Nurses who are sensitive to the legal dimensions of practice are careful to develop a strong sense of both ethical and legal accountability. Competent practice is a nurses’ best legal safeguard. When working to develop ethical and legal accountabilities, nurses must recognize that both deficiencies and or excesses of responsible caring are problematic. Although it is reasonable to hold oneself accountable for promoting the human well being of the patients, nurses can err by setting unrealistic standards of responsiveness and responsibility for themselves. Prudence is always necessary to balance responsible self care with care for others. Inexperienced nurses might feel totally responsible for effecting patient outcomes beyond their control and become frustrated and sad when unable to produce the desired outcome Conversations about what is reasonable to hold ourselves and others accountable for are always helpful.
Each employing institution or agency providing nursing service has an obligation to establish a process for reporting and handling practices by individual or by health care systems that jeopardizes a patient’s health or safety. The American Nurses Association code of Ethics obligates nurses to report professional conduct that is incompetent, unethical or illegal. For nurses, incompetent practice in measured by nursing standards, unethical practice is evaluated in light of the professional codes of ethics, while illegal practice is identified in terms of violation of federal legislations and laws.
Nurses must respect the accountability and responsibility inherent in their roles. They have the moral obligations in the provision of nursing care, hence they collaborate with other health care providers in providing comprehensive health care, recognizing the perspective and expertise of each member. Nurses have a moral right to refuse to participate in procedures that may violate their own personal moral conscience since they are entitled to conscientious objection. They must keep all information obtained in a professional capacity confidential and employ professional judgment in sharing this information on a need to know basis.
They must acknowledge that the social environment in which the patient inhabits has an impact on health. Nurses must respect the rights of individuals to make informed choices in relation to their care. They have this responsibility to inform individuals about the care available to them, and the choice to accept or reject that care. If the person is not able to speak for themselves, nurses must ensure the availability of someone to represent them. It is vital to respect the decisions made concerning the individual’s care. Standards of care are one measure of quality. Quality nursing care provides care by qualified individuals.
Likewise, the individual needs, values, and culture of the patient relative to the provision of nursing care is important to be respected and considered hence it should not be compromised for reasons of ethnicity, gender, spiritual values, disability, age, economic, social or health status, or any other grounds. Respect for an individual’s needs includes recognition of the individual’s place in a family and the community. It is due to this reason that others should be included in the provision of care, most significantly the family members. Respect for needs, beliefs and values includes culturally sensitive care, and the need for comfort, dignity, privacy and alleviation of pain and anxiety as much as possible.
“Evidence-based practice (EBP) is a problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values to make decisions about the type of care that is provided” (Melnyk, 2004). Quality of care outcomes refers to accuracy and relevance demonstrated by the decisions concerning the need for medical and surgical intervention. Evidence of appropriateness in healthcare is necessary to improve health outcomes, balance costs, provide guidance to physicians and meet the need of the new informed health consumer. Appropriateness is unlike effectiveness since the later refers to the degree in which an intervention achieves the objectives set (Muir Gray, 1997). One criterion of appropriateness is that of necessity.
As technology and improved methods of care has advanced, access to appropriate interventions should likewise improve. Today some interventions are still limited such as magnetic resonance imaging (MRI) in rural communities and since access to this technology is limited, a criterion of necessity is used to determine who is able to access and how quickly. Therefore although use of MRI may be appropriate in diagnostics, it may be underused. Advancements in technology, interventions and clinical research will provide updated evidence which in turn would affect ratings of appropriateness (Muir Gray, 1997).
Clinical guideline statements are developed from evidence to assist healthcare practitioners in making appropriate health interventions (Woolf, Grol, Hutchinson, Eccles & Grimshaw, 1999). The clinical guideline may be a general statement or concise instruction on which diagnostic test to order or how best to treat a specific condition. The purpose of clinical guidelines is as a tool for making decisions that will result in more consistent and efficient care. Guidelines are not rules nor are they mandatory. The benefits of clinical guidelines include: Improved health outcomes; Increased beneficial/appropriate care; Consistency of care; Improved patient information; Ability to positively influence policy; Provide direction to health care practitioners;
Agency of Healthcare Research and Quality. (n.d.). Outcomes research fact sheet. [Online].
Brook, R.H. (1994). Appropriateness: The next frontier. [Online]. Available:
Fitch, K., Bernstien, S. J., Aguilar, M. D., Burand, B., LaCalle, J. R., Lazaro, P. van het Loo,
McDonnell, J., Vader, J. P., & Kahan, J. P. (2001). The RAND/UCLA appropriateness
method user’s manual. [Online]. Available:
John A. Hartford Foundation. (n.d.). [Online]. Available: http://www.jhartfound.org/
Muir Gray, J.A. (1997). Evidence-based healthcare: How to make health policy and management
decisions, New York: Churchill Livingstone.
Woolf, S. H., Grol, R., Hutchinson, A., Eccles, M., & Grimshaw, J. (1999). Clinical guidelines:
Potential benefits, limitations and harms of clinical guidelines. [Online]. Available: