Geriatric nursing

1. LEGAL & ETHICAL ISSUES OF
AGED PEOPLE
PRINCY FRANICS M
Ist Yr MSc (N)
JMCON

2. LEGAL ISSUES

3. ACT OF NEGLIGENCE,
MALPRACTICE AND OMISSION
• NEGLIGENCE : It is the failure to exercise adequate
care

4. MALPRACTICE : It is the negligence on the part of a
professional person in providing care to another person.
Four conditions
# a duty to client
# a failure to meet that duty
# an injury or negative outcome caused by not meeting
that duty
# actual harm or damages suffered by the person who is
receiving care.

5. Act of Negligence, Malpractice and Omission
• Omission : It occurs when something omit , that is
ordered or expected as a normal part of treatment for a
client.
The rights of the elderly are abused when the family does
not give them adequate care and attention

6. INTENTIONAL TORTS
• Acts by a nurse performed with the intent to
bring about specific result.
• Assault: is an attempt or threat to injure another
person
• Battery : is unwanted or unconsented physical
contact

7. DEFAMATION
Written or spoken communication that
holds a person up to ridicule or scorn
and tends to harm his or her reputation.
Libel – written defamation
Slander – spoken defamation

8. Invasion of privacy
Violation of a person’s right to be left
alone or to enjoy reasonable
noninterference with his/her life.

9. ELDER ABUSE AND NEGLECT
Elder abuse can be defined as "a single, or
repeated act, or lack of appropriate action,
occurring within any relationship where
there is an expectation of trust which causes
harm or distress to an older person".

10. Types
Physical abuse: any action that causes physical
pain or injury.
Psychological/ emotional abuse: The infliction of
mental anguish. Eg: ignoring, isolating, shouting
Financial/ material abuse: The illegal or improper
exploitation and or use of funds or resources.

11. • Sexual abuse: Non-consensual contact of any kind
with an older person.
• Neglect: The refusal or failure to fulfil a care-taking
obligation including / excluding a conscious and
intentional attempt to inflict physical or emotional
distress on the older person.

12. PREVENTION OF ABUSE
• To increase public awareness and knowledge of the
issue.
• To promote education and training of professionals and
paraprofessionals in identification, treatment and
prevention.
• To further advocacy on behalf of abused and neglected
elders.
• To study into the causes, consequences, prevalence,
treatment and prevention of elder abuse and neglect.

13. •

14. ADVANCE DIRECTIVES
• Advance directives are written statements of a
person’s wishes regarding medical care .
• It is a formal, legally endorsed document that
provide instructions for care(living will) or names a
proxy decision maker (durable power of attorney)

15. ETHICAL ISSUES

16. RESTRAINTS
PHYSICAL RESTRAINTS AND
CHEMICAL RESTRAINTS
• Persumed benefit of restraint should be
carefully weighed against the risk of
complications and the insult it present to
patients dignity.

17. Physical restraint should be used only when the patient is
a danger for himself or others and when all other
behaviour management have been exhausted.
It creates an obligation for the professional to attend
carefully to the negative consequences of restraint and
preventing them.
Chemical restraints is by giving psychoactive
pharmacological agents. It is prescribed with caution and
only when for the clear benefit of the patient.

18. Do Not Resuscitate Orders
• DNR are legal and binding but must be justified as
client request or be medically indicated.
• When DNR order is made , the supporting
documentation must include client’s current condition,
prognosis, summary of decision making and who was
involved.

19. Withholding and withdrawing treatment
It include actions related to client’s
right to refuse treatment or
withdraw consent for it.

20. ASSISTED SUICIDE AND
EUTHANASIA
• Grave decision and certainly do not provide medication
to hasten death in a patient.
• Ensure that the elderly person has complete information
when asked to make a decision regarding health care.
• It is illegal in most countries

21. Medical decision making for a
potentially incompetent patient
• In incompetent ; identify appropriate proxy
• If proxy is unavailable , use best medical
judegement while locating proxy.

22. INFORMED CONSENT
• The patient’s bills of right clearly outlines a person’s
right to information before giving consent to
treatment.
• The older adults and care givers have the right to all
information available or arranging for court
appointment. If proxy is available, discuss and take
substituted judgements or best interests.

23. Enteral feeding
• It is acceptable to withhold treatment such as IV
fluids, antibiotics on request of the appropriate
proxy decision maker when life prolongation is
no longer the appropriate goal.

24. Patient opposition to placement
• Placing the patient in a nursing home based on patient
will
• Nurse remember the rights of patient as well as
caregiver.
• When all approaches failed contact outside source such
as OMBUDSMAN or Hospital ethics committee

25. References
• Smeltzer CS, Bare GB, Hinkle LJ, Cheever HK. Brunner &
Suddarth’s textbook of Medical-surgical nursing. Volume I.
Twelfth edition. NewDelhi:Wolters Kluwer (India) ; 2011.
• Lewis LS, Dirksen RS, Heitkemper MM, Bucher L. Lewis’s
Medical Surgical Nursing Assessment and management of
clinical problems. Second edition. Volume 1.India: Reed
Elsevier; 2015.
• Luggen SA. Core curriculum for gerentological nursing.
USA: Mosby publication; 1996.