Mental Health Chapter 3 PDF

Chapter 3 Ethical and Legal Issues Copyright ©2023 F.A. Davis Company Introduction § Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death. § Legislation determines what is “right” or “good” within a society. Copyright ©2023 F.A. Davis...

Chapter 3 Ethical and Legal Issues Copyright ©2023 F.A. Davis Company Introduction § Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death. § Legislation determines what is “right” or “good” within a society. Copyright ©2023 F.A. Davis Company Core Concepts § Ethics: A branch of philosophy that deals with distinguishing right from wrong § Bioethics: Term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health § Moral behavior: Conduct that results from serious critical thinking about how individuals should treat others Copyright ©2023 F.A. Davis Company Core Concepts (continued_1) § Values: Personal beliefs about what is important and desirable § Values clarification: A process of self-exploration by which people identify and rank their own personal values § Right: An expectation to which an individual is entitled by established laws, policies, or ethical principles Copyright ©2023 F.A. Davis Company Core Concepts (continued_2) § Absolute right: When there is no restriction whatsoever on the individual’s entitlement § Legal right: A right that society has agreed upon and formalized into law Copyright ©2023 F.A. Davis Company Ethical Considerations Theoretical perspectives § Utilitarianism: An ethical theory that promotes action based on the end result that produces the most good (happiness) for the most people § Kantianism: Suggests that decisions and actions are bound by a sense of duty Copyright ©2023 F.A. Davis Company Ethical Considerations (continued) § Divine Command Ethics: An approach to ethical decision making that is focused on that which is commanded by God. § Natural Law Theory: Human knowledge of the difference between good and evil directs decision making. § Ethical Egoism: Decisions are based on what is best for the individual making the decision. Copyright ©2023 F.A. Davis Company Practice Question 1. An operating room nurse asks a psychiatric nurse, “How can you work with the mentally ill day in and day out?” The psychiatric nurse replies, “It’s just the right thing to do.” The psychiatric nurse is operating from which ethical framework? A. Kantianism B. Divine command ethics C. Ethical egoism D. Utilitarianism Copyright ©2023 F.A. Davis Company Practice Answer Correct Answer: A Kantianism focuses on the morality of actions. Actions are judged as right or wrong based on ethical principles. The nurse’s response indicates a Kantian perspective. Copyright ©2023 F.A. Davis Company Ethical Dilemmas § Ethical dilemmas are situations that require individuals to make a choice between two equally unfavorable alternatives. § Taking no action is considered an action taken. Copyright ©2023 F.A. Davis Company Ethical Principles § Autonomy emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected. § Beneficence refers to one’s duty to benefit or promote the good of others. § Nonmaleficence is abstaining from negative acts toward another; includes acting carefully to avoid harm. Copyright ©2023 F.A. Davis Company Ethical Principles (continued) § Justice: The principle of justice reflects a duty to treat all individuals equally and fairly. According to this principle, the vast disparity in the quality of care dispensed to the various socioeconomic classes within our society would be considered unjust. § Veracity: Principle that refers to one’s duty to always be truthful. Copyright ©2023 F.A. Davis Company A Model for Making Ethical Decisions § Assessment § Problem identification § Planning § Implementation § Evaluation Copyright ©2023 F.A. Davis Company Ethical Issues in Psychiatric/Mental Health Nursing All clients whom a nurse attends to have the following rights: § The right to treatment § The right to refuse treatment (including medication) § The right to the least-restrictive treatment alternative Copyright ©2023 F.A. Davis Company Legal Considerations § The Nurse Practice Act defines the legal parameters of professional and practical nursing. § Types of laws Statutory law: have been enacted by a legislative body such as a state legislature or the U.S. Congress. Common law: derived from decisions that have been made in previous cases and evolve from court decisions resolving various issues. These laws may differ from state to state. Copyright ©2023 F.A. Davis Company Classifications Within Statutory and Common Law § Civil law: Protects the private and property rights of individuals and businesses Torts: a violation of a civil law in which an individual has been wronged. One party claims wrongful conduct on the part of another and seeks compensation. This may be something done intentionally or unintentionally. Contracts: one party claims that the other party failed to fulfill an obligation and has breached their contract. § Criminal law provides protection from actions that are detrimental to public welfare. It provides punishment for those found to have engaged in this conduct. § Criminal law: Provides protection from conduct deemed injurious to the public welfare Copyright ©2023 F.A. Davis Company Legal Issues in Psychiatric/Mental Health Nursing § § § § § § 1. 2. 3. 4. 5. Confidentiality and right to privacy Health Insurance Portability and Accountability Act (HIPAA): protects client confidentiality on the federal level and gives individuals the rights to access their medical records, to have corrections made to their medical records, and to decide with whom their medical information may be shared. Doctrine of privileged communication:grants certain professionals privileges under which they may refuse to reveal information about, and communications with, clients. In most states, this applies to psychiatrists and attorneys, but in some instances, psychologists, clergy, and nurses are also included. Exceptions: A duty to warn; suspected child or elder abuse: a mental health professional has a duty not only to their client, but also to individuals who are being threatened by that client. Most states now recognize that therapists have legal obligations to prevent their clients from harming themselves or others. Another exception to these laws is in cases of suspected child or elder abuse. Every state requires that health-care professionals report suspicion of child abuse to legal authorities, and many have similar statutes regarding elder abuse. Informed consent: Knowledge: The client has received adequate information on which to base their decision. 2. Competency: The individual’s cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has a legal representative. 3. Free Will: The individual has given consent voluntarily without pressure or coercion from others. The Joint Commission has established specific standards regarding the use of seclusion and restraint. Some examples of current standards include the following: Restraints and seclusion: Seclusion or restraint is discontinued at the earliest possible time. Unless state law is more restrictive, orders for restraint or seclusion must be renewed every 4 hours for adults ages 18 years and older, every 2 hours for children and adolescents ages 9 to 17 years, and every hour for children younger than 9 years. An in-person evaluation must be conducted within 1 hour of initiating restraint or seclusion. Patients who are simultaneously restrained and secluded must be continuously monitored by trained staff, either in person or through audio or video equipment. Staff who are involved in restraining and secluding patients are trained to monitor the physical and psychological well-being of the patient. False imprisonment: False imprisonment is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means. Health-care workers may be charged with false imprisonment for restraining or secluding—against the wishes of the client— anyone having been admitted to the hospital voluntarily. Copyright ©2023 F.A. Davis Company Hospitalization § Voluntary admissions § Involuntary commitments Emergency commitments should be sought when an individual displays behavior that is clearly dangerous to themselves or others. These commitments are time limited, and a court hearing must be scheduled to decide if the patient should be discharged or if additional hospitalization is necessary. A mentally ill person in need of treatment: Generally, this is defined as someone unable to make decisions regarding treatment, someone likely to harm themselves or others, or someone unable to fulfill basic personal needs. Involuntary outpatient commitment: is a court-ordered process used to compel a person with mental illness to submit to outpatient treatment. Eligibility criteria for IOC include a history of repeated decompensation requiring involuntary hospitalization, the likelihood of deterioration requiring inpatient commitment, the presence of severe and persistent mental illness, and the risk of becoming homeless, violent, or suicidal. A gravely disabled client: a guardian, conservator, or committee will be appointed by the court to ensure the management of the person. Gravely disabled is generally defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from an inability to provide for basic needs. Copyright ©2023 F.A. Davis Company Nursing Liability § Negligence Failure to exercise the care toward others that a reasonable or prudent person would do in the circumstances, or taking action that such a reasonable person would not do § Malpractice Act or continuing conduct of a professional that does not meet the standard of competence and results in provable damages to the patient Copyright ©2023 F.A. Davis Company Types of Lawsuits That Occur in Psychiatric Nursing § Breach of confidentiality § Defamation of character Libel:A nurse may be liable for defamation of character if they share false or malicious information that is detrimental to the client’s reputation. When this information is in writing, it is referred to as libel. Slander: When it is spoken, it is called slander. § Invasion of privacy § Assault and battery: Assault is an act that results in genuine fear that the individual will be touched without consent. Battery is the unconsented touching of another person. Harm or injury does not have to occur for these charges to be legitimate. § False imprisonment Copyright ©2023 F.A. Davis Company Practice Question 2. As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, “I’ll sue you for assault and battery.” The unit manager determines that the nurses are protected under which condition? A. The client is voluntarily committed and poses a danger to others on the unit. B. The client is voluntarily committed and has a history of being a danger to others. C. The client is involuntarily committed because of a history of violent behavior. D. The client is involuntarily committed and is refusing treatment. Copyright ©2023 F.A. Davis Company Practice Answer Correct Answer: A As a threat to others, the client can be restrained despite objections and voluntary commitment. Copyright ©2023 F.A. Davis Company Practice Question 3. A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client’s chart was clearly stamped “Allergic HALDOL.” The client suffered anaphylactic shock and died. How would the nurse’s actions be labeled? A. Intentional tort B. Negligence C. Battery D. Assault Copyright ©2023 F.A. Davis Company Practice Answer Correct Answer: B The nursing action was an unreasonable and careless act. The nurse was negligent and could be held liable for the client’s death. Copyright ©2023 F.A. Davis Company Avoiding Liability § Effective communication § Accurate and complete documentation in the medical record § Complying with standards of care § Knowing the client § Practicing within the nurse’s level of competence and scope of practice Copyright ©2023 F.A. Davis Company