ethical and legal issues

hospitalization - voluntary holds/detainments

• if patient voluntarily signs into mental health facility within 12 hours of admission requests discharge before the prober feels appropriate - then the provider can place the patient on a voluntary detainment for up to 5 business days

• allows the facility to hold the patient to further stabilize and treat the patient

hospitalization - involuntary hold

• adults only

• EHOLD

  • legal process

• shackled/handcuffed

• escorted by sheriff

• pleasantly psychotic

• primary diagnosis but be psychiatric and not from substance use disorder

• must have 1 of the following

  • imminent threat to self

  • imminent threat to others

  • significant inability to care for themselves

confidentiality

• HIPAA (health insurance and accountability act)

  • protected health information (PHI)

• exceptions

  • duty to warn

  • abuse

ethical issues

• right to treatment

  • anyone admitted has right to treatment and refusal

• right to refuse treatment

  • unless immediate intervention is required to prevent harm or death to patient or another person

    • involuntary hospitalization

    • forced medications

• right to the least restrictive treatment alternative

  • client can be adequately treated in an outpatient setting, they should not be hospitalization

  • if hospitalized - patient should not be sedated, restrained, or secluded unless less restrictive steps were unsuccessful

• taking no action is considered an action taken

legal issues

restraints and seclusion

• generally refer to set of leather straps used to restrain the extremities of an individual whose behavior is out of control and who poses and immediate risk to physical safety and psychological well-being of themselves and others

• never to be used as punishment or for staff convenience

• chemical

• specific standard

  • staff trained and competent to minimize use of restraint and seclusion and when indicated to use restraint and seclusion safely

  • discontinued asap regardless of order expiration

  • orders for restraint / seclusion must be renewed

    • q4h for adults 18+

    • q2h for children and adolescents 9-17

    • q1h for children younger than 9

flase imprisonment

• unlawful restraint of patient freedom of movement

• verbal or physical

• restraining without proper justification

  • refuse to allow pt to leave healthcare facility or room

  • use physical force to prevent pt from leaving

  • medication pt against will

  • lock pt in physical place with defined boundaries (like a room)

assault

act that results in genuine fear that person with be touched without consent

• verbal threat or action that causes sense of fear

battery

unconsented touching of another person, harm or injury does not have to occur for charges to be legitimate

• actual physical contact; results in pt harm

intentional tort

act someone personally does which causes harm and for which the perpetrators can be sued

negligence

duty of nurses to provide safe and competent care to pt, when fail to do so can be considered negligence

• fail to properly assess pt condition, leading to tx delay

• fail to report significant changes in pt conditions to the physician or other members of healthcare team

• fail to allow physicians orders or tx plan

• fail to properly supervise nursing assistants or other staff members

malpractice

act or continuing conduct of a professional that doesn’t meet the standard of professional competence and results in provable damages to her client or pt

such an error could be through negligence, ignorance, or intentional wrongdoing

community

group, population, cluster of people with at least one common characteristic such as geographic location, occupation, ethnicity or health concern

public health model

• primary prevention

  • services aimed at reducing incidence of mental disorders within the population

• targets both individuals and environment

  • assist individuals to increase ability to cope effectively with stress

  • targeting and diminishing harmful forces (stressors)within the environment

• secondary prevention

  • aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of illness

  • accomplished through early identification of problems and prompt initiation of effective tx

  • nursing in secondary prevention focuses on recognition of symptoms and provision of or referral for tx

• tertiary prevention

  • services aimed at reducing the residual defects that are associated with severe and persistent mental illness

  • accomplished in 2 ways

    • prevent complications of illness

    • promote rehabilitation directed toward achievement of each individuals maximum level of functining

public health pyramid

• bottom level

  • primary (universal)

    • prevention

    • programs targeted at entire population in order to provide support and education before problems occur

• middle level

  • secondary

  • screening

  • programs targeting at families in need to alleviate identified problems and prevent escalation

• top level

  • tertiary

  • treatment

  • provide interventions for those affected