5.3 Ethical and Legal Responsibilities of the Healthcare Worker
Healthcare workers should treat all clients equally and with compassion and respect for their inherent dignity, worth, and unique attributes. They should promote patient rights and safety to assist in achieving the best possible health and functioning.
As a student or a newly employed healthcare worker, you may find yourself in circumstances where you observe unethical behaviors exhibited by other agency staff. Examples of unethical behavior to avoid are as follows[1]:
- Using a personal cell phone in patient care areas
- Not responding to call lights promptly when you are available to do so
- Ignoring the phone assigned to you
- Using institutional computers for personal use
- Avoiding patients because of their ethnicity, beliefs, demeanors, or other individual characteristics
- Avoiding work by sitting in empty patient rooms or the break room during on-time work hours
- Accepting gifts or gratuities from patients or their family members
- Sharing patients’ personal information with others who are not providing direct care
- Stealing items from patients or the health care agency
Governing Agencies
When you work as a healthcare worker, you are helping vulnerable populations. Vulnerable populations include patients who are children, older adults, minorities, socially disadvantaged, underinsured, or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by inadequate health care.[2] As a result, there are many governing agencies involved in the care of these patients to ensure their needs are met.
Federal agencies that regulate and provide guidelines for health care include the following:
- Centers for Medicare and Medicaid (CMS): The CMS provides health care funding for qualifying members. Medicare is health care funding available to anyone over the age of 65, as well as those who have a permanent disability or kidney failure. There are four types of coverage that Medicare provides: care in hospitals and nursing homes (Part A); medical appointments, services, and equipment (Part B); additional services provided by private companies (Part C); and prescription drug coverage (Part D). Medicaid is health care funding available for individuals with low incomes and is provided at both the federal and state level. Both Medicare and Medicaid may cover services for resident care based on each individual’s needs.[3],[4]
- Centers for Disease Control (CDC): The CDC provides guidance for facilities related to infection and disease control.[5]
- Food and Drug Administration (FDA): The FDA protects public health by ensuring the safety of medications, biological products, medical devices, cosmetics, products that emit radiation, and the food supply. It also regulates tobacco products and helps the public get the accurate, science-based information they need to use medical products and foods to maintain and improve their health.[6]
- Occupational Safety and Health Administration (OSHA): OSHA ensures safe and healthy working conditions for workers by setting and enforcing standards and by providing training, outreach, education, and assistance.[7]
Every state has a Department of Health Services (DHS) that works with local counties, health care providers, and community partners. The DHS provides services that aid and protect the state’s citizens, such as alcohol and drug abuse prevention programs, mental health programs, public health services, disability determination, implementation of long-term care, and regulation of state nursing homes, along with numerous other services.
Federal Health Care Acts
In addition to government agencies, there are federal laws that directly affect health care. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. The HIPAA security rule requires the following:
- Ensure the confidentiality, integrity, and availability of all protected health information (PHI)
- Detect and safeguard against anticipated threats to the security of the information
- Protect against anticipated impermissible uses or disclosures
- Certify compliance by their workforce
As a healthcare worker, you must legally keep any information regarding the care of your patients confidential, including documentation, care plans, and shift reports.
Read more about HIPAA at the CDC’s Health Insurance Portability and Accountability Act of 1996 (HIPAA) web page.
During patient-centered care, an individual’s specific health needs and desired health outcomes are the driving forces behind all health care decisions. Patients are partners with the health care team members, and health care professionals treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.[8]
Elder Abuse and Neglect
Elder abuse is an intentional act, or failure to act, that causes or creates a risk of harm to someone age 60 or older. The abuse occurs at the hands of a caregiver or a person the older adult trusts. Neglect refers to a failure to provide care for oneself or to someone for whom you are enlisted to care. Review Table 2.2 for types of abuse and neglect and signs or symptoms that you should report to the nurse.
Table 2.2 Types of Abuse and Signs or Symptoms to Report[9],[10]
| Type of Abuse | Definition | Signs or Symptoms |
|---|---|---|
| Physical | Illness, pain, injury, functional impairment, distress, or death as a result of the intentional use of physical force. This includes acts such as hitting, kicking, pushing, slapping, and burning. | Bruising, fractures, burns, or any other unexplainable injury. The abused person may isolate themselves, withdraw from conversation, or change behavior when the abuser is present. |
| Sexual | Forced or unwanted sexual interaction of any kind. This may include unwanted sexual contact, penetration, or noncontact acts such as sexual harassment. | Injury to genital areas, rashes, infections, bleeding or discharge from genitals, torn clothing, and behavioral changes listed under “Physical” abuse “Signs or Symptoms.” |
| Emotional or Psychological | Verbal or nonverbal behaviors that inflict anguish, mental pain, fear, or distress on an older adult. Examples include humiliation or disrespect, verbal and nonverbal threats, control of one’s actions, harassment, or isolation from other loved ones. | Depression, anxiety, loss of self-confidence or motivation, or feelings of failure. |
| Financial | Illegal, unauthorized, or improper use of an older adult’s money, benefits, belongings, property, or assets for the benefit of someone other than the older adult. | Missing items; going without food, medications, or other necessities; or excessive use of cash if they cannot account for the spending. |
| Neglect | Failure to meet an older adult’s basic needs, including food, water, shelter, clothing, hygiene, and essential medical care. | Weight loss, skin breakdown, infection, confusion, hallucinations, dehydration, soiled linens and clothing, odors, or poor oral care. |
| Self-Neglect | Lack of self-care that threatens personal health and safety, including a failure to seek help for care. | See “Signs or Symptoms” listed under “Neglect.” |
Health care professionals are referred to as mandated reporters because they are required by state law to report suspected neglect or abuse of the elderly, vulnerable adults, and children. As a caregiver, you are required to report any signs or symptoms that are suspicious for abuse or neglect to the nurse or supervisor. At the time of the finding, you must stay with the patient until you can ensure that no further abuse or neglect occurs. If a patient reports any abuse, you are obligated to inform the nurse, charge nurse, or an administrator, regardless of the cognitive function of the person reporting so that an investigation can be performed.
Attribution
This section contains content taken from Nursing Assistant by Chippewa Valley Technical College and is licensed under a Creative Commons Attribution 4.0 International License.
- Miller-Hoover, S. (2018). I said what? Professionalism for the CNA. RN.com. https://www.rn.com/featured-stories/professionalism-cna/#:~:text=Professional%20CNAs%20are%20responsible%2C%20trustworthy,and%20being%20a%20team%20player ↵
- Waisel, D. B. (2013). Vulnerable populations. Current Opinion in Anaesthesiology, 26(2), 186-192. https://doi.org/10.1097/aco.0b013e32835e8c17 ↵
- Medicare.gov. U.S. Centers for Medicare and Medicaid Services. https://www.medicare.gov/ ↵
- Medicaid.gov. U.S. Centers for Medicare and Medicaid Services. https://www.medicaid.gov/ ↵
- Centers for Disease Control and Prevention. (2021, September 24). About CDC 24-7. https://www.cdc.gov/about/default.htm ↵
- U.S. Food & Drug Administration. (2018, March 28). What we do. https://www.fda.gov/about-fda/what-we-do ↵
- Occupational Safety & Health Administration. (n.d.). About OSHA. United States Department of Labor. https://www.osha.gov/aboutosha ↵
- NEJM Catalyst. (2017, January 1). What is patient-centered care? Massachusetts Medical Society. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559 ↵
- Centers for Disease Control and Prevention. (2021, June 2). Preventing elder abuse. https://www.cdc.gov/violenceprevention/elderabuse/fastfact.html ↵
- Washington State Department of Social and Health Services. (n.d.). Self-neglect. https://www.dshs.wa.gov/node/2444/#signs ↵
