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Law, Ethics and Communication: free practice, theory and problems
The Norwegian Health Personnel Act sets out your duties as a health professional. The most important are to work responsibly, keep confidentiality and document.
Contents
- The Health Personnel Act and confidentiality
- Patient rights and consent
- Ethics in nursing
- Communication and documentation
1. The Health Personnel Act and confidentiality
What is it about?
The Norwegian Health Personnel Act sets out your duties as a health professional. The most important are to work responsibly, keep confidentiality and document.
Concepts
- Responsible practice: you must do your work as expected from your qualifications, and ask for help when you need it.
- Confidentiality: you must prevent others from accessing information about the patient's health and personal circumstances. It also applies after you have left the job, and towards your own friends and family.
- Exceptions to confidentiality include the patient's consent, sharing with cooperating health personnel to provide care, and a statutory duty to inform (for example to child protection services in cases of serious neglect).
- Duty to document: relevant and necessary information about the patient and the care given must be recorded in the medical record.
- Snooping in records is illegal. You may only read the records of patients you are caring for.
Practise the Health Personnel Act and confidentiality in the app →
2. Patient rights and consent
What is it about?
The Norwegian Patient and User Rights Act gives patients rights. The main rule is that health care may only be given with the patient's consent.
Concepts
- Consent: the patient must have received the necessary information for the consent to be valid. Consent can be withdrawn.
- Capacity to consent: the ability to understand what the consent concerns. It can be lost wholly or partly, for example in dementia or psychosis.
- The age of consent for health care is 16 in Norway.
- The patient has the right to information about their condition and care, and the right to access their own record.
- Patients without capacity who resist necessary care can in some cases receive care under special rules (chapter 4A), with strict conditions and a formal decision.
- The patient can complain and has the right to a new assessment.
3. Ethics in nursing
What is it about?
Ethics is about what is right to do, especially when values conflict. Nurses have their own code of ethics.
Concepts
- The four principles of medical ethics: respect for autonomy (self-determination), beneficence (doing good), non-maleficence (doing no harm) and justice.
- An ethical dilemma is a situation where every choice breaks an important value.
- The Norwegian code of ethics for nurses is based on respect for human dignity and human rights.
- Nursing theorists: Joyce Travelbee (the human-to-human relationship and meaning in suffering), Virginia Henderson (helping the patient with basic needs until they manage alone) and Kari Martinsen (care as relationship and morality).
4. Communication and documentation
What is it about?
Good communication makes the patient feel safe and prevents misunderstandings. Good documentation ensures that the next shift knows what has been done and what should happen.
Concepts
- Active listening: show that you are paying attention, summarise and ask follow-up questions.
- Open questions ("How has the night been?") give more information than closed ones ("Did you sleep?").
- Interpreter: use a qualified interpreter when there is a language barrier. Children and other relatives should not be used as interpreters.
- ISBAR for verbal handover: Identify, Situation, Background, Assessment, Recommendation.
- Documentation: write objectively and concretely (what you observed and did), as soon as possible after the event, and without deleting what has been written.
Example problems with solutions
Here are some of the problems in law, Ethics and Communication. In the app, calculation problems get new numbers every time, so you can practise until it sticks – and take a graded practice exam before the real one.
The Health Personnel Act and confidentiality: A friend asks about a famous person admitted to your ward. What do you do?
Answer: Say nothing, neither confirm nor deny
Confidentiality also covers the fact that the person is admitted.
Patient rights and consent: What is the age of consent for health care in Norway?
Answer: 16
From 16, a person can as a rule consent to health care themselves.
Ethics in nursing: Which principle concerns the patient's right to decide for themselves?
Answer: Autonomy
Respect for autonomy means the patient's own choices must be respected.
Communication and documentation: Which question is open?
Answer: "How are you today?"
Open questions cannot be answered with yes or no.