Legal Aspects and Ethics

OBJECTIVES:

At the end of the class you will be able to:

1. Apply some legal principles to the care that you give.
   
2. Define standards of care, scope of practice, malpractice, negligence, abandonment, abuse, assault and battery.
   
3. Apply some ethical principles to the care that you give.
   
   

INTRODUCTION

Legal and ethical issues are very important to nursing assistants, patient care assistants, home health aides, personal care aids and others. This class will help you to give care that is legal and ethical.

LEGAL ASPECTS OF CARE

Some of the legal things that you must know about are:

• Standards of Care
  
• Scope of Practice
  
• Malpractice
  
• Negligence
  
• Criminal Negligence
  
• Abandonment
  

Standards of Care

A standard of care tells us what a person should do. One standard of care can describe what you should do if they see that a person has just fallen to the floor. The nursing assistant should call for help, stay with the person and look at the person to see if they are hurt when they fall. If you do NOT do these things, you have NOT followed a standard of care.

If you do NOT do what is expected of a nursing assistant, you can be held responsible for any harm or damage done to the patient or resident. Standards of care come from:

• The state in which one provides care. For example, states in our country say that nursing assistants are must observe and report abnormal signs and symptoms. If a nursing assistant does not report shortness of breath to the nurse, this nursing assistant is NOT providing care according to the standard of care in their state.
  
  
• Organizations. For example, an organization or association can have standards of care. For example, our national law states that patient and resident health information must be kept confidential. If a nursing assistant tells others about the health state of another person, they are NOT following a standard of care.
  
  
• The workplace. All places of work have a policy and procedure book that has standards of care.
  
  
• Books and other information. Here is an example. Books describe the correct way to do CPR. A person is not following the standard of care when they do their "own way" of CPR.
  

Scope of Practice

States tell us the scope of practice for nurses, doctors, nursing assistants and others. They list what a person can and cannot do in the job. For example, a registered nurse's scope of practice may list that the nurse can give medicines.

The scope of practice for a nursing assistant may list that they can only assist a person with their self-administration of medicine only in an assisted living home. If a nursing assistant assists a person to give themself a medicine in a nursing home, they are doing things outside of their scope of practice. They can only do this in an assisted living home.

Also, if a nursing assistant gives a person their medicine in any place, they are doing things outside of their scope of practice. They are doing something that they are NOT licensed to do.

Malpractice

A person who does NOT give care with same level of skill that they learned in school can be found guilty of malpractice when this leads to an injury or damage to the person.

For example, when a nursing assistant does NOT wash their hands between patients and some of the patients get a serious infection, this nursing assistant can be found guilty of malpractice.

Nursing assistants should know how and when to wash their hands. Handwashing is learned in school before one becomes a nursing assistant and it is again taught again on a regular basis when the nursing assistant takes an inservice class on infection control.

Negligence

Negligence is when a person does NOT act the way they should. For example, a nursing assistant is negligent when they do NOT take vital signs when they should have.

Criminal negligence occurs when a person is very reckless with patients and residents. For example, a nursing assistant can be found guilty of criminal negligence if their falls risk patient falls and dies after they were left alone for hours in a bath tub.

Abandonment

Abandonment is when a person leaves residents or patients without the care that they need. A nursing assistant has abandoned the patients and residents when they leave their place of work and go home before the end of the shift without tell the nurse.

Unprofessional Conduct

Unprofessional conduct is when a person does NOT follow standards of practice even when NO harm or injury has come to a patient or resident. For example, a nursing assistant who comes to work impaired with alcohol or drugs is showing unprofessional conduct even if none of the patients is harmed.

Assault and Battery

Assault happens when a person is put in the fear that he or she will be touched without their permission. Telling a person that they will be slapped if they do not stop yelling is an example.

Battery happens when a person is actually touched without their permission. It is battery if a nursing assistant slaps or pushes a patient. It is also physical abuse. Forcing a person to eat a meal is also battery.

Physical and psychological abuse can be criminal and/or unprofessional conduct.

GIVING LEGAL CARE

All care must be given in a legal way. You can do these things to make sure that you give care in a legal way are:

• Know your standards of care. Follow your standards of care. Make sure that you do things exactly like you were taught in school and in the place that you work. Make sure that you do all the things that are listed in the policies and procedures where you work. If you are NOT sure about how to do a task, ask the nurse. Do NOT do anything if you are not sure that you can do it in the right way.
  
  
• Do NOT do anything that is NOT in your scope of practice. Ask the nurse what to do if you are asked to do something that you think is NOT in your scope of practice.
  
  
• Give high quality care to all of your patients and residents.
  
  
• NEVER leave your patients or residents unless the nurse tells you that you can leave.
  
  
• Keep your knowledge current. Take all the classes you need to give safe care. Take all the classes that your state tells you to. For example, in Florida, you must take at least 18 hours of class EVERY year.
  
  

ETHICAL CARE

All patients and residents have a right to:

• Respect and dignity
  
• Privacy
  
• Confidentiality
  
• Freedom from abuse and neglect
  
• Control over their own money
  
• Have their personal property
  
• Know about their medical condition and treatments
  
• Choose their own doctor(s)
  
• Make decisions about their medical care
  
• Competent care
  
  

Respect, Dignity and Privacy

People do not lose their right to privacy, respect and dignity when they are in a hospital or nursing home. We must protect these rights.

Confidentiality

Patients and residents have a right to have their personal information kept secret from all other people, except those that are giving the care. NEVER talk about one of your patients with friends, neighbors, other patients or residents.

Health care workers, including nursing assistants, should NEVER tell a person's diagnosis or condition to anyone that is NOT caring for the patient. Do NOT talk about patients in halls or coffee shops. You never know who is listening!

Freedom From Abuse & Neglect

All humans should be free from abuse and neglect. They must also be free from the fear of abuse and neglect.

If you THINK that someone is abusing or neglecting a patient or resident, REPORT IT. You do NOT have to be certain! Report it if you think it may be happening.

To learn more about abuse and neglect, take our class "Patient Rights and Dignity"

Control Over Money

Patients and residents who are able to make their own decisions should have control of their money. They should be allowed to decide how to spend their money even if we do not think it is a smart thing to do. For example, if your patient wants to buy 1,000 lottery tickets a week, they should be allowed to do it if they have the money.

When a person is not able to make decisions, another person may have legal control over the person's money.

Personal Property

Residents and patients should be able to have and use own property if these things will NOT harm others.

Knowing About Care and Treatment

Patients and residents must know about their care and the choices they have about the care they receive. Doctors, nurses and others must tell all patients and residents about their condition and care in words that the person can understand.

Nursing assistants must explain things to the person before they do anything. Use simple words that the person can understand when you explain things. If the person asks you a question that you cannot answer, report this question to the nurse.

Freedom To Choose One's Own Doctor

Patients and residents must be able to choose their own doctor. Other people do not have the right to make this choice for them if they are able to make this decision.

A Person's Right to Decide What Care They Want and Do NOT Want

Patients and residents must be able to decide what care they want and do not what whenever they are able to make a decision. The doctor, nurse or family member CANNOT make the choice when the person is able to make his or her own decisions.

Competent Care

Patients and residents also have the right to safe and high quality care. Good care cannot be done unless nurses, doctors, nursing assistants and all other health care workers are able to do the right thing in the right way.

Everyone must know how to provide safe patient care in the correct way. If you are not sure of how to do something, STOP. Get the nurse and ask the nurse to teach you or to help you with it. Do NOT ever do anything unless you are sure that you can do it the right, or correct, way. Safe patient care is a RIGHT.

Summary

Patients and residents must be given care that is legal and ethical. This class has given you information about these aspects of care and how to apply this information into your daily role.

References

Nettina, Sandra M. (2001). The Lippincott Manual of Nursing Practice, 7th Ed. Philadelphia: Lippincott, Williams and Wilkins.

Pulliam, Jolynn. (1998). The Nursing Assistant: Acute, Subacute & Long-Term Care. New York: Prentice Hall.

Copyright © 2004 Alene Burke