Legal and Ethical Issues for Psychiatry and Nursing

mental-health

Legal and Ethical Concepts

*    Ethics
–    Study of philosophical beliefs about what is considered right or wrong in society
*    Bioethics
–    Ethical questions arising in health care
*    Principles of bioethics
–    Beneficence: duty to act to benefit others
–    Autonomy: respecting rights of others to make decisions
–    Justice: duty to distribute resources equally
–    Fidelity: maintaining loyalty and commitment to patient
–    Veracity: duty to communicate truthfully

Mental Health Laws:


Civil Rights and Due Process
Civil rights: people with mental illness are guaranteed same rights under federal/state laws as any other citizen
–    Due process in civil commitment: courts have recognized involuntary commitment to mental hospital is “massive curtailment of liberty” requiring due process protection, including:
–    Least restrictive alternative policy: mandates least extreme means be taken to achieve specific purpose

Historical Overview


–    Historically patients with mental illness had few rights and were institutionalized and  treated inhumanly.
–    Major change- 1963, “Community mental   Health Act”
–    During the 1970’s increased awareness of the need to provide humane treatment for mental patients that respects civil rights brought the enactment of the “Baker Act”
–    1980’ Mental Health System act- “Patient’s Bills of Rights” by U.S. Congress

RIGHTS OF INDIVIDUALS


–    Individual dignity and respect
–    Treatment- receive, quality, give or refuse, in the least restrictive environment
–    Participation in treatment and discharge planning
–    Express and informed consent
–    Communication
–    Abuse reporting
–    Care and supervision of personal effects
–    All civil rights such as voting in elections
–    and legal representation
–    Confidentiality and privacy
–    Separation of children from adults
–    Written copy of rights on admission
* Signed by patient and copies to others
–    Discussion of rights during hospitalization
–    Posting of rights and phone numbers
•    Abuse Registry/Hot line and advocacy
•     center for persons with disabilities
–    Liability for violation of rights

VOLUNTARY ADMISSION

The person must be:
–     Willing to seek treatment and agree to be hospitalized
–    Competent to provide express and informed consent
–    Be suitable for treatment
–     Be provided with:
* reason for admission
•    treatment, purpose,
approx. length and side effects
* alternate treatment
* consent may be revoked anytime

DISCHARGE OF VOLUNTARY INDIVIDUALS


–    Notice of rights to request release on admission
–    Ask for for discharge release within 24 hours

INVOLUNTARY ADMISSION


–    Clients hospitalized against
their will (Danger to self or
others and or unable to care for self)
–    Does not have the right to leave the hospital but all other rights remain intact

INITIATING INVOLUNTARY EXAMINATION

May be initiated by:
1.    Court order- the circuit court
may issue an ex-parte order
1.    A law enforcement officer
2.    A mental health professional (physician, clinical psychologist, psychiatric nurse (ARNP, CNS) and clinical social worker)

NURSING RESPONSIBILITY

–    Responsible for providing safe, competent,
legal and ethical care
–    Provides guidance and outlines

Client Confidentiality


–    Ethical considerations
–    Legal considerations
–    Health Insurance Portability and Accountability Act (HIPAA)
–    Client’s employer
–    Rights after death
–    Client privilege and human immunodeficiency virus status
–    Exceptions to the rule
–    Duty to warn and protect third parties
–    Child and elder abuse reporting statues

NURSING LIABILITY

TORTS
–    Unintentional
–    Negligence
–    Malpractice    –    Intentional
–    Assault
–    False Imprisonment
–    Punitive damages
Common Liability Issues
–    Protection of clients
–       Defamation of character
–    Libel
–    Slander
–    Supervisory liability
–    Short-staffing issues

Guidelines for Nurses who Suspect Negligence

–    Duty to intervene
The psychiatric mental health nurse has a duty to intervene when the    safety or well-being of the client or another person is obviously at risk.
–    Duty to report
–    Unethical or illegal practices

Violence

–    Nurses must protect themselves in institutional or community settings
–    Employers are not typically held responsible for employee injuries caused by violent client behavior
–    Nurses have placed themselves knowingly in the range of danger by agreeing to care for unpredictable clients
–    Good judgment means not placing oneself in a potentially violent situation

STEPS TO AVOID LIABILITY

1.    Practice within the state laws and the Nursing Practice Act
2.    Collaborate with colleges to determine the best course of action
3.    Use established practice standards and hospital manual to guide decisions and actions
1.    Always place the patient’s rights and welfare first.
2.    Develop effective interpersonal relationships with patients and families.
3.    Document care accurately through all the steps of the nursing process

Documentation of Care


   A record’s usefulness is determined by evaluating when the record is read later, how accurately, objectively and completely it portrays the client’s behavioral status at the time it was written.

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