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Ethical and Legal Responsibilities of the Nurse’s Aide

Unit 2 Lesson 1

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Provide examples of unethical behaviors that a nurse's aide should avoid
Define vulnerable populations
Describe the governing agencies and legislation involved in enforcing guidelines for health care
Identify the resident's rights in long-term care settings
Describe elder abuse and its symptoms
Explain the purpose and components of the survey process

Student Learning Outcomes

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Ethical Responsibilities

Treat all clients equally with compassion
Show respect for their dignity and worth
Promote clients' rights and safety
Help achieve best possible health outcomes
Act professionally at all times

Sandquist-Reuter, 2023

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Unethical Behaviors - Technology & Work

The Nurse’s Aide Should Never

Use personal cell phone in patient care areas
Ignore call lights when available
Ignore phones assigned to them
Use agency computers for personal use
Avoid work by hiding in empty rooms
Sit in break room during work hours

Sandquist-Reuter, 2023

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Critical Thinking Question

During a shift, a nursing aide notices a colleague using a personal cell phone in a patient care area and failing to respond promptly to call lights. How should the nursing aide address this situation to maintain ethical and professional standards?

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Unethical Behaviors - Client Relations

The Nurse’s Aide Should Never

Avoid clients due to ethnicity, beliefs, or demeanor
Accept gifts from clients or families
Share client information with unauthorized people
Steal from clients or the healthcare agency
Discriminate against any client
Break professional boundaries

Sandquist-Reuter, 2023

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Vulnerable Populations

Children and older adults
Minorities and socially disadvantaged people
Underinsured/uninsured individuals
Those with certain medical conditions
People who cannot speak up for themselves
Those with health conditions worsened by poor care

Sandquist-Reuter, 2023

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Federal Agencies - CMS & CDC

Centers for Medicare and Medicaid (CMS)

Provides healthcare funding for qualifying members
Medicare

Age 65+, disabled, kidney failure patients

Medicaid

Low-income individuals and families

Centers for Disease Control (CDC)

Provides infection and disease control guidance
Sets safety standards for healthcare facilities

Sandquist-Reuter, 2023

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Federal Agencies - FDA & OSHA

Food and Drug Administration (FDA)

Ensures safety of medications and medical devices
Regulates food supply and tobacco products
Provides science-based health information

Occupational Safety & Health Administration (OSHA)

Ensures safe working conditions
Sets and enforces safety standards
Provides safety training and education

Sandquist-Reuter, 2023

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US State Government Role

Department of Health Services (DHS)

Works with counties and healthcare providers
Provides alcohol and drug prevention programs
Manages mental health and public health services
Handles disability determination
Implements long-term care programs
Regulates state nursing homes

Sandquist-Reuter, 2023

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HIPAA Law (1996)

Health Insurance Portability and Accountability Act (HIPAA)
Protects sensitive patient health information
Requires keeping all client information confidential
Must protect documentation and care plans
Only share information with direct care providers
Detect and prevent information security threats
All healthcare workers must follow these rules

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OBRA Law (1987)

Omnibus Budget Reconciliation Act (OBRA)
Set new standards for nursing home care
Required 75+ hours nurse aide training
Created competency evaluation requirement
Established state registries for qualified aides
Focused on patient-centered care
Improved quality of life for patients

Sandquist-Reuter, 2023

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Older Americans Act (1965)

Addressed lack of social services for elderly
Created Long-Term Care Ombudsman programs
Investigates and resolves patient complaints
Provides information about long-term services
Ensures access to ombudsman services
Represents patients' interests to government

Sandquist-Reuter, 2023

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Patient Rights - Basic Rights

Be treated with respect and dignity
Be free from discrimination and abuse
Be free from restraints and neglect
Receive proper medical care
Have privacy and proper living arrangements
Make complaints without fear

Sandquist-Reuter, 2023

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Patient Rights - Decision Making

Make decisions about their own care
Involve family in care decisions if desired
Have representative notified of care changes
Receive information about services and fees
Be protected from unfair transfers
Leave facility when health allows

Sandquist-Reuter, 2023

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Critical Thinking Question

A nursing aide is caring for a client who wishes to participate in more social activities but feels limited by the current care plan. What is the best approach for the nursing aide to take?

Report the client’s desire to the supervising nurse to reassess the care plan
Encourage the client to continue with the current activities without changes
Suggest the client discuss their concerns with family members instead
Advise the client to wait until the care team brings it up again

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Patient Rights - Daily Life

Participate in activities they enjoy
Spend time with visitors
Manage their own money
Create or join groups
Receive social services
Have their preferences respected when safe

Sandquist-Reuter, 2023

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Critical Thinking Question

A nursing aide notices a client who has difficulty communicating and is often excluded from group activities. The client appears withdrawn and lonely. What should the nursing aide do to support the client’s rights and promote their well-being?

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Supporting Patient Rights

Accommodate patient requests when safe
Consult supervising nurse when unsure
Only deny requests for safety reasons
Always offer alternatives when possible
Remember dependency can cause depression
Show empathy and understanding

Sandquist-Reuter, 2023

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Elder Abuse

Intentional act that causes harm or risk
Happens to someone age 60 or older
Done by caregiver or trusted person
Can be action or failure to act
Includes physical, sexual, emotional abuse
Also includes financial abuse and neglect

Sandquist-Reuter, 2023

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Physical & Sexual Abuse

Physical Abuse Signs

Bruising, fractures, burns, unexplained injuries
Person isolates themselves or withdraws
Behavior changes when abuser is present

Sexual Abuse Signs

Injury to genital areas, infections, bleeding
Torn clothing, rashes, discharge
Same behavioral changes as physical abuse

Sandquist-Reuter, 2023

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Critical Thinking Question

While assisting with a patient’s daily hygiene routine, a nursing aide notices unexplained bruises on the patient's arms and legs. How should the nursing aide respond to this observation?

Record the bruises in the chart and wait to see if more appear
Gently ask the patient about the bruises but take no further action
Report the bruises to the nurse or supervisor immediately for further investigation
Mention the bruises casually to another staff member during a break

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Emotional & Financial Abuse

Emotional/Psychological Abuse Signs

Depression, anxiety, loss of confidence
Feelings of failure or worthlessness
Fear of certain people or situations

Financial Abuse Signs

Missing personal items or money
Going without food, medications, necessities
Excessive unexplained cash withdrawals

Sandquist-Reuter, 2023

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Critical Thinking Question

A nursing aide is caring for an elderly client who reports that a family member has been taking their money without permission. What is the most appropriate action for the nursing aide to take?

Wait to see if the client brings it up again before saying anything
Report the concern to the nurse supervisor immediately
Talk directly with the family member to try to resolve the situation
Reassure the client but avoid reporting the concern to avoid “causing trouble”

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Neglect & Self-Neglect

Neglect Signs

Weight loss, skin breakdown, infections
Confusion, hallucinations, dehydration
Soiled clothing, odors, poor oral care

Self-Neglect Signs

Same signs as neglect above
Person fails to care for themselves
Refuses help with basic needs

Sandquist-Reuter, 2023

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Reporting Responsibilities

Required by law to report suspected abuse
Report any suspicious signs to the nurse
Stay with patient until they are safe
Report even if person has cognitive problems
Investigation will be performed
Only provide facts, never guess

Sandquist-Reuter, 2023

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Survey Process

Inspections by state Department of Health Services
Follow guidelines from Medicare/Medicaid (CMS)
Standard surveys happen yearly minimum
Special surveys for complaints or incidents
Ensure all patient needs are met
Results must be made public

Sandquist-Reuter, 2023

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What Happens During Surveys

Observe care provided to patients
Watch food preparation and serving
Review care plans and documentation
Interview patients and families
Examine every aspect of facility
Check physical, emotional, social, spiritual needs

Sandquist-Reuter, 2023

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Nurse’s Aide Role During Surveys

Only provide facts, never guess
Say "I don't know" if you don't know
Explain how you would find the answer
Use phrases like "I'll check the care plan"
Stay calm and professional
Be honest and direct

Sandquist-Reuter, 2023

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Critical Thinking Question

During a survey, a nursing aide is asked about a specific procedure they are unfamiliar. What is the best response for the nursing aide to give?

Explain the general steps they usually follow, even if unsure of the exact procedure
State they don’t know and would ask the nurse
Give the answer they believe is most likely correct without confirming
Say they were trained on it before but don’t recall all the details

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Survey Results & Follow-up

Citations given if problems found
Exit interview with facility leadership
Facility creates correction plan if needed
Follow-up visit in few weeks
Results posted at facility entrance
Results available online at medicare.gov

Sandquist-Reuter, 2023

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Top 5 Rules

Always Act Ethically
Protect Vulnerable People
Support Patient Rights
Recognize and Report Abuse
When in Doubt, Ask

Sandquist-Reuter, 2023

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Ethical Dos and Don'ts

DO

Treat all clients with respect and dignity
Respond to call lights promptly
Keep client information confidential
Report suspicious signs of abuse
Ask your supervisor when unsure

Sandquist-Reuter, 2023

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Ethical Dos and Don'ts

DON'T

Use personal phone in patient areas
Accept gifts from clients/families
Share client information inappropriately
Avoid clients due to personal characteristics
Use agency computers for personal use

Sandquist-Reuter, 2023

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Patient Rights Checklist

Treated with respect
Free from abuse and neglect
Participate in care decisions
Privacy and proper living arrangements
Access to visitors and activities
Manage own money
Make complaints safely

Sandquist-Reuter, 2023

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Signs of Abuse Quick Reference

Type	Key Signs to Watch For
Physical	Unexplained bruises, fractures, burns, isolation
Sexual	Genital injuries, infections, torn clothing
Emotional	Depression, anxiety, loss of confidence
Financial	Missing items, going without necessities
Neglect	Weight loss, poor hygiene, dehydration

Sandquist-Reuter, 2023

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Survey Tips

Stay calm and professional
Only state facts you know
Say "I don't know" when you don't know
Explain how you'd find the answer
Common responses

"I'll check the care plan" or "I'll ask the nurse"

Sandquist-Reuter, 2023

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References

Sandquist-Reuter, M. (2023). Nursing Assistant. WisTech Open. https://wtcs.pressbooks.pub/nurseassist/

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