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. If you did, please be sure to give us
a like. You can drop a comment below to let me know what you liked about that video,
and it's awesome if you want to subscribe so 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!