Unit 5-ethical And Legal Issues

Unit 5

Nurse Aide I Course

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Ethical and Legal Issues Introduction As a member of the health care team, the nurse aide will frequently be faced with ethical and legal decisions that govern his or her actions. A knowledge of ethical standards, resident’s rights and legal issues are important for the protection of nurse aides, employers, and residents. DHSR Approved Curriculum-Unit 5

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5.0 Define ethics. 5.1 List at least six basic rules of ethics for the nurse aide.

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Ethics • Discipline concerned with right or wrong conduct • Guides to moral behavior • Making choices or judgments

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Nurse Aide Ethical Standards • Show respect for each resident as an individual • Understand the limits of role – Perform only acts for which adequately prepared – Perform acts only within legal scope of nurse aide DHSR Approved Curriculum-Unit 5

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Nurse Aide Ethical Standards (continued)

• Carry out assignments to best of ability • Be loyal: – Maintain a positive attitude toward institution that employs you – Support co-workers DHSR Approved Curriculum-Unit 5

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Nurse Aide Ethical Standards (continued)

• Be responsible citizen at all times – Respect others – Respect values that differ from yours

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5.1.2 Identify the kind of information that should be kept confidential.

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Nurse Aide Ethical Standards •

(continued) Resident information should be kept confidential – Discuss only in appropriate places – Discuss only with proper people – Refer questions from residents about their condition to supervisor DHSR Approved Curriculum-Unit 5

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Nurse Aide Ethical Standards • Resident (continued) information should be kept confidential (continued) – Refer questions about resident’s death to supervisor – Respect personal religious beliefs

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Nurse Aide Ethical Standards (continued)

• Respect privacy of others: – while dressing – while performing personal hygiene – during examination or treatment – during visits with clergy – during visits with spouse or significant other DHSR Approved Curriculum-Unit 5

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Nurse Aide Ethical Standards (continued) • Put resident’s needs ahead of your

own • Be sincere, honest and trustworthy in performance of duties – caring and concerned – “golden rule” DHSR Approved Curriculum-Unit 5

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5.1.3 Explain why nurse aides should not accept monetary tips for a health care service.

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Nurse Aide Ethical Standards (continued) • Do not accept monetary tips – Residents are paying for service – You are paid to provide service – Do not discriminate regardless of race, creed, color, age, financial resources – Provide care based on need DHSR Approved Curriculum-Unit 5

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Nurse Aide Ethical Standards (continued)

• Do not accept monetary tips (continued)

– Display tactful and courteous refusal of tips – Display continued desire to be helpful DHSR Approved Curriculum-Unit 5

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5.2 Demonstrate skills supporting age appropriate behavior by encouraging the resident to make personal choices, and by providing and reinforcing other resident’s dignity. DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior

• Dependent elderly residents are not children – If resident seen as a child – If resident treated as a child – Then resident behaves as a child DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior •

(continued) Residents are treated as adults in manner appropriate to person’s age

• Age-appropriate considerations: – Style of dress – Recreational – Hair style and activities – Social activities grooming DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior (continued)

• Guidelines for Nurse Aide – Address resident in a dignified way – Listen to what resident has to say – Converse with resident in an adult manner – Respect resident’s privacy DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior •

(continued) Guidelines for Nurse Aide (continued) – Don’t ignore or humor resident – Explain what care you are going to give – Promote resident independence – Treat resident as you would want to be treated DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior •

(continued) Guidelines for Nurse Aide (continued) – Encourage resident to make choices: • select clothing to wear • select books to read • select television programs to watch DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior •

(continued) Guidelines for Nurse Aide (continued) – Encourage resident to make choices: • select food and nourishments • select activities of interest • select friends DHSR Approved Curriculum-Unit 5

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Age Appropriate Behavior (continued)

• Guidelines for Nurse Aide (continued) – Recognize value of past experience – Praise age appropriate accomplishments – Encourage adult behavior

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5.3 List six legal responsibilities of a nurse aide.

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Legal Issues • Authorized or based on law – Legislated by state and federal government – Liable if laws not obeyed • Fines • Imprisonment DHSR Approved Curriculum-Unit 5

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Legal Issues (continued) • No fear of breaking laws if nurse aide: – performs only acts within scope of nurse aide – keeps skills and knowledge current – keeps resident’s safety and wellbeing in mind – understands directions for care DHSR Approved Curriculum-Unit 5

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Legal Issues (continued) • No fear of breaking laws if nurse aide: – follows facility policy – does no harm to residents or their belongings • Laws designed to protect public welfare DHSR Approved Curriculum-Unit 5

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5.3.1 Give examples of malpractice and negligence.

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Legal Issues: Civil Law Examples Of Torts

• Malpractice – Giving care for which you are not allowed legally to do – Providing improper care

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Legal Issues: Civil Law Examples Of Torts (continued) • Malpractice – Example: nurse aide giving medication – Example: nurse aide performing treatment only allowed by licensed nurses DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued)

• Negligence – Unintentional wrong – Failure to perform in reasonably prudent manner DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued) • Negligence – Example: brakes on a wheelchair not locked and resident falls – Example: defective equipment not reported and resident is harmed DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued)

• Assault – Care or treatment without proper consent (intentional) – Threatening to injure a resident or co-worker DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts • Assault (continued) – Example: rough treatment of residents during care – Example: performing procedure resident has refused – Example: threatening to restrain resident DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued)

• Battery – Unlawful touching of another person without his or her consent

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Legal Issues: Civil Law Examples Of Torts (continued)

• Battery – Example: nurse aide striking resident – Example: does procedure resident refuses DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts • Battery (continued) – Get informed consent • Written – safest • Verbal • Gesture DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued) • Invasion of privacy – Unnecessary exposure of individual – Revealing personal information without consent DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts • Invasion of(continued) privacy – Example: giving news media information without resident’s permission – Example: giving information to insurance company without permission DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued) • False imprisonment – Restraining an individual – Restricting resident’s freedom

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Legal Issues: Civil Law Examples Of Torts (continued)

• False imprisonment – Example: use of physical restraints without authorization or justification – Example: preventing resident from leaving facility against resident’s will DHSR Approved Curriculum-Unit 5

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Legal Issues: Civil Law Examples Of Torts (continued) • Defamation – False statements that cause a resident to be ridiculed or cause damage to their reputation • Example: slander – spoken • Example: libel – written DHSR Approved Curriculum-Unit 5

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5.3.2 Identify the responsibilities of the nurse aide when a resident wishes to make a will.

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Wills • Legal document giving direction on how resident wants property distributed after death – Refer requests to prepare will to supervisor – Nurse aide may witness signing of will • Check facility policy • Discuss with supervisor DHSR Approved Curriculum-Unit 5

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5.4 Support the resident’s right to make personal choices to accommodate individual needs.

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Residents’ Rights • Basic Human Rights – Protected by Constitution – Laws clarify these rights: • Right to be treated with respect • Right to live in dignity • Right to pursue a meaningful life • Right to be free of fear DHSR Approved Curriculum-Unit 5

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Residents’ Rights (continued)

• Basic Human Rights (continued) – Behavior that infringes on these rights: • addressing residents as children • using demeaning nicknames for residents • leaving door open during bath • threatening a resident with harm DHSR Approved Curriculum-Unit 5

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5.4.1 Describe the Resident’s Bill of Rights.

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Residents’ Rights (continued) • The Resident’s Rights – Ethical and legal basis – Federal and state regulations – Posted in facility – Distributed on admission in many facilities DHSR Approved Curriculum-Unit 5

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Residents’ Rights (continued)

• Residents have the right to: – Considerate and respectful care – Obtain complete current information concerning diagnosis, treatment and prognosis – Receive information necessary to give informed consent prior to treatments or procedures DHSR Approved Curriculum-Unit 5

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Residents’ Rights (continued) • Residents have the right to (continued): – Refuse treatment to extent permitted under law – Privacy of resident’s body, record, care and personal affairs – Confidential treatment of all records – Reasonable response to request for service DHSR Approved Curriculum-Unit 5

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Residents’ Rights (continued) • Residents have the right to (continued): – Examine bill and receive explanation of charges – Be informed of any facility rules and regulations DHSR Approved Curriculum-Unit 5

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5.4.2 Demonstrate behavior which maintains residents’ rights.

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Behavior That Maintains Residents’ Rights • Address as Mr., Mrs., or Miss unless asked to use a specific name • Never be rude or unkind – Never withhold social responsiveness – Never ignore residents – Make eye contact DHSR Approved Curriculum-Unit 5

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Behavior That Maintains Residents’ Rights (continued)

• Never be rude or unkind (continued) – Allow to complete sentences prior to leaving room – Don’t shut or slam door to quiet resident – Never threaten or intentionally hurt DHSR Approved Curriculum-Unit 5

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5.4.3 Give needed assistance in going to and participating in resident and family groups and activities.

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Behavior That Maintains Residents’ Rights (continued)

• Help meet emotional/spiritual/social needs. – Encourage socialization (meal-time) – Assist to activities/meetings/church DHSR Approved Curriculum-Unit 5

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Behavior That Maintains Residents’ Rights (continued)

• Help meet emotional/spiritual/social needs (continued) – Participate in planned activities – Help with phone calls, cards, mail DHSR Approved Curriculum-Unit 5

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5.4.4 Maintain the resident’s environment and care through the appropriate nurse aide behavior.

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Behavior That Maintains Residents’ Rights •

(continued) Explain care you plan to give

• Observe safety precautions • Obtain proper consent after identifying resident DHSR Approved Curriculum-Unit 5

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Behavior That Maintains Residents’ Rights (continued)

• Treat all residents equally

• Promote positive attitudes • Report errors to supervisor immediately DHSR Approved Curriculum-Unit 5

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5.4.5 Explain the purpose and value of a Resident Council.

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Resident Council : advisory group • Provides opportunity for discussion • Recommendations may be made for: – Facility policies – Decisions regarding activities – Exploration of concerns – Resolving grievances DHSR Approved Curriculum-Unit 5

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Resident Council : advisory group (continued) • Gives residents a voice in facility operations • Members – residents – facility staff members (you) – representatives from community DHSR Approved Curriculum-Unit 5

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5.5 Administer care which maintains the residents free from abuse, mistreatment, neglect, diversion of drugs, fraud, or misappropriation of property. DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Federal and State Definitions Abuse means willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.

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Mistreatment of the Elderly Federal and State Definitions

(continued)

Neglect means a failure to provide goods and services necessary to avoid physical harm, mental anguish or mental illness.

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Mistreatment of the Elderly Federal and State Definitions

(continued)

Misappropriation of property means deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a belonging or money without consent. DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Federal and State Definitions

(continued)

Diversion of drugs means the unauthorized taking or use of any drug.

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Mistreatment of the Elderly Federal and State Definitions Drug means(continued) any chemical compound that may be used on or administered to humans or animals as an aid in the diagnosis, treatment or prevention of disease or other condition or for the relief of pain or suffering or to control or improve any physiological pathologic condition. DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Federal and State Definitions

(continued) Fraud means an intentional deception

or misrepresentation made by a person with knowledge that deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under applicable Federal or State Law. DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Resident’s Right To Be Free From Abuse • Physical • Verbal • Sexual • Mental • Corporal Punishment • Involuntary Seclusion DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Signs of abuse

• Fractures • Bruises of face, upper arms, upper thighs, abdomen • Fearfulness • Withdrawn, paranoid behavior DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly • • • • •

Examples of Abuse Threatening resident Frightening resident Pinching, slapping, pushing, grabbing or kicking resident Withholding food or fluids Restraining resident against her/his will without apparent reason and doctor’s order DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Examples of Abuse

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(continued) Leaving resident in soiled

linen or clothing • Yelling angrily at or making fun of resident • Refusing to reposition or give treatment • Not answering call signal DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly Examples of Abuse

(continued) • Humiliating resident • Making disparaging, derogatory remarks • Sexual coercion • Sexual harassment • Verbal harassment DHSR Approved Curriculum-Unit 5

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Mistreatment of the Elderly

• Identification of residents at risk for abusing other residents – Residents with history of aggressive behavior

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Mistreatment of the Elderly

• Identification of residents at risk for being abused – noisy individuals – wandering individuals – philandering individuals – socially/logistically isolated individuals DHSR Approved Curriculum-Unit 5

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5.5.1 Report any instances of abuse to the appropriate facility/agency staff.

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Reporting Abuse • If observed, stop abuse and report immediately to supervisor • Cause for immediate dismissal of perpetrator and posted on NA I Registry if proven • Know state law • Not reporting abuse is aiding and abetting DHSR Approved Curriculum-Unit 5

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5.6

Assist in resolving grievances.

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Advocates • Plead cause of another • Resolve grievances • Protect resident’s rights

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Advocates (continued) • Advocates can be: – You and your co-workers – Member of resident’s family/support system – Resident’s guardian – Ombudsman DHSR Approved Curriculum-Unit 5

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Advocates Resident’s Right to Voice Grievances • • • •

Regarding services furnished Regarding services not furnished With respect to behavior of others Nurse aide must report grievances to supervisor DHSR Approved Curriculum-Unit 5

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Advocates Facility policy components for resident grievance • Acknowledgment • Prompt attempt to resolve • Resident kept apprised

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5.7 Discuss key elements of Federal Grievance Procedures.

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Grievance Procedures • Grievance Procedures – Review federal grievance procedures

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5.8 Promote care and security of residents’ personal possessions.

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Residents’ Personal Possessions

• Protect personal items

• These possessions may be all they have • Items may be impossible to replace • Report observed thefts DHSR Approved Curriculum-Unit 5

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Residents’ Personal Possessions (continued)

• Handle personal items carefully

• Add new items to list of resident’s belongings • Mark all items with resident’s name DHSR Approved Curriculum-Unit 5

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