Chapter 3
Protecting People's Rights
GOALS
- Explain what legal rights are and how they came into being.
- Give five examples of the rights of people receiving health care.
- Discuss your role in resolving residents' complaints.
- Explain the difference between legal and ethical responsibilities.
- Discuss your role as a caregiver in protecting rights and behaving in an ethical manner.
- Describe what you should do if you suspect that a person in your care is being neglected or abused.
Key Terms
The Rights of People Receiving Health Care
People receiving health care retain the same rights guaranteed by law, plus special rights due to their dependency on others. These include the right to competent, considerate, and respectful care; to information and participation in decisions; to confidentiality and privacy; and to be free from restraints and abuse. The Patient Self‑Determination Act (1991) requires facilities to provide written information about these rights and allows people to create advance directives such as living wills, durable powers of attorney, or a health care proxy.
Documents that state a person's preferences if they become unable to decide for themselves (e.g., living will, durable power of attorney, health care proxy).
Table 3-1 — Respecting and Protecting Rights
| A Person Has the Right to… | You Can… |
|---|---|
| Know his or her rights. | Refer to supervising nurse or social worker for a copy and discussion of rights. |
| Be treated with dignity and respect without discrimination. | Call the person by name; treat everyone with respect. |
| Receive considerate care. | Explain the care; get permission; involve the person in care. |
| Have needs met. | Do everything possible to address the person's needs. |
| Be told about condition and recommended treatment (informed consent). | Encourage questions; communicate needs to the team. |
| Know the cost of care. | Refer to social worker/accounting; provide literature about fees. |
| Refuse care/treatment and be told what may happen as a result; refuse experimental treatment. | Encourage questions; consider schedule changes; involve the nurse to review consequences. |
| Keep records private and see their clinical record. | Share information only with authorized persons. |
| Know services covered by Medicaid/Medicare. | Encourage a discussion with the social worker. |
| Choose caregivers. | Inform the supervising nurse about caregiver preferences. |
| Help plan care and know services/visit frequency. | Involve the person/family in the care plan. |
| Make complaints or suggest changes without retaliation. | Communicate complaints and adjust care to meet needs. |
| Be free from abuse and restraints. | Treat with dignity; report abuse; never use restraints without a doctor's order. |
| Be told in writing if care is denied/changed/ended and to appeal. | Remind of the right to appeal; ensure independent review. |
| Privacy. | Pull curtains; keep covered; ask before opening drawers; discuss health only with authorized people. |
| Manage money matters. | Never take money/gifts; refer to social worker for financial concerns. |
| Send/receive unopened mail. | Deliver mail unopened; offer help to read/open, if requested. |
| Practice religion. | Help attend services; contact clergy if requested. |
| Use own clothing/possessions. | Ensure clean clothes; mark possessions in nursing homes. |
| Be alone with partner/spouse. | Provide privacy; help plan visiting time. |
Advocating Patient Rights
Resident councils and state Long‑Term Care Ombudsman Programs advocate for residents. Ombudsmen investigate complaints confidentially and work with facilities to resolve issues and improve quality of life.
Table 3-2 — Resolving Complaints
| Informal Responses… | Formal Responses… |
|---|---|
| Listen; ask questions to clarify; tell the resident exactly what you will do. | Discuss with charge nurse/supervisor; suggest resident council; help write a complaint letter; set up/attend staff–resident meetings. |
Protecting Patients’ Health Information (HIPAA)
Protected health information (PHI) must remain private and secure. Follow HIPAA rules and your facility’s policies for handling, sharing, and documenting PHI.
Ethical Decisions and the Nurse Assistant
You have both legal duties (to protect rights) and ethical duties (to do what is right). Use the six principles of care—safety, privacy, dignity, communication, independence, and infection control—to navigate dilemmas.
Table 3-3 — Ethical Decisions
| Situation | What You Should Do | Principle |
|---|---|---|
| Hands are chapped; consider skipping handwashing once. | Always wash; use lotion; wear gloves. | Infection control |
| Dropped dentures; a small chip. | Report every incident. | Safety, dignity |
| Prefer bedpan for convenience. | Plan care around the person’s best interests. | Independence, dignity |
| Resident hides pills. | Explain you must report; encourage discussion with the doctor. | Safety, communication |
| Ran out of time for exercises. | Report so next shift can complete them. | Communication |
| Neighbor asks about a patient’s diagnosis. | Do not disclose; protect privacy. | Privacy |
Abuse, Neglect, and Exploitation
Be alert for signs of abuse (physical, emotional, sexual), neglect, and exploitation. Report immediately to your supervising nurse—this is your legal and professional duty.
Table 3-4 — Recognizing Abuse
| Type | Examples / Signs |
|---|---|
| Physical abuse | Pushing, hitting; burns, bruises, cuts; or no visible signs at all. |
| Emotional abuse | Threats, cruel words; withdrawal, fear, upset when abuser enters. |
| Sexual abuse | Rape or unwanted touching; injuries/bruises to genital areas; refusal of personal care. |
Your Role in Reporting
Report suspected abuse, neglect, or exploitation immediately. Keep observations factual and confidential while the case is investigated.