Chapter 1-6: Ethics, Resident Rights, and End of Life Care
Resident Rights and Legal Protections
Legal Rights of Residents:
Residents living in long-term care facilities maintain the exact same legal rights as all citizens of the United States.
In addition to standard constitutional rights, residents possess legally protected residents' rights specifically established by law.
Omnibus Budget Reconciliation Act (OBRA):
Federal legislation, known as OBRA, outlines specific federal laws identifying precisely how a resident must be treated while residing in a long-term care facility.
OBRA establishes an extensive, detailed list of rights and treatment standards governing resident care.
Code of Ethics for Health Care Workers:
Provides a formal code of ethics defining how health care personnel should and should not behave, act, and deliver care.
Must be prominently posted in all long-term care facilities.
Must be provided directly to every resident or their legal representative upon admission to the facility (always provided on admission).
Long-Term Care Ombudsman Program:
An ombudsman serves as a dedicated advocate assigned to support and promote the best interests of residents living in long-term care facilities.
Every resident in a North Carolina long-term care facility has access to an ombudsman assigned specifically to their district.
District assignments for North Carolina long-term care ombudsmen are managed by the North Carolina Department of Health and Human Services.
District assignment information can be accessed on the official website at
www.ncdhhs.gov/aging(updated01/12/2024).
The Role of Ethics in Health Care
Definition and Purpose of Health Care Ethics:
Ethics is defined as the knowledge of what is right and wrong.
Ethics guides the sense of duty, professional conduct, and judgment of all health care providers.
Adhering to ethical principles enables health care workers to deliver high-quality, safe care.
Ethics governs all actions taken by health care providers and is vital to the safety and well-being of all facility residents.
Professional Work Ethic and Punctuality:
Work ethic reflects an individual's operational standards, duty, and professional commitment.
Key elements of a solid work ethic include arriving early, showing respect toward coworkers, and committing to direct patient and resident care.
Core operating motto regarding punctuality: "To be on time is to be late, but to be early is to be on time."
Clinical Standards and the Plan of Care
Clinical Judgment and Information Confidentiality:
Health care workers must exercise good judgment in all clinical scenarios.
Resident information must be kept strictly confidential.
Information regarding a resident may only be shared with other members of that resident's immediate health care team.
Documentation Guidelines:
All medical documentation must be accurate and completed in a timely manner.
Staff must document objective facts only.
Personal opinions, assumptions, and subjective judgments must be omitted entirely from clinical records.
Adherence to Individualized Care Plans:
Every resident has a specific, individualized plan of care (commonly referred to as a care plan).
Health care providers must be fully knowledgeable about the contents of a resident's care plan.
Care plans must be strictly followed for all resident care interventions.
Personal Integrity:
Health care providers must maintain complete honesty and trustworthiness in all professional interactions.
Standards of Care, Empathy, and Professional Conduct
Abuse Reporting and Incident Tracking:
Health care workers are mandated to report any abuse or suspected abuse immediately.
All observations, changes in condition, and facility incidents must be reported in a timely manner.
Caregivers must fully understand and uphold resident rights at all times.
Empathy and High-Quality Care Standards:
Empathy is defined as putting oneself in another person's shoes and feeling what they feel.
All residents must be treated equally and with equal respect.
Caregivers must provide the same level of high-quality care that they would deliver to a loved one or expect to receive for themselves.
Professional Boundaries, Privacy, and Conduct:
Resident privacy must be safeguarded during all care procedures.
All personnel must maintain professionalism and completely avoid stereotyping.
Staff must stay out of personal matters that do not concern them and avoid workplace gossip.
Health care workers must conduct themselves as professional, mature adults at all times.
Ethical Behavior, Accountability, and Cultural Diversity
Property Safeguards and Personal Values:
Caregivers must actively safeguard resident property against loss or damage.
Resident values and beliefs must be respected at all times, even if they differ from those of the caregiver.
Accountability in Ethical Practice:
Ethical behavior is defined as always taking complete accountability for one's actions.
Nurses and nurse aides must practice ethical behavior always, without exception.
Cultural, Social, and Religious Diversity:
Concepts of ethical behavior vary across different cultures, social backgrounds, personal beliefs, and religions.
Because every individual thinks and operates differently, health care workers must recognize and respect individual differences.
Ethical Considerations in End-of-Life Care
Ethical Principles and Personal Beliefs:
Decisions regarding end-of-life care are guided by an individual resident's ethical principles, cultural background, upbringing, and religious beliefs.
End-of-life choices determine how a resident wishes to be treated, cared for, and made comfortable at the time of death.
Resident Autonomy and Nurse Aide Responsibilities:
Nurse aides must respect the resident's legal right to make autonomous end-of-life decisions, even if those decisions conflict with the aide's personal ethics.
Residents possess the full legal right to refuse any medical treatment.
Residents possess the full legal right to request every available medical treatment, comfort measure, and medication.
Personal Planning and Communication:
End-of-life preferences should be considered early in life because the future is unpredictable ("none of us are promised tomorrow").
Individuals should clearly communicate their personal end-of-life care wishes to family members and loved ones in advance.
Module Resources
Educational Handouts:
Supplementary handouts detailing further information are provided at the end of the learning module.