Nurs 217 Week 5 Student Deck Tagged PDF

NURS 217 : WEEK 5 UNIT 6 STUDENT DECK  CONSENT Informed consent- patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their healthcare provider recommendations (i) must be competent to understand and decide, (ii)...

NURS 217 : WEEK 5 UNIT 6 STUDENT DECK  CONSENT Informed consent- patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their healthcare provider recommendations (i) must be competent to understand and decide, (ii) receives a full disclosure, (iii) comprehends the disclosure, (iv) acts voluntarily, and (v) consents to the proposed action. For informed Consent the individual must have all the information & their questions need to be addressed. Information given must included  nature of the treatment  expected benefits of the treatment;  material risks and side effects of the treatment;  alternative courses of action;  likely consequences of not having the treatment. CNO, 2017 2   Informed Consent is the process of getting permission from a patient before conducting a healthcare intervention CONSENT (ie. vital signs).  Only a health practitioner (i.e. the most responsible provider) who has the knowledge to answer a person’s questions about the treatment/procedure/care can carry out  Obtaining Informed consent must: the process of obtaining informed consent  For a patient to provide consent to a treatment, they must 1. Be related to a be capable (i.e. - able to “understand” and “appreciate” the nature of a treatment) treatment/procedure/care plan 2. Be informed (the nature of treatment, risks, side effects, expected benefits, alternatives, likely consequences of Emergency Situations refusing are discussed) An individual can be treated in an emergency without their consent if they are experiencing severe suffering, or are at risk 3. Be voluntary (not under coercion, or of sustaining serious bodily harm to themselves or others if the under duress) treatment is not given promptly 4. Not be obtained through fraud or misrepresentation (by the HCP) Consent Can be withdrawn at any time 3  CONSENT Implied Consent Express Consent  not explicitly communicated by the patient  Express consent is explicit, clear, and but is inferred based on the circumstances. communicated in an unequivocal manner.  With implied consent, the client indirectly  It is given when a patient explicitly agrees to a accepts or refuses a proposed treatment healthcare procedure or treatment after being through their actions/behaviour provided with comprehensive information  Typically, applicable to interventions that are about the nature, potential risks, and alternatives associated with it considered standard practice in a given situation  Can be given in verbally, in writing ---ensure clearly documented how consent was provided SAMPLE FOOTER TEXT 20XX 4  Health Care Consent Act, 1996 Substitute Decisions Act, 1992 (HCCA) (SDA) a) To provide rules with respect to consent to treatment that  deals with decision-making apply consistently in all settings b) To facilitate treatment, admission to care facilities, and about personal care or Note: personal assistance services, for persons lacking the property on behalf of incapable “Nurses obtain capacity to make decisions about such matters persons informed consent c) To enhance the autonomy of persons for whom treatment is proposed, persons for whom admission to a care facility is  concerned with persons who from clients, or proposed and persons who are to receive personal from their assistance services by: (i) Allowing those who have been need decisions made on their found to be incapable to apply to a tribunal for a review of substitute the finding, (ii) Allowing incapable persons to request that a behalf on a continuing basis. representative of their choice be appointed by the tribunal decision-makers for the purpose of making decisions on their behalf concerning treatment, admission to a care facility or when clients are personal assistance services, and (iii) Requiring that wishes unable to do so, with respect to treatment, admission to a care facility or personal assistance services, expressed by persons while as set out in capable and after attaining 16 years of age CNO’s Consent d) To promote communication and understanding between guideline and the health practitioners and their patients or clients; Health Care e) To ensure a significant role for supportive family members when a person lacks the capacity to make a decision about a Consent Act, treatment, admission to a care facility or a personal assistance service 1996.” f) To permit intervention by the Public Guardian and Trustee (“PGT”) only as a last resort in decisions on behalf of CNO, 2023 (Code Ontario Health Association, incapable persons concerning treatment, admission to a care facility or personal assistance services of Conduct 2023, CNO, 2023 1.8) HEALTH CARE CONSENT ACT, 1996 (HCCA) The HCCA Act sets out rules for determining capacity in three key areas: treatment decisions; admission to care facilities; and personal assistance services. The HCCA provides rules for obtaining informed, voluntary consent from either the capable patient or their substitute decision maker (“SDM”); and provides for the review of findings of incapacity by a provincial administrative tribunal College of Nurses of Ontario, 2017, 2016  HCCA & CONSENT According to College of Nurses of Ontario (CNO), 2017 nurses are accountable for obtaining consent whether the intervention or service relates to a treatment, admission to a facility, or the provision of a personal assistance service. The HCCA, deals with these three circumstances differently. 1. Consent to treatment: Consent is required for any treatment except treatment provided in certain emergency situations. The consent must: ◗ relate to the treatment being proposed; ◗ be informed; ◗ be voluntary; and ◗ not have been obtained through misrepresentation or fraud. The health care practitioner who proposes the treatment is responsible for taking reasonable steps to ensure that treatment is not administered without consent. 2. Consent to admission to a care facility: If consent to admission to a care facility is required by law, then consent is needed in all cases except in a crisis situation. 3. Consent to personal assistance services: The HCCA does not specify that consent to a personal assistance service is required. It does, however, provide that if an evaluator finds a recipient of a personal assistance service incapable of giving consent, and the person providing the service wants to obtain consent, it may be obtained from a substitute decisionmaker using the hierarchy set out in the Act. CNO, 2017 7   CNO’s guidelines for nurses in consent advocacy NURSES’ RESPONSIBILITIES & role: ADVOCATING FOR CLIENTS REGARDING CONSENT (CNO- PRACTICE GUIDELINE: CONSENT (2017) Nurses who obtain consent have a professional accountability to be satisfied that the client is capable of giving consent Nurses are professionally accountable for acting as client advocates and for helping clients understand the information relevant to making decisions to the extent permitted by the client’s capacity SAMPLE FOOTER TEXT 20XX 8 CNO- PRACTICE GUIDELINE: CONSENT (2017) https://www.cno.org/ globalassets/docs/policy/ 41020_consent.pdf SAMPLE FOOTER TEXT 20XX 9  The Health Care Consent Act states that a client is capable of giving consent if the client understands the information that’s relevant to making the decision; and appreciates the possible consequences of a decision or lack of a decision DEFINITION OF INCAPABLE  According to the Substitution Decision Act a client is incapable of making decisions about personal care if the client is unable to understand information that’s relevant to making decisions on the client’s own health care, nutrition, shelter, clothing, hygiene or safety, or is unable to appreciate the consequences of a decision or lack of decision . CNO, 2017, 2006 20XX 10  SUBSTITUTE DECISIONS ACT, 1992 (SDA) Once an individual has been deemed incapable then the SDA provides the rules: Decision making around property or finances, and decisions about personal care Explanation and rules about power of attorney and the role of the Office of the Public Guardian and Trustee  Legal framework for Power of Attorney (POA) for personal care and property decisions Considered a piece of companion legislation to the Mental Health Act (MHA) and HCCA  deals with decision-making about personal care or property on behalf of incapable persons ---- concerned with persons who need decisions made on their behalf on a continuing basis.  SUBSTITUTE DECISION MAKER (SDM)HIERARCHY Consent must be 1.Guardian (Court appointed guardian ) obtained from the highest ranking of 2.Power of Attorney (POA) for personal care (individual named) the available SDM 3.Representative from Consent/Capacity Board 4 a.Spouse [if it is an unmarried partner, they have to be in a conjugal SDM must be at (i.e. - living together) relationship for at least 1 year, and be the “most least 16 years of age important primary person in both individuals' lives”] b. Child 16 year old/custodial parent/Children Aid Society SDM only c. Parent who has right of access only responsible for giving d. Sibling consent for the activities that client e.Other Relative (e.g. - blood-relative, marriage, adoptive, step- parents, in-laws) has been deemed incapable of 5. Public Guardian and Trustee (PGT) (i.e. - a government representative) 20XX 12 CAPACITY Capacity is the ability to understand and appreciate the consequences of a treatment/procedure/care. Key points to consider regarding capacity: 1. An individual is capable until proven otherwise 2. Capacity can fluctuate (ie. someone may be capable at one time regarding a treatment and incapable at another) 3. Capacity is task-specific 4. Capacity is treatment-specific (ie. diabetes management vs. chemotherapy for cancer) 5. Capacity is functional (i.e. - just because someone is diagnosed with a mental disorder does not mean they are incapable) 6. Disagreement or refusal with medical recommendations does not equate to incapacity 7. Acquiescing to treatment does not prove capacity 8. The best interests of the person are not relevant to the question of determining capacity SAMPLE FOOTER TEXT 20XX 13 Under HCA— Client is capable of giving consent if the client understands and appreciates A Capacity Assessment involves : Understandi Appreciation ng A. the patient's ability to understand the Description Ie Do they have Ie. Are they affected information that is relevant by a condition to not cognitive ability to appreciate the to making a decision about the ASSESSING understand? consequences? treatment/procedure/care CAPACITY Factors Ie What Ie are they able to B. the patient's ability information was apply the to appreciate the given to the pt- information to their how did they circumstances? reasonably foreseeable respond? consequences of a decision or lack of a decision. Example Ie: Ie: Incapacity occurs when, the patient fails either one or both ----this must be documented appropriately in the patient's chart. NEXT STEPS: FINDING OF INCAPACITY 1 2 3 Clients must be given Health Care Provider Note: if equally ranked notice of findings of needs to determine who SDMS cannot agree on a incapacity the appropriate SDM proposed treatment then (hierarchy) is for the the Public Guardian and incapable client and seek Trustee will be approached their informed consent for to make the decision the procedure/treatment/care 20XX 15  RESTRAINTS  Restraints should be used only for the shortest time when prevention, de-escalation and crisis management strategies have failed to keep the individual and others safe. In emergency situations, nurses may apply restraints without consent when a serious threat of harm to the patient or others exists and only after all alternative interventions were unsuccessful. Restraint use should be continually assessed by the health care team and reduced or discontinued as soon as possible CNO, 2023 Patient Restraint Minimization Act, 2001 ---This Act does not apply in circumstances in which the Mental Health Act governs the use of restraints on patients or other persons in psychiatric facilities -The purposes of this Act are to minimize the use of restraints on patients and to encourage hospitals and facilities to use alternative methods, whenever possible, when it is necessary to prevent serious bodily harm by a patient to himself or herself or to other Government of Ontario, 2023 https://www.ontario.ca/laws/statute/01p16 16 Website: https://www.oha.com/Legislative%20and %20Legal%20Issues%20Documents1/A %20Practical%20Guide%20to%20Mental %20Health%20and%20the%20Law%2c %20Fourth%20Edition%2c%202023.pdf SAMPLE FOOTER TEXT 20XX 17 MENTAL HEALTH ACT  Sets out the criteria for voluntary, informal and involuntary admissions to specially designated psychiatric facilities, as well as for the management of psychiatric out- patients.  The statute also requires the assessment of psychiatric patients’ capacity to manage property following their admission to a psychiatric facility. The statute protects the rights of psychiatric patients by requiring that patients receive formal rights advice in certain circumstances and providing for the review of informal and involuntary admissions, capacity to manage property. Ontario Hospital Association, 2016  “The Mental Health Act sets out the powers and obligations of psychiatric facilities in Ontario. It governs the admission process, the different categories of patient admission, as well as directives around assessment, care and treatment.” Canadian Mental Health Association Ontario, 2022   Voluntary patient –agreed to be admitted to the psychiatric facility for care, MENTAL HEALTH observation and treatment ACT  Informal patient – A person who has been admitted as per substitute decision maker’s “PATIENT” consent  Involuntary patient– A person who has been assessed by a psychiatrist and found to meet certain criteria –admitted under a particular form of the MHA (Form 1, 2, 3 or 4)  Patients admitted under court order (Form 6 or 8), according to the MHA.  Out-patient - a person who is “registered in a psychiatric facility for observation or treatment or both, but who is not admitted as a patient  MENTAL HEALTH ACT FORMS Form 1 (Application for Psychiatric assessment) -allows a physician to detain a patient for a psychiatric assessment for up to 72 hours -Criteria (Patient must meet at least 1 out of the 3):  A. Harm to Self; B. Harm to Others C. Physical Impairment  -Additionally there has to be evidence of a mental health disorder based on two tests 1. Past/Present Test (risk) 2. Future Test (evidence of Mental Disorder) A Form 42 (Notice to Person) is always given to a patient to notify them that they are under a Form 1. -original is given to patient and must be given promptly MENTAL HEALTH ACT FORMS Form 2 (Order for Examination)  -- Filled out by a Justice of the Peace, based on information presented by other members of the public (which can include but is not limited to an MD)  -- Similar criteria to Form 1 – danger to self or others &/or inability to care for self secondary to mental disorder  -- Valid for 7 days -> not detainment just apprehension  Allows the police to bring a person to an appropriate place for psychiatric assessment  Patient must be assessed upon arrival, and either:  placed on Form 1  admitted as a voluntary patient  allowed to leave without admission  MENTAL HEALTH ACT FORMS  Form 3 (Certificate of Involuntary Admission) - "involuntary patient" and they are not allowed to leave the facility  lasts 2 weeks (includes day form filled).  Note: Physician who signed Form 1 cannot sign a Form 3  Form 30 (Notice to Patient) -- given to a patient any time Form 3, 4 or 4a is given -- Essentially, think of it as a formal notice you give to a patient to let them know they are being involuntarily admitted & about their rights. The patient must have the original copy. MENTAL HEALTH ACT FORMS Form 4 (Certificate of Renewal) -- form issued when a patient continues to meet criteria for an involuntary admission after a Form 3 expires. The first Form 4 lasts one month (add one month, minus a day) Second Form 4 lasts two months (add two months, minus a day) Third Form 4 lasts three months (add three months, minus a day) Rights advice must be notified, give a Form 30 each time, plus patient can appeal each time A Form 4A (Certificate of Continuation), replaces what used to be the fourth certificate of renewal- not more than 3 additional months for a first or subsequent certificate of continuation.  PERSONAL HEALTH INFORMATION PROTECT ACT (PHIPA) (2004) The Personal Health Information Protection Act (PHIPA) sets out rules for the collection, use and disclosure of personal health information. These rules will apply to all health information custodians operating within the province of Ontario and to individuals and organizations that receive personal health information from health information custodians. PHIPA governs the manner in which personal health information may be collected, used and disclosed within the health sector. PHIPA regulates health information custodians ---applies to a wide variety of persons and organizations : A custodian is a person or organization that provides health care and because of their power, duties or work has custody or control of personal health information of an individual Under PHIPA, Health Information Custodians are responsible to ensure that personal health information is collected, used, stored and shared in a way that protects the confidentiality of that information, and the privacy of individuals 20XX 24  PHIPA Custodian Agent  A custodian is a person or organization listed in PHIPA that,  PHIPA defines an agent to include any person who is authorized as a result of his, her or its power or duties or work set out in by a custodian to perform services or activities in respect of PHIPA, has custody or control of personal health information. personal health information on the custodian’s behalf and for  Examples of custodians include: the purposes of that custodian. health care practitioners, (including doctors, nurses, speech-  An agent may include an individual or company that contracts language pathologists, chiropractors, dental professionals, with, is employed by, or volunteers and, may have access to dieticians, medical laboratory technologists, massage personal health information: therapists, midwives, occupational therapists, opticians and Employees and consultants physiotherapists), Health-care practitioners community care access corporations Volunteers hospitals, psychiatric facilities, Researchers long-term care home pharmacies, laboratories, ambulance services, retirement homes and homes for special Students care, medical officers of health of boards of health, the Independent contractors (including physicians and thirdparty Minister of Health and Long-Term Care and Canadian Blood vendors who provide supplies or services). Services PHIPA permits HICs to provide personal health information to their agents only if the HIC is permitted to collect, use, disclose, retain or dispose of the information. INFORMATION AND PRIVACY COMMISSIONER OF ONTARIO, 2015 20XX 25  NOT CLASSIFIED AS A HEALTH INFORMATION CUSTODIAN Health information custodians do not include: health care practitioners and other persons or organizations that provide health care as agents of a custodian someone who evaluates or assesses capacity under the Health Care Consent Act or Substitute Decisions Act a health care practitioner who acts for or on behalf of a person who is not a custodian, if the scope of duties of the practitioner do not include the provision of health care (e.g., a physician examining a person for the purpose of providing a fitness report to an insurance company or employer) an Indigenous healer who provides traditional healing services to Indigenous persons or members of an Indigenous community an Indigenous midwife who provides traditional midwifery services to Indigenous persons or members of an Indigenous community a person who provides treatment solely by spiritual means or by prayer INFORMATION AND PRIVACY COMMISSIONER OF ONTARIO, 2015 20XX 26  EXAMPLES OF PERSONAL INFORMATION Personal health information is any identifying information about an individual: Health record and health history (including family history) Case management record Assessments for service delivery Delivery of health care Health services being received Lab or test results Health care provider Health care payments (insurance) or eligibility for health care Donation of any body part or bodily substance of the individual or is derived from the testing or examination of any such body part or bodily substance Health card number  UNDER PHIPA INDIVIDUALS HAVE THE FOLLOWING RIGHTS IN ONTARIO be informed of the reasons for the collection, use and disclosure of their personal health information; be notified of the theft or loss or of the unauthorized use or disclosure of their personal health information; refuse or give consent to the collection, use or disclosure of their personal health information, except in certain circumstances; withdraw their consent by providing notice; expressly instruct that their personal health information not be used or disclosed for health care purposes without their consent; access a copy of their personal health information, except in limited circumstances; request corrections be made to their health records; complain to the Information and Privacy Commissioner of Ontario office if the individual is refused access to their personal health information; complain to the Information and Privacy Commissioner of Ontario office if the individual is refused a correction request; complain to the Information and Privacy Commissioner of Ontario office about a privacy breach or potential breach; and begin a proceeding in court for damages for actual harm suffered after an order has been issued or a person has been convicted of an offence under PHIPA. THE INFORMATION AND PRIVACY COMMISSIONER OF ONTARIO OFFICE, 2015 20XX 28  PIPHA: DISCLOSURE  Under PHIPA some personal health information can be disclosed without consent in certain circumstances.  Reasonable steps need to be taken to ensure that no information is inadvertently disclosed to unintended recipients. Office of the Information and Privacy Commission of Ontario, 2015  DISCLOSING PERSONAL HEALTH INFORMATION WITHOUT CONSENT  PHIPA includes provisions that permit a custodian to use personal health information without the consent of the client: to manage risk; to support quality of care programs; to allocate resources; to obtain payment; and to do research, if a research plan has been approved by a research ethics board PHIPA also permits disclosing personal health information without obtaining consent:  If disclosure is needed to provide health care & consent cannot be obtained quickly  To contact a relative/friend of an injure, incapacitated or ill client for consent  To confirm that a client is a resident of the facility  Provide general health status of a client (unless express consent is indicated not to)  To eliminate or reduce a significant risk of harm to a person CNO, 2022  PHIPA: PRIVACY BREACH  A privacy breach is when personal health information has been lost or stolen; or accessed, disclosed or disposed of inappropriately in a manner that does not comply with the PHIPA. When a privacy breach occurs:  Report immediately Identify the extent of the breach and takes steps to immediately contain it; Investigate the cause of the breach and work to eliminate the risk of it happening again Notify the individual(s) whose privacy was breached; Notify the Information and Privacy Commissioners Office of Ontario  PHIPA: SOME STEPS IN PREVENTING PRIVACY BREACHES Creating and enforcing policies that clearly limit access to and protect personal health information Providing privacy training sessions. Employees and service delivery partners sign a confidentiality agreement which outlines their obligations Performing random audits of information management systems to ensure employees are not accessing more client information than is necessary to do their jobs Locked offices, filing cabinets and secure methods to dispose of documents Restricting client information to only those employees who need to know Data Storage Computers are password-protected and encrypted. Mobile Devices-password protected Faxing information REFERENCES  Canadian Mental Health Association (2022). Mental Health and Addictions Legislation. Retrieved from https://ontario.cmha.ca/provincial-policy/criminal-justice/mental-health-and-addictions-legislation/  College of Nurses of Ontario (CNO) Practice Standard (2022). Confidentiality and Privacy - Personal Health Information retrieved from https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf  College of Nurses of Ontario (CNO) Practice Guideline (2017). Consent retrieved from https://www.cno.org/globalassets/docs/policy/41020_consent.pdf  Government of Ontario (2021). Health Care Consent Act, 1996, S.O. 1996, c 2, Sched A. Retrieved from https://www.ontario.ca/laws/statute/96h02  Government of Ontario (2015). Mental Health Act, R.S.O. 1990, c. M.7. Retrieved from https://www.ontario.ca/laws/statute/90m07  Government of Ontario (2022). Substitute Decisions Act, 1992, S.O. 1992, c 30. Retrieved from https://www.ontario.ca/laws/statute/92s30  Information and Privacy Commissioner of Ontario (2015). Frequently Asked Questions: Personal health Information Protection Act. Retrieved from https://www.ipc.on.ca/wp-content/uploads/2015/11/phipa-faq.pdf  Ontario Hospital Association (2016). A Practical Guide to Mental Health and the Law in Ontario, revised edition: September 2016. Retrieved from https://www.oha.com/Legislative%20and%20Legal%20Issues%20Documents1/OHA_Mental%20Health%20and%20the%20Law%20Toolkit %20-%20Revised%20(2016).pdf