UNIT 2- PSYCH LEGAL

Question 1

True or false: A goal of psychiatric care is to balance the rights of psychiatric patient and the rights of society

Answer 1

True

Question 2

What is eithical dilemma?

Answer 2

Moral conflict between two or more courses of action

Question 3

What is code of ethics for nurses?

Answer 3

1. Nurse practices compassion and respect for the inherent dignity, worth and uniquie atributes of every person
2. The nurse’s primary commitment is to th epatient whether an individual, family, group, community or population
3. The nurse promotes, advocates for and protects the rights, health and safety of the patient
4. The nurse has authority, accountability and responsibility for nursing pracice; make decisions; and takes action consistent with the obligation to promote health and to provide optimal care
5. The nurse owes the same duties to self as to others, including the responsilibilty to promote health and safety, perseve wholeness of character and integrity, maintain competense and continue personal and professional growth
6. The nurse though individual and collective effort, establishes maintains and improves the ethical environment of employement that are conductive safe, quality health care
7. THe nurse in all roles and settings advances the profession though research and scholary inquary profressional standards developement and the generation of both nursing and health policy
8. The nurse collborates with other health professionals and the public to protect human rights promote health diplomacy, and reduce health disparties
9. The profession of nursing collectively through its professional organization, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy

Question 4

What is benefiece?

Answer 4

The duty to act so as to benefit or promote the good of others

Example spending extra time to help calm an extremely anxious patient

Question 5

What is autonomy?

Answer 5

Respecting the rights of others to make their own decisions

example: acknowledging the patient’s right to refuse medication

Question 6

What is justice?

Answer 6

The duty to distrubute resources or care equally regardless of person attributes

example: Devoting equal attention to both a friendly patient and a patient who will not speak or make eye contact

Question 7

What is fidelity (nonmaleficence)?

Answer 7

Maintaining loyalty and commitment to the patient and doing no wrong to the patient

example: maintaining expertice in nursing skill through nursing education

Question 8

What is veracity

Answer 8

One’s duty to communicate truthfully

example:describing the purpose and side effects of psychotropic medications in a truthful and nonmisleading way

Question 9

Treatment for psych patients should be ____ restrictive to ____ restrictive

Answer 9

Least restrictive to most restrictive

Question 10

Outpatient treatment includes…

Answer 10

PCP
Specialtiy care providers
Clinics

Question 11

Outpatient treatment includes…

Answer 11

psych home care
day progreams- PHP & IOP
ACT

Question 12

Inpatient psych treatment includes?

Answer 12

1. Emergency care
2. Crisis stablization/OBS unit
3. Locked inpatient unit

Question 13

what is the admission and discharge procedures for pscyh care?

Answer 13

1. Due process (fair procedures before depriving someone of life, liberty or property) for commitment
2. Admission to the hospital-states are required to treat patients in the least restrictive setting as possible

Question 14

Texas mental health laws: What is voluntary commitment?

Answer 14

1. Voluntarily seeks treatment and has right to request discharge

Question 15

What is involuntary commitment according to texas mental health laws?

Answer 15

Involuntary: Brought in for evaluation aginst their will
1. application for emergency detention
2. Order or issuance of mental health warrent (court)

Question 16

What should we know about inpatient Voluntary Admission?

Answer 16

1. Adult (parent or gaudian if under 18) requests admission in WRITING for psychiatric hospitalization
2. Right to request discharge (IN WRITING) and be reevaluated
3. Must be released unless risk of harm is determined

Question 17

What should we know about inboluntary inpatient admission?

Answer 17

1. Admitted without the patients consent; cannot request discharge
2. In need of psych tx and….
3. ** danger to self or other or is unable to meet his/her basic needs **
4. Must follow legal processes

Question 18

Process of involuntary commitment is…

Answer 18

1. Application for mental health warrent by family
2. Magistrate issues bench warrent if reasonable cause. Person is detained
3. Physician must provide medical certificate within 24 hours and OPC sign by judge within 48 hours
4. Probably cuase hearing with 72 hours. Patient either discharged or legal procedding continues
5. Certificate of medical examination (CME): completed by two physcians
6. Commitment Hearing: Judge, Attorney, witnesses, patient, physican. Patient either discharged or comitted for 60-180 days

Question 19

True or false: Just because a psych patient has been detained and involuntarily comitted it does not mean they cannot refuse medicaiton?

Answer 19

True- They have the right to refuse

Question 20

What are the patients rights under law?

Answer 20

1. Right to tx
   
   • The environment must be humane
   • staff must be qualified and sufficient to provide adequate treatment
   • Plan of care must be individualized
2. Right to refuse tx
   
   • Determined by each state psychotropic medications

Question 21

What does right to informed consent for a psych patient mean?

Answer 21

1. Presence of psychotic symptoms does not necessarily mean that the patient is incompetent or incapbable of understanding
2. Patients are legally competent until declaried incompetent through a legal proceeding
3. Competency is related to the capcity to understand the consequences of one’s decsiosn

Question 22

How is conservatorship established?

Answer 22

1. Legal gurdianship is separate from civil comittment for hospitalization
2. A hearing can be held to detmine whether the person is competent. An incompetent patient cannot provide his or her own shelter, food, and clothing; cannot act in his or her own best interests; and cannot run his or her own business and financial affiars
3. If a patient is found incompetent, a guardian is appointed to speak for the patient

Question 23

What are acute hospitalization goals?

Answer 23

1. Prevention of harm to self by the patient
2. Prevention of harm to others by the patient
3. Stabilization of crisis with return to community-based programs
4. Initation or modification of psychotropic medications
5. Breif, specific problem solving
6. Rapid establishment of plan for outpatient tx

Question 24

What are some safety issues for psych inpatient tx

Answer 24

1. Safety searches: remove harmful items (contraband)
2. Safety of the environment
3. Prevent self-injury (S/P) Suicide
4. Manage agressive or violent behavior (A/P)
5. Prevent elopement/escape
6. Manage psychiatric emergencies (CODES)

Question 25

What should we know about safety searches?

Answer 25

1. 2+ staff, one of which is the same gender of the patient
2. No cavity searches
3. Belongings, pockets of clothing searched
4. Safe items returned
5. Unsafe items secured until discharge

Question 26

In the event that a patient becomes agitated what should we do…

Answer 26

This is an acute behavioral emergency requiring immediate interventions (LEAST RESTRICTIVE)

Traditional interventions inlcude: Involuntary medication or/and seclusion/restraint

BEST PRACTICE: verbal de-escalation (verbally engage, establish relationship, verbally deescalate)
1. Ensure safety of patient and others
2. Help patient manage emotions and regain control
3. Avoid use of restraint if possible
4. Avoid coercive interventions that escalate agitation

Question 27

What are predictive factors for violent outcomes?

Answer 27

1. Recent acts of violence
2. angry irritable affect
3. pacing, resltess, slamming doors
4. clenched jaw or fist, tense expression
5. verbal abuse, profanity, arguing
6. loud voice or stone silence
7. Suspicious or paranoid
8. Alcohol or drug intoxicaiton
9. Possession of a weopon

Question 28

What are some intervetions we can use to de-escalate situations

Answer 28

1. maintain patient self-esteem and dignity
2. Use clam, clear voice
3. Respond as early as possible, assess patient and situation
4. Establish what the pt considers to be his immediate need
5. Maintain ample personal space
6. avoid verbal struggles
7. Provide options; Set limits
8. Use verbal, nonverbal communication skills
9. Assess for safety
10. Use pharmacological intervetions if behavior continues

Question 29

What are the patients rights regarding restraint and secultion?

Answer 29

1. Least restrictive for the shortest amount of time
2. First line is verbal intervention and enlisting the cooperation of patients
3. medications is considered if verbal intervention and cooperation fails
4. In an emergency, trained staff can restrain or seclude and then retrain an order within an hour
5. Patient can request seclusion

Question 30

What class of meds are used for a patient experiencing an acute episode anger and agression?

Answer 30

Antipsychotics & antianxiety

1. Diphenhydramine or benztropine may be added to reduce exrapyramidal side effects
2. Example of antispychotics- haloperidol (haldol), Ziprasidone (geodon), Olanzapine (Zyprexa)
3. Example of antianxiety: Lorazepam (benzodiazepine)

Question 31

What is seclusion?

Answer 31

Involuntary confinement in specifically constructed, room where person is prevented from leaving

Question 32

What should we know about behavioral seculsion & restraint?

Answer 32

1. Written order of physcian
2. order is time limited
3. Order states reason for seclusion or restraint
4. Seculation: Patients condition is assessed and documented Q 15-30min
5. Restraint: Patient is 1:1
6. Food,toliet, hydration, comfort, safety provided
7. Never used for punishment of patient or convenience of staff
8. Contraindications

Question 33

What are the order time frame for restraints?

Answer 33

1. 18 and older 4 hours
2. 9-17 years; 2hours
3. under 9 years; 1 hours
4. must be assessed at regular and frequent intervals

Question 34

what are examples of intentional torts?

Answer 34

1. Bullying, theft, phsycial assault, sexual misconduct
2. Battery: Purposeful touching of another person resulting in physical or emotional harm
3. Assault- verval or physical action that causes a resonalble belief of immediate harm
4. false imprisonment- intentional restriction of movement w/out justification or concent
   
   • may carry criminal penalties
   • Puntive damages awarded
   • not covered by professional insurance

Question 35

What are the four elements tor prove negligence?

Answer 35

1. Duty to provide a specific level of care
2. Breach is conduct that exposes the patient to an unreasonable risk of harm through actions for failure to act
3. Causation
   
   • cause in fact “but for the nurse’s action, would this injury have occured”
   • Proximate cause or legal cause- “was there unforeseeable, intervening actions or inactions that were the actual cause of harm to the patient
4. Damages are actual damages such (loss of earnings, medical expenses, and property damages) and pain and suffering to the patient or immediate family members