NURS 204 Psychiatric Mental Health Nursing Chapter 34

Chapter 7Legal and Ethical Guidelines for Safe Practice

Ethical ConceptsEthical dilemma: Conflict between two or more courses of action, each with favorable and unfavorable consequencesEthics: The study of philosophical beliefs about what is considered right or wrong in a societyBioethics: Used in relation to ethical dilemmas surrounding health care

Five Principles of BioethicsBeneficence: The duty to promote good Autonomy: Respecting the rights of others to make their own decisionsJustice: Distribute resources or care equallyFidelity (nonmaleficence): Maintaining loyalty and commitment; doing no wrong to a patientVeracity: One's duty to always communicate truthfully Nonmalefincence

Civil Rights of Persons with Mental IllnessGuaranteed same rights under federal and state laws

Due Process in Involuntary CommitmentProbable Cause Hearing

Writ of habeas corpus

Least restrictive alternative doctrine

Admission ProceduresInformal Admission sought by patient

Voluntary Admission sought by patient or guardianInformed consentClient retains all rightsClient has a right to demand and obtain releaseTemporary AdmissionPerson confused or dementedSo ill they need emergency admission

Admission Procedures ContinuedInvoluntary admission without patients consentCriteria: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 DTS5270 - 30 day hold (GD)5300 - 180 day hold for (DTO)Temporary Conservatorship - GDLPS Conservatorship - GD

Admission Procedures ContinuedLong -Term Involuntary AdmissionMedical certificationJudicial reviewAdministrative actionInvoluntary Outpatient AdmissionMedication CapacityRiese 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 againAn individual with schizophrenia who stops taking prescribed antipsychotic drugsAn individual with bipolar disorder, manic phase, who has not eaten in 4 daysSomeone who repeatedly phones a national TV broadcasting service with news tipsDischarge ProceduresConditional release

Unconditional release

Release against medical advice (AMA)

Patients Rights Under the LawRight to treatmentRight to refuse treatmentRight to informed consentRights surrounding involuntary commitment and psychiatric advance directivesRights regarding restraint and seclusion Right to confidentiality

Patient ConfidentialityLegal considerationsHealth Insurance Portability and Accountability Act (HIPAA)Confidentiality after deathConfidentiality of professional communicationsConfidentiality and human immunodeficiency virus (HIV) status

Patient ConfidentialityContinuedExceptions to the ruleDuty to warn and protect third partiesChild and elder abuse reporting statutes

Tort LawTort 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 persons rights or propertyBattery AssaultFalse imprisonmentInvasion of privacyDefamation of character (slander or libel)

Tort LawUnintentional tort unintended acts against another that produce injury or harmNegligenceMalpractice

Five Elements to Prove NegligenceDutyBreach of dutyCause in factProximate causeDamages

Guidelines for EnsuringAdherence to Standards of CareNegligence, irresponsibility, or impairment

Unethical or illegal practices

Duty to intervene and duty to report

Common Sources of Liability in Psychiatric-Mental Health ServicesClient suicideImproper treatmentMisuse of psychotropic medicationsBreach of confidentialityFalse imprisonmentInjuries or problems related to ECTSexual contact with a clientFailure to obtain informed consentFailure to report abuseFailure to warn potential victimsDocumentation of CareA records usefulness is determined by evaluatingwhen the record is read laterhow accurately and completely it portrays the patients behavioral status at the time it was written.

Medical RecordsUsed by the facility

Used as evidence

Electronic documentation

NURS 204 Psychiatric Mental Health NursingChapter 34Therapeutic Groups and Environment

Therapeutic Factors Common to All GroupsInstillation of hopeUniversalityImparting of informationAltruismOrienting client and familySafety and the structural environmentSupportive social climateSpiritualityClient and family education

Therapeutic Factors Common to All Groups ContinuedDevelopment of socializing techniquesImitative behaviorInterpersonal learningGroup cohesivenessCatharsisExistential resolution Phases of Group DevelopmentOrientation phase

Working phase

Termination phase

Group Member RolesTask 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. Im having more trouble than anyone else in this group.Three people were late for this group. Everyone is supposed to arrive on time.I cant believe youre talking about your failed romantic relationships again.We started out talking about guilt, but we have strayed from that subject.

Group Leadership ResponsibilitiesInitiating Maintaining

Terminating

Styles of LeadershipAutocratic 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 BehaviorsMonopolizing memberComplaining member who rejects helpDemoralizing memberSilent memberCommunity Support ProgramsCrisis stabilizationEmergencyAcute inpatient careGeneral health careVocational programsAmericans with Disabilities ActDay treatment, partial hospitalization programsFamily and support networkAdvocacy NAMI resourcesHigh-Risk ClientsConcurrent substance related disordersHomeless and mentally illFrequent readmissions and relapseFrequent criminal justice system involvement