Legal, Cultural, & Spiritual Concerns of Psychiatric Care

Civil law

Laws involving disputes between individuals, such as a patient and a nurse

Tort

A civil wrongdoing that causes loss, harm, or injury and results in civil liability

Who can be involved in a tort in nursing care?

An individual person (patient) versus another individual (nurse)

What is the most common type of tort applying to nursing care?

Negligence

Negligence

Failure to do, or failure to not do, what a reasonable person would do under the same circumstances

What must be present to prove negligence?

Four elements must be present

Element #1 of negligence

Obligation of reasonable care (standard of care).

Element #2 of negligence

Duty to care

Element #3 of negligence

Breach of duty

Element #4 of negligence

Injury caused by the breach of duty

Malpractice

Professional negligence

What do claims against nurses usually arise from?

The nurse’s failure to prevent harm and uphold the standard of care

When is an employer responsible for an employee’s actions?

When the employee is acting within the scope and authority of employment

What is the Tarasoff Rule?

Mental health professionals have a duty to warn about threats of harm to others

What type of threat is specifically associated with the Tarasoff Rule?

Homicidal ideation or a threat to harm another person

Is the Tarasoff Rule considered a national standard of practice?

Yes

Can a nurse face malpractice for failing to act on a threat?

Yes, if the threat is imminent, foreseeable, and credible

What should a nurse do if a patient discloses a threat to harm someone?

The nurse should act on the threat and follow appropriate safety/professional procedures, because failing to act on an imminent, foreseeable, and credible threat could result in malpractice

What is capacity?

The ability to make informed decisions; determined by a physician or psychologist

Who determines capacity?

A physician or psychologist

What is competency?

A legal determination involving the ability to communicate choices, understand information, and compare the risks and benefits of treatment

Who determines competency?

The law

What is suspension of patient rights?

Patient privileges on and off the unit may be restricted based on the patient’s ability to follow unit rules and risk to self or others

What is the right to treatment in the least restrictive environment?

Freedom from unnecessary restriction when less restrictive and appropriate interventions are available

How quickly must a provider order seclusion or restraint?

Within 1 hour

How often must the order be re-ordered?

Every 2 hours

What type of observation is required for a patient in seclusion or restraints?

Constant observation

How often must the nurse document the patient?

Every 15 minutes

What is voluntary commitment?

The patient consents to treatment and maintains their civil rights

Can a voluntarily committed patient sign out AMA?

Yes, unless the psychiatric provider determines that an imminent risk to self or others is present

What is involuntary commitment?

A patient with legal capacity to consent refuses psychiatric treatment AND presents an imminent risk to self/others or is gravely disabled

What are the criteria for involuntary commitment?

Refusal of psychiatric treatment + imminent risk to self/others OR grave disability

What is the purpose of emergency involuntary commitment?

Acute stabilization

What is emergency involuntary commitment called in Indiana?

Emergency detention, or ED

How long can an ED last in Indiana?

Up to 72 hours, excluding holidays and weekends.

What is short-term commitment?

Care needed for more than 72 hours, granted after a certification/probable cause hearing

What is long-term commitment?

Usually 3, 6, or 12 months for individuals needing long-term psychiatric care who are deemed incapacitated

Can long-term commitment be inpatient or outpatient?

Yes

What is cultural humility?

An ongoing commitment to self-reflection, acknowledgment of personal biases, and recognition of limitations in one’s knowledge

How does culture affect the nurse-patient relationship?

Both the patient’s and nurse’s cultural perspectives can affect the relationship

How might a nurse misinterpret a patient's behavior?

The nurse may interpret normal or culturally relevant behavior as pathological

Referral to what is appropriate for more complex spiritual needs

chaplain

Why might a clinically trained chaplain be more appropriate than community clergy?

Community clergy may not be specifically trained to address the spiritual needs of psychiatric patients

What type of chaplain may be appropriate for psychiatric patients with complex spiritual needs?

A clinically trained, board-certified chaplain