Chapter 6: Legal and Ethical Basis for Practice Flashcards
- A psychiatric nurse best implements the ethical principle of autonomy when he or she:
a. intervenes when a self-mutilating patient attempts to harm self.
b. stays with a patient who is demonstrating a high level of anxiety.
c. suggests that two patients who are fighting be restricted to the unit.
d. explores alternative solutions with a patient, who then makes a choice.
ANS: D
Autonomy is the right to self-determination, that is, to make ones own decisions. When the nurse explores alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. Staying with a highly anxious patient or intervening with a self-mutilating patient demonstrates beneficence and fidelity. Suggesting that two fighting patients be restricted to the unit demonstrates the principles of fidelity and justice.
- Which action by a psychiatric nurse best supports a patients right to be treated with dignity and respect?
a. Consistently addressing a patient by title and surname.
b. Strongly encouraging a patient to participate in the unit milieu.
c. Discussing a patients condition with another health care provider in the elevator.
d. Informing a treatment team that a patient is too drowsy to participate in care planning.
ANS: A
A simple way of showing respect is to address the patient by title and surname rather than assuming that the patient would wish to be called by his or her first name. Discussing a patients condition with a health care provider in the elevator violates confidentiality. Informing a treatment team that the patient is too drowsy to participate in care planning violates patient autonomy. Encouraging a patient to participate in the unit milieu exemplifies beneficence and fidelity.
- Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion:
a. reveals that the nurse values the principle of justice.
b. reinforces the autonomy of the two patients.
c. violates the civil rights of the two patients.
d. represents the intentional tort of battery.
ANS: C
Patients have a right to treatment in the least restrictive setting. Less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion removes the patients autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment, not battery.
- In a team meeting a nurse says, Im concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision. Which ethical principle most clearly applies to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice
ANS: D
The nurse is concerned about justice, that is, the fair treatment with the least restrictive methods for both patients. Beneficence means promoting the good of others. Autonomy is the right to make ones own decisions. Fidelity is the observance of loyalty and commitment to the patient.
- Which scenario is an example of a tort?
a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patients admission.
b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized.
c. A patients admission status is changed from involuntary to voluntary after the patients hallucinations subside.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.
ANS: D
A tort is a civil wrong against a person that violates his or her rights. Giving unnecessary medication for the convenience of staff members controls behavior in a manner similar to secluding a patient; thus false imprisonment is a possible charge. The other options do not exemplify torts.
- A nurses neighbor asks, Why arent people with mental illness kept in state institutions anymore? What is the nurses best response?
a. Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent.
b. Less restrictive settings are now available to care for individuals with mental illness.
c. Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed.
d. Psychiatric institutions are no longer popular as a consequence of negative stories in the press.
ANS: B
The community is a less restrictive alternative than hospitals for the treatment of people with mental illness. The remaining options are incorrect and part of the stigma of mental illness.
- Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, Im getting out of here and no one can stop me. The nurse restrains this patient without a health care providers order and then promptly obtains an order.
b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion.
c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit.
d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
ANS: B
False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. The patient in one distractor is not competent, and the nurse is acting beneficently. The patients in the other distractors have been admitted as involuntary patients and should not be allowed to leave without permission of the treatment team.
- A patient should be considered for involuntary commitment for psychiatric care when he or she:
a. is noncompliant with the treatment regimen.
b. sells and distributes illegal drugs.
c. threatens to harm self and others.
d. fraudulently files for bankruptcy.
ANS: C
Involuntary commitment protects patients who are dangerous to themselves or others and cannot care for their own basic needs. Involuntary commitment also protects other individuals in society. The behaviors described in the other options are not sufficient to require involuntary hospitalization.
- A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, Stop! I dont want to take that medicine anymore. I hate the side effects. Select the nurses best initial action.
a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having.
b. Say to the patient, Since Ive already drawn the medication in the syringe, Im required to give it, but lets talk to the doctor about skipping next months dose.
c. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects.
d. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary.
ANS: A
Patients with mental illness retain their civil rights unless clear, cogent, and convincing evidence of dangerousness exists. The patient in this situation presents no evidence of being dangerous. The nurse, an as advocate and educator, should seek more information about the patients decision and should not force the medication.
- Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
ANS: A
Nurses are professionally bound to uphold the American Nurses Association (ANA) standards of practice, regardless of lesser standards established by a health care agency or state. Conversely, if the agency standards are higher than the ANA standards of practice, the agency standards must be upheld. The courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.
- A newly admitted patient who is acutely psychotic is a private patient of the senior psychiatrist. To whom does the psychiatric nurse who is assigned to this patient owe the duty of care?
a. Health care provider
b. Profession
c. Hospital
d. Patient
ANS: D
Although the nurse is accountable to the health care provider, the agency, the patient, and the profession, the duty of care is owed to the patient.
- An example of a breach of a patients right to privacy occurs when a nurse:
a. asks a family to share information about a patients prehospitalization behavior.
b. discusses the patients history with other staff members during care planning.
c. documents the patients daily behaviors during hospitalization.
d. releases information to the patients employer without consent.
ANS: D
The release of information without patient authorization violates the patients right to privacy. The other options are acceptable nursing practices.
- An adolescent hospitalized after a violent physical outburst tells the nurse, Im going to kill my father, but you cant tell anyone. Select the nurses best response.
a. Youre right. Federal law requires me to keep that information private.
b. Those kinds of thoughts will make your hospitalization longer.
c. You really should share this thought with your psychiatrist.
d. I am required to share information with the treatment team.
ANS: D
Breach of nurse-patient confidentiality does not pose a legal dilemma for the nurse in this circumstance because a team approach to the delivery of psychiatric care presumes communication of patient information to other staff members to develop treatment plans and outcome criteria. The patient should know that the team may have to warn the father of the risk for harm.
- A voluntarily hospitalized patient tells the nurse, Get me the forms for discharge against medical advice so I can leave now. What is the nurses best initial response?
a. I cant give you those forms without your health care providers knowledge.
b. I will get them for you, but lets talk about your decision to leave treatment.
c. Since you signed your consent for treatment, you may leave if you desire.
d. Ill get the forms for you right now and bring them to your room.
ANS: B
A patient who has been voluntarily admitted as a psychiatric inpatient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patients wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. The statement that discharge forms cannot be given without the health care providers knowledge is not true. Facilitating discharge without consent is not in the patients best interest before exploring the reason for the request.
- The family of a patient whose insurance will not pay for continuing hospitalization considers transferring the patient to a public psychiatric hospital. The family expresses concern that the patient will never get any treatment. Which reply by the nurse would be most helpful?
a. Under the law, treatment must be provided. Hospitalization without treatment violates patients rights.
b. Thats a justifiable concern because the right to treatment extends only to the provision of food, shelter, and safety.
c. Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable.
d. All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.
ANS: A
The right to medical and psychiatric treatment was conferred on all patients hospitalized in public mental hospitals with the enactment of the federal Hospitalization of Mentally Ill Act in 1964. Stating that the concern is justifiable supports the familys erroneous belief. The provisions mentioned in the third and fourth options are not part of this or any other statute governing psychiatric care.
