Teams' debates slides in canvas: Is the use of medical tools to enhance human beings morally troubling?
Anabolic steroids
Adderall, ritalin,
Paraplegics
increasing quality of life
Employees rights - Fair Treatment and Employment at Will
Employer or employee can terminate employment at any time unless under contract. Good faith to follow contract. Montana- if someone is fired, it must be a good reason/cause, cannot be out of retaliation.
Public policy exceptions: cannot limit anyone who i
Employees rights - Sides v. Duke Hospital
In the Sides v. Duke Hospital, if we are to have law, those who so act against the public interest must be held accountable for the harm inflicted hereby; to accord them civil immunity would incongruously reward their lawlessness at the unjust expense of
Employees rights - Freedom from Discrimination
Employees have a right considered for a job without discrimination based on their skills and qualifications for the job for which they are applying. The job must not be discriminated against, for example, on the basis of race, age, creed, or color.
Employees rights - Equal Pay for Equal Work - Equal Pay Act of 1963
Eliminate any potential wage discrimination between genders. Not enacted in state where minimum wage laws are not in place. An amendment to the Federal Labor Standards Act that was passed to address wage disparities based on gender.
Employees rights - Refuse to Participate in Care
Caregivers have a right to refuse to participate in certain aspects of patient care and treatment if there is a conflict with one's beliefs, such as the administration of blood or blood products, participation in elective abortions, and end-of-life issues
Employees rights - Doe v. Poelker
Refusal to Participate in Elective Abortions Upheld. In Doe v. Poelker, the city was ordered to obtain the services of physicians and personnel who had no moral objections to participating in abortions. The city also was required to pay the plaintiff's at
Employees rights - Larson v. Albany Medical Center
Refusal to Participate in Therapeutic Abortion Insubordinate. In Larson v. Albany Medical Center, the Supreme Court held that although a nurse has the right to refuse to participate in an elective termination of pregnancy on grounds of freedom from religi
Employees rights - Question Patient Care
If you don't agree with what another is recommending, talk to them about it or talk to the boss. Persistence to get the proper treatment for the patient is an absolute duty.
Employees rights - Suggest Changing Physician - when is it acceptable to do so?
There are circumstances in which a caregiver has a right to suggest that a patient or patient's family change to a different, more responsive physician. For instance, one nurse attempted to contact the patient's physician, after many failed attempts to do
Employees rights - Freedom from Sexual Harassment
Protects both employer and employee. Employees have the right to be free from sexual harassment. Sexual harassment can be verbal or physical, and it includes a request for a sexual favor, sexual advances made as a condition of employment and unreasonably
Employees rights - Freedom from Intimidation
Employees have a right to be free from intimidation by angry individuals and veiled threats by managers in the workplace - whether they are managers, coworkers, or independent contractors such as physicians.
Employees rights - Jones v. Westside-Urban Health Center
Nurse without equal pay as another nurse. Nurse manager terminated the nurse out of retaliation but the nurse ended up winning the case.
Employees rights - Privacy and Confidentiality - what is allowed?
Employer has a right to monitor emails, voicemails, videotaping of all employers.
Employees rights - Right to Family Medical Leave
12 weeks unpaid leave. It is illegal to terminate health insurance coverage for an employee on FMLA leave. The employee's job - or an equivalent job with equivalent pay, benefits, and other terms and conditions of employment - must be restored.
Employees rights - Whistleblowing
Reporting unethical behavior. 3rd leading cause of death : preventable medical care.
Employees rights - Unemployment Compensation
Employees have a right to unemployment compensation for injuries resulting from the employees work environment (Division of Unemployment Insurance).
Employee Responsibilities - Comply with State and Federal Regulations
The governing body and its agents are responsible for compliance with federal, state, and local rules and regulations regarding the operation of the organization. Governing body can also subject board members and/or their agents to civil liability and, in
Employee Responsibilities - Comply with Hospital Policy
Employees are required to comply with an organization's policies and procedures. For example, as a surveyor of an accrediting body, one would look for an approved disaster plan to provide for adequate space, staff, supplies, equipment, blood products, and
Employee Responsibilities - Comply with Job Descriptions
Employees have a responsibility to comply with the responsibilities outlined in their job descriptions. Failure to do so can be hazardous to patient safety, as well as lead to termination of the employee who fails to perform the duties required in a profe
Employee Responsibilities - Honor Patient Wishes
Caregivers have a responsibility to honor a patient's right to participate in decisions regarding his/her care, including the right to formulate advance directives and have those directives honored.
Employee Responsibilities - Maintain Confidentiality
The duty of employees and staff to maintain confidentiality encompasses both verbal and written communications and applies to consultants, contracted individuals, students, and volunteers. The ethical duty is broader and applies at all times. Health care
Employee Responsibilities - Adhere to Safe Practices
Caregivers have a responsibility to adhere to safe practices in order to minimize patient injuries and to adhere to national patient safety goals (e.g., comply with the CDC's hand-washing guidelines, patient identification, verification of operative site,
Employee Responsibilities - Adhere to Professional Standards
Caregivers have a responsibility to maintain a professional attitude in the performance of their work. Staff cooperation and communication are essential for ensuring professionalism in the provision of high-quality patient care. Unprofessional conduct, in
Employee Responsibilities - Maintain Professional Relationships
Employees are responsible for maintaining an appropriate professional relationship with patients, families, coworkers, and others who come into contact with the organization (e.g., consultants).
Maintain Professional Relationships- Sexual harassment
Employers have a responsibility to maintain a workplace that is free of sexual harassment. Forms of sexual harassment include a request for sexual favors, demeaning comments, sexually explicit jokes, pinching and fondling of a coworker, sexually explicit
Maintain Professional Relationships- Heinecke v. Department of Commerce
A nurse's sexual relations with a patient can give rise to disciplinary action resulting in the nurse's loss of license (e.g., Heinecke v. Department of Commerce - A male nurse lost his license after having a sexual relationship with a patient, even thoug
Maintain Professional Relationships- Copithorne v. Framingham Union Hospital
A hospital technologist in Copithorne v. Framingham Union Hospital alleged that a staff physician raped her during the course of a house call. The physician's sexual assault was foreseeable. There was evidentiary support for the proposition that failure t
Maintain Professional Relationships- Richard v. Larry
Avoid relationships with a patients spouse. The sexual relationship that a psychiatrist had with the spouse of a patient was found to be improper in Richard v. Larry. California Civil Code, abolishing causes of action for alienation of affection, criminal
Maintain Professional Relationships- Goldberg v. De Buono
Avoid relationships with a patients spouse. The Bureau of Professional Medical Conduct had charged the petitioner in Goldberg v. De Buono, a licensed physician and psychiatrist, with moral unfitness, gross negligence, and incompetence, negligence on more
Employee Responsibilities - Report Unethical Behavior
Caregivers have both a right and responsibility to report impaired, incompetent, and unethical colleagues in accordance with the legal requirements of each state. Unethical behavior includes conduct that threatens patient care or welfare, behavior that vi
Employee Responsibilities - Protect Patients from Harm
Caregivers have an ethical and legal responsibility to protect patients from harm. Tenets of ethical responsibility issued by the profession itself.
Employee Responsibilities - Report Patient Abuse
Caregivers have both a right and responsibility to report patient abuse. Statutes protect employees against retaliation by employers for reporting patient abuse.
Employee Responsibilities - Maintain Professional Competencies
It is expected that each professional have current understanding of one's area of specialization and practice. Every professional is responsible to be current in his/her knowledge and skills by reading professional literature, attending continuing educati
Teams' debate slides in canvas: Should a pregnant woman be punished for exposing her fetus to risk?
Unborn Victims of Violence Act of 2004
Fetal development is a delicate
balance.
Most babies face the most harm
during the first trimester.
Physical growth is stunted Quality of life is severely
diminished
Cannot function to their fullest
potential
FASD
NA
Informed consent
Expressed or Implied
Expressed: a verbal or written agreement authorizing medical care
Implied: determined by some act of silence, a presumption that consent has been authorized.
Either from patient or someone authorized to consent on patient's behalf. Wh
Code of ethics - AMA
Patient has the right to receive info from physicians & to discuss the benefits, risks & costs of appropriate treatment alternatives.
Anyone going into medical field should adhere to their code of ethics.
Proof of Consent
Verbal, written or implied. Law requires verbal or written for intentional touching involving medical procedure
Proof of Consent - Oral consent vs. written consent
Oral consent: as binding as a written consent. No legal requirement for consent be in writing though it is helpful.
Written consent: provides visible proof. Must be deemed informed consent!
Implied consent: can be assumed when immediate treatment is requi
Proof of Consent - Luka v. Lowrie
Boy whose left foot had been crushed. Physician decided that it was necessary to amputate the foot. If parents had been present the court said they would have not given consent for procedure even though the physician said it was necessary to preserve the
Proof of Consent - O'Brien v. Cunard Steam Ship Co.
Ship's passenger had an injection of vaccine. O'brien entered line voluntarily and saw what was happening so he could have exited the line. He said he didn't give consent to this. But court said he didn't have to step out of line. Consent in nonemergency
Statutory Consent
The age of consent is 18
When a patient is clinically unable to give consent to a lifesaving emergency treatment, the law implies consent
Capacity to Consent
Patient's considered competent to make decision unless court determines otherwise
Patient must understand procedure, evaluate info from physician, and voluntarily make decisions regarding his or her treatment plan.
Adequacy of Consent
Provide as much info about treatment options as necessary based on a patient's personal understanding of the physician's explanation, of the risks of treatment, probable consequences of the treatment, probable consequences of treatment, needs of each pati
Adequacy of Consent - Competent Patient -In re Melideo
Every human of adult years has the right to make decisions on their own body
Adequacy of Consent - Spouse - Greynolds v. Kurman
Spouse - patient had a TIA and sudden loss of neural function to his brain. sent to emergency room. Doctor ordered angiogram. Doctor performed this and had a stroke during it. Patient and spouse filed a case saying that there was no informed consent from
Adequacy of Consent - Parental Consent
Parents have right to authorize for children. Under 18. Children who are emancipated have the right to make their own decisions. Can be reported to state if it's harmful to life. Not required when married or other emancipated.
Adequacy of Consent - Incompetent Patients
Legal guardian or next of kin should decide or if those are not available, then state will consent.
Adequacy of Consent - Guardian
Due to a physical or mental impairment. Temporary guardian can be provided as well.
Right to Refuse Treatment
Patients have a right to refuse treatment and be secure from any touching. Adults who are mentally competent even when life threatening. - Patient self determination act
In re Fetus Brown
Could not impose a legal obligation to a pregnant woman to a medical procedure based on a viable fetus.
Refusal of Care Based on Religious Beliefs
Any person regardless of religious beliefs has the right to refuse medical treatment.
Patient Abuse
Mistreatment or neglect of individuals who are under the care of a health care organization. Occurs to those who are most vulnerable and dependent on others for care. Ex. dementia
Child Abuse- Reporting Abuse - when?
An abused child is generally defined as a person younger than 18 years of age whose parent or other person legally responsible for care inflicts physical injury or allows, permits, or encourages a child to engage in unlawful conduct. Cases have declined b
Child Abuse- Detecting Abuse - how?
All states have enacted laws to protect abused children.
Clear documentation and photographs when possible.
Appear to be part of a
pattern
: bruises, burns or broken bones. Or behavioral: no control of aggression, decreased reasoning or thinking, stems fr
Child Abuse- Good-Faith Reporting - what does this statute provide?
Generally requires mandatory reporting. Provide immunity for good-faith reporting.
Suspected child abuse must be made with a good-faith belief that the facts reported are true. Definition of good faith may vary from state to state. Must be stemmed from so
Child Abuse- Immunity and Good-Faith Reporting - Awkerman v. Tri-County Orthopedic Group
Minor child and his mother filing child abuse against doctor who failed to diagnose child with a disease. Doctor was given immunity because child mentioned that it was more than just broken bones. Just did not diagnose. Court decided that the child was ne
Senior Abuse - Reporting Senior Abuse - when and how?
Mistreatment of elderly patients is rampant. All kinds. Facilities of refuge become institutions of misery and gloom
Neglect is failure to provide care necessary to prevent harm which is different from child abuse.
Senior Abuse - Signs of Abuse - know the categories
Less likely to be reported than child abuse. Many seniors do not file because they fear retaliation. Kansas: mandated to report any evidence of elder abuse of older residents
Categories: physical, sexual, emotional, neglect, abandonment, financial, self-n
Senior Abuse -Documentation - how? What is the challenge of such?
Document suspicions of abuse
Be thorough in documentation
Accurately document signs of suspected abuse
Be objective & clear when defining physical & physiological findings.
Documentation - In re Estate of Smith v. O'Halloran
Lawsuit to improve nursing home conditions.
Abuse has to be reported. Any type of restraining procedures must be safe and ethical.
Patients in restraints: signs of abuse: physician's order for restraints, time-limited orders, # of patients physically rest
Documentation - Wanton neglect of residents: State v. Cunningham
Wanton neglect of many residents. Residents were exposed to physical dangers and unhealthy living conditions. Defendant found guilty on five counts of wanton neglect.
Documentation - Abuse of residents: Nepa v. Commonwealth Department of Public Welfare
Nepa's license was revoked because of resident abuse. Including Unbuckled belt of one resident, forcing a kiss...
Documentation - Abusive search: People v. Coe
Nurse (Coe) searched Gersh for bills while Gersh had not given authorization to do so..Gersh collapsed in his chair gasping for air. Coe administered resuscitation but was unsuccessful, Gersh died. The court held that the search became an act of physical
Documentation - Forcible administration of medications: In re Axelrod
Employee showed that the employee, after a resident refused medication, held the patient's chin and poured the meds down her throat. No emergency existed. Employee was convicted of resident abuse
Intimidation of Abusive Resident/Disciplinary Overkill - Beasley v. Sate Personnel Board
An 80 year old resident slapped an aide, Beasley. the resident said that if he's not having sex, he might as well cut off his penis. Beasley said that if he did not behave, she might accommodate him.
Intimidation of Abusive Resident/Disciplinary Overkill - Deficient care: Montgomery Health Care Facility v. Ballard (pp. 431-432)
Understaffed facility. Resident had infected sores. Many other residents were not getting the care they needed.
Socratic method of teaching and learning
Asking and answering questions
Patient Rights - Right to Know One's Rights
All Ages apply
Patient Bill of Rights -written copy should be given to patient upon hospitalization
Right to Know One's Rights - Health Insurance Portability and Accountability Act
Patients have a right to recceive notice of privacy standards, a requirement under HIPAA
Right to Know One's Rights - Disclosures that are permitted
Acceptable to have third parties review our case (other docs, insurance, military)
Patient info (e.g., diagnoses, anesthesia history, surgical and other invasive procedures, drug allergies, medication usage, lab test results, and imaging studies) may be d
Right to Know One's Rights - Limitations on disclosures
Certain third parties cannot be part of patient's info - her dad/grandma.
Right to request restrictions or limitations, nonstandard disclosures, amendments, inspect and copy medical info, file a complaint with the provider, right to paper copy, and to kno
Right to Know One's Rights - Explanation of one's rights
Patients have a right to receive an explanation of their rights and responsibilities. The patient has a right to make decisions regarding his/her medical care, including the decision to discontinue treatment, to the extent permitted by law.
Patient Rights - Right to Ask Questions
The patient has a right to ask questions and caregivers have a responsibility to listen from entry to the hospital through the time of departure (e.g., clarification on a caregiver's instructions, instructions for medical usage, treatment plan, consultati
Patient Rights - Right to Examination and Treatment
Patients have a right to expect the physician will conduct and appropriate history and physical exam based on the patient's presenting complaints. The assessment is the process by which a physician investigates the patient's state of health, looking for s
Patient Rights - Right to Emergency Care
Closest hospital is a VA office, must treat until stable to be sent to another place.
Patient Rights - Right to Admission
Whether a person is entitled to admission to a particular hospital depends on the statute establishing that hospital. Governmental hospitals, for example, are by definition creatures of some unit of government; their primary responsibility is to provide s
Patient Rights - Right to Admission - Stoick v. Caro Community Hospital
Woman had stroke, sent to community hospital, family physician was not there. Sent to the ER. Said fam physician did not refer her so they could not treat her. 5 hr. delay. Finally an ER physician treated her. This was wrong b/c it was an emergency.
Patients right - Right to Admission - Right to Have Special Needs Addressed
Patients who have language barriers or hearing or vision impairment have a right to special help to have their needs addressed in order to ensure proper care.
Patients right - Execute Advance Directives
Patients have a right to execute advance directions. A patient who becomes incapacitated or unable to make decisions on his/her behalf has a right to appoint a surrogate decision maker to make decision on his/her behalf. Each patient at the time of admiss
Patients right - Right to Know Caregivers
Credentials of doctor.
Patients have a right to know the names and positions of the caregivers who will care for them while in the hospital. Patients should know who is treatment them by name, discipline, role, and responsibility in their care plan.
Patients right - Right to Trust Caregivers - Josie King story
Infant burned in bathtub. She became dehydrated in hospital. Nurse said not true but infant ended up dying.
Patients have a right to trust the caregivers who provide their care. For example, in the William McCormack case, appendix removed, was in fact not
Patients right - Right to Access a Patient Advocate
Ombudsman acts as a patient advocate.
A patient advocate generally addresses patient concerns. Access to a patient advocate is often described in patient handbooks. Patient advocacy services should be available to both patients and families. Many states h
Patients right - Right to Chaplaincy Services - types of situations that warrant such services?
In all facilities, not just religion, could be spiritual. A multi-faith chapel as well as televised services are available in many hospitals. Music and meditation are often provided as an adjunct for pain management and stress reduction at the bedside. Ch
Patients right - Right to Ethics Consultation
Patient's rights in many hospitals allow for patient and/or families to access an ethics committee for consultation when faced with challenging treatment decisions that involve ethical dilemmas. Recommendations of an ethics committee should not be conside
Patients right - Right to Choose Treatment
Acceptable to refuse care, conflicting religious/moral values.
Patients have the right to choose the medical care they wish to receive. They have a right to know their treatment options and to accept or refuse care. As medical technology becomes more adva
Patients rights - Right to Informed Consent
Must know all parts, right to ask questions. This info should include the risks, benefits, and alternatives of each procedure or treatment option. The right to receive info from the physician includes info about the illness, the suggested course of treatm
Patients rights - Right to Refuse Treatment
Right to self-determination. The responsibility of the physician is to objectively balance the risks and benefits of each treatment option; otherwise, a form of paternalism would be present that would represent a failure to respect the patient's right to
Patients rights - Right to Timely Response to Care Needs
Reasonable timeframe. Treatment should be administered within a reasonable timeframe. Delay in responding to patient needs can place a patient's life at risk.
Patients rights - Right to Receive Quality Care
Health care professionals are expected to monitor the quality of each patient's care beginning with the history and physical, followed by the development of the treatment plan, and ultimately the delivery of care to the patient.
Patients rights - Right to Respect
For patient, family, and physician. The right to respect is a common right enjoyed by patients, families, and caregivers. It is more than a two-way street and requires the respect of all persons.
Patients rights - Right to Pain Management - review bullet list
Rate pain 1-10, with diagram of body
All patients have a right to:
A pain control treatment developed w/ the caregiver
Alternative strategies included in the pain management plan that might help improve efficacy of traditional treatment options
An explana
Patients rights - Right to Privacy and Confidentiality
Patients have a right to expect that info regarding their care and treatment will be kept confidential. Confidentiality requires that the caregiver safeguard a patient's confidences within the constraints of the law. Written permission must be obtained be
Right to Privacy and Confidentiality - Bagent v. Blessing Care Corp.
Revealing info about pregnancy results to patient's sister at a public tavern.
Right to Privacy and Confidentiality - Florida Hospital Waterman, Inc., etc. v. Teresa M. Buster, et al., and Notami and Hospital of Florida, Inc., etc. v. Evelyn Bowen, et al.
Hospitals under Amendment 7, must reveal their records of past malpractice performed at the hospital
Patients rights - Right to Know Hospital's Adverse Events
Amendment 7 - All hospitals have right to fraudulent or wrongful behavior of hospitals
Patients rights - Right to Discharge - Somoza v. St Vincent's Hospital
Could be considered false imprisonment. Patients have a right to be discharged and not be detained in a health care setting merely because of an inability to pay for services rendered; otherwise, it would be considered false imprisonment. There are circum
Patients rights - Right to Transfer - Macleod v. Miller
Mcleod never had a hearing, transferred against his will. Horrible trauma. Patients also have a right to choose a receiving facility, whenever possible. In this case, the Medicaid patient was entitled to an injunction preventing his involuntary transfer f
Patients rights - Right to Access Medical Records
Anyone who is responsible to our care. Patients have a legally enforceable interest in the information contained in their medical records and, therefore, have a right to access their records. Some states have enacted legislation permitting patients access
Patients rights - Right to Access Lab Reports
The DHHS released a statement in 2014 that strengthens the right of patients to access their lab test reports: "...Information like lab results can empower patients to track their health progress, make decisions with their health care professionals, and a
Right to Access Lab Reports - Hospital peer-review materials - patient's right to know
In Florida, the "Patients' Right to Know About Adverse Medical Incidents" indicates that in a medical malpractice action in which the plaintiffs sought the production of documents relating to the investigation of the decedent's death and any medical incid
Patients rights - Right to Know Third-Party Care Relationships
Patients have a right to know the hospital's relationships with outside parties that may influence their care and treatment. These relationships may be with educational institutions, insurers, and other caregivers.
Patients rights - Right to Know Hospital Charges
Patients have a right to transparency when requesting info about hospital emergency room, outpatient, and inpatient treatment charges. North Carolina has a bill called
Health Care Cost Reduction and Transparency Act
, which is intended to allow patients t
Patients responsibilities - Provide Full and Honest Disclosure of Medical History - Fall v. White
Provide full disclosure of all info relevant to one's medical condition, medical complaints, symptoms, location and severity of pain, previous pain control concerns, past illnesses, treatments, surgical or other invasive procedures, hospitalizations, meds
Patients responsibilities - Report Unexpected Changes in Health Status - Marsingill v. O'Malley
Relay to caregivers unexpected changes in your health status.
Doctor (O'Malley) told patient about how she would need a nasogastric tube inserted and the patient hung up the phone. Patient collapsed.
Patients responsibilities - Adhere to the Agreed-Upon Treatment Plan
Be sure to follow the treatment plan recommended. Accept responsibility for the consequences of failing to adhere to the caregiver's instructions. Refrain from self-administration of meds not prescribed by the physician, as well as those you may have brou
Patients responsibilities -Advisory Commission Describes Patient Responsibilities
What is it and what are its responsibilities?
Take responsibility for maximizing healthy habits.
Become involved in health care decisions.
Work collaboratively with HCP's in developing and carrying out treatment plans.
Disclose relevant info & clearly communicate wants and needs.
Use the health plan'
Nonverbal communication: importance?
Scenario may be given.. What skills would you use in this situation?
Nonverbal communication has been called the silent language and plays a key role in day to day communications process. During face to face communication, body language and the tone of on
7 Barriers and examples:
Know 3
1. Environmental - disruption of communication by a barking dog
2. Physiological - deafness
3. Semantic - "coke" could mean drink or cocaine
4. Syntactical
5. Organizational
6. Cultural
7. Psychological - stress