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Legal & ethical aspects in mental health nursing

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Legal & ethical aspects in mental health nursing

  1. 1. ETHICAL AND LEGALISSUES INPSYCHIATRIC/MENTALHEALTH NURSINGJayesh patidarwww.drjayeshpatidar.blogspot.com
  2. 2. Group Discussion• Have you had any ethical dilemmas?• How did you deal with them?www.drjayeshpatidar.blogspot.com
  3. 3. Legal and Ethical Concepts• Ethics– Study of philosophical beliefs about what is consideredright 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 truthfullywww.drjayeshpatidar.blogspot.com
  4. 4. Mental Health Laws:Civil Rights and Due ProcessCivil rights: people with mental illness areguaranteed same rights under federal/state lawsas any other citizen• Due process in civil commitment: courts haverecognized involuntary commitment to mentalhospital is “massive curtailment of liberty”requiring due process protection, including:– Writ of habeas corpus: procedural mechanism used tochallenge unlawful detention– Least restrictive alternative doctrine: mandates leastdrastic means be taken to achieve specific purposewww.drjayeshpatidar.blogspot.com
  5. 5. Mental Health Laws:Admission to the Hospital• Voluntary: sought by patient or guardian– Patients have right to demand and obtain release– Many states require patient submit written release notice tostaff• Involuntary admission (commitment): made withoutpatient’s consent– Necessary when person is danger to self or others, and/orunable to meet basic needs as result of psychiatric condition• Emergency involuntary hospitalization– Commitment for specified period (1-10 days) to preventdangerous behavior to self/others• Observational or temporary involuntary hospitalization– Longer duration than emergency commitment– Purpose: observation, diagnosis, and treatment for mentalillness for patients posing danger to self/otherswww.drjayeshpatidar.blogspot.com
  6. 6. Patients’ Rights• Right to treatment: requires that medical andpsychiatric care and treatment be provided toeveryone admitted to public hospital• Right to refuse treatment: right to withhold orwithdraw consent for treatment at any time– Issue of right to refuse psychotropic drugs has beendebated in courts with no clear direction yet forthcoming• Right to informed consent: based on right to self-determination– Informed consent must be obtained by physician or otherhealth care professional to perform treatment orprocedure– Presence of psychosis does not preclude this rightwww.drjayeshpatidar.blogspot.com
  7. 7. Issue of Legal Competence• All patients must be considered legally competentuntil they have been declared incompetentthrough legal proceeding– Determination made by courts– If found incompetent, court-appointed legal guardian,who is then responsible for giving or refusing consent• Implied consent– Many procedures nurse performs has element ofimplied consent (e.g., giving medications)– Some institutions require informed consent for everymedication givenwww.drjayeshpatidar.blogspot.com
  8. 8. Rights Regarding Restraint andSeclusion• Doctrine of least restrictive means of restraint forshortest time always the rule• Legislation provides strict guidelines for use– When behavior is physically harmful to patient/others– When least restrictive measures are insufficient– When decrease in sensory overstimulation (seclusiononly is needed)– When patient anticipates that controlled environmentwould be helpful and requests seclusion• Recent legislative changes have further restricteduse of these means and some facilities haveinstituted “restraint free” policieswww.drjayeshpatidar.blogspot.com
  9. 9. Patient Confidentiality• Ethical considerations– Confidentiality is right of all patients– ANA Code of Ethics for Nurses (2001) asserts duty of nurse to protectconfidentiality of patients• Legal considerations– Health Insurance Portability and Accountability Act (HIPAA), 2003• Health information may not be released without patient’s consent, except tothose people for whom it is necessary in order to implement the treatmentplan• Exceptions– Duty to Warn and Protect Third Parties• Tarasoff v. Regents of University of California (1974) ruled that psychotherapisthas duty to warn patient’s potential victim of potential harm– Most states have similar laws regarding duty to warn third parties ofpotential life threats– Staff nurse reports threats by patient to the treatment teamwww.drjayeshpatidar.blogspot.com
  10. 10. Child and Elder AbuseReporting Statutes• All states have enacted child abuse reportingstatutes– Many states specifically require nurses to reportsuspected abuse• Numerous states have also enacted elderabuse reporting statutes– Agencies receiving federal funding (i.e.,Medicare/Medicaid) must follow strict guidelinesfor reporting abuse of older adultswww.drjayeshpatidar.blogspot.com
  11. 11. Tort Law Applied toPsychiatric Settings• Protection of patients: legal issues common inpsychiatric nursing are related to failure toprotect safety of patients• Protection of self– Nurses must protect themselves in bothinstitutional and community settings– Important for nurses to participate in settingpolicies that create safe environmentwww.drjayeshpatidar.blogspot.com
  12. 12. Negligence/Malpractice• Negligence or malpractice is an act or an omission to act that breaches theduty of due care and results in or is responsible for a person’s injuries• Elements necessary to prove negligence– Duty– Breach of duty– Cause in fact– Proximate cause• DamagesCause in fact– Evaluated by asking “except for what the nurse did, would this injury haveoccurred?”• Proximate cause or legal cause– Evaluated by determining whether there were any intervening actions orindividuals that were in fact the causes of harm to patient• Damages– Include actual damages as well as pain and suffering• Foreseeability of harm– Evaluates likelihood of outcome under circumstanceswww.drjayeshpatidar.blogspot.com
  13. 13. Determination of Standard of Care• ANA has established standards for psychiatric–mental health nursing practice and credentialingfor psychiatric–mental health RN and theadvanced practice RN (ANA, 2007)– Standards differ from minimal state requirements• Nurses are held to standards of care provided byother nurses possessing the same degree of skillor knowledge in same or similar circumstances– Hospital policies and procedures set up institutionalcriteria for care– Substandard institutional policies do not absolvenurse of responsibility to practice on basis ofprofessional standards of carewww.drjayeshpatidar.blogspot.com
  14. 14. Nursing Intervention:Suspected Negligence• Most states require legal duty to report risks ofharm to patient• Nurse has obligation to report peer suspected ofbeing chemically impaired– Report to supervisor is requirement• If nurse knows physician’s orders need to beclarified or changed, it is nurse’s duty tointervene and protect patient• Abandonment– Legal concept may arise when nurse does not leavepatient safely back in hands of another health careprofessional before discontinuing treatmentwww.drjayeshpatidar.blogspot.com
  15. 15. Avoiding Liability Respond to the client Educate the client Comply with the standard of care Supervise care Adhere to the nursing process Document carefully Follow up and evaluate Maintain a good interpersonalrelationship with client and familywww.drjayeshpatidar.blogspot.com
  16. 16. Thank youwww.drjayeshpatidar.blogspot.com