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Chapter 7

Chapter 7. 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

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Chapter 7

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  1. Chapter 7 Legal and Ethical Guidelines for Safe Practice

  2. 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

  3. Five Principles of Bioethics • Beneficence: The duty to promote good • Autonomy: Respecting the rights of others to make their 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

  4. Civil Rights of Persons with Mental Illness • Guaranteed same rights under • federal and • state laws

  5. Due Process in Involuntary Commitment • Probable Cause Hearing • Writ of habeas corpus • Least restrictive alternative doctrine

  6. 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

  7. Admission Procedures Continued • Involuntary admission – without patient’s consent • Criteria: • Dangerous to self (DTS) • Danger to others (DTO) • Gravely Disabled (Unable to provide for basic needs due to Mentally illness)

  8. 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

  9. Admission Procedures Continued • Long -Term Involuntary Admission • Medical certification • Judicial review • Administrative action • Involuntary Outpatient Admission

  10. Medication Capacity • Riese Petition (Medication Capacity Hearing)

  11. Which individual with mental illness may need involuntary hospitalization? • A person with alcoholism who has been sober for 6 months but begins drinking again • An individual with schizophrenia who stops taking prescribed antipsychotic drugs • An individual with bipolar disorder, manic phase, who has not eaten in 4 days • Someone who repeatedly phones a national TV broadcasting service with news tips

  12. Discharge Procedures • Conditional release • Unconditional release • Release against medical advice (AMA)

  13. 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

  14. 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

  15. Patient ConfidentialityContinued • Exceptions to the rule • Duty to warn and protect third parties • Child and elder abuse reporting statutes

  16. 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)

  17. Tort Law • Unintentional tort – unintended acts against another that produce injury or harm • Negligence • Malpractice

  18. Five Elements to Prove Negligence • Duty • Breach of duty • Cause in fact • Proximate cause • Damages

  19. Guidelines for EnsuringAdherence to Standards of Care • Negligence, irresponsibility, or impairment • Unethical or illegal practices • Duty to intervene and duty to report

  20. Common Sources of Liability in Psychiatric-Mental Health Services • 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

  21. 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.

  22. Medical Records • Used by the facility • Used as evidence • Electronic documentation

  23. NURS 204 Psychiatric Mental Health NursingChapter 34 Therapeutic Groups and Environment

  24. Therapeutic Factors Common to All Groups • 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

  25. Therapeutic Factors Common to All Groups Continued • Development of socializing techniques • Imitative behavior • Interpersonal learning • Group cohesiveness • Catharsis • Existential resolution

  26. Phases of Group Development • Orientation phase • Working phase • Termination phase

  27. Group Member Roles • Task roles • Maintenance roles • Individual roles

  28. 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.” • “Three people were late for this group. Everyone is supposed to arrive on time.” • “I can’t believe you’re talking about your failed romantic relationships again.” • “We started out talking about guilt, but we have strayed from that subject.”

  29. Group Leadership Responsibilities • Initiating • Maintaining • Terminating

  30. Styles of Leadership • Autocratic leader • Democratic leader • Laissez-faire leader

  31. 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

  32. Advanced Practice Nurse • Group psychotherapy • Psychodrama groups • Dialectical behavior treatment

  33. Dealing with Challenging Member Behaviors • Monopolizing member • Complaining member who rejects help • Demoralizing member • Silent member

  34. 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

  35. High-Risk Clients • Concurrent substance related disorders • Homeless and mentally ill • Frequent readmissions and relapse • Frequent criminal justice system involvement

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