Unit 1 Ch 4 Ethical and Legal Issues PDF

UNIT 1 - INTRODUCTION TO PSYCHIATRIC/MENTAL HEALTH CONCEPTS CS- ETHICAL AND LEGAL ISSUES PRESENTED BY MRS. KANCHANAMALINI OCHS- NORTH SHARQIYA BRANCH 25/09/2024  2 OBJECTIVES  Defin...

UNIT 1 - INTRODUCTION TO PSYCHIATRIC/MENTAL HEALTH CONCEPTS CS- ETHICAL AND LEGAL ISSUES PRESENTED BY MRS. KANCHANAMALINI OCHS- NORTH SHARQIYA BRANCH 25/09/2024  2 OBJECTIVES  Define the following terms: ethics, moral behavior, values and right, ethical dilemma, ethical principles.  Discuss the following:  Patients rights and responsibilities  Ethical principles  Ethical issues  Legal issues relevant to psychiatric mental health nursing.  Identify the difference between restraints and seclusions.  Commitment issues. Ethical &Legal Issues 9/25/2024  3 Content  Ethics, morals behaviour, values and right, ethical dilemma, ethical principles (pp. 59- 73)  Bill of rights for psychiatric nursing (please see attachment pp. 56-60 )  Autonomy, beneficence, non-maleficence, justice and veracity  Right to refuse medication  Confidentiality and Right to Privacy, Informed consent, Restraints and Seclusion  Voluntary admission, involuntary commitment, malpractice and negligence  Study: Box 4.1 American Nurses’ Association Code of Ethics for Nurses  Box 4.3 Patient Self-Determination Act- Patient Rights Ethical &Legal Issues 9/25/2024  4 Think and Link for 5 minutes  Do we have mentally ill patients in our community?  How do the family/ community perceive their care/treatment? Ethical &Legal Issues 9/25/2024  5 Bill of rights 1. The right to human care 2. The right to mental health services 3. The right to information 4. The right to be represented or aided 5. The right to inform consent 6. The right to refuse treatment or any form of intervention. 7. The right to choose healthcare provider and facility Ethical &Legal Issues 9/25/2024  6 Bill of rights 8. The right to confidentiality 9. The right to be informed of his /her rights and obligations as a patient 10. The right to respect and dignity 11. The right to refuse participation in medical research 12. The right to receive services in Arabic or foreign languages 13. The right to understand hospital charges 14.The right to know hospital rules, policies & procedures Ethical &Legal Issues 9/25/2024  7 ETHICS  Ethics is branch of philosophy that deals with systematic approach to distinguishing right from wrong. Ethical &Legal Issues 9/25/2024  8 Moral behavior  Is defined as conduct that results from serious critical thinking about how individuals must treat others. Ethical &Legal Issues 9/25/2024  9 Values  Personal beliefs about what is important and desirable. Ethical &Legal Issues 9/25/2024  10 Rights  Right is defined as a valid legally recognized claim or privilege encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service. Ethical &Legal Issues 9/25/2024  11 Ethical Dilemma  Ethical dilemma is the a situation that requires an individual to take decision between two unfavorable alternatives Ethical &Legal Issues 9/25/2024  12 Ethical principles  Autonomy  Beneficence  Advocacy  Non maleficence  Justice  Veracity Ethical &Legal Issues 9/25/2024  13 Autonomy  The status of persons as autonomous moral agents whose right to determine the destiny should always be respected Ethical &Legal Issues 9/25/2024  14 Beneficence Refers to ones duty to benefit or promote the good of others. Ethical &Legal Issues 9/25/2024  15 Advocacy Acting in on others behalf being a supporter or defender. This means helping the client fulfill needs that may go unfulfilled because of illness. Strategies for advocacy Ethical &Legal Issues 9/25/2024  16 Non maleficence  Itis the requirement that health care workers do no harm to the clients either intentionally or non intentionally  More important to avoid doing harm than to do good. Ethical &Legal Issues 9/25/2024  17 Justice The principle of justice is referred to as the “fairness” principle. The right of individual to be treated equally regardless of age, sex, race…. Ethical &Legal Issues 9/25/2024  18 Veracity Refers to ones duty to always be truthful. Veracity requires that the health care workers tell the truth and not intentionally to deceive or mislead clients. Ethical &Legal Issues 9/25/2024  19 Ethical issues in Mental Health Nursing  Right to refuse medications  Right to the least restrictive treatment alternative. Ethical &Legal Issues 9/25/2024  20 Right to refuse medications  The patient has the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of his action.  Certain limitations exist:  Client exhibit behavior that is dangerous.  Medication must have a reasonable chance of providing help to clients  Clients who refuse medication must be judged as incompetent to take decisions. Ethical &Legal Issues 9/25/2024  21 RIGHT TO THE LEAST RESTRICTIVE TREATMENT ALTERNATIVE  Verbalrehabilitation techniques  Behavioral techniques  Chemical interventions Ethical &Legal Issues 9/25/2024  22 Legal issues in Mental Health Nursing  Confidentiality  Right to privacy: pertinent health information.  Privileged communication  Informed consent: three major elements  Restraints and seclusion ◄ Ethical &Legal Issues 9/25/2024  23 Restraints and seclusion Restraints  refers to a set of leather straps that are used to restrain the extremities of an individual whose behavior is out of control and who poses risk to the physical safety and psychological well being of the individual and staff.(JCHAHO 2000).  It should never be used as a punishment or for the convenience of the staff, Ethical &Legal Issues 9/25/2024  24 Ethical &Legal Issues 9/25/2024  25 Seclusion  Seclusion is a type of physical restraint where the patient is confined alone in a room from which they are unable to move.  The room is usually minimally furnished to provide the client with comfort and safety.  Guidelines for restraints and seclusions (page 69 Essential Psychiatric mental health nursing book)  Clients on restraints or seclusion must be assessed every 10-15 minutes with regard to circulation respiration, hydration and elimination. Ethical &Legal Issues 9/25/2024  26 Ethical &Legal Issues 9/25/2024  27 False imprisonment  Deliberate and unauthorized confinement of a patient within fixed limits by the use of physical means.  Health care workers may be charged with false imprisonment for restraining or secluding against the wishes of the client should the patient be admitted voluntarily. Ethical &Legal Issues 9/25/2024  28 Commitment issues Voluntary admission  Individual makes direct application to the institution and may stay as long as treatment is deemed necessary.  They may sign out of treatment facility at anytime, unless the health care professional determines the client may be harmful to self and others and recommends that the admission be changed from voluntary to involuntary. Ethical &Legal Issues 9/25/2024  29 Involuntary commitment The reasons for involuntary commitment may be:  In an emergency situation  For observation and treatment of mentally ill.  Gravely disabled The individual seeking involuntary admission must show probable cause why the person should be admitted or the person must show that there is a cause to believe that the person is dangerous, mentally ill, in need of treatment, or gravely disabled. Ethical &Legal Issues 9/25/2024  30 Emergency commitments They are sought when an individual manifests behavior that is clearly dangerous to self or others. These admission are initiated by relatives or friends or by the police… Emergency commitments are time limited and a court hearing is initiated after 72 hours., next hearing in 7-21 days. The court decides whether the client may be discharged or if voluntary admission is refused by the client, an additional period of involuntary commitment may be ordered. Ethical &Legal Issues 9/25/2024  31 Mentally ill in need of treatment  This is for observation and treatment of mentally ill who are in need of treatment.(examples pg 70)  The court looks for substantial evidence of abnormal conduct.  There must be clear and convincing evidence as well as probable cause to substantiate the need for involuntary commitment.  The court held that the presence of mental illness alone does not justify the involuntary commitment unless there is an involving danger. Ethical &Legal Issues 9/25/2024  32 Involuntary outpatient commitment  It is a court ordered mechanism used to compel a person with mental illness to submit to treatment on an outpatient basis.  Some eligibility criteria as follows (page 71)  The reason behind these legislation is to reduce the numbers of readmissions and length of stays.  Number of research studies. Ethical &Legal Issues 9/25/2024  33 Gravely disabled client  Defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm, resulting from inability to provide basic physical needs. It is the inability to make use of he resources available.  To determine a person as gravely disabled, a guardian, conservator, or a committee will be appointed by the court to ensure the management of the person. Ethical &Legal Issues 9/25/2024  34 Malpractice and Negligence Negligence – The failure to exercise the standard of care that a reasonably sensible person would have exercised in a similar situation. Ethical &Legal Issues 9/25/2024  35 Malpractice Malpractice- an instance of negligence or incompetence on the part of a professional. To succeed in a malpractice claim a plaintiff must also prove proximate cause and damages. Elements of nursing malpractice ( please read page 72 Essential psychiatric mental health nursing Book) Ethical &Legal Issues 9/25/2024  36 Elements of nursing malpractice lawsuit 1. a duty to the patient existed based on the recognized standard of care. 2. a breach of duty occurred meaning that the care rendered was not consistent with the recognized standard of care 3. the client was injured 4. the injury was directly caused by the breach of standard of care Ethical &Legal Issues 9/25/2024  37 Types of lawsuits 1. Breach of confidentiality- for revealing aspects about the client’s case 2. Defamation of character- shared information detrimental to the client’s reputation 3. Libel- defamation in writing 4. Slander- oral defamation Ethical &Legal Issues 9/25/2024  38 Types of lawsuits 5. Invasion of privacy- is a charge that may result when client is searched without probable cause 6. Assault- is an act that results in a person’s genuine fear and apprehension that he or she will be touched without consent. 7. Battery- is the unconsented touching of another person. These charges result when treatment is administered to client against his or her wishes and outside of an emergency situation. Ethical &Legal Issues 9/25/2024  39 Avoiding liability nursing actions 1. Responding to the patient 2. Educating the patient 3. Complying with the standard of care 4. Supervising care 5. Adhering to the nursing process 6. Documenting carefully 7. Following up by evaluating the care that was given Ethical &Legal Issues 9/25/2024  40 Question  A nurse puts a client in a room alone, without potentially dangerous items. What is this action considered?  Seclusion Ethical &Legal Issues 9/25/2024  41 Question  A nurse cares for a client and is performing vital signs and uses a blood pressure cuff that is too small. The client reports pain in the arm, but the nurse repeats the blood pressure to check the abnormal result. This occurs several times and the client files a lawsuit citing permanent nerve damage in the arm. For what can the nurse potentially be held liable?  Negligence  Malpractice Ethical &Legal Issues 9/25/2024  42 Which ethical principle is most applicable to the example given?  Client prescribed medication but refuses to take it:  AUTONOMY  Nurse intervenes when family member makes harmful decision on behalf of client:  BENEFICENCE  Nurse removes restraints from a calm client:  NONMALEFICENCE  Nurse cares for homicidal client in the same manner as all others:  JUSTICE  Explain schizophrenia is a lifelong mental illness and has no cure:  VERACITY Ethical &Legal Issues 9/25/2024  43 Question  A mental health patient tells the nurse of plans to harm a neighbour using a knife and leaves the facility without treatment. Based on privacy laws regarding sharing protected patient information, what is the appropriate nursing action?  Carefully document the client's words in exact quotes  Notify the healthcare provider (HCP) and  Call local police per facility protocol Ethical &Legal Issues 9/25/2024  Any Questions????? Thank You Ethical &Legal Issues 9/25/2024 44