Chapter 5 Ethical and Legal Issues

Legislation determines what is “___” or “___” within a society

“Right” or “Good”

Rights

Expectations

Absolute rights

Legal rights (national vs state)

Utilitarianism

Greatest-happiness principle (What makes happy)

Kantianism

Deontology (duty to do right)

Divine command ethics

Do unto others principle (determined by god)

Natural law theory

As rational humans, we know the difference between good and evil (determined by human nature)

Ethical egoism

Someone’s actions are determined by what is to their advantage (benefit to person)

Ethical dilemmas

A choice between two equally balanced alternatives

Taken no action is considered an action taken

Occurs when there can be more than one right answer

Ethical principles

1. Autonomy

2. Beneficence

3. Nonmaleficence

4. Justice

5. Veracity

Autonomy

Presumes individuals can always make independent choices (informed decisions) (educate those pts)

Beneficence

Good care must include holistic focus

Advocacy (duty to promote care)

Nonmaleficence

Do no harm, intentionally or unintentionally

Justice

Distributive, restorative, and social (right to be treated equally)

Veracity

Refers to one’s duty to always be truthful

Model for making ethical decisions:

1. Assessment

2. Problem identification

3. Plan

4. Implementation

5. Evaluation

Rights of Psychiatric/Mental Health Nursing

1. Right to treatment

2. Right to refuse treatment (with some exceptions)

3. Right to the least restrictive treatment

The right to treatment

Anyone admitted has the right to treatment

The right to refuse treatment exceptions

Involuntary hospitalization

Forced medication

Involuntary hospitalization

In cases of mania, psychosis, or etc.

PEC=72 hours

CEC=15 days

Forced medication

Must meet criteria of either emergency medication or nonemergency medication

Emergency medication

1. Required to prevent harm

2. Physicians order needed

3. Cannot be a punishment or a chemical restraint

Nonemergency medication

1. Reasonable chance to help

2. Incapable of making informed decisions

Right to the least restrictive treatment alternative

Less restrictive (try first) —> most restrictive

If pt is able to remain safe (themselves and others), they cannot be kept against their will

The patient self determination act

Written rights given to patients

The nurse practice acts

Defines terms, education, and scope of practice for nurses

Types of laws

Statutory (congress or state) or common

Confidentiality and right to privacy exceptions:

A duty to warn (3rd parties that may be at risk for harm)

Suspected child or elder abuse

Informed consent

When refusal may be challenged

Elements of informed consent (3):

1. Knowledge

2. Competency

3. Free will

Restraints and seclusion:

Use is controversial

Considered high risk interventions

Specific expectations for use

False imprisonment (threats, meds, restraints, and seclusion (without order)

Last resort

Voluntary admissions

Formal voluntary admission (FVA)

Includes rehab and therapy

Involuntary commitment

Emergency commitments

The mentally ill person in need of treatment

Involuntary outpatient commitment (Court order)

The gravely disabled client (cannot/will not provide basic needs to themselves)

Usually in cases where pt is an imminent danger to self or others

Nursing liability

1. Negligence

2. Malpractice

Negligence

The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation (poor nursing judgement)

Malpractice

Specialized for of negligence caused only by professionals

Basic elements of nursing liability:

A duty to the patient existed

A breach of duty occurred

The client was injured

The injury was directly caused by the breach of a standard of care

Types of lawsuits in psychiatric nursing:

Breach of confidentiality

Defamation of character (Libel and Slander)

Invasion of privacy

Assault

Battery

What does Catalano suggest to avoid malpractice and lawsuit risk?

1. Effective communication

2. Accurate and complete documentation

3. Complying with the standards of care

4. Knowing the client

5. Practice within competence and scope