MH CH 6

LO 6 explain the concept of legal issues regarding confidentiality in psychiatric care

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When considering facility admissions for mental health care, what characteristic is unique to a voluntary admission? The patient poses no substantial threat to themselves or others The patient has the right to seek legal counsel A request in writing is required before admission A mental illness has been previously diagnosed

A request in writing is required before admission

Rights regarding restraint and seclusion

APNA Promote a culture that minimizes, and eventually eliminate the use of seclusion and restraint The least restrictive means of restraint, for the shortest duration, is always the general rule Addressing problems can reduce, or eliminate the need for restraint or seclusion Nurses should consider the following before using seclusion and restraint: 1. Verbally intervening. 2. Reducing stimulation. 3. Actively listening. 4. Providing diversion. 5. Offering as needed medication's. A restraint can be any mechanical, or physical device as well as chemical Chemical interventions are usually less restrictive than physical or mechanical interventions; however, they can have a greater impact on the patient's ability to relate to the environment due to their affect on levels of awareness and their side effects Seclusion is confining patients alone in an area or a room in preventing them from leaving; limited to patients who are demonstrating violent or self-destructive behavior Seclusion should be distinguished from a time out; time now is when a patient chooses or except a suggestion to spend time alone in a specific area for a certain amount of time

LO 2 describe six ethical principles central to bioethics

Autonomy Beneficence Nonmaleficence Justice Fidelity Veracity

Implied consent occurs when no verbal or written agreement takes place prior to a caregiver delivering treatment. Which of the following examples represents implied consent? The mother of an unconscious patient saying OK to surgery Care given to a heroin overdose victim Immobilizing a patient who has refused to take medication Signing general intake paperwork with specific parameters

Care given to a heroin overdose victim

How can a newly hired nurse best obtain information concerning the clients mental health laws and statutes? Discuss the issue with the facilities, compliance officer Conduct an Internet search by using keywords Consult the ANAs code of ethics for nurses Review the facilities, latest edition of the policies manual

Conduct an Internet search for using the keywords " mental + health + statute + (your state)"

Rights regarding confidentiality

Confidentiality is an ethical responsibility of healthcare professionals that prohibits the disclosure of privileged information without the patient's consent Only the patient can waive the legal privilege of confidentiality HIPAA Confidentiality after death: the dead man's statue protect confidential information about individuals when they are not alive to speak for themselves Exceptions to confidentiality: 1. the duty to warn is an obligation to warn third parties, when they may be in danger from a patient 2. The duty to protect: when a therapist determines that a patient presents a serious danger of violence to another 3. Threats of harm against specified victims or classes of victims. 4. Statutes for reporting child, and older adult abuse. Failure to report suspected abuse, neglect, or exploitation of a disabled adult may result in a misdemeanor crime

Non-maleficence

Doing no harm to the patient Protecting confidential information about a patient

LO 1 differentiate the terms ethics and bioethics

Ethics is the branch of knowledge, and philosophical beliefs about what is right or wrong in a society; it describes what ought to be rather than what is Bioethics is the study of specific ethical questions that arise in healthcare

LO 7 identify situations in which HCP have a duty to break pt confidentiality

Exceptions to confidentiality: 1. the duty to warn is an obligation to warn third parties, when they may be in danger from a patient 2. The duty to protect: when a therapist determines that a patient presents a serious danger of violence to another 3. Threats of harm against specified victims or classes of victims. 4. Statutes for reporting child, and older adult abuse.

Which situation is demonstrated I will behavior on the part of the staff? Select all that apply. Forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient Leaving a patient with suicidal thoughts alone in the bathroom to shower Promising to restrain a patient who stole from another patient on the unit Reassuring a patient with paranoia that his antipsychotic medication was not tampered with Placing a patient who has repeatedly threatened to assault staff in seclusion

Forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient Leaving a patient with suicidal thoughts alone in the bathroom to shower Promising to restrain a patient who stole from another patient on the unit

A nurse makes a post on a social media page about his pier taking care of a patient with a crime related gunshot wound in the emergency department. He does not use the name of the patient. The nurse: Has not violated confidentialities laws because he did not use the patients name Cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient He has violated confidentiality laws and can be held liable Cannot be held liable because postings on social media site are excluded from confidentialities laws

He has violated confidentiality laws and can be held liable

Lucas has completed his inpatient psychiatric treatment, which was ordered by the court system. Which statement reveals that Lucas does not understand the concept of conditional release? I will continue treatment in an outpatient treatment center My nurse practitioner has recommended group therapy I am finally free, no more therapy Attending therapy and taking my meds are a part of this conditional release

I am finally free, no more therapy

LO 5 describe pt rights and legal concerns with regard to restraint and seclusion

In an emergency, a nurse may place a patient in seclusion or restraint, but obtains, a written, or verbal order as soon as possible after Orders for restraining order seclusion are never written as an as needed, or as a standing order Adult 18 years or older are limited to four hours Children and adolescents 9 to 17 years old are limited to two hours Children under nine years old, have a one hour limit Restraint or seclusion is discontinued as soon as safer and calmer behavior begins The documentation should include the specific behaviors leading to restraint, or seclusion, and the time the patient is placed in an released from restraint Assessed at regular and frequent interval, such as every 15 to 30 minutes for physical needs, safety, and comfort

The right to inform consent

Informed consent is a legal term that means the patient has been provided with basic information regarding risks and benefits, and alternatives to treatment; the person must be voluntarily excepting the treatments Consent is secured for surgery, electroconvulsive treatment, or the use of experimental drugs or procedures patients have the right to refuse and the right to voice grievances and recommend changes Patients are informed of the following elements: 1. The nature of the problem or condition. 2. The nature, in purpose of a proposed treatment. 3. The risks and benefits of that treatment. 4. The alternative treatment options. 5. The probability that the proposed treatment will be successful. 6. The risks of not consenting to treatment. Implied consent Capacity is the persons ability to make an informed decision; capacity is a fluid concept in individuals may possess capacity one minute and lack in another Competency is a legal term related to the degree of mental soundness a person has to make decisions or to carry out specific acts The order of selection; partner or spouse, adult children or grandchildren, parents, adult siblings, adult, nieces and nephews.

Which statement made by the nurse concerning ethics demonstrates the best understanding of the concept? It isn't right to deny someone healthcare because they can't pay for it I've never discuss my patient refusal of treatment The hospital needs to buy more respirators, so we always have one available Not all ICU patients have the right to unbiased attention from the staff

It isn't right to deny someone healthcare because they can't pay for it

Fidelity

Maintaining loyalty and commitment to the patient and doing no wrong to the patient Maintaining expertise in nursing skill through continuing nurse education

The right to refuse treatment

Patient may withhold consent or withdraw consent at any time The patient can retract consent previously given The patient's right to refuse treatment with psychopharmacological drugs have been debated in the courts In emergency situations, institutions can medicate a person without a court hearing: 1. The person has a serious mental illness. 2. The persons functioning is deteriorating, and if the patient is suffering or exhibiting threatening behavior. 3. The benefits of treatment outweigh the harm. 4. The person likes the capacity to make a reason decision about the treatment. 5. Less restrictive services have been found in adequate.

Based on Maslow's hierarchy of needs, physiological needs for a restrained patient include: select all that apply. Private toileting, oral hydration Checking the tightness of the restraint Therapeutic communication Maintaining a patent airway

Private toileting, oral hydration Checking the tightness of restraints Maintaining a patent airway

Which nursing intervention demonstrates the ethical principle of beneficence? Refusing to administer a placebo to a patient Attending an in-service on the operation of the new IV infusion pumps Providing frequent updates to the family of a patient currently in surgery Respecting the right of the patient to make decisions about whether or not to have electroconvulsive therapy

Providing frequent updates to the family of a patient currently in surgery

Autonomy

Respecting the rights of others to make their own decisions Acknowledging the patients right to refuse medication, supports autonomy

Ethical dilemma

Results when there is a conflict between two or more courses of action, each carrying favorable and unfavorable consequences

In providing care for patients of a mental health unit, Lee recognizes the importance of standards of care. When Lee notices that some policies, fall short of the state, licensing laws, which of the following statements represent the most appropriate standard of care pathway? Professional association, customary care, facility policy State board of nursing, facility policy, customary care Facility policy, professional, associations, state board of nursing State board of nursing, professional association, facility policy

State board of nursing, professional association, facility policy

Veracity

The duty to communicate, truthfully Describing the purpose and side effects of psychotropic medication's in a truthful and non-misleading way

Justice

The duty to distribute resources or care, equally, regardless of personal attributes The ICU nurse devote equal attention to someone who has attempted suicide as to someone who suffered a brain aneurysm

The rights regarding psychiatric advance directives

The following choices are addressed in Ohio declaration for mental health treatment: 1. Designation of preferred physician and therapist. 2. Appointment of someone to make mental health treatment decisions 3. Preferences regarding medication's to take or not take 4. Consent or lack of consent for ECT. 5. Concern or lack of consent for admission to a psychiatric facility. 6. Preferred facilities and unacceptable facilities. 7. Individuals who should not visit.

The right to treatment

The right to quality care The right to be free from excessive or unnecessary medication The right to privacy and dignity The right to an attorney, clergy, and private care providers The right to least restrictive environment The right to not be subjective to lobotomies, electroconvulsive treatments, and other treatments without fully informed consent

LO 4 discuss pt rights including the right to treatment, refuse, informed consent

The right to treatment The right to refuse The right to informed consent The rights regarding psychiatric advance directives The rights regarding restraint and seclusion The rights regarding confidentiality

Beneficence

To duty to act to benefit or promote the health and well-being of others Spending extra time to help common anxious patient