Psych - Ethical & Legal Issues

what is the difference between nursing ethics and laws?

ethics are what we should do, laws are what we must do

are bad, coercive interventions always illegal or against ethics?

no - responsibility of the nurse to safeguard patient

important guidelines for ethical dilemmas:

Guides for Virginia Nurses, Patient's Bill of Rights, Code of Ethics for Nurses

difference between criminal and civil laws:

criminal protect public from danger, civil protect individual rights

what is an unintentional tort law against?

negligence, malpractice

what is an intentional tort law against?

assault, battery, false imprisonment

what is voluntary admission?

patient opts to be hospitalized, is not required to stay

what is involuntary admission?

admission to a hospital that the patient does not want

what are the two criteria for an involuntary admission?

patient poses danger to self/others, patient suffers from a mental illness requiring immediate treatment

what is parens patriae?

state hospitalizing those unable to care for themselves

what is police power (mental health)?

state hospitalizing those who pose a danger to themselves/others

what is an Emergency Custody Order (ECO)?

4 hrs to 5 days of detention, handcuffs, clear and present danger

what is a Temporary Detention Order (TDO)?

48-72 hrs, risk of harm to others or self

what is Extended/Indeterminate Commitment?

60-180 days of hospitalization or care

how long is emergency hospitalization, generally?

48-92 hrs or until either patient or judge decides to have them stay

who must authorize emergency hospitalization?

certified mental health provider, court

what is another term for a writ of habeas corpus?

due process

what are the 3 criteria for due process/habeas corpus?

patient is entitled to meaningful objection, there is adequate notice for a hearing, and the court must rule with evidence

what is conditional release?

a discharge from custody into the community under specific terms and conditions

what is unconditional release?

patient is released with a recommended appointment scheduled from a psychiatrist

what is AMA release?

patient is allowed to leave AMA if they are not a danger to others

what prevents a patient from leaving AMA?

TDOs (allowed to leave when voluntary admit)

guideline 1 for psychiatric admission:

voluntary or involuntary admission does not mean patient is able to make informed decisions

guideline 2 for psychiatric admission

there must be a medical standard or sound justification for admission

guideline 3 for psychiatric admission

psychiatric problem must be established (via DSM-5)

guideline 4 for psychiatric admission

mental illness is causing immediate crisis

guideline 5 for psychiatric admision

expectation that the hospital will improve presenting problem

what type of cognitive issues will not fit under guideline 5 of psychiatric admission?

intellectual disabilities, dementia (tx will not improve mental functioning)

involuntary medications require:

hospitalization, judicial commitment (not voluntary admission), separate judicial hearing

what is our documentation for involuntary medications in the chart?

'committed with medications'

preventing lawsuits of malpractice or negligence requires:

constant documentation, regular monitoring, SI assessments

what is assault?

threat of harm, fear for life or safety

what is battery?

unlawful touching (often concurrent with assault)

what is false imprisonment?

confinement against patient's will (includes chemical use, verbal intimidation)

what are quasi-intentional torts?

defamation, libel, slander, invasion of privacy

what is our duty to warn?

requirement to warn potential victims of forseeable harm - protection of third parties

what are we required to report?

suspected child/elder abuse

what does confidentiality require?

no information to family or others without patient's written consent, including postmortem

what is required for a patient's active participation in care rights?

patients to participate in their own treatment, direct it, or refuse it

what is informed consent?

when a patient has decision making capacity, adequate information and can make voluntary choices

what is capacity?

the clinical determination of if an individual can make health care decisions

what are the four requirements for a patient's capacity?

communicating consistent choices, understanding relevant information, appreciating situation and consequences, reasoning about treatment options

what conditions eliminate presumption for patient capacity?

none - patients are assumed to have capacity until proven otherwise (by MSE)

what is competency?

assessment and legal determination made by a judge in court

what is the least restrictive alternative doctrine?

mandate that the least drastic means must be taken to achieve a purpose

what are the low-level treatments for least restrictive alternative doctrine?

verbal interventions, diversion/redirection, calm environment, prn meds

what do we have to do if we must escalate treatments to more restrictive?

document!

client's right to ___ consent

informed

client's right to ___ treatment

refuse

client's right to ___ in least restrictive setting

treatment

client's right to not be subjected to ___ constraints

unnecessary

client's right to ___ (information and physical)

privacy

client's right to periodic ___ of status

review

client's right to independent ___ examination

psychiatric

client's right to ___ in legal matters

participate

client's right to ___

habeas corpus

client's right to legal ___

representation

client's right to ___ clothes and personal effects

keep

client's right to ___ freedom

religious

client's right to ___

education

client's right to civil ___ status

service

what is seclusion?

confinement of patient in an area, preventing them from leaving

what is not seclusion?

patient opting voluntarily for a time out to decompress

adult limit on restraints

4 hrs

adolescent limits to restraints

2 hrs

children limits to restraints

1 hr

documentation requirements for restraints

assessment q15-30 mins, safety, physical needs, comfort

contraindications for restraints:

unstable condition, severe drug rxn/od, desire for punishment, staff convenience, delirium/dementia, severe suicidal tendencies

what is the priority for a nurse in a violent setting?

self-protection

liability concern - failure to assess ___

risk of suicide

liability concern - failure to properly ___

monitor patient

liability concern - failure to ___ or ___

communicate, document

liability concern - failure to detect ___

drug toxicity

liability concern - failure to protect ___

patient from other patients

liability concern - failure to provide ___

safe environment

liability concern - improper ___

treatment

liability concern - misuse of ___

psychotropic medication

liability concern - breach of __

confidentiality

liability concern - false ___

imprisonment

liability concern - failure to obtain ___

informed consent

liability concern - failure to report ___

abuse

liability concern - failure to warn ___

potential victims

pharmacogenetic testing - ethical issue:

if the results aren't useful, harm may outweigh benefits

predictive psychiatry - ethical issue:

stigmatization (alienation or prevention of employment), autonomy (right to know)