1990 hospital During the early to mid-1990 hospital stays after birth were shortened to 24 stays after birth were shortened to 24 hours or less….hours or less….

Consequently, there was not enough Consequently, there was not enough time for maternal and parental teaching time for maternal and parental teaching regarding self care and infant care- regarding self care and infant care- problems in infant care and health problems in infant care and health developed, breast-feeding problems, developed, breast-feeding problems, and self care problems in the mothers.and self care problems in the mothers.

SHORTENED HOSPITAL SHORTENED HOSPITAL STAYSSTAYS

Several states passed laws requiring Several states passed laws requiring longer stays for maternity and neonatal longer stays for maternity and neonatal clients..clients..

U.S. Congress passed Senate Bill 969, U.S. Congress passed Senate Bill 969, the Newborns’ and Mothers’ Protection the Newborns’ and Mothers’ Protection Act of 1996:1) Set a national standard Act of 1996:1) Set a national standard requiring health insurance and requiring health insurance and employer-provided benefit plans to employer-provided benefit plans to cover minimum hospital stay: 48hrs-cover minimum hospital stay: 48hrs-vaginal delivery,vaginal delivery,

SHORTENED HOSPITAL SHORTENED HOSPITAL STAYSSTAYS

96 hrs for c/s, early discharge with home 96 hrs for c/s, early discharge with home health care..within 24-72 hrs of discharge.health care..within 24-72 hrs of discharge.

2) Even with federal law mandating a 2) Even with federal law mandating a longer postpartum stay, nurses are still longer postpartum stay, nurses are still responsible for: verbal and written responsible for: verbal and written instructions about infant and self-care, instructions about infant and self-care, and s/s indicating problems and what to and s/s indicating problems and what to do, and f/u visit.do, and f/u visit.

In Texas nurses must teach about PP In Texas nurses must teach about PP depressiondepression

SHORTENED HOSPITAL SHORTENED HOSPITAL STAYSSTAYS

Cont. evaluation of parents’ learning, Cont. evaluation of parents’ learning, recommending timely follow-up care, recommending timely follow-up care, incliding a home visit,whenmom incliding a home visit,whenmom seems at risk after a longer stay.seems at risk after a longer stay.

UNLICENSED ASSISTIVE UNLICENSED ASSISTIVE PERSONNEL (UAP)PERSONNEL (UAP)

UAPs are healthcare workers who UAPs are healthcare workers who have no defined body of knowledge have no defined body of knowledge or educational preparation upon or educational preparation upon which to base their practicewhich to base their practice

UncreditentialedUncreditentialed No state or federal regulatory body No state or federal regulatory body

to validate their competenceto validate their competence

UAPSUAPS

Nurses are responsible for the Nurses are responsible for the delegation of tasks to UAPs…see delegation of tasks to UAPs…see Texas BON guidelines for delegation .Texas BON guidelines for delegation .

UAPs can perform repetitive tasks…UAPs can perform repetitive tasks…which are clearly defined and for which are clearly defined and for which they have been trained.which they have been trained.

Nurses should obtain information on Nurses should obtain information on UAPs’ training and skills prior to UAPs’ training and skills prior to delegating tasks.delegating tasks.

UAPSUAPS

Inappropriate delegation to UAPs Inappropriate delegation to UAPs increases the nurse’s liability and may increases the nurse’s liability and may jeopardize the nurse’s license.jeopardize the nurse’s license.

What should not be delegated to What should not be delegated to UAPs: Essential nursing processes of UAPs: Essential nursing processes of assessing,diagnosing of a problem, assessing,diagnosing of a problem, planning client care, implementing that planning client care, implementing that care, and evaluating the outcomes.And care, and evaluating the outcomes.And judgements about client status.judgements about client status.

NURSE’S ROLE AS CLIENT NURSE’S ROLE AS CLIENT ADVOCATEADVOCATE

Maintain current information about Maintain current information about issues critical to client care….issues critical to client care….

Educate clients and other significant Educate clients and other significant persons about such issues…persons about such issues…

Become involved in the political Become involved in the political process as an advocate for quality process as an advocate for quality healthcare for all healthcare healthcare for all healthcare recipients.recipients.

Other…...Other…...

LITIGATIONLITIGATION

RISK MANGEMENTRISK MANGEMENT

QUALITY ASSURANCEQUALITY ASSURANCE

DOCUMENTATIONDOCUMENTATION

CLINICAL EXAMPLES OF CLINICAL EXAMPLES OF COMMON LEGAL ISSUESCOMMON LEGAL ISSUES

ETHICAL CONSIDERATIONSETHICAL CONSIDERATIONS

ETHICS IS BASED ON A ETHICS IS BASED ON A RESPONSIBILITY OR DUTY MODEL RESPONSIBILITY OR DUTY MODEL EXAMINING WHAT OUR BEHAVIOR EXAMINING WHAT OUR BEHAVIOR OUGHT TO BE IN RELATION TO OUGHT TO BE IN RELATION TO OURSELVES, OTHER HUMAN OURSELVES, OTHER HUMAN BEINGS,AND THE ENVIRONMENTBEINGS,AND THE ENVIRONMENT

ETHICSETHICS

ETHICS INCORPORATES FACTORS ETHICS INCORPORATES FACTORS SUCH AS: RISKS.BENEFITS,OTHER SUCH AS: RISKS.BENEFITS,OTHER RELATIONSHIPS, CONCERNS, AND RELATIONSHIPS, CONCERNS, AND THE NEEDS AND ABILITIES OF THE NEEDS AND ABILITIES OF PERSONS AFFECTED BY AND PERSONS AFFECTED BY AND AFFECTING DECISIONS.AFFECTING DECISIONS.

IT IS SUBJECT TO PHILOSOPHICAL, IT IS SUBJECT TO PHILOSOPHICAL, MORAL, AND INDIVIDUAL MORAL, AND INDIVIDUAL INTERPRETATIONS.INTERPRETATIONS.

ETHICAL PRINCIPLES ETHICAL PRINCIPLES

SHOULD BE USE IN CLINICAL SHOULD BE USE IN CLINICAL PRACTICEPRACTICE

RESPECTRESPECT AUTONOMYAUTONOMY BENEFICENCEBENEFICENCE NONMALEFICENCENONMALEFICENCE VERACITY: DUTY TO TELL THE TRUTHVERACITY: DUTY TO TELL THE TRUTH

CONT. ETHICAL PRINCIPLESCONT. ETHICAL PRINCIPLES

FIDELITY: DUTY TO KEEP ONE’S FIDELITY: DUTY TO KEEP ONE’S PROMISEPROMISE

JUSTICEJUSTICE CONFIDENTIALITYCONFIDENTIALITY INFORMED CONSENTINFORMED CONSENT UNIVERSALITYUNIVERSALITY

ETHICAL DECISION-MAKING ETHICAL DECISION-MAKING FRAMEWORKFRAMEWORK

MORALMORAL M:ESSAGE THE DILEMMAM:ESSAGE THE DILEMMA O:OUTLINE THE OPTIONSO:OUTLINE THE OPTIONS R:RESOLVE THE DILEMMAR:RESOLVE THE DILEMMA A:ACT BY APPLYING THE CHOSEN A:ACT BY APPLYING THE CHOSEN

OPTION OPTION L:LOOK BACK AND EVALUATE THE L:LOOK BACK AND EVALUATE THE

ENTIRE PROCESSENTIRE PROCESS

MORALMORAL

M: MESSAGE THE DILEMMAM: MESSAGE THE DILEMMA IDENTIFY AND DEFINE ISSUES IN THE IDENTIFY AND DEFINE ISSUES IN THE

DILEMMADILEMMA DETERMINE WHO OWNS THE DETERMINE WHO OWNS THE

PROBLEM,THE INFORMATION,THE PROBLEM,THE INFORMATION,THE DECISION, AND THE CONSEQUENCES DECISION, AND THE CONSEQUENCES OF IT.OF IT.

CONT. MCONT. M

ESTABLISH THE FACTS AS BEST AS ESTABLISH THE FACTS AS BEST AS POSSIBLE.POSSIBLE.

CONSIDER THE OPTIONS,VALUES, CONSIDER THE OPTIONS,VALUES, AND MORAL POSITION OF THE MAJOR AND MORAL POSITION OF THE MAJOR PLAYERS.PLAYERS.

IDENTIFY VALUE CONFLICTS.IDENTIFY VALUE CONFLICTS.

O: OUTLINE THE OPTIONSO: OUTLINE THE OPTIONS

EXAMINE ALL OPTIONS EXAMINE ALL OPTIONS FULLY,INCLUDING THE LESS FULLY,INCLUDING THE LESS REALISTIC AND CONFLICTING ONESREALISTIC AND CONFLICTING ONES

IDENTIFY PROS AND CONS OF ALL IDENTIFY PROS AND CONS OF ALL THE OPTIONSTHE OPTIONS

FULLY COMPREHEND THE OPTIONS FULLY COMPREHEND THE OPTIONS AND ALTERATIVES AVAILABLE/AND ALTERATIVES AVAILABLE/

R: RESOLVE THE DILEMMAR: RESOLVE THE DILEMMA

REVIEW THE ISSUES AND OPTIONSREVIEW THE ISSUES AND OPTIONS APPLY ETHICAL PRINCIPLES TO EACH APPLY ETHICAL PRINCIPLES TO EACH

OPTIONOPTION DECIDE THE BEST OPTION FOR DECIDE THE BEST OPTION FOR

ACTION ON THE VIEWS OF ALL ACTION ON THE VIEWS OF ALL THOSE CONCERNEDTHOSE CONCERNED

A: ACT BY APPLYING THE A: ACT BY APPLYING THE CHOSEN OPTIONCHOSEN OPTION

IMPLEMENT THE CHOSEN OPTIONIMPLEMENT THE CHOSEN OPTION

L: LOOK BACK AND L: LOOK BACK AND EVALUATE THE ENTIRE EVALUATE THE ENTIRE

PROCESSPROCESS INCLUDING IMPLEMENTATION.INCLUDING IMPLEMENTATION. ENSURE THAT ALL THOSE INVOLVED ENSURE THAT ALL THOSE INVOLVED

ARE ABLE TO FOLLOW THROUGH ON ARE ABLE TO FOLLOW THROUGH ON THE FINAL OPTIONTHE FINAL OPTION

REVISE THE DECISION AS REVISE THE DECISION AS INDICATED,STARTING THE PROCESS INDICATED,STARTING THE PROCESS WITH THE INITIAL STEP.WITH THE INITIAL STEP.

WHERE TO GET HELP TO WHERE TO GET HELP TO MAKE AN ETHICAL MAKE AN ETHICAL

DECISION.DECISION.

Ethics committee in your Ethics committee in your organization…hospital.organization…hospital.

ClergyClergy Ethics depart.Ethics depart. Text...Text...

ETHICAL CONSIDERATIONS ETHICAL CONSIDERATIONS IN MATERNITY NURSINGIN MATERNITY NURSING

ASSISTED REPRODUCTIONASSISTED REPRODUCTION ABORTIONABORTION FETAL OR EMBRYO RESEACHFETAL OR EMBRYO RESEACH CORD BLOOD BANKINGCORD BLOOD BANKING THE HUMAN GENOME PROJECTTHE HUMAN GENOME PROJECT GENETIC COUNSELINGGENETIC COUNSELING FETAL RIGHTS VERSUS MATERNAL FETAL RIGHTS VERSUS MATERNAL

RIGHTSRIGHTS

NURSES’ NURSES’ RESPONSPONSIBLITIESRESPONSPONSIBLITIES

Learn to anticipate ethical dilemmasLearn to anticipate ethical dilemmas Identify attitudes,values, and beliefs Identify attitudes,values, and beliefs

about ethical dilemmas taking into about ethical dilemmas taking into consideration the influence of consideration the influence of cultural,religious, and social factors on cultural,religious, and social factors on the development of values.the development of values.

Recognize the influence personal values Recognize the influence personal values have on care provided for clients by have on care provided for clients by engaging in self-values clarification engaging in self-values clarification activities.activities.

NURSES’RESPONSIBILTIESNURSES’RESPONSIBILTIES

Review and update theoretical bases: Review and update theoretical bases: gather current information on gather current information on technological advances and changing technological advances and changing trends in maternity nursing, review trends in maternity nursing, review ethical principles and practice codes in ethical principles and practice codes in regard to new technology and trends, regard to new technology and trends, become familiar with the client’s become familiar with the client’s knowledge base by reading lay knowledge base by reading lay literature related to maternity and literature related to maternity and neonatal advancesneonatal advances

NURSES’ RESPONSIBILTIESNURSES’ RESPONSIBILTIES

Attend cont. ed. Programs related to ethical Attend cont. ed. Programs related to ethical issues and decision making-- participate in issues and decision making-- participate in ethics committees with other healthcare ethics committees with other healthcare professionals and inservice peers on ethical professionals and inservice peers on ethical issues and decision making.issues and decision making.

Review research journals regarding current Review research journals regarding current trends in ethical decision trends in ethical decision making .comparing and contrasting the making .comparing and contrasting the results with what is occurring in the clinical results with what is occurring in the clinical practice.practice.

NURSES’ RESPONSIBILITESNURSES’ RESPONSIBILITES

Evaluate current social norms by Evaluate current social norms by following social,legal,religious, and following social,legal,religious, and political debates that may influence political debates that may influence clinical decision making and quality clinical decision making and quality care for clients experiencing care for clients experiencing dilemmas in the maternal, neontal, dilemmas in the maternal, neontal, or women’s health areas.or women’s health areas.

Avoid judgements about the life Avoid judgements about the life decisions of others.decisions of others.

NURSES’S NURSES’S RESPONSIBILITIESRESPONSIBILITIES

Aim to accept the values of others and Aim to accept the values of others and their decisions regarding issues and their decisions regarding issues and provisions of care.provisions of care.

Don’t allow personal beliefs and values to Don’t allow personal beliefs and values to interfere with provision of quality care.interfere with provision of quality care.

Understand the legal implications of the Understand the legal implications of the issuesissues

Develop appropriate strategies for ethical Develop appropriate strategies for ethical decision making.decision making.