Unit 2: Legalities, ethics and cultural considerations

Individualism

• A Western worldview

• Has historically informed psychiatric mental health nursing in Canada

• Values autonomy & independence

• Mind and body are seen as separate entities

Indigenous

• A common worldview is that the physical, emotional, mental, and spiritual aspects of a person are interconnected

• A person is whole & healthy when in balance

• Medicine wheel

Collectivism

• A worldview embraced by many ethnocultural populations

• Interests of the group have priority over interests of the individual

• Actions reflect everyone connected to the individual

• Decision-making may involve family or community members

Medicine Wheel

Physical Behavior

Mental Behavior

Spiritual Behavior

Emotional Behavior

Jordan River Anderson

spent his entire life in hospital while federal & provincial governments could not agree on who should pay for his in-home medical care

Mr. Brian Sinclair

died of a UTI after waiting for 34 hours in a Manitoba ER without being seen

Ms. Joyce Echaquan

faced racism and discrimination before her death in a Quebec hospital

Immigrant

Someone who is able to freely choose to live permanently in another country.

Refugee

Someone forced to flee due to persecution, war, or violence and cannot return home safely.

6 PRINCIPLES OF BIOETHICS

1. Autonomy

2. Nonmaleficence

3. Beneficence

4. Justice

5. Principle of impossibility

6. Fidelity

Autonomy

respecting the rights of others to make their own decisions (e.g. acknowledging the patient’s right to refuse medication)

Nonmaleficence

the duty to minimize harm and do no wrong to the patient (e.g. by maintaining expertise in nursing skill through nursing education)

Beneficence

the duty to act to benefit or promote the good of others ( e. g. spending extra time to help calm an extremely anxious patient)

Justice

the duty to distribute resources or care equally, regardless of personal attributes (e.g., an intensive care nurse devotes equal attention to someone who has attempted suicide as to someone who has suffered brain aneurysm)

Principle of impossibility

the principle that a right or obligation that cannot be met within the current situation is no longer an obligation

Fidelity

maintaining loyalty and commitment to the patient to perform your duty in the best manner possible

The Alberta Mental Health Act

 Is the guiding document behind keeping mental health clients safe in Alberta

 Discusses making a patient "formal" or "certified"

 Discusses community treatment orders

 Sets out guidelines for CTO's and certification of patients

Formal Patients

• A patient detained in a designated facility

• This process gives authority to care for, observe, examine, assess, treat, detain, & control the patient

• Must meet admission criteria

Formal Patient Admission Criteria

All of the following criteria must be met in the opinion of two qualified health professionals. The person is:

1. Suffering from a mental disorder,

2. Has the potential to benefit from treatment for the mental disorder,

3. Within a reasonable time, likely to cause harm to others or to suffer negative effects, including substantial mental or physical deterioration or serious physical impairment, as a result of or related to the mental disorder, and

4. Unsuitable for admission to a facility other than as a formal patient.

Form 1

PROCESS FOR BECOMING A FORMAL PATIENt

 Upon arrival at a facility, two qualified health professionals must examine a person and complete two admission certificates within 24 hours, in order for the person to be detained as a formal patient

 If brought to a facility under one admission certificate, a second admission certificate must be signed within 24 hours of the person's arrival at the designated facility, or the person must be released on the expiry of 24 hours

 At least one of the admission certificates must be issued by a physician and at least one of the admission certificates must be issued by a member of the staff of the facility

 These two admission certificates give authority to diagnose, care for, observe, assess, treat, detain, and control the person in a facility for 1 month after the second admission certificate is issued

Form 2

EXTENDING DETENTION PERIOD BY RENEWAL CERTIFICATES

 If a formal patient requires hospitalization beyond the period of 1 month from the date the second admission certificate was issued, two qualified health professionals (one psychiatrist and one member of facility staff) can extend the period of detention if admission criteria are met and it is before the expiry date of the second admission certificate

In the first instance of renewal, for 1 month

In the second instance, a further month

In the third and subsequent instances, 6 additional month

Form 7 & 8

Warrant for Apprehension Issued by a Provincial Court Judge

Form 9

Extension of Warrant

Form 10

Apprehension by a Peace Officer

Community Treatment Orders

 A legal document outlining a treatment and care plan tailored to a patient’s specific needs, enabling treatment while living in the community instead of being hospitalized

 Are in effect for 6 months; may be renewed or changed any time before it expires

 Once on a CTO, the patient is no longer considered a formal patient

 If CTO requirements are not met, a health professional can ask a peace officer to bring the patient to the hospital for examination

 Must meet specific criteria to be eligible

False Imprisonment

Detention of a patient with no agency or legal policies to support detention

 Examples:

o Intent to confine to a specific area

o Indefensible use of seclusion or restraints

o Detention of a voluntarily admitted patient, with no agency

or legal policies to support detaining

Chemical Restraints

• Generally considered less restrictive

• Can have a greater impact on the client's ability to relate to the environment

• An effective & helpful alternative to physical restraints when used appropriately

Physical & Environmental Restraints

• Mechanical restraints or seclusion rooms

• Minimal force or treatment is to be used

• When in use, the client must be protected from all sources of time

• Assessment & documentation must be completed