Professional Practice, Ethics, and Legal Issues
Ethical and Legal Foundations
Practice is governed by four ethical principles: autonomy, beneficence, nonmaleficence, and justice. Autonomy drives informed consent, which requires capacity, disclosure, understanding, and voluntariness. Confidentiality is protected by law such as HIPAA, with exceptions for mandated reporting and serious threats. Scope of practice defines what a nurse practitioner may do, and collaboration or supervision requirements vary by state. Documentation should be timely, accurate, and objective, because it is both a clinical and legal record.
Traps to Watch
Questions test whether you recognize when a patient lacks capacity or when consent must come from a surrogate. Another trap is confusing confidentiality with absolute secrecy: mandatory reporting of suspected abuse or certain communicable diseases overrides it. Watch for boundary issues and impaired colleagues. Also distinguish negligence elements: duty, breach, causation, and damages. A bad outcome alone is not negligence.
Worked Example
A patient refuses a recommended treatment but understands the risks and alternatives. Trap answer: "override the refusal for the patient's benefit." Correct reasoning: a capacitated patient may refuse care; document the discussion and continue to offer support. Rule of thumb: capacity plus disclosure plus voluntariness equals valid refusal, regardless of whether you agree.