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.
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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
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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
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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
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Nurse Aide Ethical Standards
(continued)
• Resident 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
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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”
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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
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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
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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.
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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
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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
activities
– Hair style and
– Social activities
grooming
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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
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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
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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
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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
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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
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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
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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
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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
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Legal Issues:
Civil Law Examples Of Torts
(continued)
• Negligence
– Unintentional wrong
– Failure to perform in reasonably
prudent manner
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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
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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
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Legal Issues:
Civil Law Examples Of Torts
(continued)
• Assault
– Example: rough treatment of
residents during care
– Example: performing procedure
resident has refused
– Example: threatening to restrain
resident
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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
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Legal Issues:
Civil Law Examples Of Torts
(continued)
• Battery
– Get informed consent
• Written – safest
• Verbal
• Gesture
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Legal Issues:
Civil Law Examples Of Torts
(continued)
• Invasion of privacy
– Unnecessary exposure of
individual
– Revealing personal
information without
consent
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Legal Issues:
Civil Law Examples Of Torts
(continued)
• Invasion of privacy
– Example: giving news media
information without resident’s
permission
– Example: giving information to
insurance company without
permission
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Behavior That Maintains
Residents’ Rights
(continued)
• Treat all residents equally
• Promote positive attitudes
• Report errors to
supervisor immediately
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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
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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
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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.
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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.
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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
(continued)
Drug means 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.
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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.
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Mistreatment of the Elderly
•
•
•
•
•
•
Resident’s Right To Be Free
From Abuse
Physical
Verbal
Sexual
Mental
Corporal Punishment
Involuntary Seclusion
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Mistreatment of the Elderly
Signs of abuse
• Fractures
• Bruises of face, upper arms,
upper thighs, abdomen
• Fearfulness
• Withdrawn, paranoid
behavior
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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
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Mistreatment of the Elderly
Examples of Abuse
(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
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Mistreatment of the Elderly
Examples of Abuse
(continued)
• Humiliating resident
• Making disparaging,
derogatory remarks
• Sexual coercion
• Sexual harassment
• Verbal harassment
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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
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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
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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
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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
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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
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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
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