(mental) Ch 3: Patient's rights and Legal Issues
guilty but mentally ill (GBMI)
-a criminal conviction, person is sent to the correctional system -mental illness is considered a factor in the crime but not to the extent considered for a NGRI conviction -patients are subject to the correctional system's parole decisions
true
Is the following statement true or false? Involuntary commitment requires a court order.
Patient Self Determination Act (PSDA)
The _____________ Act is part of OBRA and requires facilities to inform patients at the time of admission their right to be a part of health care decisions. Also: -provide info on advance directives (living will, PAD, etc) -question at admission about advanced directives
B
Which element of malpractice occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance? A) Duty B) Breach of duty C) Injury or damage D) Causation
living will
A ___________ specifies what treatment should be omitted or refused in the event that a person is unable to make those decisions.
living power of attorney
A ________________ appoints a proxy, usually a relative or trusted friend, to make healthcare decisions on an individual's behalf if that person is incapacitated.
C (If a voluntary client who is dangerous to himself or herself or to others signs a request for discharge, the psychiatrist may file for a civil commitment to detain the client against his or her will until a hearing can take place to decide the matter. This would be a priority action because it ensures the client's safety.)
A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to "end it all." The client decides one day to leave against medical advice. Which would be the most appropriate action by the nursing staff? A) Calling security and asking them to detain the client B) Allowing the client to leave with community resources for follow-up care C) Contacting the psychiatrist for initiation of commitment proceedings D) Contacting the client's family to request they convince the client to stay
C
A client with schizophrenia has a psychiatric advance directive (PAD) which rules out the use of antipsychotics. The care team would be justified in disregarding the provisions of the PAD in which circumstance? A) The client requires inpatient treatment. B) The client is 20 years old. C) The PAD is verbal, not written. D) The PAD contradicts the client's best interests.
A
A nurse sitting with a client in a therapy session with the psychotherapist hears the client state, "I have had it with this marriage. I'm telling you, and not that I ever would do it, but I feel like hiring a hit man to kill my spouse!" Which action is the nurse obligated to take? A) Warn the client's spouse, based on the Tarasoff rule. B) Hold all psychotherapeutic content under strict confidence. C) Have the client sign a safety contract. D) Offer the client medication to help with anxiety and impulsive feelings.
informed consent
A patient who is competent to give ______________ should be able to achieve the following: -Communicate choices -Understand relevant information -Appreciate situation and consequences -Use a logical thought process to compare risks and benefits of treatment options
A,B,C
A psychiatric-mental health nurse is conducting a class for a community group about the rights of individuals with mental health problems. As part of the program, the nurse is describing the concept of self-deterrminism. The nurse determines that the program was successful when the group identifies which idea as exemplifying self-determination? (Select all that apply.) A) Right to refuse treatment B) Right to obtain other opinions C) Right to choose other forms of treatment D) Right to participate in experimentation without informed consent E) Right to refuse treatment during an emergency situation
advance care directives
At different times during the course of an illness, people with mental disorders may be unable to make sound decisions regarding treatment and care. ________________ legally protect them their periodic poor decision making abilities. -written instructions for health care when individuals are incapacitated. -includes living will, living power of attorney, and psychiatric advance directives -does NOT need to be written, reviewed, or signed by an attorney. It must be witnessed by 2 people and notarized, however.
self determinism
Forced treatment denigrates individuals, and according to _________________ theory and recovery concepts individuals are not as likely to experience treatment success if it is externally imposed.
False. (The Patient Self-Determination Act requires that agencies receiving Medicare and Medicaid reimbursement to inform patients at the time of admission of their right to be a central part of any and all health care decisions made about them or for them.)
Is the following statement true or false? The Patient Self-Determination Act ensures that a person with a mental illness is not discriminated against in the workplace.
probation
Sentence of conditional or revocable release under supervision of probation officer for specified amount of time -Sometimes used for minor offenses as long as care in a treatment facility can be arranged -Criminal charges may be dropped if treatment and rehabilitation are successful -Also used after served time but continued monitoring is needed after release from correctional facility
Mental Health Parity and Addiction Equity Act
The _____________ requires insurance plans to offer benefits and coverage for mental and substance disorders that are comparable to those offered for medical and surgical coverage.
Americans with Disabilities Act (ADA)
The ______________ ensures that people with disabilities (including mental illness), have legal protection against discrimination in the workplace, housing, public programs, transportation, and telecommunication. -the employer is free to select the most qualified candidate, and if that qualified candidate has a mental illness, the law mandates that reasonable accommodations be made for them.
A (Clients have the right to refuse medication even when they are psychotic. The client cannot be discharged just because he refuses to take his medications. Restraints are not an appropriate means of getting the client to take the medication.)
The nurse has a physician's order for haloperidol (Haldol) 10 mg for a severely psychotic client. The client refuses the medication. Which nursing intervention is an appropriate response? A) Accept the client's decision. B) Obtain a discharge order for noncompliance. C) Tell the client that he is too sick to refuse. D) Restrain the client and give the medication IM.
A
The nurse on an addictive disorders unit receives a phone call inquiring about the status of a client. The caller is not on the client's allowed contact list. Which is the appropriate response by the nurse to the caller? A) "I cannot confirm or deny the existence of any client here." B) "You will need to be placed on the client's contact list before I can discuss any information with you." C) "The person you are asking for is not a client here." D) "Hold one minute while I get the client for you."
Health Insurance Portability and Accountability Act (HIPAA)
This act provides legal protection in several areas of health care, including privacy and confidentiality. -also protects Americans from losing existing health care coverage when changing jobs and increases opportunities for purchasing healthcare.
Brady Handgun Violence Prevention Act
This act requires a background check on individuals seeking ownership of a firearm. -Prohibits mentally incompetent, having severe mental illness, or having been committed to a mental institution from gun ownership -Those who insist gun violence is a strictly mental health problem unfairly stigmatize those with mental illness
mandate to inform
What guides the intervention for a patient who tells the nurse that they want to hurt a family member: Mandate to inform or HIPAA?
B (False imprisonment involves holding a competent person against his or her will. Actual force is not a requirement of false imprisonment. The individual needs only to be placed in fear of imprisonment by someone who has the ability to carry out the threat. The client who is combative and confused is not competent, and the nurse is acting beneficently. The clients who have been admitted as involuntary clients and should not be allowed to leave without permission of the treatment team.)
Which nursing intervention constitutes false imprisonment? A) The client is confused, combative, and insists that no one can stop him from leaving. The nurse restrains the client without a physician's order, then seeks the order. B) The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion. C) A psychotic client is admitted as an involuntary client and runs out of the psychiatric unit. The nurse runs after the client and succeeds in talking the client into returning to the unit. D) A client is hospitalized as an involuntary admission and attempts to leave the unit. The nurse calls the security team per hospital protocol. They prevent the client from leaving.
PRN
__________ medications require separate entry to include reason for administration, dosage, route, and response to medication
trauma
___________ informed care is being aware, sensitive to, and doing no further harm to survivors of trauma. -Using restraints or seclusion can trigger and retraumatize a client
privacy
___________ refers to the part of person's life not governed by society's laws and government intrusion
Psychiatric advance directives (PADs)
_____________ allows patients, while competent, to document their choices of treatment and care.
chemical restraint
______________ is the used of medication for restricting patient's behavior or their freedom of movement. -may include medications that are not part of the patient's standard meds, or higher doses of their regular meds. -should only be used after all other interventions have been used and the patient continues to be a danger to self or others.
seclusion
_______________ is involuntary confinement in a room or area where the person is physically prevented from leaving. -Used for purposes of safety or behavioral management -Contains mattress and blanket, usually padded walls, environmentally safe (no hanging devices, electrical outlets, or accessible windows) -Individual observed at all times -Extremely negative client experience; many facilities have abandoned practice, outcomes may be worse if used
forensic
_______________ pertains to legal proceedings and mandated treatment of persons with a mental illness -Individuals with mental illnesses are at higher risk for arrest than the general population and more likely to be convicted for a crime -Individuals with mental illness are at high risk for being victims of crime as well
negligence
a breach of duty of reasonable care for whom a nurse is responsible that results in personal injuries.
insanity
a common misconception regarding __________ pleas is that the defense provides a loophole through which criminals can escape punishment. -in reality, the defense is extremely difficult to use, even in the care of severely ill individuals.
informed consent
a legal procedure to ensure that the client knows the benefits and costs of treatment. -mandated by state laws
malpractice
a set of torts (civil wrongs committed by one person that causes injury to another)
not guilty by reason of insanity (NGRI)
a verdict stating that defendants are not guilty of committing a crime because they were unable to distinguish right from wrong or unable to control their actions at the time of the crime. -Usually subject to involuntary commitment in a secure setting for a time equal to a guilty sentence -patient is discharged from the hospital through the courts upon recommendations of the forensic mental health professionals
fitness to stand trial
after a mental illness is diagnosed in a person who has committed a crime, the individuals ______________ is determined. -this means the person able to consult with a lawyer with a reasonable degree of rational understanding of the facts of the alleged crime, assist in the defense, and have sufficient memory of the circumstances of the alleged crime
rationality
competency is different from _____________, which is a characteristic of a patients decision, not the patients ability to make a decision.
false imprisonment
detention or imprisonment contrary to provision of the law
negligence
five elements are required to prove _______________: -duty (accepting the assignment to care for the patient) -breach of duty (failure to practice according to acceptable standards) -cause in fact (the injury wouldn't have happened if standards were followed.) -cause in proximity (harm actually occurred within the scope of foreseeable consequence. -damages (physical or emotional injury caused by breach of standard of care).
unfit to stand trial
if a person who committed a crime and has a mental illness is found ______________, it is because of mental or physical condition, and they are unable to understand the nature and purpose of the proceedings or to assist in the defense. - Hospitalization in a forensic mental health facility follows, with a goal to make the patient "fit" -if fitness cannot be attained usually within 1 year, a hearing is held, during which the facts of the alleged crime are presented to a judge who rules on the case. court may: -Dismiss charges and order a civil commitment -Extend period of hospitalization for further treatment to attain "fitness"
involuntary
in ____________ admission or commitment, the individual is hospitalized without consent but with a court order. -there must be evidence that the individual is mentally disordered, dangerous to self or others, or unable to provide for basic needs. -they have right to receive treatment and the possible right to refuse (based on state laws) -most states have provisions for an emergency short term hospitalization of 48 to 92 hours, then the patient can choose to stay or leave.
voluntary
in ____________ admission or commitment, the individual maintains all civil rights and is free to leave at any time even if it is against medical advice. -treatment strategies are recommended and agreed on by both provider and client
self determinism
in mental health care, _______________ is the right to choose ones own health related behaviors, which at times differ from the those recommended by health professionals. -based on a person's fundamental right to autonomy. -patients can choose to accept, refuse, or terminate treatment without deceit, undue influence, duress, coercion, or prejudice. -individuals are internally motivated to make choices based on personal goals, not to please others or be rewarded -autonomy and independence are key values, and are integral to recovery.
medical battery
intentional and unauthorized harmful or offensive contact, occurs when a patient is treated without informed consent
battery
intentional and unpermitted contact with another
internal rights protection systems
mental health care systems have ____________, mechanisms to combat any violation of their patient's rights. -each state operates a system that protects and advocates for the rights of individuals with mental illness, and investigates any incidents of abuse and neglect.
documentation
notes on _______________: -Common to record on one progress note; problem focused -if it wasn't recorded then it wasn't done -Clients have access to their records -can be handwritten or electronic -considered legal documents
breach of confidentiality
release of client information without the client's consent in the absence of legal compulsion or authorization
external advocacy systems
some organizations are a part of ______________ that are financially and administratively independent from the mental health agencies. -They advocate for patients but have no legal authority. -can resort to litigation that results in lawsuits and legal mandates, and in some cases, denial of accreditation to the health care institution.
competence
the degree to which the patient can understand and appreciate the information given during the consent process is called ________________. -the patients cognitive ability to process information at a specific time -decision specific. (for example, a patient may be able to decide on a simple treatment with clear consequences, but not to decide on a treatment with a complex set of outcomes)
confidentiality
the ethical duty of nondisclosure -provider has information about client and should not disclose it
Least Restrictive Environment
the right to be treated in the _________________ means that a person cannot be restricted to an institution when he or she can be successfully treated in the community. also: -medication cannot be given unnecessarily -Use of restraints or locked room are only if all other "less restrictive" interventions have been tried first
assault
the threat of unlawful force to inflict bodily injury upon another
restraint
this is the most restrictive safety intervention, and is any manual (physical or mechanical) method which immobilizes or reduces ability to move. -Must choose least restrictive type to keep client safe -should only be used after all other interventions have been used and the patient continues to be a danger to self or others. -Promptly removed when client regains control over his or her behavior -Documentation must reflect careful assessment and all previously tried unsuccessful interventions
mandate to inform
when a patient has harmed any person or is about to injure someone, professionals are mandated by law to report it. This is called legal __________________ or duty to warn. -A legal obligation to breach of confidentiality -Based on Tarasoff v. Regents of the University of California