349 - Chap 3 Patient Rights and Legal Issues

The nurse is detaining the client from leaving the hospital by refusing to allow him to take his personal items. This is an example of which of the following? False imprisonment Seclusion Restraint Slander

False Imprisionment

The nurse is caring for a client who is legally competent and who has been receiving outpatient treatment for schizophrenia. The client has been responding favorably to treatment but has now declared her intention to exclusively pursue alternative medicine. What is the nurse's most appropriate response? 1- Educate the client about the benefits of continuing the existing treatment 2 - Document the client's statement and include it in a request for a court order 3 - Inform the client that this proposed action would likely result in being declared incompetent 4 - Inform the client that she cannot make this decision without consulting the care team

1

assault

Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. intentional tort

Which element of malpractice occurs when the nurse does not act as a reasonable, prudent person would have acted in a similar circumstance? Duty Breach of duty Injury or damage Causation

Breach of duty

unintentional tort

negligence (most common) and malpractice

A nurse is talking with a psychiatric-mental health nurse practitioner and says, "I know I need to maintain a client's privacy and confidentiality, but is there a difference between these two?" Which response by the nurse practictioner would be most appropriate? "Actually, in most cases, privacy and confidentiality are the same issue." "Privacy is governed by the laws of the state." "Confidentiality affords the client privacy." "Confidentialilty protects an individual from intrusion."

"Confidentiality affords the client privacy." Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Protecting an individual from intrusion is a responsibility of health care providers. Confidentiality is the responsibility of the health care worker to limit sharing of client information with only those mandated to know. Confidentiality can be defined as an ethical duty of nondisclosure and affords the client privacy.

When a 23-year-old client, after attempting suicide, asks to speak with the nurse but wants assurance that the conversation will remain confidential, the nurse responds how? "Will this conversation involve your desire to harm yourself?" "You know that I can't keep secrets from your health care team." "Without your permission I can't give any information to anyone." "Don't you trust me to respect your right to confidentiality?

"Will this conversation involve your desire to harm yourself?"

The nurse is complaining about a client that has dementia. The client is mobile and slaps the nurse on the gluteus maximus each time he passes by. The nurse tells the client, "If you don't behave yourself, I am going to throw you out and you won't have anywhere to go." The charge nurse overhears the nurse, and states "Do you realize what your statement could be construed as?" What is the best statement for the nurse to respond? "It could be construed as battery" "It could be construed as assault" "It could be construed as negligence" "It could be construed as unintentional harm"

- assault

A client has been admitted to the psychiatric facility for the treatment of depression. The client has told the emergency department staff that she would like a close friend to make decisions surrounding her care until she "feels better." In order to identify the legal basis for the client's preference, the nurse should: 1 - determine whether a durable power of attorney has been established. 2 - explain the provisions of the Patient Self-Determination Act (PSDA) to the client and the friend. 3 - assess the competency and motivations of the friend in order to protect the client's interests. 4 - refer the case to the facility's ethics review board.

1

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? 1 - Warn the client's spouse, based on the Tarasoff rule. 2 - Hold all psychotherapeutic content under strict confidence. 3 - Have the client sign a safety contract. 4 - Offer the client medication to help with anxiety and impulsive feelings.

1

Following an assault, a client with mental illness has been declared unfit to stand trial. The nurse should draw what conclusion from this fact? 1 - The client cannot comprehend the legal proceedings 2 - The client committed an act that a person without mental illness would not have committed 3 - The client poses a significant risk to reoffend 4 - The client is openly hostile to investigators and/or the legal team

1

An adolescent on the unit is argumentative with staff and peers. The nurse tells the adolescent, "Arguing is not allowed. One more word and you will have to stay in your room the rest of the day." The nurse's directive is: 1 - inappropriate; room restriction is not treatment in the least restrictive environment. 2 - inappropriate; the adolescent should be offered a sedative before room restriction. 3 - appropriate; room restriction is an effective behavior modification technique. 4 - appropriate; the adolescent should not have conflicts with others.

1 - inappropriate; room restriction is not treatment in the least restrictive environment. Explanation: Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. It means that a client does not have to be hospitalized if he or she can be treated in an outpatient setting or in a group home. It also means that the client must be free of restraint or seclusion unless it is necessary. Verbal and behavioral techniques should be instituted before physical measures such as sedation, restraint, or seclusion.

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.) 1- Right to refuse treatment 2 - Right to obtain other opinions 3 - Right to choose other forms of treatment 4 - Right to participate in experimentation without informed consent 5 - Right to refuse treatment during an emergency situation

1, 2, 3

A malpractice lawsuit was filed after a nurse restrained the client for screaming at and attempting to strike anyone who was within striking distance. The nurse followed agency procedures that were consistent with Joint Commission Standards. For which reason is this malpractice lawsuit most likely to be unsuccessful? 1 - The nurse did not have a duty. 2 - The nurse did not breach duty. 3 - The client did not suffer some type of loss, damage, or injury. 4 - There was no evidence that a breach of duty was a direct cause of the loss, damage, or injury.

2

A nurse in the emergency department is planning for a client with mental illness to be placed in an inpatient hospitalization. Which is a condition of this type of admission? 1. is noncompliant with medication at home 2. present a clear danger to self or others 3. develops new symptoms of the illness 4. has no support systems in the community

2

The nurse is admitting a client to the hospital. The nurse gives the client information about client rights while in the hospital. Which statement by the client indicates that more teaching is needed? 1 - "I can get a copy of my medical record if I want to read it." 2 - "You can not give any information to anyone unless I agree." 3 - "The doctor can copy my information and send it to my son." 4 - "You can not tell a caller that I am in the hospital."

3 Privacy refers to that part of an individual's personal life that is not governed by society's laws and government intrusion. Protecting an individual from intrusion is a responsibility of health care providers. The client is permitted to read the personal medical record. Doctors and nurses cannot give any information out to anyone unless the client agrees, and cannot tell a caller that the client is in the hospital.

Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime? A client who is being held involuntarily in a secure psychiatric setting A client with a history of mental illness who is serving a lengthy term in a federal prison A client who is receiving care involuntarily on a community hospital's psychiatric unit A client who has been released into the community with strict limits on activity

A client who is being held involuntarily in a secure psychiatric setting Individuals found not guilty of a crime but mentally ill are normally held in a secure psychiatric setting, not a community hospital, prison, or in the community.

durable power of attorney

A durable power of attorney for health care appoints a proxy, usually a relative or trusted friend, to make health care decisions on an individual's behalf if that person is incapacitated.

A psychiatric-mental health nurse is admitting a client to the facility. How should the nurse best apply the principles of the Patient Self-Determination Act (PSDA) during this process? Ask the client about any advance care directives that that the client has established Assure the client that evidence-based care will be provided at all times during the admission Assure the client that Medicare and Medicaid reimbursement will be pursued at all times Inform the client that no information will be provided to his or her insurer without explicit permission

Ask the client about any advance care directives that that the client has established The PSDA specifies the need to recognize the presence of any advance care directives that the client may have established. Evidence-based care, confidentiality and advocacy are all aspects of high-quality care, but none is an explicit provision of the PSDA.

The nurse is threatening to give the client an injection in order to restrain the client for inappropriate behavior. This is an example of Assault Battery False imprisonment Abuse

Assault Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. Battery involves harmful or unwarranted contact with the client. False imprisonment is defined as the unjustified detention of a client such as the inappropriate use of restraint or seclusion.

A client was admitted for electroconvulsive therapy (ECT). The physician performing the procedure failed to obtain informed consent before the ECT was administered. The physician could be charged with what? Assault Battery Beneficence Fidelity

Battery All clients have the right to give informed consent before health care professionals perform interventions. Administration of treatments or procedures without a client's informed consent can result in legal action against the primary provider and the health care agency. In such lawsuits, clients will prevail, alleging battery (touching another without permission), if they can prove they did not consent to the procedure, providers did not give adequate information for a decision, or the treatment exceeded the scope of the consent.

capacity

Capacity: patient's ability (due to mental state, developmental level, or intellectual/cognitive ability) to understand and make wise decisions Nurses cannot determine competency you can discuss capacity

competency

Competency: a legal term that is determined by the courts based upon 2 different psychiatrists' evaluations about the patient's capacity to make wise decisions Treatment can be forced in emergencies: as in an involuntary/emergency admission/evaluation; or in the event that a patient in the hospital is actively harming self/others... then PRN medications can be forced which will require IM injection and a physical hold/restraint. Because of this, it is a last resort and other evidence-based alternatives must have been attempted and documented.

When is a nurse legally obligated to breach confidentiality? At any time a client is threatening If threats are made to an outside party Whenever the client becomes aggressive When the client violates the nurse's boundaries

If threats are made to an outside party

x A client was brought to the emergency department by police after neighbors reported him being loud and disruptive. The client is agitated and is extremely upset. The client states, "No one can be trusted." Which decision about about whether to involuntarily admit the client would be most appropriate? Involuntary admission is appropriate because the client is a danger to self Involuntary admission is possibly a correct decision because the client may be a danger to others Involuntary admission is the correct decision because the client is cannot provide for basic needs. Involuntary admission is inappropriate because the client does not meet the necessary criteria.

Involuntary admission is inappropriate because the client does not meet the necessary criteria. Having a mental illness alone is not sufficient for an involuntary commitment. In this situation, the client is not a danger to himself or others and is not gravely disabled (unable to provide for basic needs).

Psychiatric advance directives

Psychiatric advance directives (PADs) are relatively new legal instruments and allow patients, while competent, to document their choices of treatment and care. This declaration must be made in advance and signed by the patient and two witnesses. Through the use of a PAD, individuals are empowered to direct their treatment such as choice of medication and hospitalization. Although a physician can override this declaration during times when the patient's decision-making capacity is clearly distorted because of mental illness

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? The client requires inpatient treatment. The client is 20 years old. The PAD is verbal, not written. The PAD contradicts the client's best interests.

The PAD is verbal, not written. A PAD must be a signed and witnessed document. A PAD may not necessarily align with the client's best interests and it applies in inpatient settings. The fact that the client is 20 years old does not nullify a properly created PAD,

A psychiatric treatment team is planning care for a client who was involuntarily admitted for treatment of depression and suicide ideation. When planning care, of what legal parameters of care must the nurse be aware? The client can refuse medication. The client can obtain release against medical advice. The client is in need of a public guardian. The client is considered incompetent.

The client can refuse medication. Explanation: Competent clients have the right to refuse medication. Even thought the client is an involuntary admission, the client is competent and able to be involved in treatment planning. Because the client was admitted involuntarily, the client is not able to obtain release. The client who is legally declared incompetent is given a court appointed guardian or representative who is responsible for giving consent. A client is considered competent unless the court has declared that the client is incompetent. The client who is incompetent is not able to give or refuse consent for treatment.

A psychiatric treatment team is planning care for a client who was involuntarily admitted for treatment of depression and suicide ideation. When planning care, of what legal parameters of care must the nurse be aware? The client can refuse medication. The client can obtain release against medical advice. The client is in need of a public guardian. The client is considered incompetent.

The client can refuse medication. Explanation: Competent clients have the right to refuse medication. Even thought the client is an involuntary admission, the client is competent and able to be involved in treatment planning. Because the client was admitted involuntarily, the client is not able to obtain release. The client who is legally declared incompetent is given a court appointed guardian or representative who is responsible for giving consent. A client is considered competent unless the court has declared that the client is incompetent. The client who is incompetent is not able to give or refuse consent for treatment.

A nurse is reviewing a journal article about mental health care and voluntary and involuntary treatment. After reading the article, the nurse demonstrates a need for additional review when the nurse identifies which element as being most commonly included as part of the statute? The client must be mentally disordered. The client must be a danger to self or others. The client must be refusing medication. The client is unable to provide for basic needs.

The client must be refusing medication. Explanation: Because involuntary commitment is a prerogative of the state agency, each state and the District of Columbia have separate commitment statutes; however, three common elements are found in most of these statutes. The individual must be (1) mentally disordered, (2) dangerous to self or others, or (3) unable to provide for basic needs (i.e., "gravely disabled"). Refusing to take medication is not a common element.

A nurse is reading a journal article that describes a civil wrong that does not involve a contract in which one person causes injury to another. The nurse is reading about which concept? Negligence Tort Malpractice False imprisonment

Tort Explanation: A tort is a civil wrong not based on contract committed by one person that causes injury to another. Negligence is an unintentional tort causing harm through failure to act. Intentional torts include assault, battery, and false imprisonment.

living will

are recognized under state laws and their courts. A living will specifies what treatment should be omitted or refused in the event that a person is unable to make those decisions.

intentional torts

assault, battery, false imprisonment

Patient Rights - in general (minors, elders, spouse abuse)

confidentiality:-minors (remains confidential with exceptions of abuse, sexual relations such as statutory rape, suicide or homicidal idealizations, violent injuries, STI's to the department of health, potential harm to self, and some states require parents to be informed of abortions.-elders (report elder abuse)- duty to warn- a judgment that the client has or is going to harm someone (remember cannot report spousal abuse unless victim asks)

A client has been admitted to the psychiatric facility for the treatment of depression. The client has told the emergency department staff that she would like a close friend to make decisions surrounding her care until she "feels better." In order to identify the legal basis for the client's preference, the nurse should: determine whether a durable power of attorney has been established. explain the provisions of the Patient Self-Determination Act (PSDA) to the client and the friend. assess the competency and motivations of the friend in order to protect the client's interests. refer the case to the facility's ethics review board.

determine whether a durable power of attorney has been established

The nurse is caring for a client after having various diagnostic tests. The client discusses a proxy being in attendance for the health care provider's diagnosis. The nurse requests a copy for the file, and allows the proxy to be in attendance with what type of document? durable power of attorney living will patient rights informed consent

durable power of attorney A durable power of attorney for health care appoints a proxy, usually a relative or trusted friend, to make health care decisions on an individual's behalf. The living will, patient rights, and informed consent are not included in the durable power of attorney. A living will is a written statement detailing a person's desires regarding their medical treatment in circumstances in which they are no longer able to express informed consent, especially an advance directive. Patient rights are those basic rule of conduct between patients and medical caregivers as well as the institutions and people that support them. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits.

battery

involves harmful or unwarranted contact with the client. intentional tort

The client just received a diagnosis of end-stage renal disease. After hearing options, the client visited a lawyer and documented what treatment is to be held in the event that the client is unable to make decisions. The nurse asks for a copy of this document for the chart. The name of this document is: living will durable power of attorney patient rights informed consent

living will A living will states what treatment should be omitted or refused in the event that a person is unable to make those decisions. Informed consent is the permission granted in the knowledge of the possible consequences, typically that which is given by a patient to a doctor for treatment with full knowledge of the possible risks and benefits. Patient rights are those basic rules of conduct between patients and medical caregivers as well as the institutions and people that support them. A durable power of attorney means that the document stays in effect if you become incapacitated and unable to handle matters on your own.

A nurse is reading a journal article that describes a civil wrong that does not involve a contract in which one person causes injury to another. The nurse is reading about which concept? Negligence Tort Malpractice False imprisonment

tort A tort is a civil wrong not based on contract committed by one person that causes injury to another. Negligence is an unintentional tort causing harm through failure to act. Intentional torts include assault, battery, and false imprisonment.

Which is an accurate statement regarding an advance care directive? It must be witnessed by two people and notarized. It needs to be written by an attorney. It applies to those who can make their own decisions. It needs to be signed by an attorney.

witnessed by two people and notarized