CNA · Legal and Ethical Behavior · 7 min read
Refusal, Advance Directives and Legal Wrongs
- Identify the nurse aide's responsibilities when a resident refuses care or communicates choices through advance directives and do-not-resuscitate orders.
- Distinguish between common legal wrongs in healthcare, including negligence, malpractice, assault, battery, and false imprisonment.
- Describe safe, lawful practices regarding physical and chemical restraints, including recognizing prohibited uses and reporting safety concerns.
Resident Refusal of Care
Every resident has the legal right to refuse any care, treatment, or medication. When a resident states that they do not want assistance or tells you to stop, you must stop the task immediately. As a nurse aide, you must never force, threaten, or argue with a resident who refuses care. Forcing assistance violates the person's basic legal rights and damages the trust needed for safe daily care.
When a refusal occurs, take time to ask about the resident's reasons in a calm and respectful manner. For example, if a resident refuses help with morning hygiene, speaking gently may reveal that they are tired, experiencing discomfort, or simply want to rest a bit longer. Listening patiently shows respect for their dignity while helping you understand their point of view. You should never pressure them to change their mind.
A resident's refusal must always be reported to the licensed nurse promptly, and you must accurately record the refusal according to facility policy. Refusing care at one moment does not mean the resident gives up the right to receive care later. You should offer the refused care again at a later time if appropriate, or consult the nurse for guidance on how to support the resident safely throughout your shift.
Common mistakes
- Do not continue refused care because it seems necessary or well-intentioned; nonconsensual physical contact while providing that care can be battery.
- Believing that a do-not-resuscitate (DNR) order means basic personal care, hygiene, and pain relief should be stopped or scaled back.
- Tucking bed sheets tightly or placing a heavy tray table over a chair without realizing these actions can legally be considered restraints or false imprisonment.
- Failing to immediately report signs of poor circulation, such as numbness, redness, or blue discoloration near a restraint, to the nurse.
Key points
- Residents have the right to refuse any care; nurse aides must stop the task immediately, never argue or threaten, ask reasons calmly, report to the nurse, record the refusal, and offer care again later if appropriate.
- Advance directives and living wills communicate care choices, while a durable power of attorney for healthcare names a surrogate; nurse aides do not interpret these documents and should refer requests about signing or witnessing them to the nurse, following facility policy and state law.
- A DNR order requires provider authorization and directs staff not to attempt CPR, but routine comfort, pain management, and hygiene care must always continue.
- Negligence and breach of duty involve failing to provide prudent care, such as ignoring call signals, causing burns by not testing bath water, leaving residents soiled, or working outside the aide scope of practice.
- Assault involves intentional threats that create fear of harm, whereas battery involves touching or rough handling without consent, even if done with good intentions.
- False imprisonment restricts movement unlawfully, including tight bed sheets, locked rooms, or heavy tray tables; restraints require a provider order, cannot be used for staff convenience, and carry risks such as pressure injuries and strangulation.
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Sample lesson: Scope of Practice and Legal Responsibilities25 practice questions on this exam
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