Unit 5

Nurse Aide I Course

DHSR Approved Curriculum-Unit 5 1

 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.
DHSR Approved Curriculum-Unit 5 2
DHSR Approved Curriculum-Unit 5 3
5.0 Define ethics.
5.1 List at least six basic rules of
ethics for the nurse aide.

DHSR Approved Curriculum-Unit 5 4

 Ethics
• Discipline concerned with right or
wrong conduct
• Guides to moral behavior
• Making choices or judgments

DHSR Approved Curriculum-Unit 5 5

 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

DHSR Approved Curriculum-Unit 5 6

 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

DHSR Approved Curriculum-Unit 5 7

 Nurse Aide Ethical
Standards
(continued)
• Be responsible citizen at all times
– Respect others
– Respect values that differ from
yours

DHSR Approved Curriculum-Unit 5 8

5.1.2 Identify the kind of information
that should be kept confidential.

DHSR Approved Curriculum-Unit 5 9

 Nurse Aide Ethical
Standards
• (continued)
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
DHSR Approved Curriculum-Unit 5 10
 Nurse Aide Ethical
Standards
• Resident (continued)
information should be kept
confidential (continued)
– Refer questions about resident’s
death to supervisor
– Respect personal religious beliefs

DHSR Approved Curriculum-Unit 5 11

 Nurse Aide Ethical
Standards
(continued)
• 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
DHSR Approved Curriculum-Unit 5 12
 Nurse Aide Ethical
Standards
(continued)
• Put resident’s needs ahead of your
own
• Be sincere, honest and trustworthy in
performance of duties
– caring and concerned
– “golden rule”

DHSR Approved Curriculum-Unit 5 13

5.1.3 Explain why nurse aides should
not accept monetary tips for a
health care service.

DHSR Approved Curriculum-Unit 5 14

 Nurse Aide Ethical
Standards
(continued)
• 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
DHSR Approved Curriculum-Unit 5 15
 Nurse Aide Ethical
Standards
(continued)
• Do not accept monetary tips
(continued)
– Display tactful and courteous refusal
of tips
– Display continued desire to be
helpful

DHSR Approved Curriculum-Unit 5 16

DHSR Approved Curriculum-Unit 5 17
5.2 Demonstrate skills supporting age
appropriate behavior by
encouraging the resident to make
personal choices, and by providing
and reinforcing other resident’s
dignity.
DHSR Approved Curriculum-Unit 5 18
 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
DHSR Approved Curriculum-Unit 5 19
 Age Appropriate
Behavior
•
(continued)
Residents are treated as adults in
manner appropriate to person’s age
• Age-appropriate considerations:
– Style of dress – Recreational
– Hair style and activities
grooming – Social activities

DHSR Approved Curriculum-Unit 5 20

 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
DHSR Approved Curriculum-Unit 5 21
 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
DHSR Approved Curriculum-Unit 5 22
 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
DHSR Approved Curriculum-Unit 5 23
 Age Appropriate
Behavior
•
(continued)
Guidelines for Nurse Aide (continued)
– Encourage resident to make
choices:
• select food and nourishments
• select activities of interest
• select friends

DHSR Approved Curriculum-Unit 5 24

 Age Appropriate
Behavior
(continued)
• Guidelines for Nurse Aide (continued)
– Recognize value of past experience
– Praise age appropriate
accomplishments
– Encourage adult behavior

DHSR Approved Curriculum-Unit 5 25

DHSR Approved Curriculum-Unit 5 26
5.3 List six legal responsibilities of a
nurse aide.

DHSR Approved Curriculum-Unit 5 27

 Legal Issues
• Authorized or based on law
– Legislated by state and federal
government
– Liable if laws not obeyed
• Fines
• Imprisonment

DHSR Approved Curriculum-Unit 5 28

 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
DHSR Approved Curriculum-Unit 5 29
 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

DHSR Approved Curriculum-Unit 5 30

5.3.1 Give examples of malpractice
and negligence.

DHSR Approved Curriculum-Unit 5 31

 Legal Issues:
Civil Law Examples
Of Torts
• Malpractice
– Giving care for which you are not
allowed legally to do
– Providing improper care

DHSR Approved Curriculum-Unit 5 32

 Legal Issues:
Civil Law Examples
Of Torts
(continued)
• Malpractice
– Example: nurse aide giving
medication
– Example: nurse aide performing
treatment only allowed by licensed
nurses
DHSR Approved Curriculum-Unit 5 33
 Legal Issues:
Civil Law Examples
Of Torts
(continued)
• Negligence
– Unintentional wrong
– Failure to perform in reasonably
prudent manner

DHSR Approved Curriculum-Unit 5 34

 Legal Issues:
Civil Law Examples
Of Torts
• Negligence(continued)
– Example: brakes on a wheelchair
not locked and resident falls
– Example: defective equipment not
reported and resident is harmed

DHSR Approved Curriculum-Unit 5 35

 Legal Issues:
Civil Law Examples
Of Torts
• Assault
(continued)
– Care or treatment without proper
consent (intentional)
– Threatening to injure a resident or
co-worker

DHSR Approved Curriculum-Unit 5 36

 Legal Issues:
Civil Law Examples
Of Torts
• Assault (continued)
– Example: rough treatment of
residents during care
– Example: performing procedure
resident has refused
– Example: threatening to restrain
resident
DHSR Approved Curriculum-Unit 5 37
 Legal Issues:
Civil Law Examples
Of Torts
• Battery
(continued)
– Unlawful touching of another person
without his or her consent

DHSR Approved Curriculum-Unit 5 38

 Legal Issues:
Civil Law Examples
Of Torts
• Battery
(continued)
– Example: nurse aide striking
resident
– Example: does procedure resident
refuses
DHSR Approved Curriculum-Unit 5 39
 Legal Issues:
Civil Law Examples
Of Torts
• Battery (continued)
– Get informed consent
• Written – safest
• Verbal
• Gesture

DHSR Approved Curriculum-Unit 5 40

 Legal Issues:
Civil Law Examples
Of Torts
(continued)
• Invasion of privacy
– Unnecessary exposure of
individual
– Revealing personal
information without
consent
DHSR Approved Curriculum-Unit 5 41
 Legal Issues:
Civil Law Examples
Of Torts
• Invasion of(continued)
privacy
– Example: giving news media
information without resident’s
permission
– Example: giving information to
insurance company without
permission
DHSR Approved Curriculum-Unit 5 42
 Legal Issues:
Civil Law Examples
Of Torts
(continued)
• False imprisonment
– Restraining an individual
– Restricting resident’s freedom

DHSR Approved Curriculum-Unit 5 43

 Legal Issues:
Civil Law Examples
Of Torts
(continued)
• False imprisonment
– Example: use of physical restraints
without authorization or justification
– Example: preventing resident from
leaving facility against resident’s will

DHSR Approved Curriculum-Unit 5 44

 Legal Issues:
Civil Law Examples
Of Torts
• Defamation(continued)
– False statements that cause a
resident to be ridiculed or cause
damage to their reputation
• Example: slander – spoken
• Example: libel – written
DHSR Approved Curriculum-Unit 5 45
5.3.2 Identify the responsibilities of
the nurse aide when a resident
wishes to make a will.

DHSR Approved Curriculum-Unit 5 46

 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
DHSR Approved Curriculum-Unit 5 47
DHSR Approved Curriculum-Unit 5 48
5.4 Support the resident’s right to
make personal choices to
accommodate individual needs.

DHSR Approved Curriculum-Unit 5 49

 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
DHSR Approved Curriculum-Unit 5 50
 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
DHSR Approved Curriculum-Unit 5 51
5.4.1 Describe the Resident’s Bill of
Rights.

DHSR Approved Curriculum-Unit 5 52

 Residents’ Rights
(continued)
• The Resident’s Rights
– Ethical and legal basis
– Federal and state regulations
– Posted in facility
– Distributed on admission in many
facilities

DHSR Approved Curriculum-Unit 5 53

 Residents’ Rights
(continued)
• 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
DHSR Approved Curriculum-Unit 5 54
 Residents’ Rights
(continued)
• 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
DHSR Approved Curriculum-Unit 5 55
 Residents’ Rights
(continued)
• Residents have the right to (continued):
– Examine bill and receive
explanation of charges
– Be informed of any
facility rules and
regulations

DHSR Approved Curriculum-Unit 5 56

5.4.2 Demonstrate behavior which
maintains residents’ rights.

DHSR Approved Curriculum-Unit 5 57

 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
DHSR Approved Curriculum-Unit 5 58
 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
DHSR Approved Curriculum-Unit 5 59
5.4.3 Give needed assistance in going
to and participating in resident
and family groups and activities.

DHSR Approved Curriculum-Unit 5 60

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

DHSR Approved Curriculum-Unit 5 61

 Behavior That
Maintains
Residents’ Rights
(continued)
• Help meet emotional/spiritual/social
needs (continued)
– Participate in planned activities
– Help with phone calls, cards, mail

DHSR Approved Curriculum-Unit 5 62

5.4.4 Maintain the resident’s
environment and care through
the appropriate nurse aide
behavior.

DHSR Approved Curriculum-Unit 5 63

 Behavior That
Maintains
Residents’ Rights
•
(continued)
Explain care you plan to give
• Observe safety precautions
• Obtain proper consent after
identifying resident

DHSR Approved Curriculum-Unit 5 64

 Behavior That
Maintains
Residents’ Rights
(continued)
• Treat all residents equally
• Promote positive attitudes
• Report errors to
supervisor immediately

DHSR Approved Curriculum-Unit 5 65

5.4.5 Explain the purpose and value
of a Resident Council.

DHSR Approved Curriculum-Unit 5 66

 Resident Council :
advisory group
• Provides opportunity for discussion
• Recommendations may be made for:
– Facility policies
– Decisions regarding activities
– Exploration of concerns
– Resolving grievances

DHSR Approved Curriculum-Unit 5 67

 Resident Council :
advisory group
(continued)
• Gives residents a voice in
facility operations
• Members
– residents
– facility staff members
(you)
– representatives from
community
DHSR Approved Curriculum-Unit 5 68
DHSR Approved Curriculum-Unit 5 69
5.5 Administer care which maintains
the residents free from abuse,
mistreatment, neglect, diversion of
drugs, fraud, or misappropriation
of property.

DHSR Approved Curriculum-Unit 5 70

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.

DHSR Approved Curriculum-Unit 5 71

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.

DHSR Approved Curriculum-Unit 5 72

 Mistreatment of the
Elderly
Federal and State Definitions
(continued)
Misappropriation of property means
deliberate misplacement, exploitation,
or wrongful, temporary or permanent
use of a belonging or money without
consent.

DHSR Approved Curriculum-Unit 5 73

 Mistreatment of the
Elderly
Federal and State Definitions
(continued)
Diversion of drugs means the
unauthorized taking or use of any drug.

DHSR Approved Curriculum-Unit 5 74

Mistreatment of the
Elderly
Federal and State Definitions
Drug means(continued)
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.
DHSR Approved Curriculum-Unit 5 75
 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.
DHSR Approved Curriculum-Unit 5 76
Mistreatment of the
Elderly
Resident’s Right To Be Free
• Physical From Abuse
• Verbal
• Sexual
• Mental
• Corporal Punishment
• Involuntary Seclusion
DHSR Approved Curriculum-Unit 5 77
Mistreatment of the
Elderly
Signs of abuse
• Fractures
• Bruises of face, upper arms,
upper thighs, abdomen
• Fearfulness
• Withdrawn, paranoid
behavior

DHSR Approved Curriculum-Unit 5 78

 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
DHSR Approved Curriculum-Unit 5 79
 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
DHSR Approved Curriculum-Unit 5 80
Mistreatment of the
Elderly
Examples of Abuse
(continued)
• Humiliating resident
• Making disparaging,
derogatory remarks
• Sexual coercion
• Sexual harassment
• Verbal harassment
DHSR Approved Curriculum-Unit 5 81
 Mistreatment of the
Elderly
• Identification of residents at risk for
abusing other residents
– Residents with history of aggressive
behavior

DHSR Approved Curriculum-Unit 5 82

 Mistreatment of the
Elderly
• Identification of residents at risk for
being abused
– noisy individuals
– wandering individuals
– philandering individuals
– socially/logistically isolated
individuals
DHSR Approved Curriculum-Unit 5 83
5.5.1 Report any instances of abuse to
the appropriate facility/agency
staff.

DHSR Approved Curriculum-Unit 5 84

 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
DHSR Approved Curriculum-Unit 5 85
DHSR Approved Curriculum-Unit 5 86
5.6 Assist in resolving grievances.

DHSR Approved Curriculum-Unit 5 87

 Advocates
• Plead cause of another
• Resolve grievances
• Protect resident’s rights

DHSR Approved Curriculum-Unit 5 88

 Advocates
(continued)
• Advocates can be:
– You and your co-workers
– Member of resident’s family/support
system
– Resident’s guardian
– Ombudsman

DHSR Approved Curriculum-Unit 5 89

 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

DHSR Approved Curriculum-Unit 5 90

 Advocates
Facility policy components for
resident grievance
• Acknowledgment
• Prompt attempt to resolve
• Resident kept apprised

DHSR Approved Curriculum-Unit 5 91

DHSR Approved Curriculum-Unit 5 92
5.7 Discuss key elements of Federal
Grievance Procedures.

DHSR Approved Curriculum-Unit 5 93

 Grievance
Procedures
• Grievance Procedures
– Review federal grievance
procedures

DHSR Approved Curriculum-Unit 5 94

DHSR Approved Curriculum-Unit 5 95
5.8 Promote care and security of
residents’ personal possessions.

DHSR Approved Curriculum-Unit 5 96

 Residents’ Personal
Possessions
• Protect personal items
• These possessions may
be all they have
• Items may be impossible
to replace
• Report observed thefts

DHSR Approved Curriculum-Unit 5 97

 Residents’ Personal
Possessions
(continued)
• Handle personal items
carefully
• Add new items to list of
resident’s belongings
• Mark all items with
resident’s name

DHSR Approved Curriculum-Unit 5 98

DHSR Approved Curriculum-Unit 5 99