nursing assistant iii chapter 4: legal and ethical issues

NURSING ASSISTANT IIICHAPTER 4: LEGAL AND ETHICAL ISSUES

OBJECTIVES

• List and discuss patients’ and residents’ rights as set forth by the American Hospital Association (AHA) and the Omnibus Budget Reconciliation Act (OBRA), respectively.

• Describe two major types of advance directives and explain why advance directives play an important role in health care

• Discuss legal aspects of health care delivery

• List common legal violations that are related to the provision of health care

• Display the awareness that health care workers must have in order to avoid legal dilemmas

• Define the types of abuse and describe signs that indicate abuse

• Discuss the health care worker’s obligation in the reporting of suspected abuse

• Explain the difference between legal and ethical issues

• Describe th ethical standards that govern the nursing profession in particular, and the health care profession in general

PATIENTS’ AND RESIDENTS’ RIGHTS

• Guidelines established to protect patients

• American Hospital Association (AHA) established first “Patients’ Bill of Rights” in 1973

• Now called the “Patient Care Partnership”


• The patient has the right to:

• Considerate and respectful care

• Information about his/her diagnosis and treatment

• Make decisions about his/her plan of care, and to refuse a recommended treatment

• Specify his/her wishes regarding health care in advance in case the time comes when he/she can no longer make his/her wishes known

• Privacy

• Expect that all communications pertaining to care will be treated with confidentiality


• Review the records related to her medical care, and have the information they contain explained or interpreted as necessary

• Suggest alternatives to her planned care, or to transfer to another facility is she so desires

• Be informed of any business relationships between parties that influence the care she receives

• Participate in, or decline to participate in, experimental studies

• Be informed of her options for care when she is discharged from the hospital

• Know how the hospital settles disputes, what the hospital charges for services, and what options are available for payment


• The patient is responsible for

• Cooperating with health care providers

• Respecting the property, comfort, environment, and privacy of other patients

• Making an effort to understand, and follow, instructions concerning treatment

• Providing accurate and complete information about her health status by answering questions as truthfully and completely as possible

• Ensuring payment for services received

• Informing the health care staff of any medications brought from home

• Accepting responsibility for the consequences of refused treatment or disregarded instructions


• Residents’ Rights

• Similar to those of patients’

• Must be followed to receive Medicare payments

• Included as part of OBRA


• Residents Bill of Rights

• The resident has the right to make decisions regarding his care, including choosing his own physician, participating in planning and implementing care, having individual needs and preferences accommodated, and voice grievances about care

• The resident has the right to privacy, including privacy while receiving treatments and nursing care, making and receiving telephone calls, sending and receiving mail, and receiving visitors

• The resident has the right to be free from physical or psychological abuse, including the improper use of restraints


• The resident has the right to receive visitors, and to share a room with a spouse if both partners are residents at the same facility

• The resident has the right to use personal possessions

• The resident has the right to control own finances

• The resident has the right to information about eligibility for Medicare funds, and to be protected against Medicaid discrimination

• The resident has the right to information about the facility’s compliance with regulations, planned changes in living arrangements, and available services.


• The resident has the right to remain in the facility unless transfer or discharge is required by a change in the residents health, the resident is unable to pay for the services, or the facility closes

• The resident has the right to organize and participate in groups organized by other residents. The resident also has the right to participate in social, religious, and community activities of his choosing

• The resident has the right to information about advocacy groups

• The resident has the right to choose to work at the facility, either as a volunteer or a paid employee


• Advance Directives

• Make a patient or residents health care preferences known in advance, in case they are not able to make decisions for themselves

• Decision making capacity

• Ability to make a thoughtful decision based on the potential risks and benefits of taking a certain action

• Advance directive

• Document that allows a person to make her wishes regarding health care known to family members and health care workers, in case the time comes when she cannot make decisions for herself


• Advance Directives Cont…

• Durable power of attorney

• Type of advance directive

• Transfers the responsibility for making medical decisions on the person’s behalf to another trusted person

• Person has diminished decision making capacity

• Health Care Agent

• The person who the decision making ability is transferred to


• Advance Directives Cont…

• Living Will

• Allows person to giv instructions about what medical treatments he would or would not want done in an effort to save his life

• Play a very important role in health care

• Patient Self-Determination Act of 1990

LAWS: A WAY OF PRESERVING PATIENTS’ AND RESIDENTS’ RIGHTS

• Laws

• Rules that are made by a controlling authority, such as the state or federal government

• Gives society a way of settling disputes in a civilized orderly way

• Protect basic human rights

• Civil Laws

• Concerned with relationships between individuals

• Usually pay a fine or financial settlement


• Criminal Law

• Concerned with relationships between individuals and society

• Often sentenced to prison

• Litigation

• The lawsuit, or legal action taken against a person who is breaking the law

• Liability

• The responsibility of an individual to act within the confines of the law


• Violations of Civil Law

• Agreement between patients and health care workers

• Contract

• Tort

• Unintentional tort = negligence

• Malpractice

• Negligence committed by people who hold licenses to practice


• Intentional Torts

• Violation of civil law with intent to do harm

• Defamation

• Making untrue statements that harm a person’s reputation

• Slander

• Libel

• Assault

• Threatening or attempting to touch someone without consent



• Battery

• Touching a person without his or her consent

• Informed Consent

• Fraud

• Deception that could cause harm to another person

• False Imprisonment

• Confining another person against his or her will



• Invasion of Privacy

• Violation another person’s right to keep certain information and aspects of himself away from the examination of others.

• Confidentiality is keeping personal information that someone shares with you to yourself

• Health Insurance Portability and Accountability Act (HIPAA)

• 1996

• Regulates who has the right to view a persons medical records

• Stets standards to the storage and transmission of information

• Requires organizations to set policies that allow patient to have access to their records



• Larceny

• Stealing

• Elderly or ill are particularly vulnerable

• Not just health care workers

• Family, neighbors, fellow residents


• Violations of Criminal Law – Abuse

• The repetitive and deliberate infliction of injury on another person.

• Criminal act

• Punishable by a court of law

• Actively doing something to another person or failing to do something for another person


• Forms of Abuse

• Physical abuse

• The use of force to cause pain or injury

• Neglect

• Failure to provide for a dependent person’s basic physical needs

• Abandonment

• Act of withdrawing support or help from another person in spite of duty or responsibility


• Psychological (emotional)

• Use of words or actions to cause emotional pain or injury

• Involuntary seclusion

• Sexual

• Subjecting a person to unwanted attention of a sexual nature

• Financial

• Misusing or stealing another person’s money or property


• Perpetrators of abuse

• Sometimes rooted in desire for one person to overpower and dominate another

• Many abusers were once victims

• Caregiver becomes tired, frustrated, and overwhelmed

• Resident becomes “difficult”

• NEVER ACCEPTABLE!!!!!


• Elder Abuse

• Abuse of an older person

• Most cases occur in private homes

• The greater the disability the higher as risk

• Occurred in %30 of nations nursing homes

• At least %10 have been charged with abuse


• Role of the Nursing Assistant in Reporting Abuse

• Laws require any health care worker wo suspects abuse of a child or elderly person must report any suspicious actions

• Facility or agency will have specific policies and procedures

• Not your responsibility to investigate

• If you say nothing, you are contributing

ETHICS: GUIDELINES FOR BEHAVIOR

• What should be done with human embryos that have been frozen for future use, if the parents decide they do not want to have any more children?

• How does one decide who receives a donor organ, when there are so many people in need but few organs are available?

• When does human life begin?

• Should doctors be allowed to end a person’s life, at that person’s request?

• Medical marijuana?


• Answers to these questions depend on the individual’s values and beliefs

• Ethics

• Moral principles or standards that govern conduct

• Comes from Greek word “ethos” which means “beliefs that guide life”

• Less rigid than laws

• Determine difference between right and wrong in areas where the law fears to tread


• Professional Ethics

• Beneficence

• Do good for those in your care by preventing harm and promoting the health and welfare of the person above all else

• Nonmaleficence

• Avoid harming those in your care. Use kindness and gentleness when administering care

• Justice

• Treat people fairly and equally, regardless of race, religion, culture, disability, or ability to pay


• Professional Ethics

• Fidelity

• Act with integrity to earn others’ trust

• Autonomy

• Respect a person’s rights and personal preferences

• Confidentiality

• Maintain a person’s privacy by allowing the person to discuss sensitive issues with knowledge that the information will be kept secret


• Code of Ethics for Nursing Assistants

• Treat patients and residents with respect for their individual needs and values

• Respect the patient’s or resident’s right to choice in regard to the individual’s right to control his or her own care

• Hold confidential all information about patients and residents learned in the health care setting

• Be guided by consideration for the dignity of patients and residents

• Fulfill the obligation to provide competent care to patients and residents


• Personal Ethics

• Values

• A cherished belief or principle

• Religious or spiritual beliefs

• Type and level of education

• Culture

• Heritage

• Life experiences


• Personal Ethics

• Ethical dilemmas

• Attempt to judge other people by our own ethical standards

• Solved by allowing the patient or resident to become and informed, and active participant in their own care

nursing assistant iii chapter 4: legal and ethical issues

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