CHp.4 Rights and Legal issues

What is self-determinsim? What is a self-determined individual?

• a fundamental right to choose one’s health-related behaviors.

• A self-determined individual is internally motivated to make choices based on personal goals

What are the key values of self-determinism?

• Personal autonomy

• Avoidance of dependence on others

What are some examples of patients rights?

• Self-Determination Act: right for patients to be informed about their right to be a central part of there healthcare.

• Bill of Rights

  • Necessary because of vulnerability to abuse and mistreatment

• Americans with Disabilities Act (ADA)

  • Legal protection against discrimination against individuals with disabilities

What is competency?

• Competency refers to an individual's ability to make informed decisions regarding their own care and treatment. It is a legal standard that assumes everyone is competent unless a court determines otherwise.

What are the criteria to meet in order to be consider competent?

• Communicate choices

• Understand relevant information- have to understand the information they are being given.

• Appreciate the situation and consequences- they have to understand the situation and what their options are, and know what the consequences are of the actions.

• Use a logical thought process to compare options

• Informed consent:  a legal procedure.

What are the two types of treatment?

• Voluntary commitment: patient has full legal rights.

  • they have the right to leave, even if its AMA

• Involuntary commitment:

  • confined hospitalization of a person without the person’s consent.

    • You have to have an court order to keep them.

What are the criteria for keeping someone involuntarily?

• Mentally disordered

• Dangerous to self or others, or

• Unable to provide for basic needs

What is the right to be treated in the Least Restrictive Environment?

• An individual cannot be restrained or locked in a room unless all other less restrictive measures are tried first.

• A person cannot be restricted to an institution when he or she can be successfully treated in the community.

• Medication cannot be given unnecessarily.

How do we promote patient safety?

• observation

• de-escelation

• seclusion

• restraints

What does observation and De-escalation look like?

• Observation:

  • Observing the actions and verbal remarks of a patient.

  • Nurses can order observation on their own.

  • Document what you see and hear

• De-escalation:

  • Based on what you observe, determine the best course of action to help calm the patient and redirect them.

What is seclusion and Restaints? considerations? when is it done?

• Seclusion:

  • Empty rooms and locking the door.

  • Only done if they are a risk to others and possibly themselves.

  • 1-on-1, the second someone goes into seclusion or restraints.

  • Within an hour, an order has to be placed.

  • ASAP, all members involved in seclusion or restraint have to do a debrifement and document everything. 

• Restraints:

  • If they are a danger to themselves.

  • Offer medications if it hasn't been offered.

  • If someone is put in restraints, they need to be on their back.

What is Privacy?

• Privacy: part of a person’s life not governed by society’s laws and government intrusion

What is confidentiality?

• Confidentiality: ethical duty of nondisclosure (provider has information about patient and should not disclose it)

What is Breach of confidentiality?

• Breach of confidentiality: release of patient information without the patient’s consent in the absence of legal compulsion or authorization

What does being a mandated reporter mean?

• A legal obligation to breach confidentiality if someone reports that they are going to hurt someone.

• “Duty to warn”: when there is a judgment that the patient has harmed someone or is about to injure someone (based on Tarasoff v. Regents of University of California)

What are some documentation considerations?

• Document both symptoms that are present and the absent symptoms

• Always needed for patients who are suicidal, homicidal, aggressive, or restrained in any way

• Avoid judgmental statements (i.e., “patient manipulating staff”)

What is Not guilty by reason of insanity? NGRI

• NGRI: bot guilty by reason of insanity

  • A person has to demonstrate both:

    • They didn’t know the difference between right and wrong 

    • They weren’t in control of their actions at the time. 

What is Gulity but mentally ill? GBMI

• They have the same disposition as anyone else.

What is a Forensic commitment?

• Where people who are found NGRI go, they aren’t just set free.

• Some people might be there for months or years- treatment-based, but also might be given a sentence equal to the time served.

What is Fitness to stand trial?

• it has to be determined if the patient is able to consult with a lawyer with a reasonable degree of rational understanding of the facts of the alleged crime and the legal procedures.

• they must know the people and their roles

• be competent.