CNA Training Advisor Volume 12 Issue No. 12 DECEMBER 2014 For healthcare workers, navigating ethical issues is a regular event. Unlike many professionals, caregivers don t offer quick fixes for saving time or money. Instead, they dedicate themselves to helping and healing each person for whom they care a commitment that often includes complex responsibilities, such as reconciling a patient s wishes with the plan of care or family members interpretation of what s best for their loved one. Because of the high-stakes nature of making such decisions, healthcare professionals have many ethical requirements, including completing their training, certification, and annual continuing education credits; acting responsibly; giving the best care possible to patients; and following a code of ethics. This issue of CNA Training Advisor defines ethics and discusses its broad implications, as well as those that are more specific to healthcare environments. It unpacks the different types of ethical dilemmas that healthcare professionals often encounter and their unique responsibilities to their patients, peers, and organizations. Finally, it provides strategies for working through ethical challenges in long-term care settings. Have a good day of training, and stay tuned for next month s issue of CNA Training Advisor, which will focus on documentation standards. Ethics lingo The following terms can enhance your understanding of ethics and its relationship to healthcare. Code: a set of written rules Morality: acting in ways that agree with customs and traditions, often regarding personal or religious beliefs Standards: requirements for the way something should be done; in ethics, standards are also called principles Bioethics: healthcare ethics; the ways the standards of right and wrong are used in healthcare Quiz answer key 1. d 2. d 3. a 4. b 5. c 6. b 7. b 8. c 9. b 10. a Program Prep Program time Approximately 30 minutes Learning objectives Participants in this activity will be able to: Define ethical standards and discuss their centrality to healthcare environments Describe the various ethical requirements both institutional and personal that healthcare professionals regularly face, and interpret how they apply to longterm care settings Identify examples of ethical dilemmas and implement strategies for resolving them Preparation Review the material on pp. 1 4 Duplicate the CNA Professor insert for participants Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant s seat 2. Conduct the questionnaire as a pretest or, if participants reading skills are limited, as an oral posttest 3. Present the program material 4. Review the questionnaire 5. Discuss the answers SEE ALSO hcpro.com/long-term-care
CNA Training Advisor December 2014 This document contains privileged, copyrighted information. If you have not purchased it or are not otherwise entitled to it by agreement with HCPro, any use, disclosure, forwarding, copying, or other communication of the contents is prohibited without permission. EDITORIAL ADVISORY BOARD Product Manager Adrienne Trivers atrivers@hcpro.com Associate Editor Delaney Rebernik drebernik@hcpro.com STAY CONNECTED Interact with us and the rest of the HCPro community at HCPro.com Become a fan at facebook.com/hcproinc Follow us at twitter.com/hcpro_inc Email us at customerservice@hcpro.com Questions? Comments? Ideas? Contact Associate Editor Delaney Rebernik at drebernik@hcpro.com or 781-639-1872, Ext. 3726. Don t miss your next issue If it s been more than six months since you purchased or renewed your subscription to CNA Training Advisor, be sure to check your envelope for your renewal notice or call customer service at 800-650-6787. 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Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781-639-1872 or fax 781-639- 7857. For renewal or subscription information, call customer service at 800-650-6787, fax 800-639-8511, or email customerservice@hcpro. com. Visit our website at www.hcpro.com. Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. Opinions expressed are not necessarily those of CTA. Mention of products and serv ices does not constitute en dorse ment. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. In long-term care settings, ethical issues may arise over concerns about a resident s care experiences or choices, family involvement, and staff members compliance with facility policies and laws. To contend with the risks involved with providing care, workers must have an understanding of ethics and be able to recognize potential ethical issues. Ethics is the study of the difference between right and wrong. Ethics is closely related to human behavior, values, and morality. Over time, many people have accepted basic beliefs about right and wrong. Those common beliefs are known as ethical standards or principles. Many of these standards revolve around the concepts of doing good and not doing harm, which can become much more complicated than they sound for healthcare professionals, who are confronted with complex patient care, operational, and legal challenges on a regular basis. Therefore, in addition to negotiating universal principles and personal standards, healthcare staff must also be aware of the ethical requirements that govern their roles and workplaces. Ethical requirements in healthcare Healthcare professionals encounter situations daily that require ethical behavior and decision-making. Sometimes there are ethical and legal requirements that affect the same situation, making it difficult to come to a solution. For example: Patient care. When caring for patients, it is normal for healthcare workers to want to do the right thing. Following policies and procedures helps ensure that care is provided properly. However, questions may still arise, such as how to care for a nursing home resident who refuses to eat. Healthcare workers often find themselves wondering whether to support the patient s right to make choices when it seems that the choice is a poor one. Advance directives. Patients may sign these documents to indicate their choices about care at the end of their life. These statements are signed in advance because the patient may not be able to make choices when they reach the final stages of illness. Healthcare workers are required by laws and ethical standards to follow advance directives. Patient mental status. There are many ethical questions healthcare workers must answer when a patient s mental status changes, and the patient begins having problems making decisions and choices. To meet basic ethical standards, the entire care team must often work together. Sometimes obtaining legal advice is necessary. Families. Working with families also requires understanding ethical, and sometimes legal, standards. The Health Insurance Portability and Accountability Act (HIPAA) is a law that protects 2 HCPRO.COM 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
December 2014 CNA Training Advisor patient information. Doing the right thing means allowing the patient to decide how much information is shared with family members. Billing, finance, and legal compliance. A healthcare organization s billing practices receive a great deal of attention. Organizations must follow ethical standards when billing patients and insurance companies, including the Medicare and Medicaid programs. This means proper reporting of time and services, along with accurate charges. Every employee who is involved with billing or reporting the amount of care given to a patient must act ethically. When unethical practices occur, individual employees and entire organizations can be charged with legal offenses. In addition to the regulations for accurate billing, healthcare organizations must meet many other federal and state regulations and requirements for providing care. Facilities usually have a compliance plan, which explains how employees will meet these requirements. Ethical dilemmas in healthcare Ethical conflicts, or disagreements, occur when people have different beliefs about what is right and wrong. This happens in both personal lives and in the professional world. When different beliefs and backgrounds are combined with many choices and new technologies, it s easy to understand how there can be disagreement. Sometimes the disagreement occurs because a healthcare choice can have both positive and negative results. People may follow ethical standards but still find that there is no correct answer. This is known as an ethical dilemma. Think about ethical dilemmas in healthcare by comparing actions that seem to agree with standards but may conflict with a patient s rights, or have both good and harmful effects. The chart below outlines some examples of potential ethical dilemmas. In each of these situations, following the ethical standard can seem to conflict with doing the right thing. To navigate such complex cases, good communication is key, as is a review of the different possibilities and viewpoints of those involved. Healthcare organizations usually have an ethics committee that will help staff discuss these types of difficult situations and make the best decision possible. Personal ethics and responsibilities Healthcare workers must recognize that there are times when their own actions or the actions of coworkers, patients, and families may be questioned. Examples of ethical dilemmas Ethical standard Do no harm. Respect the right of others to make their own choices. Respect privacy and personal property. Example of following ethical standard Do not give fatty food to a resident with a heart condition. A resident has an advance directive, so a nurse does not resuscitate him when he stops breathing. Following HIPAA guidelines, a facility does not release resident information except as allowed. Possible dilemma This may conflict with the resident s right to choose and request the type of food he desires. A family member may not agree with the resident s choice and may feel that she was left to die. A daughter says she wants to help her father and requests information to do so. However, the resident has refused to release information and now may be harmed by not accepting his daughter s help. 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400. HCPRO.COM 3
CNA Training Advisor December 2014 Cultural differences, personal background, religion, and other beliefs may affect these actions and the way they are judged. Facilities have policies that require ethical conduct. Situations addressed by such policies, which may result in discipline or termination of employment if a worker does not meet standards, could include the following: Staff members are required to protect facility property, which includes not stealing or even borrowing from residents. Staff members should also avoid involvement with a resident s finances. It s normal for residents and families to want to reward good care, but most facilities have specific guidelines for accepted tips and other gifts. (For example, a box of cookies may be accepted, but a check for $50 could be against protocol.) It is unethical to provide extra care that is not part of the care plan. Following care plans means that each patient receives the necessary and fair amount of care. Meeting extensive extra requests can create conflicts. Even though residents may have personalities that make it difficult to care for them, it s never okay to be physically or emotionally abusive. after providing care. Studies have shown that accuracy decreases as time passes between performing an activity and documenting it. Offer support. Many residents have a need for emotional support. They may be lonely, dealing with a difficult diagnosis, or in pain. As a result, they may be weepy, overly dependent on you, or demanding. You can show your support by listening carefully when residents talk with you, showing kindness through gentle touch, and paying attention to details while providing care. However, remember to remain professional; while you may feel as though you re a family member, you are not. Performing your duties in an ethical manner is easier when you maintain your separate role as a caregiver. Observe and report. Since you may be involved in ethical dilemmas at any time or may see situations that appear to be questionable, it s important to look for changes in a resident s physical status, a caregiver s behavior, or care plans (e.g., a resident s new advance directive or update in care preferences). Report these changes to your supervisor. Long-term care staffs role in ethics Ethical standards are part of everything you do as a long-term care worker. Understanding these principles helps you care for residents appropriately while also meeting the facility s expectations for their employees. Some strategies for accomplishing both include: Maintaining knowledge of employee requirements. Even if you understand basic ethical standards, it s important to know how your facility includes those in its policies. Read your job description and ask questions about points you don t understand. Stay up to date with changes in policies, especially those that affect ethical and legal requirements. Read all new messages and policy changes. Attend meetings and complete annual education requirements. Avoid any appearance of unethical behavior by keeping careful records of the care that you ve provided and the time it took. Complete facility forms immediately Ethical decision-making When faced with a potential ethical problem, there are steps you can take to help make the best decision possible. Before acting, ask yourself the following questions: Is it right? Is it fair? Will someone get hurt? If my actions were reported in the newspaper, would I be embarrassed? Would I tell someone else, especially a child, to do the same thing? Does this smell right? (Your common sense may tell you that there s something wrong.) Source: Bowditch & Buono, 1997, as cited in Sellers, 2008, in P. Kelly (ed.), Nursing leadership and management (2nd ed., p. 523). Clifton Park, NY: Delmar Learning: Thomson. 4 HCPRO.COM 2014 HCPro, a division of BLR. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at copyright.com or 978-750-8400.
DECEMBER 2014 Volume 12 Issue No. 12 CNA Professor ETHICAL DILEMMAS QUIZ Mark the correct response. Name: 1. Which of the following does ethics NOT involve? a. Human behaviors b. Values c. Morality d. Easy decision-making 2. Which of the following situations requires ethical decision-making? a. Honoring residents advance directives b. Not accepting gifts from residents beyond what s allowed by the agency c. Protecting residents privacy d. All of the above 3. Which of the following situations would cause an ethical dilemma? a. A family s decision to ask the physician for a do not resuscitate order b. Informing a patient about the care plan c. Both a and b d. None of the above 4. When an employee commits an unethical action, he or she is the only one who faces legal ramifications. a. True b. False 5. Which of the following is NOT an example of an ethical behavior that a long-term care staff member should exhibit? a. Protecting facility and resident property b. Discussing resident issues during team meetings c. Overriding a resident s refusal to disclose information to family members d. Making a resident happy by paying attention to details 6. It s acceptable to perform extra duties that are not on the care plan, as long as they make the resident happy. a. True b. False Date: 7. Which of the following is NOT a good step toward resolving an ethical dilemma? a. Communicating with other care team members b. Trying new care strategies that fall outside of the facility s ethical standards c. Considering the advice of the facility s ethics committee d. Reviewing the different possibilities and viewpoints of those involved 8. Which of the following actions could be considered appropriate under a facility s ethics policy? a. Borrowing money from residents to establish a relationship of trust b. Accepting all gifts and tips from residents to avoid hurting their feelings c. Avoiding the use of physical and emotional abuse, regardless of how difficult a resident is to care for d. All of the above 9. What should long-term care workers do to stay abreast of their facility s ethics requirements for staff? a. Skip meetings and educational sessions that they don t find interesting b. Read all new messages and policy changes c. Keep any questions they have about their role at the facility to themselves to avoid overburdening busy staff d. Wait to complete forms related to resident care to formulate more detailed responses 10. Which of the following is a good way to offer support to residents? a. Listening carefully when residents speak and using personal details they share to enhance care delivery b. Using a gruff manner to help residents overcome weepy or clingy tendencies c. Considering yourself part of a resident s family d. Delivering generic, one-size-fits-all care to ensure your actions comply with facility standards A supplement to CNA Training Advisor