1. 3 Legal and Ethical Issues Define the following terms: Ethics the knowledge of right and wrong. Laws rules set by the government to help people live peacefully together and to ensure order and safety.

2. 3 Legal and Ethical Issues 1. Define the terms “law” and “ethics” and list examples of legal and ethical behavior How will these guidelines for legal and ethical behavior influence how you do your job as an NA? Be honest at all times. Protect residents’ privacy. Keep staff information confidential. Report abuse or suspected abuse of residents, and assist residents in reporting abuse if they wish to do so. Follow the care plan and your assignments.

3. 3 Legal and Ethical Issues 1. Define the terms “law” and “ethics” and list examples of legal and ethical behavior Legal and ethical guidelines (cont’d.): Do not perform any task outside your scope of practice. Report all resident observations and incidents to the nurse. Document accurately and promptly. Follow rules on safety and infection control (outlined in Chapters 5 and 6). Do not accept gifts or tips. Do not get personally or sexually involved with residents or their family members or friends.

4. 3 Legal and Ethical Issues Define the following terms: Omnibus Budget Reconciliation Act (OBRA) law passed by the federal government that includes minimum standards for nursing assistant training, staffing requirements, resident assessment instructions, and information on rights for residents. Minimum Data Set (MDS) a detailed form with guidelines for assessing residents in long-term care facilities; also details what to do if resident problems are identified.

5. 3 Legal and Ethical Issues 2. Explain the Omnibus Budget Reconciliation Act (OBRA) OBRA established the following: Set minimum standards for NA training Regular in-services for NAs State registry of NAs Increased minimum staff requirements Resident assessment requirements (MDS) Changes in survey process Residents’ rights

6. 3 Legal and Ethical Issues Define the following terms: Residents’ rights numerous rights identified in the OBRA law that relate to how residents must be treated while living in a facility; they provide an ethical code of conduct for healthcare workers. Informed consent the process in which a person, with the help of a doctor, makes informed decisions about his or her health care.

7. 3 Legal and Ethical Issues Transparency 3-1: Residents’ Rights Residents have a right to: Quality of life Services and activities to maintain a high level of wellness Be fully informed regarding rights and services Participate in their own care Make independent choices Privacy and confidentiality Dignity, respect, and freedom Security of possessions Be informed of and consent to transfers and discharges Voice complaints Have visits

8. 3 Legal and Ethical Issues 3. Explain residents’ rights and discuss why they are important REMEMBER: Making decisions about our own lives is a very important part of being an adult. It helps us feel capable and less like children. Residents’ rights guarantee that residents can continue to make many decisions about their own lives.

9. 3 Legal and Ethical Issues Define the following terms: Neglect harming a person physically, mentally, or emotionally by failing to provide needed care. Active neglect purposely harming a person by failing to provide needed care. Passive neglect unintentionally harming a person physically, mentally, or emotionally by failing to provide needed care.

10. 3 Legal and Ethical Issues Define the following terms: Negligence actions, or the failure to act or provide the proper care, that result in unintended injury to a person. Malpractice injury to a person due to professional misconduct through negligence, carelessness, or lack of skill. Abuse purposely causing physical, mental, or emotional pain or injury to someone.

11. 3 Legal and Ethical Issues Define the following terms: Physical abuse any treatment, intentional or not, that causes harm to a person’s body; includes slapping, bruising, cutting, burning, physically restraining, pushing, shoving, or even rough handling. Psychological abuse any behavior that causes a person to feel threatened, fearful, intimidated, or humiliated in any way; includes verbal abuse, social isolation, and seclusion. Verbal abuse the use of language—spoken or written—that threatens, embarrasses, or insults a person.

12. 3 Legal and Ethical Issues Define the following terms: Assault the act of threatening to touch a person without his or her permission. Battery touching a person without his or her permission. Sexual abuse forcing a person to perform or participate in sexual acts against his or her will; includes unwanted touching, exposing oneself, and sharing pornographic material.

13. 3 Legal and Ethical Issues Define the following terms: Financial abuse the act of stealing, taking advantage of, or improperly using the money, property, or other assets of another person. Domestic violence physical, sexual, or emotional abuse by spouses, intimate partners, or family members. Workplace violence verbal, physical, or sexual abuse of staff by residents or other staff members. Involuntary seclusion separating a person from others against the person’s will.

14. 3 Legal and Ethical Issues Define the following terms: Sexual harassment any unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment; includes requests for sexual favors, unwanted touching, and other acts of a sexual nature. Substance abuse the use of legal or illegal drugs, cigarettes, or alcohol in a way that is harmful to the abuser or to others. Mandated reporters people who are legally required to report suspected or observed abuse or neglect because they have regular contact with vulnerable populations, such as the elderly in facilities.

15. 3 Legal and Ethical Issues Transparency 3-2: Suspicious Injuries

16. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect Observe and report these signs and symptoms of abuse: Yelling obscenities Fear, afraid to be alone Poor self-control Constant pain Threatening to hurt others Withdrawal or apathy

17. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect Signs and symptoms of abuse (cont’d.): Alcohol or drug abuse Anxiety, stress Low self-esteem Mood changes, confusion, disorientation Private conversations not allowed, or family member/caregiver is present during all conversations Resident reports of questionable care

18. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect Observe and report these signs of neglect: Pressure sores Unclean body Body lice Unanswered call lights Soiled bedding or incontinence briefs not being changed Poorly-fitting clothing

19. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect Signs of neglect (cont’d.): Refusal of care Unmet needs relating to hearing aids, eyeglasses, etc. Weight loss Poor appetite Dehydration No fresh water or beverages

20. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect After reading Handout 3-2, think about this question: Why are these people so vulnerable?

21. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect REMEMBER: NAs must never abuse residents in any way, and must try to protect residents from others who abuse them.

22. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect Think about these questions: How are residents’ rights related to abuse? What action should the NA take if abuse is seen or suspected?

23. 3 Legal and Ethical Issues 4. Discuss abuse and neglect and explain how to report abuse and neglect REMEMBER: Reporting abuse is not an option—it is the law. NAs must follow the chain of command when reporting abuse.

24. 3 Legal and Ethical Issues 5. List examples of behavior supporting and promoting residents’ rights Think about this question: How can NAs support and promote residents’ rights?

25. 3 Legal and Ethical Issues 6. Describe what happens when a complaint of abuse is made against a nursing assistant The Nurse Aide Training Competency Evaluation Program (NATCEP): Makes rules about training and testing NAs State programs make sure federal rules are followed in facilities that receive Medicare/Medicaid payments Sets up and runs registry, which keeps track of each NA working in the state Investigates charges of abuse

26. 3 Legal and Ethical Issues 6. Describe what happens when a complaint of abuse is made against a nursing assistant REMEMBER: If ever it is determined that an NA has abused a resident, NATCEP will place that NA on an abuse registry and any potential employer will be told of the abuse.

27. 3 Legal and Ethical Issues Define the following term: Ombudsman the legal advocate for residents; helps resolve disputes and settle conflicts.

28. 3 Legal and Ethical Issues 7. Explain how disputes may be resolved and identify the ombudsman’s role An ombudsman may Advocate for residents’ rights Educate consumers and care providers Investigate and resolves complaints Appear in court Work with investigators Give information to public

29. 3 Legal and Ethical Issues Define the following terms: Confidentiality the legal and ethical principle of keeping information private. Protected health information (PHI) a person’s private health information, which includes name, address, telephone number, social security number, e-mail address, and medical record number.

30. 3 Legal and Ethical Issues 8. Explain HIPAA and list ways to protect residents’ privacy REMEMBER: HIPAA applies to all healthcare providers. Penalties may be imposed for not adhering to HIPAA.

31. 3 Legal and Ethical Issues 8. Explain HIPAA and list ways to protect residents’ privacy Look at the guidelines for protecting residents’ privacy found on pages 30-31 in the textbook, then think about this question: Can you think of any other ways that breaches in confidentiality may occur and how to prevent them?

32. 3 Legal and Ethical Issues Define the following terms: Advance directives legal documents that allow people to choose what medical care they wish to have if they cannot make those decisions themselves. Living will a document that states the medical care a person wants, or does not want, in case he or she becomes unable to make those decisions for him- or herself.

33. 3 Legal and Ethical Issues Define the following terms: Durable power of attorney for health care a signed, dated, and witnessed paper that appoints someone else to make the medical decisions for a person in the event he or she becomes unable to do so. Do-not-resuscitate (DNR) order an order that tells medical professionals not to perform CPR.

34. 3 Legal and Ethical Issues 9. Explain the Patient Self-Determination Act (PSDA) and discuss advance directives Think about these questions: Why do you think it might be important to plan out what kind of medical care you want or do not want? How do you feel personally about a DNR order? Why do you think rights relating to advance directives are so important?

35. 3 Legal and Ethical Issues 9. Explain the Patient Self-Determination Act (PSDA) and discuss advance directives According to the PSDA, the following rights must be communicated to residents at the time of admission: The right to participate in and direct health-care decisions The right to accept or refuse treatment The right to prepare an advance directive Information on the facility’s policies that govern these rights