Client Rights NURS 72050 PDF

Client Rights NURS 72050 Agenda Client Rights Obligations Legal Protections Rights of Vulnerable populations Case Study MAiD Safety Client Rights Small Group Activity As a small group develop a poster that you could use in the clinical area to illustrate the following: What do s...

Client Rights NURS 72050 Agenda Client Rights Obligations Legal Protections Rights of Vulnerable populations Case Study MAiD Safety Client Rights Small Group Activity As a small group develop a poster that you could use in the clinical area to illustrate the following: What do see as the fundamental rights of persons using the health care system? Client Rights Small Group Discussion In the clinical setting, do you feel that these rights are consistently respected? What responsibilities do you think patients have in the health care system? Rights and Obligations Rooted in ethical theory Embedded in professional code and law Human Rights Legal Rights Moral Rights Nurses have an obligation to ensure that patient’s rights are protected as they can be at risk in the health care setting. Most vulnerable include: older adults, children, the LGBTQ2 community, persons with physical or cognitive impairment, Indigenous people, and the mentally ill.  What are Rights and Obligations? Rights o A right o is a claim or privilege to which one is either legally or morally entitled o carries a corresponding obligation o Legal rights o embedded in the Charter of Rights and Freedoms and the Canada Health Act o are enforced through the courts o Moral rights o are acknowledged as societal norms o embedded in codes of ethics o may be enforced through civil action or by regulatory bodies should the breach bring harm to the patient (Keatings, 2024)  Ethics and Rights Which of the ethical principles are directly linked to the rights of the patient?  What are Rights and Obligations? The Charter of Rights and Freedoms States that every individual is to be considered equal regardless of religion, race, national or ethnic origin, colour, sex, age or mental and physical disability (Constitution Act, 1982) (Keatings, 2024)  What are Rights and Obligations?  Patients have the right to  be treated with respect  honesty and transparency  be treated with dignity  give or refuse consent  privacy and confidentiality  access information about their personal health  to be protected from harm  seek medical assistance in dying (Keatings, 2024)  What are the Responsibilities of Patients? With Rights Come Responsibilities  Patients have the responsibility to  treat others with respect  follow through with a treatment plan they agree to  disclose information important to ensure their safe care concerns when they disagree with a plan of care  notify health care providers if unable to keep commitments  arrive on time, having followed instructions prior to procedures  respect the needs of other persons (Keatings, 2024)  Patient Bill of Rights and Responsibilities  Ontario has a Patient Bill of Rights that applies to all health care settings across the province.  https://ontariohealthathome.ca/patient-bill-of-rights-responsibili ties/  Look up a few health care agencies and look to see if you are easily able to find a posted statement of the Patients' rights and Responsibilities.  What are Rights and Obligations?  If Rights Then Obligations  An obligation is anything a person must do or refrain from doing in order to permit the full exercise of the rights of another  Nurses have an obligation to ensure patient rights are protected  Nurses advocate for those most vulnerable including: the 2SLGBTQI+ community older adults Indigenous persons Children the mentally ill Incapable persons (Keatings, 2024)  Respect and Dignity  Health professionals have an obligation to treat all clients with respect and dignity. This involves  truth telling  consent  listening to their story  maintaining confidentiality  Personal Privacy  Nurses are obliged to ensure  patient privacy during bathing, examinations, or procedures  that unauthorized persons are not present and do not view the patient  that pictures are not taken without permission, even when done for educational purposes (Keatings, 2024)  Informed Consent  To exercise the right to informed consent, patients must be fully informed about  their health condition  their prognosis  treatment options, along with consequences and risks  Incorrect or incomplete information deprives patients of their right to informed consent  Treatment without informed consent can lead to liability for negligence and battery (Keatings, 2024)  Access to Health Information and Teaching  Nurses are required to provide patients (or family members) with the knowledge and skills  required to care for themselves  to gain access to the health care system when necessary  Persons have the right to access information from their health record; legislation and agency policy guide this process  Many agencies provide clients with online access to their personal health information via web portals (Keatings, 2024)  Access to Health Information and Teaching Communicating a Diagnosis  Generally only physicians and nurses holding an extended certificate are permitted to communicate a diagnoses  Communicating a diagnosis is a controlled act in Ontario  This act can be delegated  When a diagnosis has not been communicated, the nurse should advocate for the patient’s right to be informed. (Keatings, 2024)  Confidentiality Health professionals have a legal and ethical obligation to maintain patient confidentiality.  This requirement is grounded in legislation and in professional codes of ethics.  This is a fundamental component of ensuring patients’ trust in the health care team  There are limits to confidentiality when there are risks to self or others, or when disclosure is required by law. (Keatings, 2024)  Statutory Duty of Disclosure  Health care providers have a duty to disclose to authorities knowledge of  communicable or sexually transmitted diseases  suspected child and elder abuse  a person’s intent to harm or kill another person  gunshot wounds  May be required to disclose information  during legal proceeding  to Workers’ Compensation Boards who have the right to any health information relevant to an injury or claim (Keatings, 2024)  A Learners Rights (Case 10.1)  M.P. has consent to have vaginal polyps removed. Her gynecologist has explained the procedure in detail. M.P. is also aware that while under anesthesia, she will undergo a pelvic examination. However, the gynecologist has not told her specifically that there will be nursing, and medical students present during the procedure. This is a teaching hospital, and all patients are expected to be informed when they are admitted, of the role of students.  Third year medical students are present during M.P.'s procedure. To provide them experience in conducting pelvic examinations the gynecologist allows three of the medical students to perform separate examinations. The circulating nurse expresses concerns about this and expresses their concern. The nurse is told that M.P. has consented to the examination and there is nothing wrong with providing the students with a learning experience. How else are they expected to learn?  Questions to consider  Who do you agree with?  In the circumstances, is MP's consent to this examination legally and morally valid?  Were any of MP's rights violated?  What action should the circulating nurse take?  What is the hospital's responsibility?  How may appropriate learning experiences for students be ensured?  Disclosure of Confidential Information in Court Testimony  Provincial nursing statutes permit disclosure in the case of legal proceedings such as  malpractice actions  coroner’s inquests  criminal and civil proceedings.  The nurse should only disclose details relevant to the issues (Keatings, 2024) Ensuring Confidentiality in The Treatment Setting  Nurses should take care  to prevent being overheard by others when discussing patients and their care with colleagues  to ensure privacy when having discussions with a client  not to disclose confidential information to their colleagues, friends, or relatives who have no valid right to such details (Keatings, 2024)  Legal Protection of the Patient’s Right to Privacy of Health Information  All provinces and territories have enacted legislation which protects persons personal health information by  establishing rules for the collection, use, and disclosure of health records  providing individuals with a right of access  providing for independent review of complaints (Keatings, 2024)  Legal Protection of the Patient’s Right to Privacy of Health Information  For example: Ontario’s Personal Health Information Protection Act (2004) makes it explicit that  Protected health information includes physical or mental health information (including patient and family histories) the provider of health care to the individual Ø Protected health information includes Ø insurance, eligibility, or payment information Ø whether the individual is a donor of any body part or substance Ø an individual’s substitute decision maker. (Keatings, 2024)  Privacy Breaches Inappropriate Access of Information  Nurses only have access to information about a person when within the person’s circle of care  Improper access to patient/client files may result in disciplinary or legal action  Access to computerized health care information is password protected  the password is the signature of the person documenting therefore nurses must never share their password use the password of another person (Keatings, 2024)  Inappropriate Use of Social Media  Confidentiality challenges have emerged with the growth of social media.  There are potential risks associated with personal privacy.  Breaches through social media include:  Posting information about a patient even if the person’s name is not included, details may allow others to infer who the person is, especially if it is media story.  Posting pictures of patients and families.  Discussing patients with other colleagues over social media even if the name is not included.  Posting comments related to one’s profession role.  Guidelines are available for nurses regarding their use of social media. (Keatings, 2024)  Right to Be Discharged From a Health Care Facility  Competent patients have a right to leave a facility against medical advice (AMA)  They are asked to sign a waiver acknowledging that they have been advised of the risks of leaving  The team should ensure there are processes in place to ensure that patients transfer home safely  There are unique circumstances associated with persons with a mental illness (Keatings, 2024)  Special Considerations for those Most Vulnerable The Rights of Older Adults  As with other advance directive, wishes regarding life choices in the future are important  Older persons may wish to stay at home, move into a retirement facility or chose a long-term care facility.  Persons with physical or cognitive impairment are most vulnerable  In long term care legislation and regulation exists to protect the rights of older adults. (Keatings, 2024)  The Rights of Older Adults Those in institutional settings are most vulnerable when  proper assessments of the residents are lacking  care plans are not followed  families are not engaged  there are gaps in the continuity of care  care is not monitored especially when provided by non-regulated staff  staffing ratios are high  appropriate safety strategies are not initiated. These vulnerabilities came to the forefront during the COVID-19 pandemic. (Keatings, 2024)  The Rights of Older Adults Nurses must play an active role in  monitoring care and ensuring appropriate supervision of care providers  involving the resident and family in developing a plan of care that is evaluated on an ongoing basis  supporting the family’s advocacy role  intervening when residents are not being treated appropriately (Keatings, 2024)  Rate the Care  Consider the Rights of older people while we watch the video on the next slide.  After watching the video, you will be asked to rate the care as an A,B,C or D grading.  Explain your rating within the context of caring for vulnerable populations.  The Unique Challenges of 2SLGBTQI+  For example, transgender persons are in a particular position of vulnerability and misunderstanding. Nurses must  recognize their unique needs related to privacy, access to washroom facilities, room assignments etc.  refrain from making assumptions about their needs, and listen to what is most important to them  ask about their preferred names or pronouns and mirror their language when referring to themselves, their partners and their bodies. (Keatings, 2024)  Indigenous Rights  The consequences of colonialism  Focus on assimilation  Nurses need to be aware of the consequences and generational harm associated with  Residential Schools  Indian Hospitals  Forced sterilization  The Truth and Reconciliation Commission  Implications for nurses. (Keatings, 2024)  Indigenous Rights  The Federal Government has oversight over Indigenous affairs.  The Indian Act, (excludes Metis and Inuit) is paternalistic legislation designed with a focus on assimilation.  Women who married non-status men lost their status and rights.  Addressed issues related to status, land, administration, resources and education.  Some provisions ensured the protection of land reserved for their use. (Keatings, 2024)  Indigenous Rights and Health Care  Recent court decisions have highlighted the rights of Indigenous people under the Canadian Constitution.  Section 35 of the Constitution Act guarantees the treaty rights of all Indigenous people in Canada.  The Court found that these rights entitled them to pursue Indigenous health care if they so choose  With children, the right to use traditional medicines must remain consistent with the principle that the best interests of the child remain paramount.  Many Indigenous patients, choose to integrate traditional and contemporary medicine.  Non-Indigenous patients also choose to complement conventional treatment with holistic approaches. (Keatings, 2024)  The Rights of the Mentally Ill  Legislation across the country protects their rights.  There are two categories under which a person suffering a mental illness is admitted for care. I. Those who are not a threat to themselves or others  Admission and discharge is voluntary II. Those who pose a threat to themselves or others may be admitted and detained without consent, however  procedural safeguards are in place to ensure – a review of the involuntary detention – that they are not arbitrarily detained – that when they cease to pose a danger to themselves or others, their choices are respected. (Keatings, 2024)  Case Study  A. T. recalls that the student clinical placement they found most stressful was at an inpatient mental health unit. The unit used a rule-oriented approach to the care of patients. A. T. was concerned that when general rules were applied with this population, the rights and interests of individual persons were at risk of being compromised. For example, many patients were young persons with schizophrenia, and each had unique needs.  A. T. has a vivid memory of their first patient, M. J., age 22 years, and recollects the first time they admitted M. J. to the unit. The rule was that personal items had to be locked up, and this included phones. M. J. told A. T. that music helped block out the voices that M. J. heard and helped with relaxation. A. T. shared the rules with M. J. and that it was the unit’s policy to lock up valuables to prevent theft. A. T. was uncomfortable with this reasoning, but as a student thought it was important to conform to the rules. A. T. was most distressed knowing the therapeutic value of music to M. J.  M. J. experienced a number of adverse effects with the medications used to manage schizophrenia. M. J. had gained 14 kg in 2 months and had developed insulin-dependent diabetes. M. J.’s partner of 2 years ended their relationship and M. J. had become more of a social recluse. M. J. did not blame their partner for the break-up, revealing that, thanks to the medication, erectile dysfunction and the weight gain were the likely causes. No matter how much M. J. exercised, they could not lose weight. Therefore, M. J. had made the decision to stop the medications. M. J. preferred the illness to the treatment. The nurses and physicians told M. J. that without the medications there was a greater risk of psychosis, which would lead to M. J. being deemed incapable of making treatment decisions. M. J. said that if that happened, they would appeal this action.  Questions 1. Do you think it is appropriate for facilities to establish general rules that pose problems for individual patients? What if these rules are contrary to patients’ best interests and compromise their recovery? If you were a nurse on this unit, how would you respond to rules such as this? If you agree that this approach needs to change, how would you advocate for this? 2. Is M. J.’s refusal to continue on these medications a sign of incapacity? What other strategies should the team use? Do you think they are listening to M. J.’s personal story? 3. Do you think the team is providing holistic care to M. J.? What care plan would you introduce? Who would you involve in the development of the plan? 4. What factors would have to exist for the team to make a finding of incapacity? Under mental health legislation, patients can appeal findings of incapacity. What is the process? What support would M. J. receive?  The Rights of the Mentally Ill Medical Assistance in Dying  Extensive ethical debate regarding this exclusion from the legislation  Currently under review  Proponents argue that MAiD would be justified  as a last resort,  when all treatments have been exhausted,  for competent persons with an intractable psychiatric illness  Opponents express concern  about the vulnerability of this population,  regarding competency  that the focus should be on greater access to treatment (Keatings, 2024)  MAiD  Review the infographic to inform yourself on the legislation of MAiD in Canada.  https://www.justice.gc.ca/eng/cj-jp/ad-am/docs/MAID_Infograp hic_EN.pdf  MAiD and Mental Health  On March 9, 2023, former Bill C-39 received royal assent and immediately came into effect, temporarily postponing the eligibility date for persons suffering solely from a mental illness until March 17, 2024.  On February 1, 2024, the Government of Canada introduced legislation to extend, until March 17, 2027, the temporary exclusion of eligibility in circumstances where a person's sole underlying medical condition is a mental illness.  News release: The Government of Canada introduces legislation to delay Medical Assis tance in Dying expansion by 3 years (February 1, 2024)  On February 29, 2024, Bill C-62 received royal assent and immediately came into effect, temporarily postponing the MAID eligibility date for persons suffering solely from a mental illness until March 17, 2027. (Government of Canada, 2024)  The Right to Safe Care  Health care is complex therefore errors occur frequently in health care settings  Many reasons account for error, including  communication breakdowns  fatigue  workload  complexity of processes  reliance on memory over checklists  There is a growing movement to change the systems that result in error, rather than focusing on personal blame (Keatings, 2024)  A Culture of Patient Safety  There is recognition that system failures and poor processes contribute to error  Leadership is an integral part of ensuring a just culture of safety, whereby  adverse events and near misses are openly reported and communicated  people are held accountable and recognized for reporting therefore enabling improvement opportunities the focus is on learning from mistakes  Legislation regarding reporting and disclosure exists across the country. (Keatings, 2024)  Disclosure of Error  The process by which health care professionals communicate adverse events to patients or families  Disclosure of errors  acknowledges the right of patients and families to be informed  facilitates the healing process of all concerned  needs to be open and transparent (Keatings, 2024) W5-Taking on the System Start at 14:28  Summary  There is an important relationship between the rights of persons and the obligation of others to protect those rights.  Patient rights are enshrined in the law and in professional and organization codes of ethics.  These rights are grounded on ethical theory and principles.  Nurses play a significant role in protecting the rights of those most vulnerable.  Plan for Next Week  Advocacy  Week 14  References Government of Canada. (2024). The Government of Canada introduces legislation to delay Medical Assistance in Dying expansion by 3 years. https://www.canada.ca/en/health-canada/news/2024/02/the-government-of-canada- introduces-legislation-to-delay-medical-assistance-in-dying-expansion-by-3-years.html Keatings, M., & Adams, M. (2024). Ethical and Legal Issues in Canadian Nursing. (5th ed). Elsevier