CNA Legal & Ethical Behaviours 1 2 — Questions and Answers

Question 1: Which federal law protects the privacy and security of patients' health information?

The Americans with Disabilities Act (ADA)
The Health Insurance Portability and Accountability Act (HIPAA) (Correct answer)
The Omnibus Budget Reconciliation Act (OBRA)
The Fair Labor Standards Act (FLSA)

Correct answer: The Health Insurance Portability and Accountability Act (HIPAA)

HIPAA establishes federal standards for protecting the privacy and security of individually identifiable health information (Protected Health Information or PHI).

HIPAA was enacted in 1996 and includes the Privacy Rule, which protects the confidentiality of patients' Protected Health Information (PHI), and the Security Rule, which governs electronic PHI. Under HIPAA, healthcare workers may only access, use, or disclose PHI for treatment, payment, or healthcare operations without patient authorization. Patients have rights to access their own records, request corrections, and receive an accounting of disclosures. HIPAA violations can result in civil and criminal penalties ranging from fines to imprisonment. CNAs are trained on HIPAA during orientation and must consistently protect patient information in all settings.

Question 2: A resident asks the CNA to witness their signature on a legal document. The CNA should:

Witness the signature as the resident requested since it is a small favor
Decline and explain that witnessing legal documents is outside the CNA's scope of practice (Correct answer)
Ask the charge nurse to explain the document to the resident before signing
Call the administrator to approve the witnessing

Correct answer: Decline and explain that witnessing legal documents is outside the CNA's scope of practice

Witnessing legal documents is outside the CNA's scope of practice and could expose the CNA to legal liability. The CNA should politely decline and suggest appropriate resources.

Witnessing the signing of legal documents (wills, power of attorney, advance directives, etc.) is outside the CNA's scope of practice and creates potential legal conflicts. If a CNA witnesses a resident's will and later inherits from that resident, it could be challenged in court. The CNA should kindly explain that they cannot witness the document and suggest the resident contact the facility's social worker, administrator, or an attorney who can arrange appropriate witnessing. CNAs should also be aware of policies regarding accepting gifts or being named in wills, as this creates ethical and legal conflicts of interest.

Question 3: What constitutes 'negligence' in nursing care?

Intentionally harming a resident
Failing to provide the standard of care that a reasonably prudent CNA would provide, resulting in harm (Correct answer)
Making any medication error regardless of outcome
Following the care plan even when it seems outdated

Correct answer: Failing to provide the standard of care that a reasonably prudent CNA would provide, resulting in harm

Negligence is the failure to act as a reasonably prudent person would act in similar circumstances, resulting in harm to another person.

Negligence in healthcare occurs when a provider fails to deliver the standard of care that a reasonably competent provider in the same position would deliver, and this failure causes harm to the patient. Four elements must be present for a negligence claim: duty (the CNA had a responsibility to the resident), breach (the CNA failed to meet that duty), causation (the breach directly caused harm), and damages (actual harm occurred). Examples of CNA negligence include: failing to raise side rails as ordered, not answering call lights resulting in a fall, or not reporting a change in resident condition. Intent is not required — negligence is unintentional, unlike abuse.

Question 4: A resident's adult child insists that the CNA not tell their parent about a new terminal diagnosis. The CNA's ethical obligation is to:

Honor the family's wishes and withhold the information
Understand that residents have the right to information about their own health and report the family's request to the nurse (Correct answer)
Discuss the diagnosis with the resident at the family's request
Agree not to discuss it but put nothing in writing

Correct answer: Understand that residents have the right to information about their own health and report the family's request to the nurse

Residents have the right to know about their own health condition. The family cannot legally compel staff to withhold information from a competent adult resident. The CNA should report the situation to the nurse.

A competent adult resident has the legal and ethical right to full information about their medical condition, including a terminal diagnosis. Family members cannot legally override this right without specific legal authority (such as a healthcare power of attorney where the resident is legally declared incapacitated). The CNA is not the appropriate person to deliver such a diagnosis but should report the family's request to the charge nurse and social worker. The care team, often with the physician, is responsible for facilitating honest communication with the resident in a compassionate and appropriate manner. Withholding information from a competent patient violates autonomy and informed consent principles.

Question 5: Which of the following is an example of 'false imprisonment' in a healthcare setting?

Requiring a resident to eat in the dining room
Physically or chemically restraining a resident without legal justification or consent (Correct answer)
Locking the medication cart to prevent unauthorized access
Requiring visitors to sign in at the front desk

Correct answer: Physically or chemically restraining a resident without legal justification or consent

False imprisonment involves restraining a person without legal authority or their consent. In healthcare, applying restraints without proper orders and consent constitutes false imprisonment.

False imprisonment is a civil tort involving the unlawful restraint of a person's freedom of movement. In long-term care, it can occur through physical restraints (vest restraints, wrist ties, locked wheelchair belts) or chemical restraints (medications used to control behavior rather than treat a condition) applied without proper physician orders, resident/guardian consent, and care plan inclusion. Restraints are heavily regulated under OBRA '87 and CMS guidelines — they must be used only as a last resort, for the minimum time necessary, and with proper documentation and monitoring. Even well-intentioned restraint use without appropriate orders can result in legal liability.

Question 6: When a CNA suspects that a resident is being abused by another staff member, the CNA's mandatory obligation is to:

Discuss the concern with the suspected staff member directly
Report the suspicion immediately to the supervisor and, if required, to the state abuse hotline (Correct answer)
Wait to gather more evidence before reporting
Not report to avoid getting a coworker in trouble

Correct answer: Report the suspicion immediately to the supervisor and, if required, to the state abuse hotline

CNAs are mandated reporters who must report any suspicion of resident abuse immediately to their supervisor and the appropriate authorities — waiting or failing to report is a violation of law.

In all U.S. states, nursing home staff — including CNAs — are mandated reporters of suspected elder abuse, neglect, or exploitation. Mandatory reporting means the obligation exists even when the CNA is not certain abuse has occurred; suspicion alone triggers the duty to report. The CNA should immediately report to the charge nurse and/or administrator (not directly confront the suspect). Depending on state law, the CNA may also be required to report directly to the state adult protective services or long-term care ombudsman. Failure to report suspected abuse is a legal violation that can result in disciplinary action, loss of certification, and criminal charges. The resident's safety is always the priority.

CNA Legal & Ethical Behaviours 1 2

Which federal law protects the privacy and security of patients' health information?