Transcript Ethical and Legal Issues in Psychiatric

Chapter 5
Ethical and Legal Issues in Psychiatric/
Mental Health Nursing
Copyright © 2014. F.A. Davis Company
Introduction
• Nurses are constantly faced with the
challenge of making difficult decisions
regarding good and evil or life and death.
• Legislation determines what is “right” or
“good” within a society.
Copyright © 2014. F.A. Davis Company
Core Concepts
• Ethics is a branch of philosophy that deals
with distinguishing right from wrong.
• Bioethics is a term applied to ethics when
they refer to concepts within the scope of
medicine, nursing, and allied health.
Copyright © 2014. F.A. Davis Company
Core Concepts (cont.)
• Moral behavior is conduct that results from
serious critical thinking about how individuals
ought to treat others.
• Values are personal beliefs about what is
important and desirable.
• Values clarification is a process of selfexploration by which people identify and rank
their own personal values.
Copyright © 2014. F.A. Davis Company
Core Concepts (cont.)
• Right is a valid, legally recognized claim or
entitlement encompassing both freedom from
government interference or discriminatory
treatment and entitlement to a benefit or service.
• Absolute right is when there is no restriction
whatsoever on the individual’s entitlement.
• Legal right is a right on which the
society has agreed and formalized
into law.
Copyright © 2014. F.A. Davis Company
Ethical Considerations
Theoretical Perspectives
• Utilitarianism is an ethical theory that
promotes action based on the end result that
produces the most good (happiness) for the
most people.
• Kantianism suggests that decisions and
actions are bound by a sense of duty.
Copyright © 2014. F.A. Davis Company
Ethical Considerations (cont.)
Theoretical Perspectives (cont.)
• Christian ethics emphasize doing unto others
as you would have them do unto you.
• Natural law theories refer to doing good and
avoiding evil. Human knowledge of the
difference between good and evil directs
decision making.
• Ethical egoism refers to decisions that are
based on what is best for the individual
making the decision.
Copyright © 2014. F.A. Davis Company
Ethical Considerations (cont.)
1. An operating room nurse asks a psychiatric
nurse, “How can you work with the mentally
ill day in and day out?” The psychiatric nurse
replies, “It's just the right thing to do.” The
psychiatric nurse is operating from which
ethical framework?
A.
B.
C.
D.
Kantianism
Christian ethics
Ethical egoism
Utilitarianism
Copyright © 2014. F.A. Davis Company
Ethical Considerations (cont.)
• Correct answer: A
– Kantianism focuses on the morality of actions.
Actions are judged as right or wrong based on
ethical principles. The nurse’s response indicates a
Kantian perspective.
Copyright © 2014. F.A. Davis Company
Ethical Dilemmas
•
•
Ethical dilemmas occur when moral appeals
can be made for taking either of two
opposing courses of action.
Taking no action is considered an action
taken.
Copyright © 2014. F.A. Davis Company
Ethical Principles
• Autonomy emphasizes the status of persons
as autonomous moral agents whose rights to
determine their destinies should always be
respected.
• Beneficence refers to one’s duty to benefit or
promote the good of others.
Copyright © 2014. F.A. Davis Company
Ethical Principles (cont.)
•
•
•
Nonmaleficence is abstaining from negative acts
toward another, includes acting carefully to avoid
harm.
Justice is a principle based on the notion of a
hypothetical social contract between free, equal,
and rational persons. The concept of justice reflects
a duty to treat all individuals equally and fairly.
Veracity is a principle that refers to one’s duty to
always be truthful.
Copyright © 2014. F.A. Davis Company
A Model for Making Ethical Decisions
•
•
•
•
•
Assessment
Problem identification
Plan
Implementation
Evaluation
Copyright © 2014. F.A. Davis Company
Ethical Issues in Psychiatric Mental
Health Nursing
• The right to refuse medication
• The right to the least restrictive treatment
alternative
Copyright © 2014. F.A. Davis Company
Legal Considerations
•
•
The Nurse Practice Act defines the legal
parameters of professional and practical
nursing.
Types of Laws
– Statutory law
– Common law
Copyright © 2014. F.A. Davis Company
Classifications Within Statutory and
Common Law
• Civil law protects the private and property
rights of individuals and businesses.
– Torts
– Contracts
• Criminal law provides
protection from conduct
deemed injurious to the
public welfare.
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing
•
Confidentiality and Right to Privacy
- HIPAA
- Doctrine of privileged communication
- Exception: A duty to warn
•
•
Informed Consent
Restraints and Seclusion
- False imprisonment
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
•
Commitment Issues
– Voluntary admissions
– Involuntary commitments
•
•
•
•
Emergency commitments
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
Nursing Liability
• Malpractice and negligence
• Types of lawsuits that occur in psychiatric
nursing
—Breach of confidentiality
—Defamation of character
• Libel
• Slander
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
Nursing Liability (cont.)
• Invasion of privacy
• Assault and battery
• False imprisonment
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
2. As a last resort, an agitated, physically aggressive
client is placed in four-point restraints. The client
yells, “I’ll sue you for assault and battery.” The unit
manager determines that the nurses are protected
under which condition?
A. The client is voluntarily committed and poses a
danger to others on the unit.
B. The client is voluntarily committed and has a history
of being a danger to others.
C. The client is involuntarily committed because of a
history of violent behavior.
D. The client is involuntarily committed and is refusing
treatment.
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
• Correct answer: A
– As a threat to others, the client can be restrained
despite objections and voluntary commitment.
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
3. A nurse gave a client 5 mg of haloperidol
(Haldol) for agitation. The client’s chart was
clearly stamped “Allergic HALDOL.” The client
suffered anaphylactic shock and died. How
would the nurse’s actions be labeled?
A.
B.
C.
D.
Intentional tort
Negligence
Battery
Assault
Copyright © 2014. F.A. Davis Company
Legal Issues in Psychiatric Mental
Health Nursing (cont.)
• Correct answer: B
– The nursing action was an unreasonable and
careless act. The nurse was negligent and could
be held liable for the client’s death.
Copyright © 2014. F.A. Davis Company
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 as required.
Develop and maintain a good interpersonal
relationship with client and family.
Copyright © 2014. F.A. Davis Company