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NCOA Legal & Ethical Considerations & End of Life Issues for the Elderly

NCOA Legal & Ethical Considerations & End of Life Issues for the Elderly. Chapters 4 & 9 (4 th ed) Pati Cox, RN, BSN, M.Ed. Ethical Dilemma’s. Study of moral actions & values Anything that impacts “Quality of Life” Quantity versus Quality Spent much time discussing in P&VC.

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NCOA Legal & Ethical Considerations & End of Life Issues for the Elderly

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  1. NCOALegal & EthicalConsiderations & End of Life Issues for the Elderly Chapters 4 & 9 (4th ed) Pati Cox, RN, BSN, M.Ed.

  2. Ethical Dilemma’s • Study of moral actions & values • Anything that impacts “Quality of Life” • Quantity versus Quality • Spent much time discussing in P&VC

  3. Patient’s Bill of Rights • AHA - 1992 • It ensures that each patient or resident has the right to make his/her own decisions regarding care and treatment • Provided to each person • Posted in facilities (acute and LTC)

  4. The LAW • Based on rules and regulations • As a LPN, you are required to function under the mandates of the state Nurse Practice Act in which you practice. You are NOT allowed to practice outside those rules and regulations

  5. Negligence • Failure to exercise adequate care • Prudent Nurse Theory • Determination is based upon: • Level of performance that is expected • What is considered safe practice • Will discuss more in Leadership & Management • Various types of negligence

  6. Omission • Straight forward concept • Simply omit or leave something out • May be on purpose or not • But it is expected of you to complete as part of the care or treatment provided • Example: Medications or treatments

  7. Restraints • Physical and Chemical • If utilized, must be ordered; protocol must be followed to assess and release • Restraint Free Environment is Goal • Use of the least restrictive devices • Strategies of Care givers

  8. Advanced Directives • Living Will • Many states require Advanced Directives upon admittance to health care facility • Primary Objective is to follow the wishes of the patient/client/resident • Discussed in great detail in P&VC

  9. Right To Die Factors Influencing Decision Include: ./ 'Patient's Suffering ./ 'Patient's Cognitive Impairment ./ 'Patient’s and Family’s Expressed Wishes ./ QUALITY OF LIF£ ./ Current Care Setting

  10. Right TO DIE Related Issues: ./ 'Patient's competency to make decision ./ Family's view of Patient’s decision ./ NO Code and No Treatment Situations . -DO NOT Resuscitate (DNR) . "DO NOT Hospitalize (DNH) . "DO NOT Treat (DNT) “DO NOT Intubate (DNI) Doctor’s Signature Required for the orders

  11. Right To Die Possible Nursing Implications: Support Patient and Family in decisions Support Nurses and Doctors who implement policies Ensure that supportive care is maintained

  12. Informed Consent • Right to information before consent to treatment or procedure • Must be signature on consent form (or mark) • Guardian/Health care Power of Attorney may sign if necessary

  13. Informed Consent • To Give Valid Consent: • Fully informed of all risks and benefits of procedure • Competent • Nursing Implications: • Assess and screen areas of client competency carefully • Consent must be obtained first – if not – can’t do • Follow legal requirements & facility specific procedures/policy

  14. PROTECTIVE SERVICES GENERAL INFORMATION: 1. ADULT PROTECTIVE SERVICES: GENERAL TERM FOR SERVICES PROVIDED TO PROTECT AN INCOMPETENT PERSON FROM HARM ARISING FROM INABILITY TO CARE FOR SELF OR MANAGE DAILY AFFAIRS 2. GOAL IS TO PROVIDE WITH MINIMAL- DISRUPTION OF LIFE-STYLE & WITH LEAST RESTRICTIVE CARE ALTERNATIVES; BALANCE FREEDOM WITH SAFETY 3. PROTECTIVE SERVICEDS NEEDED BY ELDERLY: A. SOCIAL SUPPORT B. HOUSING ASSISTANCE C. SUPPORT WITH ACTIVITIES OF DAILY LIVING D. LEGAL AID E. FINANCIAL SUPPORT F. MEDICAL AND PERSONAL CARE G. EMERGENCY SERVICES

  15. Power of Attorney Joint Tenancy Intervious Trust Conservatorship Protective Services

  16. Power of Attorney • LEGAL DEVICE WHEREBY OLDER PERSON DESIGNATES ANOTHER TO MANAGE AFFAIRS; • PERSON MUST BE LEGALLY COMPETENT TO INITIATE THIS ACTION • Durable or Designated area (Health Care, Financial, etc.)

  17. Joint Tenancy • LEGAL DEVICE ALLOWING EITHER ELDERLY PERSON OR PERSON HAVING POWER OF ATTORNEY TO MANAGE THE FORMER'S AFFAIRS

  18. Intervious Trust • TRUST CREATED BY ELDERLY PERSON IN WHICH THAT PERSON SERVES AS THE FIRST TRUSTEE AND NAMES SUCCESSOR AS SECOND TRUSTEE

  19. Conservatorship • DESIGNATION OF A PERSON OR INSTITUTION TO TAKE OVER AND PROTECT INTERESTS OF PERSON JUDGED INCOMPETENT; • COURT APPOINTS CONSERVATOR AFTER INVESTIGATION OF PERSON'S COMPETENCE; • MOST RESTRICTIVE FORM OF PROTECTIVE SERVICE; PERSON NO LONGER HAS THE RIGHT TO VOTE, MANAGE MONEY, DETERMINE RESIDENCE, OR MAKE OTHER MAJOR DECISIONS

  20. Informal Guardianship • NONLEGAL ARRANGEMENT MADE WITH NEIGHBORS, NURSING HOMES, PRIVATE ATTORNEYS, BANKS, TRUST COMPANIES, & NONPROFIT CORPORATIONS

  21. ELDER ABUSE

  22. http://www.elderabusecenter.org/default.cfm

  23. Statewide Elderly Abuse/Neglect Hotline: 1-800-392-0210 DEPARTMENT OF SOCIAL SERVICES MISSOURI DIVISION OF AGING P.O. BOX 1337 JEFFERSON CITY, MISSOURI 65102 elderly abuse/neglect

  24. ABUSE

  25. Abuse

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