CH 3 Ethical and Legal Issues - Psych

Ethical Dilema

-An ethical dilemma is a situation that requires an individual to make a choice between two equally unfavorable alternatives. Evidence exists to support both moral "rightness" and moral "wrongness" related to a certain action. The individual who must make the choice experiences conscious conflict regarding the decision. -An ethical dilemma arises when there is no clear reason to choose one action over another. -An ethical dilemma arises when there is no clear reason to choose one action over another. -actions associated with both sides are desirable in some respects and undesirable in others. In most situations, taking no action is considered an action taken.

The Right to Treat

-Anyone who is admitted to a hospital has the right to treatment. A psychiatric patient cannot legally be hospitalized and then denied appropriate treatment. The AHA patient bill of rights- protecting the patient from a breach of reasonable standards while hospitalized. -These rights were revised in 2003 to create an emphasis on the importance of the collaborative relationship between the client and the hospital healthcare team. Titled "The Patient Care Partnership," this brochure informs patients that they have a right to high-quality care while hospitalized, to a clean and safe environment, to be involved in their care, to have their privacy protected, to get help when leaving the hospital, and to get help with their billing claims -In 2010, federal law expanded patient rights to include insurability in spite of pre-existing conditions. However, federal healthcare law continues to be a debated issue and will no doubt continue to see changes depending on the prevailing political climate. -Nurses practicing in hospital settings need to be aware of and adhere to legal statutes, accepted standards of practice, and organizational policies with regard to a client's rights during hospital treatment.

The right to refuse treatment

-Legally, patients have the right to refuse treatment unless the treatment requires immediate intervention to prevent death or serious harm to the patient or another person - Sometimes patients are involuntarily hospitalized because they are at risk of harming themselves or others and do not recognize the dangerousness of their symptoms. -In emergency cases, sedative medication may be administered without the patient's consent in order to protect patients from harming themselves or others. Because laws vary from state to state, it is important for nurses to know the laws that pertain in their local jurisdiction. Organizational policies in the nurse's practice setting should also guide decision making.

Exception: A Duty to Warn (Protection of a Third Party)

-Once a therapist does in fact determine, or under applicable professional standards should have determined, that a patient poses a serious danger of violence to others, he bears a duty to exercise reasonable care to protect the foreseeable victim of that danger. While the discharge of this duty of due care will necessarily vary with the facts of each case, in each instance the adequacy of the therapist's conduct must be measured against the traditional negligence standard of reasonable care under the circumstances.

HIPPA

-PHI is individually identifiable health information indicators that "relate to past, present, or future physical or mental health or condition of the individual, or the past, present, or future payment for the provision of health care to an individual; and (1) that identifies the individual; or (2) with respect to which there is a reasonable basis to believe the information can be used to identify the individual" -individuals have the rights to access their medical records, to have corrections made to their medical records, and to decide with whom their medical information may be shared. The actual document belongs to the facility or the therapist, but the information contained therein belongs to the client. -Pertinent medical information may be released without consent in a life-threatening situation. If information is released in an emergency, the following information must be recorded in the client's record: date of disclosure, person to whom information was disclosed, reason for disclosure, reason written consent could not be obtained, and the specific information disclosed.

Beneficence

-Refers to one's duty to benefit or promote the good of others. Healthcare workers who act in their clients' interests are beneficent, provided their actions really do serve the client's best interest. In fact, some duties seem to take preference over other duties. -Good care must include a holistic focus that considers the patient's beliefs, feelings, and wishes; the wishes of the family and significant others; and considerations about competent nursing care -Despite these guidelines, it is not always clear which action is in the best interest of the patient. When such dilemmas occur, nurses should reach out to available resources such as supervisors and ethics committees to build confidence that decisions about patient care have explored various vantage points.

Common Law

-These laws apply to a body of principles that evolve from court decisions resolving various controversies. Because common law in the United States has been developed on a state basis, the law on specific subjects may differ from state to state. -An example of a common law might be how different states deal with a nurse's refusal to provide care for a specific client.

Voluntary Admissions

-To be admitted voluntarily, an individual makes direct application to the institution for services and may stay as long as treatment is deemed necessary. -He or she may sign out of the hospital at any time unless, following a mental status examination, the healthcare professional determines that the client may be harmful to self or others and recommends that the admission status be changed from voluntary to involuntary. - these types of admissions are considered voluntary, but it is important to ensure that the individual comprehends the meaning of his or her actions, has not been coerced in any manner, and is willing to proceed with admission

defamation of character.

-When shared information is detrimental to the client's reputation, the person sharing the information may be liable for defamation of character. -When the information is in writing, the action is called libel. -Oral defamation is called slander. -Defamation of character involves communication that is malicious and false - Occasionally, libel arises out of critical, judgmental statements written in the client's medical record. -Nurses need to be very objective in their charting, backing up all statements with factual evidence.

restraints and seclusion

-a patient has the right to freedom from restraint and from seclusion except in an emergency situation. -an element of moral decision making is involved when any kind of treatment is coerced, as is often the case with seclusion and restraint. -it can be detrimental to the patient because it may produce trauma and mistrust -Because injuries and deaths have been associated with restraint and seclusion, this treatment requires careful attention whenever it is used. -there are laws, regulations, accreditation standards, and hospital policies are frequently revised, so it is important for anyone practicing in inpatient psychiatric settings to be well informed in each of these areas.

Informed consent

-all individuals have the right to decide whether to accept or reject treatment. A healthcare provider can be charged with assault and battery for providing life-sustaining treatment to a client when the client has not agreed to it. The rationale for the doctrine of informed consent is the preservation and protection of individual autonomy in determining what will and will not happen to the person's body -a client's permission granted to a physician to perform a therapeutic procedure, before information about the procedure has been presented to the client with adequate time given for consideration about the pros and cons. The client should receive information such as what treatment alternatives are available; why the physician believes this treatment is most appropriate; the possible outcomes, risks, and adverse effects; the possible outcome should the client select another treatment alternative; and the possible outcome should the client choose to have no treatment

seclusions

-another type of physical restraint in which the client is confined alone in a room from which he or she is unable to leave. The room is usually minimally furnished with items to promote the client's comfort and safety

The right to the least restrictive treatment alternative

-clients who can be adequately treated in an outpatient setting should not be hospitalized, and if they are hospitalized, they should not be sedated, restrained, or secluded unless other less restrictive measures were found to be unsuccessful -clients have a right to whatever level of treatment is effective and least restricts their freedom. The "restrictiveness" of psychiatric therapy can be described in the context of a continuum based on severity of illness. -Clients may be treated on an outpatient basis, in day hospitals, or through voluntary or involuntary hospitalization. Symptoms may be treated with verbal rehabilitative techniques and move successively to behavioral techniques, chemical interventions, mechanical restraints, or electroconvulsive therapy.

privileged communication

-codes differ markedly from state to state, most grant certain professionals privileges under which they may refuse to reveal information about, and communications with, clients. In most states, the doctrine of privileged communication applies to psychiatrists and attorneys; in some instances, psychologists, clergy, and nurses are also included. -nurses may be called on to testify in cases in which the medical record is used as evidence. In most states, the right to privacy of these records is exempted in civil or criminal proceedings. - it is important that nurses document with these possibilities in mind. Strict record-keeping using statements that are objective and nonjudgmental, care plans that are specific in their prescriptive interventions, and documentation that describes those interventions and their subsequent evaluation all serve the best interests of the client, the nurse, and the institution should questions regarding care arise. Documentation very often weighs heavily in malpractice case decisions.

Involuntary Outpatient Commitment

-court-ordered mechanism used to compel a person with mental illness to submit to treatment on an outpatient basis. A number of eligibility criteria for commitment to outpatient treatment have been cited -Most commonly, clients who are committed into the IOC programs are those with severe and persistent mental illness, such as schizophrenia. The rationale behind the legislation is to improve preventive care and reduce the number of readmissions and lengths of hospital stays of these clients. The need for this kind of legislation arose after it was recognized that individuals with schizophrenia who did not meet criteria for involuntary hospital treatment were, in some cases, ultimately dangerous to themselves or others.

patients rights

-harmless mentally ill individuals cannot be confined against their will if they are able to remain safe outside of a hospital setting. -Only if they are considered dangerous to themselves or others or are so unable to care for themselves that their safety and survival are at risk may they be confined involuntarily. -In 1981, the case of Roger v. Oken culminated in the ruling that all patients, even those involuntarily hospitalized, are competent to refuse treatment, but a legal guardian may authorize treatment (Sadock et al., 2015). -These laws and policies have attempted to better protect the rights of clients with mental illness while still recognizing that, at times, individuals with acute mental illness may be unable to make decisions in the interest of their safety and survival.

The Gravely Disabled Client

-is generally defined as a condition in which an individual, as a result of mental illness, is in danger of serious physical harm resulting from inability to provide for basic needs such as food, clothing, shelter, medical care, and personal safety. Inability to care for oneself cannot be established by showing that an individual lacks the resources to provide the necessities of life. Rather, it is established by showing the individual's inability to make use of available resources. -Should it be determined that an individual is gravely disabled, a guardian, conservator, or committee is appointed by the court to ensure the management of the person and his or her estate. To legally restore competency requires another court hearing to reverse the previous ruling. The individual whose competency is being determined has the right to be represented by an attorney. -t is an ethical and legal duty to ensure that whenever coercive treatments are used, including involuntary hospitalizations, seclusion and restraint, involuntary outpatient commitments, mandated medication, and even prison commitments, the least restrictive intervention must first be considered

long term benefits of involuntary medication

-particularly for patients with schizophrenia and bipolar disorders and current research demonstrating the particular benefits of treating a first episode of psychosis as important in decreasing long-term negative consequences may increase acceptability of involuntary medication as an early intervention when needed. -some states have adopted laws that allow a court to mandate outpatient treatment for people with mental illness who have a history of violent behavior.

Exception: Suspected Child or Elder Abuse

-suspected elder abuse or neglect be reported. -report suspicion of child abuse to legal authorities -reporting statutes generally grant immunity to anyone making a good faith report about a reasonable suspicion, and in some jurisdictions, it is a criminal act not to report -when a person is experiencing hallucinations or delusions, his or her perception about events may be distorted -explore all of the patient's perceptions of abuse or mistreatment

determining if commitment is required

-the court looks for substantial evidence of abnormal conduct—evidence that cannot be explained as the result of a physical cause. -There must be "clear and convincing evidence" as well as "probable cause" to substantiate the need for involuntary hospitalization to ensure that an individual's rights under the Constitution are protected. -the existence of mental illness alone does not justify involuntary hospitalization. -State standards require a specific impact or consequence to flow from the mental illness that involves danger or an inability to care for one's own needs. -These clients are entitled to court hearings with representation, at which time determination of commitment and length of stay are considered. -Legislative statutes governing involuntary commitments vary from state to state.

Psychiatry and restraints

-the term restraints generally refers to a set of leather straps that are used to restrain the extremities of an individual whose behavior is out of control and who poses an immediate risk to the physical safety and psychological well-being of the individual and others -the current generally accepted definition of restraint refers not only to leather restraints but also to any manual method or medication used to restrict a person's freedom of movement. Restraints are never to be used as punishment or for the convenience of staff. -Other measures to decrease agitation, such as "talking down" (verbal intervention) and chemical restraints (tranquilizing medication) are the preferred first-line interventions. -If these interventions are ineffective, mechanical restraints may be instituted (although some controversy exists as to whether chemical restraints are indeed less restrictive than mechanical restraints).

nurses role in informed consent

-usually defined by agency policy -A nurse may sign the consent form as witness for the client's signature. However, legal liability for informed consent lies with the physician. The nurse acts as client advocate ensuring that the following three major elements of informed consent have been addressed: 1. Knowledge: The client has received adequate information on which to base his or her decision. 2. Competency: The individual's cognition is not impaired to an extent that would interfere with decision making, but if cognition is so impaired, the individual has a legal representative. 3. Free will: The individual has given consent voluntarily without pressure or coercion from others.

severe psychiatric illness- informed consent

.- If an individual has been legally determined to be mentally incompetent, consent is obtained from the legal guardian. -Difficulty arises when no legal determination has been made, but the individual's current mental state prohibits informed decision making (e.g., the person who is psychotic, unconscious, or inebriated). In these instances, informed consent is usually obtained from the individual's nearest relative, or if none exist and time permits, the physician may ask the court to appoint a conservator or guardian. When time does not permit court intervention, permission may be sought from the hospital administrator.

basic elements of a nursing malpractice lawsuit:

1. A duty to the patient existed based on the recognized standard of care. 2. A breach of duty occurred, meaning that the care rendered was not consistent with the recognized standard of care. 3. The client was injured. 4. The injury was directly caused by the breach of a standard of care. -the client to prevail in a malpractice claim, each of these elements must be proved. Juries' decisions are generally based on the testimony of expert witnesses because members of the jury are laypeople and cannot be expected to know what nursing interventions should have been carried out. Without the testimony of expert witnesses, a favorable verdict usually goes to the defendant nurse.

Protective measures

1. Assessment of a threat of violence by a client toward another individual 2. Identification of the intended victim 3. Ability to intervene in a feasible, meaningful way to protect the intended victim -Not all states identify registered nurses as having a duty to warn, but other statutes include a duty to warn for anyone from a licensed practical nurse to licensed certified advanced practice nurses. -emergency nurses are often the frontline healthcare workers in a position to identify persons at risk for violence and to protect the safety of the patient and others. In psychiatric mental health nursing practice, if a client confides in the nurse the potential for harm to an intended victim, it is the duty of the nurse to report this information to the psychiatrist or to other team members. Doing so is not a breach of confidentiality, and the nurse may be considered negligent for failure to do so

Making an ethical decision

1. Assessment: Gather the subjective and objective data about a situation. Consider personal values as well as values of others involved in the ethical dilemma. 2. Problem identification: Identify the conflict between two or more alternative actions. 3. Planning: a. Explore the benefits and consequences of each alternative. b. Consider principles of ethical theories. c. Select an alternative. 4. Implementation: Act on the decision made and communicate the decision to others. 5. Evaluation: Evaluate outcomes

proactive nursing actions in an effort to avoid nursing malpractice and the risk of lawsuits:

1. Effective communication with patients and other caregivers. The SBAR model of reporting information, which stands for situation, background, assessment, and recommendations, has been identified as a useful tool for effective communication with caregivers. Establishing rapport with clients encourages open and honest communication. 2. Accurate and complete documentation in the medical record. The electronic health record (EHR) has been identified as the best way to document and share this information. The use of best sources for informatics is also identified as an important standard for quality and safety in nursing education (Institute of Medicine, 2003). 3. Complying with standards of care, including those established within the profession (such as ANA standards) and those identified by specific hospital policies. 4. Knowing the client, which includes helping the client become involved in his or her care as well as understanding and responding to aspects of care in which the client is dissatisfied. 5. Practicing within the nurse's level of competence and scope of practice, which includes not only adhering to professional standards (those of the ANA and state boards of nursing) but also keeping knowledge and nursing skills current through evidence-based literature, in-services, and continuing education.

PHI: individual identafiable indicators

1. Names 2. Postal address information (except state), including street address, city, county, precinct, and zip code 3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older 4. Telephone numbers 5. Fax numbers 6. Electronic mail addresses 7. Social Security numbers 8. Medical record numbers 9. Health plan beneficiary numbers 10. Account numbers 11. Certificate/license numbers 12. Vehicle identifiers and serial numbers, including license plate numbers 13. Device identifiers and serial numbers 14. Web Universal Resource Locators (URLs) 15. Internet protocol (IP) address numbers 16. Biometric identifiers, including finger and voice prints 17. Full face photographic images and any comparable images 18. Any other unique identifying number, characteristic, or code

Joint commission standards regarding the use of seclusion and restraint in behavioral healthcare

1. Staff are trained and competent to minimize the use of restraint and seclusion and, when use is indicated, to use restraint and seclusion safely. 2. Seclusion or restraint is discontinued at the earliest possible time regardless of when the order is scheduled to expire. 3. Unless state law is more restrictive, written and verbal orders for restraint or seclusion must be renewed every 4 hours for adults ages 18 and older, every 2 hours for children and adolescents ages 9 to 17, and every hour for children younger than 9 years. 4. The initial assessment of an individual who is at risk for harming himself or herself, staff, or others includes identifying techniques to help the individual control his or her behavior; any pre-existing medical conditions, physical disabilities, or other limitations that might place the individual at greater risk during restraint or seclusion; history of physical or sexual abuse or other trauma; and their preferences about whether they would like family notified in the event of an episode of seclusion or restraint. Patients who are simultaneously restrained and secluded must be continuously monitored in person by trained staff. After the first hour a person in seclusion without restraints may be continuously monitored through simultaneous audio and video equipment if consistent with the individual's condition and wishes. Staff who are involved in restraint and seclusion are trained and competent to assess the patient at the initiation of restraint or seclusion and every 15 minutes thereafter including assessment for any signs of injury, nutrition and hydration, circulation and range of motion, vital signs, hygiene and elimination, physical and psychological status and comfort, and readiness for discontinuation of restraint or seclusion.

ANA code of ethics for nurses

1. The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person. 2. The nurse's primary commitment is to the patient whether an individual, family, group, community, or population. 3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. 4. The nurse has authority, accountability, and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to promote health and to provide optimal care. 5. The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. 6. The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care. 7. The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. 8. The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. 9. The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.

Patient Self-Determination Act-Patients rights

1. The right to appropriate treatment and related services in a setting and under conditions that are the most supportive of such person's personal liability, and restrict such liberty only to the extent necessary consistent with such person's treatment needs, applicable requirements of law, and applicable judicial orders. 2. The right to an individualized, written treatment or service plan (such plan to be developed promptly after admission of such person), the right to treatment based on such plan, the right to periodic review and reassessment of treatment and related service needs, and the right to appropriate revision of such plan, including any revision necessary to provide a description of mental health services that may be needed after such person is discharged from such program or facility. 3. The right to ongoing participation, in a manner appropriate to a person's capabilities, in the planning of mental health services to be provided (including the right to participate in the development and periodic revision of the plan). 4. The right to be provided with a reasonable explanation, in terms and language appropriate to a person's condition and ability to understand the person's general mental and physical (if appropriate) condition, the objectives of treatment, the nature and significant possible adverse effects of recommended treatment, the reasons why a particular treatment is considered appropriate, and reasons why access to certain visitors may not be appropriate, and any appropriate and available alternative treatments, services, and types of providers of mental health services. 5. The right not to receive a mode or course of treatment in the absence of informed, voluntary, written consent to treatment except during an emergency situation or as permitted by law when the person is being treated as a result of a court order. 6. The right not to participate in experimentation in the absence of informed, voluntary, written consent (includes human subject protection). 7. The right to freedom from restraint or seclusion, other than as a mode or course of treatment or restraint or seclusion during an emergency situation with a written order by a responsible mental health professional. 8. The right to a humane treatment environment that affords reasonable protection from harm and appropriate privacy with regard to personal needs. 9. The right to access, on request, to such person's mental healthcare records. 10. The right, in the case of a person admitted on a residential or inpatient care basis, to converse with others privately, to have convenient and reasonable access to the telephone and mail, and to see visitors during regularly scheduled hours. (For treatment purposes, specific individuals may be excluded.) 11. The right to be informed promptly and in writing at the time of admission of these rights. 12. The right to assert grievances with respect to infringement of these rights. 13. The right to exercise these rights without reprisal. 14. The right of referral to other providers upon discharge.

client's refusal to accept treatment may be challenged under the following circumstances

1. When a client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm 2. When refusing treatment endangers the life or health of another 3. During an emergency in which a client is in no condition to exercise judgment 4. When the client is a child (consent is obtained from parent or surrogate) 5. In the case of therapeutic privilege: Information about a treatment may be withheld if the physician can show that full disclosure would a. Hinder or complicate necessary treatment, b. Cause severe psychological harm, or c. Be so upsetting as to render a rational decision by the client impossible.

withdraw consent

A client or guardian always has the right to withdraw consent after it has been given. When this occurs, the physician should inform (or re-inform) the client about the consequences of refusing treatment. If treatment has already been initiated, the physician should terminate treatment in a way least likely to cause injury to the client and inform the client or guardian of the risks associated with interrupted treatment.

breach of confidentiality

A nurse may be charged with breach of confidentiality for revealing aspects about a client's case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm.

Rights

A right is defined as "a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or service" (Levy & Rubenstein, 1996). A right is absolute when there is no restriction whatsoever on the individual's entitlement. A legal right is one on which the society has agreed and formalized into law. Both the National League for Nursing and the American Hospital Association (AHA) have established guidelines of patients' rights. Although these are not considered legal documents, nurses and hospitals are considered responsible for upholding these rights of patients.

The Mentally Ill Person in Need of Treatment

A second type of involuntary commitment is for the observation and treatment of mentally ill persons in need of treatment. These are typically longer than emergency commitments. Most states have established definitions of what constitutes "mentally ill" for purposes of state involuntary admission statutes.

Tort

A tort is a violation of a civil law in which an individual has been wronged. In a tort action, one party asserts that wrongful conduct on the part of the other has caused harm, and the first party seeks compensation for harm suffered. A tort may be intentional or unintentional. Examples of unintentional torts are malpractice and negligence actions. An example of an intentional tort is the touching of another person without that person's consent. Intentional touching (e.g., a medical treatment) without the client's consent can result in a charge of battery, an intentional tort.

assult and battery

Assault is an act that results in a person's genuine fear and apprehension that he or she will be touched without consent. Battery is the unconsented touching of another person. These charges can result when a treatment is administered to a client against his or her wishes and outside of an emergency situation. Harm or injury need not have occurred for these charges to be legitimate.

Criminal Law

Criminal law provides protection from conduct deemed injurious to the public welfare. It provides for punishment of those found to have engaged in such conduct, which commonly includes imprisonment, parole conditions, a loss of privilege (such as a license), a fine, or any combination of these (Ellis & Hartley, 2012). An example of a violation of criminal law is the theft by a hospital employee of supplies or drugs.

Ethical Egoism

Ethical egoism espouses that what is right and good is what is best for the individual making the decision. An individual's actions are determined by what is to his or her own advantage. The action may not be best for anyone else involved, but consideration is only for the individual making the decision.

Ethical Principles

Ethical principles are fundamental guidelines that influence decision making. The ethical principles of autonomy, beneficence, nonmaleficence, veracity, and justice are helpful and used frequently by healthcare workers to assist with ethical decision making.

confinement against patients wishes

For confining a client against his or her wishes, and outside of an emergency situation, the nurse may be charged with false imprisonment. Examples of actions that may invoke these charges include locking an individual in a room; taking a client's clothes for purposes of detainment against his or her will; and retaining in mechanical restraints a competent, voluntary client who demands to be released.

Contracts

In a contract action, one party asserts that the other party, in failing to fulfill an obligation, has breached the contract, and either compensation or performance of the obligation is sought as remedy. An example is an action by a mental health professional whose clinical privileges have been reduced or terminated in violation of an implied contract between the professional and a hospital.

Invasion of privacy

Invasion of privacy is a charge that may result when a client is searched without probable cause. Many institutions conduct body searches on clients with mental illness as a routine intervention. In these cases, there should be a physician's order and written rationale showing probable cause for the intervention. Many institutions are reexamining their policies regarding this procedure.

Malpractice

Malpractice may be defined as an act or continuing conduct of a professional that does not meet the standard of professional competence and results in provable damages to his or her client or patient. Such an error or omission may be through negligence, ignorance (when the professional should have known), or intentional wrongdoing (Hill & Hill, 2018). In the absence of any state statutes, common law is the basis of liability for injuries to clients caused by acts of malpractice and negligence of individual practitioners. In other words, most decisions of negligence in the professional setting are based on legal precedent (decisions that have previously been made about similar cases) rather than any specific action taken by the legislature. -when the breach of duty is characterized as malpractice, the action is weighed against the professional standard. When it is brought forth as negligence, action is contrasted with what a reasonably prudent professional would have done in the same or similar circumstances.

Kantianism

Named for philosopher Immanuel Kant, Kantianism is directly opposed to utilitarianism. Kant argued that it is not the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the action is based that is the morally decisive factor. Kantianism suggests that our actions are bound by a sense of duty. This theory is often called deontology (from the Greek word deon, which means "that which is binding; duty"). Kantian-directed ethical decisions are made out of respect for moral law. For example, "I make this choice because it is morally right and my duty to do so" (not because of consideration for a possible outcome)

Natural Law theory

Natural law theory is based on the writings of St. Thomas Aquinas. It advances the idea that decisions about right versus wrong are self-evident and determined by human nature. The theory espouses that, as rational human beings, we inherently know the difference between good and evil (believed to be knowledge that is given to man from God), and this knowledge directs our decision making

Negligence

Negligence has been defined as failure to exercise the care toward others that a reasonable or prudent person would do in the circumstances, or taking action that such a reasonable person would not. Negligence is accidental as distinguished from "intentional torts" (assault or trespass, for example) or from crimes, but a crime can also constitute negligence, such as reckless driving (Hill & Hill, 2018). Any person may be negligent. In contrast, malpractice is a specialized form of negligence applicable only to professionals.

suit prone clients

Some clients appear to be more "suit prone" than others. Suit-prone clients are often very critical, complaining, uncooperative, and even hostile. A natural staff response to these clients is to become defensive or withdrawn. Either of these behaviors increases the likelihood of a lawsuit should an unfavorable event occur (Ellis & Hartley, 2012). No matter how high the nurse's technical competence and skill, his or her insensitivity to a client's complaints and failure to meet the client's emotional needs often influence whether or not a lawsuit is generated. A great deal depends on the psychosocial skills of the healthcare professional.

Patient Self-Determination Act

The Patient Self-determination Act requires healthcare facilities to provide clear written information for every patient concerning his/her legal rights to make healthcare decisions, including the right to accept or refuse treatment.

Autonomy

The principle of autonomy arises from the Kantian view of persons as independent moral agents whose right to determine their own destinies should always be respected. Autonomy presumes that individuals are always capable of making independent choices for themselves. Healthcare workers know that this is not always the case. Children, comatose individuals, and people with serious mental illness are examples of clients who are incapable of making informed choices. In these instances, a representative for the individual is usually asked to intervene and give consent. However, healthcare workers must ensure that respect for an individual's autonomy is not disregarded in favor of what another person may view as best for the client.

Justice

The principle of justice has been referred to as the "justice as fairness" principle. It is sometimes called distributive justice, and its basic premise lies with the right of individuals to be treated equally and fairly regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious beliefs . When applied to healthcare, this principle suggests that all resources within the society (including healthcare services) ought to be distributed evenly without respect to socioeconomic status. the vast disparity in the quality of care dispensed to the various classes within our society would be considered unjust. Retribution or restorative justice refers to the rules for responding when expectations for fairness are violated. Social justice can be summarized as the principle that rules for both distribution and rules for retribution should be fair and people should play by the rules . It is important for nurses to recognize that in the latest revision of the Code of Ethics for Nurses (ANA, 2015), a new focus in one of the provisions states that nursing should integrate principles of social justice both in practice and in developing health policy.

when making a decision about forced meds

The treatment team must determine that three criteria be met to force medication without client consent. The client must exhibit behavior that is dangerous to self or others; the medication ordered by the physician must have a reasonable chance of providing help to the client; and clients who refuse medication must be judged incompetent to evaluate the benefits of the treatment in question.

Christian ethics

This approach to ethical decision making is focused on the way of life and teachings of Jesus Christ. It advances the importance of virtues such as love, forgiveness, and honesty. One basic principle often associated with Christian ethics is known as the golden rule: "Do unto others as you would have them do unto you." The imperative demand of Christian ethics is that all decisions about right and wrong should be centered in love for God and in treating others with the same respect and dignity with which we would expect to be treated.

Values and Values Clarification

Values are personal beliefs about what is important and desirable.. Values clarification is a process of self-exploration through which individuals identify and rank their own personal values. This process increases awareness about why individuals behave in certain ways. Values clarification is important in nursing to increase understanding about why certain choices and decisions are made over others and how values affect nursing outcomes.

ethical issues arise in selecting the least restrictive means among involuntary chemical intervention, seclusion, and mechanical restraints.-

distinguishing among these interventions on the basis of restrictiveness proves to be a purely subjective exercise fraught with personal bias. Moreover, each of these three interventions is both more and less restrictive than each of the other two. Nevertheless, the effort should be made to think in terms of restrictiveness when deciding how to treat patients.

Advocacy

essential role for the psychiatric nurse. The term advocacy means acting in another's behalf—being a supporter or defender. Being a client advocate in psychiatric nursing means helping clients fulfill needs that, without assistance and because of their illness, may go unfulfilled. Individuals with mental illness are not always able to speak for themselves. Nurses serve in this manner to protect the clients' rights and interests. Strategies include educating clients and their families about their legal rights, ensuring that clients have sufficient information to make informed decisions or to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make. Additionally, nurses may act as advocates by speaking on behalf of individuals with mental illness to secure essential mental health services.

Utilitarianism

is "the greatest-happiness principle." This principle holds that actions are right to the degree that they tend to promote happiness and wrong as they tend to produce the reverse of happiness. Thus, the good is happiness and the right is that which promotes the good. Conversely, the wrongness of an action is determined by its tendency to bring about unhappiness. An ethical decision based on the utilitarian view looks at the end results of the decision. Action is taken on the basis of the end results that produced the most good (happiness) for the most people.

Nonmaleficence

is the requirement that healthcare providers do no harm to their clients, either intentionally or unintentionally. Some philosophers suggest that this principle is more important than beneficence; that is, they support the notion that it is more important to avoid doing harm than it is to do good. In any event, ethical dilemmas often arise when a conflict exists between an individual's rights and what is thought to best represent the welfare of the individual. An example of this conflict might occur when a psychiatric client refuses antipsychotic medication (consistent with his or her rights), and the nurse must then decide how to maintain client safety while psychotic symptoms continue.

Bioethics

is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health.

ethics

is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health.

moral behavior

is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health.

Statutory Law

law that has been enacted by a legislative body, such as a county or city council, state legislature, or the U.S. Congress. An example of statutory law is the nurse practice acts

Civil Law

protects the private and property rights of individuals and businesses. Private individuals or groups may bring a legal action to court for breach of civil law. These legal actions are of two basic types: torts and contrac

veracity

refers to one's duty to always be truthful. veracity "requires the health care provider to tell the truth and not intentionally deceive or mislead clients" . There are times when limitations must be placed on this principle, such as when the truth would knowingly produce harm or interfere with the recovery process. Clients have the right to know about their diagnosis, treatment, and prognosis.

Nurse Practice Act

■ The definition of important terms, including the definition of nursing and the various types of nurses recognized ■ A statement of the education and other training or requirements for licensure and reciprocity ■ Broad statements that describe the scope of practice for various levels of nursing (APN, RN, LPN) ■ Conditions under which a nurse's license may be suspended or revoked, and instructions for appeal ■ The general authority and powers of the state board of nursing

Emergency Commitments

sought when an individual manifests behavior that is clearly and imminently dangerous to self or others. These admissions are usually instigated by relatives or friends of the individual, police officers, the court, or healthcare professionals. Emergency commitments are time-limited, and a court hearing for the individual is scheduled, usually within 72 hours. At that time, the court may decide that the client may be discharged; or, if deemed necessary, and voluntary admission is refused by the client, an additional period of involuntary hospitalization may be ordered. In most instances, another hearing is scheduled for a specified time (usually in 7 to 21 days).

False Imprisonment

the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means (Ellis & Hartley, 2012). Healthcare workers may be charged with false imprisonment for restraining or secluding—against the wishes of the client—anyone having been admitted to the hospital voluntarily. Should a voluntarily admitted client decompensate to a point that restraint or seclusion for protection of self or others is necessary, court intervention to determine competency and involuntary commitment is required to preserve the client's rights to privacy and freedom. Hospitalization

Involuntary Outpatient Commitment criteria

■ A history of repeated decompensation requiring involuntary hospitalization ■ Likelihood that without treatment the individual will deteriorate to the point of requiring inpatient commitment ■ Presence of severe and persistent mental illness (e.g., schizophrenia or bipolar disorder) and limited awareness of the illness or need for treatment ■ Presence of severe and persistent mental illness contributing to a risk for homelessness, incarceration, violence, or suicide. ■ Existence of an individualized treatment plan likely to be effective and a service provider who has agreed to provide the treatment

Involuntary Commitment criteria

■ The person is imminently dangerous to himself or herself (i.e., suicidal intent). ■ The person is a danger to others (i.e., aggressive, violent, or homicidal). ■ The person is unable to take care of basic personal needs (the "gravely disabled"). the individual recommending involuntary hospitalization must show probable cause for hospitalizing the client against his or her wishes; that is, the person must show that there is cause to believe that the client would be dangerous to self or others, is mentally ill and in need of treatment, or is gravely disabled.

Some examples include individuals who, because of severe mental illness, are

■ Unable to make informed decisions concerning treatment ■ Likely to cause harm to self or others ■ Unable to fulfill basic personal needs necessary for health and safety