Ch 4 The right to refuse medication in psychiatric setting

1992 the AHA pt.'s bill of rights states

pt. has the right to refuse treatment to the extend permitted by law and needs to be informed of the medical consequences of his actions

Negligence

- any person may be negligent - is a failure to exercise the standard of care that another person would do in simular situation - practicing below the legal standards

Torts : are under civil laws: can say you are liable

- violation of the civil law in which person has been wronged. CAN be intentional - touching another person without their permission. Ex. Medical treatment without the pt's consent can result in the charge of battery. or unintentional - malpractice or negligence ( terms ofetn used interchangeably)

Elements of informed consent?

1. Knowledge- enough info. has been given to pt to make decision 2. Competency - cognition is not impaired to make decision , otherwise pt would need a legal representation 3. Free will - consent has been given voluntarily without pressure or coercion from others.

Med can be forced to pt. without consent . This is based on 3 criterias

1. pt has to be harmful to self or others 2. med which is ordered by the MD must have resonable chance to help the pt. 3. pt . must be judged incompetent to evaluate the benefits of the treatment

Treatment can be provided without informed consent in the case of

1. pt. is mentally incompentent to make decision and tretament is necessary to sustain life 2. By refusing treatment pt. endangers somebody's elses life 3. during emergency, when pt can't make decision 4. when the pt. is a child ( consent is obtained form the parents or guardians) 5. In the case of therapeutic privillage ( if information would hinder ( utrudniac) necessary treatment , cause severes psychological harm , be upsetting to pt

The Join Commission states

1. seclusion and restraint: d/c at earliest possible . Time regardless if the order is scheduled to expire. 2. orders for restraints or seclusions must be renewed every : 4 hours forADULTS 18 or older every 2 hrs. for CHILDREN and adolescents 9 to 17 every 1 hr for children younger than 9 yrs. old ALL this apply within max of 24 consecutive hrs. 3.. An in-person evaluation (by MD, clinical psychologist) must be done within 1 hr. of initiating restraint or seclusion. ( NURSE can also do that if training is provided must consult with MD) 4. Pt. must be continoulsy monitored

To bring a nursing malpractice lawsuit, there are 4 elements which has to be proved

1.Duty to the pt. existed , based in the recognized standards of care 2. A breach of duty occured ( care below the legal standards) 3. Pt. was injured 4. The injury was the cause of not following the standard of care .

Best way to avoid nursing liability

Develop and maintain a good interpersonal relationship with client and family

False imprisonment

deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means. HCP can be charged with false impr. for restraining or secluding a pt. against their wishes, this applly if pt was admitted to hospital voluntarily.

In psychiatric setting informed consent is required for

electroconvulsive therapy

HIPAA stands for

health insurance Portability and Accountability Act

Malpractice

is a specialized form of negligence ( pertains to professionals )

Defamation of character can be done by two ways: slander or libel

is the communication of a false statement that harms the reputation of an individual person, business, product, group, government, religion, or nation.

Informed consent

must be obtained form the pt. otherwise the health care provider can be charged with assult or battery for providing life sustained treatment.

Libel in polish

oszczerstwo na pismie

Slander in polish

oszczerstwo slowne

PHI stands for

protected health information includ. past , present and future physical and mental health or condition pt. medical records can be realised without consent in life-threatening situations HIPAA - federal privacy rule applies to PHI

Seclusion

pt. is confined alone in a room which he or she is unable to leave

Assult / ATAK

scaring pt. that he/she will be touched without consent VERBAL

Slander

sharing false information about pt's health h/y - oral defamation

Libel

sharing false information about pt's health h/y in writting

Restrains and seclusion used as the last method , use least restricitve method first

talking down ( verabl intervention) chemical restrains ( trangulizing medications) then mechanical restrains can be applied

Battery

unconsented touching of another person - when treatment is administered to pt. without consent PHYSICAL