Transcript File
Consumer Rights and Responsibilities and Legal and Ethical Issues in Health Care It is important to be aware of and follow legal regulations for your own protection, the protection of your employer and the safety and well-being of your patient. Being an advocate We must be an advocate for our patients and respect their rights Sometimes we are the only ones that can speak up for them Patient advocates began years ago as a way to make sure that every patient received the care they deserved HS-NE-1d, HS-NE-7a Health Care Consumer Rights Documents that detail rights given to consumers Patient’s Rights -given to those in a hospital Client’s Rights -given to those receiving care in their homes Resident’s Rights -given to those in a skilled care facility Legislated by OBRA of 1987 Health care workers must be familiar with the rights of those they are taking care of Knowing and supporting these rights contributes to more effective care Includes being an advocate and letting your supervisor know if someone is doing things to violate patient/resident/client rights. HS-NE-7a Health Care Consumer Rights Each document is similar and emphasizes the right to: Be treated with dignity and respect (being given privacy and confidentiality) Receive continuity of care Be informed of resources for resolving conflicts or grievances Have Informed Consent Make personal choices to accommodate their needs Permission for and purpose of procedures, advance directives, and any risks involved with their care HS-NE-3b, HS-NE-3c, HS-NE-3d Residents have the right to Be free from abuse Be free from restraints Privacy and confidentiality Participate in social, religious, and community activities Share a room with a spouse Free choice Physician Treatment Medication administration Participate in research HS-NE-3b, HS-NE-3c, HS-NE-3d, HS-NE-3e, HS-NE-3f Voice grievances and file complaints Assistance organizing, getting to and participating in family and resident groups Manage personal funds Visit with their family and friends Use personal possessions and be ensured they are cared for and secure Patients have the right to Considerate and respectful care Information about diagnosis and prognosis Know who is involved in their care Make decisions regarding their care Have an advance directive Privacy and confidentiality Be informed of resources for filing grievances and conflict Continuity of care HS-NE-3b, HS-NE-3c, HS-NE-3d, HS-NE-3e, HS-NE-3f Clients have the right to Be treated with dignity and with respect Receive a timely response to requests of service Participate in planning of care Expect confidentiality Have your property treated with respect Know how to make a complaint Be informed of termination of services Be informed of the treatment required, how much it will cost and how payment will be handled HS-NE-3b, HS-NE-3c, HS-NE-3d, HS-NE-3e, HS-NE-3f Responsibilities of Health Care Consumers Maintain personal health care records Provide information regarding past hospitalization and medications Inform physicians if they will have trouble following the treatment plan Accept responsibility for managing their own health Ask for clarification if they do not understand Live a healthy lifestyle and avoid unnecessary risks Accept financial responsibility for payment Ethical vs. Legal Standards Will you be held liable? Ethical Standards Involve the moral right or wrong of an action Guides to moral behavior You as a SNA agree to live up to these standards-to give safe, correct care and to do no harm Legal Standards Involve the legality of your behavior Guides to lawful behavior When not obeyed, the NA can be held liable for injury or damage and face fines and/or imprisonment The Golden Rule “Do Unto Others As You Would Have Them Do Unto You” Let this guide your NA practice Placing your personal comfort and convenience ahead of your patient’s interests ahead of your own, you fulfill your legal and ethical obligations and protect your patient’s safely and reduce your risk of legal liability HS-NE-7e Ethics in the Workplace There are many ethical questions that come up in healthcare: Is euthanasia (assisted death) ever justified? Does an unborn baby have rights? When does human life actually begin? How will a choice be made when there is only one organ but two people who could benefit? Should the body organs of a brain-dead person be harvested for transplants in the living? Should food and water be withheld to speed death when the patient has expressed this is his wish? We must Respect Certain Things Respect for Life One of the basic rules of ethics is that life is precious! When death is certain, our objective must be to keep the dying person comfortable People have come to appreciate each persons individual wishes and the quality of their remaining time We must Respect Certain Things Respect for the Individual Each person is a unique individual! This uniqueness is demonstrated by differences in: Age, race, religion, gender, sexual preference, culture, attitudes, background, response to illness These differences that make each person special, may also make dealing with that person challenging or difficult. You must learn to accept and work with each person in the best possible way We must give care to a person based on their need and nothing else We must Respect Certain Things Omnibus Budget Reconciliation Act of 1987 Patient information is confidential and must not be shared! Only discuss patient information in appropriate places and not: In the patient’s room With anyone in your family or community During lunch or coffee breaks HS-NE-7b, HS-NE-7c We must Respect Certain Things Patient information is confidential! Only discuss information with the proper people During conference or report with your supervisor out of earshot of visitors or other patients Do not discuss patient information with: Other patients, family members or friends Tactfully inform those asking: That you do not know all the details of the patient’s condition By firmly but politely indicating that you do not have the authority to share that information and redirecting them to the proper authority HS-NE-7b, HS-NE-7c HIPAA Health Insurance Portability and Accountability Act (HIPAA) was enacted by the U.S. Congress in 1996. “Improved efficiency in healthcare delivery by standardizing electronic data interchange, and protection of confidentiality and security of health data through setting and enforcing standards.” http://www.hipaadvisory.com/REGS/HIPAAprimer.htm http://www.hhs.gov/ocr/hipaa/consumer_summary. pdf HS-NE-7c Ombudsmen A Long Term Care Ombudsman: Resolves complaints made by or for residents of long term care facilities Educates consumers and long term care providers about residents' rights and good care practices Promotes community involvement through volunteer opportunities Provides information to the public on nursing homes and other long term care facilities and services, residents' rights, and legislative and policy issues Advocates for residents' rights and quality care in nursing homes, personal care, residential care and other long term care facilities Promotes the development of citizen organizations, family councils and resident councils. http://www.ltcombudsman.org/ HS-NE-7c We must Respect Certain Things We must respect each person’s religious beliefs! Inform the nurse of requests for clergy visits Avoid imposing your own beliefs on your patients Respectfully treat the patient’s religious articles Know when the chapel is open for use Know correct information about the type of chaplain services provided in your facility When clergy visits we should be Helpful, escort them to the patient’s bedside, draw the curtain or close the door for privacy and leave the room Tipping Tipping is not allowed as part of our ethical code The care we give patients should be based on the ethical code and not the patient’s race, creed, or ability to pay. The salary you receive is the only payment you should expect for services you provide to the patient. Firmly but courteously refuse the money. If the patient continues to insist, continue to politely refuse and report this to your supervisor. Legal Issues You can be certain that you do not break these laws if you: Stay within your scope of practice Do only those things you have been taught Carry out procedures carefully and as you were taught Keep your skills/knowledge up to date Request guidance from your supervisor before engaging in a questionable situation Keep the safety of the patient foremost in your mind Make sure you fully understand your directions Perform your job according to facility guidelines Stay within OBRA guidelines Maintain in-service requirements of OBRA DO NO HARM TO THE PATIENT Respect your patient’s belongings Negligence Failing to exercise the degree of care considered reasonable under the circumstances, when that failure results in unintended injury to a person Basically this is carelessness and caused by hurrying or not focusing on the task at hand A patient falls because you did not put up siderails A patient is burned because you did not check bath water temperature You transfer a patient by your self when you know you need to have another NA help you A patient is burned when you did not check the temperature of an enema solution that you prepared HS-NE-7d, HS-NE-3f Malpractice Improper, negligent, or unethical conduct that causes harm, injury or loss to a patient Practicing within your scope of practice Following facility policies and procedures Doing things as you were taught Being discreet Respecting confidentiality Avoiding gossip Be kind and polite to patient. If a patient complains about something you have done, apologize and promptly correct the problem without getting defensive! Theft (Misappropriation of Property) Taking anything that does not belong to you Aiding and abetting If you see someone stealing and do not report it You work closely with patients and their belongings Honesty and integrity are the hallmarks of a sincere and conscientious NA. Opportunities for poor practice, illegal activities and neglect are always present. Resist any temptation to lower your standards. HS-NE-7d Defamation Making false statements about someone to a third party and the character of the first person is injured Libel Making false statements in writing Slander Making false statements verbally False Imprisonment Restraining a person’s movements or actions without proper authorization Using physical or chemical restraints or threatening to do so in order to make a patient cooperate Chemical restraints are psychoactive meds that affect the patient’s mobility (sedatives) Physical restraints is anything that A patient cannot remove easily Restrict a patient’s movement Does not allow the patient normal access to his body Wrist/arm/leg/ankle restraints, vest or jacket restraints or hand mitts, geriatric chairs, wheelchair or chair safety belts, bed rails, tucking in or tying a sheet tightly so that a patient’s movement is restricted HS-NE-3f Assault and Battery Assault-intentionally attempting or threatening to touch a person’s body Battery-actually touching a person without their permission We must have a patient’s informed consent to provide care To avoid this Inform the patient of what you plan to do Make sure the patient understands Always give the patient the opportunity to refuse Report a patient’s refusal to your supervisor Never carry out a procedure on your own against a patient’s wishes Avoid forcing a patient a patient against his wishes (coercion) Many times if you wait awhile and go back, you will be able to do your procedure HS-NE-3f Abuse Defined as any act or failure to act that is nonaccidental and causes or could cause harm or death to a patient Can be verbal, sexual, physical, psychological, or involuntary seclusion Violates ethical and legal standards Suspected abuse musts be reported to police and state agencies Penalties can be severe, from fines to imprisonment Caregiver stress is often the cause* HS-NE-7d, HS-NE-3f Abuse Verbal Abuse Use profanity with patient Raise your voice in anger Call the patient names Tease or embarrass the patient Use threatening or obscene gestures Make written threats or abusive statements Use inappropriate words in relation to a patient’s race or nationality Sexual Abuse Can be any behavior that is seductive, sexually demeaning, harassing or reasonably interpreted as sexual by the patient Tormenting or teasing a patient with sexual gestures or words Touching a patient in a sexual way Suggesting that the patient engage in sexual acts with you HS-NE-7d, HS-NE-3f Abuse Physical Abuse Handling a patient roughly Hitting, slapping, pushing, kicking or pinching a patient Performing the wrong treatment on the patient HS-NE-7d, HS-NE-3f Psychological Abuse Making the patient fearful of you* Threatening the patient with harm Threatening to withhold care Making fun of or belittling the patient in any way (using terms like “honey”) Abuse Involuntary Seclusion Separating a patient against their will Shutting the door when the patient requests it left open Continually placing a patient’s Geri chair far from others Leaving the patient without a call bell HS-NE-7d, HS-NE-3f Involuntary seclusion may be used as part of a therapeutic plan to reduce agitation. Avoid using words like uncooperative, belligerent or hostile Always describe the exact action you see Abuse Suspected abuse must be reported. Could be statements made by the patient, unexplained bruises, poor personal hygiene, changes in personality Failure to report abuse can cause you to be held liable You report your suspicions to your supervisor Abuse can be done by Families, the spouse, the patient HS-NE-7d, HS-NE-3f Abuse is Often a Result Of Stress Recognize the signs of stress Difficulty sleeping irritability or anxiety Loss of appetite, or loss or interest in work Drug or alcohol misuse Ways to reduce stress Identify the cause of stress Talk with your supervisor about your feelings Consider asking for a change of patient assignment Request counseling HS-NE-7d, HS-NE-3f Neglect Failure to provide the services or care necessary to avoid physical harm, mental anguish or mental illness May be accidental or intentional Bedsores caused by failure to turn patients Failure to carry out personal hygiene (bathing, dressing, changing, shaving) Failure to help those who need assistance eating Failure to provide water Failure to perform ROM to a patient HS-NE-7d, HS-NE-3f Invasion of Privacy Taking liberties with a person or personal rights of another Protect your patient’s privacy by Keeping them covered when doing procedures Knocking and pausing before entering a room Drawing curtains when providing care Leaving while visitors are with the patient HS-NE-7b Not listening to telephone calls Abiding by the rules of confidentiality Not forcing a patient to accept your beliefs or views Not discussing the patient with anyone outside of work Summary In conclusion, there are many aspects of healthcare where we can easily violate patient/resident/client rights without even thinking about it. Remembering the legal and ethical responsibilities you have toward those you care for will ensure that you are not violating the rights of those who need our care.