Boundaries and Ethics Flashcards
What are some Ethical Issues in Acute Care?
Threats to dignity
Control, seclusion, and restraint
Psychiatric Advance Directives
Boundaries
Confidentiality and privacy
Social justice
Duty to protect
Assess persons risk for danger towards another
Identify persons being threatened
Take appropriate action to protect
Suspected child abuse
-non malfeasance
-when to break confidentialtity
Ethical decision making framework
Clarify the problem
a. Identify the uncertainty
b. Analyze your biases
c. Clarify the question
d. List the majo stakeholders
- Describe the Ethical Considerations
a. Clinical issues
b. Context
c. Ethical principles involved
d. List options - Choose a Solution
a. List the risks and consequences
b. Consider applicable rules and duties
c. Consider all relationships
d. Make a choice and justify it - Inplement and Evaluate
a. Make an action plan
b. Evaluation
c. Is there any moral distress or residue?
d. Are there implications for the organization of profession (i.e., policy changes)?
Boundary Crossing
A deviation from a typical therapeutic activity/intervention that is non-exploitative, and possibility even therapeutic
Multiple crossings – lead to violations
‘slippery slope’
Boundary Violation
A harmful (or potential harmful) act that transgresses from the psychiatrics’ nurses typical role or actions
Ex Dual Relationship, sexual relationship, financial relationship
Reflection-on-action Vs.
Reflection-in-action
Reflection-on-action: After an event took place
Reflection-in-action: In the moment as a challenge or event unfolds
Abandonment
When a nurse discontinues care without (any 1 or more of following):
- Negotiating a mutually acceptable withdrawal of service with the client
- Arranging for suitable alternative or replacement services
- Allowing the employer a reasonable opportunity to provide for alternative or replacement services
Moral Dilemma
must act but must choose between incompatible alternatives
Moral Distress
occurs when one feels unable to take what they believe to be an ethically appropriate or right course of action,
sensitivity to the ethics of practice and a commitment to public trust
Clinical Recovery
don’t match the DSM definition
i.e., remission or cure, symptom relief
Personal Recovery
satisfying life living with illness
when the client feels better. Have a sence of hope, empowerment and a meaningful role in life, even if they still have symptoms of the disorder.
-client informed care, person centered aproches
Secondary Traumatization
indirect exposure to trauma through a firsthand account or narrative of a traumatic event
may occur suddenly, after hearing a patient’s story one time
Vicarious Traumatization
a negative reaction to trauma exposure and includes a range of psychosocial symptoms
represents a shift in the clinicians attitude and worldview after prolonged exposure to patients’ suffering
