Client and Mental Health Team Member Safety – Legal and Ethical Considerations

• Milieu Therapy

• Therapeutic “milieu” – “healing environment”

• Organized and focused on healing

• Develop life and social skills 

• Components of Therapeutic Milieu

  • Developing

• Developing physical healing spaces (physical environment)

  • Ensure safety.

  • Ensure healing.

• Components of Therapeutic Milieu

  • Creating

• Creating a healing culture (psychosocial environment)

  • Developing awareness and intention for healing with client and staff.

  • Ensuring experiences for personal wholeness.

  • Cultivating healing relationships.

  • Applying collaborative therapies.

• Ethics: Principles and Rights

• Autonomy

• Nonmaleficence

• Beneficence

• Fidelity

• Veracity (truthfulness)

• Justice

• Code of Ethics for Nursing

• Purpose

  • Guidance for practice

  • Commitment and duty to society

  • Decision-making

• Ethical dilemma

• Nursing obligation

• Client Rights to Privacy

• Clients’ Bill of Rights

• Confidentiality

• Privacy

• Exceptions to confidentiality and privacy

  • - Danger to self

  • - Duty to warn

  • - Evidence of abuse or client report of abuse

• Informed Consent

  • Must include

• Description of treatment 

• Possible benefits from treatment 

• Possible risks involved in receiving the treatment 

• Possible consequences of not receiving the treatment 

• Alternative treatments availible 

• Client is unable to provide informed consent 

• Deemed legally as mentally inconpetent 

• Alternate decision maker 

• Psychiatric Advanced Directives (PAD)

• - Self-direction

• - Autonomy

• Health care power of attorney

• - Names surrogate decision-maker

• Advanced directives for mental health care

• - Treatment choices

• - Medication choices

• - Choices of provider

Torts

• Unintentional

  • Negligence

  • Malpractice

• Intentional

  • Assault

  • Battery

  • False imprisonment

• Documentation – Legal Considerations


• Evidence in lawsuits, including malpractice 

• Record of client progress

• Record of nursing care

• Description of client behavior and response to care

  • - Detailed and accurate

  • - Nonjudgmental

• Trauma-Informed Approach

• Create a culture of empathy

• Restraints/seclusion perceived as assault

  • Cultural considerations

  • Previous experiences

• Consider psychological and emotional risk

• Restraint and Seclusion Protocols

• Provider order

• Continuous focus on client safety and well-being

• Environmental considerations

• Observation and client response

• Care of client’s basic needs

• Release from restraints/seclusion

• Documentation

• Nursing Consideration: Restraints or Seclusion

  • While the client is in restraints or in seclusion, care must include:

• Support and reassurance of their safety.

• Ongoing assessment of circulation and skin integrity.

• Care of basic needs such as hydration, food, and elimination.

• Range of motion.

• Medical interventions including medications.

• Evaluation of response to the intervention of seclusion or restraints and readiness for release.

• Documentation of Restraints

• Client behavior leading up to the restraint

• Who was consulted before restraining

• Ordering provider of restraints or seclusion

• All interventions prior and during restraints or seclusion

• Client response to restraints or seclusion

• Client Rights to Treatment

• Publicized rights 

• Right to treatment

• Right to refuse treatment

  • Cost

  • Lack of understanding

  • Second opinion

  • Serious mental illness (SMI)

• Least-restrictive setting