MNA Mosby ’ s Long Term Care Assistant Chapter 4 Ethics and the Law

Ethical Issues What is Right and What is Wrong Nonjudgmental Nonbiased Making the right choices

Ethical Issues Rules of Conduct Respect each person Perform only acts you have been prepared to do Do not take drugs Perform to the best of your ability Follow policies and procedures Safety

Ethical Issues Rules of Conduct Loyal Good citizen Recognize limits Confidentiality Privacy Cause no harm

Boundaries Separates helpful behaviors from behaviors that are not helpful. Boundary crossing Boundary violation Professional sexual misconduct Under involved Helpful zone Over involved

Boundaries Crossing: Brief, thoughtless, did not mean to do, or could be on purpose (hugs)

Boundaries Violation: Meets your needs not the resident, not ethical, Violates code of conduct (telling about your personal problems)

Boundaries Sexual misconduct: Act, behavior or comment that is sexual in nature. Still misconduct even if consensual

Rules for Maintaining Boundaries Follow Code of Conduct Do not date, flirt, kiss or have sexual relations with residents or family members Do not make sexual comments or jokes

Rules for Maintaining Boundaries Do not use offensive language DO not discuss your personal life with residents or families Use touch correctly Do not accept or give gifts

Rules for Maintaining Boundaries Do not help resident with financial matters Do not take resident home with you Do not borrow from resident Do not spend extra time with resident who is not your assignment

Boundaries Signs Thinking about the person when you are not at work Spending excess time with the person Dressing for the person Sharing info about yourself with the person Having secrets with the person

Legal Aspects LAW - What you can and cannot do Criminal laws – against public/society Civil Laws – relationships btw people ETHICS: What you should or should not do

Civil Laws Torts: Wrong against a person or person’s property Intentional Unintentional Harm was intended Harm was not intended

Unintentional Torts Negligence Did not act in a reasonably and careful manner. Person or person’s property was harmed.

Unintentional Torts Malpractice Negligence by a professional person. Nurses, doctors, dentist, pharmacist.

Intentional Torts Defamation Libel Slander False statements in print, writing, pictures False statements made orally

Intentional Torts False Imprisonment Unlawful restriction of person’s movement

Intentional Torts Invasion of Privacy Violating person’s right not to have name, photo, info exposed or made public. Keep all info confidential Screen person Expose only body parts involved in care Do not discuss person with anyone except nurse supervising your work Ask visitors to leave room when care is given Do not open mail Allow phone, visits in private

HIPAA Health Insurance Portability A ccountability Act 1996 Protects privacy and security of person’s health information. Paper, electronic, oral Failure to follow results in fines, penalties, jail time.

Intentional Torts Fraud saying something to trick, fool or deceive a person Telling a resident you are a nurse Giving wrong or incomplete info on job application

Intentional Torts Assault intentionally attempting or threatening to touch a person's body w/o their permission

Intentional Torts Battery touching a person's body w/o their permission

Informed Consent Explain: Reason for treatment What will be done How it will be done Expected outcome Other treatment options Effect of not having the treatment

Informed Consent Cannot give informed consent if: Not legal age (18) Mentally incompetent Under influence of alcohol Sedated, comatose, confused Mental health disorders

Types of Consent Written signs a form. U are not responsible for written consent Verbal Says aloud. “yes” “ok” Implied movement implies consent. Extends arm for B/P

Wills Legal statement of how a person wants property distributed after death. Can witness or decline to witness. Cannot prepare will Cannot witness if named in the will.

Reporting Abuse ABUSE - Intentional mistreatment or harm of another person. Physical Verbal Involuntary Seclusion Mental Financial Sexual

OBRA Nursing Centers cannot hire persons who have been convicted of abuse, neglect or mistreatment. OBRA State law requires the reporting of elder abuse Where to Report?

Signs of Elder Abuse Unsafe, unclean living conditions Weight loss Assistive devices are missing or broken Frequent injuries Old and new injuries Complaints of pain or itching in the genital area Bleeding or bruising in the genital area Burns on the feet, hands or buttocks

Signs of Elder Abuse Pressure ulcers (bed sores) Person is very quiet or withdrawn The person is fearful, anxious or agitated Reluctance to talk or answer questions Restraints Private conversations are not allowed

Signs of Elder Abuse Anxious to please the care giver Drugs not taken properly Frequent visits to the ER Changing doctors often

Child Abuse Involves a child 18 years or younger Involves a child 18 years or younger The act or failure to act results in death, serious physical or emotional harm, sexual abuse or exploitation The act or failure to act results in death, serious physical or emotional harm, sexual abuse or exploitation Occurs at EVERY social and income level Occurs at EVERY social and income level

Child Abuse—Risk Factors Stress Stress Family Crisis Family Crisis Drug or ETOH abuse Drug or ETOH abuse Abuser was abused as a child Abuser was abused as a child Discipline beliefs that include physical punishment Discipline beliefs that include physical punishment Lack of emotional attachment to child (mental health issues) Lack of emotional attachment to child (mental health issues) Child with birth defects or chronic illness Child with birth defects or chronic illness Child with personality/behavior disorders Child with personality/behavior disorders Unrealistic expectations Unrealistic expectations Families that move often and do not have help Families that move often and do not have help

Domestic Abuse Occurs in relationships Occurs in relationships May be: May be: –Physical –Sexual –Verbal –Economic –social

Is It Abuse? A NA tells a resident to be nice, otherwise they will not get lunch. A resident cannot control his bowels, the NA calls him a baby. The resident gets his bath in the morning even though he prefers it in the evening

Is It Abuse? The NA uses the residents phone to make a call The resident lays in soiled linen all night long. The resident is forced to eat A resident is not allowed to smoke except at designated times

Review A resident’s picture is made public without his consent. This is an example of ? Invasion of privacy

Review What is the difference between abuse and neglect? What is the difference between abuse and neglect? Abuse=injuring the child/person on purpose Neglect=unintention ally harming a person

Review A NA tells other staff members that Mr. R is homosexual. This statement is based on rumors. This would be an example of ? defamation slander

Review You suspect a resident has been abused. What should you do ? Tell a nurse

Review On your day off you call the center to check on a resident. This is called ? Boundary sign

Review To maintain professional boundaries, your behavior must ? Help the person

Review You must perform all tasks and procedures as directed by the nurse. True or False

Review If it is illegal…. it is unethical. True or False

Review If it is unethical…. it is illegal. True or False

Review A tort is a criminal law. True or False

Review You are responsible for your own actions. True or False

Review Assault is threatening another person with bodily harm. True or False

Review You are allowed to assist the resident in preparing a will. True or False

Review Negligence is a crime. True or False

Review What are some signs of abuse?

Questions??