Psych Nursing: Legal & Ethical Considerations

Milieu Therapy

treatment of the environment (physical and psychosocial)

Ethics

A system of moral principles or standards governing conduct

Nonmaleficence

A principle based on the oath of nursing practice to "do no harm"

Beneficence

Preventing harm by removing harmful conditions to benefit the client or others

Fidelity

An ethical principle of fairness, truthfulness, advocacy, loyalty, and dedication in relationships. This significantly includes keeping promises, following through with commitments, and telling the truth

Veracity

Dealing truthfully with clients and others during professional interactions

Justice

The element of **fairness** where each person receives what they deserve and is an essential principle of ethics that influences nursing decisions and care

Confidentiality

The right to keep information private or undisclosed to a third party unless permission is given for disclosure

Boundary Violations

Intentional or unintentional crossing of established boundaries between client and nurse. This may include excessive personal disclosure by the nurse, role reversal, use of social media, or blurring of roles between professional and personal life

Informed Consent

An individual's voluntary agreement to participate in treatment or medical procedures based on their understanding of the risks and benefits as well as any alternative treatments

Burden of Treatment

Negative impact of treatment outweighing potential benefits.

Autonomy

right for a patient for make their own decisions regarding their care

Competence

A client's ability to understand information, use reasonable thought processes, communicate their wishes, and understand the consequences of their decisions.

Capacity

Refers to a client's ability or inability to make decisions about proposed medical treatments or aspects of their health care. Some clients can make straightforward decisions such as taking a medication but lack capacity to determine more complicated decisions

Parity

Equal coverage for mental and physical health in accessibility to health insurance

Support Act

addresses the nations opioid crisis

21st Century Cures Act

focuses on issues of accountability and leadership at the federal level for mental health care and treatment

CARA

increases the availability of resources for treatment and prevention related to substance use.

Mental Health Parity and Addiction Equity Act

requires insurance companies to provide coverage for mental health or substance use disorders comparable to those offered for medical care

Children's Health Act of 2000

focuses on children and adolescents; reauthorizes SAMHSA programs to work to improve mental health and substance abuse services

Patient Record Confidentiality

protects disclosure of client records related to substance use

Involuntary Admission

A type of admission that is initiated for a client who is experiencing severe manifestations of mental illness and is deemed a danger to themselves or others, is unable to meet basic self-care needs, and their illness prevents them from recognizing the need for seeking care; also called assisted inpatient treatment

Voluntary Admission

A type of admission whereby a client recognizes the need for and often requests treatment

Emergency Admission

A type of temporary admission that occurs when a client is an imminent danger to themselves or others and in some cases is detained by law enforcement

Patient Committal Admission

Judge or magistrate reviews and may issue an order for immediate detention by a sheriff, evaluated to determine if a full commitment hearing is necessary

Brought in by sheriff, up to 5 says for court order, deem if they stay or get to leave

Stigma

When a person views you negatively because of a personal trait or characteristic that they think is a disadvantage.

HIPPA

describes clients' rights to confidentiality, as well as the conditions for the use and disclosure of client information

Duty to Warn

Mental health professional's responsibility to break confidentiality and notify the potential victim whom a client has specifically threatened.

Battery

Contact with another person without their consent that is unwanted and considered offensive, regardless of whether an injury occurred.

Incompetent

A legal term whereby a client has been found by a judge to have significant impairment in their ability to make decisions, such as those related to finances, health care needs, and entering into legal contracts -- not able to give informed consent -- go to clients legal representative for informed consent

Surrogate Decison Maker

An individual appointed by a provision of law who makes decisions requiring consent for someone who is not competent to do so

Implied Consent

Occurs in an emergency situation when a client is unconscious or otherwise unable to give informed consent for a treatment or procedure -- exception to informed consent

Psychiatric Advance Directive (PAD)

A legal advance directive whereby a client provides written instructions for their wishes regarding treatment if a mental health crisis should occur and they become unable to make self-care decisions; also called a PAD.

Liable

Responsibility for a violation of a societal, professional, or state standard resulting in injury or harm that the court determines a monetary amount be paid

Assault

A threat made to a client that instills a fear or apprehension of being touched and thus harmed, regardless of whether an injury occurred

Tort

A civil wrongful act that is either intentional or unintentional that results in harm to another person

Negligence

Occurs when any person is careless or fails to provide a basic standard of care to another person; it is the most common unintentional tort. It is most often a failure to provide ordinary care

Malpractice

A specific type of negligence that occurs when a professional fails to follow established professional standards of care when there is the expectation and duty to do so

Intentional Fort

action in which an individual deliberately acts in a way that causes harm to another - like assault, battery, and false imprionment

False Imprisonment

The confinement of a client when there are no legal grounds to do so - includes both mechanical and chemical restraint

Seclusion vs Timeout

Seclusion (restraint) is purposefully keeping patient away unwillingly while timeout (not restraint) allows a moment to themselves and time to think

Affordable Care Act 2010

mandated that mental health care be included in insurance policies

Hospice

End-of-life care, focused on comfort but not prolonging life

Palliative

Specialty of medicine dedicated to caring for clients with severe illnesses, not focused on curing

Incivility

Rude or disrespectful behavior, whether intended to harm or not

Bullying

has intent - purposeful harm and continuous

For an involuntary admission, how many physicians are needed to determine a patients mental health status?

2

How often should documentation take place when patient is in a restraint/seclusion?

15-30 minutes