Legal & Ethical Aspects of Psychiatric Nursing

Legal & Ethical Aspects of Psychiatric Nursing

• The legal context of care is crucial for psychiatric nurses, focusing on patient rights and quality of care.
• Patient rights (civil, criminal, and consumer) have expanded through the legal system.
• Psychiatric nurses must understand the legal provisions of their state of practice. This enhances both nurse and patient freedom, ultimately improving psychiatric care.

Hospitalization of Patients (Admission)

• There are three types of admission: informal, voluntary, and involuntary.

Informal Admission

• Patients request entry and release orally.
• Patients can leave at any time, even before treatment completion.
• Patients may be asked to sign themselves out "against medical advice" (AMA), but it's not mandatory.

Voluntary Admission

• Admission is through a written application by the patient or guardian.
• The individual agrees to treatment and hospital rules.
• Patients may seek help based on personal decision or professional advice.
• This type of admission is preferred as it mirrors a typical medical hospitalization.
• Patients have the right to demand and obtain discharge.

Involuntary Admission

• Admission is without patient request.
• It's necessary when a person is a danger to themselves or others, due to a mental disorder, or in need of psychiatric treatment.

Emergency Hospitalization

• Necessary for acutely ill patients.
• Aims for short-term control over immediate threats to self or others.
• Admission duration is from 48 to 72 hours.
• Police officers, physicians, and psychiatrists can authorize detention of dangerous individuals.

Short-Term or Observational Hospitalization

• Primary purpose is observation, diagnosis and treatment.
• A person is admitted if they have a mental illness or pose a danger to themselves or others, with a medical certificate from two physicians.
• Focuses on extended care and treatment of mentally ill persons.
• Admissions could be ongoing until the patient is ready for discharge.

Dangerousness of Mentally Ill Persons

• Most mentally ill persons are not dangerous.
• Studies show violence rates are similar to the general population.
• Specific mental disorders and conditions can increase risk.
• No differences are found in the offenses committed by mentally disordered suspects compared with non-mentally disordered suspects.

Discharge of Mentally Ill Patients

• Voluntary patients have the right to demand and receive release.
• Involuntary patients can't demand release until a court order or medical certificate states their condition has improved.
• Regular reviews of the patient's status are conducted.
• Patients who secretly leave are subject to the hospital's obligation to alert police.

Kinds of Discharge

• Three kinds of discharges exist: conditional, absolute, and judicial.

Conditional Discharge

• A specific treatment period determines the patient's compliance and reintegration into society.
• Allows gradual adjustment in the community.
• If the patient adjusts, a final "absolute discharge" can follow.

Absolute Discharge

• A final discharge, given when the patient successfully functions in the community.
• Cases where patients don't improve are also considered for absolute discharge.
• Family/guardians are notified to assist in aftercare planning.

Judicial Discharge

• Patients or families can appeal a discharge if they disagree (with the hospital).
• Provides another way for patients and/or families to advocate for appropriate discharge conditions.

Patient Rights

• Civil and personal rights of the mentally ill are legally supported.

Patient Rights (Specific Examples)

• Right to communicate with outsiders (phone, letters)
• Right to personal possessions (clothing, belongings).
• Right to religious freedom
• Right to employment
• Right to education
• Right to independent psychiatric examination
• Right to privacy
• Right to informed consent—doctors must provide adequate treatment information and get the patient's agreement
• Right to treatment in the least restrictive setting—focuses on patient autonomy and preventing unnecessary isolation.