ATI Ch 2, Legal And Ethical Issues Flashcards
What are the responsibilities of a nurse in the mental health setting?
Practicing ethically, competently, safely, and in accordance with laws.
What rights do clients with mental health disorders have?
Civil rights equal to any other citizen, including:
* Right to humane treatment
* Right to vote
* Rights related to driver’s license
* Right to due process
What specific rights do clients in mental health settings have?
Including:
* Informed consent and right to refuse treatment
* Confidentiality
* Written plan of care
* Communication with outside individuals
* Adequate interpretive services
* Respect and dignity in care
* Freedom from harm
* Psychiatric advance directive
* Least restrictive interventions
What is a tort?
A wrongful act or injury committed by one entity against another.
What does the Mental Health Parity and Addiction Equity Act of 2008 require?
Insurance coverage for mental illness must be considered as any other medical treatment.
How do ethical issues differ from legal issues in nursing?
Ethical issues are philosophical ideas about right and wrong, while legal issues are based on laws and regulations.
What is an ethical dilemma?
A situation where there is a conflict between two or more courses of action.
What is beneficence in nursing ethics?
The quality of doing good or charity.
What is autonomy in the context of mental health nursing?
The client’s right to make their own decisions and accept the consequences.
What does justice refer to in ethical nursing practice?
Fair and equal treatment for all clients.
Fill in the blank: A nurse helps a newly admitted client with a psychotic disorder feel _______ in the environment of the mental health facility.
[safe]
Fill in the blank: The ethical principle that involves exploring alternatives with a client is called _______.
[autonomy]
True or False: Ethical dilemmas in nursing often have clear-cut solutions.
False
What must a nurse be aware of regarding state laws?
Specific laws regarding client care in the state(s) where they practice.
How does the FDA view pharmacogenetic testing for psychotropic medications?
The FDA does not support genetic testing due to lack of clinical evidence.
What is the role of ethical principles in nursing?
To help decide ethical issues in client care.
What is fidelity in nursing?
Loyalty and faithfulness to the client and to one’s duty.
Example: A client asks a nurse to be present when they talk to their guardian for the first time in a year. The nurse remains with the client during this interaction.
Define veracity in the context of nursing.
Honesty when dealing with a client.
Example: A client states, ‘You and that other staff member were talking about me, weren’t you?’ The nurse truthfully replies, ‘We were discussing ways to help you relate to the other clients in a more positive way.’
What does the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule protect?
The client’s right to privacy.
What should a nurse do with client information?
Share information only with those responsible for implementing the client’s treatment plan.
The nurse should not discuss client information in public places, and social media should never be used to discuss clients or their information.
When can a nurse share client information with others?
Only if the client provides consent.
What does the Dead Man’s Statute protect?
Confidential information about individuals when they are not alive to speak for themselves.
In what situations can healthcare professionals break confidentiality?
Duty to warn and protect third parties and reporting of child and vulnerable adult abuse.
What should a nurse do if they become aware of a violation of a client’s right to privacy?
Immediately take action to stop the violation.
List some resources for solving ethical client issues.
- Code of Ethics for Nurses
- Patient Care Partnership
- The nurse practice act of a specific state
- Legal advice from attorneys
- Facility policies
- Other members of the healthcare team
- Members of the clergy and other spiritual or ethical counselors
What is informal admission in a mental health facility?
The least restrictive form of admission where the client does not pose a substantial threat to self or others.
What characterizes voluntary admission to a mental health facility?
The client or guardian chooses admission for treatment and can refuse medication and treatment.
What is a temporary emergency admission?
Admission for emergent mental health care due to the client’s inability to make decisions regarding care.
What are the criteria for involuntary admission?
- Manifestations of mental illness
- Poses a danger to self or others
- Severe disability or inability to meet basic necessities
- Requires treatment but unable to seek it voluntarily
How many physicians are usually required to certify an involuntary admission?
Usually two, but it varies by state.
What rights do clients admitted under involuntary commitment retain?
They are still considered competent and have the right to refuse treatment, including medication.
What is long-term involuntary admission?
A type of admission similar to temporary commitment but must be imposed by the courts.
What is the typical duration of long-term involuntary admission?
Usually 60 to 180 days, sometimes with no set release date.
What must nurses know regarding the use of restraints?
Nurses must know and follow federal/state/facility policies that govern the use of restraints.
Restraints can include physical or chemical methods.
What are the two types of restraints?
Restraints are either physical or chemical (neuroleptic medication to calm the client).
What is a temporary timeout?
A client can voluntarily request a temporary timeout in cases in which the environment is disturbing or seems too stimulating.
How does a timeout differ from prescribed seclusion?
A timeout is by the request of the client, while prescribed seclusion is not.
Under what circumstances should seclusion or restraint be prescribed?
Seclusion and/or restraint should be prescribed for the shortest duration necessary, and only if less restrictive measures are not sufficient.
What are examples of less restrictive measures?
- Verbal interventions (encouraging the client to calm down)
- Diversion or redirection
- Providing a calm, quiet environment
- Offering a PRN medication
When should seclusion or restraint not be used?
- Convenience of the staff
- Punishment of the client
- Clients who are extremely physically or mentally unstable
- Clients who cannot tolerate decreased stimulation
- When all other less restrictive means have been tried
What is required before using seclusion or restraint?
The provider must prescribe the seclusion or restraint in writing.
What are the time limits for seclusion or restraints based on age?
- Age 18 years and older: 4 hr
- Age 9 to 17 years: 2 hr
- Age 8 years and younger: 1 hr
How often must the provider reassess a client in seclusion or restraint?
The provider must reassess the client and rewrite the prescription every 24 hr or as specified by facility policy.
What supervision is required for clients in seclusion?
Clients should never be left alone in a locked room, unsupervised; continuous in-person or remote supervision is necessary.
What responsibilities does the facility protocol identify for nursing?
- Assessing the client (including safety and physical needs)
- Documenting the client’s behavior
- Offering food and fluid
- Toileting
- Monitoring vital signs and pain
How often should complete documentation occur during the use of seclusion or restraint?
Complete documentation should occur every 15 to 30 min or according to facility policy.
In what circumstance can a nurse use seclusion or restraints without a provider’s prescription?
A nurse can use seclusion or restraints without a provider’s prescription in an emergency situation.
What must occur once restraints or seclusion are discontinued?
The nurse must obtain a new prescription before initiating restraints again.
What is a tort?
A tort is referred to as a civil wrongdoing, in which monetary damages can potentially be awarded to the plaintiff.
What are intentional torts?
Intentional torts are willful actions that damage a client’s property or violate client rights.
What is considered false imprisonment?
Confining a client to a specific area when it is not part of the client’s treatment is considered false imprisonment.
What constitutes assault in a healthcare setting?
Making a threat to a client’s person is considered assault.
Define battery in the context of healthcare.
Touching a client in a harmful or offensive way is considered battery.
What is invasion of privacy in a healthcare context?
Breaking confidences or taking photographs without the client’s permission.
What are unintentional torts?
Actions or inactions that cause unintended harm due to failing to meet one’s duty of care in personal or professional situations.
Unintentional torts primarily involve negligence.
Define negligence.
Failing to provide adequate care when one has an obligation to do so.
Negligence must meet specific criteria to establish liability.
What must be proven for a professional to be liable for negligence?
The following must be proven:
* Duty to protect
* Breach of duty
* Proximate cause
* Cause in fact
* Damages occurred
Proximate cause relates to whether the injury was a foreseeable result of the action or inaction.
What is malpractice?
A type of professional negligence consisting of five elements.
Malpractice applies specifically within professional contexts, such as healthcare.
List the five elements of malpractice.
- Breach of duty
- Cause in fact
- Proximate cause
- Damages
- Duty
Each element must be established to prove malpractice.
What does ‘breach of duty’ refer to in malpractice?
Not meeting the standards of care.
Standards of care vary by profession and situation.
Explain ‘cause in fact’ and ‘proximate cause’ in the context of malpractice.
‘Cause in fact’ refers to whether the injury occurred as a result of the action taken or not taken, while ‘proximate cause’ relates to whether the nurse foresaw the injury as a result of their action or inaction.
Both elements are crucial for establishing a connection between the action and the injury.
What types of damages can occur in malpractice cases?
- Loss of earnings
- Property loss
- Pain and suffering
Damages are compensation sought by the injured party.
What does duty refer to in the context of malpractice?
Understanding that specific knowledge and skills are needed for specialty nursing.
This includes recognizing the competencies required in areas such as psychiatry.
Why is documentation important in nursing?
It is vital to clearly and objectively document information related to violent or unusual episodes.
Proper documentation can protect against claims of negligence or malpractice.
What should a nurse document regarding client behavior?
Client behavior in a clear and objective manner.
Documentation should provide an accurate account of events.
Give an example of how to document staff response to disruptive behavior.
Example: The client states, ‘I’m going to pound (other client) into the ground.’ Client has picked up a chair and is standing 3 ft from other client with chair held over their head. Nurse calls for help.
This documentation should include the timeline and extent of the response.
What details should be documented regarding notification of the provider?
The time the nurse notified the provider and any prescriptions received.
This is critical for maintaining a clear medical record.
