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Ethical and legal issues in nursing

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Ethical and legal issues in nursing

  1. 1. SUBMITTED BY, Mrs. Jays George 2ND YEAR MSC (N) DYPCON SEMINAR ON LEGAL AND ETHICAL ISSUES SUBMITTED TO, Mrs.MANKUMARI MISTRY, VICE-PRINCIPAL, DYPCON
  2. 2. GENERAL OBJECTIVES: On the completion of the seminar the students will learn about ethical and social issues, legal system in nursing, patient and employment issues, medico legal cases, rights of patient and special group and standard safety measures for infection control in hospital and able to apply it during nursing care process and ensure provision of quality nursing care at the hospital settings. SPECIFIC OBJECTIVES The students will be able to;  Describe code of ethics, professional conduct, and legal system, ethical and legal issues in nursing.  Identify various patient care, employment and administrative level issues.  Discuss in detail about patient right, consumer protection act and rights of special group.  Explain nursing regulatory mechanism and medico legal case.  Discuss the process infection control and standard safety measures.
  3. 3. INTRODUCTION The contribution of nursing to the alleviation of suffering and to protection and promotion and restoration of health is a proud chapter in the history. The image of any organization depends upon the behavior of people who constitute it. So, there is great obligation on the part of employees to behave in an ethical way at the work place. This is equally applicable to the nurses who are working in different sectors of health care delivery system. The way nurses behave, reflect the image of that organization. Today the nurses face a variety of ethical problems than ever before. MEANING The word Ethics is derived from Greek word “Ethos” which means customs or guiding beliefs (character). DEFINITIONS It can be viewed as a generic term for several ways of examining the morale of life. -BEAUCHAMP TL Ethics is the study of good conduct, character and motives. -POTTER
  4. 4. ETHICAL PRINCIPLES Beauchamp and Childress (2009) developed four Ethical Principles 1. Respect for Autonomy 2. Beneficence 3. Non-maleficence 4. Justice 1. RESPECT FOR AUTONOMY  Autonomy can be defined as „” self-rule with no control, undue influence or interference from other” (Griffith and Tengnah, 2010:29).  It is about respecting other people’s wishes and supporting them in their decisions (Beauchamp and Childress, 2009). 2. BENEFICENCE  This can be defined as “the principle of doing well and providing care to others” (Berglund, 2007:12).  Promotion of well-being (Edwards, 2009).  As employees are we properly trained and competent to carry out the tasks we are providing to our children/families/clients/customers. 3. NON-MALEFICENCE  “Obligation not to inflict harm on others” (Beauchamp and Childress, 2009:149).  Goes hand in hand with beneficence.  However, do we sometimes cause short term harm for long term good 4. JUSTICE  Simply defined as “equal treatment of equal cases” (Hendrick. 2004:7).  Treating everyone the same.  However, some people need to be treated differently if they require special care over and above what other people may need.
  5. 5.  Justice is about meeting everyone’s individual needs fairly. Rowson (2006) Ethical Framework F.A.I.R. 1. Fairness 2. Respect for Autonomy 3. Integrity 4. Seeking the most beneficial and least harmful consequences, or Results. 1. FAIRNESS  Linked to the idea of justice.  Providing benefits- Social welfare, education, healthcare, protection, opportunities  Distributing burdens- Exclusions of benefits, allocation of responsibilities. 2. RESPECT FOR AUTONOMYPROFESSIONAL SHOULD  Not prevent people from carrying out decisions they make for themselves about: - What they ought to do- What they will do- What should be done to them- What should be done with information about them  Enable others to make autonomous decisions. 3. INTEGRITY  Acting with professional integrity means that one’s actions are the same as your professional values. For example, maintaining confidentiality, working in some one’s best interests. Simply put, it is when what you do matches what you believe.  Seeking the most beneficial and least harmful consequences, or Results Two Aims.  Producing as many benefits as possible.  Avoiding causing, or preventing, as much harm as possible.  Two more concepts which are not linked to either ethical framework, but which are important are the ideas of veracity & fidelity 4. VERACITY  It is concerned with being open, honest and truthful with people (Berglund, 2007)
  6. 6.  It is also the accurate transfer of information in a way that is suitable for the individual to understand (Edwards, 2009).  “This is not always an easy principle to maintain when you are asked difficult questions, or your answer may be distressing” 5. FIDELITY Fidelity is about ■ Being Faithful ■ keeping promises ■ always doing what is right ■ being trust worthy ■ Confidential ■ Showing respect and dignity ■ respecting autonomy ■ Acting in their best interest.
  7. 7. INTERNATIONAL CODE OF NURSING ETHICS THE ICN CODE OF ETHICS FOR NURSES An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2005. PREAMBLE Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status. Nurses render health services to the individual, the family and the community and co-ordinate their services with those of related groups. THE ICN CODE The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct.
  8. 8. ELEMENTS OF THE CODE 1. NURSES AND PEOPLE  The nurse’s primary professional responsibility is to people requiring nursing care.  In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected.  The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.  The nurse holds in confidence personal information and uses judgement in sharing this information. 2. NURSES AND PRACTICE  The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning.  The nurse maintains a standard of personal health such that the ability to provide care is not compromised.  The nurse uses judgement regarding individual competence when accepting and delegating responsibility.  The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence.  The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people  The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations.  The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction
  9. 9. 3. NURSES AND THE PROFESSION  The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education.  The nurse is active in developing a core of research- based professional knowledge.  The nurse, acting through the professional organization, participates in creating and maintaining safe, equitable social and economic working conditions in nursing. 4. NURSES AND CO-WORKERS  The nurse sustains a co-operative relationship with co-workers in nursing and other fields.  The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co- worker or any other person 5. NURSES AND SOCIETY  Participate and share responsibility with other citizens & other health professionals.  Recognize and perform the duties of citizenship  Aware of laws and regulations which affect the practice of medicine and nursing. INC CODE OF ETHICS FOR NURSES IN INDIA  The nurse respects the uniqueness of individual in provision of care  Provides care for individuals without consideration of caste, creed, religion, culture, ethnicity, gender, socio-economic and political status, personal attributes, or any other grounds  The nurse respects the uniqueness of individual in provision of care
  10. 10.  Individualizes the care considering the care considering the beliefs, values and cultural sensitivity  The nurse respects the uniqueness of individual in provision of care  Appreciates the place of the individual in family and community and facilitates participation of significant others in the care.  The nurse respects the uniqueness of individual in provision of care  Develops and promotes trustful relationship with individual(s).  Recognizes uniqueness of response of individuals to interventions and adapts accordingly.  The nurse respects the uniqueness of individual in provision of care  Appreciates the place of the individual in family and community and facilitates participation of significant others in the care.  The nurse respects the rights of individuals as partner in care and helps in making informed choices  Appreciates individual’s right to make decisions about their care and therefore gives adequate and accurate information for enabling them to make informed choices.  The nurse respects the rights of individuals as partner in care and helps in making informed choices  Respects the decisions made by individual (s) regarding their care.  Protects public from misinformation and misinterpretations.  Advocates special provisions to protect vulnerable individuals/groups.  The nurse respects individual’s right to privacy, maintains confidentiality, and shares information judiciously.  Respects the individual’s right to privacy of their personal information.  Maintains confidentiality of privileged information except in life threatening situations and uses discretion in sharing information  Nurse maintains competence in order to render Quality Nursing Care  Nursing care must be provided only by registered nurse.  Nurse strives to maintain quality nursing care and upholds the standards of care.  Nurse values continuing education, initiates and utilizes all opportunities for self- development.
  11. 11.  Nurse maintains competence in order to render Quality Nursing Care  Nurse values research as a means of development of nursing profession and participates in nursing research adhering to ethical principles.  The nurse is obliged to practice within the framework of ethical, professional and legal boundaries  Adheres to code of ethics and code of professional conduct for nurses in India developed by Indian Nursing council.  Familiarizes with relevant laws and practices in accordance with the law of the state.  Nurse is obliged to work harmoniously with the members of the health team.  Appreciates the team efforts in rendering care.  Cooperates, coordinates and collaborates with the members of the health team to meet the needs of the people.  Nurse commits to reciprocate the trust invested in nursing profession by society  Demonstrates personal etiquettes in all dealings.  Demonstrates professional attributes in all dealings.
  12. 12. INC CODE OF PROFESSIONAL CONDUCT FOR NURSES IN INDIA 1. PROFESSIONAL RESPONSIBILITY AND ACCOUNTABILITY  Appreciates sense of self-worth and nurtures it.  Maintains standards of personal conduct reflecting credit upon the profession.  Carries out responsibilities within the framework of the professional boundary  Is accountable for maintaining practice standards set by Indian Nursing Council  Is accountable for own decisions and actions  Is compassionate  Is responsible for continuous improvement of current practices  Provides adequate information to individuals that allows them informed  Practices healthful behavior 2. NURSING PRACTICE  Provides care in accordance with set standards of practice  Treats all individuals and families with human dignity in providing physical, psychological, emotional, social and spiritual aspects of care  Respects individual and families in the context of traditional and cultural practices and discouraging harmful practices  Presents realistic picture truthfully in all situations for facilitating autonomous decision- making by individuals and families  Promotes participation of individuals and significant others in the care  Ensures safe practice  Consults, coordinates, collaborates and follows up appropriately when individuals’ care needs exceed the nurse’s competence.
  13. 13. 3. COMMUNICATION AND INTERPERSONAL RELATIONSHIPS  Establishes and maintains effective interpersonal relationship with individuals, families and communities  Upholds the dignity of team members and maintains effective interpersonal relationship with them  Appreciates and nurtures professional role of team members  Cooperates with other health professionals to meet the needs of the individuals, families and community 4. VALUING HUMAN BEING  Takes appropriate action to protect individuals from harmful unethical practice  Consider relevant facts while taking conscience decisions in the best interest of individuals  Encourage and support individuals in their right to speak for themselves on issues affecting their health and welfare  Respects and supports choices made by individual 5. MANAGEMENT  Ensures appropriate allocation and utilization of available resources  Participates in supervision and education of students and other formal care providers  Uses judgment in relation to individual competence while accepting and delegating responsibility  Facilitates conducive work culture in order to achieve institutional objective  Communicates effectively following appropriate channels of communication  Participates in performance appraisal  Participates in evaluation of nursing services  Participates in policy decisions, following the principle of equity and accessibility of services  Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation.
  14. 14. 6. PROFESSIONAL ADVANCEMENT  Ensures the protection of the human rights while pursuing the advancement of knowledge  Contributes to the development  Participates in determining and implementing quality care  Takes responsibility for updating own knowledge and competencies  Contributes to the core of professional knowledge by conducting and participating in research TYPE OF ETHICAL THEORIES 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 holds 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. OTHERS • Rights-Oriented Ethical theories • Goal-oriented ethical theories • Intuitionist ethical theory ETHICAL DILEMMAS A dilemma is defined as a situation requiring a choice between two equally desirable or undesirable alternatives.
  15. 15. Example- • Too many patients but scarce resources (How to provide proper care) • Don’t resuscitate • Euthanasia • Treatment of terminally ill patient like end stage cancer, HIV etc • Rights of psychiatry patient etc. ROLES AND FUNCTIONS OF ADMINISTRATOR IN ETHICAL ISSUES • 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 model’s 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
  16. 16. DECISION MAKING PROCESS Ethical decision making is the application of processes and theories of moral philosophy to a real situation.
  17. 17. LEGAL ASPECTS IN NURSING MEANING The word law is derived from an Anglo-Saxon term meaning that which is laid down or fixed. DEFINITION Law is a rule or a body of rules of conduct inherent in human nature and essential to or binding upon human society and guide human functions. TYPES OF LAW 1. PUBLIC LAW  Constitutional law  Administrative law  Criminal law 2. CIVIL LAW  Tort law  Contract law IMPORTANCE OF LAW IN NURSING  It protects the patients /clients against deliberate and inadvertent injury by a nurse.  It protects the nurses also against the suits if she renders right care
  18. 18. LEGAL LIABILITY IN NURSING 1. UNINTENTIONAL TORTS: These types of torts are accidents that cause injury to another person or property. NEGLIGENCE: Nursing negligence usually means failure by the nurse to take the appropriate action to protect the patient from harm. E.g.: Burns, falls, medication errors, failure to observe, use of defective equipment’s, loss of patient property, patient mix up. MALPRACTICE: Medical malpractice is an act or omission by a health care provider which deviates from accepted standards of practice in the medical community and which cause injury to the patient. ELEMENTS OF MALPRACTICE  FOUR elements must be met to prove guilty of malpractice.  DUTY- (relationship) nurse’s responsibility to provide care in an acceptable manner.  BREACH OF DUTY- failed to provide care in acceptable manner.  INJURY (DAMAGES)- nurses act caused harm.  PROXIMATE CAUSE-reasonable cause and effect can be shown between the omission or commission and the harm.  Leaving foreign objects like sponge or forceps, inside a patient during surgery.  Failing to assess and observe patient as directed.  Failing to report a change in a patient’s condition such as vital signs, circulatory status and level of consciousness.  Failure to select appropriate site by the nurse to administer intramuscular injection that causes permanent damage to patient’s extremity.  Falling to obtain an informed consent.
  19. 19. 2. INTENTIONAL TORTS: These types of torts are deliberate actions in which the intent is cause injury to a person or property. ASSAULT: assault is an intentional, unlawful offer of bodily injury to another by force. BATTERY is the intentional touching of, or application of force to the body of another person.  False Imprisonment  criminal battery  civil battery 3. QUASI INTENTIONAL TORTS: It is usually involving situations of communication and often violates a person’s reputation, personal privacy or civil rights.  Defamation; It is the issuance of a false statement about another person which causes that person to suffer harm.  Fraud: Fraud is a crime or offence of deliberately deceiving another in order to damage another to obtain property or services and a civil law violation.  Invasion of privacy LEGAL ISSUES IN NURSING PRACTICE AREA  Controlled substances One of the legal issues that might arise for nurses involves the use of controlled substances. The two acts that control the use of poisons in medicine is: misuse of drug act 1971 and dangerous drug act 1965and 1967.the misuse of drug act aims at checking cause harm if misused. Drugs affected by this act are referred as controlled drugs. The common controlled drugs under the dangerous drug act include cocaine, heroin, methadone,morphine,opium,pethidine,hallucinogen etc.
  20. 20.  Patients property Many of the unconscious patients admitted in emergency their belongings should be listed, checked by two nurses and put in safe keeping. When the patient dies in hospital, his possessions must be recorded in the property book, but money and valuable should be listed and packed separately. Also write the color of ornaments, and inform to administrative officers. Preoperatively and during delivery; these things should take care of.  Caring patients with AIDs The care of AIDs and HIV patients has legal implications for nurses. Confidential information must be protected of HIV patients. An infected person cannot be discriminated against based on contagiousness. The courts have upheld the employer’s right to fire a nurse who refused to care for an AIDS patient.  Living wills and health care surrogates Living wills are documents instructing physician to hold or withdraw Life sustaining procedures whose death is imminent. Each state providing living will need two witnesses, neither whom can be a relative or doctor are needed when the client sign the documents, medical special directives also must be directive also must be legally prepared with the appropriate witness of the clients signature.  Deaths and dying There are many legal issues regarding definition of death. Even though the client may be legally in brain dead, the actual pronouncement of death is usually the legal responsibility of the physician, nurses must be aware of legal definition of death.  Autopsy and organ donation Legally competent persons are free to donate their bodies or organs for medical use. Consent forms are available for the purpose. IMPORTANT LEGAL SAFEGUARD  Licensure Nurse employed for the nursing service required possessing a valid registration certificate issued by respective state nursing council/India nursing council. Registration aims to protecting patients by providing qualified nurse.
  21. 21.  Standards of care Each institution / hospital need to have the policies and procedures defining the standards of care for the nurses of different levels. These are the legal guidelines for safe nursing practice.  Standing orders Nurses are required to execute prescribed orders.in case of emergency or the doctor/medical personnel is not available each nursing service area should have standing instruction or orders for nurse to carry out.  Informed consent It is a client’s agreement to allow something to happen, such as surgery based on full disclosure of the risks, benefits, alternatives and consequences of refusal. o A patient may give his own consent if she/he has attained the age of 18 years or is a minor who has attained the age of 16 years. o Consent of a person of unsound mind, of person under intoxication, and of a child below 14 years of age is also excluded under this act.  Correct identity All babies born in the hospital are correctly labeled at birth and to ensure that no time they are placed in the wrong cot or handed to the wrong mothers. All person in the hospital should wear identity card.  Documentation Keeping accurate and comprehensive records are essential in any health care facility. Records provide a legal and business documents. Regardless of the format used to record the data should be accurate, concise and up to date.  Drug maintenance Checking the unlawful use of narcotic drugs is liable to drug dependence. These drugs should be kept under lock and key. LEGAL RESPONSIBILITIES OF NURSES 1. AT ADMINISTRATIVE AND SUPERVISORY LEVEL
  22. 22.  Appointing and assigning the nurses  Quality control  Material management  Proper documentation system  Effective public relation  Disaster management  Staff management 2. AT OPERATIONAL LEVEL  Carrying out physician’s orders  Verbal orders  Do not resuscitate  Alert for mishap  Following 5 R’s of administering medications  Maintaining safe environment  Use of safe equipment's  Maintenance of proper records  Staffing PATIENT CARE ISSUES • Nursing shortage • Health care reforms • Low salaries • Standard care MANAGEMENT ISSUES  Turnover  Funding  Workload
  23. 23.  Issues regarding malpractice in nursing management  Issues of delegation and supervision  Issues related to staffing  Ethics  Effect  Issues in nursing curriculum development  Collaboration issues EMPLOYMENT ISSUES  Issues related to nursing shortage  Issues in nurse migration  The right to work and right to practice  Exploitation and discrimination  Essential terms and conditions in an employment contract  Misconduct and imposition of punishment  Sexual harassment at the workplace  Renewal of nursing registration  Diploma vs degree in nursing for registration to practice nursing  Specialization in clinical area  Nursing care standards MEDICO-LEGAL CASE DEFINITION
  24. 24. Medico legal situation is defined as one where there is an allegation, confession or suspicion of causes attributing to body injury or danger to life. - Modi NJ EXAMPLES OF MEDICO-LEGAL CASES  Road side accidents, factory accidents, unnatural mishaps or any other disaster.  Suspected or evident, suicides including attempted. All types of poisoning cases, sexual offences and criminal abortions.  Burns injuries of any cause.  Any suspected foul play, unnatural deaths, brought in dead, found dead, unconscious patient without any proper history.  Injury case where there is likelihood of death in near future.  Case referred by court or otherwise requiring. LEGAL IMPLICATION IN MEDICO-LEGAL CASES (MLCs)  Well defined guidelines should be available for each department.  Emergency outpatient departments should be equipped adequately with the functional equipment's and vital drugs to meet all types of emergencies.  Medical, nursing and other staff, transportation facilities should always be available at opd complex.  The civil police should be informed both in writing as well as on telephone.  All clothing worn by injured /deceased, blood stains, gastric lavage ,bullets, vomitus material etc. should preserved, sealed properly and handed it over to police on application after obtaining proper receipt.
  25. 25.  All x-rays of MLCs are of vital importance; utmost care should be taken while handling them.  All medico legal reports and registers shall be kept proper safe custody.  An up to date chart of the treatment and antidotes of all types of poisoning cases should be available.  Availability of working facility for patients and essential investigation facilities should be ensured as and when required and shall be guided for that.  Due care with all the precautions should be given in blood transfusion and intravenous fluid.  Consent of a patient or of the nearest of kin mandatory requirement before subjecting him for any operational procedure.  Ensure no foreign body is left inside the patient body after operation.  Utmost care is required in the management of newborn and infants to avoid injury and baby mix in the nursery.  A female patient always be examined in the presence of a female attendant.  Ensure continuity and correct dispensing of medicines to right patient.  Safety measures to prevent , anaphylactic shock, cardiac arrest , proper identification of medical gases , radiation , fire, preventive maintenance of equipment's etc. and action plan to combat the hazards of these occurrences should be available. CONSUMER PROTECTION ACT CONSUMER  All of us are consumers of goods and services.
  26. 26.  For the purpose of the consumer protection act, the word consumer has been defined separately goods and services.  For the purpose of goods ,a consumer means a person belonging to the following :  One who buys or agrees to buy any goods for a consideration which has been paid or promised or partly paid and partially promised or under any system of deferred payment.  It includes any user of such goods other than the person who actually buys goods and such use is made with the approval of the purchaser.  For the purpose of services ,a consumer means a person ;  One who hires or avails of any service or services for a consideration which has been paid or promised or partly paid or partly promised or under any system of deferred payment.  It includes any beneficiary of such services other than the one who actually hires or avails of the services for consideration and such services are availed with the approval of such person. WHO CAN FILE A COMPLAINT?  A consumer to whom goods are sold or delivered or agreed to be sold or delivered or such services provided or agreed to be provided.  A voluntary consumer organization.  The central government.  The state government, union territory administration.  One or more consumers where they are of same interest.  In case of death of consumer, his or her legal heir of representatives. GROUNDS TO FILE A COMPLAINT  Adoption of any unfair trade practice or restrictive trade practice.  The goods bought or agreed to be bought suffer from one or more defects  Services hired /availed or agreed to be hired/availed suffer from any deficiency.
  27. 27.  The trader has charged for the goods or services a piece in excess of the stipulated price.  The goods or services being offered to the public are hazardous to life and safety. GRIEVANCE REDRESSAL MECHANISM UNDER CPA  Rs 20 lakh –district consumer court  20lakh-1 crore-state consumer commission  Above 1 crore-national commission CATEGORIES OF PATIENT AS CONSUMERS  PATIENT OF GOVERNMENT HOSPITALS Patients availing free medical care in general wards are not consumers but patients availing medical care in private wards of these hospitals are consumers as they are hiring services for a consideration.  PATIENTS OF CHARITABLE HOSPITALS The patient of charitable hospitals is a consumer when he pays for the medical treatment either partially or in full, but he is not a consumer when he does not pay at all.  PATIENTS OF NURSING HOMES AND PRIVATE PRATIONERS Patient of nursing homes and private practitioners are covered under the act because they satisfy the definition of consumer and service as given under section 2(1)(d) and 2(1)(0). Hence as a consumer the services should have been rendered to him, the services should have been hired by him and for hiring the services, he should have paid a consideration.
  28. 28. RIGHTS OF SPECIAL GROUPS: CHILDREN, WOMEN, AGED, HIV, HANDICAPPED  Rights are legal, social, or ethical principles of freedom or entitlement; that is, rights are the fundamental normative rules about what is allowed of people or owed to people, according to some legal system, social convention, or ethical theory. Special groups are those who need special attention such as children, women, HIV, handicap and ageing. So to protect these groups the rights have been formulated by the constitution. RIGHTS OF CHILDREN  In 1946, the Economic and Social Council of the United Nations recommended that the Geneva Declaration be reaffirmed as a sign of commitment to the cause of children.  Child must be given the means needed for its normal development, both materially and spiritually.  Hungry child should be fed; sick child should be helped; and the orphan and the homeless child should be sheltered and secured.  Child must be first to receive relief in times of distress.  Child must be put in a position to earn a livelihood and must be protected against every form of exploitation.  Child must be brought up in the consciousness that its best qualities are to be used in the service of its fellow men.  Article 15: Shall not discriminate against any citizen, Nothing in this article shall prevent the State from making special provision for women and children.  Article 21 A: Shall provide free and compulsory education to all children of the age of six to fourteen years.  Article 23: Traffic in human beings and beggar and other similar forms of forced labor are prohibited.
  29. 29. MAJOR CONSTITUTIONAL PROVISIONS  Article 24: No child below the age of fourteen years shall be employed to work in any factory or mine or engaged in any other hazardous employment.  Article 39: (e) The tender age of children are not abused and not forced by economic necessity to enter avocations unsuited to their age or strength;  (f) That children are given opportunities and facilities to develop in a healthy manner and in conditions of freedom and dignity and that childhood protected against exploitation and against moral and material abandonment.  Article 45: Provide early childhood care and education for all children until they complete the age of six years.  Article 51A: (k) Parent or guardian to provide opportunities for education to his child or, as the case may be, ward between the age of six and fourteen years.  The Right of Children to Free and Compulsory Education Act was enforced April 1, 2010.  Pre-conception and pre-natal diagnostic Techniques (prohibition of sex selection) Act 1994.  Infant milk substitutes, feeding bottles and infant foods (regulation of production, supply and distribution) Act, 1992. ACT FOR CHILD WELFARE  The juvenile justice (care and protection of children) Act, 2000.  The child Labour (prohibition and Regulation) Act, 1986.  The child Marriage restraint Act, 1929.  Non-discrimination.  Special protection, opportunities and facilities to develop physically, mentally, morally, spiritually and socially in a healthy and normal manner and in conditions of freedom and dignity.  The right to a name and nationality.
  30. 30.  The right to social security, adequate nutrition, housing, recreation and medical services.  UN DECLARATION OF THE RIGHTS OF THE CHILD  The differently-abled child to be given special treatment, education and care.  The need for love and understanding so that the child grows in the care and responsibility of his/her parents, and in an atmosphere of affection and moral and material security.  Entitlement to education, which should be free and compulsory, at least in the elementary stages.  The child should be among the first to receive protection and relief in all circumstances.  Protection against all forms of neglect, cruelty and exploitation, including that associated with employment.  Protection from practices that may foster racial, religious and other forms of discrimination.  The Right to enjoy these rights, regardless of race, color, sex, religion, national or social origin.  Right to develop in an atmosphere of affection and security and protection against all forms of neglect, cruelty, exploitation and traffic.  Right to enjoy the benefits of social security, including nutrition, housing and medical care.  Right to a name and nationality.  Right to free education.  Right to full opportunity for play and recreation.  Right to special treatment, education and appropriate care, if handicapped.  Right to be among the first to receive protection and relief in times of disaster.  Right to learn to be useful member of society and to develop in a healthy and normal manner and in conditions of freedom and dignity.
  31. 31.  Right to be brought up in spirit of understanding, tolerance, friendship among people, peace and universal brotherhood.  Right to enjoy these rights, regardless of race, color, sex, religion, national or social origin  The status of women in India has been subject to many great changes over the past few millennia. In modern India, women have adorned high offices in India including that of the President, Prime minister, Speaker of the Lok Sabha, Leader of Opposition, etc. RIGHTS OF WOMEN  Gender equality  Empowers the State to adopt measures of positive discrimination in favor of women.  Women’s advancement in different spheres. IMPORTANT CONSTITUTIONAL AND LEGAL PROVISIONS FOR WOMEN IN INDIA  The Constitution of India not only grants equality to women but also empowers the State to adopt measures of positive discrimination in favor of women.  Fundamental Rights prohibits discrimination against any citizen on grounds of religion, race, caste, sex or place of birth, and guarantee equality of opportunity to all citizens in matters relating to employment. CONSTITUTIONAL PROVISIONS  Equality for women (Article 14)  The State not to discriminate against any citizen on grounds only of religion, race, caste, sex, place of birth (Article 15)  The State to make special provision in favor of women and children (Article 15)  Equality of opportunity for all citizens in matters relating to employment or appointment to any office under the State (Article 16)  Constitutional Privileges
  32. 32.  The State to direct its policy towards securing for men and women equally the right to an adequate means of livelihood; and equal pay for equal work for both men and women (Article 39)  To promote justice, on a basis of equal opportunity and to provide free legal aid by suitable legislation or scheme (Article 39 )  The State to make provision for securing just and humane conditions of work and for maternity relief (Article 42)  The State to promote with special care the educational and economic interests of the weaker sections of the people and to protect them from social injustice and all forms of exploitation (Article 46)  The State to raise the level of nutrition and the standard of living of its people (Article 47)  To promote harmony and the spirit of common brotherhood amongst all the people of India and to renounce practices derogatory to the dignity of women (Article 51)  Not less than one-third of the total number of seats to be filled by direct election in every Panchayat, Municipality to be reserved for women (Article 243 )  To uphold the Constitutional mandate, the State has enacted various legislative measures intended to ensure equal rights, to counter social discrimination and various forms of violence and atrocities and to provide support services especially to working women.  Although women may be victims of any of the crimes such as 'Murder', 'Robbery', 'Cheating' etc, the crimes, which are directed specifically against women, are characterized as 'Crime against Women'. LEGAL PROVISIONS  Rape (Sec. 376 IPC)  Kidnapping & Abduction for different purposes ( Sec. 363-373)  Homicide for Dowry, Dowry Deaths or their attempts (Sec. 302/304-B IPC)
  33. 33.  Torture, both mental and physical (Sec. 498-A IPC)  Molestation (Sec. 354 IPC)  Sexual Harassment (Sec. 509 IPC)  Importation of girls (up to 21 years of age) The Crimes Identified Under the Indian Penal Code (IPC)  The Employees State Insurance Act, 1948  The Plantation Labour Act, 1951  The Family Courts Act, 1954  The Special Marriage Act, 1954  The Hindu Marriage Act, 1955  The Hindu Succession Act, 1956 with amendment in 2005  Immoral Traffic (Prevention) Act, 1956  The Maternity Benefit Act, 1961 (Amended in 1995)  Dowry Prohibition Act, 1961 The Crimes identified under the Special Laws (SLL)  The Medical Termination of Pregnancy Act, 1971  The Contract Labour (Regulation and Abolition) Act, 1976  The Equal Remuneration Act, 1976  The Prohibition of Child Marriage Act, 2006  The Criminal Law Act, 1983  The Factories Act, 1986  Indecent Representation of Women (Prohibition) Act, 1986  Commission of Sati (Prevention) Act, 1987  The Protection of Women from Domestic Violence Act, 2005
  34. 34.  The Employees State Insurance Act, 1948  National Commission for Women  Reservation for Women in Local Self - Government  The National Plan of Action for the Girl Child (1991-2000)  National Policy for the Empowerment of Women, 2001 SPECIAL INITIATIVES FOR WOMEN RIGHTS OF HIV PATIENTS  People with HIV infection/AIDS have same basic rights & responsibilities like: Liberty, autonomy, security of the person and freedom of movement.  HIV testing RIGHTS OF HIV  Confidentiality and privacy  Health and support services, public benefits, medical schemes and insurance.  Education on HIV and AIDS.  The responsibility of media.  The right of safer sex 8. The right of prisoners  Duties of persons with HIV or AIDS.  Persons with disabilities face discrimination and barriers that restrict them from participating in society on an equal basis with others every day Disabled have however, remained largely ‘invisible and unable to enjoy the full range of human rights. In recent years, there has been a revolutionary change in approach, globally, to close the protection gap and ensure that persons with disabilities enjoy the same standards of equality, rights and dignity as everyone else.
  35. 35. RIGHTS OF HANDICAP  General legal provisions  The disabled and the constitution  Education Law for the Disabled  Health Laws  Family Laws  Succession Laws for the Disabled  Labour Laws for the Disabled  The rights of the disabled  Judicial procedures for the disabled  Income Tax Concessions LEGAL RIGHTS OF THE DISABLED IN INDIA  The persons with disabilities (equal opportunities, protection of rights and full participation) act, 1995 Prevention and early detection of disabilities Education ,Employment ,Affirmative Action, Non-Discrimination, Research and Manpower Development Social Security Grievance Redressal .  The Mental Health Act, 1987  The Rehabilitation Council of India Act, 1992.  The national trust for welfare of persons with autism, cerebral palsy, mental retardation and multiple disabilities act, 1999  The mentally retarded person has, to the maximum degree of feasibility, the same rights as under human beings.  The mentally retarded person has a right to proper medical care  Right of economic security  Whenever possible, the mentally retarded person should live with his own family or with his foster parents and participate in different forms of community life.  The family with which he lives should receive assistance.  The mentally retarded person has a right to a qualified guardian.  The mentally retarded person has a right to get protection from exploitation, abuse and a degrading treatment.
  36. 36.  Whenever mentally retarded persons are unable to exercise their rights in a meaningful way or it should become necessary to restrict or deny some or all of their rights  The Bill replaces the Persons with Disabilities v Act, 1995. Instead of seven disabilities specified in the Act, the Bill covers 19 conditions.  Persons with at least 40% of a disability are entitled to certain benefits such as reservations in education and employment, preference in government schemes, etc.  The Bill confers several rights including disabled friendly access to all public buildings, hospitals, modes of transport, polling stations, etc. The Right of Persons with Disabilities Bill, 2014  In case of mentally ill persons, district courts may award two types of guardianship: a limited guardian & plenary guardian.  Violation of any provision of the Act is punishable with imprisonment up to six months, and/or fine of Rs 10,000. Subsequent violations carry a higher penalty. RIGHTS OF AGED  National Policy for Older Persons on January 13, 1999:  Pension fund  Construction of old age homes and day care centers for every 3-4 districts  Concessional rail/air fares for travel  Enacting legislation for ensuring compulsory geriatric care in all the public hospitals GOVERNMENTAL PROTECTIONS  The Ministry of Justice and Empowerment has announced regarding the setting up of a National Council for Older Person, called age well Foundation. It will seek opinion of aged on measures to make life easier for them.  Attempts to sensitize school children to live and work with the elderly. Setting up of a round the clock help line and discouraging social ostracism of the older persons are being taken up.  The government policy encourages a prompt settlement of pension, provident fund (PF), gratuity, etc. in order to save the superannuated persons from any hardships
  37. 37.  The policy also accords high priority to their health care needs.  According to Sec.88-B, 88-D and 88-DDB of Income Tax Act there are discount in tax for the elderly persons.  Life Insurance Corporation of India (LIC) has also been providing several scheme for the benefit of aged persons, i.e.,Jeevan Dhara Yojana, Jeevan Akshay Yojana, Senior Citizen Unit Yojana, Medical Insurance Yojana. qFormer Prime Minister A.B.Bajpai was also launch ‘Annapurana Yojana’ for the benefit of aged persons.  It is proposed to allot 10 percent of the houses constructed under government schemes for the urban and rural lower income segments to the older persons on easy loan
  38. 38. INFECTION CONTROL AND STANDARD SAFETY MEASURES DEFINITION OF INFECTION Injurious contamination of body or parts of the body by bacteria, viruses,fungi,protozoa and rickettsia or by toxin that they may produce infection may be local or generalized and spread throughout the body.
  39. 39. SURGICAL ASEPSIS COMMONLY USED DISINFECTANTS AND GERMICIDES  Bacillocids  Korsolex  Cidex  Savlon  Sterilium
  40. 40.  Betadine  formalin PREVENTION Standard precautions are meant to reduce the risk of transmission of blood borne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in the care of all patients. Hand hygiene is a major component of standard precautions and one of the most effective methods to prevent transmission of pathogens associated with health care. In addition to hand hygiene, the use of personal protective equipment should be guided by risk assessment and the extent of contact anticipated with blood and body fluids, or pathogens. HEALTH POLICY  Promote a safety climate.  Develop policies which facilitate the implementation of infection control measures.  Hand hygiene  Perform hand hygiene by means of hand rubbing or hand washing (see overleaf for detailed indications).  Hands should always be washed with soap and water if hands are visibly soiled, or exposure to spore-forming organisms is proven or strongly suspected, or after using the restroom. For other indications, if resources permit, perform hand rubbing with an alcohol-based preparation.  Ensure availability of hand-washing facilities with clean running water.  Ensure availability of hand hygiene products (clean water, soap, single use clean towels, alcohol-based hand rub). Alcohol-based hand rubs should ideally be available at the point of care. PERSONAL PROTECTIVE EQUIPMENT (PPE) ASSESS THE RISK of exposure to body substances or contaminated surfaces BEFORE any health-care activity. Make this a routine!
  41. 41.  Select PPE based on the assessment of risk:  Clean non-sterile gloves.  Clean, non-sterile fluid-resistant gown.  Mask and eye protection or a face shield. Respiratory hygiene and cough etiquette  Education of health workers, patients and visitors.  Use of source control measures.  Hand hygiene after contact with respiratory secretions.  Spatial separation of persons with acute febrile respiratory symptoms. 1. HAND HYGIENE1 SUMMARY TECHNIQUE:  Hand washing (40–60 sec): wet hands and apply soap; rub all surfaces; rinse hands and dry thoroughly with a single use towel; use towel to turn off faucet.  Hand rubbing (20–30 sec): apply enough product to cover all areas of the hands; rub hands until dry. Summary indications:  Before and after any direct patient contact and between patients, whether or not gloves are worn. Immediately after gloves are removed.  Before handling an invasive device.  After touching blood, body fluids, secretions, excretions, non-intact skin, and contaminated items, even if gloves are worn.  During patient care, when moving from a contaminated to a clean body site of the patient.  After contact with inanimate objects in the immediate vicinity of the patient. 2. GLOVES  Wear when touching blood, body fluids, secretions, excretions, mucous membranes, nonimpact skin.  Change between tasks and procedures on the same patient after contact with potentially infectious material.  Remove after use, before touching non-contaminated items and surfaces, and before going to another patient.
  42. 42.  Perform hand hygiene immediately after removal 3. FACIAL PROTECTION (EYES, NOSE, AND MOUTH)  Wear a surgical or procedure mask and eye protection (face shield, goggles) to protect mucous membranes of the eyes, nose, and mouth during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. 4. GOWN  Wear to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions.  Remove soiled gown as soon as possible, and perform hand hygiene 5. PREVENTION OF NEEDLE STICK INJURIES 2 Use care when:  Handling needles, scalpels, and other sharp instruments or devices  Cleaning used instruments  Disposing of used needles.  Respiratory hygiene and cough etiquette Persons with respiratory symptoms should apply source control measures:  Cover their nose and mouth when coughing/sneezing with tissue or mask, dispose of used tissues and masks, and perform hand hygiene after contact with respiratory secretions.  Health care facilities should:  place acute febrile respiratory symptomatic patients at least 1 meter (3 feet) away from others in common waiting areas, if possible.  Post visual alerts at the entrance to health-care facilities instructing persons with respiratory symptoms to practice respiratory hygiene/cough etiquette.  Consider making hand hygiene resources, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses.
  43. 43. 6. ENVIRONMENTAL CLEANING  Use adequate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces. 7. LINENS HANDLE, TRANSPORT, AND PROCESS USED LINEN IN A MANNER WHICH:  Prevents skin and mucous membrane exposures and contamination of clothing.  Avoids transfer of pathogens to other patients and or the environment. 8. WASTE DISPOSAL  Ensure safe waste management.  Treat waste contaminated with blood, body fluids, secretions and excretions as clinical waste, in accordance with local regulations.  Human tissues and laboratory waste that is directly associated with specimen processing should also be treated as clinical waste.  Discard single use items properly. 9. PATIENT CARE EQUIPMENT  Handle equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of pathogens to other patients or the environment.  Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.
  44. 44. CONCLUSION This seminar include legal and ethical system, issues ,types of law, patient care issues, medico legal case, nursing regulatory mechanisms, patient rights, consumer protection act, rights of special groups ,infection control and standard safety measures. Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering. The need for nursing is universal. Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, color, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.Nurses render health services to the individual, the family and the community and co-ordinate their services with those of related groups.
  45. 45. ASSIGNMENT The case scenario Three years ago, Ms. EH, an 86-year-old woman, was referred to me after a debilitating stroke affected her right side (pre-morbidly her dominant side). Ms. EH was admitted under home health after running out of Medicare allowable days at a skilled nursing facility (SNF). Ms. EH needed considerable assistance with all activities of daily living (ADL) and was primarily wheelchair-bound due to her inability to walk independently. She lived with her 88-year-old husband Mr. RH, who was also not in the best of health. Due to financial constraints the couple opted against long-term or assisted living placement in favor of their trailer home. Ms. EH demonstrated good rehabilitation potential and progress with all her home health services. One night, approximately three weeks after her return home from the SNF, Mr. RH suffered a massive myocardial infarction. He was hospitalized and underwent cardiac catheterization. It indicated diffuse blockage of multiple vessels and he was deemed a poor candidate for surgery. Subsequent medical interventions were primarily conservative with a poor prognosis. He was later transferred to a nursing home. Ms. EH obviously was very concerned and depressed about the situation. She was devoted and would visit Mr. RH for four to six hours every day at the nursing home after being driven there by her friends and family. No one could persuade Ms. EH to avoid the exertion. She would simply state,” He has always been there for me. Shouldn’t I?” Soon after her husband’s admission to the nursing home, Ms. EH began to have difficulty keeping up with her appointments with me and the other home health providers. Medicare’s guidelines for clients to receive home health under Part-A Insurance Plan require them to meet certain “homebound” criteria. The Center for Medicare and Medicaid Services (CMS), formerly called the Health Care Financing Agency (HCFA), describing homebound status states that, “there exists a normal inability to leave home and, consequently, leaving home would require a considerable and taxing effort. If the patient does in fact leave the home, the patient may nevertheless be considered homebound if the absences from the home are infrequent or for periods of relatively short duration, or are attributable to the need to receive health care treatment…” comparison with ethical dilemmas?
  46. 46. BIBLIOGRAPHY 1. Jogindra vati, Principles and practices of nursing management and administration, jaypee brother’s medical publication, 1st edition, 2013, page: no: 46-79. 2. Mithun kumar, A comprehensive text book on nursing management, emmess medical publishers,1st edition,2013page no:487-566. 3. Center for Medicare and Medicaid Services [web page on the Internet]. Home health manual (Rev. 302): Chapter II-Coverage of services. Baltimore (MD): Center for Medicare and Medicaid Services; c2003- [cited 2005 July 24]. Available from: http://www.cMshhs.gov/manuals/11_hha/hh200.asp. 4. Joseph K Wells, Indian journal for medical ethics, case study, Ethical dilemma and resolution: a case scenario, DOI: https://doi.org/10.20529/IJME.2007.010. 5. Legal & ethical issues in nursing- issues in India prepared by Mr. Migron rubin m.sc. Nursing (fy), https://www.slideshare.net/MigronRubin/legal-ethical-issues-in-nursing- issues-in-india. 6. Hospital infection control guidelines, ICMR, http://icmr.nic.in/guidelines/Hospital%20Infection%20control%20guidelines-
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