Ethical and Legal Issues (W2)

ethics vs bioethics

- ethics: systematic approaches to distinguishing right from wrong behavior

- bioethics: systematic approaches to distinguishing right from wrong behavior within the scope of medicine, nursing, and allied health

define autonomy

the right to choose/make decisions for self (unless eergency)

beneficence vs nonmaleficence

- beneficence: obligation to do good

- nonmaleficence: obligation not to do harm

fidelity vs veracity

- fidelity: faithfulness/loyalty to a person

- veracity: always telling truth

define paternalism

action performed with the intent of promoting another's good but occurring against the others will/consent

describe the bill of right for person receiving mental health services

all patients should receive a copy that details the appropriate treatment and services that a patient can expect to recieve to support/restrict liberty as necessary (ex. right to revise tx, right to participate/not-participate, right to refuse, free from restraints, confidentiality)

describe self-determinism

having free will to make moral judgements based on internal motivation, focuses on personal autonomy and avoidance of dependence on others

describe the patient self-determination act

- patient must receive info about rights to use or complete advance care docs and refuse treatment

- involves advance care directives (ex. living will or durable power of attorney)

informed consent is a legal procedures to ensure a patient knows...

what can be done to their bodies and minds, as well as the benefits and costs of treatement

describe the duty to warn (tarasoff v regents of university of cali 1974)

you MUST report any specific threat to person/place to the person themselves and to law enforcement

what is the criteria for admission to inpatient MH facility

1. danger to self or others

2. least restrictive environment

3. can benefit from hospitalization

describe the 72 hr hold

INVOLUNTARY hold in hospital for 72 hrs (excluding holidays or weekends) where the patient cannot leave AMA

describe MIW (KRS 202A.026)

"mental inquest warrant": if individual is suffering from Mh disorder, refusing tx or cannot get tx, family can get order to send officers to take individual for assessment

describe the KRS 504.020

"insanity plea": is the person criminally responsible or not, based on their mental status

when is the only time a pt cannot refuse tx

if they are a danger to themselves or others

describe the right to the least restrictive treatment alternative

- if a client can be adequately treated in a n outpatient scenario, they should not be hospitalized

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

what is the idea of false imprisonment

restraints are never to be used as punishment or for the convenience of staff

what are the 2 main categories of restraints

physical (ex. straps) or chemical (ex. haloperidol (meds))

restraints should only be used if...

less restrictive measure have been failed (ex. verbal de-escalation, PRN meds, redirection), and for the shortest duration necessary

what must you have for restraints?

PROVIDERS ORDER

what are the time limits for seclusions/restraints and when the order must be renewed

- >18yrs: 4hr

- 9-17yrs: 2 hr

- <8yrs: 1 hr

- can be renewed per these time increments for up to 24 consecutive hrs

if seclusion/restraint continues, the provider must reassess the patient and rewrite the order every ___hrs

24

generally describe the nurses role duiring restraint/seclusion events

- assess behavior, safety, physical needs

- document every 15 minutes!

- chart precipitating events leading to restraints, alternative action taken, time tx began, pt needs provided for, meds, time released from restraints

libel vs slander

- libel: written defamation

- slander: verbal defamation

assault vs battery

- assault: placing a person in fear or immediate bodily harm

- battery: unlawfully touching a person

what are actions to avoid lawsuits in nursing

- effective communication, accurate/complete documentation, complying with standards of care, practice within scope

if a restrain had to be emergently placed due to violent behavior, when should the provider assess the client to write an order?

60 mins