Nursing Ethics and Legal Responsibilities
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Questions and Answers

What is the most important legal document that must be obtained before a medical procedure?

  • Advance directives
  • Patient's medical history
  • Release of information form
  • Informed consent form (correct)

    • Which ethical principle is violated when a nurse shares a patient's diagnosis with a friend?

  • Autonomy
  • Non-maleficence
  • Beneficence
  • Confidentiality (correct)

    • What is the purpose of mandatory reporting laws in nursing?

  • To track patient outcomes
  • To ensure patient confidentiality
  • To report suspected abuse or neglect (correct)
  • To protect nurses from legal liability

    • Which of the following is NOT a legal responsibility of a nurse?

    <p>Prescribing medications (B)</p> Signup and view all the answers

    Which ethical principle is most closely associated with acting in the best interest of the patient?

    <p>Beneficence (D)</p> Signup and view all the answers

    What is the primary purpose of documentation in nursing?

    <p>All of the above (D)</p> Signup and view all the answers

    Which principle is violated when a nurse provides different levels of care based on a patient's socioeconomic status?

    <p>Justice (A)</p> Signup and view all the answers

    Under what circumstances can a nurse legally disclose a patient's confidential information?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the purpose of the initial evaluation in the involuntary commitment process?

    <p>To determine if the individual is a danger to themselves or others (C)</p> Signup and view all the answers

    Who typically conducts the initial evaluation in involuntary commitment cases?

    <p>A psychiatrist and a mental health professional (D)</p> Signup and view all the answers

    What is the maximum duration of the initial detention in the involuntary commitment process?

    <p>48 hours (D)</p> Signup and view all the answers

    What is the role of the court hearing in the involuntary commitment process?

    <p>To review the initial evaluation and determine if involuntary commitment is necessary (A)</p> Signup and view all the answers

    Who can file an application for emergency detention of an individual in Texas?

    <p>A peace officer, mental health professional, or adult (C)</p> Signup and view all the answers

    What happens if longer-term treatment is deemed necessary for an individual after the initial detention?

    <p>An application for court-ordered treatment must be filed (D)</p> Signup and view all the answers

    What is the timeframe for the court hearing after an application for involuntary commitment is filed?

    <p>Within 14 days (D)</p> Signup and view all the answers

    What is the judge's role in the involuntary commitment process?

    <p>To order temporary or extended commitment based on evidence presented (D)</p> Signup and view all the answers

    How long is an involuntary patient held before a court hearing is required for an extended commitment?

    <p>90 days (B)</p> Signup and view all the answers

    What is the primary reason for involuntary commitment beyond the initial 90-day period?

    <p>Risk of harm to self or others (C)</p> Signup and view all the answers

    What is the role of an attorney in the involuntary commitment process?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT a right of an individual facing involuntary commitment?

    <p>Right to choose their legal representation (A)</p> Signup and view all the answers

    What is the legal process for extending involuntary commitment beyond the initial 90-day period?

    <p>A formal application filed with the court (A)</p> Signup and view all the answers

    When can a voluntary patient leave a treatment facility?

    <p>At any time, with a possible short hold period (D)</p> Signup and view all the answers

    What is required to force an involuntary patient to take medications against their will?

    <p>A court order (B)</p> Signup and view all the answers

    What is the primary goal in balancing an individual's rights with the need for treatment and public safety?

    <p>Providing effective treatment while safeguarding individual rights (C)</p> Signup and view all the answers

    Which of the following is NOT a key area of concern for psychiatric nurses in relation to legal and ethical considerations?

    <p>Providing spiritual guidance and religious support (B)</p> Signup and view all the answers

    Which of these elements should be included in psychiatric nursing documentation?

    <p>Symptoms and their severity, including both psychiatric and physical conditions (C)</p> Signup and view all the answers

    What is a primary reason for maintaining clear communication with patients and other healthcare providers in psychiatric nursing?

    <p>To avoid any misunderstandings and legal complications (A)</p> Signup and view all the answers

    Which of these factors is NOT directly related to minimizing the risk of torts for psychiatric nurses?

    <p>Building strong relationships with patient families (C)</p> Signup and view all the answers

    What is the primary focus of mental status assessment in psychiatric nursing documentation?

    <p>To identify any potential risks to the patient or others, including self-harm or aggression (A)</p> Signup and view all the answers

    Which of these is NOT a key element of proper documentation in psychiatric nursing?

    <p>Inclusion of personal opinions and judgments about the patient's progress (B)</p> Signup and view all the answers

    Why is thorough documentation so important in psychiatric nursing?

    <p>To provide a detailed record of the patient's progress and treatment plan (C)</p> Signup and view all the answers

    What is the most crucial aspect to consider while documenting patient care in psychiatric settings?

    <p>Focusing on capturing key information related to the patient's mental status, treatment, and progress (D)</p> Signup and view all the answers

    What is the primary ethical principle that guides the nurse's decision to balance patient autonomy with safety concerns?

    <p>Respect for persons (C)</p> Signup and view all the answers

    Which of these is NOT considered a key ethical principle that psychiatric nurses should consider when dealing with legal and ethical issues?

    <p>Fidelity (A)</p> Signup and view all the answers

    Which of these is NOT a patient right as listed in the content?

    <p>Right to a Second Opinion (A)</p> Signup and view all the answers

    According to the content, when should a nurse maintain patient confidentiality?

    <p>Except when there is a duty to warn or report (C)</p> Signup and view all the answers

    What is the term used to describe the use of the least invasive interventions necessary to ensure patient safety when restricting their freedom?

    <p>Least Restrictive Environment (A)</p> Signup and view all the answers

    When dealing with a patient who poses a danger to themselves or others, what is the nurse's primary duty of care?

    <p>Protect the patient from harm (C)</p> Signup and view all the answers

    Which legal and ethical consideration emphasizes providing patients with enough context to make informed decisions about their treatment?

    <p>Informed Consent (A)</p> Signup and view all the answers

    What is the primary function of legal requirements in psychiatric nursing?

    <p>To protect the patient's rights (D)</p> Signup and view all the answers

    When assessing the credibility of a threat, which of the following is NOT a relevant factor?

    <p>The student's prior academic performance (B)</p> Signup and view all the answers

    When a student threatens violence, which of the following is NOT a potential target?

    <p>The school counselor (A)</p> Signup and view all the answers

    A nurse's duty to protect the school community in the case of a potential threat balances against which ethical principle?

    <p>Autonomy (C)</p> Signup and view all the answers

    Which of the following actions is NOT recommended when a student discloses a threat of violence?

    <p>Immediately contacting the police (C)</p> Signup and view all the answers

    When balancing confidentiality and duty to protect, which of the following actions is MOST appropriate?

    <p>Sharing only necessary information with appropriate parties (B)</p> Signup and view all the answers

    In the context of a potential threat of violence, which action should NOT be taken?

    <p>Encouraging the student to confide in their friends (B)</p> Signup and view all the answers

    What is the ethical principle that guides the nurse's actions to protect the broader school community from potential harm?

    <p>Non-maleficence (C)</p> Signup and view all the answers

    Which question is LEAST relevant when assessing the immediacy and credibility of a threat?

    <p>What are your plans for the future? (A)</p> Signup and view all the answers

    Study Notes

    • Nursing practice is governed by state laws and regulations, including licensure requirements and scope of practice definitions.
    • Nurses must understand and uphold patients' legal rights, including informed consent, privacy, and confidentiality.
    • Nurses can be held legally accountable for negligence or errors in patient care.
    • Accurate and timely documentation is crucial for legal protection and can be used as evidence in court.
    • Nurses often face situations where legal and ethical considerations intersect.
    • Nurses are often required by law to report certain situations, such as suspected abuse or neglect.
    • Nurses may face criminal charges related to their professional conduct.
    • Understanding legal and ethical intersections is essential for safe, ethical, and legally compliant nursing practice, while providing optimal patient care.

    Objectives

    • Understand how nursing intersects with the legal system
    • Describe issues related to voluntary versus involuntary commitment
    • Recognize patient rights and the nurse's role in protecting those rights
    • Identify concerns related to the nurse-client relationship

    10 Major Ideas

    • Patient Rights
    • Safety
    • Restraints
    • Ethics/Ethical decision-making & Legal issues
    • Informed consent/confidentiality
    • Patient Advocacy
    • Documentation

    Ethical Principles in Psychiatric Nursing

    • Autonomy: Respecting the patient's right to make their own decisions
    • Beneficence: Acting in the best interest of the patient
    • Non-maleficence: Avoiding harm to the patient
    • Justice: Providing fair and equitable treatment to all patients
    • Fidelity: Maintaining trust and keeping promises to patients
    • Veracity: Honesty and truthfulness in communication

    Case Example

    • John, a 28-year-old man with a history of major depressive disorder and generalized anxiety, struggles with suicidal thoughts.
    • He is admitted to a psychiatric hospital and Dr. Patel discusses treatment options, including medication and CBT.
    • Dr. Patel supports John's choice to try therapy first; respecting John's right to participate in treatment options and respect his choice.
    • He is fully informed about options to avoid distress or side effects associated with medications.
    • Voluntary patients generally have more rights than involuntary patients, including the ability to request discharge (though there may be subject to a short hold period), and greater control over treatment decisions.
    • However, the line between a voluntary and involuntary status can be blurry.

    Admission Process

    • Voluntary admission typically requires the patient to sign consent forms.
    • Involuntary commitment usually involves a legal process, often initiated by a mental health professional or law enforcement.
    • Emergency involuntary holds (EDO) may precede longer-term commitment.

    Civil Commitment

    • Action involves involuntary commitment in a hospital or mental health facility to protect the individual and their well-being, like a parent protecting a child.
    • An individual can voluntarily admit themselves to a facility; staff will determine whether or not treatment and extended stay are needed.

    Criteria for Involuntary Commitment

    • Danger to Self: Individual poses a clear and imminent risk of serious harm to themselves (suicidal behavior or intent).
    • Danger to Others: Individual poses a significant risk of harm to others (threats or violent behavior).
    • Grave Disability: Individual is unable to care for basic needs (e.g., food, clothing, shelter) due to mental illness.
    • Severe Mental Illness: Individual has a mental illness that severely impairs judgment, behavior, or reality.
    • Lack of Insight: Individual is unaware of their condition (anosognosia) and refuses treatment despite risk.
    • Inadequate Alternatives: Less restrictive interventions have been tried, and the individual's situation requires a structured hospital environment.

    Procedures in Involuntary Commitment

    • A family member, mental health professional, or primary care practitioner can request a court order for evaluation.
    • The judge agrees, and an initial evaluation is ordered by mental health professionals or physicians.
    • Two professionals (psychiatrist and mental health professional) evaluate the individual's mental state, capacity for self-care, and risk of harm.
    • A formal hearing follows with testimony from examiners, family, friends, and the individual, often with legal representation for the person.

    Involuntary Commitment in Texas

    • Emergency detention involves taking the person to an inpatient mental health facility for evaluation which can last up to 48 hours, initiated by a peace officer.
    • Alternatively, an adult can file an application for emergency detention with the court and the involved individuals. 

    Length of Stay (LOS) and Discharge

    • Voluntary patients can theoretically leave at will, but may face a short hold period if they request discharge.
    • Involuntary patients are held for a set period determined by law, varying by jurisdiction.
    • Extending involuntary commitment usually requires additional legal proceedings.

    Treatment

    • Involuntary patients may be forced to take medications or undergo other treatments against their will, requiring a court order to override civil rights.

    Perception and Stigma

    • Involuntary commitment can be stigmatizing and traumatic for patients.

    Ethical Considerations

    • Balancing patient autonomy with the need to protect individuals.
    • Concerns about coercion and the use of involuntary treatment.
    • Debate over the effectiveness and potential harm of forced treatment.
    • Understanding these issues is vital for mental health professionals as the voluntary/involuntary distinction significantly impacts patient care, rights, and outcomes.

    Mental Health Clients' Rights

    • Treated with dignity, respect, and consideration for personal autonomy.
    • Freedom from discrimination based on race, ethnicity, age, gender, sexual orientation, disability, or other protected characteristics.
    • Protection from physical, sexual, or emotional abuse and inhumane treatment.
    • Confidentiality of personal information and communications, within legal limits.
    • Right to give informed consent or refuse any service/treatment.
    • Freedom from unnecessary restraint or seclusion.
    • Inform of and refuse any unusual or hazardous procedures.

    Intentional Torts

    • Nurses aren't immune to criminal prosecution if they break the law.
    • Examples include negligent homicide, insurance fraud, theft of narcotics, manslaughter, and falsifying medical records.

    Assault

    • Causing fear or apprehension of physical harm in a patient.

    Battery

    • Touching a patient without consent or beyond the scope of consent. 

    False Imprisonment

    • Confining or restraining a patient against their will without proper justification.

    Invasion of Privacy

    • Violating a patient's right to privacy and confidentiality.

    Defamation (Slander/Libel)

    • Making false statements about a patient or disclosing private information without authorization.

    • Assault is a valid claim if the alleged victim is aware of potential harm and the actions reasonably induce fear of bodily harm.

    • Battery is the intentional, wrongful physical contact without consent. 

    • The victim must be aware of potential harm in assault; in battery, the victim does not need to be aware.

    Unintentional Torts

    • Negligence: Failing to exercise ordinary care.
    • Malpractice: Specific form of negligence by licensed healthcare professional.
    • Fraud: Deceiving a patient for personal gain.

    Psychiatric Nursing & Ethical Considerations

    • Obtaining proper informed consent.
    • Respecting patient autonomy.
    • Maintaining confidentiality.
    • Proper assessment and monitoring of patients.
    • Properly documenting patient care and communications.
    • Following proper procedures for involuntary commitment and restraint.
    • Properly administering medication and monitoring side effects.

    The Nurse-Client Relationship

    • Confidentiality and duty to warn
    • Protecting patient's confidentiality unless a duty to warn/report exists.
    • Recognizing the therapist-client relationship concerns
    • Legal and ethical obligation to clients in the context of the nurse-client relationship.
    • The therapist's responsibility to warn if present danger to another exists, even if the threat is nonspecific (e.g. from Tarasoff v Board of Regents case).

    Key Principles of the Tarasoff Ruling

    • Duty to Protect: Mental health professionals have an obligation to take reasonable steps to protect identifiable individuals threatened.
    • Duty to Warn/Notify Authorities: Warning the potential victim or notifying authorities who can protect them.
    • Assessment of Threat: Professionals must evaluate seriousness and credibility of threats.
    • Balancing Confidentiality and Public Safety: Prioritizing public safety and balancing it with patient confidentiality. 

    Implications for Nursing Practice

    • Threat Assessment: Nurses must be vigilant in assessing and documenting potential threats made by patients.
    • Reporting Protocols: Nurses must familiarize themselves with facility protocols for reporting threats and concerns.
    • Collaboration: Working closely with the healthcare team, including mental health professionals.
    • Documentation: Thorough and accurate documentation of patient statements, behaviors, and nurse actions.
    • Ethical Considerations: Balancing patient confidentiality with the duty to protect potential victims.
    • Legal Awareness: Understanding state-specific laws regarding the duty to warn.

    Restraints

    • Last resort measure used after other de-escalation techniques fail.
    • Alternatives like verbal de-escalation, medications, and environmental modifications should be attempted first.
    • Restraints are only used for immediate safety risk.
    • Follow facility policies and relevant laws/regulations.
    • Physician order is required.

    Key Points About Applying Restraints

    • Orders are time-limited, renewed based on reassessment.
    • Restraints removed as soon as patient is no longer a danger.
    • Documentation with rationale, alternatives attempted, patient response.
    • Patient informed of reasons for restraint use.
    • Post-incident debriefings for identifying future prevention methods.
    • Awareness of physical and psychological risks for restraint use. 

    Patient's Rights in Psychiatric Settings

    • Patients admitted to psychiatric facilities maintain their civil rights.
    • Rights to information, treatment decisions, least restrictive environments, choice of providers, confidentiality, nondiscrimination.
    • Treatment is determined by professionals, not third-party payers. 

    Key Considerations in Ethical/Legal Situations

    • Patient rights and autonomy (respecting patient's decisions when competent).
    • Safety and duty of care (protecting patients from harm).
    • Least restrictive environment (using least restrictive interventions possible).
    • Ethical principles (beneficence, non-maleficence, justice).
    • Legal requirements.
    • Informed consent (providing adequate information for informed decisions).
    • Confidentiality (except when a duty to warn exists).
    • Patient advocacy (advocating for patient rights).
    • Documentation, of the entire process (clinical reasoning, ethical considerations and decision-making).

    Table Talk: Discussion Points

    • Assessing immediacy and credibility of threat.
    • Identifying potential victims.
    • Legal/ethical implications to the nurse.
    • Appropriate steps for the nurse to take.
    • Balancing patient confidentiality with duty to protect.

    Specific Scenarios (Examples)

    • High school student threatened to bring gun to school
    • Patient alleging food poisoning by spouse
    • Patient with paranoid delusions believing neighbor is spying.

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    Related Documents

    Legal and Ethical Issues Concerning Nursing Practice PDF

    Description

    Test your knowledge on the crucial legal documents and ethical principles in nursing. This quiz covers topics such as patient confidentiality, documentation, and the involuntary commitment process. Evaluate your understanding of the responsibilities and ethical obligations of nurses in various scenarios.

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