Legal and Ethical Concerns/Abuse and Neglect

Question 1

key issues for the elderly

Answer 1

1 . autonomy and rights
2 . advance directives
3 . legal issues specific to long term care settings
4 . ethical issues in gerontological nursing
5 . MAiD

Question 2

autonomy and right

Answer 2

competency
- the ability to fulfill ones role and handle ones affairs in a responsible manner
decision making capacity
- a measure of a persons ability to make and informed and logical decision about a particular aspect of their health care
trusteeship
- applies when an older adult no longer has the capacity to make a decision on financial matters

Question 3

guardianship

Answer 3

partial guardianship
- the incompetent person continues to make limited decisions
full guardianship
- the person loses all their right to make decisions

Question 4

advance directives

Answer 4

def.
- 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 communicating their wishes

Question 5

advance directives examples

Answer 5

medical orders for scope of treatment (MOST)
- DNR under MOST
representation agreement/ living will

Question 6

legal issues specific to long term care settings

Answer 6

nursing home residents rights in Canada are primarily legislated at the provincial/territorial level
- ethical issues are associated with questions about safety vs freedom of the residents

Question 7

ethical issues in gerontological nursing

Answer 7

• use of restraints
• artificial nutrition and hydration

Question 8

use of restraints

Answer 8

physical restraint
- immobilizes or reduces the ability of pt to move

Question 9

use of artificial nutrition and hydration (ANH)

Answer 9

AHN: methods of bypassing the upper GI system to deliver nutrition
ex:
- percutaneous endoscopic gastrostomy (PEG) tube
- jejunostomy tube
- nasogastric (NG) tube
- total parenteral nutrition (TPN) via a central intravenous catheter
- hypodermoclysis (subcutaneous delivery of fluids

Question 10

MAiD

Answer 10

eligible for MAiD only if the meet ALL the criteria
- person has a grievous and irremediable medical condition only if ALL the criteria

Question 11

role of RN in MAiD

Answer 11

• limited to aiding the physician or NP 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 MAiD

Question 12

role of RN regarding legal and ethical issues

Answer 12

• Promote Advance Care Planning
• Implement Advance Directives
• Facilitate Decisions about Care
• Promoting Caregiver Wellness

Question 13

senior abuse

Answer 13

refers to a wide variety of harms to older adults that are committed by a person(s) they know and would have normally have reason to trust

Question 14

perpetrator

Answer 14

• mental illness
• alcoholism
• hostility
• financial dependency on the victim

Question 15

victim

Answer 15

• cognitive impairment/ dementia
• problem behaviors
• disability (physical, communicative)
• physical dependency
• financial dependency
• shared living arrangements
• isolation or lack of social supports

Question 16

physical abuse
p. 164

Answer 16

inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving someone of a basic need

Question 17

sexual abuse
p. 164

Answer 17

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

Question 18

emotional abuse

Question 19

spiritual abuse

Answer 19

denial of a residents right to spiritual practices

Question 20

financial exploitation
p. 164

Answer 20

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

Question 21

neglect definition

Answer 21

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

Question 22

key points

Answer 22

• Legal and ethical challenges for older adults are often best managed with early and
  open communication between family members and caregivers.
• The nurse’s role is to provide information and support, and refer to further assistance.
• BCCNM has a Duty to Report Standard based on the Health Professions Act
• There are many reasons why residents do not report elder abuse
• There are many reasons why residential care staff do not report elder abuse
• Reporting elder abuse is everyone’s moral responsibility and the nurse’s professional
  legal responsibility