1125 Unit 1 Legal, Ethical, & treatment issues in Psychiatric Nursing
Unit Introduction
Instructor: M. Shackelford MSN, RN
Foundational Concepts of Mental Health Nursing
Covers Chapters 1, 2, & 6
Perspectives on Mental Health
Notably stigmatized clients often feel isolated.
How Mental Health Affects Us
Emotions & emotional well-being: Influences how we feel.
Thinking & Learning: Affects cognitive functions and ability to learn.
Communicating: Impacts how effectively we interact with others.
Resilience: Our ability to bounce back from challenges.
Self-esteem: Influences personal value and confidence.
Relationships: Affects personal and social connections.
Daily functioning: Overall ability to perform daily tasks.
What is Mental Illness?
A wide range of conditions related to mental and emotional health.
Disrupts mental wellness and is associated with distress and problems functioning in social, work, or family activities.
Causes: Does not occur from a single case but involves multiple factors.
Impact of Mental Illness
Associated with distress and problems in:
Daily functioning: Impacts social and family relationships, work or school performance.
Risk Factors:
Traumatic life experiences
Feelings of loneliness or isolation
Substance use
Biological or genetic predispositions
Leads to changes in emotions, thinking, and behavior.
Examples of Mental Health Disorders
Types of Disorders:
Neurodevelopmental disorders
Neurocognitive disorders
Schizophrenia spectrum disorders
Anxiety disorders
Eating disorders
Each disorder is categorized by clinical manifestations.
Populations at Risk for Mental Illness
Underserved Individuals:
Social determinants of health
Adverse childhood experiences
Geographic or environmental settings
Marginalized social or ethnic groups
Specific Populations:
Incarcerated individuals
Homeless community
Important History of Mental Health
National Mental Health Act of 1946: Aims for improvement in mental health of U.S. citizens, led to the establishment of the National Institute of Mental Health (NIMH).
Community Mental Health Act (CMHA) of 1963: Promoted deinstitutionalization and enhanced care within the community, though it had unintended effects.
The Mental Health Continuum
Ranges from excellent well-being to mental illness, with everyone on this continuum.
Each person's experience is unique and fluctuates throughout life, reflecting daily functioning.
VC Zones on the Continuum
Zones Include:
Surviving
Thriving
Struggling
Excelling
Crisis
Well-being
Mental illness
Mental Health Continuum Self-Check Tool
Framework for assessing mental health status spans from reacting and injured to healthy alongside well-being and mental illness.
Continuum of Care
Wellness Paradigm: Includes a wellness-illness model.
Considers general areas of health across a continuum from poor health to optimal well-being.
Diathesis-Stress Model
A two-part theory describing:
Diathesis: Genetic or biological predisposition to mental illness.
Stress: Environmental changes that trigger symptoms of mental illness.
Contributing Factors to Mental Health
Includes household, community, and broader local and global factors affecting mental health.
Mental Health Care Settings
Types of Care Providers:
Primary care providers
Outpatient mental health clinics
Case management services
Home-based services
Telehealth
Mobile mental health crisis teams
Day treatment facilities
Family and peer services
Outpatient settings
Crisis Treatment Settings
Settings Include:
Crisis stabilization beds
Community-based hospitals
State hospital facilities
Transitional or respite facilities
Long-term facilities
Substance use disorder treatment centers (Detoxification and acute residential treatment)
Inpatient care settings.
Specialty Mental Health Care
Encompasses military veteran care, pediatric/adolescent care, geriatric care, and forensic care.
Health Interventions in Mental Health
Intervention Levels:
Primary prevention
Secondary prevention
Tertiary prevention
Mental Health Prevention for Children
Tiers of Prevention:
Tier 1: Universal promotion
Tier 2: Targeted prevention
Tier 3: Individualized intensive support
Emphasizes a multitiered system approach for mental health interventions for school-aged children.
Disparities in Mental Health Care
Resulting disparities linked to:
Social inequities
Discrimination
Adverse early life experiences
Inadequate education
Key impacts: unemployment, poverty, inadequate living conditions, reduced quality of life, and social well-being.
Social Determinants of Mental Health
Factors such as environmental influences and individual attributes impacting mental health outcomes.
Accessibility of Mental Health Care
Factors Impacting Accessibility:
Distance to providers
Availability of transportation: adequate, safe, or available
Variations in care access between rural and urban settings.
Cultural Competence in Mental Health Care
Impacts of Lack of Cultural Competence:
Limited access to quality care
Perceived discrimination, discouragement, or discontinuation of treatment
Key factors for effective culturally competent care: race, gender identification, and shared language or culture.
Economic Factors Affecting Mental Health Care
Issues include:
Affordability and economic hardships
Lack of adequate insurance
High costs and deductibles linked to mental health care.
Strategies to Reduce Disparities
Recommendations include:
Culturally sensitive client-centered care
Diversity in workforce
Awareness raising on mental health disparities
Promote cultural and language competence in care.
Importance of education on social determinants of health in nursing school.
Advocate for system changes to reduce disparities.
Importance of Culturally Sensitive Nursing Care
Implementing cultural humility in practice:
Client-centered, respectful, and holistic approaches
Recognition of power imbalances and understanding client cultural practices and values.
Promotes client-nurse relationships and empowers client autonomy.
Team Roles and Responsibilities in Mental Health
Intraprofessional and Interprofessional Teams:
Involve professionals such as psychiatrists, psychologists, social workers, occupational therapists, counselors, and psychiatric pharmacists.
Professional Nursing Values
Adhere to ANA Nursing Scope and Standards of Practice.
Abide by the ANA Code of Ethics for Nursing.
Ethical Principles in Mental Health
Key ethical principles include:
Beneficence
Autonomy
Nonmaleficence
Justice
Fidelity
Veracity
Confidentiality
Ethics: Principles and Rights
Ethical considerations related to informed consent and boundary violations.
Informed Consent in Mental Health
Must include:
Description of treatment
Possible benefits and risks
Consequences of not receiving treatment
Available alternatives
If the client cannot provide consent, a legally determined alternate decision-maker is necessary.
Implied Consent in Emergency Situations
Occurs when the client is unconscious or unable to consent and legal representation is unavailable.
Capacity vs. Competence
Capacity: Medical term assessing cognitive function and ability to consent, determined by qualified providers.
Competence: Legal status determined by a judge, indicating whether a person can make decisions and provide informed consent.
Mental Health Policy and Parity
Key Acts:
Mental Health Parity and Addiction Equity Act (2008)
Patient Protection and Affordable Care Act (2010)
Health Care and Education Reconciliation Act (2010)
Client Protection in Mental Health
HIPAA: Ensures health insurance portability and confidentiality.
Duty to warn: Protection protocols for vulnerable individuals.
Types of Admissions in Mental Health
Emergency Hospitalization: Necessary when a client is in crisis, requiring knowledge of state laws regulating admissions.
Admission Types:
Voluntary admissions: Client requests treatment and consents.
Involuntary admissions: Occurs when a client cannot consent.
The Therapeutic Milieu
The therapeutic environment aims to enable clients to learn coping skills, adapt behaviors, interact, and strengthen relationships under nursing supervision.
Restraint and Seclusion Protocols
Involves provider orders, client safety, environmental assessments, and ongoing observation of client response.
Proper release from restraints or seclusion and documentation practices are crucial.
Nursing Considerations in Restraint and Seclusion
While in restraints or seclusion, essential care includes support for safety, ongoing assessment, and fulfillment of basic needs with appropriate medical interventions.
De-Escalation Strategies in Mental Health
Effective strategies include
Calm verbal communication
Non-threatening body language
Respectful, supportive engagement with clients
Setting clear limits within a therapeutic environment.
Least Restrictive Measures in Mental Health
Centers for Medicare and Medicaid Services audit the use of restraints and seclusions, validating the least restrictive alternatives for client safety balanced against their personal liberties.
Types of Restraints
Physical restraints: Use of devices to restrict movement.
Chemical restraints: Medications used to sedate.
Documentation Practices for Restraints
Key documentation includes:
Provider's prescription for restraints
Behavior leading to restraint use
Evidence of de-escalation techniques attempted
Monitoring details recorded every 15 minutes.
Continued Documentation Needs
Pertains to client’s behaviors, consultations, ordering provider details, and responses during restraints or seclusion.
Client Rights in Mental Health Care
Clients have rights including:
Respectful and considerate treatment
Making advance directives
Access to understandable information regarding care and treatment outcomes
Right to refuse recommended treatments
Privacy and confidentiality protection
Continuity of care and informed charges/policies.
The right to review their medical records and decline participation in research studies.