Psychiatric Nursing Legal Aspects Quiz

Legal and Ethical Aspects of Psychiatric Nursing

• The legal context of care is important for psychiatric nurses, focusing on patient rights and the quality of care.
• Civil, criminal, and consumer rights of patients are established and expanded through the legal system.
• Psychiatric nurses must be familiar with the legal provisions of their state of practice, enhancing the freedom of both nurses and patients, leading to better care.

Hospitalizing a Patient (Admission)

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

1. Informal Admission

• Entry and release from the hospital is orally requested by the patient.
• Patients are free to leave at any time, even before treatment is completed.
• They may be asked to sign themselves out "against medical advice" (AMA), but it's not mandatory.

2. Voluntary Admission

• Admission is through a written application by the patient or their guardian.
• The individual agrees to receive treatment and follow hospital rules.
• Individuals may seek help based on their personal decision or medical advice.
• This is preferred because it is similar to a medical hospitalization, reflecting the patient's acknowledgment of problems and their active participation in finding solutions.

3. Involuntary Admission

• The patient did not request hospitalization.
• It's necessary when a person is a danger to themselves or others due to a mental disorder or when they need psychiatric treatment.

A. Emergency Hospitalization

• Necessary for patients who are acutely ill, primarily to control an immediate threat to self or others.
• Duration is 48 to 72 hours.
• Police officers, physicians, and psychiatrists can authorize the detention of those who are a danger to themselves or others.

B. Short-Term or Observational Hospitalization

• The primary purpose is observation, diagnosis, and treatment of individuals with mental illnesses who pose a danger to themselves or others.
• Admission is through a medical certificate from two physicians, confirming mental illness and need for treatment.

C. Long-Term Hospitalization (Indeterminate or Extended)

• The purpose is extended care and treatment of mentally ill persons.
• Admission is through judicial or administrative action or medical certification.
• It lasts for an indefinite time or until the patient is ready for discharge.

Dangerousness of Mentally Ill Persons

• Most mentally ill persons are not dangerous to themselves or others.
• Studies show that the incidence of violence among psychiatric patients is similar to that in the general population.
• Only certain mental disorders and circumstances can lead to violence.

Discharge of Mentally Ill Patients

• Voluntary patients have the right to demand release, and can only be brought back if they agree.
• Involuntary patients do not have the right to demand release except under court order or when medical certification shows improved condition.
• Patient status should be reviewed regularly.
• Committed patients who leave secretly can apply for another commitment hearing.
• Hospitals have the obligation to notify the police and these patients often return home or visit friends and family.

Kinds of Discharge

• There are three kinds of discharges: conditional, absolute, and judicial.

1. Conditional Discharge

• Usually requires outpatient treatment for a specific period to determine the client's compliance with medication and ability to reintegrate into the community.
• It allows for gradual integration into the community.
• The hospital can issue an absolute discharge if the patient has adjusted well.

2. Absolute Discharge

• This is a final discharge that occurs when the patient can function well in the community.
• Patients who haven't improved, but unlikely to in the future, can receive absolute discharge.
• Contacting families or guardians to arrange care is necessary.

3. Judicial Discharge

• Patients or their families can appeal a hospital's discharge decision if they feel it's not appropriate.

Patient Rights

• In recent years, the legislative acts have supported the civil and personal rights of the mentally ill.

1. Right to Communicate

• Patients can communicate with people outside the hospital, hold telephone conversations, and send unopened letters.

2. Right to Keep Personal Effects

• Patients can keep their clothing and personal items in the hospital considering storage space.

3. Right to Religious Freedom

• Patients have the right to follow their religious beliefs.

4. Right to Be Employed

• Patients, when possible, have the right to work.

5. Right to Education

• Parents can exercise this right on behalf of emotionally or mentally challenged children.

6. Right to Independent Psychiatric Examination

• Patients can demand a psychiatric examination by a physician of their choice.

7. Right to Privacy

• Patients have the right to keep some information confidential.

8. Right to Informed Consent

• Physicians must inform patients about proposed treatments and obtain their consent.
• Nurses often are responsible for ensuring appropriate consent processes

9. Right to Treatment

• Important factors in psychiatric treatment include patient preference, religious beliefs, family impact, potential side effects, and prognosis.

10. Right to Treatment in the Least Restrictive Setting

• The goal is to maximize personal freedom, autonomy, dignity, and integrity in treatment decisions.
• Rationale for using seclusion or restraints must be documented.