Transcript Professional Behaviors

Professional Behaviors
Spring 2010
Objectives
• Identify the legal and ethical roles of the
nursing professional and adhere to standars of
professional practice
• Demonstrate beginning skill in using the
nursing process to care for a client
• Recognize values significant to professional
nursing
• (Pages 119-133)
Objective 1
• Goal of psychiatric care: strike a balance
between rights of the individual patient and
the rights of society at large
• Ethical dilemma: conflict between two or
more courses of action
– Each carry favorable and unfavorable
consequences
• Ethics: study of philosophical beliefs
– Right versus wrong
Terms
• Beneficence: duty, to promote good
• Autonomy: respecting the rights of others to
make their own decisions
• Justice: the duty to distribute resources or
equal care, regardless of personal attributes
• Fidelity: loyalty, commitment to the patient
and doing no wrong to the patient
• Veracity: duty to communicate truthfully
Civil Rights
• Persons with mental illness are guaranteed
the same rights under federal and state laws
• Writ of habeas corpus: formal written order to
free the person
– Procedural mechanism to challenge unlawful
detention
• Least restrictive alternative doctrine:
mandates the least drastic means be taken to
achieve a specific purpose
Admissions Criteria
• Voluntary/involuntary admission: neither
determine a patient’s ability to make informed
decisions about their health care
• Must have a medical reason to justify
admission
• Psychiatric problem classified in DSM-IV-TR
• Illness causes an immediate crisis
• Treatment/hospitalization will improve the
presenting problems
Types of Admissions
• Informal: type of voluntary admission sought
by patient (can stay or leave)
• Voluntary: sought by patient or guardian
– Patients can demand and obtain release
– State laws do not mandate patients be told the
rights associated with their status
• Temporary admission: for people who are so
confused or demented they cannot make
decisions on their own
Types of Admissions cont.
• Involuntary
– Admission to a facility without the patient’s
consent
– When one presents a danger to self or others
– Unable to meet his/her own basic needs
– Patient retains freedom from unreasonable bodily
restraints, the right to informed consent, right to
refuse medications
– Physician (s) must certify the patients status
justifies detention
Involuntary cont.
• Immediate family members must be notified
of hospitalization
• Patient has right of access to legal council
• Patient can be kept up to 60 days for
treatment
• Case must then be reviewed
• Patient can file a writ of habeas corpus
Types of Admissions cont.
• Long-term involuntary: extended care and
treatment of the mentally ill
– Admitted through medical certification, judicial
review or administrative action
• Involuntary outpatient admission:
– May be a preventive measure
– Usually tied to services/goods provided by social
welfare agencies: disability or housing
Discharge Procedures
• Conditional release: requires outpatient
treatment for a specified period
– Measure ability to meet basic needs, adherence with
medications, and ability to reintegrate into the
community
• Unconditional release: termination of a patientinstitutional relationship
• Release against medical advice (AMA) treatment
would be beneficial, but no compelling reason to
seek involuntary continuance of stay
Patients’ Rights Under Law
• Right to treatment
• Right to refuse treatment
• Right to informed consent
– Based on a person’s right to self-determination
• Rights regarding involuntary admission and
advance psychiatric directives
• Rights regarding confidentiality
• HIPPA
Patients’ Rights Under Law cont.
• Confidentiality after death
• Confidentiality of Professional
communications
• Confidentiality regarding HIV status
• Exception to the Rule
– Duty to warn and protect third parties
– Patient’s potential victim or potential harm
• Duty to protect that other person
Terms
• Competency: capacity to understand the
consequences of one’s decisions
– Patient’s are legally competent until declared
incompetent through legal prodeeding
• Informed consent: for consent to be effective
legally it must be informed
Failure to Protect Patients
• Legal issues common in psychiatric mental
institutions relate to the failure to protect the
safety of the patients
• Tort Law: civil wrong
– Injury to person, property or reputation
• Intentional Torts: willful or intentional acts that
violate another person’s rights or property
– Examples: assault, battery and false imprisionment
Cont.
• Unintentional Torts: unintended acts against
another person that produce injury or harm
• Negligence
– Fail to act in accordance with professional
standards
• Malpractice
– Duty, breach of duty, the client was injured, the
nurse’s failure to carry out the duty caused the
injury
Determination of a Standard Care
• State’s qualifications for practice provide
consumer protection
• Standard based on what other nurses who
possess the same degree of skill or knowledge
in the same or similar circumstances would do
Guidelines for Ensuring Adherence to
Standards of Care
• You have a legal duty to report
– Risks of harm to the patient
– Chemically impaired peers
– Those practicing irresponsibly
– Diversion of medications
– Incompetent colleagues
– Known abusive behavior
Have a duty to intervene and duty to report
Medical Record
• Documentation of Care
• Medical Record
• Evaluates how accurately and completely it
portrays the patient’s behavioral status at the
time it was written
• Can determine areas of potential liability for
the facility
• Evaluate patient care
Medical Records as Evidence
• Good evidence, because it is presumed to be
true, honest, and untainted by memory lapses
• May be used in police investigations civil
conservatorship proceedings, competency
hearings, involuntary admissions
• Used to determine whether a cause of action
exists in a professional negligence or hospital
negligence case
Objective 3
• Nurse practices with compassion and respect
for the inherent dignity, worth and uniqueness
of every individual, and is unbiased
• Primary commitment is to the patient
• Promotes, advocates for and strives to protect
the health, safety, and rights of the patient
• The nurse is responsible and accountable for
nursing care and the appropriate delegation
and provide optimum patient care
Cont.
• The nurse owes the same duties to self as to
others, and preserves integrity and safety,
maintains competence and continue personal
and profession growth
• Participates in establishing, maintaining, and
improving health care environments and
conditions of employment conducive to the
provision of quality health care, and values are
consistent with the profession
Cont.
• Participates in the advancement of the
profession
• Collaborates with other health professionals
and the public in promoting community,
national and international efforts to meet
health needs
• The profession of nursing is responsible for
articulation nursing values, and maintaining
the integrity of the profession and its practice