Legal & Ethical Issues

Mental Health Exam 2

What are some examples of patient rights in mental health care?

Humane treatment, self-determination, involvement in care, informed consent, least restrictive interventions, freedom from harm, confidentiality, and unrestricted visitors.

What does the Health Insurance Portability and Accountability Act (HIPAA) do?

It protects patient privacy and confidentiality in health care.

What is the nurse’s responsibility concerning patient privacy rights?

To be knowledgeable of and follow laws and policies that protect patient privacy, including reporting obligations.

What are the ethical principles that nursing must consider?

Beneficence, nonmaleficence, autonomy, justice, fidelity, and veracity.

What is the difference between competence and incompetence in a mental health context?

Competence refers to an individual's mental capacity to participate legally; incompetence means a person has been declared unable to do so, often requiring a guardian.

What are the criteria for involuntary admission to a mental health facility?

Manifestations of mental illness, danger to self or others, inability to provide self-care, and inability to voluntarily seek treatment.

What interventions are considered least to most restrictive in mental health care?

De-escalation techniques, chemical restraints, seclusion, and physical restraints.

Under what circumstances can seclusion and restraints be used?

When the patient is imminent danger to self or others and all other least restrictive measures have failed.

What does the term 'Tort Law' encompass in mental health settings?

Intentional torts such as false imprisonment, assault, battery, and invasion of privacy; and unintentional torts such as negligence and malpractice.

What essential resources should nurses be knowledgeable about?

local, state, and national laws and regulations; professional guidelines (ANA Code of Ethics); agency policies and procedures; accrediting standards

Why must nurses be aware of their own values, beliefs, and biases?

helps prevent moral distress and ensures ethical care.

What does the right to humane treatment and care mean?

ensures that patients receive respectful, dignified, and compassionate care.

What is self-determination/autonomy in patient rights?

the right of patients to make their own decisions regarding their care.

How are patients involved in their own care?

have the right to participate in planning and decision-making about their treatment.

What are the informed consent rights of patients?

Patients can receive treatment information and choose to accept or refuse treatment.

What does the principle of least restrictive interventions imply?

care should limit patients' freedom as little as possible while ensuring safety.

What is a Psychiatric Advance Directive?

a legal document where patients specify their preferences for future psychiatric care.

What is the Dead Man’s Statute?

state-specific law that may allow certain communications to be released after a patient’s death, though details vary by state.

When is it acceptable to break patient confidentiality?

to protect third parties (duty to warn), report abuse of children or vulnerable adults, or when required by law.

What does the 'duty to warn' mean for nurses?

an exception to confidentiality where nurses must notify identifiable third parties if a patient poses a threat to them.

What is beneficience?

acting in the best interest of the patient

What is nonmaleficience?

do no harm; avoiding actions that cause harm to patients.

What is justice?

fairness and equality; all pts receive equitable care

What is fidelity?

maintaining trust with pts and colleagues

What is veracity?

obligation to be truthful

What is an ethical dilemma?

2 or more conflicting ethical principles involved making the choice unclear.

What is an ethical issue?

a situation that involves moral principles and requires choice b/t right and wrong.

What is the main principle of Provision 1 of the ANA Code of Ethics?

nurses must practice with compassion and respect for the dignity, worth, and uniqueness of every person.

What does Provision 1 say about discrimination in nursing care?

Everyone has the right to be treated with respect and dignity, without discrimination.​

What is competence in a legal or healthcare context?

having the mental capacity and necessary skills to participate in legal proceedings or make decisions.

What is an informal admission to a mental health facility?

least restrictive type of admission, where the patient is free to leave at any time and poses no threat to self or others.

What characterizes a voluntary admission?

patient or their guardian chooses admission, and the patient is considered competent with all rights intact.

What is a temporary emergency admission?

when a patient cannot make their own care decisions, and a medical provider initiates admission for evaluation by a mental health professional.

How long does a temporary emergency admission typically last?

usually does not exceed 15 days, though this varies by state.

What is involuntary admission to a mental health facility?

person is admitted against their will by family, a guardian, or a healthcare provider with process based on state laws

What are the criteria for involuntary admission?

patient must have severe mental illness, pose a danger to self or others, be unable to provide basic self-care, or be unable to voluntarily seek necessary treatment.

Does an involuntarily admitted patient retain their legal rights?

Yes, they are considered competent unless legally declared otherwise, but they do not have the right to leave freely.

What happens if a patient is declared incompetent during involuntary admission?

court appoints a legal guardian to make decisions on their behalf.

How long can an involuntary commitment last without review?

60 days, after which a psychiatric and legal review is required.

When is a patient released from involuntary commitment?

When they are no longer considered a danger to themselves or others.

What is long-term involuntary admission?

court-ordered admission to a mental health facility for an extended period due to severe mental illness.

How long does a long-term involuntary admission typically last?

60 to 180 days, but varies by state.

Who imposes long-term involuntary admission?

courts

Does a long-term involuntary admission always have a set release date?

no

What is the least restrictive intervention for managing a crisis?

de-escalation

What are chemical restraints, and how are they administered?

medications used to control behavior given oral or IM

What are physical restraints, and what types exist?

limit pt’s movement and include human or mechanical restraints

When are seclusion and restraint permitted in patient care?

used as a last resort when a patient is aggressive and dangerous to themselves or others, and all least restrictive measures have failed.

For how long can seclusion and restraint be used?

shortest time necessary

What is seclusion in a mental health setting?

involuntary confinement in a locked, specially constructed room with direct visual monitoring via a security window or camera.

How is restraint defined in patient care?

direct application of physical force to person without permission​

Can an RN initiate seclusion or restraint without an order?

Yes, in an emergency, but a written order must be obtained within 15-30 minutes.

How often must orders for seclusion or restraint be renewed based on age?

8yrs and younger: every 1hr
9-17yrs: every 2hrs
18yrs+: every 4hrs

What must happen if seclusion or restraint continues beyond the initial order?

face-to-face reassessment is required, and the order must be rewritten (usually every 24hrs)

How frequently should patients in seclusion or restraints be monitored?

1:1 monitoring is required per facility policy and patient needs.

When is the debriefing session after seclusion or restraint?

within 24hrs after release

What is an intentional tort in a mental health setting?

a deliberate act that violates a patient’s rights, such as false imprisonment, assault, battery, or invasion of privacy.

What constitutes false imprisonment in mental health care?

Restricting a patient's freedom without legal justification, such as improperly using restraints or seclusion.

How is assault defined in a healthcare context?

Threatening a patient with harm, causing them to fear imminent injury.

What is considered battery in mental health care?

Physical contact with a patient without consent, such as administering treatment forcefully.

What are unintentional torts in healthcare?

Actions causing harm due to negligence or malpractice, rather than intentional misconduct.

What are the less restrictive measures used before seclusion or restraints?

verbal interventions, diversion/redirection, providing calm environment, offering PRN med

In what instances should a nurse NEVER use seclusion or restraints?

staff convenience, punishment, pts extremely physically/mentally unstable, pts who can’t tolerate decreased stimulation.

How often should documentation be taken during seclusion/restraint and what should it include?

every 15-30 min; precipitating events and pt behavior before seclusion/restraint, alternative actions taken to avoid seclusion/restraint, time tx began, pt’s current behavior, food & fluids offered/taken, V/S, med admin, time released

What facility protocol should be in place concerning nursing responsibilites during seclusion/restraint?

how often the pt is: assessed (safety, physical needs, behavior, skin), offered food/fluid, toileted, monitored for V/S and pain

When is the initial order for seclusion or restraints written?

after conducting face-to-face assessment

What is the maximum initial order duration for seclusion or restraints for an adult (18 years or older)?

4 hours

What is the maximum initial order duration for seclusion or restraints for children and adolescents aged 9 to 17 years?

2 hours

What is the maximum initial order duration for seclusion or restraints for children under 9 years old?

1 hour

What must occur after 24 hours if seclusion or restraints are still needed?

new face-to-face assessment and new order written

For how long can the initial order be renewed without a face-to-face assessment?

up to 24 hours

What factors can supersede the standard time limits for seclusion or restraint orders?

State law, facility policy, or the patient’s condition.

When can a provider renew an order without conducting a face-to-face assessment?

w/in the first 24hrs