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NURS 406 > Chapter 4: Patient Rights, Ethics and Legal Issues > Flashcards

Chapter 4: Patient Rights, Ethics and Legal Issues Flashcards

1
Q

Key values of self determinism:

A
  1. personal autonomy
  2. avoidance of dependence
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2
Q

Self determinism

A

is the right to choose one’s own health related behaviors, which at times differ from those recommended by health professionals

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3
Q

Advanced Care Directives

A

Written instructions for healthcare when individuals are incapacitated

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4
Q

Power of attorney aka health proxies

A

living wills and appointment directives

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5
Q

living will

A

what treatment should be omitted or refused in the event that a person is unable to make those decisions

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6
Q

Durable power of attorney

A

A Durable power of attorney appoints a proxy (usually friend or family member), to make healthcare decisions on an individual’s behalf if that person is incapacitated

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7
Q

Special rules for advance directive

A

it doesn’t need to be written, reviewed or signed by attorney.

It must be witnessed by two people and notarized and applies only if the individual is unable to make their own decisions as a result of being incapacitated or unable to make decisions

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8
Q

Psychiatric Advance Directives (PADs):

A

allows pts while competent, to document their choices of treatment and care

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9
Q

Mental Health Systems Act

A

requires each state review and revise its laws to ensure that mental health pts receive these human rights protections and services

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10
Q

American with Disabilities

A

ensures that people with disabilities, including those with mental illness and addiction, have legal protection against discrimination in the workplace, housing, public protection etc.

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11
Q

The Mental Health Parity and Addiction Equity Act

A

requires insurance plans to offer comparable benefits and coverage for mental and substance disorders that are offered for medical and surgical coverage

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12
Q

The patient Bill of Rights includes the right for a pt to refuse treatment. But this does not apply in what circumstances?

A

The right to refuse treatment, except during an emergency situation or as permitted under law in the case of a person committed by a court for treatment

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13
Q

External Advocacy System

A

Financially and administratively independent from the mental health agencies

these groups advocate through negotiation and recommendation but have no legal authority

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14
Q

Accreditation

A

The recognition or approval of an institution according to the accrediting body’s criteria

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15
Q

The Centers for Medicare and Medicaid Services (CMS)

A

sets pt rights standards for institutions seeking Medicare and Medicaid funding

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16
Q

Incompetent

A

unable to understand and appreciate the info given during the consent process

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17
Q

Competence

A

or the degree to which the patient can understand and appreciate the info given during the consent process

refers to the pt’s ability to process info at a specific time

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18
Q

When is it possible to force treatement on a pt

A

when they are judged incompetent

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19
Q

informed consent

A

a legal procedure to ensure that the pt knows the benefits and costs of treatment

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20
Q

Least Restrictive Environment

A

which means that an individual cannot be restricted to an institution when they can be successfully treated in the community

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21
Q

A pt cannot be restrained or locked in a room unless

A

all other less restrictive interventions are tried first

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22
Q

Seclusion

A

involuntary confinement of a person in a room or an area where the person is physically prevented from leaving

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23
Q

Why is person in seclusion?

A

for purposes of safety or behavioral management

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24
Q

The most restrictive safety measure

A

the use of restraints

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25
Q

restraints

A

any manual, physical or mechanical that immobilizes or reduces the ability of the pt to move

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26
Q

chemical restraints

A

the use of meds for restricting pt’s behavior or their freedom of movement

includes meds that are not part of their standard psych treatment

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27
Q

Trauma informed care

A

being aware of, and sensitive to doing no further harm to survivors of trauma

pt needs to feel connected, valued informed and hopeful

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28
Q

How long should seclusion/restraint be used?

A

must be used for the minimal amount of time necessary to ensure the safety of the pt and others

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29
Q

Voluntary admission

A

inpt treatment reserved for pts acutely ill.

if hospitalizationis required the person enters, participates and follows through with treatment.

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30
Q

When can a person who was voluntarily admitted leave the hospital?

A

the individual maintains civil rights and is free to leave at any time even if it AMA

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31
Q

Voluntary commitment

A

If pt is admitted to a public facility (full legal rights are retained)

32
Q

Involuntary commitment

A

is the mandated treatment without a person’s consent but with a court order

33
Q

Three elements needed to involuntarily commit

A
  1. mentally disordered
  2. dangerous to self or others
  3. unable to provide for basic needs
34
Q

Pts who are involuntarily committed have the ________but they also may have the right to ________

A

right to receive treatment and right refuse it

35
Q

How long is emergency short term hospitalization?

A

48 to 92 hours authorized by a certified mental health provider without court approval

36
Q

At end of 48 to 92 hours, what happens to pt/

A

at end of time limited period, either individual agrees to voluntary treatment or extended commitment procedure are begun

  • judge must order commitment and individual is afforded several legal rights, notice of proceedings a full hearing, in which gov must prove grounds for commitment
37
Q

Privacy

A

part of idividuals life not governed by society’s laws and gov intrusion

38
Q

Confidentiality

A

pertains to an ethical duty of nondisclosure

39
Q

Breach of confidentiality

A

occurs when a nurse divulges a pt’s personal info without pt’s consent

40
Q

Health Insurance Portability and Accountability Act

A

provides legal protection in several areas of health care, including privacy and confidentiality

41
Q

When are health care professionals legally obligated to breach confidentiality?

A

when there is a judgement that the pt has harmed any person or is about to injure someone, professionals are mandated to report to authorities

42
Q

Forensic

A

Pertains to legal proceedings and mandated treatment of persons with mental illness

43
Q

Fitness to stand trial

A

Fitness: pt is able to consult a lawyer with a reasonable degree of rational understanding of the facts of the crime and of legal proceedings

44
Q

Unfit to stand trial

A

mental or physical condition, they are unable to understand the nature and purpose of the proceedings or to assist in the defense

45
Q

What is the next step when someone is found unfit to stand trial?

A

hospitalization in a forensic mental health facility

46
Q

What is the goal of a hospitalization in a forensic mental health facility

A

is to help the person become fit to stand trial, not to treat the mental illness

47
Q

How long can a person be deemed unfit?

A

not forever

if fitness is not retain within a year, hearing is held during which the facts of the alleged crime are presented to a judge who rules on the case

48
Q

IF charges aer dismissed by judge for crime done by unfit person what happens?

A

if charges are dismissed, the judge could order a civil commitment

49
Q

If there is sufficient evidence to commit an individual who was deemed unfit,

A

the individual could be sent back to the hospital for further treatment to attain fitness

50
Q

No guilty by reason of insanity

A

The accused is judged unable to distinguish right from wrong or to be unable to control their actions at the time of the crime

rationale ruling is fairness

51
Q

What happens to individuals found NGRI?

A

Nearly all pts found NGRI are subject to involuntary commitment in a secure setting

52
Q

Guilty but mentally ill (GBMI)

A

is a criminal conviction

person is sent to the correctional system

mental illness is considered a factor of the crime but not to the extent that the individual is incapable of knowing right from wrong or controlling their actions

53
Q

Similarities between NGRI and GBMI persons and difference

A

Both NGRI and GBMI persons are treated for their mental disorders,

54
Q

difference between NGRI and GBMI persons

A

one is treated in jail and the other in a hospital

conditions of release differ

55
Q

Conditions of release for GBMI

A

individuals with a GBMI are subject to the correctional system’s parole decisions

56
Q

Conditions for release of NGRI

A

those with an NGRI are discharged from the hospital through the courts upon recommendation of the forensic mental health professionals

57
Q

Probation

A

is a sentence of conditional or revocable release under the supervision of a probation officer for a specified time

58
Q

Brady Act

A

requires background check on people seeking firearm ownership

59
Q

Torts

A

a civil wrong not based on contract committed by one person that causes injury to another

a wrongful act, resulting in injury, loss or damage

60
Q

Two types of unintentional torts

A
  1. Negligence
  2. Malpractice
61
Q

Elements needed to prove malpractice

A

Duty

Breach of duty

injury or damage

causation

62
Q

Types of Intentional torts:

A
  1. Assault
  2. Battery
  3. False imprisonment
63
Q

Three elements to prove liability for tort:

A
  1. willful, voluntary
  2. intention to bring about consequences or injury
  3. act was substantial factor in injury or consequences
64
Q

Assault

A

is the threat of unlawful force inflicted bodily injury upon another

65
Q

Medical battery

A

intentional, unauthorized harmful or offensive contact, occurs when a pt is treated without informed consent

66
Q

Example of medical battery

A

clinician does not get consent before procedure

failure to respect a patient’s advance directives

67
Q

Negligence

A

breach of duty of reasonable care for a patient for whom a nurse is responsible that results in personal injuries

68
Q

Five elements needed to prove negligence:

A
  1. duty (accepting to care for pt)
  2. breach of duty (failure to practice according to standards)
  3. cause in fact (injury wouldn’t have happened if standards were followed)
  4. cause in proximity (harm actually occurred within the scope of foreseeable consequence)
  5. damages (physical, emotional injury by breach of care)
69
Q

Utilitarianism

A

decisions based on the greatest good for the greatest number

70
Q

Deontology

A

decisions based on whether an action is right or wrong

71
Q

Autonomy

A

right to self determination

72
Q

Beneficence

A

duty to benefit others or promote good

73
Q

Nonmaleficence:

A

Nonmaleficence: requirement to do no harm

74
Q

Justice

A

Fairness

75
Q

Veracity

A

Honesty, truthfulness

76
Q

Fidelity

A

obligation to honor commitments and contracts

77
Q

Deontologic principles

A

Autonomy

Beneficence

Nonmaleficence

Justice

Veracity

Fidelity

NURS 406 (29 decks)

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