NURSING ASSISTANT III
CHAPTER 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
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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 the 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”
PATIENTS’ AND RESIDENTS’ RIGHTS
• The patient has the right to:
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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
PATIENTS’ AND RESIDENTS’ RIGHTS
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Review the records related to her medical care, and have the information they contain
explained or interpreted as necessary
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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
PATIENTS’ AND RESIDENTS’ RIGHTS
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The patient is responsible for
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Cooperating with health care providers
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Ensuring payment for services received
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
Informing the health care staff of any medications brought from home
Accepting responsibility for the consequences of refused treatment or disregarded instructions
PATIENTS’ AND RESIDENTS’ RIGHTS
• Residents’ Rights
• Similar to those of patients’
• Must be followed to receive Medicare payments
• Included as part of OBRA
PATIENTS’ AND RESIDENTS’ RIGHTS
• 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
PATIENTS’ AND RESIDENTS’ RIGHTS
• 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.
PATIENTS’ AND RESIDENTS’ RIGHTS
• 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
PATIENTS’ AND RESIDENTS’ RIGHTS
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Advance Directives
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Make a patient or residents health care preferences known in advance, in case they are not
able to make decisions for themselves
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Decision making capacity
• Ability to make a thoughtful decision based on the potential risks and benefits of taking a certain
action
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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
PATIENTS’ AND RESIDENTS’ RIGHTS
• Advance Directives Cont…
• Durable power of attorney
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Type of advance directive
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Person has diminished decision making capacity
Transfers the responsibility for making medical decisions on the person’s behalf to another
trusted person
• Health Care Agent
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The person who the decision making ability is transferred to
PATIENTS’ AND RESIDENTS’ RIGHTS
• Advance Directives Cont…
• Living Will
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Allows person to giv instructions about what medical treatments he would or would not want
done in an effort to save his life
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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
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• 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
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Violations of Civil Law
• Agreement between patients and health care workers
• Contract
• Tort
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Unintentional tort = negligence
• Malpractice
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Negligence committed by people who hold licenses to practice
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Intentional Torts
• Violation of civil law with intent to do harm
• Defamation
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Making untrue statements that harm a person’s reputation
Slander
Libel
• Assault
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Threatening or attempting to touch someone without consent
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Intentional Torts
• Battery
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Touching a person without his or her consent
Informed Consent
• Fraud
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Deception that could cause harm to another person
• False Imprisonment
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Confining another person against his or her will
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
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Intentional Torts
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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)
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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
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Intentional Torts
• Larceny
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Stealing
Elderly or ill are particularly vulnerable
Not just health care workers
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Family, neighbors, fellow residents
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Violations of Criminal Law – Abuse
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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
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Forms of Abuse
• Physical abuse
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The use of force to cause pain or injury
• Neglect
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Failure to provide for a dependent person’s basic physical needs
• Abandonment
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Act of withdrawing support or help from another person in spite of duty or responsibility
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Psychological (emotional)
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Use of words or actions to cause emotional pain or injury
Involuntary seclusion
• Sexual
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Subjecting a person to unwanted attention of a sexual nature
• Financial
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Misusing or stealing another person’s money or property
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Perpetrators of abuse
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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!!!!!
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• Elder Abuse
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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
LAWS: A WAY OF PRESERVING PATIENTS’ AND
RESIDENTS’ RIGHTS
• 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?
ETHICS: GUIDELINES FOR BEHAVIOR
• Answers to these questions depend on the individual’s values and beliefs
• Ethics
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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
ETHICS: GUIDELINES FOR BEHAVIOR
• Professional Ethics
• Beneficence
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Do good for those in your care by preventing harm and promoting the health and welfare of
the person above all else
• Nonmaleficence
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Avoid harming those in your care. Use kindness and gentleness when administering care
• Justice
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Treat people fairly and equally, regardless of race, religion, culture, disability, or ability to
pay
ETHICS: GUIDELINES FOR BEHAVIOR
• Professional Ethics
• Fidelity
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Act with integrity to earn others’ trust
• Autonomy
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Respect a person’s rights and personal preferences
• Confidentiality
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Maintain a person’s privacy by allowing the person to discuss sensitive issues with knowledge
that the information will be kept secret
ETHICS: GUIDELINES FOR BEHAVIOR
• 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
ETHICS: GUIDELINES FOR BEHAVIOR
• Personal Ethics
• Values
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A cherished belief or principle
Religious or spiritual beliefs
Type and level of education
Culture
Heritage
Life experiences
ETHICS: GUIDELINES FOR BEHAVIOR
• Personal Ethics
• Ethical dilemmas
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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