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DFS Approved Curriculum-Unit 5 2
Ethical and Legal IssuesIntroduction
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.
DFS Approved Curriculum-Unit 5 4
5.0 Define ethics.
5.1 List at least six basic rules of ethics for the nurse aide.
DFS Approved Curriculum-Unit 5 5
Ethics• Discipline concerned with right or
wrong conduct• Guides to moral behavior• Making choices or judgments
DFS Approved Curriculum-Unit 5 6
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
DFS Approved Curriculum-Unit 5 7
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
DFS Approved Curriculum-Unit 5 8
Nurse Aide Ethical Standards(continued)
• Be responsible citizen at all times –Respect others–Respect values that differ from yours
DFS Approved Curriculum-Unit 5 9
5.1.2 Identify the kind of information that should be kept confidential.
DFS Approved Curriculum-Unit 5 10
• 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
Nurse Aide Ethical Standards(continued)
DFS Approved Curriculum-Unit 5 11
• Resident information should be kept confidential (continued)
– Refer questions about resident’s death to supervisor
– Respect personal religious beliefs
Nurse Aide Ethical Standards(continued)
DFS Approved Curriculum-Unit 5 12
• 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
Nurse Aide Ethical Standards(continued)
DFS Approved Curriculum-Unit 5 13
• Put resident’s needs ahead of your own
• Be sincere, honest and trustworthy in performance of duties– caring and concerned– “golden rule”
Nurse Aide Ethical Standards(continued)
DFS Approved Curriculum-Unit 5 14
5.1.3 Explain why nurse aides should not accept monetary tips for a health care service.
DFS Approved Curriculum-Unit 5 15
• 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
Nurse Aide Ethical Standards(continued)
DFS Approved Curriculum-Unit 5 16
• Do not accept monetary tips (continued)
– Display tactful and courteous refusal of tips
– Display continued desire to be helpful
Nurse Aide Ethical Standards(continued)
DFS Approved Curriculum-Unit 5 18
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.
DFS Approved Curriculum-Unit 5 19
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
DFS Approved Curriculum-Unit 5 20
Age Appropriate Behavior(continued)
• Residents are treated as adults in manner appropriate to person’s age
• Age-appropriate considerations:– Recreational
activities– Social activities
– Style of dress– Hair style and
grooming
DFS Approved Curriculum-Unit 5 21
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
DFS Approved Curriculum-Unit 5 22
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
DFS Approved Curriculum-Unit 5 23
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
DFS Approved Curriculum-Unit 5 24
Age Appropriate Behavior(continued)• Guidelines for Nurse Aide (continued)
– Encourage resident to make choices:• select food and nourishments• select activities of interest• select friends
DFS Approved Curriculum-Unit 5 25
Age Appropriate Behavior(continued)
• Guidelines for Nurse Aide (continued)
– Recognize value of past experience– Praise age appropriate
accomplishments– Encourage adult behavior
DFS Approved Curriculum-Unit 5 28
Legal Issues• Authorized or based on law
– Legislated by state and federal government
– Liable if laws not obeyed• Fines• Imprisonment
DFS Approved Curriculum-Unit 5 29
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 well-being in mind
– understands directions for care
DFS Approved Curriculum-Unit 5 30
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
DFS Approved Curriculum-Unit 5 32
Legal Issues: Civil Law Examples
Of Torts• Malpractice
– Giving care for which you are not allowed legally to do
– Providing improper care
DFS Approved Curriculum-Unit 5 33
Legal Issues: Civil Law Examples
Of Torts(continued)• Malpractice
– Example: nurse aide giving medication
– Example: nurse aide performing treatment only allowed by licensed nurses
DFS Approved Curriculum-Unit 5 34
• Negligence
– Unintentional wrong
– Failure to perform in reasonably prudent manner
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 35
• Negligence
– Example: brakes on a wheelchair not locked and resident falls
– Example: defective equipment not reported and resident is harmed
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 36
• Assault– Care or treatment without proper
consent (intentional)– Threatening to injure a resident or
co-worker
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 37
• Assault– Example: rough treatment of
residents during care– Example: performing procedure
resident has refused– Example: threatening to restrain
resident
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 38
• Battery
– Unlawful touching of another person without his or her consent
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 39
• Battery
– Example: nurse aide striking resident
– Example: does procedure resident refuses
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 40
• Battery– Get informed consent
• Written – safest• Verbal• Gesture
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 41
• Invasion of privacy– Unnecessary exposure of
individual– Revealing personal
information without consent
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 42
• Invasion of privacy– Example: giving news media
information without resident’s permission
– Example: giving information to insurance company without permission
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 43
• False imprisonment– Restraining an individual– Restricting resident’s freedom
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 44
• False imprisonment– Example: use of physical restraints
without authorization or justification– Example: preventing resident from
leaving facility against resident’s will
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 45
• Defamation– False statements that cause a
resident to be ridiculed or cause damage to their reputation• Example: slander – spoken• Example: libel – written
Legal Issues: Civil Law Examples
Of Torts(continued)
DFS Approved Curriculum-Unit 5 46
5.3.2 Identify the responsibilities of the nurse aide when a resident wishes to make a will.
DFS Approved Curriculum-Unit 5 47
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
DFS Approved Curriculum-Unit 5 49
5.4 Support the resident’s right to make personal choices to accommodate individual needs.
DFS Approved Curriculum-Unit 5 50
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
DFS Approved Curriculum-Unit 5 51
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
DFS Approved Curriculum-Unit 5 53
• The Resident’s Rights– Ethical and legal basis– Federal and state regulations– Posted in facility– Distributed on admission in many
facilities
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 54
• 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
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 55
• 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
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 56
– Examine bill and receive explanation of charges
– Be informed of any facility rules and regulations
• Residents have the right to (continued):
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 58
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
DFS Approved Curriculum-Unit 5 59
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
DFS Approved Curriculum-Unit 5 60
5.4.3 Give needed assistance in going to and participating in resident and family groups and activities.
DFS Approved Curriculum-Unit 5 61
• Help meet emotional/spiritual/social needs.
– Encourage socialization (meal-time)
– Assist to activities/meetings/church
Behavior That Maintains
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 62
• Help meet emotional/spiritual/social needs (continued)
– Participate in planned activities
– Help with phone calls, cards, mail
Behavior That Maintains
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 63
5.4.4 Maintain the resident’s environment and care through the appropriate nurse aide behavior.
DFS Approved Curriculum-Unit 5 64
• Explain care you plan to give
• Observe safety precautions
• Obtain proper consent after identifying resident
Behavior That Maintains
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 65
• Treat all residents equally
• Promote positive attitudes
• Report errors to supervisor immediately
Behavior That Maintains
Residents’ Rights(continued)
DFS Approved Curriculum-Unit 5 67
Resident Council : advisory group
• Provides opportunity for discussion• Recommendations may be made for:
– Facility policies– Decisions regarding activities– Exploration of concerns– Resolving grievances
DFS Approved Curriculum-Unit 5 68
Resident Council : advisory group
(continued)• Gives residents a voice in facility operations
• Members– residents– facility staff members (you)– representatives from
community
DFS Approved Curriculum-Unit 5 70
5.5 Administer care which maintains the residents free from abuse, mistreatment, neglect, diversion of drugs, fraud, or misappropriation of property.
DFS Approved Curriculum-Unit 5 71
Mistreatment of the Elderly
Federal and State DefinitionsAbuse means willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish.
DFS Approved Curriculum-Unit 5 72
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.
DFS Approved Curriculum-Unit 5 73
Misappropriation of property means deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a belonging or money without consent.
Mistreatment of the Elderly
Federal and State Definitions
(continued)
DFS Approved Curriculum-Unit 5 74
Diversion of drugs means the unauthorized taking or use of any drug.
Mistreatment of the Elderly
Federal and State Definitions
(continued)
DFS Approved Curriculum-Unit 5 75
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.
DFS Approved Curriculum-Unit 5 76
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.
DFS Approved Curriculum-Unit 5 77
Mistreatment of the Elderly
Resident’s Right To Be Free From Abuse• Physical
• Verbal
• Sexual
• Mental
• Corporal Punishment
• Involuntary Seclusion
DFS Approved Curriculum-Unit 5 78
Mistreatment of the Elderly
Signs of abuse• Fractures
• Bruises of face, upper arms, upper thighs, abdomen
• Fearfulness
• Withdrawn, paranoid behavior
DFS Approved Curriculum-Unit 5 79
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
DFS Approved Curriculum-Unit 5 80
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
DFS Approved Curriculum-Unit 5 81
Mistreatment of the Elderly
Examples of Abuse
(continued)• Humiliating resident• Making disparaging,
derogatory remarks• Sexual coercion• Sexual harassment• Verbal harassment
DFS Approved Curriculum-Unit 5 82
Mistreatment of the Elderly
• Identification of residents at risk for abusing other residents
– Residents with history of aggressive behavior
DFS Approved Curriculum-Unit 5 83
Mistreatment of the Elderly
• Identification of residents at risk for being abused
– noisy individuals
– wandering individuals
– philandering individuals
– socially/logistically isolated individuals
DFS Approved Curriculum-Unit 5 84
5.5.1 Report any instances of abuse to the appropriate facility/agency staff.
DFS Approved Curriculum-Unit 5 85
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
DFS Approved Curriculum-Unit 5 88
Advocates• Plead cause of another• Resolve grievances• Protect resident’s rights
DFS Approved Curriculum-Unit 5 89
Advocates(continued)
• Advocates can be:–You and your co-workers–Member of resident’s family/support
system–Resident’s guardian–Ombudsman
DFS Approved Curriculum-Unit 5 90
AdvocatesResident’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
DFS Approved Curriculum-Unit 5 91
AdvocatesFacility policy components for
resident grievance
• Acknowledgment• Prompt attempt to resolve• Resident kept apprised
DFS Approved Curriculum-Unit 5 94
Grievance Procedures
• Grievance Procedures
–Review federal grievance procedures
DFS Approved Curriculum-Unit 5 97
Residents’ Personal Possessions
• Protect personal items
• These possessions may be all they have
• Items may be impossible to replace
• Report observed thefts
DFS Approved Curriculum-Unit 5 98
Residents’ Personal Possessions(continued)
• Handle personal items carefully
• Add new items to list of resident’s belongings
• Mark all items with resident’s name