Page 6 nursing.elitecme.com Complete Your CE Test Online - Click Here and the nurse refrains from inappropriate involvement with the client or the client’s family. Nurses have an ethical and legal obligation to maintain client privacy and confidentiality at all times and when using social media do not identify clients by name or post or publish information that may lead to the identification of a client. Limiting access to postings through privacy settings is not sufficient to ensure privacy. Nurses must promptly report any identified breach of confidentiality or privacy.” The issue of professional boundaries and social media use is a complex one. For further information, access: https://www.bon.texas.gov/practice_ bon_position_statements_content.asp#15.29 Position statements demonstrate how the Texas Board of Nursing interprets appropriate behavior regarding various aspects of practice. The NPA, Rules/Standards of Nursing Practice, and Position Statements, among other Board of Nursing publications, are important resources for clarifying ethical principles and delineating professional boundaries in nursing practice. Ethics and the law Ethics is defined as “an area of philosophy that examines values, actions, and choices to determine right and wrong.” Ethics also includes “the study of standards of conduct and moral judgments” (Texas Board of Nursing, 2015). Most healthcare professions have developed ethical codes of conduct that delineate the professions’ goals, values, and ideals, which provide guidance as to what the public should expect from professionals in any setting (Mathes & Reifsnyder, 2014). Ethics and law overlap to a certain extent. Codes of ethics generally describe a vision that exceeds what is expected under prevailing laws. The law is what must be done; ethical codes provide a picture of what ought to be done. Therefore, ethical conduct means that at the very least, a nurse or other healthcare professional is performing duties legally and also acting with integrity and fidelity according to the profession’s principles of ethical behavior (Mathes & Reifsnyder, 2014). It is essential that nurses understand both legal and ethical concepts and fulfill their professional roles accordingly. Basic legal concepts Nurses should be able to define the terms negligence and malpractice and identify the elements of malpractice. Negligence is defined as doing something or failing to act as a careful, reasonable, prudent person would or would not in the same situation (Mathes & Reifsnyder, 2014). As it relates to nursing, negligence is the failure to meet accepted standards for nursing competence and scope of practice. The definition of negligence is not based on what a nurse or nurses “think” is appropriate in a given situation. It is based on whether a nurse acted with the education, knowledge, and skill that is reasonably expected of a nurse with similar education, knowledge, and skill (Mathes & Reifsnyder, 2014). Professional malpractice, a type of negligence, is defined as negligence committed in carrying out professional duties. The primary question to be addressed is, “What is the nursing care that reasonably should have been delivered under the circumstances?” If a nurse is sued for malpractice, the judge or jury will consider whether or not the nurse’s actions demonstrated knowledge and skill reasonably expected of a nurse with that level of education and training. Determination is based on nursing standards of care, nurse practice acts, professional boundaries, ethical principles, and appropriate care standards as established by professional associations, such as the American Nurses Association (Mathes & Reifsnyder, 2014). The six major categories of negligence that result in nursing malpractice lawsuits are (Mathes & Reifsnyder, 2014): ● ● Failure to follow standards of care. ● ● Failure to use equipment properly. ● ● Failure to communicate. ● ● Failure to document. ● ● Failure to assess and monitor. ● ● Failure to act as a client advocate. Malpractice alert! The person who files a lawsuit that initiates legal action is generally referred to as the plaintiff (Mathes & Reifsnyder, 2014). To prove that a nurse has committed malpractice, certain elements must be established. It must be proven that (Mathes & Reifsnyder, 2014): ● ● The nurse had a legal duty to the client/plaintiff. ● ● The nurse breached the duty to the client/plaintiff. ● ● The client/plaintiff actually suffered harm. ● ● The nurse’s breach of duty actually caused the harm. ● ● Because of the harm, the client/plaintiff has damages, meaning that the harm is capable of being compensated in money. Legal duty What is a legal duty? A legal duty is defined as “an obligation recognized by and enforceable by law” (Mathes & Reifsnyder, 2014). A nurse’s legal duty begins as soon as the nurse-client relationship is established. As soon as this relationship is established, it is the nurse’s legal duty to ensure that nursing care provided conforms to the appropriate nursing standards of care, which are the basis for this element. The nurse-client relationship means that the client relies upon the ability of the nurse to deliver professionally safe and competent care (Mathes & Reifsnyder, 2014). The plaintiff’s attorney will cite standards of nursing care to establish malpractice. Judges and/or juries will examine customary practices to identify appropriate standards of care. In addition to reviewing such standards, customary practice may be established via the testimony of expert witnesses. These witnesses are other nurses who have recognized expertise in nursing (Mathes & Reifsnyder, 2014). Breach of duty Breach of duty is defined as a violation of nursing standards of care. The client/plaintiff’s attorney will provide evidence to support the claim that a breach of duty occurred. Such evidence can be obtained from: written documentation on the client’s medical record; diagnostic test results; photos; and testimony from witnesses including hospital personnel, other nurses, experts in the field, and client/family members (Mathes & Reifsnyder, 2014). Harm In order for the plaintiff to win a malpractice lawsuit, it must be shown that the breach of duty caused harm to the client/plaintiff. In other words, actual harm must have occurred because of the nurse’s actions (Mathes & Reifsnyder, 2014). For example, suppose a nurse fails to administer a dose of antibiotic to the client, but the client suffers no harm from missing one dose of the medication. Although a breach of duty occurred in the form of a medication error (i.e. failure to deliver a prescribed dose of medication), no harm occurred, so the element of harm is not proven. Suppose a nurse fails to adhere to sterile technique ordered for a complex dressing change. The client suffers no harm, and the nurse is counseled by her manager regarding appropriate sterile technique. Later that same day, the client falls and breaks her arm. Although harm occurred, it was not directly related to the specific incident of the dressing change; therefore, cause and breach of duty cannot be traced to the incident of improper dressing change. Now consider this example: Upon admission to a medical unit at the hospital, a registered nurse asks a nursing assistant to take a newly-