DFS Approved Curriculum-Unit 51 Nurse Aide I Course Unit 5

DFS Approved Curriculum-Unit 5 1

Nurse Aide I Course

Unit 5


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.



5.0 Define ethics.

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


Ethics• Discipline concerned with right or

wrong conduct• Guides to moral behavior• Making choices or judgments


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


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



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


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


• 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



• Resident information should be kept confidential (continued)

– Refer questions about resident’s death to supervisor

– Respect personal religious beliefs



• 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



• Put resident’s needs ahead of your own

• Be sincere, honest and trustworthy in performance of duties– caring and concerned– “golden rule”



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


• 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



• Do not accept monetary tips (continued)

– Display tactful and courteous refusal of tips

– Display continued desire to be helpful




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.


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


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



• 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


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



– Encourage resident to make choices:• select clothing to wear• select books to read• select television programs to

watch



– Encourage resident to make choices:• select food and nourishments• select activities of interest• select friends



• Guidelines for Nurse Aide (continued)

– Recognize value of past experience– Praise age appropriate

accomplishments– Encourage adult behavior



5.3 List six legal responsibilities of a nurse aide.


Legal Issues• Authorized or based on law

– Legislated by state and federal government

– Liable if laws not obeyed• Fines• Imprisonment


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


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


5.3.1 Give examples of malpractice and negligence.


Legal Issues: Civil Law Examples

Of Torts• Malpractice

– Giving care for which you are not allowed legally to do

– Providing improper care



Of Torts(continued)• Malpractice

– Example: nurse aide giving medication

– Example: nurse aide performing treatment only allowed by licensed nurses


• Negligence

– Unintentional wrong

– Failure to perform in reasonably prudent manner


Of Torts(continued)


• Negligence

– Example: brakes on a wheelchair not locked and resident falls

– Example: defective equipment not reported and resident is harmed


Of Torts(continued)


• Assault– Care or treatment without proper

consent (intentional)– Threatening to injure a resident or

co-worker


Of Torts(continued)


• Assault– Example: rough treatment of

residents during care– Example: performing procedure

resident has refused– Example: threatening to restrain

resident


Of Torts(continued)


• Battery

– Unlawful touching of another person without his or her consent


Of Torts(continued)


• Battery

– Example: nurse aide striking resident

– Example: does procedure resident refuses


Of Torts(continued)


• Battery– Get informed consent

• Written – safest• Verbal• Gesture


Of Torts(continued)


• Invasion of privacy– Unnecessary exposure of

individual– Revealing personal

information without consent


Of Torts(continued)


• Invasion of privacy– Example: giving news media

information without resident’s permission

– Example: giving information to insurance company without permission


Of Torts(continued)


• False imprisonment– Restraining an individual– Restricting resident’s freedom


Of Torts(continued)


• False imprisonment– Example: use of physical restraints

without authorization or justification– Example: preventing resident from

leaving facility against resident’s will


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


Of Torts(continued)


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


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



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


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


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


5.4.1 Describe the Resident’s Bill of Rights.


• The Resident’s Rights– Ethical and legal basis– Federal and state regulations– Posted in facility– Distributed on admission in many

facilities



• 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 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



– Examine bill and receive explanation of charges

– Be informed of any facility rules and regulations

• Residents have the right to (continued):



5.4.2 Demonstrate behavior which maintains residents’ rights.


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




• 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


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


• Help meet emotional/spiritual/social needs.

– Encourage socialization (meal-time)

– Assist to activities/meetings/church




• Help meet emotional/spiritual/social needs (continued)

– Participate in planned activities

– Help with phone calls, cards, mail




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


• Explain care you plan to give

• Observe safety precautions

• Obtain proper consent after identifying resident




• Treat all residents equally

• Promote positive attitudes

• Report errors to supervisor immediately




5.4.5 Explain the purpose and value of a Resident Council.


Resident Council : advisory group

• Provides opportunity for discussion• Recommendations may be made for:

– Facility policies– Decisions regarding activities– Exploration of concerns– Resolving grievances


Resident Council : advisory group

(continued)• Gives residents a voice in facility operations

• Members– residents– facility staff members (you)– representatives from

community



5.5 Administer care which maintains the residents free from abuse, mistreatment, neglect, diversion of drugs, fraud, or misappropriation of property.


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.



Federal and State Definitions (continued)

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


Misappropriation of property means deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a belonging or money without consent.


Federal and State Definitions

(continued)


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



(continued)




(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.




(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.



Resident’s Right To Be Free From Abuse• Physical

• Verbal

• Sexual

• Mental

• Corporal Punishment

• Involuntary Seclusion



Signs of abuse• Fractures

• Bruises of face, upper arms, upper thighs, abdomen

• Fearfulness

• Withdrawn, paranoid behavior



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



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



Examples of Abuse

(continued)• Humiliating resident• Making disparaging,

derogatory remarks• Sexual coercion• Sexual harassment• Verbal harassment



• Identification of residents at risk for abusing other residents

– Residents with history of aggressive behavior



• Identification of residents at risk for being abused

– noisy individuals

– wandering individuals

– philandering individuals

– socially/logistically isolated individuals


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


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



5.6 Assist in resolving grievances.


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


Advocates(continued)

• Advocates can be:–You and your co-workers–Member of resident’s family/support

system–Resident’s guardian–Ombudsman


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


AdvocatesFacility policy components for

resident grievance

• Acknowledgment• Prompt attempt to resolve• Resident kept apprised



5.7 Discuss key elements of Federal Grievance Procedures.


Grievance Procedures

• Grievance Procedures

–Review federal grievance procedures



5.8 Promote care and security of residents’ personal possessions.


Residents’ Personal Possessions

• Protect personal items

• These possessions may be all they have

• Items may be impossible to replace

• Report observed thefts


Residents’ Personal Possessions(continued)

• Handle personal items carefully

• Add new items to list of resident’s belongings

• Mark all items with resident’s name


Documents

DFS Approved Curriculum-Unit 51 Nurse Aide I Course Unit 5