Five Legal and Ethical Concepts That Shape Nursing Practice, and a Policy for Early Goals-of-Care Conversations in the Intensive Care Unit
Student Name
Master of Science in Nursing Program, Aspen University
N520: Legal and Ethical Issues in Health Care
Instructor Name
Month Day, Year
Slide 2: Introduction
Law sets the minimum; ethics asks for more
Five concepts: informed consent, negligence, confidentiality, delegation, self-determination
For each: impact on the agency and on patient care
Ends with a policy proposal and advocacy strategies
Speaker notes: Nurses practice within legal duties and ethical obligations that overlap but are not identical. This presentation examines five concepts that shape everyday practice and asks how each affects both the viability of a health care agency and the quality of patient care. It then identifies where ethical duties are most often violated and proposes a policy, with advocacy strategies to make it work.
Slide 3: Concept 1, Informed Consent
Capacity, disclosure, understanding, voluntariness
Material risks, benefits, and alternatives
The form is evidence; the conversation is consent
Nurse's role: witness, assess understanding, advocate
Speaker notes: Valid informed consent requires a patient with capacity who receives material information, understands it, and agrees voluntarily. The signed form is only evidence that the discussion took place (Guido, 2020). Nurses witness signatures, check whether the patient understands, and advocate by alerting the physician when a patient has questions or seems unsure.
Slide 4: Informed Consent, Impact
Agency: lack of consent can support battery or negligence claims
Agency: accreditation and regulatory citations
Care: patients who understand choose treatments they will follow
Care: trust depends on honest disclosure
Speaker notes: Failures of consent expose agencies to claims of battery or negligent nondisclosure and to citations from regulators. For patients, genuine consent improves quality: people who understand their options choose treatments that fit their values and are more likely to follow through. Consent is where respect for autonomy becomes visible (Beauchamp & Childress, 2019).
Slide 5: Concept 2, Negligence and Malpractice
Four elements: duty, breach, causation, harm
Standard: the reasonably prudent nurse
Breach proven with expert testimony, policy, and records
Common claims: monitoring, medication, communication failures
Speaker notes: Negligence requires duty, breach, causation, and harm. The yardstick for breach is the conduct of a reasonably careful nurse facing the same facts; plaintiffs typically establish it with expert testimony, the facility's policies, and the medical record (Brous, 2019). Frequent sources of claims include failures to monitor, medication errors, and failures to communicate changes in a patient's condition.
Slide 6: Negligence, Impact
Agency: judgments, settlements, and rising premiums
Agency: corporate negligence for staffing and policies
Care: every claim began as a patient harmed
Care: learning systems reduce repeat events
Speaker notes: For agencies, negligence brings financial costs, higher insurance premiums, and reputational damage, and hospitals can be directly liable for inadequate staffing or unsafe policies. More importantly, each claim represents a patient who was harmed. Agencies that treat adverse events as learning opportunities, rather than only as legal threats, reduce repeat harm and improve quality.
Slide 7: Concept 3, Confidentiality and Privacy
Federal privacy rules protect health information
Minimum necessary use and disclosure
Social media: no patient information, even without names
Breaches can be civil, regulatory, and disciplinary matters
Speaker notes: Confidentiality is both an ethical duty and a legal requirement under federal privacy rules. Nurses share information only with those who need it for care. Social media creates new risks: regulators caution that posts can identify patients even without names, and inappropriate posts have led to board discipline and termination (Spector & Kappel, 2012).
Slide 8: Confidentiality, Impact
Agency: fines, breach notifications, lost trust
Agency: security investment and training
Care: patients withhold information they fear will be shared
Care: privacy protects dignity
Speaker notes: Privacy breaches can lead to federal penalties, costly breach notifications, and loss of community trust. For patients, confidentiality affects the quality of care directly, since people who fear exposure may withhold information about substance use, mental health, or sexual history that clinicians need. Protecting privacy protects both dignity and diagnosis.
Slide 9: Concept 4, Delegation and Scope of Practice
Nurse practice acts define what nurses may do
Delegation: right task, circumstance, person, directions, supervision
Accountability stays with the delegating nurse
Employer must ensure competency and policies
Speaker notes: Each state's nurse practice act defines scope of practice. Delegation lets nurses assign tasks to assistive personnel, but national guidelines keep the delegating nurse accountable and require the employer to ensure training and clear policies (National Council of State Boards of Nursing, 2016). Scope violations and poor delegation are common threads in disciplinary and malpractice cases.
Slide 10: Delegation and Scope, Impact
Agency: liability for negligent delegation and inadequate training
Agency: efficient use of licensed staff
Care: missed reporting of abnormal findings
Care: right person for the right task
Speaker notes: Well-designed delegation allows agencies to use licensed nurses efficiently, but poor delegation creates liability and harm, especially when abnormal findings are not reported. For patients, good delegation means each task is done by someone competent to do it, with clear instructions about what to report and when.
Slide 11: Concept 5, Patient Self-Determination
Patient Self-Determination Act of 1990
Facilities must inform patients of rights to accept or refuse treatment and make advance directives
Ask about, document, and honor advance directives
Surrogates decide based on the patient's known wishes
Speaker notes: The Patient Self-Determination Act requires hospitals and other facilities that receive Medicare or Medicaid funds to inform adult patients at admission of their rights under state law to accept or refuse treatment and to make advance directives, and to document whether they have one (Guido, 2020). When patients cannot speak for themselves, surrogates decide based on what the patient would want.
Slide 12: Self-Determination, Impact
Agency: regulatory compliance and fewer end-of-life disputes
Agency: resources used in line with patient goals
Care: treatment matches values
Care: families spared impossible guesses
Speaker notes: Agencies that engage patients in advance care planning comply with federal law and experience fewer conflicts at the end of life, when disagreements consume staff time and create moral distress. For patients, care that matches their values is higher-quality care, and families who know the patient's wishes are spared the burden of guessing.
Slide 13: Where Ethical Duties Are Violated
Consent reduced to a signature
Monitoring gaps hidden behind 'patient sleeping'
Gossip and social media posts
Delegation without follow-up
Advance directives recorded but never discussed
Speaker notes: Each concept has a characteristic violation. Consent is reduced to a signature without understanding. Monitoring is skipped when a patient appears to be sleeping. Confidentiality is broken in hallway conversations and online. Tasks are delegated without follow-up. And the question about advance directives is asked at admission but never discussed again. Each violates provisions of the Code of Ethics, including respect for persons and the duty to protect patients.
Slide 14: The Problem Behind the Policy
ICU conflicts over potentially inappropriate treatment
Directives often absent or unknown
Goals-of-care discussions start late, in crisis
Result: moral distress, disputes, and care patients may not want
Speaker notes: The policy proposal addresses a problem where several concepts meet: conflict in intensive care over treatment that clinicians believe will not help. These conflicts often arise because goals of care were never discussed until a crisis. A multisociety statement recommends proactive communication and a fair process to prevent and resolve such disputes (Bosslet et al., 2015).
Slide 15: Policy Proposal
Goals-of-care conversation within 72 hours of ICU admission
Attending physician leads; bedside nurse participates
Review advance directive and identify surrogate
Standard note in the record; palliative care consult for defined triggers
Speaker notes: The proposed policy requires a documented goals-of-care conversation within 72 hours of ICU admission for every patient, led by the attending physician with the bedside nurse present. The conversation reviews any advance directive, identifies the legal surrogate, explores the patient's values, and is recorded in a standard note. Defined triggers, such as multiorgan failure or prolonged ventilation, prompt a palliative care consultation.
Slide 16: Recommendations for Implementation
Communication training for physicians and nurses
Electronic health record prompt and note template
Nurse empowered to request the meeting
Ethics consultation pathway for unresolved disagreement
Speaker notes: Implementation depends on training clinicians in communication, building an electronic prompt and template so the conversation is not forgotten, and giving nurses explicit authority to request the meeting if it has not occurred. For disagreements that persist, the policy links to an ethics consultation process consistent with the multisociety recommendations (Bosslet et al., 2015).
Slide 17: Evaluating the Policy
Percentage of ICU patients with a documented conversation within 72 hours
Time from admission to palliative care consultation
Number of ethics consultations for treatment disputes
Nurse moral distress scores before and after
Speaker notes: The policy's success can be measured by the percentage of ICU patients with a documented conversation within 72 hours, time to palliative consultation for patients who meet triggers, the number of ethics consultations for treatment disputes, and nurse moral distress measured before and after implementation. Results would be reviewed quarterly and the policy revised as needed.
Slide 18: Impact on Agency Viability and Care Quality
Fewer disputes and legal exposure
Better use of ICU resources
Care aligned with patient goals
Retention of nurses who experience less moral distress
Speaker notes: The policy supports agency viability by reducing disputes and legal exposure, using intensive care resources in line with patient goals, and helping retain nurses by reducing moral distress. It improves quality by ensuring that care reflects what patients want, which is the purpose behind informed consent and self-determination.
Slide 19: Nursing Advocacy Strategies
Speak up at rounds for patients whose goals are unknown
Use the chain of command when care seems inconsistent with wishes
Join ethics and policy committees
Educate patients and families about advance directives
Speaker notes: Nurses advocate at the bedside by raising goals of care at rounds, using the chain of command when care appears inconsistent with a patient's wishes, and ensuring the patient's voice is heard. At the organizational level, nurses can serve on ethics and policy committees and lead education for patients and families about advance directives. Advocacy turns legal rights into lived practice.
Slide 20: Conclusion
Five concepts protect patients and sustain agencies
Violations cluster where routines replace judgment
Early goals-of-care conversations bring several concepts together
Nurses are central to making the policy work
Speaker notes: Informed consent, negligence standards, confidentiality, delegation, and self-determination protect patients and help agencies remain viable. Violations tend to occur when routines replace judgment. The proposed policy brings several concepts together to prevent conflict and align care with patients' goals, and nurses are central to making it work.
References
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Bosslet, G. T., Pope, T. M., Rubenfeld, G. D., Lo, B., Truog, R. D., Rushton, C. H., Curtis, J. R., Ford, D. W., Osborne, M., Misak, C., Au, D. H., Azoulay, E., Brody, B., Fahy, B. G., Hall, J. B., Kesecioglu, J., Kon, A. A., Lindell, K. O., & White, D. B. (2015). An official ATS/AACN/ACCP/ESICM/SCCM policy statement: Responding to requests for potentially inappropriate treatments in intensive care units. American Journal of Respiratory and Critical Care Medicine, 191(11), 1318-1330. https://doi.org/10.1164/rccm.201505-0924ST
Brous, E. (2019). The elements of a nursing malpractice case, part 2: Breach. American Journal of Nursing, 119(9), 42-46. https://doi.org/10.1097/01.NAJ.0000580256.10914.2e
Guido, G. W. (2020). Legal and ethical issues in nursing (7th ed.). Pearson.
National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3
Spector, N., & Kappel, D. M. (2012). Guidelines for using electronic and social media: The regulatory perspective. OJIN: The Online Journal of Issues in Nursing, 17(3), Manuscript 1. https://doi.org/10.3912/OJIN.Vol17No03Man01
How this N 520 Module 7 example is structured
N520 Module 7 is typically the capstone: at least 20 slides including title, introduction, conclusion and references, with detailed speaker notes and recorded audio, on five legal or ethical concepts, their impact on agency viability and care quality, potential ethical violations, a policy proposal and nursing advocacy, with at least four scholarly sources. In some versions this falls in the final module. The audio is your own. Aspen revises courses, so follow your classroom's prompt.
N520 Module 7 questions, answered
What does N520 Module 7 usually ask for?
The capstone presentation: at least 20 slides with speaker notes and recorded audio on five legal or ethical concepts that influence nursing practice, their impact on agency viability and care quality, potential violations of ethical duties, a policy proposal and nursing advocacy strategies, with at least four scholarly sources.
Which five concepts work well for the capstone?
Concepts with clear agency and patient impacts work best, such as informed consent, negligence, confidentiality and privacy, delegation and scope of practice, and patient self-determination under the Patient Self-Determination Act.
What makes a strong policy proposal?
A specific problem, a clear policy statement with who does what and when, implementation steps, measurable outcomes and a link to the concepts analyzed earlier, so the policy grows out of the presentation rather than being added at the end.
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