Ethics, Clients' Rights, and Legal and Forensic Issues - Ch. 5

emergency commitment

temporary measure with limited, short-range goals, and it deals largely with the prevention of behavior likely to create a "clear and present" danger to the client or others.

tarasoff decision

the court's ruling underlined the mental health care preofessional's responsibility to balance confidentiality with the "duty to warn" and the "duty to protect'

temporary or observational commitment

the involuntary commitment of an allegedly mentally disordered individual for a specified period of time to allow for adequate observation so that a diagnosis can be made and treatment instituted

absolute discharge

the legal relationship between the institution and the client is terminated

marriage and divorce and psychiatric patients

the patient must: - understand the nature of the marriage relationship - know the duties and obligations involved

beneficence

to do good to others. Protecting clients from self-harm or from doing harm to other is done in keeping with this principle (i.e. involuntarily committing a patient who is threatening to kill his spouse and children)

Involuntary Commitment

(emergency, temporary, extended, or outpatient commitment) Can come about if the designated bodies, such as a court, an administrative tribunal, or the required number of physicians, find that the prospective client's mental state meets the statutory criteria for involuntary commitment. Hospitalized against one's will. Placed on a 72-hour hold if necessary. The appropriate legal steps need to be take.

Tort law

- a tort is a wrongful act resulting in injury for which the injured party files a civil suit requesting legal redress, usually in the form of monetary damages. - torts may be intentional, or unintentional (negligence)

elements of informed consent

- competency: can't be under the influence of med that alter their cognition when signing a consent form - information - voluntary

Involuntary commitment Criteria

- dangerous to self or others - unable to provide for basic needs - mentally ill - note that they do not include homelessness or any specific diagnoses

what can happen after temporary/observational commitment

- discharge the client - encourage the client to stay voluntarily - file an application for extended hospitalization

what are the clients rights?

- right to informed consent - right to treatment - right to refuse treatment - Right to treatment in the least restrictive setting - right to communicate with others - right to receive mail - right not to be subjected to unnecessary mechanical restrains - right to privacy - right to periodic review - right to independent psychiatric exam - right to participate in legal matters

client confidentiality and the nurse's three safe guards

1) convey to the clients the limit of confidentiality in your exchanges - that is, what you do with the information a client shares 2) attempt to portray accurately to others the reliability, validity, and representativeness of the data you communicate about a client 3) recognize the strict confidentiality may have to be violated when an innocent third party is endangered

Two scources ethical guidelines for psychiatric-mental health stem from

1) the standards for psychiatric-mental health nursing practice 2) ANA code of ethics

involuntary outpatient commitment

Criteria includes proof of mental illness and dangerousness - used to prevent further deterioration of the patient so they do not have to be admitted.

Voluntary Admission

Patients give informed consent to be admitted. This comes about by written application via yourself or someone acting on your behalf. This implies that the client has a right to demand and obtain release. The client agrees to give notice in writing on the intention to leave during a grace period from 12 hours to 15 days. This gives staff time to change patient status to involuntary if deemed necessary to protect the patient or others or to persuade patient to stay on a voluntary basis.

the making of wills and psychiatric patients

They are able to make a will as long as: - they are aware of making a will - they are familiar with the property being disposed of - know the names, identities, and relationships of the people named in the will

Right to refuse treament

all patients have the right to refuse treatment even if voluntarily admitted to an inpatient unit

psychosurgery

cingulotomies and amygdalotomies - removal of brain tissue to treat severe cases of treatment-resistant disorders: depression, OCD, ect.

conditional discharge

complete discharge depends on whether the person fulfills certain conditions over a specified period of time, usually 6 months to 1 year - adherence to outpatient care, demonstrated ability and willingness to take medications, and the ability to meet the needs of daily living are a few of the possible requests.

legal sanity

defined as an individual's ability to know right from wrong with reference to the act charged, the capacity to know the nature and quality of the act charged, and the capacity to form the intent to commit the crime.

habeas corpus

requires the speedy release of any person who has been illegally detained. Any client can petition for release on the grounds of being sane

right to treatment

ensures that clients are not in a treatment setting for custodial purposes only.

autonomy

helping patient and families make choices and supporting them even when their choice is one that you may think is not in their best interest

Bill of Rights inpatients receive

includes the right to refuse treatment, to have a written treatment plan, to have the least restrictive treatment, to have all medical information kept confidential, and to receive mail.

nonmaleficence

intention to do no harm

veracity

intention to tell the truth

Fidelity

maintaining loyalty to patients and keeping your promises, fulfilling your obligations. Crucial to building a trusting relationship

psychiatric advance directive

modeled after advance directives for end-of-life care. They provide clients with some control over their treatment and empowerment. They are legal instruments that allow competent persons to document their preferences regarding mental health treatment.

voting and psychiatric patients

often denied the opportunity to vote on the grounds that they are not competent] despite the fact that most states do not actually prohibit them from voting; they are usually kept from voting by caretakers and community or poll workers, election officials and service providers - the federal law cannot stop someone from voting except in very limited circumstances

involuntary hospitalization

only justified to protect patient or others. We believe that if a patient were well (mentally healthy and capable) he would not choose to harm himself or others, so we justify involuntary hospitalization

malpractice

refers to the negligent acts of health care professionals when they fail to act in a responsible and prudent manner in carrying out their professional duties.

Justice

treating others fairly and equally

psychotropic medication/chemical control of behavior justification

we justify use of meds like lorazepam or haldol by explaining violent behaviors as an indirect request for limits. So, we are meeting a patient's need for self-control and safety

negligence

whenever a nurse fails to act in a manner in which most reasonable and prudent people would act or when a nurse acts in a way that a reasonably prudent person would not act under similar circumstances. LOOK UP EXAMPLES P. 97