Ethics & Laws Chapter 3

Ethical Aspects Ethics: Knowledge of what is right and wrong Involves not being prejudiced or biased Not making judgments prior to knowing the facts

Patient Rights Patient Care Partnership: Explains the person’s rights and expectations during hospital stays Relationship between the doctor, the healthcare team and the patient Omnibus Budget and Reconciliation Act of 1987 (OBRA) Applies to all 50 states Nursing centers must provide care in a manner and in a setting that maintains or improves each person’s quality of life, health and safety

Resident Rights Rights to information Right to refuse treatment Right to privacy & confidentiality Right to personal choice Right to disputes & grievances Right to work or not to work Right to participation in resident & family groups Right to care and security of personal possessions Right to freedom from abuse, mistreatment & neglect Right to freedom from restraint Right to quality of life

Advance Directives Patient Self-Determination Act and OBRA give the patient the right to accept or refuse medical treatment Advance Directive Document stating a person’s wishes about health care when that person cannot make his or her own decisions Living Will: Document about measures that support or maintain life when death is likely Power of Attorney: Gives power to make healthcare decisions to another person

Federal Drug Laws Intent of federal drug laws is to protect patients, residents and anyone who used drugs Goal is safe and effective drug use Federal Food, Drug and Cosmetic Act of 1938 Comprehensive Drug Abuse Prevention & Control Act of 1970

Federal Food, Drug & Cosmetic Act This Act gives the Food & Drug Administration (FDA) the power to: Determine the safety & effectiveness of drugs before marketing Ensure that manufactures meeting labeling requirements Ensure advertising standards are met when manufacturers market drugs

Comprehensive Drug Abuse Prevention & Control Act This Act serves to control the manufacturing, distributing and dispensing of certain drugs Commonly called the Controlled Substance Act Drug Enforcement Administration (DEA) enforces this law 5 Classifications or schedules of controlled substances. Depends upon: Degree of control Required record keeping Required order forms

Schedules of Drugs Schedule I drugs have no current accepted medical use. All drugs is Schedule II, III and IV require prescriptions. Some Schedule V drugs require prescription

Schedule I High potential for abuse No currently accepted medical use in the US Lacks accepted safety for use under medical supervision Ex: Lysergic Acid Diethylamide (LSD), Marijuana, Peyote, Heroin, Hashish

Schedule II High potential for abuse Have accepted medical use in the US May lead to severe psychological or physical dependency Ex. Secobarital, Pentobarbital, Amphetamines, Morphine, Merperidine, Methadone, Percodan, Methylphenidate

Schedule III High potential for abuse. Less potential that Schedule I and II drugs Have accepted medical use in the US May lead to moderate to low physical dependency May lead to high psychological dependency Ex. Lortab, Fiorinal, Tylenol with Codeine

Schedule IV Low potential for abuse. Less potential than Schedule III Have accepted medical use in the US May lead to limited physical or psycological dependency Ex. Phenobarbital, Darvon, Chloral Hydrate, Librium, Valium, Dalmane, Temeazepam

Schedule V Low potential for abuse. Less potential than those in Schedule IV Have accepted medical use in the US Have limited potential for physical or psychological dependency A prescription may not be required. Ex. Lomotil, Robitussin A-C

Prescriptions All prescriptions must contain: Prescribers name, address and DEA registration number Prescriber’s signature Name and Address of the patient Date of issue When a Schedule II drug is GIVEN, the person giving the drug must record the following information: Name of the patient Date & Time administered Drug given Dosage

Prescription Label

Torts & Crimes Civil Laws: Criminal Laws: Concerned with relationships between people Laws that involve contracts and nursing practice Those found guilty usually have to pay a sum of money to the injured party. Criminal Laws: Concerned with offenses against public & society Those found guilty may be fined or sent to prison Remember….You are responsible for your own actions, the nurse is responsible for your supervision

Torts Tort: A “wrong” committed against a person or the person’s property 2 types of Torts Unintentional Tort Intentional Tort

Unintentional Torts Negligence: Malpractice: Not acting in a reasonable and careful manner Harm was not intended Malpractice: Negligence by a professional person “Professional” status is awarded to an individual because of education & training

What actions could lead to a MA-C negligence charge? Administering a medication to the wrong person Administering the wrong medication Administering the wrong dose Administering the wrong route Administering the medication at the wrong time Failure to administer an ordered medication

Intentional Torts Knowingly performing an act with the intent of being harmful Defamation: Injuring a person’s name and reputation by making false statements Libel: Making false statements in print, writing or via pictures False Imprisonment: Unlawful restraint or restriction of a person’s freedom of movement Invasion of Privacy: Violating a person’s right not to have his/her name, photo or private affairs exposed or made public without giving consent Abide HIPAA!!!

HIPAA Health Insurance Portability and Accountability Act of 1996 (HIPAA) Protects the privacy and security of a person’s health information How to protect patient privacy? Keep all information confidential Utilize screens and curtains Only expose body parts in immediate care Avoid “shop talk” Ask visitors to leave when care is provided Do not open patient mail Allow private phone use and/or private conversations

Crimes Assault: Battery: Possession of Controlled Substances Intentionally attempting or threatening to touch a person’s body without consent Battery: Touching a person’s body without consent Possession of Controlled Substances Nurses give controlled substance ONLY under doctor directive Controlled substances that arte not used must be returned to where it was obtained, i.e. doctor or pharmacy

Reporting Abuse Abuse: Intentional mistreatment or harm of another person Posses one or more of the following elements: Willful causing or injury Unreasonable confinement Intimidation Punishment Deprivation of good or services needed for physical, mental or psychosocial well-being

Abuse Examples: Physical abuse Neglect Verbal abuse Involuntary seclusion Financial exploitation Emotional abuse Sexual abuse Abandonment Substance abuse

Signs of Elder Abuse Living conditions are unsafe, unclean, inadequate Personal hygiene is lacking Weight loss Assistive devices are missing or broken Ex. Glasses, hearing devices, dentures, walker, etc. Frequent injuries Complaints of pain or itching in genital region Pressure ulcers or contractures Resident is quiet or withdrawn, fearful, anxious or agitated Changes in alertness Depression