#12 NHA CCMA: Medical Directives, Confidentiality, Violations, Unbiased Care, and Nutrition

What is an advance directive?

A written statement by a patient detailing their preferences for medical care if they become incapacitated and unable to communicate. It includes treatment wishes and designates a health care agent to make decisions on their behalf.

Why must health care providers obtain, review, and comply with advance directives?

Because they are legal documents that guide end-of-life care and ensure a patient’s treatment preferences are honored when the patient can’t speak for themselves.

What are the two main components of an advance directive?

• Living Will

• Durable Power of Attorney for Health Care

What is a living will?

A legal document that outlines which medical treatments a patient does or does not want and under what conditions. Common topics include:

• Pain relief (analgesia)

• Antibiotics/antivirals

• IV fluids

• Artificial feeding

• CPR

• Use of ventilators

• Dialysis

• Organ donation

• Do-not-resuscitate (DNR) orders

What is a Durable Power of Attorney (DPOA) for health care?

A legal document that names a health care agent or proxy to make medical decisions for a patient if they become incapacitated or unable to communicate. The agent has the same rights to accept or refuse treatment as the patient would.

How does a DPOA differ from a living will?

allows a designated person to make decisions across a broad range of medical issues and scenarios, offering more flexibility than a living will, which only outlines specific treatment preferences.

What types of decisions can a health care agent make under a DPOA?

• Admit or discharge the patient from care facilities

• Approve or refuse treatments

• Decide who has access to medical records

• Donate organs, request an autopsy, and arrange funeral plans

What happens if a patient does not have a health care agent?

The state may appoint a decision-maker, usually in this order:

• Court-appointed guardian/conservator

• Spouse or domestic partner

• Adult child

• Adult sibling

• Close friend

• Nearest living relative

Are advance directives legally valid in all states?

Yes, once signed in front of the required witnesses. Laws vary by state, so providers must evaluate directives based on local regulations. Directives remain valid until officially changed.

What is a Do-Not-Resuscitate (DNR) order?

A legal document stating that a patient does not wish to receive CPR or advanced cardiac life support if they stop breathing or their heart stops. It does not affect other treatments like chemotherapy or dialysis.

What is a POLST form?

Physician Orders for Life-Sustaining Treatment — a medical order completed by a physician for seriously ill or terminal patients, detailing specific end-of-life care preferences. POLST forms are portable, meaning they remain valid across different health care settings.

What are the three types of safeguards used to protect patient information?

• Administrative safeguards: Written policies and procedures for HIPAA compliance

• Physical safeguards: Controls over physical access to Protected Health Information (PHI)

• Technical safeguards: Measures to secure electronic PHI through technology

What law primarily governs the protection of medical records and patient privacy?

HIPAA (Health Insurance Portability and Accountability Act), which gives patients rights over their health information and sets standards for privacy and confidentiality.

What rights does HIPAA give to patients regarding their medical records?

• The right to access and receive a copy of their records

• The right to request corrections

• The right to know who has accessed their records

• The right to authorize who may access their information

Who owns the medical record and who owns the information in it?

The health care provider or facility owns the physical medical record, but the patient owns the information (data) contained in the record.

How can medical records be legally shared with another provider or entity?

Only with a signed release form from the patient that authorizes the release of their information to a specified provider or organization.

What are some exceptions where medical records can be released without patient consent?

• Criminal acts (e.g., gunshot wounds, abuse)

• Court orders/subpoenas (subpoena duces tecum)

• Communicable diseases reporting (e.g., HIV, syphilis, TB)

• Mandated exams for workers’ compensation by insurers or employers

What is the HIPAA Security Rule?

A set of regulations requiring reasonable safeguards to protect electronic PHI and prevent data breaches.

Does HIPAA require providers to share patient information with family or friends?

No, not unless the person is legally designated as the patient’s personal representative.

What are the two main categories of law that health care professionals need to be aware of?

Criminal law and civil law.

What does criminal law address?

Violations against society based on criminal statutes or codes, with punishments such as fines, imprisonment, or even the death penalty.

What are misdemeanors?

Lesser crimes punishable by fines and/or imprisonment of one year or less.

What are felonies?

More serious crimes punishable by larger fines, imprisonment for more than one year, or in some cases, the death penalty. Felony convictions can also lead to revocation of a health care professional’s license.

What are examples of crimes a health care professional might be prosecuted for?

• Practicing without a license

• Falsifying information to obtain a license

• Failing to provide life support

• Performing treatment without informed consent (battery)

What legal consequence might occur if a health care provider treats a patient without informed consent?

It may be considered battery, a felony involving unconsented physical contact.

What does civil law protect?

The private rights of a person or their property, covering areas like contracts, property, labor, privacy, and family law.

What happens when civil law is violated?

The victim may file a civil lawsuit to hold the responsible party accountable.

What is a tort?

A wrongful act that causes harm to an individual but is not a crime.

What are the two major classifications of torts?

Intentional torts and unintentional torts (negligence).

What is an intentional tort?

A deliberate act violating another’s rights, such as assault, battery, defamation, invasion of privacy, or administering an injection without consent.

What is negligence?

Failure to act reasonably when there is a duty to do so, resulting in harm, without intent to cause harm.

What is malpractice?

A type of negligence where a health care professional provides improper or illegal treatment causing injury. It requires proof of breach of standard care that caused harm.

How is the standard of care defined in malpractice cases?

The care an ordinary, prudent health care professional with similar training would provide under similar circumstances.

What are the penalties in civil law?

Mostly monetary damages awarded to the injured party.

What are the "four Ds" of negligence?

• Duty of Care: Legal obligation to act responsibly.

• Dereliction of Duty: Breach of that duty.

• Direct Cause: The breach directly causes harm.

• Damages: The harm is compensated with money.

What is mandated reporting in health care?

It is the legal obligation of health care providers to report and document incidents concerning patient safety and public welfare to appropriate agencies.

What types of events must be reported promptly under mandated reporting laws?

• Births

• Deaths

• Certain communicable diseases, including specific STIs

• Assaults or criminal acts

• Abuse, neglect, and exploitation (child, older adult, intimate partner)

What are national notifiable diseases?

Diseases required by law to be reported to government authorities, such as tuberculosis, meningitis, AIDS, and many sexually transmitted diseases.

Why is reporting communicable diseases important?

It helps authorities prepare for and prevent the spread of contagious diseases, protecting the general population and guiding public health policies.

Who is generally required to report communicable diseases to local health departments?

Physicians, veterinarians, podiatrists, nurse practitioners, nurses, nurse midwives, physician assistants, medical examiners, coroners, dentists, and health facility administrators.

What forms of abuse are subject to mandatory reporting?

Child abuse, elder abuse, and often domestic violence.

What types of professionals are typically required to report suspected abuse?

• Social workers

• School personnel (teachers, principals)

• Health care professionals (physicians, nurses)

• Counselors and mental health professionals

• Childcare providers

• Medical examiners or coroners

• Law enforcement officers

Are reporters of suspected abuse protected from lawsuits?

Yes, individuals who report in good faith are legally protected.

Does suspected abuse need to be proven before reporting?

No, suspected abuse must be reported even if not proven.

Can information from abuse evaluations be used in legal proceedings?

Yes, information obtained during evaluations may be used against the alleged perpetrator in court.

What are examples of physical abuse?

Pushing, hitting, shoving, punching, biting, choking, and physically restraining or blocking movement.

What are examples of verbal or emotional abuse?

Criticizing, degrading, swearing, blaming, and any verbal attacks that harm a person’s self-esteem.

What behaviors are considered psychological abuse?

Isolating someone from family and friends, controlling their actions or decisions, stalking, and invading their privacy or personal space.

What actions fall under sexual abuse?

• Forcing or demanding sex

• Forcing sex with another person

• Coercing someone into prostitution or pornography

• Refusing to use safe sex practices

What is economic abuse?

Preventing someone from working, controlling their access to money, or exploiting their citizenship status to restrict employment.

What are some red flags or signs that may indicate abuse?

• Previously filed reports of child physical or sexual abuse

• Known history of abuse toward other family members

• Conflicting stories between parent and child about an incident

• Suspicious stories or explanations for injuries

• Blaming injuries on other family members

• Frequent ER visits for injuries

• Bruising/discoloration on buttocks, back, or abdomen

• Dislocations of elbow, wrist, or shoulder

• Delayed physical or developmental growth

• Irregular school attendance

• Poor hygiene or signs of neglect

• Malnutrition

• Obvious dental neglect

• Missed basic medical care like immunizations

Why is cultural competence important for Medical Assistants (MAs)?

MAs serve a diverse population with varying backgrounds, beliefs, values, and identities. Cultural competence allows them to effectively communicate and provide care that meets the unique needs of each patient.

What does cultural competence mean in health care?

It’s the ability of health care providers and organizations to deliver services that meet the cultural, social, and linguistic needs of patients.

What factors may influence a patient's background and identity?

Race, ethnicity, sex, age, religion, language, education, sexual orientation, and gender identity.

How is culture defined in this context?

Culture refers to the shared experiences, beliefs, and values of a group that shape how its members understand the world. It includes things like race, national origin, class, sex, and religion, and influences actions, communication, relationships, and decision-making.

What is bias?

A preference for or against a person, group, or idea—either conscious (explicit) or unconscious (implicit)—that can affect judgment and behavior.

What are the two main types of bias?

• Conscious bias (explicit): Deliberate attitudes or beliefs.

• Unconscious bias (implicit): Automatic, unintentional preferences or stereotypes.

What are some characteristics people might have biases against?

Race, age, sex, gender identity, religion, sexual orientation, weight, physical abilities, and more.

Why is confronting personal bias important for health care professionals?

Because bias can harm patient care and reduce inclusion and acceptance in the clinical setting. Recognizing and addressing bias helps build multicultural competence and provide better, more equitable care.

What can happen if a health care professional discriminates based on bias?

They may face disciplinary action, termination, or even criminal charges for violating anti-discrimination laws and policies.

Is cultural competence a one-time achievement?

No, it is an ongoing learning process requiring continuous awareness and adjustment to sociocultural influences in the patient-provider relationship.

What are nutrients?

Substances in food necessary for energy, growth, repair, disease resistance, fluid balance, and body temperature regulation.

What’s the difference between essential and nonessential nutrients?

• Essential nutrients must come from food because the body can't produce them (e.g., some vitamins, minerals, amino acids).

• Nonessential nutrients are made by the body (e.g., vitamin D, cholesterol).

Which nutrients contain calories?

Proteins, carbohydrates, and fats (lipids).

Which nutrients do not contain calories?

Water, vitamins, minerals, and fiber.

What are the six primary nutrients?

• Water

• Carbohydrates

• Protein

• Fat

• Vitamins

• Minerals

Why did MyPlate remove generalized daily intake recommendations?

Because nutrition needs vary greatly by individual and life stage.

What factors are used to create personalized nutrition plans on myplate.gov?

• Age

• Sex

• Height

• Weight

• Physical activity level

What percentage of the human body is made up of water?

50% to 80%

How much water is generally recommended per day?

2 to 3 liters (64 to 96 oz)

What are the key functions of water in the body?

• Transports nutrients and oxygen

• Removes waste

• Regulates body temperature

• Forms blood and bodily fluids

What are proteins made of?

Amino acids

What are the three types of amino acids?

• Essential: Must come from food

• Nonessential: Made by the body

• Conditional: Needed only during stress/illness

What are the functions of protein?

• Builds and repairs tissues

• Supports fluid balance

• Creates transport molecules

• Can be used for energy (though inefficiently)

How many calories does each gram of protein provide?

4 calories

When does the body require more protein?

During recovery from burns, surgery, trauma, infections, and during pregnancy, breastfeeding, infancy, and adolescence.

What are carbohydrates made of?

Carbon, hydrogen, and oxygen

What are the two types of carbohydrates?

• Simple sugars: e.g., honey, candy

• Complex carbohydrates: e.g., fruits, vegetables, whole grains, rice, pasta, beans

What is the body’s preferred energy source?

Glucose, a simple sugar

How does the body store excess glucose?

As glycogen in the liver

How many calories does each gram of carbohydrate provide?

4 calories

What are the risks of too little or too much carbohydrate intake?

• Too little: Fatigue, weight loss, muscle loss

• Too much: Weight gain, tooth decay

What is the primary function of fat in the body?

It provides a concentrated energy source, serves as backup energy to glucose, supports vitamin absorption, and contributes to cell structure and hormone production.

What are fatty acids?

The building blocks of fat molecules.

What’s the difference between saturated and unsaturated fats?

• Unsaturated fats are oils, less dense, and do not raise cholesterol as much.

  • Monounsaturated: Olive, canola, peanut oils

  • Polyunsaturated: Corn, sunflower, safflower oils

• Saturated fats are solid at room temperature and raise LDL (“bad”) cholesterol.

  • Found in meats, palm oil, coconut oil

What is trans fat?

A processed fat (from hydrogenation) that increases LDL cholesterol and is used to preserve processed foods.

What are some health risks of too much or too little fat?

• Too little: Vitamin deficiencies, fatigue, dry skin

• Too much: Obesity, heart disease

How many calories per gram does fat provide?

9 calories

What are key functions of fat besides providing energy?

• Absorption of fat-soluble vitamins (A, D, E, K)

• Cell membrane structure

• Growth in children

• Hormone regulation (e.g., blood pressure, clotting)

• Skin health

• Protection and insulation of organs

What are vitamins and why are they important?

Organic substances needed for cellular function. They help metabolize energy but do not provide energy themselves.

Which vitamins can the body produce in limited amounts?

D, A, and B3

What are the two types of vitamins?

• Fat-soluble: A, D, E, K — stored in body fat

• Water-soluble: B1, B2, B3, B6, folate, B12, pantothenic acid, biotin, C — excreted in urine, not stored long-term

What are minerals and what are they used for?

Inorganic substances vital for body structure and function. They're involved in bones, muscles, nerves, blood, acid-base balance, and tissue repair.

What role do minerals play with enzymes?

They act as cofactors, helping enzymes function properly.

What systems do minerals support?

Musculoskeletal, neurological, hematological

What are good food sources of water?

Plain water, fruits, vegetables

What are good food sources of protein?

Meat, poultry, fish, cooked beans, eggs, nuts, seeds, nut butters

What are good food sources of carbohydrates?

Whole grains, fruits, vegetables, rice, beans, potatoes

What are good food sources of fats?

Fatty fish (tuna, salmon, sardines), avocado, olive oil

What are good food sources of vitamin A?

Milk fat, meat, leafy vegetables, egg yolks, fish oil, orange and yellow fruits