Legal & Ethical Issues
· Introduction:
o Nursing competency and patient care accountability are compromised when the nurse has inadequate knowledge about the laws that regulate the practice of nursing.
· Core concepts:
o Ethics is a branch of philosophy that deals with systematic approaches to distinguishing right from wrong behavior.
o Bioethics is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health.
o Moral behavior is conduct that results from critical thinking about how individuals should treat others. This behavior reflects the way a person interprets basic respect for others, including autonomy, freedom, justice, honesty, and confidentiality.
o Values are personal beliefs about what is important. Values clarification is a process of self-evaluation in which people identify their own personal values. This is an important process for nurses so that they may better understand why certain decisions should be made and how their own values may affect nursing outcomes.
o Rights are expectations to which an individual is entitled either by established laws, policies, or ethical principles.
· Nurses should use ethical principles to decide upon ethical issues:
o Autonomy
o Beneficence
o Nonmaleficence
o Justice
o Veracity
· Theoretical Perspectives (ethical theories)
o Utilitarianism: Produces the “most good” (or happiness) to others.
o Kantianism: suggests that decisions and actions are bound by a sense of duty.
o Christian Ethics: Do unto others as you would have them do unto you.
o Natural Law Theory: Do good and avoid evil.
o Ethical Egoism: Decisions are based on what is best for the individual making the decision.
· An operating room nurse asks a psychiatric nurse, “How can you work with the mentally ill day in and day out?” The psychiatric nurse replies, “It’s just the right thing to do.” The psychiatric nurse is operating from which ethical framework?
Kantianism
Christian ethics
Ethical egoism
Utilitarianism
· A Model for making ethical decisions
o Assessment à Gather subjective and objective data.
o Problem Identification à Identify the conflict between two or more alternative actions.
o Planning à Explore the benefit and consequence of each action.
o Implementation à Act on the decision made and communicate to others.
o Evaluation à Evaluate the outcomes.
· Ethical and legal issues in mental health nursing
The right to treatment
The right to refuse treatment (including medications)*
The right to the least restrictive treatment alternative
Confidentiality and right to privacy *
· Informed consent in the psychiatric facility
o Informed consent: the preservation and protection of individual autonomy in determining what will and will not happen to a person’s body.
o Informed consent grants the physician the right to perform a therapeutic procedure. In some cases, treatment may be performed without obtaining informed consent from the client.
o A client or guardian always has the right to withdraw consent after it has been given.
· Restraints and Seclusion
o Seclusion: A type of physical restraint in which the client is confined alone in a room and they are unable to leave.
o Restraints: Leather restraints are used in psychiatric facilities. Also called “4-point restraints”
o Restraint chair: Newer physical restraint used over the past few years; the patient is still restrained but can sit up instead of laying down.
o Seclusion/restraints should never be used for convenience, punishment, extremely physically or mentally unstable patients, and those that cannot tolerate the decreased stimulation of a seclusion room.
o Time limits are based upon the age of the patient. *
o If the need for seclusion or restraints is indicated, the provider must reassess the patient and write another order. *
o Patients should never be left alone in seclusion or leather restraints!
o Documentation should always be completed on the event of seclusion/restraint!
· Hospitalizations/admissions to a psych facility
o Voluntary admission
§ A person chooses to obtain treatment at a mental health facility
§ The client is considered competent and has the right to refuse medications/treatment
§ Sometimes voluntary can become involuntary
o Involuntary admission
§ A person is admitted against their will
§ Admission is based on the need for psychiatric treatment*
§ CON*
o Emergency commitments (Temporary)
§ When a person manifests behavior that is a danger to self or others
§ Time-limited and court hearing must be conducted (Within 72 hours)
§ The court will decide if the person should be discharged or involuntarily committed
o Long-term involuntary admission
§ Similar to temporary commitment but must be imposed by the courts.
§ Time will vary on LOS
· A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency commitment?
A client who has schizophrenia with delusions of grandeur.
A client who has manifestations of depression and attempted suicide a year ago.
A client who has borderline personality disorder and assaulted a homeless man with a metal rod.
A client who has bipolar disorder and paces quickly around the room while talking to themselves.
· Nursing Liability: Unintentional torts
o Negligence
o Malpractice
· Nursing liability: Intentional Torts
Assault
Battery
False imprisonment
Invasion of privacy
Defamation of character
Slander
libel
· A nurse gave a patient 5 mg of haloperidol (Haldol) for agitation. The patient’s chart was clearly stamped “Allergic HALDOL.” The client suffered anaphylactic shock and died. How would the nurse’s actions be labeled?
Intentional Tort
Negligence
Battery
Assault
· Avoiding liability
o Proactive nursing actions in an effort to avoid nursing malpractice and lawsuit risk:
Effective communication
Accurate and complete documentation in the medical record
Complying with the standards of care
Knowing the client
Practice within the nurse’s level of competence and scope of practice