Southern Luzon State University

College of Allied Medicine

NCM 114- CARE OF OLDER PERSON

Module 7 & 8 – Ethico -Legal in the

care of older Adult Care of Older Person

Course Description

This course deals with concepts, principles, theories and techniques in

the care of older adults. The learners are expected to perform holistic
nursing care of the older person in wellness and chronic illness utilizing
the nursing process.

Class schedule: Theory -2 Units (36 hours ) Mondays Sec A 7:30-9:30,

Sec B 8:00-10:00

Dear students
This module is dedicated to the students of Southern Luzon
State University at College of Allied Medicine in support to distant
learning during this time of pandemic, we hope that the students who
read this book will prepare you to shape your future in health care.
Southern Luzon State
University Brgy Kulapi,
Lucban Quezon

09761439535

[https://
classroom.google.com/
u/1/h] (Courtesy Image from Google.com)

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023

 Southern Luzon State University
College of Allied Medicine

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023

 Southern Luzon State University
College of Allied Medicine

OVERVIEW
This module will discuss the ethico-legal considerations in the care of older adults. It includes the laws
affecting senior Citizen, medications, ethical principles in long term and palliative care, advance directives, end of
life, spirituality and ethical dilemmas. The course will help the student to be aware and be able to understood the
ethico-legal considerations during the practice in the care of older person.

LEARNING OBJECTIVES

At the end of the subject the student will be able to:

 Discuss the ethico-legal considerations in providing care to older persons.

 Describe ethical standards and principles guiding nursing practice.
 Identify measures to help nurses make ethical decisions.

DISCUSSION

Good day my dear students. How are you this day? Let us talk about legalities. Gerontological nurses
are likely to face difficult situations wherein their advices and guidance may be requested by patients and
families. You will be their angels with a stethoscope.
Laws are generated from several sources. addition to laws, there are voluntary standards by which a
nurse can be judged. The American Nurses’ Association publication Scope and Standards of
Gerontological Nursing provides guidelines for gerontological nurses that offer descriptions of what is
considered safe and effective care.
Key concept: situations that increase the risk of liability include working with insufficient resources,
failing to follow policy and procedures, taking shortcuts or working when feeling highly stressed. There
are acts that could result in legal liability for nurses are assault, battery, defamation of character, false
imprisonment, fraud, invasion of privacy, larceny, negligence. Duty, negligence and injury must be
present for malpractice to exist.

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023

 Southern Luzon State University
College of Allied Medicine

Nurses must always be alert to all potential legal risks in their practice and make a conscious effort to
minimize them. Some of which are the so-called MALPRACTICE. As we say, focus and presence of mind is
the key. CONFIDENTIALITY is another one, patient consent they are entitled to know the full implications
of procedures and make an independent decision as to whether they choose to have them performed.
Patients who do not fully comprehend or who have fluctuating levels of mental function are incapable of
granting legally sound CONSENT. PATIENT COMPETENCY, various forms of guardianship also called
conservatorship can be granted when a person has been judged incompetent. A durable power of
attorney can be useful for patients with Alzheimer’s disease because they can appoint someone to
make decision on their behalf at a time when they may be incompetent to do so.
A nurse needs to ensure that those caregivers to whom tasks are delegated are competent to perform
the tasks and carry out their assignment properly. Nurses are responsible for the safe administration of
the prescribed MEDICATIONS. Anything that physically or mentally restricts a patient’s movement can be
considered a RESTRAINT. STAFF SUPERVISION gerontological nurses are responsible for supervising
other staff. This falls under the doctrine of respondent superior (let the master answer). TELEPHONE
ORDERS changes in the patient’s condition and requests for new or altered treatments may be
communicated over the telephone. DNR do not resuscitate orders, see to it that it is legally written and
signed on physician’s order sheet to be valid.
ADVANCE DIRECTIVES and issues related to death and dying. Some issues arise long before death occurs,
when patient choose to execute an advance directive or a living will. ELDER ABUSE, occur particularly in
long-term caregiving relationships in which family members or staff “burn out”. Caregiver stress can lead
to abuse of older adults.
LEGAL SAFEGUARD FOR NURSES = Common sense can be the best ally of sound nursing practice. Do not
forget that patients, visitors, and employees do not forfeit their legal rights or responsibilities when they
are within the health care environment. Laws and regulations impose additional rights and responsibilities
in patient-provider and employee-employer relationships. Nurses can and should protect themselves by
familiarization with the laws and rules in their specific care agency/facility, be knowledgeable about the
policies and procedures and adhere to them strictly. Function within the scope of nursing practice,
determine the competency of the employees for whom they are responsible, check the work of
employees under their supervision, obtain legal guidance when in doubt about the situation, report and
document any unusual occurrence, refuse to work under circumstances that create a risk to safe patient
care and carry liability insurance.
Now we go to Republic Act 7432 = it is an act to maximize the contribution of senior citizens to nation
building, grant benefits and special privileges and for other purposes.
RA 9257 = is an act granting additional benefits and privileges to senior citizens amending for the purpose.
RA 7432. Approved on February 26, 2004. It shall train community-based health workers among senior
citizens and health personnel to specialize in the geriatric care and health problems of senior citizens.
“Expanded senior Citizen Act of 2003” and further amended by RA 9994 known as the “Expanded Senior
Citizens Act of 2010”= defines senior citizen or elderly as any resident citizen of the Philippines at least
60 years old.
List of benefits = such as income tax exemption for minimum wage earners, training fee exemption on
socio-economic programs, free medical and dental services in government facilities, free flu and
pneumococcal vaccinations for indigent senior citizen, 20% discount and VAT exemptions , on
professional fee, domestic and sea travel fares, public land transportation, hotels, restaurants,
recreation centers, places of leisure, funeral and burial services. Retirement benefits SSS, PAG IBIG GSIS,

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023

 Southern Luzon State University
College of Allied Medicine

express lanes. Wow, lots, plentiful, good for me, I am nearly approaching. What about your loved ones?
Grandparents? Do they enjoy the benefits already? What if you faced a certain situation: you begin
documenting your observations but are told by your immediate supervisor to “just bite your tongue
and live with it because he is the administrator’s son? How would you react on this?
When we say polypharmacy, = it is the increase in the number of medications or the use of more
medications than are medically necessary. It is common in older ambulatory care, hospital and nursing
home patients. It increases the risk of numerous negative health consequences in the elderly, so nurses,
be watchful on your clients, those effects, refresh and recall. Tired, sleepiness, decreased alertness,
constipation, diarrhea or incontinence are some. Others are loss of appetite, confusion, falls, special
considerations for medication use in older population. Close supervision and adherence to sound
principles of safe drug use are essential in gerontological nursing.
When several drugs are taken concurrently, protein-bound drugs may not achieve desired results =
because of ineffective binding to reduce protein molecules. It is a key concept that the extended
biological half-life of drugs in older adults increases the risk of adverse reactions. In addition to these, the
risk of adverse drug reactions(ADR) is high in older adults because of age-related differences in
pharmacokinetics and pharmacodynamics. Please review and recall your ADME my dear level 3. Those
key terminologies and Nurses therapeutic communication. NURSES = should ensure that drug induced
cognitive and behavioral problems are not treated with additional drugs. Read those inappropriate drugs
to use in older adults. Be always reminded that regular review of drug’s ongoing necessity and
effectiveness is essential. to facilitate To ensure that oral medications achieve full benefit, encourage
good oral hygiene, ample fluids and proper positioning swallowing.
Lower body temperature and decreased circulation to the lower bowel and vagina can prolong the
time for suppositories to melt. Older adults are at risk for circulatory overload during intravenous drug
therapy, close monitoring is essential. Provide patient teaching.
There are risk factors for medication errors: use of multiple medications, cognitive impairment,
hearing deficits, arthritic/weak hands, history of non-compliance with medical care, lack of knowledge
regarding medications, limited finances, illiteracy, lack of support system, history of inappropriate self-
medication and presence of expired of borrowed medication in home
Drug values should be monitored. Find time to read the tips for safe drug use: teaching tool it will be
useful in your future activities. Review certain drugs such as analgesics (acetaminophen), antacids,
antibiotics, anticoagulants, anticonvulsants, antidiabetic (hypoglycemic), my antihypertensive, those
NSAIDs, cholesterol lowering, and cognitive enhancing drugs, those indications and effects of digoxin, the
types of diuretics and how do laxatives differ from one another. what are those anxiolytics?
What about a speech power gymnastic? What key points would you include in a program to educate
senior citizens about safe drug use.

Now let us take a look at the ethical aspects of gerontological Nursing. Try to identify measures to help
nurses make ethical decisions. Although the concept guiding the right and wrong conduct is not new to
nursing, ethics has received increasing attention. Many arise in daily practice. It is a must for nurses to
understand both the ethics of nursing profession and their own personal ethics and to be aware of the
ethical dilemmas facing gerontological nurses today. It is the review of autonomy, beneficence,
confidentiality, ethics, fidelity, justice, nonmaleficence, veracity. There are philosophies guiding
ethical thinking, ethics originated in ancient Greece, ethos (beliefs that guide life) it determines the right
and wrong courses of action. Try to refresh in your neurons the utilitarianism, egoism, relativism,

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023

 Southern Luzon State University
College of Allied Medicine

absolutism. Individuals can be guided by a wide range of ethical philosophies that cause them to view the
same situation in vastly different ways.
See for yourself the Code of Ethics for Nurses, how a nurse practices his profession, who is your primary
concern, how do you protect health safety and rights of the patient? What about your responsibility and
accountability, what about your personal and professional growth? Since we participate and collaborate,
what are those responsibilities to be maintained for the integrity of the profession? As I was saying since I
met you, be a wide reader, and a great movie critic. (movie marathon din pag may time).
Most clinical situations do not lend themselves to simple, clear-cut ethical decisions. It is the conflict
between right of patients and nurses’ responsibilities to those patients. There are measures to help
nurses make ethical decisions. Nurses should minimize their struggles in making ethical decisions by using
critical thinking. they can: ENCOURAGE patients to express their desires (advance directives, wills),
IDENTIFY significant others, who impact and are impacted (their concerns and preferences),
KNOW THYSELF (review your personal value system), READ (review medical literature for discussion and
case experiences for wider perspective), DISCUSS talk about issues in formal education program or
informal coffee breaks.
FORM AN ETHICS COMMITTEE bring along various members of the health team, clergy attorney lay
persons to study ethical problems within the specific settings, clarify legal and regulatory boundaries.
CONSULT it takes the form of ethics committee or consultation provided by expert individuals,
(philosophers, lawyers, clinicians who specialize in bioethics. When facing ethical decisions, it is
beneficial to be clear about one’s own value system.
That ends my topic in ethical aspects, my questions are incorporated in this learning material, try to
answer those as part of your self- assessment. Thank you and good night.

Evaluation
Essay:
1. A civil wrongdoing, committed against a person or a person’s property.
2. Defamation by means of writing, print or pictures
3. The willful touching of a person, his clothing, or something the person is carrying.
4. Negligent act of a person engaged in profession or occupation in which highly technical or professional
skills are employed
5. It is a mercy-killing
6. Being faithful to one’s commitments and promises.
7. These are obligations associated with rights.

REFERENCES

Textbook :

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023

 Southern Luzon State University
College of Allied Medicine

Hogstel Mildred, (2015) Gerontolgy Nursing Care of the Older Adult, Delmar Thomson Learning
Asia, Singapore
Eliopouslos, Charlotte, (2014) Grontological Nursing 8 th edition, Wolters Kluwer Health Lippincott
Williams & Wilkins USA.

E-sources:

Adrian N S Badana, MPH, Ross Andel, PhD, The Gerontologist, Volume 58, Issue 2, April 2018,
https://doi.org/10.1093/geront/gnx203, Published: 08 January 2018

NCM 114 Care of Older Adult. Pedrido, Sabas. 2022-2023