Unit 2 Ethics and Legal Chapter 6

Question 1

Voluntary Admission

Answer 1

Voluntary admissions occur when patients apply in writing for admission to the facility.

Question 2

Do Voluntary Admission patients have the right to obtain release?

A. Yes
B. No

Answer 2

A. Yes

Voluntarily admitted patients have the right to request and obtain release. Before being released, reevaluation may be nec- essary. Reevaluation can result in a decision on the part of the care provider to initiate an involuntary commitment according to criteria established by state law.

Question 3

Involuntary commitment

Answer 3

Involuntary commitment, also known as assisted inpatient psychiatric treatment, is a court-ordered admission to a facility without the patient’s approval. State laws vary, but they address both the criteria for commitment and the process for com- mitment.

Question 4

Criteria for Involuntary commitment

Answer 4

1. Diagnosed with mental illness
2. Posing a danger to self or others
3. Gravely disabled (unable to provide for basic necessities such
   as food, clothing, and shelter)
4. In need of treatment and the mental illness itself prevents
   voluntary help-seeking

Question 5

Veracity

Answer 5

• Veracity – duty to be truthful

Question 6

Fidelity

Answer 6

Fidelity – Do no wrong; maintain loyalty, maintain expertise in nursing skills, being faithful to your promises

Question 7

Justice

Answer 7

Justice – duty to distribute resources equally, regardless of personal attribute (to be fair)

Question 8

Autonomy

Answer 8

Autonomy - respecting the rights of others to make their own decision.

The right to approve or disapprove treatment and drugs

Question 9

Beneficence

Answer 9

Beneficence – the duty to act to benefit or promote the good of others

Question 10

Bioethics

Answer 10

Bioethics – study of specific ethical issues in healthcare

Question 11

Ethics

Answer 11

Ethics - study of beliefs of what is right and wrong in society

Question 12

Patients Rights Under the Law

Answer 12

*Right to Refuse Treatment
*Right to Treatment
*Right to Informed Consent
*Rights Regarding Psychiatric Advance Directives
*Rights Regarding Restraint and Seclusion
*Rights Regarding Confidentiality

Question 13

Patients Rights Under the Law (Right to treatment)

Answer 13

They include:
* The right to be free from excessive or unnecessary medica-
tion
* The right to privacy and dignity
* The right to the least restrictive environment
* The right to an attorney, clergy, and private care providers
* The right to not be subjected to lobotomies, electroconvul-
sive treatments, and other treatments without fully informed consent

Question 14

The Health Insurance Portability and Accountability Act (HIPAA),

Answer 14

The Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, legally protects the psychiatric patient’s right to receive treatment and to have medical records kept confidential. Generally, your legal duty to maintain confi- dentiality is to protect the patient’s right to privacy.

Question 15

Rights Regarding Restraint and Seclusion

Answer 15

Rights Regarding Restraint and Seclusion
* ONLY utilized in emergency situations, when the patient is danger to self or others
and less-restrictive interventions have failed ** least restrictive interventions are
always tried first **

Question 16

Right to Treatment

Answer 16

Right to Treatment – quality care

Question 17

Right to Informed Consent

Answer 17

Right to Informed Consent – informed about disorder, tx options, tx benefits and tx
risks

Question 18

Rights regarding Psychiatric Advance Directives

Answer 18

Rights regarding Psychiatric Advance Directives - Patients who have experienced an episode of severe mental ill- ness have the opportunity to express their treatment preferences in a psychiatric advance directive.

This document is prepared when the individuals are well and identifies, in detail, their wishes and treatment choices.

Question 19

Rights Regarding Confidentiality

Answer 19

• Ethical responsibility of healthcare provider
• Patient must give consent to release information

Question 20

Right to Refuse Treatment

Answer 20

Right to Refuse Treatment – may withdrawal or with hold consent at any time
* Violent patients (danger to self or other – Chemical Restraint
* Psychotic patients, but not violent
* Court order to force scheduled meds
* Criteria: Serious mental illness, Deteriorating function or suffering from violent behavior, benefit
outweighs harm, lacks capacity to make reasoned decision, less-restrictive services have failed

Question 21

Conditional Release

Answer 21

A conditional release usually requires outpatient treatment for a specified period of time. During this time, the individ- ual is evaluated for follow-through with the medication regi- men, ability to meet basic needs, and the ability to reintegrate into the community. Generally, a voluntarily admitted patient who is conditionally released can only be involuntarily admit- ted through the usual methods described earlier. However, an involuntarily admitted patient who is conditionally released may be readmitted based on the original commitment order.

Question 22

Unconditional release

Answer 22

The most common type of release from a hospital after admis- sion is an unconditional release, which is the termination of the legal patient-institution relationship. This release may be ordered by the attending psychiatrist or other advanced practice mental health professional (e.g., psychiatric registered nurse practitioner or physician assistant) or it may be court ordered.
Sometimes, patients wish to be released due to issues such as being unsatisfied with care, lack of insurance coverage, or the need to return to work. When the patient requests a discharge, the care provider may agree with the request. If the clinician has doubts as to the safety of a discharge, a patient may be held for similar to an involuntary admission. As previously discussed, nearly every state allows a 72-hour holding period for profes- sional evaluation.

Question 23

Releasing Against Medical Advice

Answer 23

In some cases, there is a disagreement between the mental healthcare providers and the patient as to whether continued hospitalization is necessary. In cases where treatment seems beneficial but there is no compelling reason (e.g., danger to self or others) to seek an involuntary continuance of stay, patients may be released against medical advice (AMA). Patients are required to sign a form indicating that they are leaving AMA. This form becomes part of the patient’s permanent record.
An AMA discharge may present an ethical dilemma for cli- nicians. On the one hand, patient autonomy and the right to refuse treatment support the patient’s wishes for discharge. On the other, the clinician beneficence would support benefiting and promoting good, which includes protecting the patient.

Question 24

Discharge Procedures

Answer 24

Discharge Procedures
Release from hospitalization depends on the patient’s admission status. As previously discussed, voluntarily admitted patients have the right to request and receive release. Some states, how- ever, do provide for conditional release of voluntary patients, which enables the treating physician or administrator to order continued treatment on an outpatient basis if the patient needs further care.

Question 25

Does the patient in restraints deserve toileting right?

A. Yes
B. No

Answer 25

A. Yes

The patient is monitored through continuous observation. Patients in restraints are assessed at regular and frequent intervals, such as every 15 to 30 minutes for physical needs (e.g., food, hydration, and toileting), safety, and comfort.

Each of these assessments requires documentation. While in restraints, patients require protection from harm since they are in a vulnerable state.

Question 26

Is the patients in restraints need continuous monitoring?

A. Yes
B. No

Answer 26

A. Yes

The patient is monitored through continuous observation. Patients in restraints are assessed at regular and frequent intervals, such as every 15 to 30 minutes for physical needs (e.g., food, hydration, and toileting), safety, and comfort.

Question 27

Seclusion regulation

Answer 27

Seclusion is confining patients alone in an area or a room and preventing them from leaving. Seclusion is limited to patients who are demonstrating violent or self-destructive behavior that jeopardizes the safety of others or themselves. Even if the door is not locked, making threats if the patient tries to leave the room is still considered secluding. However, a person who is physically restrained in an open room is not considered to be in seclusion.

Seclusion should be distinguished from timeout. Timeout is when a patient chooses to or accepts a suggestion to spend time alone in a specific area for a certain amount of time. The patient can leave the timeout area at any point.

Question 28

Intentional Tort-Assault vs Battery

Answer 28

Assault
* Intentional threat to make another fearful you will cause harm
* Verbal threats
-threatening that if the pt doesn’t take the medication you will harm him

• Battery
• Actual harmful or offensive touching another
  -forcing pt to take meds

Question 29

False Imprisonment( Intentional Tort)

Answer 29

False Imprisonment
* Inappropriate Seclusion or restraint

Question 30

Unintentional Tort- Negligence vs Malpractice

Answer 30

• Negligence
• Failure to use ordinary care in a situation when you have the duty to do so.
• Malpractice
• Professional Negligence (5 elements)
• Duty
• Breach of duty
• Cause in fact
• Proximate cause
• Damages

Question 31

Documentation regulation

Answer 31

Accurate and complete information
* Descriptive of the patient’s behavior, thought process, etc…
* Should demonstrate the patient’s reaction to treatment – improvement, decline

Question 32

Lucas has completed his inpatient psychiatric treatment,
which was ordered by the court system. Which statement reveals that Lucas does not understand the concept of con- ditional release?
a. “I will continue treatment in an outpatient treatment
center.”
b. “My nurse practitioner has recommended group therapy.”
c. “I am finally free, no more therapy.”
d. “Attending therapy and taking my meds are a part of this
conditional release.”

Answer 32

c. “I am finally free, no more therapy.”

Question 33

10. Based on Maslow’s hierarchy of needs, physiological needs
    for a restrained patient include: Select all that apply.
    a. Private toileting, oral hydration
    b. Checking the tightness of the restraints
    c. Therapeutic communication
    d. Maintaining a patent airway

Answer 33

d. Maintaining a patent airway
a. Private toileting, oral hydration
b. Checking the tightness of the restraints

Question 34

The right to determine one’s own destiny is to autonomy as the duty to benefit or promote the good of others is to:

1. Nonmaleficence

2. Justice.

3. Veracity
4. Beneficence.

Answer 34

4. Beneficence.

Question 35

On which client would a nurse on an in-patient psychiatric unit appropriately use four- point restraints?

1. A client who is hostile and threatening the staff and other clients.

2. A client who is intrusive and demanding and requires added attention.
3. A client who is noncompliant with medications and treatments.
4. A client who splits staff and manipulates other clients.

Answer 35


1. A client who is hostile and threatening the staff and other clients.

Question 36

A client has been placed in seclusion because the client has been deemed a danger to others. Which is the priority nursing intervention for this client?

1. Have little contact with the client to decrease stimulation
.
2. Provide the client with privacy to maintain confidentiality.

3. Maintain contact and assure the client that seclusion will maintain the client’s safety.
4. Teach the client relaxation techniques and effective coping strategies to deal with anger. 


Answer 36

3. Maintain contact and assure the client that seclusion will maintain the client’s safety.

(Rationale : although pt is in restraints or secluded the nurses priority is to ensure 1 on 1 with is enforced to monitor patients safety which is the nurses priority intervention

Question 37

9. Implied consent occurs when no verbal or written agree-
   ment takes place prior to a caregiver delivering treatment. Which of the following examples represents implied con- sent?
   a. The mother of an unconscious patient saying okay to
   surgery
   b. Care given to a heroin overdose victim
   c. Immobilizing a patient who has refused to take medica-
   tion
   d. Signing general intake paperwork with specific parame-
   ters

Answer 37

b. Care given to a heroin overdose victim

Question 38

. When a client makes a (Voluntary)written application to be admitted to a psychiatric facility, which statement about this client applies?


1. The client may retain none, some, or all civil rights depending on state law.

2. The client cannot make discharge decisions. These are initiated by the hospital or 
court or both. 

3. The client has been determined to be a danger to self or others.
   

4. The client makes decisions about discharge, unless he or she is determined to be a 
danger to self or others.

Answer 38

4. The client makes decisions about discharge, unless he or she is determined to be a 
danger to self or others.

(Rationale : if patient is mentally competent they can leave , 4.A voluntarily admitted client can make decisions about discharge, unless the client has been determined to be a danger to self or others. If the treatment team determines that a voluntarily admitted client is a danger to self or others, the client is held for a court hearing, and the client’s admission status is changed to involuntary. )

Question 39

A client has been involuntarily committed to a psychiatric unit. During the delivery of the evening dinner trays, the client elopes(leaving without permission) from the unit, gets on a bus, and crosses into a neighboring state. Which nursing intervention is appropriate in this situation?

1. Call the psychiatric facility located in the neighboring state and attempt to have 
that facility involuntarily admit the client.
   
   2. Notify the client’s physician, follow facility policy, document the incident, and 
review elopement precautions. 

   3. Send a therapeutic assistant out to relocate the client and bring him or her back to 
the facility. 

   4. Notify the police in the neighboring state and have them pick the client up and 
readmit the client to the facility.

Answer 39

2. Notify the client’s physician, follow facility policy, document the incident, and 
review elopement precautions. 


Question 40

17.On an in-patient locked psychiatric unit, a newly admitted client requests to leave against medical advice (AMA). What should be the initial nursing action for this client?


A. Tell the client that, because he or she is on a locked unit, he or she cannot leave AMA

B.Check the client’s admission status and discuss the client’s reasons for wanting to 
leave

C.In a matter-of-fact way, initiate room restrictions.


D.Place the client on one-on-one observation.

Answer 40

B.Check the client’s admission status and discuss the client’s reasons for wanting to 
leave

( Rationale:It is important for the nurse to know the admission status of this client. If the cli- ent is involuntarily admitted, the client is unable to leave the facility. If the client is voluntarily admitted, the client may leave AMA, unless the treatment team has de- termined that the client is a danger to self or others.

Question 41

18. The nurse is having a therapeutic conversation with a client in a locked in-patient psychiatric unit. The client states, “Please don’t tell anyone about my sexual abuse.” Which is the appropriate nursing response?


A. “Yes, I will keep this information confidential.

” B.“All of the health-care team is focused on helping you. I will bring information to the team that can assist them in planning your treatment.”


C.“Why don’t you want the team to know about your sexual abuse? It is significant information.”


D.“Let’s talk about your feelings about your history of sexual abuse.”

Answer 41

” B.“All of the health-care team is focused on helping you. I will bring information to the team that can assist them in planning your treatment.”

(Rationale:It is the priority intervention of the in-
structor to correct and remind the student of the importance of maintaining client confidentiality. The instructor should advise the student to use only client initials
on any student paperwork.)

Question 42

The phone rings at the nurse’s station of an in-patient psychiatric facility. The caller asks to speak with Mr. Hawkins, a client in room 200. Which nursing response protects this client’s right to autonomy and confidentiality?


A. “I am sorry; you cannot talk to Mr. Hawkins.”


B. “I cannot confirm or deny that Mr. Hawkins is a client admitted here.”


C. “I’ll see if Mr. Hawkins wants to talk with you.

”
D. “I’m sorry; Mr. Hawkins is not taking any calls.” 


Answer 42


B. “I cannot confirm or deny that Mr. Hawkins is a client admitted here.”

(Rationale: The nurse is being honest and open with the client and giving information about the client focus of the treatment team. This builds trust and sets limits on potentially manipulative behavior by the client.

Question 43

In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by using restraint to prevent one client from self-mutilation, while the care plan for another selfmutilating client requires one-on-one supervision.” Which ethical principle most clearly applies to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice

Answer 43

d. Justice

ANS: D
The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both clients. Beneficence means promoting the good of others. Autonomy is the right to make one’s own decisions. Fidelity is the observance of loyalty and commitment to the client.

Question 44

Malpractice

Answer 44

Malpractice is a special type of professional negligence. The five elements required to prove negligence are:
1. Duty
2. Breach of duty
3. Cause in fact
4. Proximate cause
5. Damages