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NRSG 126: Mental Health > [Exam 2] Chapter 9: Legal and Ethical Issues > Flashcards

[Exam 2] Chapter 9: Legal and Ethical Issues Flashcards

1
Q

Clients receiving mental health retain all civil rights afforded to all people except

A

right to leave the hospital in the case of involuntary commitment

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2
Q

What rights do mental health patients have?

A

Right to refuse treatment

Send/recieve mail

Have or refuse visitors

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3
Q

What must happen if patient has restrictions placed against them?

A

Must have a verifiable, documented reason

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4
Q

Example of restrictions for suicidal client?

A

May not be permitted to keep a belt, shoelaces, or scissors because he/she may use for self-harm

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5
Q

What did the American Psychiatric Association develop?

A

Principles for the Provision of Mental Health and Substance Abuse Treatment Services.

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6
Q

What are some hihglights of a patients bill of rights?

A

To be informed about benefits, qualifications of all providers.

Confidentiality and choice of providers

All benefits within scope of benefit plan

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7
Q

Involuntary Hospitalization: What does it mean to be admitted on a voluntary basis?

A

Means they are willing to seek treatment and agree to be hospitalized.

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8
Q

Involuntary Hospitalization: Clients hospitalized against their will under these conditions are committed to a facility of psychiatric care until ..

A

they no longer pose a danger to themselves or to anyone else

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9
Q

Involuntary Hospitalization: Civil commitment or involuntary hospitalization curtails what?

A

The client’s right to freedom (ability to leave the hospital when they wish to). Clients right however remain intact

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10
Q

Involuntary Hospitalization: How long can a person be detained for on an emergency basis?

A

48-72 hours until hearing conducted to determine whether or not they should be committed.

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11
Q

Release from Hospital: If a voluntary client who is dangerous to themselves signs a request for discharge, a psychiatrist may file for

A

a civil commitment to detain the client against their will until a hearing can take place to decide matter

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12
Q

Release from Hospital: What may make someone eligable for discharge?

A

IF the committed client takes medications and improves fairly and is no longer a danger

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13
Q

Release from Hospital: Patient mood after stopping their medications after discharge?

A

Threatening, aggressive, or dangerous

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14
Q

Release from Hospital: Who is held legally liable for the criminal actions of released patients?

A

Mental health clinicians

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15
Q

Mandatory Outpatient Treatment: What is this?

A

Requirement that clients continue to participate in treatment on an involuntary basis after their release from the hospital

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16
Q

Mandatory Outpatient Treatment: What does this involve?

A

Taking prescribed meds, keeping appointments with health care providers for follow-up, and attending specific treatment groups

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17
Q

Mandatory Outpatient Treatment: What four states do not have assisted outpatient treatment?

A

Connecticut, MAryland, Massachusetts, and Tennessee

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18
Q

Mandatory Outpatient Treatment: What are the benefits of these treatments?

A

Shorter inpatient hospital stays, though may be hospitalized more frequently

Reduced mortality risk for clients considered dangerous

Protection of clients from criminal victimization by others

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19
Q

Mandatory Outpatient Treatment: After initial financial investiment, assisted outpatient treatment is more cost-effective than repeated

A

involuntary hospital stays

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20
Q

Mandatory Outpatient Treatment: Voluntary clients may do what against medical advice?

A

Sign a written request for discharge

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21
Q

Mandatory Outpatient Treatment: Mandated outpatient treatment is sometimes also called what?

A

Conditional release or outpatient commitment

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22
Q

Mandatory Outpatient Treatment: Court-ordered outpatient treatment is most common among who?

A

Persons with severe and persistent mental illness who have had frequent and multiple contacts with mental health ,social welfare, and criminal justice agencies

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23
Q

Mandatory Outpatient Treatment: When is court-ordered considered ?

A

When the attempts to voluntarily comply with outpatient treatment recommendations have been unsuccessful

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24
Q

Mandatory Outpatient Treatment: What is the courts concern with court-ordered outpatient treatment?

A

Concenr is that clients with psychiatric disorders have civil rights and should not be unreasonably required to participate in any activies against their will

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25
Q

Conservatorship and Guardianship: What is the description of someone who is gravely disabled?

A

Incompetent. Cannot provide food, clothing, and shelter for themselves even when resources exist. And cannot act in their own best interests.

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26
Q

Conservatorship and Guardianship: What may someone who is gravely disabled require?

A

Appointment of a conservator or legal guardian . Court appoints person to act as legal guardian who assumes responsibilites of the person

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27
Q

Conservatorship and Guardianship: Client with a guardian loses the right to what?

A

Enter into legal contracts or agreements that require a signature

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28
Q

Conservatorship and Guardianship: Because of this, the nurse must obtain consent from who?

A

The guardian.

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29
Q

Conservatorship and Guardianship: What is a conservator?

A

A person assigned by the court to manage all financial affairs of the client

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30
Q

Conservatorship and Guardianship: What are some of the responsibilities of a conservator ?

A

Receiving the client’s disability check, paying bills, making purchases, and providing client with spending money

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31
Q

Least Restrictive Environment: What is this?

A

Means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. Means client must be free of restraint or seclusion unless its necessary

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32
Q

Least Restrictive Environment: How often does the Joint Commission develop and update standards for restraint and seclusion?

A

Every 2 years with accreditation manuals provided to facilities. Others, standards available for purchase only

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33
Q

Least Restrictive Environment: What is restraint?

A

The direct application of physical force to a person without his or her permission to restrict his or her freedom of movement

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34
Q

Least Restrictive Environment: Human restraint occurs when?

A

Staff members physically control the client and move him or her to a seclusion room

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35
Q

Least Restrictive Environment: What are mechanical restraints?

A

Devices, usually ankle and wrist restraints, fastened the bed frame to curtail the client’s physical aggression, such as hitting, kicking, and hair pulling

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36
Q

Seclusion: What is this?

A

Involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for direct visual monitoring

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37
Q

Seclusion: For safety, what does the room have?

A

Bed bolted to floor and mattress. Sharps are removed

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38
Q

Seclusion: What does seclusion do to someone?

A

Decreases stimulation, protects other from the client, prevents property destruction, and provides privacy for the client

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39
Q

Seclusion: What is the goal of this?

A

Give the client the opportunity to regain physical and emotional self-control

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40
Q

Seclusion: Short-term use of restraint or seclusion is permitted only when

A

client is imminently aggressive and dangerous to him or herself and all other means of calming have been unsuccessful

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41
Q

Seclusion: For adults, use of restraints and seclusion requires what?

A

Face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint or seclusion and every 8 hours after

Physicians order every 4 hours

Documented assessment by nurse every 1-2 hours

Close supervision

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42
Q

Seclusion: For children, use of restraints and seclusion requires what?

A

Must be renewed every 2 hours with a face-to-face evaluation every 4 hours.

Nurse asses the client for any injury

Staff must monitor a client in restraints continuously on a one-to-one basis

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43
Q

Seclusion: Client in seclusion is monitored how often?

A

One-on-one for first hour and then may be monitored by audio and video equipment after

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44
Q

Seclusion: What is something the nurse would document about the patient?

A

Skin condition, blood circulation in hands/feet, emotional well-being, and readiness to discontinue seclusion or restraint

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45
Q

Seclusion: As soon as possible, staff members must inform the client of the behavioral criteria that will be used to determine whether

A

to decrease or to end the use of restraint or secluson

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46
Q

Seclusion: What does behavioral critera include?

A

Client’s ability to verbalize feelings and concerns rationally, to make no verbal threats, to have decreased muscle tension adn to decomstrate self-control

47
Q

Seclusion: If client remains in restraints for 1-2 hours, 2 staff memebrs can do what?

A

Free one limb at a time for movement and exercise

48
Q

Seclusion: What is required after release from seclusion or restraint?

A

Debriefing session within 24 hours.

49
Q

Seclusion: What should the nurse tell the family is restaints used?

A

Give a careful and thorough explanation about the client’s behavior and subsequent use of restraint or seclusion is important

50
Q

Seclusion: Goal is seclusion is to give the client the opportunity to regain

A

self-control, both emotionally and physically

51
Q

Seclusion: What are clients feelings toward seclusion that have been in there?

A

Angry, agitated, bored, frustrated, helpless, and afraid while in seclusion.

Perceive seclusion as a punishment

52
Q

Seclusion: What do clients who have not been there think about it?

A

Think of it as helpful, caring, fair, and good.

Express the wish that “that never happens to me.”

53
Q

Confidentiality: what deos HIPAA guarantee?

A

Guarantees the privacy and protection of health information and outlines penalties for violations

54
Q

Confidentiality: Mandaroyc ompliance with teh final HIPAA Privacy Rule took effect on 2003, for who?

A

All health care providers, including individuals and organizations that provide or pay for care.

55
Q

Confidentiality: Protected helath information includes what?

A

Is any information that an indentifies an individual in oral, written, or electronic form

56
Q

Confidentiality: In community, HIPAA has had a negative impact on patient care why?

A

COmpliance with the privacy rule has decreased communication and collaboration among providers and communication with family caregivers

57
Q

Duty to Warn Third Parties What was the result of Tarasoff vs REgents of University of California?

A

Mental health clinicians may have a duty to warn identifable third parties of threats made by clients, even if threats made were discussed during therapy sessions

58
Q

Insanity Defense: What is the M’Nagten Rule?

A

Argument that a person accused of a crime is not guilty because that person cannot control his or her actions or cannot understand wrongfulness of the act

59
Q

Insanity Defense: What happens when someone meets M’Nagten Rule criteria?

A

he or she may be found not guilty by reason of insanity

60
Q

Insanity Defense: What does it mean for someone to receive a verdict of guilty but insane?

A

This means the person is held responsible for the criminal behavior but can receive treatment for mental illness

61
Q

Insanity Defense: What do critics of this verdict say?

A

Argue that people do not alwasy receive needed psychiatric treatment and that this verdict absolves the legal system of its responsibility

62
Q

Nursing Liability: Nurses are expected to meet standards of care, meaning

A

the care they provide to clients meets set expectations and is what any nurse in a similar siutation would do

63
Q

Nursing Liability: Standards of care are developed from what?

A

Professional standards, state nurse practice acts, federal agency regulation, agency policies, and procesures

64
Q

Torts: What is a tort?

A

Wrongful act that results in injury, loss, or damage. May be unintentional or intentional

65
Q

Unintentional TortS: What is Negligence?

A

An unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances

66
Q

Unintentional TortS: What is Malpractice?

A

Refers specifically to professionals such as nurses and physicians. Clients or families can file malpractice lawuits in any cause of injury, loss, or death

67
Q

Unintentional TortS: For malpractice suit to be successful, what must happen?

A

for Nurse, physician, or hospital or agency to be liable, client or family needs to provide four elements

68
Q

Unintentional TortS: What four elements are needed for Malpractice?

A

Duty
Breach of Duty
Injury or Damage
Causation

69
Q

Unintentional TortS: What is Duty?

A

Legally recognized relationship (physician to client) existed. Nurse had a duty to the client, meaning that the nurse was acting in the capacity of the nurse

70
Q

Unintentional TortS: What is Breach of Duty?

A

Nurse failed to conform to standard of care, thereby breaching or failing the existing duty. Nurse did not act as a reasonable, prudent nurse would have acted

71
Q

Unintentional TortS: what is injury or damage?

A

Client suffered some type of loss, damage, or injury

72
Q

Unintentional TortS: What is causation?

A

Breach of duty was the direct cause of the loss, damage, or injury. In other words, if would not have occured if nurse had acted in a reasonable, prudent manner

73
Q

Unintentional TortS: In mental health setting, lawsuits are most often related to

A

suicide and suicide attempts.

Clients harming others, sexual asult, and med error count too

74
Q

Intentional Torts: What is this?

A

Psychiatric nurses may also be liable for intentional torts or voluntary acts that results in harm ot the client

75
Q

Intentional Torts: Example of this?

A

Assault, battery, and false imprisonment

76
Q

Intentional Torts: What is assault?

A

Involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically infurious without consent or authority

77
Q

Intentional Torts: Examples of Assult?

A

Making threats to restrain the clients to give him or her an injection for failure tocooperation

78
Q

Intentional Torts: What is battery?

A

Involves harmful or unwarranted contact with a client; actual harm or injury may or may nor have occured

79
Q

Intentional Torts: Example of battery?

A

Touching a client without consent or unnecessaryily restraining a client

80
Q

Intentional Torts: What is False Imprisonment?

A

Defined as the unjustifiable detention of a client, such as inappropriate use of restraint or seclusioin

81
Q

Intentional Torts: Proving liability for an intentional tort involves what three elements?

A

Act was willful and voluntary on part of defendant

Nurse intended to bring about consequences or injury to the person

Act was a substantial factor in causing injury or consequences

82
Q

Prevention of Liability: What are some examples of this?

A

Practice within scope of state law

Collaborate with colleagues to determine best action

Always put clients rights and welfare first

83
Q

Ethical IssueS: What is Ethics?

A

Branch of philosophy that delas with values of human conduct related to the rightness or wrongness of actions and to the goodness and badness of the motives and ends of such actions

84
Q

Ethical IssueS: What are ethical theroeis?

A

Sets of principles used to decide what is morally right or wrong

85
Q

Ethical IssueS: What is Utilitarianism?

A

Theory based on decisions on “greatest good for the greatest number” .

86
Q

Ethical IssueS: Decisions based on utilitarianism consider what?

A

Which action would produce the greatest benefit for most people

87
Q

Ethical IssueS: What is Denotology?

A

Theory that says decisions should be based on whether an action is morally right with no regard for the result or consequence

88
Q

Ethical IssueS: What principles are used in Deontology?

A

Autonomy, Beneficence, Nonmaleficence, Justice, Veracity, Fidelity

89
Q

Ethical IssueS: What is Autonomy?

A

refers to a persons right to self-determination adn indepence

90
Q

Ethical IssueS: What is beneficence?

A

Refers to ones duty to benefit or to promote the good of others

91
Q

Ethical IssueS: What is nonmaleficence?

A

Requirement to do no harm to others either intentionally or unintentionally

92
Q

Ethical IssueS: What is justice?

A

Refers to fairness, treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs

93
Q

Ethical IssueS: What is veracity?

A

Duty to be honest or truthful

94
Q

Ethical IssueS: What is fidelity?

A

Refers to obligation to honor commitments and contracts

95
Q

Ethical IssueS: How does a nurse respect clients autonomy?

A

Through patient’s rights and informed consent and by encouraigng the client to make choices about his or her health care

96
Q

Ethical IssueS: Example of beneficence?

A

Nurse has a duty to take actions that promote clients health

97
Q

Ethical IssueS: Example of nonmaleficence?

A

Actions that do not harm the client

98
Q

Ethical IssueS: Example of justice?

A

Treating all clients fairly

99
Q

Ethical IssueS: Example of veracity?

A

Be truthful and honest

100
Q

Ethical IssueS: Example of fidelity

A

honor all duties and commitments to clients and families

101
Q

Ethical Dilemmas in Mental health: What is an Ethical Dilemma?

A

Siutaiton in which ethical principles conflict or when there si no one clear course of action in a given situation

102
Q

Ethical Dilemmas in Mental health: Example of Ethical Dilemma?

A

Client who refuses medication or treatment is allowed to do so on the basis of the principles of autonomy

103
Q

Ethical Dilemmas in Mental health: Example of principle of nonmaleficence (Do no harm) is at risk?

A

Client presents an imminent threat of danger to him or herself or others

104
Q

Ethical Dilemmas in Mental health: What is the legal aspect of an action?

A

Is behavior that is allowed or required by law - there is almost always a clear “answer” to a question about the legality of an action

105
Q

Ethical Dilemmas in Mental health: The ethical aspect of an action invovles what?

A

What is “right” or what a person should do. Answer is not always clear and there is often more than one possible outcome.

106
Q

Ethical Dilemmas in Mental health: Many dilemmas in mental health involve?

A

Client’s right to self determination and independence (autonomy) and concern for the public good (utilitarianism)

107
Q

Ethical Dilemmas in Mental health: Examples of ehtical dilemas?

A

Once client is stabilized on psychotropic meds, should client be forced to remain on med through use of enforce depot injections or through outpatient commitment?

Should physicians break confidentiality to report clients who drive cars at high speeds and recklessly

108
Q

Ethical Decision-Making: Models for Ethical-decision making include

A

gathering information, clarifying values, identifying options, identifying legal considerations and practial restraints, building consenus for the decision reached

109
Q

Patients rights include what?

A

Right to receive and refuse treatment

To be involved in the plan of Care

To be treated in the least restrictive environment

To refuse to participate in research

To have unrestricted visitors, mail and phone calls

110
Q

The use of seclusion and restraint falls under the domain of

A

the patient’s right ot the least restrictive environment .

111
Q

Short term use is permitted only if

A

the client is imminently aggressive and dangerous to him or herself or to others

112
Q

Nurses have the responsibility to provide safe, competent, legal, and ethical care as outlined in nurse practice acts…

A

Scope and Standards of Psychiatric-Mental Health Nurse Practice and Code of Ethics for Nurses

113
Q

What is a tort?

A

Wrongful act that results in injury, loss, or damage

114
Q

What is negligence?

A

Unintentional tort cuasing harm through failure to act

NRSG 126: Mental Health (24 decks)

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