Ecosystem Interactions Class Discussion Presentation in Blue Green Lined Styl...
Legal & ethical aspects in mental health nursing
1. ETHICAL AND LEGAL
ISSUES IN
PSYCHIATRIC/MENTAL
HEALTH NURSING
Jayesh patidar
www.drjayeshpatidar.blogspot.com
2. Group Discussion
• Have you had any ethical dilemmas?
• How did you deal with them?
www.drjayeshpatidar.blogspot.com
3. Legal and Ethical Concepts
• Ethics
– Study of philosophical beliefs about what is considered
right or wrong in society
• Bioethics
– Ethical questions arising in health care
• Principles of bioethics
– Beneficence: duty to act to benefit others
– Autonomy: respecting rights of others to make decisions
– Justice: duty to distribute resources equally
– Fidelity: maintaining loyalty and commitment to patient
– Veracity: duty to communicate truthfully
www.drjayeshpatidar.blogspot.com
4. Mental Health Laws:
Civil Rights and Due Process
Civil rights: people with mental illness are
guaranteed same rights under federal/state laws
as any other citizen
• Due process in civil commitment: courts have
recognized involuntary commitment to mental
hospital is “massive curtailment of liberty”
requiring due process protection, including:
– Writ of habeas corpus: procedural mechanism used to
challenge unlawful detention
– Least restrictive alternative doctrine: mandates least
drastic means be taken to achieve specific purpose
www.drjayeshpatidar.blogspot.com
5. Mental Health Laws:
Admission to the Hospital
• Voluntary: sought by patient or guardian
– Patients have right to demand and obtain release
– Many states require patient submit written release notice to
staff
• Involuntary admission (commitment): made without
patient’s consent
– Necessary when person is danger to self or others, and/or
unable to meet basic needs as result of psychiatric condition
• Emergency involuntary hospitalization
– Commitment for specified period (1-10 days) to prevent
dangerous behavior to self/others
• Observational or temporary involuntary hospitalization
– Longer duration than emergency commitment
– Purpose: observation, diagnosis, and treatment for mental
illness for patients posing danger to self/others
www.drjayeshpatidar.blogspot.com
6. Patients’ Rights
• Right to treatment: requires that medical and
psychiatric care and treatment be provided to
everyone admitted to public hospital
• Right to refuse treatment: right to withhold or
withdraw consent for treatment at any time
– Issue of right to refuse psychotropic drugs has been
debated in courts with no clear direction yet forthcoming
• Right to informed consent: based on right to self-
determination
– Informed consent must be obtained by physician or other
health care professional to perform treatment or
procedure
– Presence of psychosis does not preclude this right
www.drjayeshpatidar.blogspot.com
7. Issue of Legal Competence
• All patients must be considered legally competent
until they have been declared incompetent
through legal proceeding
– Determination made by courts
– If found incompetent, court-appointed legal guardian,
who is then responsible for giving or refusing consent
• Implied consent
– Many procedures nurse performs has element of
implied consent (e.g., giving medications)
– Some institutions require informed consent for every
medication given
www.drjayeshpatidar.blogspot.com
8. Rights Regarding Restraint and
Seclusion
• Doctrine of least restrictive means of restraint for
shortest time always the rule
• Legislation provides strict guidelines for use
– When behavior is physically harmful to patient/others
– When least restrictive measures are insufficient
– When decrease in sensory overstimulation (seclusion
only is needed)
– When patient anticipates that controlled environment
would be helpful and requests seclusion
• Recent legislative changes have further restricted
use of these means and some facilities have
instituted “restraint free” policies
www.drjayeshpatidar.blogspot.com
9. Patient Confidentiality
• Ethical considerations
– Confidentiality is right of all patients
– ANA Code of Ethics for Nurses (2001) asserts duty of nurse to protect
confidentiality of patients
• Legal considerations
– Health Insurance Portability and Accountability Act (HIPAA), 2003
• Health information may not be released without patient’s consent, except to
those people for whom it is necessary in order to implement the treatment
plan
• Exceptions
– Duty to Warn and Protect Third Parties
• Tarasoff v. Regents of University of California (1974) ruled that psychotherapist
has duty to warn patient’s potential victim of potential harm
– Most states have similar laws regarding duty to warn third parties of
potential life threats
– Staff nurse reports threats by patient to the treatment team
www.drjayeshpatidar.blogspot.com
10. Child and Elder Abuse
Reporting Statutes
• All states have enacted child abuse reporting
statutes
– Many states specifically require nurses to report
suspected abuse
• Numerous states have also enacted elder
abuse reporting statutes
– Agencies receiving federal funding (i.e.,
Medicare/Medicaid) must follow strict guidelines
for reporting abuse of older adults
www.drjayeshpatidar.blogspot.com
11. Tort Law Applied to
Psychiatric Settings
• Protection of patients: legal issues common in
psychiatric nursing are related to failure to
protect safety of patients
• Protection of self
– Nurses must protect themselves in both
institutional and community settings
– Important for nurses to participate in setting
policies that create safe environment
www.drjayeshpatidar.blogspot.com
12. Negligence/Malpractice
• Negligence or malpractice is an act or an omission to act that breaches the
duty of due care and results in or is responsible for a person’s injuries
• Elements necessary to prove negligence
– Duty
– Breach of duty
– Cause in fact
– Proximate cause
• DamagesCause in fact
– Evaluated by asking “except for what the nurse did, would this injury have
occurred?”
• Proximate cause or legal cause
– Evaluated by determining whether there were any intervening actions or
individuals that were in fact the causes of harm to patient
• Damages
– Include actual damages as well as pain and suffering
• Foreseeability of harm
– Evaluates likelihood of outcome under circumstances
www.drjayeshpatidar.blogspot.com
13. Determination of Standard of Care
• ANA has established standards for psychiatric–
mental health nursing practice and credentialing
for psychiatric–mental health RN and the
advanced practice RN (ANA, 2007)
– Standards differ from minimal state requirements
• Nurses are held to standards of care provided by
other nurses possessing the same degree of skill
or knowledge in same or similar circumstances
– Hospital policies and procedures set up institutional
criteria for care
– Substandard institutional policies do not absolve
nurse of responsibility to practice on basis of
professional standards of care
www.drjayeshpatidar.blogspot.com
14. Nursing Intervention:
Suspected Negligence
• Most states require legal duty to report risks of
harm to patient
• Nurse has obligation to report peer suspected of
being chemically impaired
– Report to supervisor is requirement
• If nurse knows physician’s orders need to be
clarified or changed, it is nurse’s duty to
intervene and protect patient
• Abandonment
– Legal concept may arise when nurse does not leave
patient safely back in hands of another health care
professional before discontinuing treatment
www.drjayeshpatidar.blogspot.com
15. 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 and evaluate
Maintain a good interpersonal
relationship with client and family
www.drjayeshpatidar.blogspot.com
