3 Legal and Ethical Issues Define the following terms: Ethics the knowledge of right and wrong. Laws...

3Legal and Ethical Issues

Define the following terms:

Ethicsthe knowledge of right and wrong.

Lawsrules set by the government to help people live peacefully together and to ensure order and safety.

3Legal and Ethical Issues1. 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.

3Legal and Ethical Issues1. 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.



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.


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



Residents’ rightsnumerous 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 consentthe process in which a person, with the help of a doctor, makes informed decisions about his or her health care.

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


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.



Neglect harming a person physically, mentally, or emotionally by failing to provide needed care.

Active neglectpurposely harming a person by failing to provide needed care.

Passive neglectunintentionally harming a person physically, mentally, or emotionally by failing to provide needed care.



Negligenceactions, or the failure to act or provide the proper care, that result in unintended injury to a person.

Malpracticeinjury to a person due to professional misconduct through negligence, carelessness, or lack of skill.

Abusepurposely causing physical, mental, or emotional pain or injury to someone.


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.



Assaultthe act of threatening to touch a person without his or her permission.

Batterytouching a person without his or her permission.

Sexual abuseforcing a person to perform or participate in sexual acts against his or her will; includes unwanted touching, exposing oneself, and sharing pornographic material.


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.


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 reporterspeople 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.

3 Legal and Ethical Issues

Transparency 3-2: Suspicious Injuries

3Legal and Ethical Issues4. 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


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


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


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


After reading Handout 3-2, think about this question:Why are these people so vulnerable?


REMEMBER:NAs must never abuse residents in any way, and must try to protect residents from others who abuse them.


Think about these questions:• How are residents’ rights related to abuse? • What action should the NA take if abuse is seen or suspected?


REMEMBER:• Reporting abuse is not an option—it is the law. • NAs must follow the chain of command when reporting abuse.

3Legal and Ethical Issues5. List examples of behavior supporting and promoting residents’ rights

Think about this question:How can NAs support and promote residents’ rights?

3Legal and Ethical Issues6. 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

3Legal and Ethical Issues6. 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.


Define the following term:

Ombudsmanthe legal advocate for residents; helps resolve disputes and settle conflicts.

3Legal and Ethical Issues7. 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



Confidentialitythe 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.


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.


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?



Advance directiveslegal documents that allow people to choose what medical care they wish to have if they cannot make those decisions themselves.

Living willa 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.



Durable power of attorney for health carea 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) orderan order that tells medical professionals not to perform CPR.

3Legal and Ethical Issues9. 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?

3Legal and Ethical Issues9. 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

3 Legal and Ethical Issues Define the following terms: Ethics the knowledge of right and wrong. Laws...

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