ETHICAL & LEGAL ISSUES IN COMMUNITY HEALTH NURSING FOR GRADUATE & MASTER NURSING STUDENTS

2. INTRODUCTION
 In a civilized society, a system of law promotes order, protects the
rights of citizen and provides the framework for a wide variety of
relationships.
 In today’s complex world, with advancing technologies and an array
of societal problems, legal issues are an important aspect of life.
 For nurses in practice within the current health care system,
knowledge of basic legal concepts is vital.
 Interesting and important development in the system of law affect
both the nurse and her practice.

3. ETHICALAND LEGAL RIGHTS OF PEOPLE IN
COMMUNITY
 The collection of the individual rights of people reflect the
rights of the community.
 The basic rights of people are as follows :
1. To seek information about health programmes.
2. To be respected.
3. To possess confidentiality.
4. Get consent from community people to implement any health
program.
5. To access health care services.
6. To participate in any health programme.
7. To access quality care from health care professionals.
8. Disenfranchised community to access basic resources.

4. 9. Equal rights for all people with cultural diversity, no
discrimination.
10. Right to know details about entry of any epidemic
disease and their symptoms.

5. LEGAL LIMITS OF NURSING
1. STANDARD OF CARE
It is defined as those act that are permitted or
prohibited from being performed by a prudent
person working within the parameters of her
training, license, experiences and conditions
existing at the time.

6. 2. REGISTRATION
 One type of law that directly affects nursing
practise is nursing practice act. These acts are
designed in order to protect the profession from
encroachment by other group, and the public from
those who practice nursing without a license.
 Registration is mandatory i.e. to practice nursing
one must be licensed as nurse.

7. 3. NURSING COUNCILACT
 An aspect of the nurse - society relationship is
spelled out in the state nursing practice act(NPA).
 To practice nursing, one must be registered. This is
the way to protect the public from incompetent,
unscrupulous and illegal behaviour.

8. Board of nursing activities include the following :
I. RULES AND REGULATIONS
 Administrative rules and regulation are written
within the scope of the authority granted by the
legislative body of the respective state.
 These rules and regulations explain how the act will
be implemented, and describe those procedures
which are measurable and enforceable.

9. II. STANDARD OPERATING PROCEDURES
 Each health care agencies has established standard
operating procedures that have been approved by
its administrative body.
 Standard operating procedures are written
document that contains rules, policies, procedures,
regulations and order for the patient care in various
stipulated circumstances that are unique to the
agency.

10.  IPHS are a set of standards envisaged to improve
the quality of health care delivery in the country.
 Our country has a large number of public health
institutions in rural areas from Sub-centres at the
most peripheral level to the District Hospital at the
District level. It is highly desirable that they should
be fully functional and deliver quality care in a safe
manner.

11.  Standard Operating Procedures and Standard
Treatment Protocols for common ailments and the
National Health Programmes should be available and
followed. To maintain quality of services, external
monitoring through Panchayati Raj Institutions and
internal monitoring at appropriate intervals is
advocated. Guidelines are being provided for
management of routine and emergency cases under the
National Health Programmes so as to maintain
uniformity in Management in tune with the National
Health Policy.

12. OBJECTIVES OF INDIAN PUBLIC HEALTH
STANDARDS (IPHS) FOR CHCs
 To provide optimal expert care to the community.
 To achieve and maintain an acceptable standard of
quality of care.
 To ensure that services at CHC are commensurate with
universal best practices and are responsive and sensitive
to the client needs/expectations.

13. LIST OF STATUTORY COMPLIANCES
1. No objection certificate from the
Competent Fire Authority.
2. Authorization under Bio-medical Waste
(Management and Handling) Rules, 1998.
3. Authorization from Atomic Energy
Regulation Board.
4. Excise permit to store Spirit.
5. Vehicle registration certificates for
Ambulances.
6. Consumer Protection Act.
7. Drug & Cosmetic Act 1950.
8. Fatal Accidents Act 1855.
9. Indian Lunacy Act 1912.
10. Indian Medical Council Act and code of
Medical Ethics.
11. Indian Nursing Council Act.
12. Maternity Benefit Act 1961.
13. Boilers Act as amended in 2007.
14. MTP Act 1971.
15. Persons with Disability Act 1995.
16. Pharmacy Act 1948.
17. PNDT Act 1996.
18. Registration of Births and Deaths Act
1969.
19. License for Blood Bank or Authorization
for Blood Storage facility.
20. Right to Information act.
21. Narcotics and psychotropic substances
Act 1985.
22. Clinical Establishments (Registration
and
Regulation) Act 2010.

14. III. EMPLOYEE POLICIES
 It is often described in a handbook that is
distributed to all newly appointed employees.
 It should provide them with the key information
about the operation of the organisation.

15. PATIENT’S BILL OR RIGHT
 In 1973, the American hospital association has
adopted a patient’s bill or rights as a national policy
statement and had distributed it to its members in the
hospitals throughout the country.
 The summarized 11 rights are –
1. Right to have considerate and respectful care.
2. Right to obtain complete and current information
regarding his/ her diagnosis and prognosis from his
physician.

16. 3. Right to receive necessary information by physician
regarding his/ her treatment.
4. Right to refuse treatment to the extent permitted by law,
and to be informed of the medical consequences of his
action.
5. Right to privacy concerning his own medical care
programme.
6. Right to expect that all the communications and record
pertaining to his care should be treated as confidential.
7. Right to expect that within its capacity a hospital must
make reasonable response to the request made by a
patient for services.

17. 8. Right to be advised if the hospital proposes to engage
him in or perform human experimentation affecting
his treatment.
9. Right to expect reasonable continuity of care.
10. Right to examine and receive an explanation of his
bills regardless of the source of payment.
11. Right to know what hospital rules and regulations
apply to his conduct as a patient.

18. STUDENT NURSES
 If a client suffers harm as a direct result of the
nursing student’s action or from the lack of it, the
liability for the incorrect action is generally shared by
the students, instructors, hospitals, the health care
faculty and the educational institution.
 Student nurses should never be assigned the task for
which they are unprepared and should be carefully
supervised by instructors when they are learning new
procedures

19. LEGAL LIABILITY IN NURSING
LEGAL LIABILITY IN
NURSING
TORTS
UNINTENTIONAL
NEGLIGENCE
INTENTIONAL
ASSAULT BATTERY DEFAMATION OF
CHARACTER FRAUD
MALPRACTICE

20. TORTS
 A torts is a civil wrong for which remedy is a
common law action for damages that are not
liquidated and which is not exclusively the breach
of contract or trust or a mere equitable obligation.
 They are of two types:
A. UNINTENTIONAL TORTS
B. INTENTIONAL TORTS

21. A. UNINTENTIONAL TORTS
a. NEGLIGENCE
 It is an act of omission, i.e. neglecting to do
something that a reasonably prudent person
would do or doing something that he/ she would
not do.
 Common cases of negligence include foreign
objects(such as sponges) left inside a patient, burn
caused by equipments or solution etc.

22. B. INTENTIONAL TORTS
a. ASSAULT – It is the threat touching another person
without his or her consent.
b. BATTERY- It is the actual carrying out of such a threat.
It is an intentional touching of another body.
c. DEFAMATION OF CHARACTER – This includes false
communication resulting in injury to a person’s reputation
by mean of prints or speech .
d. FRAUD – It is the wilful, purposeful, misrepresentation of
self or an act that may cause harm to a person or property.

23. MALPRACTICE
 Malpractice is a professional misconduct,
unreasonable lack of skills or infidelity in
professional duties, evil practice, or
illegal or immoral conduct.

24. DEFENSES
 The nurse who wants to stay out of court
should always remember the following 3 D’s
of nursing malpractice defence :
3 D’s
DEDICATION
DEMEANORDOCUMENTATION

25. 1. DEDICATION
 Competency is of primary importance in avoiding
law suits. The licensed practical nurse must
maintain the highest level of competency at all
times, including maintaining skills through
continuing education.
 A dedicated nurse always gives the best quality
care.

26. 2. DEMEANOR
 The nurse’s demeanor is often the determining
factor in case the patient sues the nurse.
 The nurse must never underestimate the
significance of demeanor and rapport in
malpractice.

27. 3. DOCUMENTATION
 In the medical record it provides the only credible
proof in court to prove that appropriate care was
given and the standards of care was met with.
 The nurse should always remember that if it was
not charted, it was not done.

28. LEGAL RESPONSIBILITY
 Legal responsibility in nursing practice is very
important.
 The purposes of this knowledge for a nurse are to
help her understand :
i. The legal responsibilities she has while practicing
nursing.
ii. Which authority can enforce these
responsibilities.
iii. What area of nursing practice can mostly create
legal difficulties.

29. GUIDES FOR LEGAL RESPONSIBILITY
 There are 5 areas of authority that gives us guidance on
legal responsibility for the nursing practice :
1. Central government act binding by law.
2. State government act binding by law.
3. International code for nurses subscribed by TNAI.
4. Institutional rules.
5. Regulations or standing orders, or an example of
what court decision has been made before in a similar
case.

30. LIST OF DO’S AND DON’T AS
GUIDELINES FOR SAFE PRACTICE
 DO’S :-
 Documentation of all unusual incidences.
 Know your job description.
 Follow policies and procedures as established by your
employing agency.
 Keep your registration updated.
 Perform procedures that you have been taught and that are
within the standard scope of your practice.
 Protect patient from injuring themselves.
 Remain alert and focused.
 Establish and maintain rapport with the patients and family.
 Seek and clarify orders given by the physician.
 Practice safety with physician’s verbal order.

31. DONT’S:-
 Remove side rails from patient’s bed unless there is an
order or hospital policy to do so.
 Allow patient’s to leave the hospital or nursing home
unless there is an order or a signed release.
 Accept money or gifts from patient.
 Give advice that is contrary to physician order or the
nursing care plan.
 Give medical advice to friend and neighbours.
 Attempt to practice medicine.
 Witness a patient’s will.
 Take medications that belong to patients.
 Work as a licensed practical/ vocational nurse in a state in
which you are not licensed.