Ethics

Question 1

Bill of Rights for Psychiatric Clients

Answer 1

• tx must be least restrictive
• client must be told their dx and participate in tx plan
• discussion on how to prepare for discharge
• right to consent to tx, refuse tx, and to be discharged
• right to make own life decisions
• confidentiality

Question 2

Legal Commitment

Answer 2

Involuntary hospitalization: committed to a healthcare facility until no longer DTS/DTO

• when person is acute danger to themselves/others
• no insight, don’t want to be in hospital
• doc signs involuntary legal paperwork stating clinical opinion is that they need to be hospitalized

Voluntary: most clients have the right to leave voluntarily as long as no DTS/DTO
-doc and client sign paperwork for hospitalization

Question 3

Medication over objection

Answer 3

process in which a judge requires a client to undergo tx

Question 4

Mandated Outpatient

Answer 4

Kendra’s Law - court ordered assisted outpatient treatment (AOT) for individuals w/ history of mental illness and hx of violence or hospitalizations

Question 5

Confidentiality

Answer 5

HIPAA

civil and criminal penalties for violation of client privacy

Question 6

Duty to Warn

Answer 6

when client says they want to harm someone else

homicidal ideation/plan

states have differing variations on this

nurse’s duty to report this immediately to supervisor, docs, and other team members

psychiatrist usually determines if police/third party needs to be called and calls them

needs to be evaluated further to determine course of action

priority nursing intervention would be to implement safety actions (constant supervision)

Question 7

Seclusion

Answer 7

• placement of person in a room that isolates them after becoming agitated and/or DTS or DTO
• typically has a bed and nothing in the room that could be used to cause harm
• may include placing pt in a room w/ locked door
• decreased stimulation

goal = to give client opportunity to regain self control

Question 8

Restraint

Answer 8

physically preventing pt freedom of movement when DTS or DTO through the use of force or straps (mechanical or human)

follow hospital policy

Question 9

Seclusion and Restraints: Procedure

Answer 9

per hospital policy

• placed under constant observation
• asked about need for bathroom/water/food
• vital signs
• circulation check
• provider order (time period for when order is placed and when provider needs to get there to assess)
• procedure for reassessmnet
• have the practitioner release from restraints when no longer DTS/DTO

Question 10

Professional Guideline

Answer 10

ANA - code of ethics/scope and standards of practice, standards of care (care must be provided to what a nurse in a similar situation would do)

Question 11

Tort

Answer 11

wrongful act that results in injury, loss, or damage

• intentional
• unintentional

Question 12

Unintentional Tort

Answer 12

negligence: causing harm by failing to do what a reasonably prudent person would do in similar situation

malpractice: need to prove four elements
1. duty: contract w/ the pt
2. breach of duty: deviation from the standard of care
3. injury or damage: physical, financial, emotional
4. causation: injury resulted directly from breach of duty

Question 13

Assault

Answer 13

threat
no actual physical touch is required

ex) threat to patient of an injection

Question 14

Battery

Answer 14

harmful or unwarranted contact

ex) forcing walking against the will of the client

Question 15

False Imprisonment

Answer 15

not allowing a pt to leave AMA

inappropriate use of restraints

Question 16

Ethical Issues

Answer 16

utilitarianism: greatest good for the greatest number of people
deontology: decisions based on acts that are morally right with no regard for the result (decisions used while considering autonomy, beneficence, etc)

ethics consult

ethical dilemma: scenario where a difficult choice has to be made, ethical principles conflict or no clear course of action

Question 17

Autonomy

Answer 17

personal freedom and right to make own decisions

respect for pt right to make decisions even if we don’t agree with the decision

Question 18

Beneficence

Answer 18

actions promote good

difficulty in defining “good”

Question 19

Nonmaleficience

Answer 19

do no harm

avoidance of inflicting pain or suffering on others

Question 20

Veracity

Answer 20

truth telling

• should always tell the truth and the whole truth
• providing information in a way that pt’s and family can understand
• telling the pt when information is not available
• can we make informed decisions if we don’t have all the info? ex - providing alternatives to care

Question 21

Fidelity

Answer 21

keeping promises

be careful of assurances
someone cannot be pain free

Question 22

Justice

Answer 22

fair and equal treatment
not making judgements

ex) COVID and scarcity of resources, transplants

Question 23

Respect for others

Answer 23

incorporates other ethical principles