Week 4: Legal & Ethical Concerns

What are 5 key issues for the elderly?

1. Autonomy & rights

2. Advance directives

3. Legal issues specific to long term care settings

4. Ethical issues in Gerontological nursing

5. MAID

Competency

A legal term that refers to the ability to fulfill one's role and handle one's affairs in a responsible manner

Decision making capacity

A measure of a person's ability to make an informed and logical decision about a particular aspect of his or her health care

What are 2 types of guardianship and what do they mean?

Partial guardianship: the incompetent person continues to make limited decisions

Full guardianship: the person loses all his or her rights to make decisions

Trusteeship

Applies when an older adult no longer has the capacity to make a decision on financial matters

Advance Directives

Legally binding document that allows competent people to document what medical care they would or would not receive if they were not capable of making decisions/communicating their wishes

^ can only be made while a person is still competent

Which level of government are nursing home resident's rights legislated?

Provincial/territorial level

What ethical issue is associated with LTC facilities

Questions about safety versus freedom of the residents

- Safety is more important

What are 2 ethical issues of gerontological nursing

1. Use of restraints

2. Artificial nutrition and hydration

Physical restraints

Any device, method or equipment that immobilizes or reduces the ability of the patient to move their arms, legs, body or head freely

Types of Restraints:

physical - all bed rails up

chemical - sedatives, usually PRN

environmental - locked in room

Artificial Nutrition & Hydration (ANH)

Refers to methods of bypassing the upper gastrointestinal system to deliver nutritional substances

Examples of ANH routes

- percutaneous endoscopic gastronomy tube

- NG tube

- jejunostomy tube

^digestive

- total parenteral nutrition via IV catheter

- subcutaneous delivery of fluids (Hypodermoclysis) —> less fluid, not absorbed as well

^dont enter GI system

MAiD

The criminal code of Canada was amended to allow a person to request and receive, under limited circumstances, a substance intended to end their life

- Bill C-14

Eligibility for MAiD

- Person is eligible only if they meet ALL the criteria

- A person has a grievous and irremediable medical condition

What is the role of an RN in MAiD?

- Limited to aiding a physician or NP in the provision of MAiD

- RNs are not allowed to prescribe, compound, dispense or administer any substance intended for the purpose of MAiD

What are 4 roles of a nurse regarding legal and ethical issues?

1. Facilitate decisions about care

2. Implement advance directives

3. Promoting caregiver wellness

4. Promote advance care planning

Senior Abuse

Refers to a wide variety of harms to older adults that are committed by a person they know and would normally have a reason to trust

What are some perpetrator risk factors for elder abuse/neglect?

(Greater risk of becoming a perpetrator is you have these)

Financial dependency on victim

Alcoholism

Hostility

Mental illness

What are some victim risk factors for elder abuse/neglect?

Cognitive impairment/dementia

Problem behaviours

Disability

Physical dependency

Financial dependency

Shared living arrangements

Isolation

Lack of social supports

What are 7 types of abuse?

1. Physical

2. Sexual

3. Emotional/psychological

4. Exploitation

5. Neglect

6. Abandonment

7. Self neglect

Physical abuse

Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need

Ex. Pinching, spitting, environmental restraints

Sexual abuse

- Nonconsensual sexual contact of any kind

- Coercing an elder to witness sexual behaviour

Emotional abuse examples

Not considering a resident's wishes

Not respecting a resident's belongings

Speaking in a different language in front of the resident

Inappropriate control of activities

Treating a resident like a child

Bullying

Ignoring or disregarding behaviours

What are possible indicators of receiving emotional abuse?

Low self esteem

Extreme tiredness

Nervousness and being uncomfortable around a particular individual

Depression

Anxiety

Increased isolation

Fear

Withdrawal

Spiritual abuse

The denial of a resident's right to spiritual practices:

- restricting or denying spiritual practices, customs, traditions

- not providing privacy for prayer

- diet related religious taboos

- body related care that is insensitive to religious customs (cutting the hair of a Sikh male)

Financial exploitation

Illegal taking, misuse, or concealment of funds, property or assets of a vulnerable elder

What is neglect?

The refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder

What are some reasons elders may not report abuse?

- do not recognize/ACKNOWLEDGE the behavior as abuse

- do not know where to get help

- fear it will get worse

- worry about what will happen if abuse becomes known

- feel humiliated

- take blame for abuse

- fear a loss of connection

- believe that family honor is at stake

- privacy is at stake

- unable to express themselves (aphasia, dementia, language barriers, severe illness)

Why is it difficult for staff to report?

Fear of:

- revenge

- job loss

- lack of support

- getting someone in trouble

- getting involved

Lack of knowledge about:

- what abuse is

- what can be done

- the Law

- resources within or outside facility

- protocols and procedures