Eileen Mieras Kohlenberg
§The rights include
§ (supported by the American Hospital Association)
§respectful care;
§current information about diagnosis,
treatment and prognosis;
§informed consent;
§refusal of treatment;
§privacy and confidential
communication;
§reasonable response to request for patient
services;
§information about relationship of hospital with
other institutions;
§information about research and experimentation;
§continuity of care;
§explanation of bill;
§and rules and regulations related to conduct of
patients.
§ supported by the American Civil Liberties Union
§ informed participation during care and research
protocols;
§ right to privacy regarding source of payment and
patient information;
§ right to accurate medical information regarding
condition, care, and procedures;
§ right to prompt attention;
§ right to know professional status of caregivers;
§ right to have access to an interpreter;
§ right to access medical records and to receive a clear
itemized bill for services;
§ right to access consultant specialist;
§ right to refuse treatments;
§ right to access persons outside of the health facility;
§ right to leave the facility and to have explanation for
transfer to another facility;
§ right to have notification of discharge 24 hours in
advance;
§ right to have counseling for financial assistance and
timely notification of termination of third party
payment;
§ and 24-hour access to a patient rights advocate.
§An elderly man is admitted to the
emergency room (ER) in respiratory
distress. He is treated with inhalation
therapy and given a prescription to be
filled. He is discharged without further
instructions by the physician. Before the
patient leaves the ER, the nurse should
clarify discharge instructions with the
physician and instruct the patient using
written instructions for the prescription,
follow-up treatment, and future
appointments.
§respect for the uniqueness of each
individual;
§primary commitment to the patient and
his/her rights;
§appropriate delegation of tasks for
optimum care;
§continued personal and professional
growth;
§improvement of health environments at
national and international levels;
§advancement of the profession;
§and maintaining the integrity of the
profession and shaping social policy.
§Case:
§A patient questions items on a bill that has
been received from the hospital for his
care. What is the appropriate response?
§The nurse should respond, “As a patient,
you have the right to an itemized bill and
explanation of expenditures. You may call
the cashier’s office or patient advocate in
the hospital for assistance.”
§The federal privacy standards that were put in
effect in April 2003 include provisions for
§access to medical records,
§notice of privacy practices,
§limits on use of personal medical
information,
§prohibition of certain marketing practices,
§support of stronger state privacy laws,
§confidential communications,
§and a mechanism for filing complaints.
§For instance, if the patient asked that the
physician call him at work rather than at
home to ensure confidential
communications, this request should be
honored under the new privacy rules.
§Case:
§A competent adult patient would like to see
his/her medical record. What should I do?
§While the court system has determined that
hospitals and physicians own the records of
patients, the competent adult patient has a
right to see his/her medical record.
Hospitals and physicians may establish a
procedure for access of medical records
that must be followed by the patient.
§The nurse should advise the patient of the
right to see his/her medical record and any
procedures that must be followed.
§A relative with the patient’s approval,
parents/guardian of a minor child, or
parents/guardian of an incompetent patient
may access the medical record under most
circumstances.
§Case:
§The patient would like to discuss his/her
condition with a specialist consultant. What
should I do?
§The patient has the right to engage a
specialist consultant.
§The nurse may suggest that the primary
physician/healthcare provider be notified of
the request. Conditions related to payment
for a specialist consultant should be
reviewed with the patient.
§Case:
§A competent adult patient refuses to take a
medication. What are the nurse’s
responsibilities?
§The nurse should immediately stop
preparations to administer the medication.
§The physician and nursing supervisor should
be notified immediately.
§All actions should be documented in the patient
record.
§Administration of a medication to a competent
patient against his/her will constitutes battery.
§Justification for administering a medication
against a patient’s will may include
incompetence of the patient, protecting the
life of the patient, and when refusal
endangers the public.
§In these circumstances, the nursing
supervisor and physician should be
contacted to authorize administration of the
medication.
§In some circumstances, a court order may be
needed to proceed with the administration.
§Case:
§A patient desires to leave the healthcare facility
without consent of the physician. What are the
nurse’s responsibilities?
§A competent patient has the legal right to leave
the healthcare facility without consent of the
physician.
§The physician should be notified, and the
appropriate forms for leaving against medical
advice (AMA) should be completed.
§If the patient refuses to sign these forms,
documentation should be noted in the patient
record. Appropriate discharge planning should
be given to the patient.
§Patients who pose threats to themselves
or others may be legally detained.
Restraints, when necessary, may be
used for psychiatric patients, prisoners,
and violent patients.
§Call security for assistance when
necessary and consult the hospital
policies for specific interventions.
§Case: A competent adult patient with a
Christian Scientist background refuses
treatment in the emergency room. What
should be my response to this patient?
§The nurse should respond, “As a
competent adult patient, you have the
right to refuse treatment in the
emergency room. I am responsible for
protecting your right to refuse
treatment.”