Lecture 14 Ethical and legal issues

Question 1

Actions that can result in elder mistreatment include _

Answer 1

1. Abuse - physical, sexual, emotional, or psychological.
2. Neglect / self-neglect.
3. Exploitation - financial or material.
4. Abandonment.

Question 2

Elder Assessment Instrument (EAI)

Answer 2

1. A 41-item instrument designed to assess signs, symptoms, and subjective complaints of elder mistreatment (EM).
2. A patient should be referred to social services if the following exists: (1) Any evidence of mistreatment without sufficient clinical explanation; (2) a subjective complaint by the elder of EM; or (3) if the clinician believes there is high risk or probable abuse, neglect, exploitation, or abandonment.

Question 3

Family Preferences Index (FPRI)

Answer 3

1. A brief, easy to administer (yes/no) instrument to measure family preferences, or family caregiver’s personal choices about providing care to their hospitalized relatives.
2. Should be supplemented with an evaluation of other factors that impact caregiving ability, including the family’s legal authority (power of attorney status), the family’s understanding of the patient’s needs, and stress level.

Question 4

Recommendations of the AACN/GNEC consortium - planning nursing care for older adults (1 of 2)

Answer 4

1. Facilitate advance health planning; help with decision making regarding assessment, diagnostic testing, and treatments in light of the OA’s life expectancy, functional, physical and cognitive status, quality of life, and social supports.
2. OAs should be considered at increased risk for developing adverse responses and complications related to medications, treatment, and geriatric syndromes.
3. OAs should be viewed as an at risk population.

Question 5

Recommendations of the AACN/GNEC consortium - planning nursing care for older adults (2 of 2)

Answer 5

1. Regardless of the clinical setting, OAs should be assessed for functional and cognitive status, pain, and geriatric syndromes.
2. OAs should have access to a hospital system-based model of care, interdisciplinary assessment, volunteer programs, and case management known to implement strategies that prevent geriatric syndromes.

Question 6

Advance directives

Answer 6

1. Legal documents that direct decisions about medical care that is provided or withheld if a person becomes incapable of making decisions or communicating their wishes.
2. Common types include: Living wills, do not resuscitate orders, and durable health care power of attorney.
3. May be written or oral, but an oral advance directive can be legally disputed.

Question 7

Do not resuscitate (DNR) order

Answer 7

A specific type of advance directive that compels health care providers to refrain from cardiopulmonary resuscitation if the person is no longer breathing and has no heartbeat.

Question 8

Neglect

Answer 8

Refusal or failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.

Question 9

Self-neglect

Answer 9

Behavior of an elderly person that threatens his or her own health or safety, such as failure to provide adequate food and nutrition for oneself or failure to take essential medications.

Question 10

Autonomy

Answer 10

The personal freedom to direct one’s own life as long as it does not infringe on the rights of others.

Question 11

Competency

Answer 11

The legal term referring to the ability to fulfill one’s role (e.g., driving) and handle one’s affairs in a responsible manner.

Question 12

Decision-making capacity

Answer 12

1. The measure of the ability to make an informed and logical decision.
2. Requires the ability to decide and the ability to act.

Question 13

Patient Self-Determination Act (PSDA) (1991)

Answer 13

Federal law requiring health care organizations that receive federal funding to provide education for staff and patients on issues concerning treatment and end-of-life issues - living wills.

Question 14

The purpose of a living will is to _

Answer 14

Clearly state a person’s wishes when they are unable to do so.

Question 15

Regarding living wills, provisions related to _ vary by state in terms of scope/specificity.

Answer 15

Feeding tubes.

Question 16

Medical power of attorney

Answer 16

1. A way to give power to make medical decisions about care to another person (also called a health care proxy).
2. The patient’s agent can make all decisions regarding health care, personal care, or custody in the event that the patient becomes incompetent or disabled and is unable to make decisions.

Question 17

LaPOST (Louisiana Physician Orders for Scope of Treatment)

Answer 17

An advance directive that can be developed when a patient is in a nursing home, and transferred with the patient when they are admitted to the hospital (it “follows” the patient to ensure their wishes are upheld).

Question 18

Omnibus Budget Reconciliation Act of 1987 (OBRA)

Answer 18

1. Requires nursing homes to meet certain standards of care (monitor benchmarks - UTIs, falls, etc.; ensure each patient is fully assessed at regular intervals).
2. Requires nurses to document assessments and care plans.
3. Positive outcomes: 50% reduction in the use of restraints; increase in family involvement in resident care plans and decisions; decrease in the use of psychotropic drugs; increase in the use of hearing aids; increase in behavior management programs; incontinence programs doubled.

Question 19

An important difference between a living will and medical power of attorney is that _

Answer 19

The power of attorney must be notarized.

Question 20

Elder abuse

Answer 20

1. Anything that causes harm or distress to an older person and occurs in a relationship with a trust expectation.
2. Over 5.9 million reported cases annually, and it is estimated that only 1 in 23 cases is actually reported. About 10% of older adults have experienced abuse.
3. Three basic categories: Domestic, institutional, and self-neglect.

Question 21

Statistically, the leading category of elder abuse is _

Answer 21

Self-neglect.

Question 22

The abuser of an older adult is most likely to be his or her _

Answer 22

Son (1st) or daughter (2nd).

Question 23

Although all categories of elder abuse are underreported, _ is especially underreported because individuals may be unaware of it or embarrassed.

Answer 23

Financial exploitation.

Question 24

Nursing diagnoses relevant to elder abuse include _

Answer 24

1. Disabled family coping.
2. Caregiver role strain.
3. Risk for injury.
4. Decisional conflict.