Legal Ethics Flashcards
Ethics
study of beliefs about what is right or wrong
- mortality through different approaches
Bioethics
ethical questions arise in healthcare
Laws tend to reflect
ethical values of society
Standards of Practice for Nurses
- assess
- nursing dx
- outcome what
- plan
- implement
- intervention
- evaluate
Code of Ethics in Nursing
Ethics, advocacy, respectful, and equitable practice communicate, elaborate, continue education, scholarly inquiry, quality of practice, stewardship, professional practice
the goal of psychiatric care is to
to balance the rights of the psychiatric patient and the rights of society
The ethical dilemma is the
moral conflict between two or more courses of action
What are the 9 codes of ethics for nurses?
- Compassion and respect for every person
- commitment to the patient
- advocacy and protect their rights and safety
- responsibility, decision-making, consistent
- maintain personal self-care
- improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care
- research
- teamwork
- Uphold nursing policies
Beneficence
duty to act to benefit or promote the good of others
- spend extra time to calm an extremely anxious pt
Autonomy
Respecting the rights of others to make their own decisions
- right to refuse medication
Justice
duty to distribute resources or care equally regardless of person attributes
- devote equal attention to all patients regardless
Fidelity (Nonmaleficence)
Maintaining loyalty and commitment to the patient and doing no wrong to the patient
- maintain expertise through education
Veracity
One’s duty to communicate truthfully
- no misleading
Community Mental Health Center Act 1963 by JFK for Rosemary
Widespread use of psychotropic drugs enabling people to integrate into the community instead of living in asylums
- insurance coverage for mental health or substance abuse
Civil Rights for the mentally ill
- vote
- civil service ranking
- granting, forfeit, or denial of license
- purchases/contracts unless incompetent
- press charges
- personal/religious expression
- humane care and tx
- courts for nonviolent cases with mental illness
Hx of inhumane tx
segregated in asylums not to tx or cure
“social deviants” - divine punishment
hydrotherapy to lower agitation
restraints
forced to expel “demons”
infected so removing body parts
Tx environment order
Outpt - PCP, specialty, clinics
Psych home care, day programs,(PHP&IOP), ACT
Inpt - emergency care hold, crisis stabilization, locked unit
Admission/D/C Procedures
- Due process for commitment
- Admission to hospital (least restrictive to most)
Due process
fair procedures before depriving someone of life, liberty, or property
Voluntary patient in TX mental health laws
seeks tx and has right to request discharge
Involuntary patient in TX mental health laws
brought in for eval against their will
- application for emergency detention (family)
- order of insurance of mental health warrant (court)
Voluntary Inpatient Admission
adult (younger than 18 than parent)
- request admission in writing
- right to request d/c (in writing and be reevaluated
- released unless risk of harm
InVoluntary Inpatient Admission
admitted w/o consent can’t request D/C
- Tx and danger to self/others/UNABLE TO MEET own basic needs
- legal process
For a family member to involuntary sign patient for hospitalization, what legal process occurs?
Bench warrant if reasonable cause - detainment
- Physician must provide a medical certificate within 24 and Order of Protective Custody signed by a judge with 48 hours
- Probable cause hearing within 72 hours
- Certificate of Medical Exam by 2 physicians w/in 2 weeks
- Commitment hearing: judge, attorney, witness, pt, physician
D/C or committed for 60-180 days
If an involuntary pt refuses tx, should you still make them take the medication.
No, they have a right to refuse medication even psychotropic meds
The pt’s right to treatment
environment humane
qualified staff and sufficient to provide adequate tx
an individual plan of care
Right to Informed Consent
presence of psychotic symptoms not mean pt is incompetent to incapable of understanding
- legally competent until declared not
Competency
capacity to understand the consequences of one’s decisions
Medicine Commitment Hearing
forced by law to take medicine
Bench Warrant
forensic study to determine competency
Furlough
conditional release with appointments
Conservatorship
patient is found incompetent, a guardian is appointed to speak for the patient
An incompetent pt can not
provide his or her shelter, food, and clothing;
cannot act in his or her own best interests;
cannot run his or her own business and financial affairs.
Acute Hospitalization Goals (6)
Prevention selfharm
Prevent harm to others
Stabilization of crisis with return to community programs
Psychotropic medications
Brief, specific problem-solving
Rapid establishment of output tx
Safety Issues and Precautions for Psych patients
Searches (remove contraband)
Milieu
Prevent self-injury
Manage aggressive/violent behavior
Prevent elopement/escape
Manage emergencies
Assualt and Elopement Precautions
What to do in a safety search?
2 staff (1 as the same gender)
No cavity searches
Belongings. pockets of clothing searched
Safe items returned
If unsafe - secured till D/C
Policy
Unsafe Items include
sharp objects
medications/drugs
alcohol
strings, belt
lighters/matches
When a pt becomes aggressive, how many people communicate with the pt?
only 1
What should the nurse avoid wearing,
dangling earrings
stethoscope
lanyard
watch
eyeglasses
- know layout of area
When addressing an aggressive pt stand
10 ft away and to the side
- avoid confrontation
Agitation
acute behavioral emergency requiring immediate interventions (least restrictive)
What is the best practice when dealing with agitation?
verbal de-escalation (engage, relationship)
- ensure safety pt and others
- help pt manage emotions/control
- Avoid restraints and coercive interventions
Traditional Interventions for agitation
involuntary medication or seclusion/restraint
Anger
Emotional response to frustration of desires, threat to one’s needs (physical or emotional), or a challenge
Aggression
Action or behavior that results in a verbal or physical attack
Violence
Intentional use of force that results in, or has potential to result in, injury to another person
Predictive Factors for Violent Outcomes
Recent acts of violence
Angry, irritable affect
Pacing, restless, slamming doors
Clenched jaw or fist, tense expression
Verbal abuse, profanity, arguing
Loud voice or stone silence
Suspicious or paranoid
ETOH or drug intoxication
Possession of weapon
Milieu conducive to violence (loud, crowded, staff inexperience or controlling, poor limit setting)
De-escalation Technique Interventions
pt’s self-esteem and dignity
calm and clear voice
- respond ASAP to assess pt and situation
- immediate need
- personal 10 ft space
- avoid verbal struggles
- set limits
- communication skills(don’t stare)
- safety
- injection if forced
Rights regarding restraint and seclusion
- least restrictive for shortest amount of time
- 1st verbal and cooperation
- 2nd medications
- Emergency, staff restrain/seclude and retain order within 1 hour
- Pt can request seclusion
The psychiatrist needs to assess the patient how long after sedation?
1 hour
Tx for acute anger and aggression are
antipsychotics and antianxiety
What medications can be added in an emergency situation to reduce extrapyramidal side effects?
Diphenhydramine or benztropine
Antipsychotics for Anger and aggression acute episodes
Haloperidol (Haldol)
Ziprasidone (Geodon)
Olanzapine (Zyprexa)
Antianxiety for Anger and aggression acute episodes
Lorazepam (benzo)
Seclusion:
involuntary confinement in specially constructed, room where person is prevented from leaving (lock door)
Restraint
any manual method or physical or mechanical device that immobilizes the ability of person to move
Seclusion/Restraint Interventions
Use of least restrictive means of restraint for the shortest duration of time
- harmful to self/others
- less restrictive are insufficient
- decrease sensory stim required
- request seclusion
Behavioral Seclusion/Restraint order need
written order of physician
time limited
reason listed
Seclusion: assess/doc every 15 minutes
Restraint: 1:1 with them
food, toilet, hydration, comfort, safety
NEVER USE FOR PUNISHMENT/CONVENIENCE
Restraints/Seclusion is contraindicated for
fractures
Time limit of seclusion/restraint if 18+
4 hours
Time limit of seclusion/restraint if 9-17
2 hours
Time limit of seclusion/restraint if less than 9
1 hour
Confidentiality
HIPAA
duty to warn and protect 3rd party
- protective privilege ends where public peril begins”
Notify who is threatened
- notify potential victim, family, and police
-discharge by therapist
Duty to protect and report
- suspected child/elder/disabled abuse, neglect, exploitation
When the abuser is in drug/alcohol tx disclosure cannot be made until
Court order is obtained
Report can be made without identifying abuser
Report can be made anonymously
Intentional Torts
bullying, theft, physical assault, sexual misconduct, exploitation, or fraud
- Battery, Assualt, False Imprisonment
Battery
purposeful touching of another person resulting in physical or emotional harm
Assault
verbal or physical action that causes a reasonable belief of immediate harm
False Imprisonment
Intentional restriction of movement without justification or consent
- May carry criminal penalties
- Punitive damages awarded
- Not covered by professional insurance
What are the 4 elements to prove negligence?
- duty to provide a specific level of care
- Breach BY FAILING TO ACT
- Causation (purpose and proximate/legal)
- Damages/pain/suffering
Breach is a
conduct that exposes the patient to an unreasonable risk of harm through actions for failure to act
Causation
- Cause in fact /purpose “but for the nurse’s action, would this injury have occurred”
- Proximate cause or legal cause “was there unforeseeable, intervening actions or inactions that were the actual cause of harm to the patient (indirect)
Guidelines to Avoid Liability
Patient’s rights and welfare first
within scope of practice
go by practice standards
policy and procedures
documentation
Protection of Patient
- legal issues r/t failure to protect patients
Suicidal left alone with means to harm themselves
prevent harm when restrained
protect from other violent/abusive patients
Abuse of therapist-patient relationship (sexual misconduct)
Guidelines for Nurses Suspecting Negligence
art and take action regarding incompetent, unethical, illegal practices that place rights in jeopardy
- communicate your concerns to person immediately
As a patient advocate, if a nurse believes an order needs to clarified or changed, it is their duty to
intervene and protect the patient.
Patient abandonment –
nurse does not leave a patient safely reassigned to another health care professional when leaving
- pass off has no occurred
- no follow through care
3 Unethical or illegal practices
diversion of drugs
sexual misconduct with patients
report colleague as a pt advocate
