Legal & Ethical Aspects of Psychiatric Nursing PDF

Legal & Ethical Aspects of Psychiatric Nursing Introduction The legal context of care is important for all psychiatric nurses because it focuses concern on the rights patients and the quality of care they receive. In the past two decades civil, criminal, and consumer rights of patients hav...

Legal & Ethical Aspects of Psychiatric Nursing Introduction The legal context of care is important for all psychiatric nurses because it focuses concern on the rights patients and the quality of care they receive. In the past two decades civil, criminal, and consumer rights of patients have been established and expanded through the legal system. Psychiatric nurses must become familiar with the legal provisions of the state in which they practice. This knowledge enhances the freedom of both the nurse and the patients and ultimately results in better care for psychiatric patients. Hospitalizing the patient: (Admission): There are three major types of admission; informal, voluntary and involuntary. 1. Informal Admission: Entry into and release from the hospital is orally requested by patient. The individual is free to leave at any time if patients leave before treatment is completed. They are often asked to sign themselves out "against medical advice" (AMA) but are not required to do so. 2. Voluntary Admission: The admission is through written application by the patient or the patient's guardian. The individual agrees to receive treatment and abide by hospital rules. Individuals may seek help based on their personal decision or the advice of - 36 - family or healthy professional. In most state children under the age of 16 years may be admitted if their parents sign the required application form. Voluntary admission is preferred because it is similar to a medical hospitalization. It indicates that the individual acknowledges problems in living, seeks help in coping with them, and will probably actively participate in finding solutions, voluntary patient have the right to demand & obtain discharge. 3-Involuntary hospitalization (admission) Involuntary admission means that the patient did not request hospitalization it is necessary when a person is a danger to him or herself or others as a result of a mental disorder or when a person is in need of psychiatric treatment. Category of involuntary admission: A- Emergency Hospitalization: Is necessary for patient who is actually ill. The goals are short term and are primarily intended to control an immediate threat to self or other. The length of emergency admission is from 48 to 72 hours police officers, physicians and psychiatrists may be designated by the government to authorize the detention of mentally ill persons who are dangerous to themselves or others. B-Short-term or observational Hospitalization: The primary purpose is observation, diagnosis, Treatment of person who suffers from mental illness or poses a danger to themselves or others. A person's admission is through medical certificate by two physicians that a person is mentally ill and is in need of treatment. - 37 - C- Long-Term Hospitalization (Indeterminate or Extended) The primary purpose is extended care and treatment of mentally ill person. The person is admitted through Judicial or administrative action or medical certification as the observational involuntary hospitalization. This type of admission last 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 incidence of violence among psychiatric patients is the same as that among the general population. Only certain mental disorders and under certain conditions does mental illness result in violence. No differences were found between mentally disordered and non mentally disordered suspects regarding the type of crimes committed. Discharge of mentally ill patients: Voluntary patients have the right to demand and receive release. They can be brought back to the hospital only if they agree. Involuntary patients don't have the right to demand and receive release except after court order or medical certificate that their condition has improved. Patient’s status should be reviewed periodically. The patient may also apply for another commitment hearing if a committed patient leaves secretly. The staff has the legal obligation to notify the police frequently, these patients return home or visit family or friends and can be easily located. Kinds of Discharge: There are three kinds of discharges: conditional, absolute, and judicial discharge - 38 - 1. Conditional Discharge: Usually requires outpatient treatment for a specific period to determine (the client's compliance with medication, ability to meet his or her basic needs. The ability to reintegrate into the community.  Its advantage is that it allows the patient gradual integration into the community.  If at the end of the conditional period the patient has adjusted well. The hospital can issue an absolute discharge. 2. Absolute Discharge: It's a final discharge it occurs when the patient can function well in the community. However, there are also cases when patient who have not improved are unlikely to do so in the future are granted absolute discharges. In these instances, families or guardian are contacted to arrange satisfactory care for the patient, in this type of discharge if the patient needs to return to the hospital at some future time new admission proceedings must begin. 3. Judicial Discharge: The law allowing patients or their families the right to appeal for a discharge even though the hospital does not agree with the discharge request. This gives the patients and their families another opportunity if they believe hospitalization is no longer appropriate. Patients Rights: In recent years the civil & personal rights of the mentally ill have been supported in legislative acts throughout the country. - 39 - Patients presently have the following right: 1. Right to communicate with people outside the hospital. This right entails the freedom of (the patient to hold telephone conversation in privacy & send unopened letters to anyone of his choice. 2. Right to keep personal effects. The right to being clothing & personal items with him to the hospital taking into consideration the amount of space available for storage of them. 3. Right to religious freedom 4. Right to be employed if possible The right to work whenever possible & (the right to be compensated for it). 5. Right to education This right is being exercised by many parents on behalf of their emotionally ill or mentally retarded children. 6. Right to independent psychiatric examination The patient has the right to demand a psychiatric examination by a physician of this own choice. 7. Right lo privacy It implies the right of the patient to keep some information about himself completely secret from others. It is the responsibility of every psychiatric professional to sale guards a patient's right to confidentiality in all aspects of psychiatric treatment, including - 40 - even the knowledge that a person is in therapy or in a hospital in some situations breaking confidentiality is both ethical & legal. 8. Right to informed consent Informed consent means a physician must give the patient a certain amount of information about the proposed treatment & must attain the patients consent. Consent forms usually require the signature of the patient or a family member. Nurses are frequently responsible in this regard. In the hospital has the right to treat the patient. 9. Right to Treatment Important factors in applying psychiatric treatment are:  Patient preference regarding treatment when competent.  Person's religious belief.  The effect of treatment, or lack of it, on the person's family.  The probability of an adverse side effect.  The risks involved in the refusal of the treatment.  The prognosis with treatment. 10. Right to treatment in the least restrictive setting Its goal is evaluating the specific needs of each patient & maintaining the greatest amount of personal freedom, autonomy, dignity, & integrity in determining treatment. Issues related to the use of seclusion & restraints are of particular concern. There must be adequate rationale for the use of these practices. Documentation should include a description of the precipitin even that led to seclusion or restraint. Medication if used to prevent violence, suicide, or preserve security, can be viewed as a "chemical, restraint" & justified as a "Public protection" not just an individual treatment. - 41 -