All abuse or suspected abuse must be reported. Every health care facility has a procedure for handling concerns about client care. If the issue cannot be resolved, it moves to the next level of authority. If an incident involves a supervisor, proceed to the next level. In this case, if a nurse aide observes the charge nurse in situation that could be dangerous or neglectful for the client, the nurse aide can go directly to the Nursing or Administrative Supervisor.
HIPAA (Health Insurance Portability and Privacy Act) is the Federal law that protects a resident's privacy. This includes documentation, records, and communications. Information can only be shared with those who need it to provide treatment. There are severe penalties for sharing information, even if it is unintentional.
"Register" is the formality of speech, depending on the circumstances. It always applies to how you address someone. For example, you may first address a new client as "Mr. Smith" until he asks you to call him "Bob." Do not assume that because his family calls him "Bubba" that you can, too. All languages have register, and usually we know exactly how to switch from formal to informal.
Abuse and neglect occur when a client does not receive necessary physical or mental care. This includes failure to respond to a call light. Do not assume the client does not need assistance. If a client is accidentally hitting the call light, it is the staff's responsibility to fix the situation.
All health care professionals must be trained in HIPAA regulations before beginning client care. Facilities are responsible for protecting client privacy at every level. It can be tempting to want to learn more about a certain client, and possible to do because you are an employee. But even basic information or a conversation violate HIPAA. You could lose your job for seeking information.
If you make a mistake, follow your facility’s policy for correction. Many times a single line through the mistake, with date, time, and your initials is acceptable. Never erase, black out, or use correction fluid.
Patients can become aggressive or combative for several reasons. They may be angry at their situation or someone else. They may be confused or scared. Do not let them hurt you. Step out of the way and speak In a soft, reassuring way. Listen to their words and emotions, and try to find the cause of their behavior.
Learning does not end with certification. New methods and advancements are constantly being discovered. Staying current makes sure that clients are getting the safest care and best treatment. Also, hospitals and facilities must show training records to maintian accreditation, so continuing education must be current.
Assault is an intentional attempt or threat to touch someone without their consent. There does not need to be actual touching. If the person feels afraid of being harmed, assault can be charged, even if there was no possibility of being touched. A simple assault is when no harm is done. It is a misdemeanor. Aggravated assault happens when a child, elderly person, patient, or someone in a protected class is threatened. It is a serious felony charge.
Every staff member has a role in providing excellent client care. Each person can work within their scope of practice and allow others with different authority to handle appropriate tasks. The nurse aide reports to the RN or LVN, who reports to the Director of Nursing. The facility's Administrator and Medical Director may be the people with the most responsibility. A staff development nurse oversees training and education.
All clients have a right to have access to their care givers. For clients who are confined to bed or have limited mobility, their safety could be at stake. A client who needs something might be in distress, or try to get out of bed alone. When they use their call light, a quick response is a clinical standard.
Each state licensing board has regulations regarding reinstatement after claims of abuse or neglect. If the state allows reinstatement, they will provide information about the process. An attorney may be useful in reviewing the case and helping dispute or reinstate the license.
The HIPAA Privacy Act regarding protecting a client's confidential information is clear: Absolutely no information can be shared outside those who need it in order to care for the client. Even a discussion in a hallway or the cafeteria, where others can overhear, is a violation. Discussing other workplace issues in a public place is rude and inappropriate; these can be disturbing or misunderstood by other restaurant patrons.
Advanced directives describe the kind of medical treatment you want for yourself if you are in serious health condition or unable to speak for yourself. Anyone over age 18 can have an Advanced directive. Once in place, it is a legal document that cannot be revoked. A person can choose to have a Living Will, which lists the person's wishes regarding end-of-life care. The person can also designate someone who can make medical decisions if the person is unable to; this is called the Medical Power of Attorney. A person can also indicate they wish to be a DNR, or Do Not Resuscitate, patient if their heart stops beating or they stop breathing.
Verbal abuse (also called bullying) is a form of emotional abuse that can be as harmful as physical abuse. It includes yelling, criticism, blaming, insulting, belittling, or threatening. Clients are emotionally vulnerable, and verbal abuse leads to stress and low self-esteem. It must be reported the same as physical abuse.
When a client is grateful for the care they have received, they may wish to acknowledge the nurse aide with a money. The nurse aide's response can be, "I'm sorry, but I can't accept." Gifts or money compromise the client-nurse boundary. It can also destroy the trust that clients have in nurses. In some facilities, it can result in disciplinary action.
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CNA Legal & Ethical Behaviours #2
