Understanding Legal and Ethical Behavior in Healthcare

1. 1. Define the terms law and ethics and list examples of legal and ethical behavior • 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. 1. Define the terms law and ethics and list examples of legal and ethical behavior • What will each of these guidelines for legal and ethical behavior mean for an NA on the job? • 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. • Do not perform any task outside your scope of practice. • Report all resident observations and incidents to the nurse.

3. 1. Define the terms law and ethics and list examples of legal and ethical behavior Guidelines for legal and ethical behavior (cont’d): Document accurately and promptly. Follow rules on safety and infection prevention (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. 1. Define the terms law and ethics and list examples of legal and ethical behavior REMEMBER: Each NA has a responsibility to promote legal and ethical behavior in the workplace. Know what to observe and how to report any illegal activity.

5. 2. Explain the Omnibus Budget Reconciliation Act (OBRA) 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.

6. 2. Explain the Omnibus Budget Reconciliation Act (OBRA) The Omnibus Budget Reconciliation Act (OBRA) Sets minimum standards for NA training (75 hours) Requires competency exam for NAs Requires regular in-service training for NAs (12 hours annually) Establishes state registry of NAs Sets standards that instructors must meet to train NAs

7. 2. Explain the Omnibus Budget Reconciliation Act (OBRA) OBRA (cont’d) • Sets minimum staff requirements • Defines minimum services that LTCFs must provide • Establishes resident assessment requirements (MDS) • Introduced changes in survey process • Defines Residents’ Rights

8. 3. Explain Residents’ Rights and discuss why they are important 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.

9. Transparency 3-1: Residents’ Rights Residents have a legal 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 • Have access to social services

10. 3. Explain Residents’ Rights and discuss why they are important Think about this question: How can an NA promote Residents’ Rights as she does her job?

11. Handout 3-1: Decision Quiz Choices I have made today include: 1.__________________________________________ 2.__________________________________________ 3.__________________________________________ 4.__________________________________________ 5.__________________________________________ 6.__________________________________________

12. 3. Explain Residents’ Rights and discuss why they are important REMEMBER: The Americans with Disabilities Act (ADA) prohibits discrimination because of a disability. Providers of health care, including LTCFs, must provide equal opportunities, which may include making some changes to their services.

13. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: abuse purposeful mistreatment that causes physical, mental, or emotional pain or injury to someone. neglect the failure to provide needed care that results in physical, mental, or emotional harm to a person. physical abuse any treatment, intentional or not, that causes harm to a person’s body.

14. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: psychological abuse emotional harm caused by threatening, scaring, humiliating, intimidating, isolating, or insulting a person, or treating him as a child; also includes verbal abuse. verbal abuse the use of spoken or written words, pictures, or gestures that threaten, embarrass, or insult a person. sexual abuse the forcing of a person to perform or participate in sexual acts against his or her will; includes unwanted touching, exposing oneself, and the sharing of pornographic material.

15. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: financial abuse the improper or illegal use of a person’s money, possessions, property or other assets. assault a threat to harm a person, resulting in the person feeling fearful that he or she will be harmed. battery the intentional touching of a person without his or her consent.

16. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: domestic violence physical, sexual, or emotional abuse by spouses, intimate partners, or family members. workplace violence verbal, physical, or sexual abuse of staff by other staff members, residents, or visitors. false imprisonment the unlawful restraint of someone which affects the person’s freedom of movement; includes both the threat of being physically restrained and actually being physically restrained.

17. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: involuntary seclusion the separation of a person from others against the person’s will. sexual harrassment any unwelcome sexual advance or behavior that creates an intimidating, hostile, or offensive working environment. substance abuse the repeated use of legal or illegal drugs, cigarettes, or alcohol in a way that is harmful to oneself or others.

18. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: active neglect the purposeful failure to provide needed care, resulting in harm to a person. passive neglect the unintentional failure to provide needed care, resulting in physical, mental, or emotional harm to a person. negligence actions, or the failure to act or provide the proper care, that result in unintended injury to a person.

19. 4. Discuss abuse and neglect and explain how to report abuse and neglect Define the following terms: malpractice injury to a person due to professional misconduct through negligence, carelessness, or lack of skill. 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 care facilities.

20. Transparency 3-2: Suspicious Injuries The following injuries are considered suspicious and should be reported: Poisoning or traumatic injury Teeth marks Belt buckle or strap marks Bruises, contusions, or welts Scars Fractures, dislocation Burns of unusual shape and in unusual locations, cigarette burns Scalding burns Scratches and puncture wounds Scalp tenderness and patches of missing hair Swelling in the face, broken teeth, nasal discharge Bruises, bleeding, or discharge from the vaginal area

21. 4. Discuss abuse and neglect and explain how to report abuse and neglect Think about this question: Why might NAs notice suspicious injuries that other members of the care team don’t see?

22. Transparency 3-3: Signs of Abuse Signs that could indicate abuse include the following: Yelling obscenities Fear, apprehension, fear of being alone Poor self-control Constant pain Threatening to hurt others Withdrawal or apathy Alcohol or drug abuse Agitation or anxiety, signs of stress Low self-esteem Mood changes, confusion, disorientation Private conversations are not allowed, or the family member/caregiver is present during all conversations Resident or family reports of questionable care

23. 4. Discuss abuse and neglect and explain how to report abuse and neglect Think about this question: What should an NA do if he sees signs of abuse?

24. Transparency 3-4: Signs of Neglect Signs that could indicate neglect include the following: Pressure ulcers Body not clean Body lice Unanswered call lights Soiled bedding or incontinence briefs not being changed Poorly-fitting clothing Unmet needs relating to hearing aids, eyeglasses, etc. Weight loss, poor appetite Uneaten food Dehydration Fresh water or beverages not being offered regularly

25. 4. Discuss abuse and neglect and explain how to report abuse and neglect Think about these questions: What might happen in a facility to cause neglect of a resident? What might happen in the home to cause neglect of client (by family or by home care staff)? How can neglect be prevented?

26. Handout 3-2: Who Is Vulnerable to Abuse or Neglect?

27. Handout 3-2: Who Is Vulnerable to Abuse or Neglect? • Some people are more vulnerable to adult abuse or neglect than others. They include: • • Elderly • • Physically ill or disabled • • Developmentally disabled • • Mentally ill or disabled • • People with communication problems, such as hearing, speech, and vision • All of these people have a few things in common that make them so vulnerable. They are often unable to stand up for themselves, or report abuse or neglect to others. They may not even understand that they have rights. Often these people can be much more demanding to care for, which increases the stress that caregivers have to deal with. • Caregivers may not have been properly trained to care for these particular people, and they may not understand why these people behave the way they do. Caregivers may also be overworked, tired, stressed, and unappreciated, all while caring for someone who requires so much time and energy. • These are the people who most need your help in protecting themselves. They may not be able to speak for themselves, but the signs of abuse and neglect may speak volumes for them, if you just know how to recognize these signs.

28. 4. Discuss abuse and neglect and explain how to report abuse and neglect Think about this question: Why are these people so vulnerable?

29. 4. Discuss abuse and neglect and explain how to report abuse and neglect Consider these ways in which people may be vulnerable to abuse: Older people may be unable to stand up for themselves. Older people may be unable to report abuse or neglect to others. Older people may not understand that they have rights. Older people may be much more demanding to care for. Caregivers may not be trained properly. Caregivers may not understand their behavior. Caregivers may be overworked, tired, stressed, and unappreciated, on top of caring for someone who requires so much time and energy.

30. 4. Discuss abuse and neglect and explain how to report abuse and neglect Think about this question: How can NAs help protect those who are vulnerable to abuse and neglect?

31. 4. Discuss abuse and neglect and explain how to report abuse and neglect REMEMBER: An NA must never abuse residents in any way, and must try to protect residents from others who abuse them. Reporting abuse is not an option - it is the law.

32. 4. Discuss abuse and neglect and explain how to report abuse and neglect REMEMBER: Follow the chain of command when reporting abuse.

33. 4. Discuss abuse and neglect and explain how to report abuse and neglect In addition to federal laws relating to Residents’ Rights, which forbid abuse and neglect, there are other legal protections designed to help elders and other vulnerable adults: Some states have Vulnerable Adults Acts or Adult Protective Services laws. The Elder Justice Act of 2010 is the first federal law designed specifically to combat elder abuse.

34. 5. List examples of behavior supporting and promoting Residents’ Rights Think about this question: What are some specific examples of ways NAs can promote Residents’ Rights?

35. 6. Describe what happens when a complaint of abuse is made against a nursing assistant Remember these points about 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

36. 6. Describe what happens when a complaint of abuse is made against a nursing assistant REMEMBER: If it is determined that an NA has abused a resident, NATCEP will place that NA on an abuse registry. Any potential employer will be told of the abuse.

37. 7. Explain how disputes may be resolved and identify the ombudsman’s role Define the following term: ombudsman a legal advocate for residents in long-term care facilities; helps resolve disputes and settle conflicts.

38. 7. Explain how disputes may be resolved and identify the ombudsman’s role The following are typical tasks for an ombudsman: Advocates for residents’ rights Educates consumers and care providers Investigates and resolves complaints Appears in court Works with investigators Gives information to public

39. 8. Explain HIPAA and list ways to protect residents’ privacy Define the following term: confidentiality the legal and ethical principle of keeping information private.

40. 8. Explain HIPAA and list ways to protect residents’ privacy REMEMBER: HIPAA applies to all healthcare providers, and penalties can be serious if violations occur.

41. 8. Explain HIPAA and list ways to protect residents’ privacy Think about these questions: How might breaches of confidentiality happen? How could they be prevented?

42. 9. Explain the Patient Self-Determination Act (PSDA) and discuss advance directives Define the following terms: advance directives legal documents that allow people to choose what medical care they wish to have if they are unable to make those decisions themselves. living will a document that outlines the medical care a person wants, or does not want, in case he or she becomes unable to make those decisions.

43. 9. Explain the Patient Self-Determination Act (PSDA) and discuss advance directives Define the following terms: durable power of attorney for health care a signed, dated, and witnessed legal document 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 a type of advance directive that instructs medical professionals not to perform CPR if a person’s heartbeat or breathing stops.

44. 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 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?

45. 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 healthcare 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

46. Exam Multiple Choice. Choose the correct answer. _____ have to do with the knowledge of right and wrong. (A) Laws (B) Ethics (C) Advance directives Living wills An example of ethical behavior by a nursing assistant (NA) is (A) Protecting a resident’s privacy (B) Changing the care plan if the NA believes it is inappropriate for a resident (C) Performing a task outside her scope of practice when a resident requests that she do so (D) Accepting a gift from a resident for a job well done

47. Exam OBRA was passed as a response to (A) Lack of funding for long-term care facilities (B) Reports of poor care and abuse in long-term care facilities (C) Nursing assistants being unable to pass competency exams (D) Staff members not reporting to work on time How many hours of training does OBRA require for nursing assistants? (A) At least 50 hours (B) At least 75 hours (C) At least 100 hours (D) At least 120 hours

48. Exam How many hours of in-service education does OBRA require for nursing assistants every year? (A) At least 34 hours (B) At least 28 hours (C) At least 18 hours (D) At least 12 hours A nursing assistant tells a resident that her grandchildren are noisy and disrupt the facility and suggests that next time her daughter visits, she should leave the kids at home. Which Residents’ Right might this behavior violate? (A) The right to voice complaints without fear of punishment (B) The right to refuse medication and treatment (C) The right to have visitors (D) The right to confidentiality

49. Exam Which of the following terms means harming a person physically, mentally, or emotionally by failing to provide needed care? (A) Neglect (B) Assault (C) Battery Abuse Which of the following terms means to steal, take advantage of, or improperly use the money, property, or other assets of another person? (A) Substance abuse (B) Financial abuse (C) Verbal abuse (D) Sexual abuse

50. Exam Which of the following is an example of sexual abuse? (A) Rubbing up against a resident inappropriately (B) Confining a resident in a separate physical space without the resident’s consent (C) Using alcohol in a harmful way (D) Failing to provide needed care for a resident Which of the following is an example of physical abuse? (A) Stealing from a resident (B) Showing a resident pornographic material (C) Shoving a resident (D) Threatening a resident