Advanced Directives Standards and Cultural Competence

Advanced Directives Standards and Cultural Competence

LP9 Assignment: Advanced Directives Standards and Cultural Competence

Directions: Create a paper investigating the cultural competence of the advanced directives policy where you work or in a community health care facility near you.

To assist you, reference the following websites:

1. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standard \”R.I.1.2.4 The hospital addresses advance directives\” (you will need to scroll down the page).

2. National Standards on Culturally and Linguistically Appropriate Services (CLAS)

Consider the following when writing your paper: Is the agency meeting the standards in these areas? In what language(s) are advance directive forms available? Analyze your findings.

Submit this document via the dropbox “LP9 Assignment: Advanced Directives Standards and Cultural Competence\” located in the Navigation Bar above. This assignment is worth 50 points; grading will be based on the LP9 Scoring Guide.
Scoring Guide (50 Points) Rating Scale
10 Work meets or exceeds criterion at a high level of competence.
9 Work reflects an understanding of criterion with minor misunderstandings/misconceptions.
8 Criterion partially met, but one or more important concepts/skills are missing or flawed.
7 Work reflects an attempt to meet criterion, but significant misunderstandings/misconceptions are apparent.
6-0 Criterion not met or work is absent.
1. The advance directives policy of the local health care agency is identified.
2. The advance directives policy of the local health care agency and available language(s) is identified.
3. The CLAS and Advanced Directives standards are considered simultaneously.
4. The local health care agency policy on Advance Directives in light of the CLAS standards is reviewed and analyzed.
5. Work reflects use of data sources, is APA formatted, and submitted on time.
Ethics Committee Core Curriculum
JCAHO 1997

Ethics Committee Core Curriculum
JCAHO 1997

Karen Maricle
The goal of this functional chapter is to promote improved patient outcomes by respecting each patient’s rights and conducting business relationships with patients and the public in an ethical manner. The chapter is divided into two major components: Patients Rights and Organizational Ethics. Although the 1997 Standards remain unchanged from those of 1996, there has been a change in the method of scoring. Historically, when the Joint Commission institutes new Standards, they \”cap\” those Standards for a year or two in order to provide time for organizations to institute measures to be in full compliance. Prior to 1997 the Standards related to Organizational Ethics were capped at two. A score of two indicates significant compliance; therefore, even if there was no evidence of intent to meet the Standard, a score of two was obtained. In 1997 all Standards related to Organizational Ethics have been capped at three. A score of three indicates minimal compliance. A score of three for several related Standards can result in a Type 1 Recommendation.

I will now present an overview of the 1997 Standards; emphasizing new intents or areas of increased importance.

The Patients Rights Standards continue to emphasize access to care, treatment of patients and respect for patients and their families. While these Standards are requirements, various strategies may be utilized to achieve compliance. Hospital Ethics Committees, while not required, have been effective in addressing many of the issues outlined in these Standards.

RI.1 The hospital addresses ethical issues in providing patient care
Hospitals must have processes and structures in place to support ethical decision making and all staff members must be aware of the ethical issues regarding patient care. Implicit in this Standard is a mechanism for staff education. The following patients’ rights must be guaranteed: access to care, care that is considerate and respectful of his or her personal values and beliefs, informed participation in care decisions, participation in ethical questions that arise in the course of his or her care, privacy, confidentiality, security, surrogate decision making and the right to access protective services. The 1997 Accreditation Manual defines protective services as the need for protective intervention, correction of hazardous living conditions or situations in which vulnerable adults are unable to care for themselves, and investigate evidence of neglect, abuse, or exploitation. Mechanisms to provide protective services can include guardianship and advocacy services, conservatorship, referral to state survey and certification agency, state licensure office, the state ombudsman program, the protection and advocacy network, and the Medicaid fraud control unit.

RI1.1 The patient’s right to treatment or service is respected and supported
The intent of this standard is to provide care that is in response to a patient’s desire or need, as long as that care is within the hospital’s ability, its mission and not in violation of relevant laws and regulations. If a hospital cannot provide required or requested services, the patient is informed and if medically advisable, appropriate transfer arrangements are made.. The decision to transfer must not be made solely for economic reasons.

RI.1.2 Patients are involved in all aspects of their care
The aspects of care that are referred to are informed consent, making care decisions, resolving dilemmas about care decisions, formulating advance directives, withholding resuscitative services, forgoing or withdrawing life-sustaining treatment, and care at the end of life. Hospitals must also allow patients and their families to express their cultural and spiritual practices and beliefs as long as this does not interfere in the treatment of others.

RI.1.2.1 Informed consent is obtained
Treatments or procedures must be fully explained to the patient, and when appropriate the family. The risks and potential benefits must be addressed as well as the possible result of nontreatment. Significant alternatives to the proposed treatment must be shared. Staff members must also inform the patient of any potential conflict of interest, including business relationships and relationships to educational institutions. This Standard includes the requirement of informed consent for all investigational studies or clinical trials. The hospital must have policies and procedures in place which ensure that when patients are asked to participate in an investigational study or clinical trial, they receive appropriate information upon which to base their decision. It is essential that patients understand that their refusal to participate in such trials will not compromise their access to the hospital’s services

RI.1.2.2 The family participates in care decisions
This Standard requires a surrogate decision maker to be identified when a patient cannot make decisions regarding his or her care. In the case of an unemancipated minor, the family or guardian is legally responsible for approving the care prescribed. The patient also has the right to exclude any or all family members from participating in his or her care decisions.

RI.1.2.4 The hospital addresses advance directives
Hospitals are required to determine whether a patient has an advance directive and if not, wishes to implement one. Hospitals must provide assistance to patients in formulating advance directives. The discussion must be conducted by an authorized staff member who has specific training in this area or be the attending physician. If a patient does not wish to implement an advance directive, this must be indicated in the medical record. Once an advance directive is executed, hospitals are required to honor the directive within the limits of the law and the organization\’s mission, philosophy, and capabilities. Finally, in the absence of the actual advance directive, the substance of the directive is documented in the medical record by hospital staff. This final issue has raised concern since its implementation in 1996. The concern centers around the ability of the staff member to capture the true essence of the advance directive in light of the patient\’s present condition and limited contact with the patient. Organizations would be prudent to consult with their legal counsel regarding this issue.

RI.1.2.5 The hospital addresses withholding resuscitative services
RI.1.2.6 The hospital addresses forgoing or withdrawing life-sustaining treatment
Policies and procedures should provide a framework which ensures that the decision-making process is applied consistently and that lines of accountability are clear. Hospitals will conform to the legal requirements of their jurisdiction. Policies and procedures should be adopted by the medical staff and approved by the governing board.

RI.1.2.7 The hospital addresses care a the end of life
This Standard provides for the appropriate care of dying patients. The framework used must address the following issues: pain management, sensitively addressing issues such as autopsy and organ donation, respecting the patient\’s values, religion and philosophy, involving the patient and where appropriate the family in all aspects of care, and responding to the psychological, social, emotional spiritual and cultural concerns of the patient and family

RI.1.3 The hospital demonstrates respect for the following patient needs: confidentiality, privacy, security, resolution of complaints, pastoral counseling and communication.
When the hospital restricts a patient\’s visitors, mail, telephone calls, or other forms of communication, the restrictions are evaluated for their therapeutic effectiveness. Any restrictions on communication are fully explained to the patient and family, and are determined with their participation.

RI.1.4 Each patient receives a written statement of his or her rights
RI.1.5 The hospital supports the patient\’s right to access protective services
This Standard refers to the provision of guardianship and advocacy services, conservatorship, and child or adult protective services for at risk populations.

RI.2 The hospital has a policy and procedures, developed with medical staffs\’ participation, for the procuring and donation of organs and other tissues
Policies and procedures for organ and tissue procurement and donation include the following elements: identification of the organ or tissue procurement agency with which the hospital is affiliated, criteria for identifying potential organ and tissue donors, procedures for notifying the family of each donor of the organ to donate, and for recording their decision, discretion and sensitivity to the circumstances, beliefs, and desires of the families of potential donors, procedures for directly notifying appropriate organ procurement organizations and tissue banks when an organ or other tissue is potentially available, written documentation showing that the patient or family accepts or declines the opportunity for the patient to become an organ or tissue donor and records of potential organ donors whose names have been sent to organ or tissue procurement organizations.

RI.3 The hospital protects patients and respects their rights during research, investigation, and clinical trials involving human subjects (please refer to consent Standard)
RI.4 The hospital operates according to a code of ethical behavior This code addresses ethical practices regarding marketing, admission, transfer, discharge and billing, and resolution of conflicts associated with patient billing.
The code ensures that the hospital conducts its business and patient care practices in an honest, decent and proper manner. The code of ethical behavior is driven by leadership and must be approved by the governing board.

RI.4.3 In hospitals with longer lengths of stay, the code addresses a patient\’s rights to perform or refuse to perform tasks in or for the hospital.
Patients have a right to refuse the work. Work must be appropriate to the patient\’s need and therapeutic goals.

Reference: 1997 Hospital Accreditation Standards. Joint Commission
Other Resources:

Cleveland Clinic: What Do They Mean by \”Organizational Ethics?\”

COPYRIGHT © 1997, UB Center for Clinical Ethics and Humanities in Health Care Return to Core Curriculum Table of Contents
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Last Revised 2/15/97
are the two references she wants us to uses. I have provided them for you. I work for University of New Mexico Hospital we are a level trauma one center Yes we meet all the criteria.