Chapter 6 Legal and Ethical Basis for Practice

Question 1

A fundamental goal of psychiatric care is to strike a balance between the rights of the individual client and the rights of society at large.
Balance between rights of indiv and rights of society at large - some difficulty between ethical and legal issues in mental health

Answer 1

Legal and ethical basis for care

Question 2

Admission to the psychiatric Hospital
Psychiatric problem must be based on the Diagnostic and Statistical Manual of Mental Disorders (5th edition, text revision) (DSM-5).
Illness must present an immediate crisis.
Voluntary admission - seek treatment and agree to it; admitted to psychiatric facility
Involuntary admission (commitment)

Answer 2

Admissions

Question 3

Olmsted v. L.C. (1999): U.S. Supreme Court
Clients with mental health illness are to be placed in less restrictive community settings rather than in institutions. - based on DSM-5; crisis going on if hospitalized; less restrictive methods of care; improvement because of care

Answer 3

Admission to the psychiatric Hospital - Admissions

Question 4

Other, less restrictive alternatives are inadequate or unavailable.
The expectation exists that hospitalization and treatment will improve the immediate problem.

Answer 4

Illness must present an immediate crisis. - Admissions

Question 5

admitted to psychiatric facility
Often under court sys; need be assessed by 2 HCP for involuntary hold; often under influence or have cognitive disorder; after there thinking disorder clears up may admit themself
Judicial determination - Judge to be eval
Administrative determination
Agency determination - certain agency
Can be held involuntarily - 96 hrs - do assessment and eval and if still refuse sign in voluntarily and meet requirements start court proceeding as involuntary proceeding; sometimes sign voluntarily in time period

Answer 5

Involuntary admission (commitment) - Admissions

Question 6

admitted to psychiatric facility
Often under court sys; need be assessed by 2 HCP for involuntary hold; often under influence or have cognitive disorder; after there thinking disorder clears up may admit themself
Judicial determination - Judge to be eval
Administrative determination
Agency determination - certain agency

Answer 6

Involuntary admission (commitment)

Question 7

In addition, a specified number of physicians must certify that the person’s mental health status justifies detention and treatment.
Mental health professionals to see if meet criteria admission
Criteria:

Answer 7

Agency determination - certain agency

Question 8

Danger to self
Danger to others
If not treated, condition will worsen

Answer 8

Criteria: - Agency determination - certain agency

Question 9

Right to Treatment - pats have rights

Answer 9

Summarize the client’s rights as they pertain to right to treatment, right to refuse treatment, and right to informed consent

Question 10

1964: Hospitalization of the Mentally Ill Act
Treatment must meet the following: - expectations
Regardless if involuntary or voluntary

Answer 10

Right to Treatment - pats have rights

Question 11

Medical and psychiatric care and treatment must be provided to everyone admitted to a public hospital.

Answer 11

1964: Hospitalization of the Mentally Ill Act

Question 12

Humane environment
Qualified and sufficient staff to provide adequate treatment
Individualized plan of care

Answer 12

Treatment must meet the following: - expectations

Question 13

Right to Refuse Treatment
Right to withhold consent - if want do ECT
Right to withdraw consent any time
Right to retract consent; must be honored, whether verbal or written
The right of a client who is mentally ill to refuse treatment with psychotropic drugs has been debated in the courts - ethical issue: not take meds condition worsen which look at for involuntary admission; give med against will doc clearly and reason for that cause harm for self/others if not have it

Answer 13

Client’s rights

Question 14

If a clinician approaches the client with medication in hand and the client indicates a willingness to receive the medication, then implied consent has occurred. - take voluntarily agree to take med
ECT - informed consent
General rule to follow: The more intrusive or risky the procedure, the higher the likelihood informed consent must be obtained.

Answer 14

Implied consent

Question 15

Most state laws prohibit the use of unnecessary physical restraint or isolation as much as possible; sometimes might need be restrained - doc reason and doing care for them - may have phys and chem restraints
Behavioral restraint and seclusion are authorized as interventions if:
An emergency situation must exist:
Client must be protected from harm.
The following must be documented:
Use of seclusion and restraint is permitted only under the following circumstances:
Client’s condition is reviewed and documented regularly (e.g., every 15 minutes). - treating with humane care
Original order may be extended after a review and reauthorization:
In an emergency, the nurse may place the client in seclusion and/or in restraints but must then obtain a written or verbal order within a hour following a client’s placement in seclusion and/or restraints.
Doc and treat humanly
Client must be:

Answer 15

Restraint and seclusion

Question 16

Behavior is physically harmful to the client or a third party. - potential harm - doc and demonstrate that
Alternative, less-restrictive measures are insufficient in protecting the client and others from harm. - tried other things; doc upon request and what doing
Decrease in sensory overstimulation is needed (seclusion only). - help indiv and reason
Client requests seclusion. - realize need less stim but chart to ensure clear

Answer 16

Behavioral restraint and seclusion are authorized as interventions if: - Restraint and seclusion

Question 17

Immediate risk of harm to the client or others - doc well, time placed and released
Exception: Client requests seclusion

Answer 17

An emergency situation must exist: - Restraint and seclusion

Question 18

Behavior leading to restraint
Time client is placed in and released from restraint or seclusion

Answer 18

The following must be documented: - Restraint and seclusion

Question 19

Written order of a physician
Confined to specific, time-limited periods (e.g., 2 to 4 hours)

Answer 19

Use of seclusion and restraint is permitted only under the following circumstances: - Restraint and seclusion

Question 20

Review and reauthorization are typically conducted every 24 hours.
Must specify the type of restraint.

Answer 20

Original order may be extended after a review and reauthorization: - Restraint and seclusion

Question 21

A telephone order is acceptable but must be followed by a written order in the chart with physician follow-up and a physician signature.

Answer 21

In an emergency, the nurse may place the client in seclusion and/or in restraints but must then obtain a written or verbal order within a hour following a client’s placement in seclusion and/or restraints. - Restraint and seclusion

Question 22

Assessed at regular and frequent intervals for physical needs (e.g., food, hydration, toileting), safety, and comfort every 15 to 30 minutes - give them breaks - doc treated humanly
Removed from restraints when safer and quieter behavior is observed
Reorder to cont that and doc serving that
Observed, and observations must be documented every 15 to 30 minutes

Answer 22

Client must be: - Restraint and seclusion

Question 23

Because state laws vary, students are encouraged to become familiar with the requirements of their states. - increase in number of abuse; mandatory reporters
Elder Abuse Reporting Statutes

Answer 23

Elder abuse reporting

Question 24

Apply to older adults—65 years of age and older.
Many states require registered nurses to report abuse.
Federally funded agencies (e.g., Medicare, Medicaid) have strict guidelines for reporting and preventing elder abuse.

Answer 24

Elder Abuse Reporting Statutes

Question 25

Justified in bringing him to center - risk for harming center and others
Jail - not breaking any laws
Prbs with processing and thinking

Answer 25

Bandi lives in a cemetery under a tarp. He scavenges for food around the local supermarket. Today, the manager of the supermarket calls the police. Upon arrival, they find Bandi pushing multiple grocery carts, agitated, his fingers bleeding. He tells the police, “I have to scrub all the rust off these carts and all the carts in the world. Then I can be saved and go to heaven.” The police bring Bandi to the community mental health center. Discuss this patient’s legal rights. Were the police justified in bringing him to the center? Explain your answers. Should he have been initially taken to jail? Why or why not?

Question 26

Which one of the following applies to Bandi’s rights as a citizen?
A. His rights were violated.
B. His rights were upheld.
C. His rights were not considered.
D. His rights were misinterpreted

Answer 26

Answer: B
A - He was deemed at risk to self as evidenced by his statements.
B - He was deemed at risk for harm to self. Aeb statements
C - The police upheld the law.
D - He posed a risk for harm to self and/or to others.

Question 27

When Bandi was apprehended by the police, he was handcuffed and placed in the police car. Care was taken to ensure that he was not injured during the process. The officers told Bandi that he was being taken to a safe place. Upon arrival at the facility, Bandi was escorted to the emergency services area where he was assessed and admitted to the crisis stabilization unit. He was frightened, paranoid, and physically struggling with the mental health technicians, yelling, “I ain’t finished my mission. The grocery carts are still covered in rust! I’m gonna die!” As the nurse manager of the unit, how should you intervene? What are your legal options and responsibilities?

Answer 27

Descalate - therapeutic communication; quiter environment
Legal options: harmful to self/others - showing is

Question 28

Upon entry to the crisis stabilization unit, Bandi was taken to the seclusion room and chemically restrained. What does this mean?
A. He was medicated against his will.
B. He was forced to swallow drugs.
C. He was a victim of assault and battery.
D. He was a victim of false imprisonmen

Answer 28

Answer: A
Chemical restrainsts common in mental health world
Doc reason for doing that - doing for his safety and others

Question 29

Bandi has been observed in the seclusion room for the past 2 hours. His hygiene is very poor. He is drowsy with slurred speech, vital signs are stable, and he states that he is hungry. What is the nurse manager’s best intervention(s) at this time?
A.Ask the mental health technician (MHT) to bring Bandi to the day room, seat him at a table, and offer him a snack.
B.Offer Bandi a snack, and ask the MHT to offer fluids and toileting; then medicate the patient again as a precaution against his aggression.
C.Ask the MHT to assist Bandi with a shower. Return him to the seclusion room, and then offer him a snack.
D.Offer Bandi a snack, and then assist the MHT in taking Bandi to his assigned room to lie down. Document the interventions and outcomes.

Answer 29

Answer: D

Question 30

Bandi is discharged to a homeless shelter after a 10-day stay in the crisis stabilization unit. What nursing care does he need? Is he likely to receive this care? If he returns to the cemetery and to the supermarket parking lot, what will his rights be as a patient discharged from a psychiatric unit? What do you predict was included in his discharge documentation?

Answer 30

Case manager helpful

Question 31

Which one of the following applies to Bandi’s treatment by the nurse manager?
A. Legal protocol was followed.
B. Ethical boundaries were crossed.
C. The patient will probably file a lawsuit.
D. Informed consent was not obtained.

Answer 31

Answer: A
(Typically, medication is considered if verbal interventions fail. Chemical interventions are usually considered less restrictive than mechanical.) - against will initially doc reason for that