CH: 4 Patient Rights & Legal Issues

mandates to inform

- a legal obligation to breach confidentiality - "duty to warn" - judgement that the patient has harmed someone or is about to harm someone - based on Tarasoff v. Regents of the University of California

confidentiality

- ethical duty of nondisclosure - provider has information about patient and should not disclose it

voluntary admission or commitment

- person retains full civil rights - free to leave at any time, even against medical advice - required to give a 72hr notice before leaving

American Recovery and Reinvestment Act

- 2009 - provisions for managing health information - focus on maintaining privacy of electronic transfer and storage of health information and communication

protection of patient rights

- Bill of Rights for Mental Health Patients - Americans with Disabilities Act (ADA) and Job Discrimination - Internal Rights Protection Systems (Public Law 99-319) - External Advocacy Systems - Accreditation of Mental Health Care Delivery Systems

Bill of Rights for Mental Health Patients

- The right to appropriate treatment and related services under conditions that support the person's personal liberty and restrict such liberty only as necessary to comply with treatment needs, laws, and judicial orders. - The right to an individualized, written, treatment or service plan (to be developed promptly after admission), treatment based on the plan, periodic review and reassessment of needs and appropriate revisions of the plan, including a description of services that may be needed after discharge. - The right to ongoing participation in the planning of services to be provided and in the development and periodic revision of the treatment plan, and the right to be provided with a reasonable explanation of all aspects of one's own condition and treatment. - The right to refuse treatment, except during an emergency situation, or as permitted under law in the case of a person committed by a court for treatment. - The right not to participate in experimentation in the absence of the patient's informed, voluntary, written consent, the right to appropriate protections associated with such participation, the right to an opportunity to revoke such consent. - The right to freedom from restraints or seclusion, other than during an emergency situation. - The right to a humane treatment environment that affords reasonable protection from harm and appropriate privacy. - The right to confidentiality of records. - The right to access, upon request, one's own mental health care records. - The right (in residential or inpatient care) to converse with others privately and to have access to the telephone and mails unless denial of access is documented as necessary for treatment. - The right to be informed promptly, in appropriate language and terms, of the rights described in this section. - The right to assert grievances with respect to infringement of the Bill of Rights, including the right to have such grievances considered in a fair, timely, and impartial procedure. - The right of access to protection, service, and a qualified advocate in order to understand, exercise, and protect one's rights. - The right to exercise the rights described in this section without reprisal, including reprisal in the form of denial of any appropriate, available treatment. - The right to referral as appropriate to other providers of mental health services upon discharge.

determination of competency

- communicate choices - understand relevant information - appreciate situation and consequences - use a logical thought process to compare risk and benefits of treatment options

involuntary commitment

- court ordered without the person's consent - can be inpatient or outpatient - patients have the right to receive treatment, and possible right to refuse treatment - provisions for emergency short-term hospitalization of 48-92 hours - after this time the individual either agrees to voluntary treatment or extended commitment procedures are begun

competency

- degree to which a patient can understand and appreciate the information given during the consent process - cognitive ability to process information at a specific time - different from rationality- which is a characteristic of the decision, not the patient's ability to make the decision - not clearly defined across the states

self-determinism

- empowerment or having free will to make moral judgements - internal motivation to make choices based on personal goals - key values: personal autonomy; avoidance of dependence on others - a basic and fundamental psychological need

writing documentation

- hand written documentation always in pen, no erasers - corrected entries initialed by person making corrections - entry written clearly and without jargon - meaningful, accurate, objective descriptions; no general or stereotypic statements - electronic records held to same standard as nonelectronic records

documentation

- handwritten or electronic - common for all disciplines to record on one progress note; problem focused - patients have access to their records - nursing documentation based on nursing standards

Patient Self Determination Act

- information about advance care documents - question on admission and document about having an advance care document - information about rights to complete advance care documents and to refuse treatment

least restrictive environment

- larger concept underlying patient's right to refuse treatment - a person cannot be restricted to an institution when they can be successfully treated in the community - medication cannot be given unnecessarily - use of restraints or seclusion room only if all other "less restrictive" interventions have been tried first

accountability

- legal liability in psychiatric nursing practice - assault: threat - battery: action - medical battery: treated without consent - false imprisonment: seclusion room/restraints without proper protocol - negligence: didn't do what prudent nurse would do - common areas for lawsuits: patients who are suicidal or violent

informed consent

- legal procedure to ensure patient knows the benefits and cost of procedure - mandated by state laws - complicated in mental health treatment: patient must be competent to give consent, but the individual's decision-making ability often is compromised by the mental illness

advanced care directives in mental health

- living will, durable power of attorney - psychiatric advance directive - states what treatment should be omitted or refused in the event that a person is unable to make those decisions

commitment criteria

- mentally disordered - dangerous to self or others - unable to provide for basic needs: gravely disabled

required nursing documentation

- observations of subjective and objective physical, psychological, and social responses - interventions implemented and patient's response - observations of therapeutic and side effects of medication - evaluation of outcomes and interventions

Health Insurance Portability and Accountability Act (HIPAA)

- patient authorization necessary for the release of information with the exception of that required for treatment, payment, and health care administrative operations

patient record

- primary documentation of patient's problems - verifies behavior and describes care provided

self-determinism and mental health care

- right to choose one's own health related behaviors - possibly different from those recommended by health professionals

privacy

part of a person's life not governed by society's laws and government intrusion

breach of confidentiality

release of patient information without the patient's consent in the absence of legal compulsion or authorization