How does UK law influence nursing obligations?
The law is a fundamental part of nursing that underlies the relationship between you and your patient. Nurses have an obligation to adhere to legal frameworks and legislation when engaging in patient care etc.
In healthcare, law is related to the rules that determine the minimum standard of acceptable care you can deliver to a patient. In reality, patients deserve the highest level of care that can be delivered, and therefore the standard required for the nursing profession is higher than expected by law. However, laws define instances where legal obligations to a patient group are broken, allowing for the use of sanctions.
Laws may help in addressing complex care situations where ethical and professional obligations may conflict with wider societal views. Examples include the laws surrounding end-of-life care and euthanasia. Nursing staff may be conflicted over the use of interventions designed to end the life of a patient, as this action may relieve suffering. However, the law provides clear guidance on the limitations of individual judgement in contrast to national law; such actions are deemed inappropriate and illegal. The law prohibits the intentional use of medications or interventions to end the life of the patient.
Nurses must comply with UK laws and legislation. Legislation emphasises the role of law in guiding patient interactions, including the need for consent, respect of human rights and use of medications. Competent adults always have a right to determine what is done to them, including any healthcare intervention, examination or associated process. Nurses who do not seek consent before acting may be liable under criminal law and can be prosecuted. This is uncommon, but the laying on of hands without consent may lead to civil lawsuits against the nurse or their place of work; it is important to adhere to the legal framework of consent. Human rights are also protected under a legal framework and nurses should act to ensure these rights are upheld at all times. Acting without considering human rights may lead to professional disciplinary action, as well as legal action.
Maintaining patient confidentiality
Confidentiality is a fundamental principle in healthcare, and nurses must understand how this applies to their practice. Confidentiality pertains to restricting the sharing of sensitive patient information and only sharing information when it is necessary either by law or professional duty. Patients should be allowed to choose when their information is shared with others. Therefore, nurses need to respect the wishes of patients and seek their permission before sharing potentially sensitive information.
Many types of healthcare information are considered confidential. Sharing details of the patient’s condition, treatment or personal life with other patients or family members is considered unethical. When discussing care details with the patient, any information exchanged or personal details shared are subject to confidential treatment. This is true even where the family members of the patient may have an interest in the information; for instance, if a patient admits to substance abuse but does not wish their family to know.
As well as maintaining confidentiality in conversations with others, documentation needs to uphold the principle of confidentiality. Discussing patient details in public or outside of the ward or office, even with another healthcare professional, is not advised, as others may be listening. When transporting or handling patient notes or sensitive documentation, care must be taken to ensure these documents are not lost or left where they can be viewed by other patients or members of the general public. When sharing information in the research setting or during conferences, removal of patient identifiable information is essential, and patient consent advisable.
Confidentiality is complex; it is not always possible, or ethical, to withhold information from other parties when engaging in patient care. For instance, when the patient poses a risk of severe harm to him or herself or others, the nurse may be obliged to share confidential information with members of law enforcement or associated professionals. Similarly, if the patient reveals medical information that may place others at risk, it is the duty of the nurse to consider his or her ethical obligation to protect the rights of the patient, balanced with the rights of others or society in general. Ethical decision-making therefore can play a big role in maintaining confidentiality in practice.
Conclusion
This chapter introduces the role of the nurse and the ethics of nursing in contemporary practice. Ethics affects all areas of nursing practice, and it is not always straightforward to decide if one management option is definitely without risk to the patient. Ethical judgements need to be made based on the best available evidence, with respect to the rights of the individual, and through careful balancing of risks and benefits. It is important not to be overwhelmed by ethics when applying them to practice – in many cases, there are no right or wrong answers. Provided that you consider the ethics of patient care during any decision-making process, the outcome is likely to be a fair and effective course of action.
