Legal, Ethical financial

Legal, Ethical, & Financial Considerations

Introduction to Ethics

  • Definition of Ethics

    • Ethics considers the values of an individual and the relationships formed as a result of those values.

    • An understanding of one's own value system and ethical framework is essential.

  • Development of Ethical Competence

    • Ethical competence is influenced significantly by personal experiences.

  • Study Focus

    • Ethics encompasses the examination of moral actions and values.

End-of-Life Care and Vulnerabilities

  • relevant issues

    • Vulnerabilities associated with dementia are particularly significant in the context of end-of-life care.

    • Examples of Ethical Dilemmas

    • Elder abuse is a critical ethical issue needing attention in gerontological nursing.

Patient Care Partnership

  • Purpose

    • A patient care partnership establishes expected ethical behaviors for the care of hospital patients.

  • Tools for Ethical Decision-Making

    • Ethical Codes

    • Utilized to guide nursing practice.

    • Standards of Care

    • Identify both legal and ethical limits within patient care.

    • Professional Code of Ethics

    • Considers personal values along with federal and state standards, as well as organizational standards.

Understanding the Law in Nursing

  • Definition of Law

    • Laws are rules and regulations that guide society and provide a formal and binding structure.

    • The law serves as a framework within which nursing and patient care operate, which may sometimes conflict with personal values.

  • Application

    • It is imperative to understand and apply laws to every nursing care situation to ensure compliance and patient safety.

Laws Influencing Gerontological Nursing

  • Key Legislative Acts

    • 1973: Patient Bill of Rights

    • Adopted by the American Hospital Association (AHA); established patient care partnership. Although not a legal document, federal law mandates similar documents be available in nursing homes, outlining resident rights.

    • 1990: Patient Self-Determination Act

    • 1996: Health Insurance Portability and Accountability Act (HIPAA)

Risk and Liability in Nursing

  • Understanding Liability

    • Liability risks can be increased by factors such as:

    • Personal fatigue.

    • Inadequate staffing.

    • Use of inappropriate equipment.

    • Noncompliance with established procedures.

    • Practicing beyond established professional scope.

    • Presence of impaired care providers.

    • Moral and Legal Responsibility

    • Nurses are both legally and morally accountable for their actions taken in the course of their duties.

Case Study: RaDonda Vaught

  • Incident Overview

    • A nurse, Rolando Vught, was implicated in an incident leading to charges of reckless homicide.

  • Trial Outcome

    • The trial concluded on March 25, 2022, with a jury finding Vaught guilty of criminally negligent homicide and abuse involving an impaired adult.

  • Discussion Questions

    • Factors leading to medication errors.

    • Opinions on the conviction of the nurse.

    • Preventive measures to be implemented in hospitals to mitigate such errors.

Key Legal and Ethical Definitions

  • Negligence

    • Defined as the failure to use appropriate care and caution to prevent harm.

  • Malpractice

    • Refers to professional negligence.

  • Omission

    • Involves failing to perform an expected action or address a critical concern.

Regulatory Framework on Restraints

  • Omnibus Reconciliation Act (OBRA)

    • Prohibited the routine use of restraints on elderly individuals.

    • Short-term restraints require a physician's order and must be monitored closely.

    • Documentation for restraint use should be meticulous.

    • Creating a restraint-free environment necessitates staff education.

Informed Consent

  • Overview of Informed Consent

    • Key components include:

    • Providing comprehensive treatment or procedure information.

    • Ensuring the appropriate consent form is signed.

    • The nurse's role is to act as the patient advocate.

  • Essential Elements of Informed Consent

    • Written description of the procedure and its purpose.

    • An explanation must be given by the healthcare professional performing the procedure.

    • Alternatives to the procedure should be presented.

    • Expected consequences and potential risks must be articulated.

    • Signature of the patient, which is to be witnessed and dated.

Advance Directives (AD)

  • Definition

    • An advance directive is a legal document executed by a competent adult addressing end-of-life care preferences and decisions regarding life-sustaining treatments.

  • Healthcare Institution Protocol

    • Healthcare institutions are required to inquire about advance directives from patients.

  • Types of Advance Directives

    • A Living Will.

    • A Durable Power of Attorney (POA) for healthcare decisions.

Identifying Physical Signs of Elder Abuse

  • Common Indicators

    • Dehydration or unusual weight loss.

    • Missing aids necessary for daily living.

    • Unexplained injuries such as bruises, cuts, or sores.

    • Poor hygiene and unsanitary living conditions.

    • Neglected medical needs.

Reporting Elder Abuse

  • Legal Obligations

    • Elder abuse is illegal in every state; individuals are responsible for understanding state laws and organizational procedures for reporting abuse.

  • Types of Elder Abuse

    • Physical.

    • Sexual.

    • Emotional abuse.

    • Neglect.

    • Abandonment.

    • Financial abuse.

Financial Considerations in Health Care

  • Overview of Financial Impact on Care

    • Costs related to hospitalization, outpatient services, home care, hospice, and prescription medications.

    • Coverage varies depending on whether a patient has Medicare parts A, B, or C.

  • Limitations of Medicare

    • Medicare does not cover long-term care or private nursing services.

  • Private Health Insurance

    • Typically excludes long-term care coverage.

    • The Affordable Care Act (ACA) has influenced medication costs and increased access to preventive services.

    • Financial challenges can significantly impact older adults' ability to secure housing and healthcare, particularly for those on fixed incomes.