Hi. I'm Meris, and in this video we're going to be talking about advance
directives and HIPAA. I will be following along with our Fundamentals of Nursing
flashcards which are available on LevelUpRN.com. If you are following along with me, I am starting
on card number seven, so let's get started. Alright. Let's talk about advance directives.
One of the things that you're going to notice on this card is that we talk first about the Patient
Self Determination Act, and this is the legal act that is actually the thing that guarantees that a
patient has the right to make their own decisions about their healthcare. Very important to
understand that that's what this document sets up. This is how we are able to have the ethical
principle of autonomy. Now let's talk about some
different types of advance directives. And they are what they sound like. It is a patient
being allowed to direct their care in advance. So this means that if I am incapacitated
or brain-dead or something similar, I have already legally expressed my wishes somehow,
and we're going to talk about the different ways. This is very important for patients who
have specific wishes they wish to be followed. So the first one we're going to talk about is a
living will. And a living will is the document a patient draws up which indicates the types
of interventions they do and do not want to have if they were incapacitated and unable to
provide consent for themselves. So this is very specific. The patient can say, I don't wish to be
intubated. I do wish to have tube feedings. I don't want this kind of intervention.
That is the document, a living will. Now a Do Not Resuscitate order is a specific type
of advance directives that says, "in the event of cardiac death, I do not want for you to perform
CPR." No resuscitative actions, and depending on your state, there may be variations of this,
so definitely make yourself familiar with all of the different DNR options available in your state.
But if your patient is a DNR and they have a cardiac arrest, we would not begin CPR. So the
thing that's important to understand though is that we do require physician's orders
for life-sustaining treatment [(POLST)] to be in place. And this means that the
physician needs to actually put orders into the system saying something like,
"do not resuscitate," or "comfort care only," or whatever the patient's advance directives
are. The physician does need to put orders in so that we can as nurses carry out those orders.
Now durable power of attorney is something you're going to hear a lot about in nursing school, and
this is a legal document that designates another person as being able to make medical decisions for
the patient. So for instance, if I had a durable power of attorney, I could say in the event I'm
unable to give consent myself, my husband, my mother, whoever I wish to designate, they have
the legal ability to give consent for medical treatment only, medical treatment in my stead.
There are other forms of power of attorney that allow you to give consent for other things,
but not this. Medical care only. The other thing is they don't have to be related to the person.
So for instance, I could say "Cathy Parkes, you are my durable power of attorney.
We are not related, but will you be the one to make healthcare decisions if I could not?"
So those are very important advance directives to understand, because you will
certainly see these come up on your nursing exams. Okay, next we're going to be talking about HIPAA,
which is the Health Insurance Portability and Accountability Act. This is very important for
you to understand. It's highly testable because it's so important, because this is the law that
sets forth the principles protecting a patient's privacy when it comes to their medical records.
So very important to understand. So we have a lot of things to go over here. I
would recommend reviewing this card in depth, because this is very testable information.
So some things that you need to keep in mind about HIPAA.
You are absolutely allowed to discuss a patient's care with other members of the
healthcare team who are providing direct patient care, such as their physician
or the respiratory therapist. That's okay. What isn't allowable by HIPAA though would
be something like speaking to a nurse on a different unit about the patient who isn't
providing care to that patient. Furthermore, if your patient's
spouse wanted information on their lab work or their medicines, that's okay
only if the patient has signed a release of information indicating that you are allowed to
share that information with that person. So don't give away any of the protected health information
of your patients unless you have that written signature saying it's okay to talk to this person.
Now when you do have conversations with other members of the healthcare team, make sure that
these are in secure locations such as the break room or the nurses' station. That's all okay,
but don't have these conversations in public areas such as the cafeteria or
in the elevator. That would not be appropriate. Now when it comes to the electronic health record,
EHR, there's some things to keep in mind there too as to how to protect their information when
you're working on the computer. One of the most important things
is going to be your password. You need to use a strong and unique password, change it frequently,
and never share that password with anyone, including your own manager. That's very important.
When you step away from the computer, you need to log off entirely. It's not enough
to just turn off your screen or turn the screen away. That's not allowable by HIPAA.
Some other things to keep in mind, you can only access patient charts for the patients
that you are directly caring for, so you can't look up charts for a friend of yours
or a celebrity that's in the hospital. That's not an okay use of a patient's health record.
So that is essentially the best practices around HIPAA. Keep in
mind that accidents happen and people do break confidentiality intentionally or otherwise.
When that happens though, you need to hold yourself accountable and hold others accountable
and report that breach to your direct supervisor. It's uncomfortable but it's very important.
Okay, so that's it for advance directives and HIPAA. I hope you found that review helpful.
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that you don't miss any of the videos that we put out on lots of different nursing content.
Next, I hope you join me. We're going to talk about something that is really important but very
tricky. We're going to talk about intentional and unintentional torts. Really important concepts.
And we're also going to go over mandatory reporting. Thanks so much and happy studying!