GUIDE FOR INTERVENERS AND USERS

GUIDE FOR INTERVENERS AND USERS OF THE PATHWAYS TO MIYUPIMAATISIIUN SERVICES HEREBY REFERRED TO AS CODE OF ETHICS Approved by the Board of Directors on March 19, 2009 1

Table of Contents Introduction & structure of document 4 Definitions 5 Preamble 6 Mandate, Key Values 7 Section I: The recognition of user rights 8/ 9 Respect and Dignity 10 Autonomy and Personal Needs 10 Integrity 11 Intimacy and Respect of Privacy 11 Equality and Equity 12 Freedom of Conscience, Freedom of Thought 12 Belief, Opinion and Expression 12 Section II: The right to the protection of the person 13 Protection, Safety, Attention 13 Section III: The right to quality and accessible services 14 Access to Services, Adequate and Quality Services 14 Continuous and Personalized Services 15 Section IV: The right to information 16 Responsible Use of Services, Information on Available Services& accessibility 16 Access to file, Disclosure of Accident, Complaints Examination Procedure 17 Professional Secrecy and Confidentiality 18 Section V: The right to participation 19 Care and Services, Intervention Plan, User or Resident 19 Section VI: The right to support and assistance 20 Assistance to Understand Information 20 Assistance to Voice a Concern or Obtain a Service 20 Complaints Examination Procedure 20 Approved by the Board of Directors on March 19, 2009 2

Section VII: The right to representation 21 Recognized Rights for the User and Consent of a Representative 21 Section VIII: The user s responsibilities 22 Towards Himself 22 Towards Other Users 22 Towards the Professionals and Staff Members 23 Towards the CBHSSJB 23 Final provisions 24 Approved by the Board of Directors on March 19, 2009 3

Introduction During a Special General Assembly on health and services held in Ouje-Bougoumou in February 1999, the following vision statement was developed for the Cree Board of Health and Social Services of James Bay (CBHSSJB). The Eeyou Nation of Eeyou Istchee, with the guidance of Tsheymendo, is committed to developing responsible, healthy communities in such a way as to result in: Individuals who are well-balanced emotionally, spiritually, mentally and physically; Families that live in harmony and contribute to healthy communities; Communities that are supportive, responsive and accountable; A healthy environment that will continue to produce traditional resources; In the context of a strong national Eeyou government that exercises complete jurisdiction and control over the delivery of quality comprehensive, integrated, inter-agency health and social services. That promotes Cree human resources development and applies adequate resources to address our needs with a strong expression of the Cree values of respect, honesty, loving, caring and sharing. The vision statement and its expressed values are the foundation to the present Code of Ethics. The Code was created with the input of interveners, managers, and users as well as members of the CBHSSJB Board of the Directors. It is based on similar codes used by various other health and social services institutions elsewhere. The purpose of the present document is to create awareness about accountability. It highlights the responsibilities of the interveners who seek to meet the needs and expectations of the community which they serve. It is not a list of all rights and responsibilities regarding the user. Also, it is not a list of all practices and conducts regarding the interveners who are also governed by the specific codes of their respective professions. The Code of Ethics includes some definitions to clarify some terms that are used in this document. The preamble deals with the scope and objectives of the Code. The core of the Code of Ethics (Sections I to VII) lists the fundamental rights of the user and describes the practices and conduct expected from the interveners who are expected to act in respect of these rights. The second part of the Code (Section VIII) addresses the users responsibilities towards himself, other users, the interveners and the organization. In the final provisions, the Code deals with the complaints procedure and the time frame for the suggested review period. Approved by the Board of Directors on March 19, 2009 4

Definitions Tsheymendo: Cree term which translates as Great Spirit ; variant spelling of Chishaaminituu. Miyupimaatisiiun: Cree term which translates as being alive well that describes a holistic state of wellness, including the spiritual, emotional, mental and physical aspects of one s life. This state of wellness includes the family, the community, the environment and all elements in the environment that contribute to the person s well-being such as food and shelter. User: Any person receiving health or social services from an institution or from an affiliated resource linked to such institution. The term could include any person who has been mandated to represent the user. Institution: Term which refers to the CBHSSJB as a regional organization for health and social services. It includes every centre where services are provided as outlined in the mandate of the CBHSSJB. (Page 7) This term also refers to any other public facility where health and social services are dispensed outside the territory. Intervener: Any person providing a service to the user. Professional: Any person who is a member of a professional corporation, whose activities are governed by specific legislation, namely a code of deontology. (This category includes, amongst others: physicians, dentists, pharmacists, nurses social workers). Accident: An action or a situation that is or could be harmful to the health or well-being of a user, an intervener, a professional involved or a third party. Incident: An action or a situation that is not harmful to the health or well-being of a user, an intervener, a professional involved or a third person, but the outcome of which is unusual and could have been harmful should the circumstances have been different. Informed consent: A process of communication between a user and a professional that results in the user s authorization to accept a specific clinical orientation or intervention. In this process, the user should have the opportunity to ask questions to elicit a better understanding of such specific orientation or intervention, so he can make an informed decision to proceed or to refuse. Approved by the Board of Directors on March 19, 2009 5

Preamble The word ethic refers to a way of acting aimed at the well-being of the person who is receiving the service. It requires a continuous awareness and commitment on the part of the intervener to behave in an ethical manner at all times. The Code of Ethics is not an evaluation or a prevention tool. Rather, it is a guiding tool concerning the actions and interactions of all involved in the course of service delivery to people. It recognizes each person's right to receive appropriate, adequate, and continuous health and social services. Through this recognition, the interveners commit to respecting the users' rights by providing them with quality care and services in a considerate way. As well, the Code of Ethics is meant to be a promotion tool for user rights. It emphasizes the building and upholding of good relationships in a spirit of mutual respect. The Code of Ethics also presents an opportunity for continual reflection with the aim of easing the relationships between the interveners and the users. This Code of Ethics does not replace nor prevail over the set of laws, regulations or agreements in effect in the province of Québec. Approved by the Board of Directors on March 19, 2009 6

Mandate, Key values Mandate The CBHSSJB is the regional organization responsible for: The development and the delivery of quality, comprehensive, integrated, inter-agency health and social services in its jurisdiction. Research is also an important aspect of the mandate of the CBHSSJB as it relates to specific issues common in the territory. These services are provided through various centres including: A Hospital Centre Community Miyupimaatisiiun Centres (health and social services) Youth Readaptation Centres Rehabilitation day centres (Multi Services Day Centres) Although Cree traditional practices with respect to health and well-being are not currently part of the CBHSSJB s mandate, the organization wishes to integrate these miyupimaatisiiun practices in its approaches to care. Key Values Based on the values specified in the introduction, key aspects of values have been identified to help attain the overall goal of miyupimaatisiiun. These are: Keep people safe. Treat people with respect, trust, and dignity. Consider all community members needs with sensitivity. Use a holistic and integrative approach regarding the provision of care. Assist community members in achieving greater levels of self-sufficiency and autonomy in regards to their own health and well-being. Ensure that the user has adequate information so that he can make knowledgeable decisions regarding his care plan. Ensure public trust through personal and professional integrity. Approved by the Board of Directors on March 19, 2009 7

Section I: Recognition of user rights BECAUSE the users are at the heart of the CBHSSJB s mission, the respect of their private person is a value we endorse. Therefore, the CBHSSJB considers the recognition of the following rights to be essential. As a user of services you have: the right to be respected and to have your dignity respected the right of recognition of your autonomy and the respect of your personal needs the right to be treated, at all times, with courtesy, fairness and understanding the right to the respect of your integrity the right to be informed of your state of health and of the various options open to you before giving your consent to care the right to accept or refuse care, on your own or through your spokesperson, freely and in an informed manner the right to your privacy the right to be treated with equality the right of your freedom of conscience and religion the right to your freedom of thought, belief, opinion and expression the right to protection the right to be informed as soon as possible of any accident that occurs during the provision of services the right to quality and accessible services the right to receive, with continuity and in a personalized and safe manner services that are appropriate the right to information the right to be informed of existing services and the way to obtain them the right to have access to your record, which is confidential The right to participation the right to participate in the decisions that concern you Approved by the Board of Directors on March 19, 2009 8

the right to support and assistance the right to be escorted or assisted by the person of your choice in getting information about services the right to file a complaint without the risk of reprisal the right to be informed of the complaint examination procedure the right to be escorted or assisted in the complaint examination procedure, if required the right to representation the right to be represented in regard to all your recognized rights if you are unable to give your consent Approved by the Board of Directors on March 19, 2009 9

To ensure that the users rights are complied with, the interveners are expected to adopt the following practices and conducts: Regarding the user s right to respect and dignity Be available to welcome the user or to assist him with consideration, civility, politeness and respect. Identify yourself to the user by stating your name and function. Specify the object of the visit at each visit and explain the nature of the actions you are about to carry out, if necessary. Use respectful language, whether by the tone of voice, the content or the way of speaking. The language or terms used should be clear, accessible and understandable by the user. Adapt the way you communicate so that the user understands you. Use the name that the user prefers. Avoid using informal or childish language. Respect the human and spiritual values of each person as much as possible. Respect the privacy and the dignity of the user. Show reserve and thoughtfulness. Take reasonable and appropriate means in providing hygiene or other intimate care. If the user expresses the wish to receive hygiene care from a person of the same sex, allow him to have it when possible. Regarding the user s right to autonomy and respect of personal needs Encourage the user to be as autonomous as possible in his daily life activities while respecting his individuality. Assist him as needed. Seek the user s cooperation in the development and use of care and intervention plans. Approved by the Board of Directors on March 19, 2009 10

Adjust the intervention to the user with regard to his capabilities or his limitations. Regarding the user s right to integrity Obtain free and informed consent from the user before providing him with the necessary care, except when emergency care is needed or when consent cannot be obtained in due time. Ensure the user understands the various choices of suggested care or services, as well as the potential risks and consequences. Comply with the user s refusal of care or treatment, even if his choice may be harmful to his health. Ensure that the user is aware of the possible consequences of his refusal. The right of refusal does not apply to hygiene care or when a court orders particular care or services regarding the user. Do not tolerate verbal, physical or psychological violence nor any indecent action or gesture toward a user. Protect the user from any form of abuse, harassment, exploitation or neglect. Report any type of harm or any unacceptable behaviour toward the user to the right person in the institution. As much as possible, offer the user all the help he needs to get proper assistance. Regarding the user s right of privacy Respect the user's private life and of his need to receive or refuse visitors. Use tact and good judgment as to whether the disclosure of information could harm the user or his relations in any way. Avoid getting involved in the personal affairs of the user or his relations. Approved by the Board of Directors on March 19, 2009 11

Regarding the user s right to equality o Treat all users equally while taking into consideration their needs as well as the available resources of the organization. Regarding the user s right to freedom of conscience or religion Respect the user's freedom of conscience or religion as much as possible within the limits provided by the law. At the same time, give consideration to the rights and freedoms of other users or interveners within the premises of the institution. Regarding the user s right to freedom of thought, belief, opinion and expression Allow the user's freedom of expression. Respect his opinions to the extent that they do not violate the rights and freedoms of other users or interveners within the premises of the institution. Respect the feelings expressed by the user and show compassion regarding the user's emotional behaviours related to his health condition. Approved by the Board of Directors on March 19, 2009 12

Section II: The right to protection BECAUSE we believe in the importance of ensuring the user's protection, the CBHSSJB considers the recognition of the following rights to be essential: The right to protection The right to safety The right to timely attention THE PRACTICES AND CONDUCT EXPECTED FROM THE INTERVENERS Regarding the user s right to protection Protect the user by providing him with quality care and services at all times. Ensure that emergency care is offered when his life or his integrity is threatened. Regarding the user s right to safety Create a climate of trust and take the means necessary to ensure that the user feels safe. Ensure a safe delivery of care and services. Know and apply the safety and hygiene standards in effect in the institution. Be vigilant to limit the risks of incidents or accidents. Report any incident or accident affecting the user to the person responsible in the institution. Provide help and protection to the user when he shows dangerous behaviour for himself or others. Regarding the user s right to attention Show empathy and give proper attention to the user. Pay attention to his specific needs by taking into account his health condition. Approved by the Board of Directors on March 19, 2009 13

Section III: The right to quality and accessible services BECAUSE we believe in the importance of offering quality services and ensuring their access and continuity, the CBHSSJB considers the recognition of the following rights to be essential: The right of access to services The right to adequate and quality services The right to continuous and personalized services THE PRACTICES AND CONDUCT EXPECTED FROM THE INTERVENERS Regarding the user s right of Access to the services Provide the available care and services as soon possible. If the CBHSSJB cannot offer the required care or services, it should inform the user of alternatives, providing him with all the required assistance. In the case of unilingual Cree speakers, ensure that adequate interpreting resources are available before communicating information. Regarding the user s right to adequate and quality services Within the framework of a personalized approach, assess the needs and determine the kind of services which are required. Maintain skills and knowledge in the carrying out of responsibilities. Commit to the continuous improvement of service quality. Encourage the user to take part in the development of his intervention or care plan. Encourage the cooperation of his family, if possible. Always keep in mind the user's well-being and quality of life. Approved by the Board of Directors on March 19, 2009 14

Regarding the user s right to continuous and personalized services Ensure continuous services to the user as required by his health condition. Within the scope of CBHSSJB s mission and resources, provide personalized services by taking into account the users' specific needs. Should the user be transferred to another institution, organization or professional, ensure an efficient liaison. Forward all required information to the concerned persons in a safe and protective manner. Inform the user of this exchange of information and, if applicable, obtain his consent. Approved by the Board of Directors on March 19, 2009 15

Section IV: The right to information BECAUSE it is important for the user to make informed decisions regarding his health condition and well-being, the institution must provide information on: The responsible use of the services The available services and resources and the way they can be accessed The user s health condition Access to his file The disclosure of any accident The complaints examination procedure Professional secrecy Confidentiality THE PRACTICES AND CONDUCT EXPECTED FROM THE INTERVENERS Information on the responsible use of the services Communicate all important information and answer any questions so that the user may make informed choices about improving his health condition. Information on available services and resources and their accessibility Inform the user of the services offered by the institution which correspond to his needs. If needed, inform the user of other available health and social services resources as well as the way to access them. Inform the user about the registration, admission and discharge processes used in the institution. Provide him with all necessary information on the procedures used in the Community Miyupmaatisiiun Centers or external resources in making appointments, for example. Approved by the Board of Directors on March 19, 2009 16

Information on health condition Help the user to better understand his health condition. Use clear and simple words. Explain the goals of the care and services offered and their potential impacts on his health condition. Provide the user with the necessary support to easily follow his intervention plan. When required and authorized by the user, this support should also be available to the persons who are assisting him. Access to the file Allow every user who is fourteen years of age and older, in accordance with legislative provisions, to have access to his file. Explain the access procedures and restrictions regarding the information identifying or coming from a third party. Disclosure of any incident/accident Inform the user or his relatives of any incident or accident during service delivery that may have harmful effects to his health or well being. Inform the user about the measures that have been taken to respond to the harmful effects, if any, or to prevent future incidents or accidents. Provide any support necessary to the user and his relatives. Complaints examination procedure Provide the user, his spokesperson or his family with a copy of the complaints examination procedure. Approved by the Board of Directors on March 19, 2009 17

Professional secrecy and confidentiality All professionals must: Not disclose confidential information obtained during the performance of their duties without the user's consent, unless ordered by law. All interveners must: Show discretion and carefully comply with the rules of confidentiality regarding a user s personal information. Ensure the confidentiality of the files and communications between the user and the interveners. Choose an appropriate location to discuss information regarding the user. Ensure the relevance and accuracy of the clinical notes and documents added to the file. Ensure that only the authorized persons have access to the user's file. Disclose only the necessary information. Consult with the user about the nature and the scope of the information which can be revealed to his relatives. Approved by the Board of Directors on March 19, 2009 18

Section V: The right to participation BECAUSE we believe that the user s participation is important, the CBHSSJB wishes to ensure that the user is involved in the following phases: During the delivery of care and services During the development or the review of the intervention plan or of the individualized services plan THE PRACTICES AND CONDUCT EXPECTED FROM THE INTERVENERS During the delivery of Care and services Support the user s participation in the care and services with which he is provided. Create an environment that encourages the user to express his needs and expectations. Provide the user with all the necessary information that he needs to make his own decisions in a clear and supportive fashion. During the development or the review of an intervention plan or individualized services plan Ensure that the user understands his intervention or services plan. Involve him in the development, review, or change of the plan. Approved by the Board of Directors on March 19, 2009 19

Section VI: The right to support & assistance It is important that the user understands the information he is given and should assistance be required, it must be provided. THE PRACTICES AND CONDUCT EXPECTED FROM THE INTERVENERS Help to understand information Give clear explanations to the user, particularly information on medical or social details relating to his case. Adapt to the user's capacity to understand and ensure that the information provided is clearly understood. Provide any help requested by the user to favour his understanding of the information. Support and help to voice a concern or obtain a service Provide help to any user who wishes to voice his concerns about a situation pertaining to him. Provide help to any user who seeks help to obtain a service or a follow up. Complaints examination procedure Allow the user to express his dissatisfaction regarding any problem that he had with the health or social services provided by or through the CBHSSJB. Direct the user who requires help regarding his complaint to the Commissioner of Complaints and Quality of Services. Approved by the Board of Directors on March 19, 2009 20

Section VII: The right to representation BECAUSE we believe in the importance of representation when the user looses the ability to make decisions, the CBHSSJB considers representation on behalf of the user to be essential in the following circumstances: To exercise the rights recognized by law when the user is no longer able to speak for himself. To obtain consent from a representative when the user is no longer able to provide it himself. THE PRACTICES AND CONDUCT EXPECTED FROM THE INTERVENERS The consent of a representative When the user can no longer consent to the care required by his health situation, the person legally authorized to act on his behalf can give his consent. Support the involvement of the user's representative and provide him with the necessary information to allow him to carry out his role. Approved by the Board of Directors on March 19, 2009 21

Section VIII: The user s responsibilities BECAUSE we believe in the importance of mutual respect and mutual responsibility, the CBHSSJB considers the following responsibilities regarding the user to be essential: Towards himself The user is encouraged to be responsible, as much as possible, for his own health. The user is encouraged to seek information about the various services offered by the CBHSSJB. The user keeps the appointments that have been made for him. The user has the responsibility to inform the interveners of the institution as soon as possible when he cannot keep the appointment. The user takes an active role in the care and services that have been recommended for him and to express his needs and expectations. The user commits to participating in the preparation of his intervention or individualized services plan. Towards other users The user is responsible for the quality of relationships with others and is called upon to be patient, considerate, discreet, thoughtful, and respectful of others. The user has the responsibility not to bring anything that could be harmful to him/ or to others while he is under the care of the institution. Towards the interveners The user is responsible for the quality of relationships with the interveners who interact with him. The user his responsible to communicate all the information needed for the development or review of intervention and individualized services plan, so that Approved by the Board of Directors on March 19, 2009 22

accurate assessments can be made. The user is responsible to ask for clear information about the care and services suggested to him if he does not understand them. Toward the CBHSSJB The user is responsible to take care of the equipment or material that is made available for him to use. The user is called upon to respect all safety guidelines. The user is called upon to respect admission, registration and discharge procedures of the institution. The user is responsible for the payment of any contribution not covered by health insurance or non-insured health benefits. The user is encouraged to provide the institution with the names of the person(s) authorized to act on his behalf in the event that he cannot make his own decisions regarding his health. When there is no person authorized to act on behalf of the user, should the need arise, the user is called upon to find such a person. Approved by the Board of Directors on March 19, 2009 23

The final provisions Application of the Code - Any breach to the CBHSSJB's Code of Ethics on the part of an intervener can be the object of a complaint with the Commissioner of Complaints and Quality of Services. Complaints examination procedures - The complaints examination procedure is available at the CBHSSJB s office of the Commissioner of Complaints and Quality of Services and at every point of service of the CBHSSJB. Information - For additional information on user rights: You can reach the COMMISSIONER OF COMPLAINTS AND QUALITY OF SERVICES AT: Address Phone # Person in charge of the application of the Code of ethics - The Commissioner of Complaints and Quality of Services is the person responsible for the application of the Code of Ethics and its promotion amongst the users and the interveners in the institution. Review - The Code of Ethics must be reviewed every three (3) years, at the latest, following its adoption by the Board of Directors. Approved by the Board of Directors on March 19, 2009 24