ethical and legal issues in psych/mental health nursing

background

mental health clients do not necessarily shout mental illness → suffer from a brain disorder → stigmatized by their illness and experience feelings of shame and sadness

autonomy

to respect the clients right to make decisions

beneficence

to do good

nonmaleficence

to do no harm

justice

to distribute resources or care equally

fidelity

loyalty and commitment to the client

veracity

to tell the truth

assault

the intentional threat designed to make another person fearful of harm

battery

actual harmful or offensive touching of another person

false imprisonment

when a person is confined to a limited area

intentional torts

intentional acts that violate another person’s rights or property

negligence

failure to act in accordance with ordinary professional standards

malpractice

an act or omission that breaches the duty to care

admission criteria: voluntary admission

client chooses to be hospitalized

free to leave; even AMA, but can turn into involuntary if pt deemed unsafe

occurs when pt apply in writing to be admitted to a facility; under age of 16 requires legal guardian, custodian or next of kin

admission criteria: involuntary admission

admission without the client’s consent; taking autonomy away

client must meet criteria of: diagnosed with mental illness, danger to self or others, unable to care for self, in need of treatment and the mental illness itself prevents voluntary help

to support an application, usually 2 physicians or other mental health professionals are required to certify a persons mental health status to justify detention and treatment

pts regain their rights to refuse meds and treatment, freedom from unreasonable restraint, and the right to informed consent

admission criteria: emergency commitment

AKA temporary admission or emergency hospitalization

for people so confused they cannot make decisions on their own; and for people so ill they need emergency admission

court hearing is held for discharge, voluntary admission, or involuntary commitment

humane environment

a supportive milieu in which clients feel respected and basic needs are met; food, safety

qualified staff

staff must meet specific requirements with ongoing inservices

individualized plan of care

multidisciplinary treatment team individualizes the plan of care (include pt when appropriate)

pt rights

right to refuse treatment unless considered an emergency or after court hearing, a person can be medicated if they meet the following criteria:
- person has a serious mental illness
- person’s functioning is deteriorating and if the person is suffering or exhibiting threatening behavior
- benefits of treatment outweigh the harm
- person lacks the capacity to make a reasoned decision about the treatment
- less restrictive services have been found inadequate

informed consent

pt has been provided with basic info regarding risks and benefits, and alternatives to treatment

voluntary acceptance of the treatment

implied consent

pts willingness to accept treatment

acceptance of meds through receipt of services (handling a pt med and the pt accepting the meds)

can be revoked at any time

calling 911 is an example

capacity

person’s ability to make an informed decision

fluid concept with individuals meeting and not meeting the ability

competency

legal term related to an individual’s degree of mental soundness to make decisions or carry out specific acts

spouse or partner (1), adult children or grandchildren (2), parents (3), adult siblings (4), adult nieces and nephews (5). if no family available, a court trained volunteer may be appointed

pt restraint and seclusion

specific circumstances may require seclusion and restraint; last case scenario

the use of the least restrictive means of restraint for the shortest duration is always the general rule

reasons for restraints and seclusions

when alternative and less restrictive measures are insufficient to protect the client or others from harm; must document that you tried alternative measures to protect client and others

when the behavior is physically harmful to the client or another

when client requires decreased stimuli

when client requires seclusion; distinguish from a timeout where a pt chooses or accepts a suggestion to spend time alone

seclusions and restraints require

a physician or APRN order

time specific orders. once the pt has been removed from S&R, a new order is required

criteria that specify periodic review of a client’s condition are needed; Q15 min for safety and circulation checks

pt rights to confidentiality

HIPAA: special protection for psychotherapy notes to be kept separate from the pts health info

confidentiality after death: dead man’s statute (not alive to speak for themselves)

exceptions: duty to warn and protect third parties, child or elder abuse, suicidal pts

documentation dos

chart in a timely manner and provide all factual and pertinent info

follow the policy in your facility and make your charting conform to this standard

chart: fact fully, descriptively, and accurately; what you see, hear, feel, and smell; observations about psychosocial interactions, physical symptoms, and behaviors; follow up care; all nursing interventions, treatments, and outcomes; pts subjective feelings and symptoms

documentation don’ts

do not chart opinions that are not supported by facts, do not chart before an event occurs, generalizations, suppositions, or pat phrases

do not defame pts by calling them names or making derogatory statements about them

do not obliterate, erase, alter, or destroy a record

do not leave blank spaces for chronological notes

if an incident report is filed, do not note in the chart that one was filed