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

2. DFS Approved Curriculum-Unit 52 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.

3. DFS Approved Curriculum-Unit 53

4. 4 5.0Define ethics. 5.1List at least six basic rules of ethics for the nurse aide.

5. DFS Approved Curriculum-Unit 55 Ethics Discipline concerned with right or wrong conduct Guides to moral behavior Making choices or judgments

6. DFS Approved Curriculum-Unit 56 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

7. DFS Approved Curriculum-Unit 57 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

8. DFS Approved Curriculum-Unit 58 Nurse Aide Ethical Standards (continued) Be responsible citizen at all times –Respect others –Respect values that differ from yours

9. DFS Approved Curriculum-Unit 59 5.1.2Identify the kind of information that should be kept confidential.

10. DFS Approved Curriculum-Unit 510 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)

11. DFS Approved Curriculum-Unit 511 Resident information should be kept confidential (continued) –Refer questions about resident’s death to supervisor –Respect personal religious beliefs Nurse Aide Ethical Standards (continued)

12. DFS Approved Curriculum-Unit 512 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)

13. DFS Approved Curriculum-Unit 513 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)

14. DFS Approved Curriculum-Unit 514 5.1.3Explain why nurse aides should not accept monetary tips for a health care service.

15. DFS Approved Curriculum-Unit 515 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)

16. DFS Approved Curriculum-Unit 516 Do not accept monetary tips (continued) –Display tactful and courteous refusal of tips –Display continued desire to be helpful Nurse Aide Ethical Standards (continued)

17. DFS Approved Curriculum-Unit 517

18. DFS Approved Curriculum-Unit 518 5.2Demonstrate skills supporting age appropriate behavior by encouraging the resident to make personal choices, and by providing and reinforcing other resident’s dignity.

19. DFS Approved Curriculum-Unit 519 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

20. DFS Approved Curriculum-Unit 520 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

21. DFS Approved Curriculum-Unit 521 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

22. DFS Approved Curriculum-Unit 522 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

23. DFS Approved Curriculum-Unit 523 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

24. DFS Approved Curriculum-Unit 524 Age Appropriate Behavior (continued) Guidelines for Nurse Aide (continued) –Encourage resident to make choices: select food and nourishments select activities of interest select friends

25. DFS Approved Curriculum-Unit 525 Age Appropriate Behavior (continued) Guidelines for Nurse Aide (continued) –Recognize value of past experience –Praise age appropriate accomplishments –Encourage adult behavior

26. DFS Approved Curriculum-Unit 526

27. DFS Approved Curriculum-Unit 527 5.3List six legal responsibilities of a nurse aide.

28. DFS Approved Curriculum-Unit 528 Legal Issues Authorized or based on law –Legislated by state and federal government –Liable if laws not obeyed Fines Imprisonment

29. DFS Approved Curriculum-Unit 529 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

30. DFS Approved Curriculum-Unit 530 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

31. DFS Approved Curriculum-Unit 531 5.3.1Give examples of malpractice and negligence.

32. DFS Approved Curriculum-Unit 532 Legal Issues: Civil Law Examples Of Torts Malpractice –Giving care for which you are not allowed legally to do –Providing improper care

33. DFS Approved Curriculum-Unit 533 Legal Issues: Civil Law Examples Of Torts (continued) Malpractice –Example: nurse aide giving medication –Example: nurse aide performing treatment only allowed by licensed nurses

34. DFS Approved Curriculum-Unit 534 Negligence –Unintentional wrong –Failure to perform in reasonably prudent manner Legal Issues: Civil Law Examples Of Torts (continued)

35. DFS Approved Curriculum-Unit 535 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)

36. DFS Approved Curriculum-Unit 536 Assault –Care or treatment without proper consent (intentional) –Threatening to injure a resident or co-worker Legal Issues: Civil Law Examples Of Torts (continued)

37. DFS Approved Curriculum-Unit 537 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)

38. DFS Approved Curriculum-Unit 538 Battery –Unlawful touching of another person without his or her consent Legal Issues: Civil Law Examples Of Torts (continued)

39. DFS Approved Curriculum-Unit 539 Battery –Example: nurse aide striking resident –Example: does procedure resident refuses Legal Issues: Civil Law Examples Of Torts (continued)

40. DFS Approved Curriculum-Unit 540 Battery –Get informed consent Written – safest Verbal Gesture Legal Issues: Civil Law Examples Of Torts (continued)

41. DFS Approved Curriculum-Unit 541 Invasion of privacy –Unnecessary exposure of individual –Revealing personal information without consent Legal Issues: Civil Law Examples Of Torts (continued)

42. DFS Approved Curriculum-Unit 542 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)

43. DFS Approved Curriculum-Unit 543 False imprisonment –Restraining an individual –Restricting resident’s freedom Legal Issues: Civil Law Examples Of Torts (continued)

44. DFS Approved Curriculum-Unit 544 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)

45. DFS Approved Curriculum-Unit 545 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)

46. DFS Approved Curriculum-Unit 546 5.3.2Identify the responsibilities of the nurse aide when a resident wishes to make a will.

47. DFS Approved Curriculum-Unit 547 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

48. DFS Approved Curriculum-Unit 548

49. DFS Approved Curriculum-Unit 549 5.4Support the resident’s right to make personal choices to accommodate individual needs.

50. DFS Approved Curriculum-Unit 550 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

51. DFS Approved Curriculum-Unit 551 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

52. DFS Approved Curriculum-Unit 552 5.4.1Describe the Resident’s Bill of Rights.

53. DFS Approved Curriculum-Unit 553 The Resident’s Rights –Ethical and legal basis –Federal and state regulations –Posted in facility –Distributed on admission in many facilities Residents’ Rights (continued)

54. DFS Approved Curriculum-Unit 554 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)

55. DFS Approved Curriculum-Unit 555 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)

56. DFS Approved Curriculum-Unit 556 –Examine bill and receive explanation of charges –Be informed of any facility rules and regulations Residents have the right to (continued) : Residents’ Rights (continued)

57. DFS Approved Curriculum-Unit 557 5.4.2Demonstrate behavior which maintains residents’ rights.

58. DFS Approved Curriculum-Unit 558 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

59. DFS Approved Curriculum-Unit 559 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

60. DFS Approved Curriculum-Unit 560 5.4.3Give needed assistance in going to and participating in resident and family groups and activities.

61. DFS Approved Curriculum-Unit 561 Help meet emotional/spiritual/social needs. –Encourage socialization (meal-time) –Assist to activities/meetings/church Behavior That Maintains Residents’ Rights (continued)

62. DFS Approved Curriculum-Unit 562 Help meet emotional/spiritual/social needs (continued) –Participate in planned activities –Help with phone calls, cards, mail Behavior That Maintains Residents’ Rights (continued)

63. DFS Approved Curriculum-Unit 563 5.4.4Maintain the resident’s environment and care through the appropriate nurse aide behavior.

64. DFS Approved Curriculum-Unit 564 Explain care you plan to give Observe safety precautions Obtain proper consent after identifying resident Behavior That Maintains Residents’ Rights (continued)

65. DFS Approved Curriculum-Unit 565 Treat all residents equally Promote positive attitudes Report errors to supervisor immediately Behavior That Maintains Residents’ Rights (continued)

66. DFS Approved Curriculum-Unit 566 5.4.5Explain the purpose and value of a Resident Council.

67. DFS Approved Curriculum-Unit 567 Resident Council : advisory group Provides opportunity for discussion Recommendations may be made for: –Facility policies –Decisions regarding activities –Exploration of concerns –Resolving grievances

68. DFS Approved Curriculum-Unit 568 Resident Council : advisory group (continued) Gives residents a voice in facility operations Members –residents –facility staff members (you) –representatives from community

69. DFS Approved Curriculum-Unit 569

70. DFS Approved Curriculum-Unit 570 5.5Administer care which maintains the residents free from abuse, mistreatment, neglect, diversion of drugs, fraud, or misappropriation of property.

71. DFS Approved Curriculum-Unit 571 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.

72. DFS Approved Curriculum-Unit 572 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.

73. DFS Approved Curriculum-Unit 573 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)

74. DFS Approved Curriculum-Unit 574 Diversion of drugs means the unauthorized taking or use of any drug. Mistreatment of the Elderly Federal and State Definitions (continued)

75. DFS Approved Curriculum-Unit 575 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.

76. DFS Approved Curriculum-Unit 576 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.

77. DFS Approved Curriculum-Unit 577 Mistreatment of the Elderly Resident’s Right To Be Free From Abuse Physical Verbal Sexual Mental Corporal Punishment Involuntary Seclusion

78. DFS Approved Curriculum-Unit 578 Mistreatment of the Elderly Signs of abuse Fractures Bruises of face, upper arms, upper thighs, abdomen Fearfulness Withdrawn, paranoid behavior

79. DFS Approved Curriculum-Unit 579 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

80. DFS Approved Curriculum-Unit 580 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

81. DFS Approved Curriculum-Unit 581 Mistreatment of the Elderly Examples of Abuse (continued) Humiliating resident Making disparaging, derogatory remarks Sexual coercion Sexual harassment Verbal harassment

82. DFS Approved Curriculum-Unit 582 Mistreatment of the Elderly Identification of residents at risk for abusing other residents –Residents with history of aggressive behavior

83. DFS Approved Curriculum-Unit 583 Mistreatment of the Elderly Identification of residents at risk for being abused –noisy individuals –wandering individuals –philandering individuals –socially/logistically isolated individuals

84. DFS Approved Curriculum-Unit 584 5.5.1Report any instances of abuse to the appropriate facility/agency staff.

85. DFS Approved Curriculum-Unit 585 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

86. DFS Approved Curriculum-Unit 586

87. DFS Approved Curriculum-Unit 587 5.6Assist in resolving grievances.

88. DFS Approved Curriculum-Unit 588 Advocates Plead cause of another Resolve grievances Protect resident’s rights

89. DFS Approved Curriculum-Unit 589 Advocates (continued) Advocates can be: –You and your co-workers –Member of resident’s family/support system –Resident’s guardian –Ombudsman

90. DFS Approved Curriculum-Unit 590 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

91. DFS Approved Curriculum-Unit 591 Advocates Facility policy components for resident grievance Acknowledgment Prompt attempt to resolve Resident kept apprised

92. DFS Approved Curriculum-Unit 592

93. DFS Approved Curriculum-Unit 593 5.7Discuss key elements of Federal Grievance Procedures.

94. DFS Approved Curriculum-Unit 594 Grievance Procedures –Review federal grievance procedures

95. DFS Approved Curriculum-Unit 595

96. DFS Approved Curriculum-Unit 596 5.8Promote care and security of residents’ personal possessions.

97. DFS Approved Curriculum-Unit 597 Residents’ Personal Possessions Protect personal items These possessions may be all they have Items may be impossible to replace Report observed thefts

98. DFS Approved Curriculum-Unit 598 Residents’ Personal Possessions (continued) Handle personal items carefully Add new items to list of resident’s belongings Mark all items with resident’s name

99. DFS Approved Curriculum-Unit 599