Ethical & Legal Issues In Healthcare

Important terms:

  • Ethics: Knowledge of what’s right and wrong

  • Laws: Rules to protect the public

    • Civil

    • Criminal

  • Etiquette: Proper behavior and courtesy in the healthcare setting

Nursing Code of Ethics:

  • Provisions 1-3 Upholding nurses’ fundamental commitments and values

  • Provisions 4-6: Identifying nurses’ parameters of loyalty

  • Provisions 4-6: Defining duties beyond direct nurse-patient encounters

Ethical principals

  • Justice: fairness in distributing care

  • Beneficence: doing good and the right thing

  • Nonmaleficence: doing no harm

  • Autonomy and client self-determination: accept the client as a unique person

Client rights are based on the universal declaration of Human Rights and need to be advocated for and upheld by nurses

  • Privacy

  • Confidentiality

  • Respect and dignity

  • Select their doctors

  • Transparency of condition and treatment

  • Autonomous decisions about care incl. reject treatment

  • Freedom from abuse and neglect

CNA Ethical Behavior

  • Protecting life and promoting the health of patients

  • Keeping personal information confidential

  • Respecting each person as an individual

  • Giving care based on need, not gratuities

  • Treating all patients equally regardless of their religious or ethnic background

Unethical Behavior of a CNA May Include:

  • Avoiding work by sitting in empty patient rooms o the break room during on-time work hours

  • Having personal conversations on your cell phone in patient care areas

  • Not responding to call lights promptly, when you are available to do so

  • Ignoring the phone(s) assigned to you

  • Using the hospital computer for personal use

  • Avoiding a patient because of his or her ethnicity, demeanor, or other variable characteristics

Omibuyy Budget Reconciliation Act (OBRA)

  • Originated in 1987

  • Regulates education and certification of nursing aides

  • Established a registry of individuals who successfully completed their training

  • CNAs must be educated in an approved program

  • CNAs must be certified by their state

  • Annual in-service training/continuing education (CEUs)

  • OBRA allows State boards of Nursing to supply the details, through the NATCEP (Nurse Aide Training and Competency Evaluation)

  • Individual states determine:

    • Educational standards

    • Licensure by exam and performance of skills

    • Continuing education

    • Scope of Practice

      • The skills and responsibilities you are legally authorized to perform, based on your training and licensure

      • Outlined in Nurse Practice Ace

      • Specific to each state

      • Mandated vs Permissible Skills

      • NEVER perform a skill unless you have been adequately trained

      • When you accept an assignment, you must be capable of finishing it correctly and SAFELY

Reciprocity

  • CNA certification may be transferred from state to state

  • Typically done through endorsement process:

    • Complete application

    • Verify good standing of initial license

    • Submit copy of license

    • Fingerprints/background checks

    • Pay fee

Regulation

  • Licensure/Certification

  • Every member of the health care team is licensed

  • Facility licensed by state to conduct

  • Facility certification required to accept Medicare/Medicaid payments

Accreditation

  • Review of institution to see if it meets quality standards

  • The Joint Commission (TJC)

Rights and Responsibilities

The Basics

  • The right to dignity, respect, and freedom

  • Full participation in decision-making—including the right to refuse care

  • Informed consent

  • Privacy and confidentiality

  • Continuity of Care

  • To receive quality care bu adequately trained professionals

  • To complain

  • Advance Directives

Patient Responsibilities

  • Honesty

    • Health history

  • Ask questions/participate in care decisions

  • Manage health

  • Inform of noncompliance

  • Accept responsibility for decisions, refusal of care, payment

Patient Self Determination Act

  • Federal law

  • Compliance is mandatory

  • Purpose of this act is to ensure that a patient’s right to self-determination in health care decisions is communicated and protected

Abuse and Neglect

Laws:

  • Civil

    • Law concerned with the relationships between individuals

    • Violation is called a tort

    • Can be unintentional or intentional tort

    • Basically, causing harm or injury to another person or their property

    • Negligence is considered malpractice

  • Criminal

    • Law concerned with the relationship between individuals and society

    • Abuse

    • Often serve jail time

Negligence

  • Failing to do what a “careful and reasonable” person would do

  • CNAs are held LIABLE

  • Malpractice is identified when harm and/or death occurs

Mandated Reporters

  • CNAs are legally required to report abuse, suspected abuse, neglect, or suspected neglect

  • Provide the RN with as much information as possible

  • Be objective in your communications

  • If you don’t document—you didn’t do it!