4. Ethical and Legal Issues Flashcards
5 ethical concepts
- beneficence
- autonomy
- justice
- fidelity
- veracity
mental health civil rights and due process includes what?
- client consent
- communication
- freedom from harm
- dignity and respect
- confidentiality
- participation in their treatment plan
empowerment or having free will to make moral judgements; uses internal motivation; important part of the recovery process
self-determinism
key values of self-determinism
- personal autonomy (right to choose own health-related behaviors; even if different from those recommended by health professionals)
- avoidance of dependence on others
Patient Self-Determination Act provides what?
- information about advance care documents
- question on admission and document about having advance care documents
- information about rights to complete advance care documents and to refuse treatment
advanced care documents in mental health
- living will: states what treatment is refused when the person can’t make decisions
- durable power of attorney: usually relative or trusted friend to make decisions on person’s behalf if they can’t
- psychiatric advance directives: document their choices about treatment and care; must have 2 witnesses
gives patients with mental health disorders additional protection
bill of rights for mental health patients
protection from job discrimination and mandates accommodations for individuals
Americans with Disabilities Act (ADA)
mechanisms to combat any violation of patients rights; requires advocacy and investigation of abuse/neglect
internal rights protection systems (Public Law 99-319)
organization that operate independently of mental health agencies and advocate for treatment and rights of mental health patients
external advocacy systems
degree to which patient can understand and appreciate the info given during the consent process; cognitive ability to process info at a specific time
competency
T/F: competency is clearly defined across the US
False
Areas of determining competency
- communicate choices
- understand relevant info
- appreciate situation and consequences
- use a logical though process to compare risks and benefits of tx options
legal procedure to ensure pt knows benefits and costs of tx; mandate of state laws
informed consent
how is informed consent complicated in mental health tx
- decision-making ability often compromised in mental illness
- competency necessary to give consent
explain voluntary admission or commitment
- person retains full civil rights
- free to leave any time, even AMA
explain involuntary admission
- court ordered and without the person’s consent
- right to receive treatment; possible right to refuse
- provisions for emergency short-term hospitalization of 48-92 hours
3 common elements of involuntary admission
- mentally disordered
- dangerous to self or others
- unable to provide for basic needs (can’t perform ADLs)
elements of least restrictive environment
- larger concept underlying pt’s right to refuse tx
- person can’t be restricted to an institution when he or she can be successfully treated in the community
- medication can’t be given unnecessarily
- use of restraints or locked room only if all other “less restrictive” interventions have been tried first
steps to promote safety from least restrictive to most restrictive
- observation
- de-escalation
- seclusion
- restraints (chemical then physical)
What is needed to physically restrain patients?
doctors order (except in emergency situations -> nurse can place restraints and then obtain an order)
When should restraints be removed from patients?
as soon as they are no longer a danger to themselves or others and can follow directions
part of a person’s life not governed by society’s laws and government intrusion
privacy
ethical duty of nondisclosure (prover has info about pt and should not disclose it); involves 2 people (person who disclosed info and person who info was shared with)
confidentiality
release of pt info without the pt’s consent in the absence of legal compulsion or authorization
breach of confidentiality
states that pt authorization is necessary for release of info with exception of that required for tx, payment, and health care administrative operations
Health Insurance Portability and Accountability Act (HIPAA)
a legal obligation to breach confidentiality
mandates to inform
What is the “duty to warn”
- judgement that a pt has harmed someone or is about to injure someone
- mandated to report that to the authorities or person who is threatened
- only statement about harm can be reported; details of thoughts found in therapist or psychiatrist notes can only be accessed w/ court order
5 types of legal liability in psychiatric nursing practice
- assault: threatening to hurt pt
- battery: harmful or offensive touching of pt
- medical battery: causing harm or touching pt without medical consent or failing to follow advanced directive
- false imprisonment: restraining pt without justification (also not discharging voluntary pt at their request)
- negligence: doing something or failing to do something that a component nurse would or would not do
required parts of nursing documentation
- observations of subjective and objective physical, psychological, and social responses
- interventions implemented and pt responses
- observations of meds therapeutic and side effects
- evaluation of outcomes of interventions
What is NGRI
Not Guilty by Reason of Insanity (involuntarily hospitalized); person deemed unable to control their actions at the time of the crime
What is GBMI
Guilty but Mentally Ill (goes to jail); mental illness is considered in the crime but not to the extent that the person didn’t know they were doing something wrong or unable to control actions
