1. Chapter 4 Ethics and Laws Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. Introduction  The following serve to protect patients and residents from harm:  Nurse practice acts  Your training and job description  Safe delegation  A complex set of rules and standards of conduct Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 2

3. Ethical Aspects  Ethics is knowledge of what is right conduct and wrong conduct.  Morals are involved.  It deals with choices or judgments about what should or should not be done.  Ethical behavior involves not being prejudiced or biased.  Ethical problems involve making choices.  Professional groups have codes of ethics. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 3

4. Ethical Aspects (cont’d)  Boundaries  Professional boundaries separate helpful behaviors from behaviors that are not helpful. The following can occur when you are over- involved or under-involved with the person. Boundary crossing—A brief act or behavior outside of the helpful zone Boundary crossing—A brief act or behavior outside of the helpful zone Boundary violation—An act or behavior that meets your needs, not the person’s needs Boundary violation—An act or behavior that meets your needs, not the person’s needs Professional sexual misconduct—An act, behavior, or comment that is sexual in nature Professional sexual misconduct—An act, behavior, or comment that is sexual in nature Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 4

5. Ethical Aspects (cont’d)  Boundary signs are acts, behaviors, or thoughts that warn of a boundary crossing or violation. Be alert to these signs. Be alert to these signs. Some violations and some types of sexual misconduct also are crimes. Some violations and some types of sexual misconduct also are crimes. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 5

6. Legal Aspects  Ethics  What you should or should not do  Laws  Tell you what you can and cannot do  A law is a rule of conduct made by a government body. Criminal—generally offenses against the public and society Criminal—generally offenses against the public and society Civil—concerned with relationships between people Civil—concerned with relationships between people Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 6

7. Legal Aspects (cont’d)  Torts  A wrong committed against a person or the person’s property Part of civil law Part of civil law Unintentional—harm was not intended Unintentional—harm was not intended Intentional—harm was intended Intentional—harm was intended Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 7

8. Legal Aspects (cont’d)  Unintentional tort Negligence Negligence  Malpractice is negligence by a professional person.  Intentional tort Defamation—injuring a person’s name and reputation by making false statements Defamation—injuring a person’s name and reputation by making false statements  Libel—made in print  Slander—made orally Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 8

9. Legal Aspects (cont’d)  Intentional torts (cont’d) False imprisonment—unlawful restraint or restriction of a person’s freedom of movement False imprisonment—unlawful restraint or restriction of a person’s freedom of movement Invasion of privacy—private affairs exposed or made public without consent Invasion of privacy—private affairs exposed or made public without consent  Health Insurance Portability and Accountability Act of 1996 (HIPAA) Fraud—saying or doing something to trick, fool, or deceive a person Fraud—saying or doing something to trick, fool, or deceive a person Assault and battery—may result in both civil and criminal charges Assault and battery—may result in both civil and criminal charges Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 9

10. Legal Aspects (cont’d)  Informed consent  Consent is informed when the person clearly understands: Reason for treatment, procedure, or care measure Reason for treatment, procedure, or care measure What will be done What will be done How it will be done How it will be done Who will do it Who will do it The expected outcomes The expected outcomes Other treatment, procedure, or care options Other treatment, procedure, or care options The effects of not having the treatment, procedure, or care measure The effects of not having the treatment, procedure, or care measure Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 10

11. Legal Aspects (cont’d)  Wills  You can ethically and legally witness the signing of a will.  You can refuse to witness the signing of a will.  You must politely refuse to prepare a will.  Know your agency’s policy before you agree to witness a will.  If you have questions, ask the nurse. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 11

12. Reporting Abuse  Elements of abuse  Willful infliction of injury  Unreasonable confinement  Intimidation  Punishment  Depriving the person (or the person’s caregiver) of the goods or services needed to attain or maintain well-being  Involuntary seclusion Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 12

13. Reporting Abuse (cont’d)  Abuse is a crime.  It can occur at home or in a health care agency.  All persons must be protected including those in a coma.  The abuser is usually a family member or caregiver.  Both men and women are abusers.  Both men and women are abused.  Many states, accrediting agencies, and OBRA do not allow agencies to employ persons who were convicted of abuse, neglect, or mistreatment. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 13

14. Reporting Abuse (cont’d)  Vulnerable adults  Persons 18 years old or older who have disabilities or conditions that make them at risk to be wounded, attacked, or damaged  They have problems caring for or protecting themselves due to: A mental, emotional, physical, or developmental disability A mental, emotional, physical, or developmental disability Brain damage Brain damage Changes from aging Changes from aging Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 14

15. Reporting Abuse (cont’d)  Elder abuse—any knowing, intentional, or negligent act by a caregiver or any other person to an older adult  Forms of elder abuse Physical abuseNeglect Physical abuseNeglect Verbal abuseInvoluntary seclusion Verbal abuseInvoluntary seclusion Emotional or mental abuseSexual abuse Emotional or mental abuseSexual abuse Abandonment Abandonment Financial exploitation or misappropriation Financial exploitation or misappropriation  Federal and state laws require the reporting of elder abuse. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 15

16. Reporting Abuse (cont’d)  Child abuse and neglect  May involve the following: A child 18 years old or younger A child 18 years old or younger Any recent act or failure to act on the part of a parent or caregiver Any recent act or failure to act on the part of a parent or caregiver The act or failure to act results in death, serious physical or emotional harm, sexual abuse, or exploitation. The act or failure to act results in death, serious physical or emotional harm, sexual abuse, or exploitation. The act or failure to act presents a likely or immediate risk for harm. The act or failure to act presents a likely or immediate risk for harm. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 16

17. Reporting Abuse (cont’d)  Types of child abuse and neglect Physical abuse Physical abuse Physical or emotional neglect Physical or emotional neglect Sexual abuse Sexual abuse  Rape or sexual assault  Molestation  Incest  Child pornography  Child prostitution Emotional abuse Emotional abuse Substance abuse Substance abuse Abandonment Abandonment Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 17

18. Reporting Abuse (cont’d)  Report any changes in the child’s body or behavior. Child and parent behaviors may signal a problem. Child and parent behaviors may signal a problem. The child may be quiet and withdrawn. The child may be quiet and withdrawn. The child may fear adults. The child may fear adults. Sometimes children are afraid to go home. Sometimes children are afraid to go home. Sudden behavior changes are common. Sudden behavior changes are common.  Bed-wetting, thumb-sucking, loss of appetite, poor grades, running away Some children attempt suicide. Some children attempt suicide. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 18

19. Reporting Abuse (cont’d)  Child abuse is complex. Parents give different stories about what happened. Parents give different stories about what happened. Frequent emergency room visits are common. Frequent emergency room visits are common.  All states require the reporting of suspected child abuse. If you suspect child abuse, share your concerns with the nurse. If you suspect child abuse, share your concerns with the nurse. Give as much detail as you can. Give as much detail as you can. Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 19

20. Reporting Abuse (cont’d)  Domestic abuse (domestic violence) occurs in relationships.  One partner has power and control over the other through abuse.  Abuse may be physical, sexual, verbal, economic, or social.  Usually more than one type of abuse is present.  Patients and residents can suffer from domestic abuse.  State laws vary about reporting domestic abuse.  If you suspect domestic abuse, share your concerns with the nurse. Slide 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.