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    Ethical and Legal Issues
    Affecting the Nursing Assistant

    Edited by Brenda Holmes MSN/Ed, RN


                                      Copyright © 2008 Delmar Learning. All rights reserved.
* Spell and define terms.
* Discuss ethical and legal situations in health care.
* Describe the legal and ethical responsibilities of the
 nursing assistant concerning patient information.
* Describe tactful ways to refuse a tip offered by a
 patient.
* Describe the legal responsibilities of a nursing
 assistant.




                                 *

                                     Copyright © 2008 Delmar Learning. All rights reserved.
* Describe how to protect the patient’s right to
 privacy.
* Define sexual harassment and give examples of
 activities that may be perceived as being
 sexually harassing.




                             *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Ethical standards
  * Guides to moral behavior
* People who provide health care
  * Voluntarily agree to live up to these standards




               *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* When these rules are not followed:
  * Nursing assistant fails to live up to the promise to
   give safe, correct care and to do no harm




                *

                                    Copyright © 2008 Delmar Learning. All rights reserved.
* Legal standards are guides to lawful behavior
* When laws are not obeyed:
  * Nursing assistant may be prosecuted and found liable for
    injury or damage
* Legal guilt can result in the payment of fines or
 imprisonment



                       *

                                      Copyright © 2008 Delmar Learning. All rights reserved.
* At no other time in history have questions of
 medical ethics been under such scrutiny




                 *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Questions health care providers ask:
  * When is life gone from a person on life support
    systems?
  * How much lifesaving effort should be given in
    situations of terminal illness?




                  *

                                      Copyright © 2008 Delmar Learning. All rights reserved.
* When does human life actually begin?
* How much assistance should be given to the
 conception process?
* Should the body organs of a brain-dead person
 be harvested for transplants for the living?
* Does an unborn baby have rights?




                *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Is assisting a patient before or after an
 abortion right or wrong?
* Is euthanasia ever justified?
* Should animals be used in research of potential
 value to human life?




                 *

                                  Copyright © 2008 Delmar Learning. All rights reserved.
* Should food and water be withheld to speed
 death when a patient has expressed the desire
 to have this action performed?




                *

                               Copyright © 2008 Delmar Learning. All rights reserved.
* Who makes decisions about removing life
 support systems when there is no direct
 expression of the patient’s wishes or there is
 conflict within the family?




                *

                                Copyright © 2008 Delmar Learning. All rights reserved.
* How will a choice be made when two or more
 people could benefit from an organ transplant
 but only one organ is available?




               *

                               Copyright © 2008 Delmar Learning. All rights reserved.
* How should the limited money available be
 spent when many serious disease conditions
 need to be researched?
* Who has the final authority over whether a
 woman will carry a pregnancy to term?




        *

                                Copyright © 2008 Delmar Learning. All rights reserved.
* Should marijuana be used for medicinal
 purposes?




                *

                               Copyright © 2008 Delmar Learning. All rights reserved.
* One of the most basic rules of ethics is that life
 is precious.




                  *

                                  Copyright © 2008 Delmar Learning. All rights reserved.
* Respect for each patient as a unique individual
 is another ethical principle
* Uniqueness is shown by differences in:
  * Age
  * Race
  * Religion
  * Gender



                   *

                                Copyright © 2008 Delmar Learning. All rights reserved.
* Uniqueness is shown by differences in:
  * Sexual preference
  * Culture
  * Attitudes
  * Background
  * Response to illness


                          *

                                    Copyright © 2008 Delmar Learning. All rights reserved.
* Do unto others as you would have them do unto you
  * Implies your intent to provide proper care




                     *

                                       Copyright © 2008 Delmar Learning. All rights reserved.
* Your good intentions are effective only when you act on
 them
* To provide proper care:
  * You also have the ethical responsibility to maintain
    competence in your practice




                     *

                                       Copyright © 2008 Delmar Learning. All rights reserved.
* Treat others the way they want to be treated
* Platinum Rule
  * Shifts focus from treating everyone alike to
   providing highly individualized care




                       *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* Find out what patients want
  * Give it to them, as much as possible, and in
    keeping with their plans of care
* Use both principles to guide your practice




                        *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* Discuss patient information only in appropriate
 places
* Discuss patient information only with the
 proper people




   *

                                Copyright © 2008 Delmar Learning. All rights reserved.
* Refer patient requests for information about
 laboratory results, the patient’s condition, or
 course of the illness to the nurse or physician.




          *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Let the nurse or physician relay information
    about a patient’s death.
* Follow the ethical code to ensure respect of a
    patient’s personal religious beliefs.




*

                                    Copyright © 2008 Delmar Learning. All rights reserved.
* Laws are passed by governments and are to be
 obeyed by citizens.
* Anyone who fails to obey a law may be liable
 for fines or imprisonment.




                          *

                                Copyright © 2008 Delmar Learning. All rights reserved.
* You need not fear breaking laws if you are
 careful to:
  * Stay within your scope of practice
  * Not overstep your authority
  * Do only those things you have been taught
    * Within the scope of your training




                               *

                                      Copyright © 2008 Delmar Learning. All rights reserved.
* You need not fear breaking laws if you are
 careful to:
  * Carry out procedures carefully and as you were
    taught
  * Keep your skills and knowledge up to date




                            *

                                  Copyright © 2008 Delmar Learning. All rights reserved.
* You need not fear breaking laws if you are
 careful to:
  * Request guidance from the proper person before
    you take action in a questionable situation




                             *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* You need not fear breaking laws if you are
 careful to:
  * Always keep the safety and well-being of the
    patient a priority
  * Make sure you thoroughly understand the
    instructions for the care you are to give




                              *

                                    Copyright © 2008 Delmar Learning. All rights reserved.
* You need not fear breaking laws if you are
 careful to:
  * Perform your job according to facility policy
  * Stay within OBRA guidelines




                             *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* You need not fear breaking laws if you are
 careful to:
  * Maintain in-service requirements of OBRA
  * Do no harm to the patient
  * Respect the patient’s belongings




                            *

                                  Copyright © 2008 Delmar Learning. All rights reserved.
* Nursing assistants
  * Are educated care providers and are expected to
    perform in certain ways




                              *

                                  Copyright © 2008 Delmar Learning. All rights reserved.
* You would be guilty of negligence if you injured
 a patient by:
  * Not performing your work as taught
  * Not carrying out your job in a conscientious
    manner




                               *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* Negligence may be accidental or deliberate
* It may be the result of an action or omission
  * Failure to act
* In either situation, the patient is not given the
 expected level of care




                              *

                                  Copyright © 2008 Delmar Learning. All rights reserved.
* Restraining a person’s movement or actions
 without proper authorization constitutes
 unlawful or false imprisonment.




         *

                               Copyright © 2008 Delmar Learning. All rights reserved.
* Assault
  * Intentionally attempting to touch the body of a
    person or even threatening to do so
* Battery
  * Touching a person without that person’s
    permission




            *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* Abuse
  * Any act or failure to act that is non-accidental
   and causes or could cause harm or death to a
   patient
* Verbal abuse
  * May be directed toward a patient or expressed
   about a patient




                                                *

                                    Copyright © 2008 Delmar Learning. All rights reserved.
* Sexual abuse
  * Use of physical means or verbal threats to force
   a patient to perform sexual acts.




                                               *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
* Physical abuse
  * Does actual physical harm to a patient
* Psychological abuse
  * Involves making a patient fearful of you
    * Such as threatening not to respond when he or she
      calls




                                                 *

                                     Copyright © 2008 Delmar Learning. All rights reserved.
* Involuntary seclusion
  * Involves separating a patient from other patients
    against the patient’s will
* Misappropriation of property
  * Involves taking or using the patient’s belongings
    without permission




                                                *

                                    Copyright © 2008 Delmar Learning. All rights reserved.
* If you suspect a person in your care is being
 abused by others
  * Discuss this matter with your supervisor
* You are not responsible for determining
 whether abuse has occurred




                 *

                                   Copyright © 2008 Delmar Learning. All rights reserved.
*
* If you feel like your own tolerance level is being tested
  * You need to find ways to safeguard the patient and release
    your stress




                                      Copyright © 2008 Delmar Learning. All rights reserved.
* Failure to provide the services or care
 necessary to avoid physical harm, mental
 anguish, or mental illness.




                                       *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Patients have a right to have their person and
 personal affairs kept confidential.




           *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Physical, verbal, or nonverbal actions or
 advances that are unwelcome by the other
 person.




           *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* This may be in the form of sexual advances,
 requests for sexual favors, and other verbal or
 physical conduct of a sexual nature.




           *

                                Copyright © 2008 Delmar Learning. All rights reserved.
* Sexual harassment is illegal




            *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Your facility will have policies and procedures
 listing actions to take and penalties if
 harassment occurs.




            *

                                 Copyright © 2008 Delmar Learning. All rights reserved.
* Upon being informed that an incident of sexual
 harassment has occurred:
  * Hospital is responsible for investigating the
    situation
* During investigation:
  * Facility must protect the victim from further
    harassment




            *

                                    Copyright © 2008 Delmar Learning. All rights reserved.

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Chapter 04 ethical and legal issues affecting nursing assistant

  • 1. * Ethical and Legal Issues Affecting the Nursing Assistant Edited by Brenda Holmes MSN/Ed, RN Copyright © 2008 Delmar Learning. All rights reserved.
  • 2. * Spell and define terms. * Discuss ethical and legal situations in health care. * Describe the legal and ethical responsibilities of the nursing assistant concerning patient information. * Describe tactful ways to refuse a tip offered by a patient. * Describe the legal responsibilities of a nursing assistant. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 3. * Describe how to protect the patient’s right to privacy. * Define sexual harassment and give examples of activities that may be perceived as being sexually harassing. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 4. * Ethical standards * Guides to moral behavior * People who provide health care * Voluntarily agree to live up to these standards * Copyright © 2008 Delmar Learning. All rights reserved.
  • 5. * When these rules are not followed: * Nursing assistant fails to live up to the promise to give safe, correct care and to do no harm * Copyright © 2008 Delmar Learning. All rights reserved.
  • 6. * Legal standards are guides to lawful behavior * When laws are not obeyed: * Nursing assistant may be prosecuted and found liable for injury or damage * Legal guilt can result in the payment of fines or imprisonment * Copyright © 2008 Delmar Learning. All rights reserved.
  • 7. * At no other time in history have questions of medical ethics been under such scrutiny * Copyright © 2008 Delmar Learning. All rights reserved.
  • 8. * Questions health care providers ask: * When is life gone from a person on life support systems? * How much lifesaving effort should be given in situations of terminal illness? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 9. * When does human life actually begin? * How much assistance should be given to the conception process? * Should the body organs of a brain-dead person be harvested for transplants for the living? * Does an unborn baby have rights? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 10. * Is assisting a patient before or after an abortion right or wrong? * Is euthanasia ever justified? * Should animals be used in research of potential value to human life? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 11. * Should food and water be withheld to speed death when a patient has expressed the desire to have this action performed? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 12. * Who makes decisions about removing life support systems when there is no direct expression of the patient’s wishes or there is conflict within the family? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 13. * How will a choice be made when two or more people could benefit from an organ transplant but only one organ is available? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 14. * How should the limited money available be spent when many serious disease conditions need to be researched? * Who has the final authority over whether a woman will carry a pregnancy to term? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 15. * Should marijuana be used for medicinal purposes? * Copyright © 2008 Delmar Learning. All rights reserved.
  • 16. * One of the most basic rules of ethics is that life is precious. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 17. * Respect for each patient as a unique individual is another ethical principle * Uniqueness is shown by differences in: * Age * Race * Religion * Gender * Copyright © 2008 Delmar Learning. All rights reserved.
  • 18. * Uniqueness is shown by differences in: * Sexual preference * Culture * Attitudes * Background * Response to illness * Copyright © 2008 Delmar Learning. All rights reserved.
  • 19. * Do unto others as you would have them do unto you * Implies your intent to provide proper care * Copyright © 2008 Delmar Learning. All rights reserved.
  • 20. * Your good intentions are effective only when you act on them * To provide proper care: * You also have the ethical responsibility to maintain competence in your practice * Copyright © 2008 Delmar Learning. All rights reserved.
  • 21. * Treat others the way they want to be treated * Platinum Rule * Shifts focus from treating everyone alike to providing highly individualized care * Copyright © 2008 Delmar Learning. All rights reserved.
  • 22. * Find out what patients want * Give it to them, as much as possible, and in keeping with their plans of care * Use both principles to guide your practice * Copyright © 2008 Delmar Learning. All rights reserved.
  • 23. * Discuss patient information only in appropriate places * Discuss patient information only with the proper people * Copyright © 2008 Delmar Learning. All rights reserved.
  • 24. * Refer patient requests for information about laboratory results, the patient’s condition, or course of the illness to the nurse or physician. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 25. * Let the nurse or physician relay information about a patient’s death. * Follow the ethical code to ensure respect of a patient’s personal religious beliefs. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 26. * Laws are passed by governments and are to be obeyed by citizens. * Anyone who fails to obey a law may be liable for fines or imprisonment. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 27. * You need not fear breaking laws if you are careful to: * Stay within your scope of practice * Not overstep your authority * Do only those things you have been taught * Within the scope of your training * Copyright © 2008 Delmar Learning. All rights reserved.
  • 28. * You need not fear breaking laws if you are careful to: * Carry out procedures carefully and as you were taught * Keep your skills and knowledge up to date * Copyright © 2008 Delmar Learning. All rights reserved.
  • 29. * You need not fear breaking laws if you are careful to: * Request guidance from the proper person before you take action in a questionable situation * Copyright © 2008 Delmar Learning. All rights reserved.
  • 30. * You need not fear breaking laws if you are careful to: * Always keep the safety and well-being of the patient a priority * Make sure you thoroughly understand the instructions for the care you are to give * Copyright © 2008 Delmar Learning. All rights reserved.
  • 31. * You need not fear breaking laws if you are careful to: * Perform your job according to facility policy * Stay within OBRA guidelines * Copyright © 2008 Delmar Learning. All rights reserved.
  • 32. * You need not fear breaking laws if you are careful to: * Maintain in-service requirements of OBRA * Do no harm to the patient * Respect the patient’s belongings * Copyright © 2008 Delmar Learning. All rights reserved.
  • 33. * Nursing assistants * Are educated care providers and are expected to perform in certain ways * Copyright © 2008 Delmar Learning. All rights reserved.
  • 34. * You would be guilty of negligence if you injured a patient by: * Not performing your work as taught * Not carrying out your job in a conscientious manner * Copyright © 2008 Delmar Learning. All rights reserved.
  • 35. * Negligence may be accidental or deliberate * It may be the result of an action or omission * Failure to act * In either situation, the patient is not given the expected level of care * Copyright © 2008 Delmar Learning. All rights reserved.
  • 36. * Restraining a person’s movement or actions without proper authorization constitutes unlawful or false imprisonment. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 37. * Assault * Intentionally attempting to touch the body of a person or even threatening to do so * Battery * Touching a person without that person’s permission * Copyright © 2008 Delmar Learning. All rights reserved.
  • 38. * Abuse * Any act or failure to act that is non-accidental and causes or could cause harm or death to a patient * Verbal abuse * May be directed toward a patient or expressed about a patient * Copyright © 2008 Delmar Learning. All rights reserved.
  • 39. * Sexual abuse * Use of physical means or verbal threats to force a patient to perform sexual acts. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 40. * Physical abuse * Does actual physical harm to a patient * Psychological abuse * Involves making a patient fearful of you * Such as threatening not to respond when he or she calls * Copyright © 2008 Delmar Learning. All rights reserved.
  • 41. * Involuntary seclusion * Involves separating a patient from other patients against the patient’s will * Misappropriation of property * Involves taking or using the patient’s belongings without permission * Copyright © 2008 Delmar Learning. All rights reserved.
  • 42. * If you suspect a person in your care is being abused by others * Discuss this matter with your supervisor * You are not responsible for determining whether abuse has occurred * Copyright © 2008 Delmar Learning. All rights reserved.
  • 43. * * If you feel like your own tolerance level is being tested * You need to find ways to safeguard the patient and release your stress Copyright © 2008 Delmar Learning. All rights reserved.
  • 44. * Failure to provide the services or care necessary to avoid physical harm, mental anguish, or mental illness. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 45. * Patients have a right to have their person and personal affairs kept confidential. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 46. * Physical, verbal, or nonverbal actions or advances that are unwelcome by the other person. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 47. * This may be in the form of sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 48. * Sexual harassment is illegal * Copyright © 2008 Delmar Learning. All rights reserved.
  • 49. * Your facility will have policies and procedures listing actions to take and penalties if harassment occurs. * Copyright © 2008 Delmar Learning. All rights reserved.
  • 50. * Upon being informed that an incident of sexual harassment has occurred: * Hospital is responsible for investigating the situation * During investigation: * Facility must protect the victim from further harassment * Copyright © 2008 Delmar Learning. All rights reserved.