Several legal and ethical concepts are vital to ensuring patient outcomes, institution improvement, and overall nursing care efficiency in the ever-changing healthcare landscape. Nursing practitioners’ knowledge of the moral and legal landscape at the care centers increases their contributions to quality improvement, promoting healthcare institutions to thrive. This essay explores five legal concepts that are most important to healthcare improvement and explains their impact on nursing practice, healthcare institutions, and the quality of patient care. The five concepts described in this essay are patient-informed consent, autonomy, documentation of care, beneficence, malpractice, and negligence.
Objectives
The primary objective is to analyze the current developments in four legal/ethical concepts potentially changing service provision in healthcare, including patient-informed consent, malpractice and negligence, autonomy, and documentation of care. The objective is tied to the need to explain how these four legal concepts impact nursing practice, healthcare institutions, and the quality of patient outcomes. The second objective is to develop a policy proposal with measures and recommendations for sustainable change management in healthcare institutions. The goal is tied to other desired service quality outcomes such as positive improvements in nursing practice, pushing healthcare institutions to thrive, and raising the quality/standards of patient outcomes. The last objective is to explain, through policy framework and scholarly literature, how practitioners can advocate for implementing policy proposals into practice.
Patients’ Informed Consent
The laws governing patient consent require healthcare providers to disclose complete information on diagnosis, proposed treatment options, and their risks and dangers to patients to help them comprehend and make informed choices. Informed consent is based on mutual agreement between parties, and its validity is determined by the patient’s understanding of the material facts (Pozgar, 2020). Patients can sue for unconsented touching when healthcare providers perform a treatment or procedure to which they did not consent. Additionally, even if the treatment was conducted correctly and the patient’s condition improved, they can still sue for damages for procedures they did not agree to. Patients’ right to consent is grounded in the law that protects individuals from harmful or invasive touching of their bodies (Guido, 2020).
Informed consent can influence the nursing practice and the patient’s outcome resulting from the treatment procedures presented to them. It gives the patients power over their bodies and thus helps them decide the best treatment option. It also promotes shared medical decision-making, where patients and healthcare providers collaborate on selecting appropriate treatment plans. Informed consent mitigates lawsuits and enhances patients’ and their families’ participation in the treatment, improving their outcomes (Varkey, 2021). Moreover, Guido (2020) and Pozgar (2020) further explain that informed consent tailors care plans to patient preferences and values, thereby enhancing the quality of care. The concept also impacts healthcare institutions through policy development, resource allocation, and legal compliance to mitigate risks and possible lawsuits arising from rights infringements.
Autonomy
Patient autonomy is an ethical approach to client-centered care, a subset of their fundamental rights as humans entitled to healthcare services. Guido (2020) explained autonomy as the personal freedom to self-determination exercised by giving patients the privilege to decide on their treatment preferences. According to Guido (2020), the ethics of patient autonomy is foundational in deriving the legal doctrine of obtaining informed consent, contributing to the dynamicity between legal and moral obligations that practitioners have in providing quality and patient-centered care. In Pozgar’s (2020) list of the code of ethics for organizations, one of the requirements is that practitioners must preserve patient rights, autonomy, and self-esteem. The implication is that a practitioner should be aware of the contemporary approaches to ensuring client autonomy by observing the four critical components of autonomy.
The liberty approach to client autonomy entails giving patients the freedom to take positive actions to their skills and capabilities without manipulation or coercion from the nursing practitioner. Guido (2020) tied liberty to self-determination, an ethical obligation achievable by providing the client with adequate information so that they can make critical decisions within their powers to act. Clients must be informed and allowed to exercise independence, which might entail following one’s cultural and personal values to support decision-making. Patient autonomy in quality healthcare settings includes the freedom to exercise agency, which Guido (2020) described as the power to be in command of personal actions. Nurses must pursue only the treatment options a client has consented to, as choosing alternatives without consultation becomes unethical (Pozgar, 2020). The implication for future practice is that nurses must exercise autonomy alongside informed consent, meeting the legal and ethical obligations as intricate concepts for achieving quality care.
Malpractice and Negligence
Malpractice and negligence are two legal frameworks that shape the quality-of-care outcomes during patient-practitioner interactions. According to Guido (2020), the two terms are often used interchangeably but with different repercussions on professional practice or medical outcomes when legally contravened. Negligence occurs when there is a lack of professionalism in a nurse’s due care obligations. A nurse becomes legally negligent by failing to meet primary obligations or acting unprofessionally (Guido, 2020). Pozgar (2020) used carelessness and departure from nursing standards to explain how some professionals become negligent. Interestingly, professionals guilty of being legally negligent are also culpable of criminal malpractice. Pozgar (2020) observed that most instances of criminal negligence that involve reckless disregard for client rights and other ethical obligations, such as safety, amount to malpractice. A nurse can be guilty of ordinary negligence, which requires no special legal interpretation to recognize, or professional negligence, which is also classified as malpractice (Guido, 2020). The key observation is that negligence and malpractice legal scenarios emanate from nurses’ conduct or behavior.
The future of nursing practice in managing sustainable change for positive healthcare quality transformation must entail personal behavioral change and improved knowledge of legal standards. Nurses must ensure they are not involved in deliberate omissions or commissions that could be tortfeasors. According to Guido (2020), the tortfeasor is a scenario where the nurse commits a civil wrong, mainly to a scale where the professional could have acted appropriately but chose not to do so. Nurses should promote rapid developments and improvements in client care and protection by acquiring skills, learning and practicing their ethical obligations, and following established rules and principles.
Beneficence
Beneficence considered a health promotion, is a collaborative approach between the nursing practitioner and the client to promote the patient’s perception of good. Beneficence is partly an obligation to assist others and partly the ethical requirement for nurses to promote good (Guido, 2020; Pozgar, 2020). As a fundamental principle in nursing ethics, nurses are expected to strive to benefit those in their care, a role that entails determining and preventing harm through professional actions (Guido, 2020). The ethical concept requires a delicate balance between the nurse’s scientific or professional judgment against the actions they take to provide quality care for their patients or the client’s families (Guido, 2020). Given Pozgar’s (2020) position that beneficence is a direct promotion of health, the ethical concept can be used in setting foundations for future advocacies and multicultural practices that promote good to a client and their families, ethnicity notwithstanding.
Documentation of Care
Documentation of care in nursing practice improves the administration of clinical and other legal or ethical practices that could result from the services offered. Pozgar (2020) explained the importance of documentation, besides keeping medical records and history, as preserving documentary evidence. Authenticated copies, including medical records, autopsy reports, and birth certificates, contain critical information that nurses must document for future reference (Pozgar, 2020). Practitioners keep medical records based on patients’ status, needs, limitations, problems, and treatment intervention response. Relevant patients’ information on their symptoms and feelings should be documented so that no information is forgotten or overlooked during treatment (Guido, 2020). The medical records should also elaborate on the continuity of care, the implemented interventions, and the patient’s response to therapies. Emphasis on accuracy, timeliness, and standardization of the documentation process are advocacy initiatives that nurses can make in their healthcare facilities to introduce sustainable improvements in future client care practices.
Adequate documentation is critical in healthcare facilities to improve nursing practices and the quality of care for patients. Patients’ medical records communicate what, why, and how interventions are administered to the patient and other healthcare professionals to offer the best treatment care. Documentation facilitates patients’ coordination and navigation along the continuum of care and transitioning from different stages of the treatment plan (Lake et al., 2020). This reduces the risks of medical errors since the patients’ treatment progress is well-recorded and accessible to authorized personnel. Similarly, medical records and documentation serve as evidence for care and treatment, helping healthcare institutions against lawsuits.
A Policy Proposal on the Standardization of Electronic Medical Records
Issues
Nurses have conventionally used paper medical records to store self-reported patient data and diagnostic notes. Paper documentation must have uniformity in the record-keeping procedures to ensure the continuity of care as the patient moves from one facility to another. Healthcare administrations and the nursing fraternity should seek to improve the quality of care by moving to standardized electronic medical records, beating the risks of committing medical errors brought on by illegible writing, unapproved abbreviations, and misspellings (Guido, 2020). However, standardized electronic medical records can promote continuity of care by sharing a patient’s medical history with the right institution while keeping ethical responsibilities such as privacy to avoid harm to a client. Recent blockchain data technologies can be used to promote standardization in the documentation of care and record sharing among healthcare institutions.
Concept
The concept of the proposed complete adoption of electronic medical records uses computers to compile and store patients’ medical records. The documentation approach benefits include easy and instant access to patient information and reduced medication errors (Guido, 2020). Standardized documentation of care implies that a nurse in one facility can easily interpret medical records from a patient given a treatment referral. The role of technology is to ensure that records are securely stored with backups. Additionally, the healthcare team can view and edit the data remotely, and the time when the changes were made is recorded, which will be possible from either hospital in the case of a continuity of care. Electronic medical records also promote patients’ confidentiality by limiting the number of people accessing protected health information (Ferry et al., 2021). Implementing electronic medical records will, therefore, improve nursing practice, healthcare institutions, and the quality of patient outcomes.
Measures
The evaluation measures for electronic documentation policies will be based on several factors that will determine the effectiveness of the policy. The first measure will evaluate the effectiveness of care coordination for services like online booking, drug prescription, and billing. The activities should be standardized and given codes to match the procedures. Practitioners can refer to those codes from their databases to understand the critical details in each documentation. The second measure will gauge the percentage rate of reduction of medical errors due to documentation standardization. The third aspect will evaluate nurses’ satisfaction with the new changes in documentation, mainly when they handle clients from different institutions/departments. The evaluation of these measures will determine the effectiveness of the policy and areas that need continuous improvement.
Recommendations
Healthcare administrations should collaboratively provide new standardized frameworks for electronic health record system design that meet regulatory requirements for patient privacy. The system should also be flexible and easy for patients and the healthcare team to transfer and interpret without confusion. Nurses’ training is recommended to occur before implementing the policy. Adequate training is necessary to minimize change resistance, embrace the system, and prevent other medical documentation errors in the future. Lastly, the patients should also be educated on using the system for confidential information and protecting their privacy (Aguirre et al., 2019).
How Nursing Could Advocate for Incorporating the Policy Proposal into Practice
Nurses are strong advocates in healthcare, and they play a critical role in promoting change. They act to safeguard and improve patient outcomes; thus, incorporating standardized electronic health records is crucial in preventing medication errors and improving service delivery efficiency. Nurses can advocate for incorporating electronic health records (EHR) into practice by getting informed through continuous education and practice. Gaining system experience makes encouraging conversation about reforms easier and fosters collaboration among the healthcare team to embrace the change (Ting et al., 2021). Additionally, they can get involved in the policy generation and implementation processes. When the nurses understand the workings of the system and its effectiveness, they can advocate for the policy. Most importantly, nurses should advocate the incorporation of standardized EHR into practice by embracing innovation and technology in their workplace. Innovations such as blockchain data transfer are driving forces in patient outcome improvement. Technology is equally crucial in increasing efficiency in service delivery in the healthcare system. Therefore, nursing advocacy on implementing standardized EHR into practice will help reduce medical errors, save time, and improve the quality of continued care.
Conclusion
In conclusion, several ethical issues and concepts influence nursing practice and quality patient outcomes in healthcare institutions. Patients’ informed consent influences the nursing practice and the patient’s outcomes by giving them the power to decide on intervention approaches. Also, negligence and malpractice legal principles regulate nursing conduct to prevent intentional deviation from expected standards of professionalism, which promotes the standard of care. On the other hand, documenting medical records improves nursing care and patient care by reducing the risks of medical errors and maintaining patients’ confidentiality. Similarly, the nurse promotes patient autonomy and beneficence to avoid harm and maximize benefit to the client and family members.
Implementing standardized adoption of electronic medical records reduces the risks of medical errors and saves time storing and sharing information across treatment facilities in the continuity of care. The policy focuses on increasing efficiency and preserving the confidentiality of patient’s medical history, besides making it possible for facilities to transmit client data safely. Nurses have an essential role in advocating policies into practice by getting involved in its formulation, being informed, and embracing innovation and technology.
References
Aguirre, R. R., Suarez, O., Fuentes, M., & Sanchez-Gonzalez, M. A. (2019). Electronic health record implementation: A review of resources and tools. Cureus, 11(9). https://doi.org/10.7759%2Fcureus.5649
Ferry, A. M., Davis, M. J., Rumprecht, E., Nigro, A. L., Desai, P., & Hollier, L. H. (2021). Medical documentation in low- and middle-income countries: Lessons learned from implementing specialized charting software. Plastic and Reconstructive Surgery – Global Open, 9(6), e3651. https://doi.org/10.1097/gox.0000000000003651
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.
Lake, E. T., Riman, K. A., & Sloane, D. M. (2020). Improved work environments and staffing lead to less missed nursing care: A panel study. Journal of Nursing Management, 28(8), 2157–2165. https://doi.org/10.1111/jonm.12970
Pozgar, G. D. (2020). Legal and ethical issues for health professionals (5th ed.). Jones & Bartlett Learning.
Ting, J., Garnett, A., & Donelle, L. (2021). Nursing education and training on electronic health record systems: An integrative review. Nurse Education in Practice, 55, 103168. https://doi.org/10.1016/j.nepr.2021.103168
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. https://doi.org/10.1159/000509119
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