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NURS 212 > Legal and Ethical Concerns/Abuse and Neglect > Flashcards

Legal and Ethical Concerns/Abuse and Neglect Flashcards

1
Q

Autonomy

A

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

  • For older adults with dementia and other conditions that affect decision-making abilities, lost of autonomy is a challenge that is frequently addressed by families and health care professionals throughout the course of the conditions.
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2
Q

Competency

A

is a legal term that refers to the ability to fulfil one’s role and handle one’s affairs in a responsible manner.

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3
Q

partial or a full Guardianship

A
  • Partial guardianship, the incompetent person continues to make
    limited decisions
  • Full guardianship, the person loses all of his or her rights to make
    decisions.
          - Guardianship typically remains in place until the 
            incompetent person dies

      - Guardianship is initiated only as a last resort when no 
           other legal intervention is appropriate.
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4
Q

Trusteeship

A

applies when an older adult no longer has the capacity to make a decision on financial matters.

  • An individual who is the subject of a trusteeship order is called a
    “represented adult”
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5
Q

Decision-making Capacity

A

is a measure of a person’s ability too make an informed and logical decision about a particular aspect of his or her health care.

It requires that the person be able to do all the following:

  • Understand and process information that is relevant to the decision about diagnosis, prognosis and treatment options
  • Weight the relative risks, benefits and outcomes of decisions in relation to one’s own situation
  • Apply personal values to the situation
  • Arrive at the decision that is consistent over time
  • Communicate f the decision to others
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6
Q

Executive control functions

A

Which are the cognitive skills involved in successfully planning and carrying out goal-oriented behaviour, such as self-care tasks.

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7
Q

Key Issues for the Elderly

A
  1. Autonomy and Rights
  2. Advanced Directives
  3. Legal Issues Specific to Long Term Care Setting
  4. Ethical Issues in Gerontological Nursing
  5. Medical Assistance in Dying (MAiD)

mnemonic: “All Adults Learn Ethical Matters”

  • Autonomy and Rights
  • Advance Directives
  • Legal Issues Specific to Long Term Care Settings
  • Ethical Issues in Gerontological Nursing
  • Medical Assistance in Dying (MAiD)
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8
Q
  1. Autonomy & Right
A
  • Competency: A legal term that refers to the ability to fulfill one’s role and handle one’s affairs in a responsible manner.
  • Decision-making capacity: A measure of a person’s ability to
    make an informed and logical decision about a particular aspect
    of his or her health care.
  • Guardianship
  • Trusteeship

Nurses need to be familiar with legal and ethical guidelines related to competency and decision-making capacity.

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9
Q

Autonomy & rights: Guardianship

A
  • Partial guardian ship: the incompetent person continues to make
    limited decisions.
  • Full guardianship: The person loses all his or her rights to make decisions.
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10
Q
  1. Advanced directives
A

Legally binding documents that allow competent people to document what medical care they would or would not want to receive if they were not capable of making decisions and/or community their wishes.

  • Examples in practice:
       * Medical Orders for Scope of Treatment (MOST)

   *  Representation Agreement/ Living Will: purpose is to guide decisions about care that is provided or withheld under certain circumstances, usually at the end of life.
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11
Q
  1. Legal Issues Specific to Long Term Care Setting
A
  • Nursing home residents’ rights in Canada are primarily legislated at the provincial/ territorial level.
  • Ethical issues are associated with questions about safety versus freedom of the residents.
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12
Q
  1. Ethical Issues in Gerontological Nursing
A
  • Use of restraints
  • Artificial Nutrition and Hydrations
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13
Q
  1. Ethical Issues in Gerontological Nursing: Use of restraints
A
  • Physical restraint: any device, method, or equipment that immobilizes or reduce the ability of the patient to movie his or her arms, leg, body or head freely
  • Increasingly, restraints are not seen as patient safety and protection devices, but as limiting their autonomy and dignity
  • Restraints are associated with serious harm, including increased risk for fractures, delirium, soft tissue injury and death (Bradas et al, 2012)
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14
Q

Use of Artificial Nutrition and Hydration (ANH)

A

Refers to methods of bypassing the upper Gastrointestinal system to deliver nutritional substances

  • Percutaneous endoscopic gastrostomy (PEG) tube
  • Jejunostomy tube
  • Nasogastric (NG) tube
  • Total parenteral nutrition (TPN) via a central intravenous catheter
  • Hypodermoclysis (subcutaneous delivery of fluids)
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15
Q
  1. Medical Assistance In Dying (MAiD)
A
  • Bill C-14 came into effect in Canada, June 2016
  • The Criminal Code of Canada was amended to allow a person to request and receive, under limited circumstances, a substance intended to end their life.
  • Only two forms of medical assistance in dying (MAiD) are permitted under the Criminal Code.
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16
Q

MAiD: Eligibility Criteria

A

A person is eligible for medical assistance in dying only if they meet all of the criteria

A person has a grievous and irremediable medical condition only if all of the criteria

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17
Q

3 roles related to Medical Assistance in Dying

A
  • Determining eligibility
  • Providing MAiD
  • Aiding in the provision of MAiD
18
Q

The role of the registered nurse in MAiD

A
  • Limited to aiding a physician or nurse practitioner in the provision of medical assistance in dying.
  • RN are not allowed to prescribe, compound, dispense or administer any substance intended for the purpose of medical assistance in dying.
19
Q

Role of the Nurse regarding Legal and Ethical Issues

A
  • Promote Advance Care planning
  • Implement Advance Directives
  • Facilitate Decisions about care
  • Promoting Caregiver Wellness
20
Q

Senior Abuse

A

A generic term referring to a wide variety of harms to older adults that are committed by a person or persons they know and would normally have a reason to trust.

21
Q

Risk Factors for Elder Abuse and Neglect: Perpetrator

A
  • Mental illness
  • Alcoholism
  • Hostility
  • Financial dependency on the victim
22
Q

Risk Factors for Elder Abuse and Neglect: Victim

A
  • Cognitive Impairment/Dementia
  • Problem Behaviors
  • Disability (physical, communicative)
  • physical dependency
  • Shared living arrangements
  • Isolation or lack of social supports
23
Q

Types of Abuse

A
  • Physical abuse
  • Sexual abuse
  • Emotional/psychological abuse
  • Exploitation
  • Neglect
  • Abandonment
  • Self-Neglect
24
Q

Physical Abuse

A

Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving him or her of a basic need.

Pinching
Spitting
Environmental restraints
Medications
Forcible handling
pulling hair
pushing
shoving
Hitting
Slapping
Poking
Biting

25
Q

Sexual Abuse

A

Nonconsensual sexual contact of any kind, coercing an elder to witness sexual behaviors.

26
Q

Emotional Abuse: Can look like

A
  • not considering a resident’s wishes
  • not respecting a resident’s belongings
  • speaking in a different language in front of a resident
  • Inappropriate control of activities
  • treating a resident like a child
  • bullying
  • name-calling
  • Ignoring or disregarding behaviors.
27
Q

Emotional Abuse: Possible indicators

A
  • Low self-esteem
  • Extreme tiredness
  • Nervousness and being uncomfortable around a particular
    individual
  • Depression
  • Anxiety
  • Increased isolation
  • Fear
  • Withdrawal
28
Q

Spiritual Abuse

A

The denial of a resident’s right to spiritual practices

  • Restricting or denying spiritual practices, customs, traditions
  • Not providing privacy for prayer
  • Diet-related religious taboos
  • Body related care that is insensitive to religious customs such as
    cutting the hair of a Sikh male
29
Q

Financial Exploitation

A

Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.

30
Q

Why do elders tend not to report abuse?

A

Do not recognize the behavior as abusive
* Do not know where to get help
* Fear it will get worse
* Worry about what will happen if the abuse becomes known
* Feel humiliated
* Take blame for the abuse
* Fear a loss of connection
* Believe that family honor is at stake
* Believe that privacy is at stake
* Unable to express themselves (aphasia, dementia, language
barriers, severe illness)

31
Q

Why is it difficult for staff to report?

A
  • Fear of:
    * Revenge
    * Job loss
    * Lack of support
    * Getting someone into trouble
    * Getting involved
  • Lack of knowledge about:
    * What abuse is
    * What can be done
    * The Law (mandatory reporting)
    * Resources within or outside the facility
    * Protocols and procedures
32
Q

Suspecting and reporting elder abuse

A
  • Mandatory reporting laws do not require reporters
    to know whether abuse or neglect has occurred, but
    to report if they suspect its occurrence.
  • Responsibility for verifying the problem rests with
    the public agency (ie police).
  • Investigation of all reports of elder abuse usually
    occur in 24-72hrs.
  • Suspecting elder abuse means detecting signs of
    violence (ie bruises, welts or fractures) or
    recognizing conditions associated with neglect (ie
    frostbite, dehydration, over sedation, mental
    changes, uncontrolled medical conditions).
  • Most reporting laws provide immunity for
    mandatory reporters- nurses who act in good faith
    and without malicious intent.
33
Q

A 76-year-old Asian woman has been admitted to the hospital. There are no advance directives in the chart. Which question will best prepare the nurse to begin a dialogue with this client about advance directives?

Question 1Select one:

a.
“Is there someone we should call to join us while we discuss your care?”

b.
“Tell me about your living arrangements; do you live alone or with others?”

c.
“Who do you talk to about your health care decisions?”

d.
“I see that you have no advanced directives on your chart, could you tell me about that?”

A

Who do you talk to about your health care decisions?

34
Q

A 78-year-old was diagnosed with colorectal cancer 18 months ago and underwent a round of chemotherapy. The most recent computed tomographic scan, however, reveals that the cancer has metastasized to the lungs and liver. The older adult states, “I feel quite well and do not wish to undergo another round of chemotherapy.” The client’s children are adamantly opposed to their parent’s decision to forgo treatment and have appealed to the nurse. Which factor is the priority consideration for the nurse to determine the best course of action?

Question 2Select one:

a.
The client’s prognosis

b.
The client’s treatment options

c.
The client’s autonomy

d.
The family’s wishes

A

The client’s autonomy

35
Q

The children of a resident of a nursing home have approached the nurse because they believe their parent is being manipulated by a person who also lives in the facility. Their parent has a diagnosis of early-stage Alzheimer disease and various comorbidities that affect mobility and function. How should the care team appraise the parent’s decision-making capacity?

Question 3Select one:

a.
A surrogate should be appointed to make her decisions because she has been diagnosed with Alzheimer disease.

b.
Her decision-making capacity should be determined according to objective criteria.

c.
She should be asked to demonstrate sound decision making in minor matter before being allowed to make more important decisions.

d.
Her decision-making ability is nullified by the presence of a dementia.

A

Her decision-making capacity should be determined according to objective criteria.

36
Q

In which situation would a living will provide clear direction to the care and treatment of the individual involved?

Question 4Select one:

a.
84-year-old male client has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive.

b.
78-year-old female client has been brought to the emergency department after falling on an escalator.

c.
77-year-old female client has been admitted to hospital with an electrolyte imbalance secondary to an accidental overdose of diuretics.

d.
81-year-old male client diagnosed with bone cancer is experiencing severe pain and has been presented with treatment options.

A

84-year-old male client has suffered a severe hemorrhagic stroke and is unconscious and unlikely to survive.

37
Q

A series of transient ischemic attacks have caused an older adult to become dysphagic. Despite failing a swallowing assessment, the client is opposed to eating a minced and pureed diet and wishes to eat a regular diet. How should the care team respond to this request?

Question 5Select one:

a.
Defer responsibility for feeding to the client’s friends and family.

b.
Provide the client’s requested diet after ensuring the client understands the risks.

c.
Insert a feeding tube to provide nutrition while eliminating the risk of aspiration.

d.
Continue providing a minced and pureed diet to the client in order to ensure safety.

A

Provide the client’s requested diet after ensuring the client understands the risks

38
Q

An 80-year-old is seen in the emergency department for a fall. The client has bruises on the upper arms and appears depressed. The client is accompanied by a grandchild, who is unkempt, glassy-eyed and whose breath smells of alcohol. Which nursing action should be the priority?

Question 6Select one:

a.
Assess the client’s degree of frailty and chronic health problems.

b.
Determine the mental capacity of the older adult.

c.
Assess whether the older adult is safe in the home environment.

d.
Determine whether legal interventions are appropriate.

A

assess whether the older adult is safe in the home environment

39
Q

Which is true about cognitive impairment and abuse of older adults?

Question 7Select one:

a.
Older adults become more vulnerable to abuse because of cognitive impairment.

b.
Cognitively impaired older adults are usually able to meet minimum standards of care.

c.
When the older adult denies cognitive impairment, the risk for abuse declines.

d.
Older adults who live alone are always willing to acknowledge their impairments.

A

Older adults become more vulnerable to abuse because of cognitive impairment.

40
Q

A neighbor notices an 81-year-old getting water from someone’s outside faucet. The neighbor notices that this person’s ankles are very swollen and there is an open wound on her left leg. The older adult says, “I stopped taking my pills because the water department turned off my water and I can’t use the bathroom. My daughter did not pay the water bill, and she never has time to take me to the doctor so my legs can be checked.” The neighbor calls adult protective services. Which of the following interventions is the priority when the nurse visits for an evaluation and does not find any immediate danger?

Question 8Select one:

a.
An involuntary legal intervention needs to be initiated immediately.

b.
The daughter needs to be picked up by the police on a neglect charge.

c.
The older adult needs to be involuntarily committed to a long-term care facility.

d.
The competency of the older adult in making decisions needs to be determined.

A

The competency of the older adult in making decisions needs to be determined.

41
Q

A 30-year-old grandchild lives with and provides care for the 75-year-old grandparent. The grandparent has congestive heart failure, hypothyroidism and chronic pain from a compression fracture and osteoporosis. The grandchild supervises the older adult’s medications. The home health nurse notes that the older adult has extra diuretic pills and that the pain medications for a month have been used and cannot be refilled for 2 more weeks. The older adult tells the nurse: “Those pain pills don’t work, my back is always hurting.” The nurse notes that the older adult’s ankles are very swollen. Which should the nurse do first?

Question 9Select one:

a.
Tell the older adult that her grandchild is probably taking her pain medications.

b.
Call adult protective services and ask for an immediate evaluation.

c.
Take the grandmother to the emergency department immediately.

d.
Assess the grandchild’s understanding of her grandmother’s needs.

A

Assess the grandchild’s understanding of her grandmother’s needs.

42
Q

An older adult who appears to be between 85 and 95 has been brought to the emergency department by emergency medical services after being found wandering in the street. The older adult is filthy and confused and exhibits numerous bruises to the face and neck as well as signs of malnutrition and dehydration. What problem should the nurses prioritize for assessment and intervention?

Question 10Select one:

a.
Hygiene

b.
Malnutrition

c.
Dehydration

d.
Potential elder abuse

A

Dehydration

NURS 212 (6 decks)

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