GERONTOLOGICAL NURSING

ETHICAL and LEGAL ISSUES

By: Eleazar Belgica, RN

a. Professional Standards: Their Origin and Legal Significance

Nurses are responsible for providing care to the degree, skill, and diligence as measured by recognized and applicable standards of care. The duty of care rises as the patients physical and mental conditions and ability for self-care declines. Bylaws and internal rules and policies also help to establish the standard of care in an organization, although, depending on the circumstances of a situation, their importance may vary.

b. Relevant Laws
b.1. Sources of Law -Statutes
-Common laws -Regulations

 b.2. Federal and State Laws

U.S. federal government, under the Social Security Act, has the primary responsibility of providing medical services to certain aged and indigent Americans.

-The Omnibus Budget Reconciliation Act of

1987, or OBRA 87

 b.3. Older Adult Abuse and Protective Services

-Elderly Protective Services
Include: >protective orders issued to shield an older adult from an abusive member of their household >elder abuse statutes, which outlaw harmful acts that victimize older adults >and laws enacted to protect older residents of nursing homes from abuse.

c. Nursing Home Reform

Omnibus Budget Reconciliation Act of 1987
- applies to all Medicare and Medicaid-certified nursing homes

OBRAs Three Major Parts

Provision of Service Requirements Survey and Certification Process Enforcement mechanisms and Sanctions

Provision of Service Requirements

Quality of Care
-assessment is used to develop a written and comprehensive plan of care for each resident.

Resident Rights
-requiring that residents be notified, both orally and in writing, of their rights and responsibilities, and of all rules governing resident conduct.

Resident Bill of Rights

1. The right to select a personal attending physician and to receive complete information about ones care and treatment, including access to all records pertaining to the resident. 2. Freedom from physical or mental abuse, corporal punishment, involuntary seclusion, and any unwarranted physical or chemical restraints. 3. Privacy with regard to accommodations, medical treatment, mail and telephone communication, visits, and meeting of the family and resident groups. 4. Confidentiality regarding personal and clinical records. 5. Residing and receiving services with reasonable accommodations of individual needs and preferences. 6. Protesting ones treatment or care without discrimination or reprisal including refusal to participate in experimental research. 7. Participation in resident and family groups. 8. Participation in social, religious, and community activities. 9. The right to examine the federal or state authorities survey of a nursing home.

 Unnecessary Drugs
Treatments must be ruled out before drug therapy is initiated.

 Chemical and Physical Restraints

Physical restraints e.g. limbs restraints, vests, jackets, and waist belts The order must include the type of restraint, the condition or specific behaviour for which it is to be applied, and a specified time or duration for its use.

 Urinary Incontinence
One of three key reasons older adults enter nursing homes.

ENFORCEMENT MECHANISMS and SANCTIONS

DHHS and the states may apply sanctions or penalties against a facility for failure to meet requirements and standards. Can include: - civil money penalties - appointment of a temporary manager to run a facility while deficiencies are remedied - closure of a facility or transfer of residents to another facility, or both.