ch 31 - common legal and ethical issues Flashcards
conditions/circumstances that result in a higher than usual responsibility of HCPs to ensure consent is informed (7)
- impaired sensory functioning
- low educational level
- low/limited health literacy
- low literacy of any kind
- questionable cognitive status
- complex procedure (surgery of any kind)
- participation in research
examples of representatives for advanced care planning
- power of attorney
- health care proxy
- guardians and conservators
legal rep: Legally appointed to act on behalf of another
in ways specifically indicated in a legal document
power of attorney
legal rep: Authority to act on a person’s behalf when he or she has lost capacity to make decisions and
has not documented what he or she wants
health care proxy
legal rep: Individual, agencies, or corporations appointed to take care, custody, and control of an incapacitated person and assure needs are met
guardians and conservators
purpose of power of attorney
- general POA for business
- durable POA for medical decisions
- made in advance of need
purpose of health care proxy
-how decisions are made when pt is incapacitated or POA hasn’t been selected
purpose of conservator
manage finances
purpose of guardians of the person
- helps incapacitated person make decisions
- ensures pt safety and wellbeing
- can provide consent for pt
people who are more likely to abuse/neglect
- family member
- one with mental/emotional illnesses
- abuser of alcohol/substances
- h/o family violence
- cultural acceptance of interpersonal violence
- caregiver frustration
- social isolation
- impaired impulse control of caregiver
people who are more likely to be abused/neglected
- cognitively impaired
- dependent on abuser
- physically/mentally frail
- abused caregiver in earlier life
- women living alone or in household with family
- h/o being abused
- behavior considered aggressive, demanding or unappreciative
- living in institutional setting
- feels deserving of abuse due to personal inadequacies
types of abuse of older adult (7)
- physical
- sexual
- psychological
- medical
- financial
- discrimination
- abandonment
type of abuse: physical force that results in threat of or infliction of bodily injury, physical pain, or impairment
physical abuse
type of abuse: nonconsensual sexual contact of any kind
sexual abuse
type of abuse: inflict of anguish, pain, of distress through verbal or nonverbal acts, including intimidation or enforced social isolation
psychological abuse
type of abuse: subjecting person to unwanted medical Tx or procedures
medical abuse
type of abuse: illegal or improper use of another’s funds, property or assets
financial abuse
type of abuse: illegal cultural or social behaviors that are demeaning, belittling, or withholding of full rights to persons, especially those at risk of physical, emotional, or sexual abuse
discrimination
type of abuse: desertion of person by individual who had assumed responsibility for providing care or assistance
abandonment
factors increasing risk of elder abuse (6)
- cultural/societal tolerance violence, especially against women
- shame and embarrassment
- fear of retaliation
- fear of institutionalization
- social isolation
- unacceptability of emotional expression, especially fear or distress
latino cultural variations increasing risk for abuse/neglect
- expectation of men to neglect self on behalf of others if necessary
- role expectation of women to tolerate abuse and focus on service of others
- need to protect family of shame
- emphases on family instead of outsiders
- extreme level of guilt if not able to provide care to older members of family
asian/pacific islander cultural variations increasing risk for abuse/neglect
- ability to endure violence as symbol of strength and honor
- not familiar with terms of abuse
- psychological abuse considered worst type of abuse
- strong belief of duty to care for parents may result in excessive burdens
- unacceptability to express emotions
chinese cultural variations increasing risk for abuse/neglect
- must be kept in family
- disrespect biggest form of mistreatment
- cultural disparities in expectations between younger and older adults
asian indian cultural variations increasing risk for abuse/neglect
- children leaving family home may be considered elder abandonment
- oldest son handles all finances
- physical abuse uncommon as old age is respected
japanese cultural variations increasing risk for abuse/neglect
- psychological abuse considered worst type of abuse
- often reported daughters-in-law cause emotional neglect, or emotional/physical abuse
- lack of caring for elder is socially unacceptable
- suffering expected to be done in stoic manner
- self-blame
- those who expose family “shame” may be considered traitor
korean cultural variations increasing risk for abuse/neglect
- financial exploitation not considered abuse
- high tolerance for neglect
- placing in nursing home considered shameful and abuse
viatnamese cultural variations increasing risk for abuse/neglect
- family problems kept at home
- neglect brings shame to family
- psychological “silent Tx” most serious
health problems that victims of violence often experience
- bone/joint problems
- digestive problems
- depression/anxiety
- chronic pain
- HTN and CVD
Results from failure of action by person with responsibility to provide care
neglect by caregiver
People fail to meet their own basic needs in
manner in which the average person would in
similar circumstances
self neglect
interventions for potential questions of right to decision making
- clarify issues at hand and present conflicts
- discuss situation with pt
- participate in assessment of elder’s capacity
- clarify type of POA that is held
- document to whom and what health info can be released
volunteer or paid staff member
responsible for acting as advocate for vulnerable residents in institution
ombudsman
S+S physical abuse (2)
- unexplained bruising/lacerations in various locations and in various stages of healing
- fractures inconsistent with functional ability
S+S sexual abuse (3)
- bruises or scratching in genital/breast area
- fear/unusual amount of anxiety related to routine exam of genital area
- torn undergarments or presence of blood
S+S medical abuse (1)
-caregiver repeatedly requesting procedures that are not recommended or not desired by pt
S+S medical neglect (2)
- unusual delay between when health problem began and when help was sought
- repeated missed appts without reasonable explanation
S+S psychological abuse (3)
- caregiver does all of talking when pt is capable
- caregiver appears angry/frustrated when pt seems frightened/hesitant
- caregiver or pt aggressive toward one another or nurse
S+S neglect by self or caregiver (6)
- weight loss
- uncharacteristic neglected grooming
- evidence malnutrition/dehydration
- fecal/urine smell
- inappropriate clothing to situation/weather
- insect infestation
one who maintains or promotes a cause; defends, pleads, or acts on behalf of another; and fights for someone who cannot fight for him or herself
advocacy
