ethical & legal issues

christian ethics

"do unto others as you would have others do unto you"

proactive nursing actions to avoid malpractice

-responding to the pt -educating the pt -complying with the standard of care -supervising care -adhering to the nursing process -documenting carefully -following up by evaluating the care that was given *in addition it is a positive practice to develop and maintain a good interpersonal relationship with the client and their family. some clients appear to be more "suit prone" than others. suit prone clients are often very critical, complaining, uncooperative, and even hostile. a natural response by the staff to these clients is to become defensive or withdrawn. ether of these behaviors increases the likelihood of a lawsuit should an unfavorable event occur. no matter how high the degree of technical competence and skill of the nurse, their insensitivity to a clients complaints and failure to meet the clients emotional needs often influence whether or not a lawsuit is generated. a great deal depends on the psychosocial skills of the healthcare professional.

basic elements of a nursing malpractice lawsuit

1. a duty to the pt existed based on the recognized standards of care 2. a breach of duty occurred, meaning that the care rendered was not consistent with the recognized standards of care 3. the client was injured 4. the injury was directly caused by the breach of a standard of care *for a 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.

model for making ethical decisions

1. assessment -gather 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

specific standards from the joint commission regarding the use of seclusion and restraint

1. seclusion or restraint is discontinued at the earliest possible time regardless of when the order is scheduled to expire 2. unless state law is more restrictive, orders, for restraint or seclusion must be renewed every 4 hrs for adults (age 18 and up), every 2 hrs for children (age 9-17), and every hr for children younger than 9 *orders may be renewed according to these time limits for a maximum of 24 consecutive hrs 3. an in person evaluation (by a physician, clinical psychologist, or other licensed independent practitioner responsible for the care of the patient) must be conducted within 1 hr of initiating restraints or seclusion. appropriately trained RNs and physician assistants may also conduct this assessment, but they must consult with the physician. 4. patients who are simultaneously restrained and secluded must be continuously monitored by trained staff, either in person or through audio or video equipment positioned near the patient 5. staff who are involved in restraining and secluding patients are trained to monitor the physical and psychological well being of the patient including (but not limited to) respiratory and circulatory status, skin integrity, and vital signs

what are the three criteria that must be met when making a decision about forced meds?

1. the client must exhibit behavior that is dangerous to self or others 2. the med ordered by the physician must have a reasonable chance of providing help to the client 3. clients who refuse meds must be judged incompetent to evaluate the benefits of the tx in question

which amendments of the US constitution protect an individuals privacy?

4th, 5th, 14th amendments -the only individuals who have a right to observe a client or have access to medical info are those involved in their medical care -the pt must provide written consent for healthcare info to be shared with anyone outside the current tx plan

the nurse decides to respect family wishes and not tell the clients of his terminal status because that would bring the most happiness to the most people. which of the following ethical theories is considered in this decision? a. utilitarianism b. kantianism c. christian ethics d. ethical egoism

a

an OR nurse asks a psychiatric nurse "how can you work with the mentally ill day in and day out?". the psychiatric nurse replies "its just the right thing to do". the psychiatric nurse is operating from which ethical framework? a. kantianism b. christian ethics c. ethical egoism d. utilitarianism

a -kantianism focuses on the morality of actions. actions are judged as right or wrong based on ethical principles. the nurses response indicates a Kantian perspective.

ethics

a branch of philosophy that deals with distinguishing right from wrong

what is informed consent?

a clients permission granted to a physician to perform a therapeutic procedure, before which 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 info such as: -what tx alternatives are available -why the physician believes this tx is the most appropriate -the possible outcomes, risks, adverse effects -the possible outcome should the client select another tx alternative -the possible outcome should the client choose to have no tx

values clarification

a process of self exploration by which people identify and rank their own personal values

legal right

a right in which society has agreed and formalized into law

the mentally ill person in need of tx

a second type of involuntary commitment is for the observation and tx of mentally ill persons in need of tx. these are typically longer than emergency commitments. most states have established definitions of what constitutes "mentally ill" for purposes of state involuntary admission statutes. some examples include individuals who, because of severe mental illness, are: -unable to make informed decisions concerning tx -likely to cause harm to self or others -unable to fulfill basic personal needs necessary for health and safety in determining whether 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 than an individuals rights under the constitution are protected. -state standards require a specific impact or consequence to flow from the mental illness that involves danger or an inability to care for ones 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

in psychiatry, what does the term restraints generally refer 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 persons freedom of movement

right

a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

tort

a violation of a civil law in which an individual has been wronged -may be intentional (ex: touching another person without their consent) or unintentional (ex: malpractice and negligence actions)

guidelines related to "duty to warn" state that a therapist should consider taking action to warn a third party when his or her client does which of the following? select all that apply. a. threatens violence toward another individual b. identifies a specific intended victim c. is having command hallucinations d. reveals paranoid delusions about another individual

a, b

an individual may be considered gravely disabled for which of the following reasons? select all that apply. a. a person, because of mental illness, cannot fulfill basic needs b. a mentally ill person is in danger of physical harm based on inability to care for self c. a mentally ill person lacks the resources to provide the necessities of life d. a mentally ill person is unable to make use of available resources to meet daily living requirements

a, b, d

nonmaleficence

abstaining from negative acts toward others, including acting carefully to avoid harm

assault

an act resulting in a persons genuine fear and apprehension that he or she will be touched without consent

utilitarianism

an ethical theory on which decisions are based that ensure the greatest happiness to the greatest number of people

seclusion

another type of physical restraint in which the client is confined alone in a room from which they are unable to leave -the room is usually minimally furnished with items to promote the clients comfort and safety

the nurse assists the physician with electroconvulsive therapy on his client who has refused to give consent. with which of the following legal actions might the nurse be charged because of this nursing action? a. assault b. battery c. false imprisonment d. breach of confidentiality

b

the nurse decides to go against family wishes and tell the client of his terminal status because that is what she would want if she were the client. which of the following ethical theories is considered in this decision? a. kantianism b. christian ethics c. natural law theories d. ethical egoism

b

which of the following statements is correct regarding the use of restraints? select all that apply. a. restraints may never be initiated without a physicians order b. orders for restraints must be reissued by a physician every 2 hrs for children and adolescents c. clients in restraints must be observed and assessed every hour for issues regarding circulation, nutrition, respiration, hydration, and elimination d. an in person evaluation must be conducted within 1 hr of initiating restraints

b, d

a competent, voluntary client has stated he wants to leave the hospital. the nurse hides his clothes in an effort to keep him from leaving. with which of the following legal actions might the nurse be charged because of this nursing action? a. assault b. battery c. false imprisonment d. breach of confidentiality

c

the nurse decides to tell the client of his terminal status because she believes it is her duty to do so. which of the following ethical theories is considered in this decision? a. natural law theories b. ethical egoism c. kantianism d. utilitarianism

c

autonomy

capable of making choices

what are the two different types of unlawful acts?

civil and criminal -both statutory and common law have both civil and criminal components

moral behavior

conduct that results from serious critical thinking about how individuals should treat others

involuntary outpatient commitment (IOC)

court ordered mechanism used to compel a person with mental illness to submit to tx on an outpatient basis. eligibility criteria for commitment are the following: -a history of repeated decompensation requiring involuntary hospitalization -likelihood that without tx the individual will deteriorate to the point of requiring inpatient commitment -presence of severe and persistent mental illness (ex: schizophrenia, bipolar disorder) and limited awareness of the illness or need for tx -presence of severe and persistent mental illness contributing to a risk of becoming homeless, incarcerated, or violent, or of committing suicide -existence of an individualized tx plan likely to be effective and a service provider who has agreed to provide the tx most states have already enacted IOC legislation or currently have resolutions that speak to this topic on their agendas. most commonly, clients who are committed into the IOC programs are those with severe persistent mental illness (ex: 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. -there should be provisions to prevent violence rather than waiting until it happens *kendras law- subsequent law governing IOC pertaining to New York case where woman was pushed to her death in front of a subway by a man with schizophrenia who stopped taking his meds (opponents of this legislation fear that it may violate the individual rights of psychiatric clients without significant improvement in outcomes)

Joe is very restless and is pacing a lot. the nurse says to Joe "if you don't sit down in the chair and be still, I am going to put you in restraints!" with which of the following legal actions might the nurse be charged because of this nursing actions? a. defamation of character b. battery c. breach of confidentiality d. assault

d

what is the nurses role in obtaining informed consent?

defined by agency policy -a nurse may sign the consent form as witness for the clients 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 their decision 2. competency- the individuals 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

nurse practice acts

defines the legal parameters of professional and practical nursing within each state -passed by the state legislature these acts are concerned with: -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 -conditions under which a nurses license may be suspended or revoked, and instructions for appeal -the general authority and powers of the state board of nursing most nurse practice acts are general in their terms and do not provide specific guidelines for practice. nurses must understand the scope of practice that is protected by their license and should seek assistance from legal counsel if they are unsure about the proper interpretation of a nurse practice act.

natural law theories

do good and avoid evil -human knowledge of the difference between good and evil directs decision making

what is an example of a tx in the psychiatric area that requires informed consent?

electroconvulsive therapy

ethical dilemmas

ethical dilemmas are situations that require individuals to make a choice between two equally unfavorable alternatives -taking no action is considered an action taken

kantianism

ethical theory by which decisions are based on a sense of duty

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 -ex: 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

protected health information (PHI)

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 healthcare to an individual -applies to most individuals and institutions involved in healthcare

what does the 4th amendment protect?

individuals are protected from unlawful searches and seizures without probable cause. therefore, the individual recommending involuntary hospitalization must show probably cause for hospitalizing the client against their wishes. meaning, 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 tx, or is gravely disabled.

what does the right to the least restrictive tx alternative mean?

it means that 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 tx is effective and least restricts their freedom

what does the patient self-determination act require?

it requires healthcare facilities to provide clear written information for every pt concerning their legal rights to make healthcare decisions, including the right to accept or refuse tx

statutory law

law that has been enacted by legislative bodies

common law

law that is derived from decisions made in previous cases

civil law

law that 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 contracts)

ethical egoism

making decisions based on what is most advantageous for the person making the decision

should restraints ever be used as punishment or for the convenience of staff?

no

will inpatient facilities admit anyone who is intoxicated?

no

beneficence

ones duty to benefit or promote the good of others

when can someone be confined involuntarily?

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

what is usually tried before administering restraints?

other measures to decrease agitation -"talking down" (verbal intervention) -chemical restraints (tranquilizing medication) *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)

values

personal beliefs about what is important and desirable

involuntary commitment

process by which a person suffering from a mental illness, who is unable to care for self or who is deemed a danger to self or others, may be temporarily detained and committed to a hospital or outpatient treatment on a compulsory basis -governed by individual states criteria: danger to self and/or others, inability to attend to basic needs (gravely disabled), refuses hospitalization, or incompetent to consent emergency -risk of harm to self and/or others -short term civil or judicial -stand before a judge and doctor has to show up and prove why the patient should stay in facility; patient has attorney -protects community from persons posing a threat -mandatory outpatient treatment -long term

criminal law

provides protection from conduct deemed injurious to the public welfare -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 combo of these -ex: theft by a hospital employee of supplies or drugs

admission to behavioral health facility criteria

severity of symptoms -are they suicidal? -are they psychotic? -are they a threat to others or themselves? risk of danger to self and others patient/family preference and needs financial situations two types: voluntary and involuntary -with voluntary, patient consents and may request discharge

what are the two general categories of law that are of most concern to nurses?

statutory and common law statutory law- law that has been enacted by a legislative body *ex: nurse practice acts common law- derived from decisions made in previous cases *apply to a body of principles that evolve from court decisions resolving various controversies *developed on a state basis, so may differ from state to state *ex: how different states deal with a nurses refusal to provide care for a specific client

bioethics

term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health

false imprisonment

the deliberate and unauthorized confinement of a person within fixed limits by the use of threat or force -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 clients rights to privacy and freedom.

malpractice

the failure of a professional to perform or to refrain from performing in a manner in which a reputable member within the profession would be expected to do -a specialized form of negligence that is only applicable to professionals

negligence

the failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation -any conduct that falls below the legal standard established to protect others against unreasonable risk of harm, except for conduct that in intentionally or willfully disregardful of others rights -any person may be negligent

what protects a patients privacy and personal security?

the patient self determination act of 1991 -this legislation includes a set of patient rights, one of which is an individuals right to freedom from restraint and from seclusion except in an emergency situation. the use of seclusion and restraint as a therapeutic intervention for psychiatric patients has been controversial, and many efforts have been made through federal and state regulations and through standards set forth by accrediting bodies to minimize or eliminate its use. in addition, an element of moral decision making is involved when any kind of tx is coerced, as is often the case with seclusion and restraint. -although coercion may sometimes be necessary, it can be detrimental to the pt because it may produce trauma and mistrust -most hospitals have a forum, such as an ethics committee, to discuss these ethical issues -one advantage of using such forums to guide moral decision making is that, by exploring issues (such as the use of seclusion and restraint) with a diverse group of people who have different vantage points, alternative treatments can be identified and explored.

what is the rationale for the doctrine of informed consent?

the preservation and protection of individual autonomy in determining what will and will not happen to the persons body

natural law

the theory on which decisions are based in which evil acts are never condoned, even if they are intended to advance the noblest of ends

battery

the touching of another person without consent

voluntary admissions

to be admitted voluntarily, an individual makes direct application to the institution for services and may stay as long as tx is deemed necessary. they may sign out of the hospital at any time unless, following a mental status exam, 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. although these types of admissions are considered voluntary, it is important to ensure that the individual comprehends the meaning of their actions, has not been coerced in any manner, and is willing to proceed with admission.

justice

treat all individuals equally and carefully

true or false: 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

true

true or false: some states have adopted laws that allow a court to mandate outpatient tx for people with mental illness who have a hx of violent behavior

true

true or false: according to law, all individuals have the right to decide whether to accept or reject treatment

true -a healthcare provider can be charged with assault and battery for providing life sustaining tx to a client when the client has not agreed to it

true or false: for confining a client against their wishes, and outside of an emergency situation, the nurse may be charged with false imprisonment

true -examples of actions that may invoke these charges include locking an individual in a room, taking a clients clothes for purposes of detainment against their will, and retaining in mechanical restraints a competent, voluntary client who demands to be released

true or false: a number of states have statutes that specifically define the "gravely disabled" client

true -for those that do not use this label, the description of the individual who, because of mental illness, is unable to take care of basic personal needs is very similar gravely disabled- 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 individuals 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 their 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.

true or false: assault and battery can result when a tx is administered to a client against his or her wishes and outside of an emergency situation

true -harm or injury need not have occurred for these charges to be legitimate

true or false: although most clients in psychiatric and mental health facilities are competent and capable of giving informed consent, those with severe psychiatric illness do not possess the cognitive ability to do so

true -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 individuals current mental state prohibits informed decision making (ex: the person who is psychotic, unconscious, or inebriated). in these instances, informed consent is usually obtained from the individuals 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.

true or false: even in states that do not address a duty to warn, practitioners still need to make an ethical decision about warning a potential victim

true -if the client confides in the nurse the potential for harm to an intended victim, it is the duty of the nurse to report this info 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. all members of the tx team must be made aware of the potential danger that the client poses to self or others. detailed written documentation of the situation is also essential.

true or false: most states now recognize that therapists have ethical and legal obligations to prevent their clients from harming themselves or others

true -many states have passed their own variations on the original "protect and warn" legislation, but in most cases, courts have outlined the following guidelines for therapists to follow in determining their obligation to take protective measures: 1. assessment of a threat of violence by a client toward anther individual 2. identification of the intended victim 3. ability to intervene in a feasible, meaningful way to protect the intended victim *when these guidelines apply to a specific situation, it is reasonable for the therapist to notify the victim, law enforcement authorities, and/or relatives of the intended victim. the therapist may also consider initiating voluntary or involuntary commitment of the client in an effort to prevent potential violence.

true or false: ideally, it is hoped that the person with mental illness recognizes his or her need for tx and agrees voluntarily to be hospitalized if so recommended by the healthcare provider

true -the client who is voluntarily hospitalized typically signs a consent to tx upon admission, but it remains the clients right, as a voluntary patient, to revoke that consent and to be discharged from the hospital if they so choose

true or false: under certain circumstances, a therapist might be required to warn an individual, notify police, or take whatever steps are necessary to protect the intended victim from harm

true -this duty to protect can also occur in instances when patients must be protected by healthcare providers because they are vulnerable as a result of their inability to identify harmful situations

true or false: when the breach of duty is characterized as malpractice, the action is weighed against the professional standard

true -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

true or false: a client or guardian always has the right to withdraw consent after it has been given

true -when this occurs, the physician should inform (or reinform) the client about the consequences of refusing tx. if tx has already been initiated, the physician should terminate tx in a way least likely to cause injury to the client and inform the client or guardian of the risks associated with interrupted tx.

veracity

truthfulness

HIPPA

under this law, individuals have the right to access their medical records, to have corrections made to their medical records, and to decide with whom their medical info be shared -the actual document belongs to the facility or the therapist, but the info contained in it belongs to the client

slander

verbalizing false and malicious information about a person

when are emergency commitments sought?

when an individual manifests behavior that is clearly and imminently dangerous to self or others -theses 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 hrs. at that time, the court may decide that the client may be discharged, or, if by the client, an additional period of involuntary hospitalization may be ordered. in most instances, another hearing is scheduled for a specified time (usually 7-21 days)

absolute right

when there is no restriction whatsoever on the individuals entitlement -ex: breathing

libel

writing false and malicious information about a person

does a mental health professional have a duty not only to a client but also to individuals who are being threatened by that client?

yes

are there some conditions under which tx may be performed without obtaining informed consent?

yes a clients refusal to accept tx may be challenged under the following circumstances: -when a client is mentally incompetent to make a decision and tx is necessary to preserve life or avoid serious harm -when refusing tx endangers the life or health of another -during an emergency in which a client is in no condition to exercise judgement -when the client is a child (consent is obtained from parent or surrogate) -in the case of therapeutic privilege: info about a tx may be withheld if the physician can show that full disclosure would: *hinder or complicate necessary tx *cause severe psychological harm *be so upsetting as to render a rational decision by the client impossible

do most states have statutes that pertain to the doctrine of privileged communication?

yes -although the codes differ from state to state, most grant certain professionals privileges under which they may refuse to reveal info 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.

does every state require that healthcare professionals report suspicion of child & elder abuse to legal authorities?

yes -at times, healthcare professionals are worried that they may be liable for false allegations and therefore may be reluctant to report, but 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 "so declining to report should not be an option"

does anyone admitted to a hospital have the right to treatment?

yes -ex: a psychiatric pt cannot legally be hospitalized and then denied appropriate tx -the American Hospital Association (AHA), although not having the authority of law, has identified rights of any hospitalized pt. their pt bill of rights was written with an emphasis on protecting the pt 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. this brochure called "the patient care partnership" informs pts 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. nurses practicing in hospital settings need to be aware and adhere to legal statutes, accepted standards of practice, and organizational policies with regard to a clients rights during hospital tx.

can pertinent medical info be released without consent in a life threatening situation?

yes -if info is released in an emergency, the following info must be recorded in the clients record: date of disclosure, reason for disclosure, reason written consent could not be obtained, and the specific info disclosed

in certain instances, can nurses be called on to testify in cases in which the medical record is used as evidence?

yes -in most states, the right to privacy of these records is exempted in civil or criminal proceedings. therefore, it is important that nurses document with theses possibilities in mind. strict record keeping using statements that are objective and nonjudgemental, 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.

is invasion of privacy a charge?

yes -may result when a client is searched without probable cause -many institutions conduct body searches on client with mental illness as a routine intervention. in these cases, there should be a physicians order and written rationale showing probable cause for the intervention. many institutions are reexamining their policies regarding this procedure.

does involuntary hospitalization result in substantial restrictions of the rights of an individual?

yes -the admission process is subject to the guarantee of the 14th amendment to the US constitution that provides citizens protection against loss of liberty and ensures due process rights

does the nurse have a responsibility to explore all of the patients perceptions of abuse or mistreatment and discuss them with other healthcare team members to identify the most appropriate decision considering legal, ethical, and clinical factors?

yes -there is often an element of clinical judgement about whether a pts communication raises a reasonable suspicion of abuse *ex: when a person is experiencing hallucinations or delusions, their perception about events may be distorted

are most malpractice suits against nurses are civil actions?

yes -they are considered a breach of conduct actions on the part of the professional, for which compensation is being sought. the nurse in the psychiatric setting should be aware of the types of behaviors that may result in charges of malpractice. basic to the psychiatric clients hospitalization is their right to confidentiality and privacy. a nurse may be charged with breach of confidentiality for revealing aspects about a clients case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm. when shared info is detrimental to the clients reputation, the person sharing the info may be liable for defamation of character. when the info 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 clients medical record. nurses need to be very objective in their charting, backing up all statements with factual evidence.

have injuries and deaths been associated with restraint and seclusion?

yes -this tx requires careful attention whenever it is used. further, the 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.

do patients have the right to refuse tx?

yes, including meds -pts have the right to refuse tx unless the tx requires immediate intervention to prevent death or serious harm to the pt or another person -in psych however, there are both ethical and legal issues that must be considered. sometimes pts 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 meds may be administered without the pts consent in order to protect pts from harming themselves or others. -because laws vary from state to state, it is important for nurses to know the laws that pertain to their state. organizational policies in the nurses practice setting should also guide decision making.