NCMP117 MIDTERM LEC
CHAPTER 9: LEGAL & ETHICAL ISSUES
Rights of Clients and Related Issues
Clients receiving mental health care retain all civil rights, except the right to leave the hospital in cases of involuntary commitment.
Highlights of Patient’s Bill of Rights
Informed about treatment: Clients should be informed about the benefits, qualifications of all providers, treatment options, appeals, and grievance procedures.
Least restrictive environment: Clients have the right to treatment in the least restrictive environment suitable for their needs.
Confidentiality: Clients' privacy must be respected and safeguarded.
Choice of providers: Clients can choose their health care providers.
Professional determination of treatment: Treatment decisions should be made by professionals, not by third-party payers.
Parity: Ensuring equality between mental and physical health treatment plans.
Nondiscrimination: Treatment without discrimination based on race, color, gender, etc.
Comprehensive benefits: All benefits within the scope of the client's plan should be honored.
Accountability: Professionals and payers must be held accountable for harm caused by negligence or poor clinical decisions.
Involuntary Hospitalization
Health care professionals must respect a client's wishes unless they are a danger to themselves or others (e.g., suicidal ideation).
Clients may be hospitalized involuntarily until they pose no danger to themselves or others.
Emergency detentions can last 48 to 72 hours until a hearing is held to determine commitment.
Release from the Hospital
Clients admitted voluntarily can leave unless they are deemed a risk to themselves or others.
Mandatory Outpatient Treatment
Clients may be required to continue treatment involuntarily after hospital discharge, which may include medication adherence and follow-up appointments.
This is sometimes referred to as conditional release or outpatient commitment.
Conservatorship and Guardianship
Conservatorship: A conservator manages the financial affairs of a client unable to do so themselves.
Guardianship: Courts appoint guardians to manage personal affairs and ensure clients receive necessary care.
Clients with guardians cannot enter into legal contracts, and consent must be obtained from the guardian.
Least Restrictive Environment
Clients should be free from restraints or seclusion unless absolutely necessary.
Restraint: The direct application of physical force without consent.
Mechanical restraints: Devices like cuffs used to limit physical aggression.
Seclusion: Involuntary confinement in a locked room monitored for safety.
Confidentiality and Duty to Warn
Governed by HIPAA (Health Insurance Portability and Accountability Act) with civil and criminal penalties for breaches.
Duty to warn: Clinicians may need to inform third parties if a client poses a danger to them, considering specific criteria like the seriousness and accessibility of the threat.
Insanity Defense
M’Naghten Rule: A defendant is not criminally responsible if they did not understand the nature of the act or recognize it as wrong due to mental illness.
Irresistible Impulse: The inability to control actions due to mental illness.
Substantial Capacity Test: Lacks significant capability to understand that the act was wrong.
Durham Rule: Excuses behavior if caused by mental illness.
Torts
Tort: A wrongful act resulting in harm or injury.
Unintentional Torts:
Negligence: Harm resulting from failing to meet a standard of care.
Malpractice: Professional negligence by the health care provider.
Intentional Torts:
Assault: Causing fear of harmful contact.
Battery: Actual harmful contact with the client.
False imprisonment: Unlawful restraint.
Prevention: Safe, competent care and thorough documentation can minimize lawsuits.
Ethical Issues
Ethics involves the principles guiding right and wrong actions.
Utilitarianism: The best action offers the greatest good.
Deontology: Moral obligation over consequences.
Autonomy: Right to self-determination.
Beneficence: Promote good for others.
Nonmaleficence: Avoid causing harm.
Justice: Fairness in treatment.
Veracity: Commitment to truth.
Fidelity: Honor commitments.
Ethical Dilemma: Conflict of ethical principles without a clear resolution.
CHAPTER 10: GRIEF AND LOSS
Grief and Grieving
Grief: Subjective emotional response to loss.
Grieving (Bereavement): The process of experiencing grief,
Anticipatory grieving: Preparing for an imminent loss.
Mourning: Outward expression of grief.
Types of Losses
Hierarchically starts with physiologic needs and safety, moving to relational and self-esteem needs.
Physiologic loss: Amputation, loss of mobility.
Safety loss: Results from violence or abuse.
Loss of security: Relationships ending, such as through death.
Loss related to self-esteem: Changes in self-worth.
Loss of self-actualization: Blockage of fulfillment.
Theories of Grieving (Kübler-Ross)
Denial: Initial shock and disbelief.
Anger: Directed towards self or others.
Bargaining: Hope to postpone loss.
Depression: Deep realization of loss.
Acceptance: Coming to terms with loss.
Dimensions of Grieving
Cognitive: Seeking understanding of the loss.
Emotional: Various feelings expressed.
Spiritual: Exploration of beliefs related to loss.
Behavioral: Actions taken in response to grief.
Physiologic: Physical manifestations of grief.
Nurse’s Role
Encourage clients to engage in meaningful grieving activities (e.g., rituals, memorials).
Recognize disenfranchised grief: Unacknowledged loss affecting relationships.
Vulnerability factors: Impact from lack of recognition of loss can include nontraditional grieving relationships.
Complicated Grieving
Unusual reactions, prolonged grief, or emotion void.
Characteristics of Susceptibility: Includes low self-image, psychiatric history, and unhelpful familial support.
CHAPTER 11: ANGER, HOSTILITY, AND AGGRESSION
Anger and Related Concepts
Anger: Natural emotion in response to provocation that must be managed.
Hostility: Expressed through abuse and disruptive behavior.
Physical aggression: Active harm or damage to others or property.
Catharsis and Aggression Phases
Catharsis: Expressive activities to manage anger.
Stages in aggressive incidents:
Triggering Phase
Escalation Phase
Crisis Phase
Recovery Phase
Post Crisis Phase
Intermittent Explosive Disorder (IED)
Characterized by impulsive aggressive outbursts leading to harm or damage.
Aggression Etiology
Neurobiological Factors: Impact of serotonin and brain structure on aggression.
Psychosocial Factors: Emotional responses to rejection and control desires can lead to aggression, and culture-bound syndromes exist.
Treatment for Aggression
Medications: Carbamazepine and Valproate for aggression; atypical antipsychotics such as Clozapine, Risperidone, and Olanzapine are beneficial.
Benzodiazepines: Reduce agitation in older patients but can complicate issues in those without dementia.
Nursing Process for Aggression
Assessment: Identify factors influencing aggression in the milieu.
Five-Phase Aggression Cycle: Observe and address escalating behaviors effectively.
Nursing Diagnosis: Risk for other-directed violence and ineffective coping.
Intervention: Create structured environments to decrease aggressive behaviors, employ de-escalation techniques, and manage crisis situations empathetically while ensuring safety.
CHAPTER 12: ABUSE AND VIOLENCE
Abuse Definition and Clinical Picture
Abuse: Wrongful use and mistreatment of individuals, affecting individuals across the lifespan.
Victims may present with physical injuries and complex emotional issues.
Common emotional responses include guilt, low self-esteem, and erratic emotional reactions.
Characteristics of Violent Families
Isolation: Families often avoid contact with others.
Power and Control: The abuser usually dominates through power dynamics.
Abuse often perpetuates through generations.
Intimate Partner Violence
Domestic violence: Occurs equally across genders and sexual orientations, marked by control and fear cycles.
Assessment and Intervention for Victims
Assess for physical injuries and emotional states; develop safety plans.
Resources include shelters and restraining orders to provide protection.
Child Abuse Types
Physical: Abusive punishment causing injuries.
Sexual: Involves engagement of children in sexual acts.
Neglect: Withholding necessities for well-being.
Psychological: Emotional harm through verbal abuse.
Elder Abuse Characteristics and Indicators
Elder victims often show signs of neglect or maltreatment in caregiver settings, experiencing physical injuries, emotional distress, or material abuse.
CHAPTER 13: TRAUMA AND STRESSOR-RELATED DISORDER
Posttraumatic Stress Disorder (PTSD)
PTSD: Develops after trauma, with symptoms such as nightmares, hyperarousal, and negative cognition often worsening over time if untreated.
Treatment should aim for early intervention through therapy and counseling.
Dissociation and Related Disorders
Dissociation: A mental defense mechanism against trauma, leading to memory loss and identity fragmentation.
Defines various dissociative disorders such as dissociative identity disorder, amnesia, and detachment experiences.
Nursing Process and Treatment
Involve group therapy and SSRI medications in managing PTSD among patients, ensuring thorough monitoring for safety.
CHAPTER 14: ANXIETY AND ANXIETY DISORDER
Anxiety Overview
Anxiety: A response to perceived threats, leading to varied psychological and physical symptoms.
Distinction between anxiety and fear lies in the context of perceived danger.
Types of Anxiety Disorders
Panic Disorder: Characterized by sudden, intense fear episodes.
Agoraphobia: Fear of situations where escape might be difficult.
Specific and Social Anxiety Disorder: Persistent fears impacting daily functioning.
Treatment Approaches
Include cognitive-behavioral therapy (CBT), medications such as SSRIs, and exposure therapies.
Summary of Key Concepts
Condensed the intricacies of mental health laws, ethical concerns in practice, various grieving processes, anger management, patterns of abuse, trauma-related disorders, and the spectrum of anxiety disorders as fundamental elements in understanding effective nursing interventions and care.