Module 7: The Fundamentals of Ethico-Moral and Legal Considerations in Nursing | FUNDA12022 | AUF_CON

The Fundamentals of Ethico-Moral and Legal 4. Accountability is accepting responsibility for one's
Considerations in Nursing own actions. TRUE
Sources: Modules & Lecture (May 31, 2022) 5. Express consent may take the form of either an oral
Angeles University Foundation | 2nd Sem | 2nd Cycle | Fundamentals of Nursing Practice or written agreement. TRUE
6. Informed consent is an agreement by a client to
accept a course of treatment or a procedure after
MODULE 7 OVERVIEW being provided complete information, including the
benefits and risks of treatment, alternatives to the
● This self-instructional module is designed and treatment, and prognosis if not treated by a health
prepared for BSN I students so they may understand care provider. TRUE
the very core concept of the Fundamentals of 7. The patient has the right to consent to or decline to
Ethico-Moral and Legal Consideration in participate in proposed research studies or human
Nursing. experimentation. TRUE
● Nurses practice their profession within a set of 8. Veracity is being completely” truthful” with patients.
norms, rules and regulations of the nursing TRUE
profession. They deliver nursing care with 9. Nurses have the right to negotiate the conditions of
compassion and are required to do no harm to their employment, either as individuals or
patients. Deliverance of health care is ensured that collectively, in selected practice settings. FALSE
it is within the bounds governed by moral, ethical and 10. Ethical values are vital for any healthcare provider.
legal principles. This means that as the nurses These are universal rules of conduct that provide a
perform their nursing and medical interventions to practical basis for identifying what kinds of actions,
clients in both the hospital or community setting, the intentions, and motives are valued. TRUE
activities provided to clients must be conducted with
deep considerations of their client’s welfare and DEFINITION OF TERMS
benefit. It is a must that safety is a priority and that
no moral, ethical or legal issues are violated or not
● ETHICS - is a principle that describes what is
followed.
expected in terms of right and correct and wrong or
● A Patient's Bill of Rights lists down the assurance
incorrect in terms of behavior.
for those receiving medical care that might be in the
● ETHICAL VALUES - These are universal rules of
form of a law or a declaration. A patient's bill of rights
conduct that provide a practical basis for identifying
guarantees that the client will receive information,
what kinds of actions, intentions, and motives are
fair treatment, and autonomy over medical decisions
valued.
and among other rights. On the other hand, the Bill
● NURSING ETHICS - refers to ethical issues that
of Rights for Registered Nurses clearly states that
occur in the practice of nursing. Nurses are
nurses have the right to a safe work environment, to
advocates for patients and must find a balance while
practice in a manner that ensures the provision of
delivering patient care.
safe care through adherence to professional
● AUTONOMY- ethical principle recognizing each
standards and ethical practice, and to advocate
individual patient’s right to self-determination and
freely on behalf of themselves and their patients.
decision-making.
● BENEFICENCE –ethical principle of “doing good
PRE-TEST - TRUE OR FALSE and the right thing” for the patient.
● NONMALEFICENCE - ethical principle of doing no
1. Ethics is a principle that describes what is expected harm” for the patient.
in terms of right and correct and wrong or incorrect ● INFORMED CONSENT - is an agreement by a client
in terms of behavior. TRUE to accept a course of treatment or a procedure after
2. Beneficence is “doing good and the right thing” for being provided complete information, including the
the patient.TRUE benefits and risks of treatment, alternatives to the
3. The Patient's Bill of Rights is a guide for “carrying out treatment, and prognosis if not treated by a health
nursing responsibilities in a manner consistent with care provider.
quality in nursing care and the ethical obligations of ● PATIENT’S BILL OF RIGHTS - is a statement of the
the profession. FALSE rights to which patients are entitled as recipients of
medical care.

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● ACCOUNTABILITY -This is accepting responsibility

DIFFERENT ETHICAL PRINCIPLES
for one's own actions.
● RIGHT - is a privilege or fundamental power to which
an individual is entitled unless it is revoked by law or A. AUTONOMY is recognizing each individual
given up voluntarily. patient’s right to self-determination and
decision-making.
a. Nurses accept the client as a unique person
PART 1 : ETHICS AND MORALITY
who has the innate right to have their own
opinions, perspectives, values, and beliefs.
● ETHICS is a principle that describes what is B. BENEFICENCE
expected in terms of right and correct and wrong a. Is “doing good and the right thing” for the
or incorrect in terms of behavior. patient. To promote goodness, kindness, and
● ETHICAL VALUES are vital for any healthcare charity.
provider. These are universal rules of conduct b. The American Nurses Association defines
that provide a practical basis for identifying what this as “actions guided by compassion.”
kinds of actions, intentions, and motives are C. NONMALEFICENCE
valued. a. Is “doing no harm” as stated in the historical
● NURSING ETHICS refers to ethical issues that Hippocratic Oath. Harm can be intentional or
occur in the practice of nursing. Nurses are unintentional.
advocates for patients and must find a balance b. This is the most well-known of the main
while delivering patient care. principles of nursing ethics.
● According to the American Nurses Association c. It ensures the safety of the patient and
(ANA),.” the NURSING CODE OF ETHICS is a community in all care delivery.
guide for “carrying out nursing responsibilities in d. Nurses are also responsible to report
a manner consistent with quality in nursing care treatment options that are causing significant
and the ethical obligations of the profession harm to a patient which may include suicidal
● Ethics, in general, are the moral principles or homicidal ideations.
that dictate how a person will conduct D. ACCOUNTABILITY
themselves. Ethical values are essential for a. Is accepting responsibility for one's own
ALL healthcare workers, especially Nurses actions.
b. Nurses are accountable for their nursing care
PURPOSE OF ETHICAL PRINCIPLES and other actions.
1. Establish common ground among nurses, c. They must accept all of the professional and
patients, and other health care professionals, and personal consequences that can occur as the
society for the discussion of ethical questions and result of their actions.
ethical decision-making. E. FIDELITY
2. Permit people to take a consistent position on a. Is “keeping one's promises”. Nurses must be
specific or related issues. faithful and true to their professional
3. Provide an analytical framework by which moral promises and responsibilities by providing
problems can be evaluated. high quality, safe care in a competent
manner.
F. JUSTICE
a. Nurses must be “fair” when they distribute
care. There should be an element of fairness
in all medical and nursing decisions and care.
b. Nurses must care for all patients with the
same level of fairness despite the individual's
financial abilities, race, religion, gender,
and/or sexual orientation.

G. VERACITY
a. Is being completely “truthful” with patients.
i. Telling the truth

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b. Nurses must not withhold the whole truth medtechs, pharmacists) for the
from clients even when it may lead to patient curative, preventive, and rehabilitative
distress. aspects of care, restoration of health,
H. Nurses must also have PROFESSIONAL alleviation of suffering, and when
ACCOUNTABILITY AND RESPONSIBILITY. recovery is not possible, towards a
a. According to the Code of Ethics for Nurses peaceful death.
(Fowler, 2015), accountability means d. As nurses begin their professional
“answerable, or to give an account or obligations, their legal responsibilities
defense to oneself and others for one’s own begin as well.
choices, decisions and actions as measured
against a standard”. IT SHALL BE THE DUTY OF THE NURSE TO
b. Responsibility refers to “the A. Provide nursing care through the utilization of
blameworthiness or praiseworthiness that the nursing process. Nursing care includes, but
one bears for one’s conduct or the is not limited to, traditional and innovative
performance of duties”. Thus, the ethical approaches (provide evidence based practice),
nurse is able to explain the rationale behind therapeutic use of self, executing health care
every action and recognize the standards to techniques and procedures, essential primary
which he or she will be held. health care (e.g., immunizations), comfort
measures, health teachings, and administration of
END OF PART 1: ETHICS AND MORALITY written prescription for treatment, therapies, oral,
topical and parenteral medications, internal
examination during labor in the absence of
antenatal bleeding and delivery. In case of
PART 2 : SCOPE OF NURSING PRACTICE
suturing of perineal laceration, special training
shall be provided according to the protocol
A. REPUBLIC ACT NO. 9173 established;
a. AN ACT PROVIDING FOR A MORE B. Establish linkages with community resources
RESPONSIVE NURSING and coordination with the health team; working
PROFESSION, REPEALING FOR THE with barangay officials/ LGU or administrative
PURPOSE REPUBLIC ACT NO. 7164, department.
b. OTHERWISE KNOWN AS “THE C. Provide health education to individuals,
PHILIPPINE NURSING ACT OF 1991” families and communities;
AND FOR OTHER PURPOSES. D. Teach, guide and supervise students in
B. SEC. 28. SCOPE OF NURSING nursing education programs including the
a. A person shall be deemed to be administration of nursing services in varied
practicing nursing within the meaning of settings such as hospitals and clinics; undertake
this Act when he/she singly (e.g., private consultation services; engage in such activities
nurse) or in collaboration with another, that require the utilization of knowledge and
initiates and performs nursing services to decision-making skills of a registered nurse; and
individuals, families, and communities in E. Undertake nursing and health human resource
any health care setting. It includes, but is development training and research, which shall
not limited to, nursing care during include, but not limited to, the development of
conception, labor, delivery, infancy, advanced nursing practice;
childhood, toddler, pre-school, school a. Provided, that this section shall not apply to
age, adolescence, adulthood, and old nursing students who perform nursing
age. functions under the direct supervision of a
b. Independent practitioners, nurses are qualified faculty:
primarily responsible for the b. Provided, further, that in the practice of
promotion of health and prevention of nursing in all settings, the nurse is duty-
illness. bound to observe the Code of Ethics for
c. As members of the health team, nurses nurses and uphold the standards of safe
shall collaborate with other health nursing practice.
care providers (e.g., doctors,

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F. The nurse is required to maintain competence ● Guidelines for nurses who choose to render
by continual learning through continuing emergency care are as follows:
professional education to be provided by the 1. Limit actions to those normally considered
accredited professional organization or any first aid, if possible.
recognized professional nursing organization: 2. Do not perform actions that you do not
Provided, finally, That the program and activity for know how to do.
the continuing professional education shall be 3. Offer assistance, but do not insist.
submitted to and approved by the Board. 4. Have someone call or go for additional
help.
END OF PART 2: SCOPE OF NURSING PRACTICE 5. Do not leave the scene until the injured
individual leaves or another qualified
individual takes over.
6. Do not accept any compensation.
PART 3 : LEGAL ASPECTS
CONTROLLED SUBSTANCES
● Nurses need to Recognize and apply legal aspects ● Only authorized personnel are able to access it
in their many roles. and are stored securely.
● As CLIENT ADVOCATES, nurses ensure the ● U.S. laws regulate the distribution and use of
client’s right to informed consent or refusal, and they controlled substances such as opioids,
identify and report violent behavior and neglect of depressants, stimulants, and hallucinogens.
vulnerable clients. ● Misuse of controlled substances leads to criminal
penalties.
LEGAL LIABILITY
A. LAWS LEGAL RISK AREAS
a. Nurses are governed by civil and criminal laws
as providers of services, employees, and
private citizens.
B. NEGLIGENCE
a. Is misconduct or practice that is below the
standard expected of an ordinary, reasonable,
and prudent individual.
C. MALPRACTICE
a. Negligence on the part of the nurse.
b. Ex: Failing to properly monitor a patient and
missing a change in their vital signs.

GOOD SAMARITAN LAW

● Offers legal immunity provided they give
reasonable care.
● Laws designed to protect healthcare providers
who provide assistance at the scene of an
emergency against claims of professional
negligence unless it can be shown that there was
a gross departure from the normal standard of
career willful wrongdoing on their part.
● GROSS NEGLIGENCE usually involves further
injury of harm to the individual.
● Ex: an automobile may strike an injured child left
side of the road when the nurse leaves to obtain A. ASSAULT
help. • Threatening words
● The Good Samaritan Act is a law which protects • As an attempt or threat to touch another
any volunteer giving aid to an injured person in an individual unjustifiably.
emergency situation.

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• Precedes battery; it is the act that causes the damaged. An example of slander would be
individual to believe a battery is about to for the nurse to tell a client that another nurse
occur. is incompetent.
• For example, the individual who threatens F. FRAUD
someone by making a menacing gesture with ● Wrongful or criminal deception intended
a club or a closed fist is guilty of assault. to result in financial or personal gain.
• A nurse who threatens a client with an ● It is the intentional deception to secure
injection after the client refuses to take the unfair or unlawful gain, or deprive a victim
medication orally would be committing of a legal right.
assault. ● Ex: Billing for items and services that are
B. BATTERY not medically necessary
• Is the willful touching of an individual (or the
individual’s clothes or even something the END OF PART 3: LEGAL ASPECTS
individual is carrying) that may or may not
cause harm.
• Battery exists when there is no consent, even PART 4 : INFORMED CONSENT
if the plaintiff was not asked for consent.
Unless there is implied consent, such as in
life - threatening emergencies, a procedure ● Nurses need to recognize and apply legal aspects in
performed on an unconscious client without their many different roles. As client advocates, nurses
informed consent is battery. ensure the client’s right to informed consent or
• Ex: touching done w/o permission, that is refusal, and they identify and report violent
embarrassing, or that causes injury. behavior and neglect of vulnerable clients.
• In the previous example, if the nurse followed ● Informed consent is an agreement by a client to
through on the threat and gave the injection accept a course of treatment or a procedure after
without the client’s consent, the nurse would being provided complete information, including the
be committing battery. benefits and risks of treatment, alternatives to the
C. INVASION OF PRIVACY treatment, and prognosis if not treated by a health
● It is a direct wring of a personal nature. It care provider.
injures the feelings of the individual and does ● Is the client’s approval to have his/ her body touched
not take into account the effect of revealed by a specific individual
information on the reputation of the individual ● Are legal documents that indicate the client’s
in the community. permission to perform surgery, perform a treatment or
● The right to privacy is the right of individuals procedure, or give information to a third party.
to withhold themselves and their lives from ● is “mutual decision making between both professional
public scrutiny. and patient over the treatment option that the patient
D. FALSE IMPRISONMENT wishes to receive or not to receive”.
● “Unjustifiable detention of a person without ○ The form is a record of the informed consent,
legal warrant to confine a person” not the informed consent itself.
● False imprisonment accompanied by forceful
restraint or threat is battery. GOAL OF INFORMED CONSENT
E. DEFAMATION
● Is communication that is false or made with a
VALID CONSENT The consent must be:
careless disregard for the truth, and results in
● Given by a person with capacity;
injury to the reputation of an individual.
● Voluntarily given, without any element of duress
● Libel is defamation by means of print, writing,
and;
or pictures. Writing in the nurse’s notes that a
● With the requisite information of risks, side-
primary care provider is incompetent
effects and alternatives such that the patient is
because he did not respond immediately to a
able to make an informed decision as to whether
call is an example of libel.
or not to proceed with treatment.
● Slander is defamation by the spoken word,
stating unprivileged (not legally protected) or
false words by which a reputation is

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TYPES OF CONSENT ● Any special circumstances, such as the use of an

● EXPRESS CONSENT may take the form of either interpreter, should be documented.
an oral or written agreement. Usually, the more ● When documenting the use of an interpreter,
invasive a procedure or the greater the potential including the interpreter’s full name and title.
for risk to the client, the greater the need for
written permission. END OF PART 5: DOCUMENTATION
● IMPLIED CONSENT exists when the individual’s
nonverbal behavior indicates agreement. For
example, clients who position their bodies for
PART 6 : THE PATIENT’S BILL OF RIGHTS
injection or cooperate with the taking of vital signs
infer implied consent.
○ CONSENT IS ALSO IMPLIED in a THE PATIENT’S BILL OF RIGHTS
medical emergency when an individual ● The American Hospital Association presents A
cannot provide express consent because Patient’s Bill of Rights with the expectation that
of physical condition. it will contribute to more effective patient care and
○ Obtaining informed consent for specific be supported by the hospital on behalf of the
medical and surgical treatments is the institution, its medical staff, employees, and
responsibility of the person who is going patients.
to perform the procedure. ● The American Hospital Association
○ Generally, this person is the primary care encourages health care institutions to tailor this
provider; however, it could also be a bill of rights to their patient community by
nurse practitioner, nurse anesthetist, translating and/or simplifying the language of this
nurse midwife, clinical nurse specialist, or bill of rights as may be necessary to ensure that
physician assistant who is performing patients and their families understand their rights
procedures in their advanced practices. and responsibilities.
● These rights can be exercised on the patient’s
THREE MAJOR ELEMENT OF INFORMED CONSENT behalf by a designated surrogate or proxy
1. The consent must be given voluntarily. decision-maker if the patient lacks decision-
2. The consent must be given by a client or making capacity, is legally incompetent, or is a
individual with the capacity and competence to minor.
understand.
3. The client or individual must be given enough 1. The patient has the right to considerate and
information to be the ultimate decision-maker. respectful care.
● Similar to informed consent, it is important to 2. The patient has the right to and is encouraged
verify that the client is aware of the pros and cons to obtain from physicians and other direct
of refusal and is making an informed decision. caregivers relevant, current, and understandable
● The nurse needs to notify the health care provider information concerning diagnosis, treatment, and
of the client’s refusal and document the refusal in prognosis. Except in emergencies when the
the chart. patient lacks decision - making capacity and the
need for treatment is urgent, the patient is entitled
END OF PART 4: INFORMED CONSENT to the opportunity to discuss and request
information related to the specific procedures
and/or treatments, the risks involved, the possible
PART 5 : DOCUMENTATION
length of recuperation, and the medically
reasonable alternatives and their accompanying
● Is an important aspect of informed consent. A risks and benefits.
client’s concerns or questions must be 3. Patients have the right to know the identity of
documented along with the notification of the physicians, nurses, and others involved in their
health care provider. care, as well as when those involved are
● Equally important is documenting when the client students, residents, or other trainees.
states understanding. 4. The patient also has the right to know the
● RECORD any teaching as a result of nursing- immediate and long-term financial implications of
related questions by the client. treatment choices, insofar as they are known.

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5. The patient has the right to make decisions and legally permissible, or when a patient has so
about the plan of care prior to and during the requested, a patient may be transferred to
course of treatment and to refuse a another facility. The institution to which the
recommended treatment or plan of care to the patient is to be transferred must first have
extent permitted by law and hospital policy and to accepted the patient for transfer. The patient
be informed of the medical consequences of this must also have the benefit of complete
action. In case of such refusal, the patient is information and explanation concerning the need
entitled to other appropriate care and services for, risks, benefits, and alternatives to such a
that the hospital provides or transfer to another transfer.
hospital. The hospital should notify patients of 11. The patient has the right to ask and be informed
any policy that might affect patient choice within of the existence of business relationships among
the institution. the hospital, educational institutions, other health
6. The patient has the right to have an advance care providers, or payers that may influence the
directive (such as a living will, health care proxy, patient’s treatment and care.
or durable power of attorney for health care) 12. The patient has the right to consent to or
concerning treatment or designating a surrogate decline to participate in proposed research
decision-maker with the expectation that the studies or human experimentation affecting care
hospital will honor the intent of that directive to the and treatment or requiring direct patient
extent permitted by law and hospital policy. involvement and to have those studies fully
Health care institutions must advise patients of explained prior to consent. A patient who declines
their rights under state law and hospital policy to to participate in research or experimentation is
make informed medical choices, ask if the patient entitled to the most effective care that the hospital
has an advance directive, and include that can otherwise provide.
information in patient records. The patient has the 13. The patient has the right to expect reasonable
right to timely information about hospital policy continuity of care when appropriate and to be
that may limit its ability to fully implement a legally informed by physicians and other caregivers of
valid advance directive. available and realistic patient care options when
7. The patient has the right to every consideration hospital care is no longer appropriate.
of privacy. Case discussion, consultation, 14. The patient has the right to be informed of
examination, and treatment should be conducted hospital policies and practices that relate to
so as to protect each patient’s privacy. patient care, treatment, and responsibilities. The
8. The patient has the right to expect that all patient has the right to be informed of available
communications and records pertaining to his/her resources for resolving disputes, grievances, and
care will be treated as confidential by the hospital, conflicts, such as ethics committees, patient
except in cases such as suspected abuse and representatives, or other mechanisms available
public health hazards when reporting is permitted in the institution. The patient has the right to be
or required by law. The patient has the right to informed of the hospital’s charges for services
expect that the hospital will emphasize the and available payment methods.
confidentiality of this information when it releases
it to any other parties entitled to review END OF PART 6: THE PATIENT’S BILL OF RIGHTS
information in these records.
9. The patient has the right to review the records
(laboratory results) pertaining to his/her medical
PART 7 : NURSES’ BILL OF RIGHTS
care and to have the information explained or
interpreted as necessary, except when restricted
by law. 1. Nurses have the right to practice in a manner
10. The patient has the right to expect that, within that fulfills their obligations to society and to those
its capacity and policies, a hospital will make who receive nursing care.
reasonable responses to the request of a patient 2. Nurses have the right to practice in
for appropriate and medically indicated care and environments that allow them to act in
services. The hospital must provide evaluation, accordance with professional standards and
service, and/or referral as indicated by the legally authorized scopes of practice.
urgency of the case. When medically appropriate

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3. Nurses have the right to a work environment

PART 9 : SEXUAL HARASSMENT
that supports and facilitates ethical practice, in
accordance with the Code of Ethics for Nurses
and its interpretive statements. ● Is prohibited. It includes unwelcome conduct of a
4. Nurses have the right to freely and openly sexual nature.
advocate for themselves and their patients, ● Sexual harassment is a violation of an individual’s
without fear of retribution. rights and a form of discrimination.
5. Nurses have the right to fair compensation for ● The Equal Employment Opportunity Commission
their work, consistent with their knowledge, (EEOC) defines sexual harassment as
experience, and professional responsibilities. “unwelcome sexual advances, requests for
6. Nurses have the right to a work environment sexual favors, and other verbal or physical
that is safe for themselves and their patients. conduct of a sexual nature” occurring in the
7. Nurses have the right to negotiate the conditions following circumstances (Guidelines on
of their employment, either as individuals or Discrimination Because of Sex, 2016, section
collectively, in all practice settings. 1604.11):
8. Nurses have the right not to be abused in any ○ “When submission to such conduct is
form by physicians, pharmacists, administrators, considered, either explicitly or implicitly,
or nursing directors. Any abuse that occurs a condition of an individual’s employment
should be dealt with in a professional and ○ When submission to or rejection of such
impartial manner by the nurse’s employer. conduct is used as the basis for
9. Nurses have the right not to be exploited and employment decisions affecting the
abused by being floated to areas of practice that individual
they are not familiar with. ○ When such conduct interferes with an
10. Nurses have the right to refuse any assignment individual’s work performance or creates
that they feel is unsafe. Such as when a nurse is an intimidating, hostile, or offensive
assigned a patient load, he/she feels is unsafe. A working environment.”
nurse is assigned to work in an area of nursing in
which he/she is not familiar. A nurse knows that END OF PART 9: SEXUAL HARASSMENT
equipment/supplies are inadequate or not
available.
SUMMARY AND CONCLUSION
END OF PART 7: NURSES’ BILL OF RIGHTS

● In this module, the learners have learned all

about policies/ principles related to ethico-legal
PART 8 : NURSING RESPONSIBILITIES and moral consideration in nursing practice.
● Being knowledgeable about the ethico-legal
● Nurses are required to report communicable responsibilities, Nurses will be fair when
diseases or criminal activities such as child or rendering care to all patients.
elder abuse, domestic violence; dog bite or other ● In addition, as future nurses, it is essential to have
animal bite, gunshots or stabbed wound, an understanding regarding the ethics and law in
assaults, homicide and suicide to appropriate healthcare which is basically a part of nurses'
authorities. professional standards.
● If a nurse suspects that a coworker is abusing ● The learners were given the opportunity to
chemicals and potentially jeopardizing a client’s enhance their ability to recognize the Patient
safety, the nurse must report the individual in a Bill of Rights and address legal and ethical
confidential manner. issues that will arise in their professional
● Employees can confidentially report working practice.
conditions that violate regulations. ● Finally, Ethics within healthcare is important
because workers must recognize healthcare
END OF PART 8: NURSING RESPONSIBILITIES problems, make good judgments and decisions
based on their values while obeying the laws that
govern them.

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