Transcript NURS 204 Psychiatric Mental Health Nursing Chapter 34

Legal and Ethical Guidelines for Safe
Practice
Ethical Concepts
 Ethical dilemma: Conflict between two or more
courses of action, each with favorable and unfavorable
consequences
 Ethics: The study of philosophical beliefs about what is
considered right or wrong in a society
 Bioethics: Used in relation to ethical dilemmas
surrounding health care
Five Principles of Bioethics
1. Beneficence: The duty to promote good
2. Autonomy: Respecting the rights of others to make their
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own decisions
Justice: Distribute resources or care equally
Fidelity (nonmaleficence): Maintaining loyalty and
commitment; doing no wrong to a patient
Veracity: One's duty to always communicate truthfully
Nonmalefincence
Civil Rights of Persons
with Mental Illness
 Guaranteed same rights under
 federal and
 state laws
Due Process in
Involuntary Commitment
 Probable Cause Hearing
 Writ of habeas corpus
 Least restrictive alternative doctrine
Admission Procedures
 Informal Admission – sought by patient
 Voluntary Admission – sought by patient or guardian
 Informed consent
 Client retains all rights
 Client has a right to demand and obtain release
 Temporary Admission
 Person confused or demented
 So ill they need emergency admission
Admission Procedures
Continued
 Involuntary admission – without patient’s consent
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Dangerous to self (DTS)
Danger to others (DTO)
Gravely Disabled (Unable to provide for basic needs due to
Mentally illness)
Involuntary Commitment
 5150 - 72 hour-hold (DTS, DTO, GD)
 5250 - 14 day hold (DTS, DTO, GD)
 5260 - Consecutive 14 day hold for DTS
 5270 - 30 day hold (GD)
 5300 - 180 day hold for (DTO)
 Temporary Conservatorship - GD
 LPS Conservatorship - GD
Admission Procedures
Continued
 Long -Term Involuntary Admission
 Medical certification
 Judicial review
 Administrative action
 Involuntary Outpatient Admission
Medication Capacity
 Riese Petition (Medication Capacity Hearing)
Which individual with mental illness may
need involuntary hospitalization?
A person with alcoholism who has been sober for 6
months but begins drinking again
b. An individual with schizophrenia who stops taking
prescribed antipsychotic drugs
c. An individual with bipolar disorder, manic phase, who
has not eaten in 4 days
d. Someone who repeatedly phones a national TV
broadcasting service with news tips
a.
Discharge Procedures
 Conditional release
 Unconditional release
 Release against medical advice (AMA)
Patients’ Rights Under the Law
 Right to treatment
 Right to refuse treatment
 Right to informed consent
 Rights surrounding involuntary commitment and
psychiatric advance directives
 Rights regarding restraint and seclusion
 Right to confidentiality
Patient Confidentiality
 Legal considerations
 Health Insurance Portability and Accountability Act
(HIPAA)
 Confidentiality after death
 Confidentiality of professional communications
 Confidentiality and human immunodeficiency virus
(HIV) status
Patient Confidentiality
Continued
 Exceptions to the rule
 Duty to warn and protect third parties
 Child and elder abuse reporting statutes
Tort Law
 Tort – A civil wrong for which money damages may be
collected by the injured party (plaintiff) from the
responsible party (the defendant)
 Intentional tort – Willful or intentional acts that
violate another person’s rights or property
 Battery
 Assault
 False imprisonment
 Invasion of privacy
 Defamation of character (slander or libel)
Tort Law
 Unintentional tort – unintended acts against another
that produce injury or harm
 Negligence
 Malpractice
Five Elements to Prove Negligence
 Duty
 Breach of duty
 Cause in fact
 Proximate cause
 Damages
Guidelines for Ensuring
Adherence to Standards of Care
 Negligence, irresponsibility, or impairment
 Unethical or illegal practices
 Duty to intervene and duty to report
Common Sources of Liability in
Psychiatric-Mental Health Services
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Client suicide
Improper treatment
Misuse of psychotropic medications
Breach of confidentiality
False imprisonment
Injuries or problems related to ECT
Sexual contact with a client
Failure to obtain informed consent
Failure to report abuse
Failure to warn potential victims
Documentation of Care
 A record’s usefulness is determined by evaluating—
when the record is read later—how accurately and
completely it portrays the patient’s behavioral status at
the time it was written.
Medical Records
 Used by the facility
 Used as evidence
 Electronic documentation
Therapeutic Groups and Environment
Therapeutic Factors
Common to All Groups
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Instillation of hope
Universality
Imparting of information
Altruism
Orienting client and family
Safety and the structural environment
Supportive social climate
Spirituality
Client and family education
Therapeutic Factors
Common to All Groups
Continued
 Development of socializing techniques
 Imitative behavior
 Interpersonal learning
 Group cohesiveness
 Catharsis
 Existential resolution
Phases of Group Development
Orientation phase
 Working phase
 Termination phase
Group Member Roles
 Task roles
 Maintenance roles
 Individual roles
Which of the following comments made by
members of a group best demonstrates a
task role?
“I want to tell how my problems started. I’m having more
trouble than anyone else in this group.”
b. “Three people were late for this group. Everyone is
supposed to arrive on time.”
c. “I can’t believe you’re talking about your failed romantic
relationships again.”
d. “We started out talking about guilt, but we have strayed
from that subject.”
a.
Group Leadership Responsibilities
 Initiating
 Maintaining
 Terminating
Styles of Leadership
 Autocratic leader
 Democratic leader
 Laissez-faire leader
Basic Level Registered Nurse
 Psychoeducational groups
 Medication education groups
 Health education groups
 Dual-diagnosis groups
 Symptom-management groups
 Stress-management groups
 Support and self-help groups
Advanced Practice Nurse
 Group psychotherapy
 Psychodrama groups
 Dialectical behavior treatment
Dealing with Challenging Member
Behaviors
 Monopolizing member
 Complaining member who rejects help
 Demoralizing member
 Silent member
Community Support Programs
 Crisis stabilization
 Emergency
 Acute inpatient care
 General health care
 Vocational programs
 Americans with Disabilities Act
 Day treatment, partial hospitalization programs
 Family and support network
 Advocacy – NAMI resources
High-Risk Clients
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Concurrent substance related disorders
Homeless and mentally ill
Frequent readmissions and relapse
Frequent criminal justice system involvement