Chapter 6 MENTAL HEALTH EXAM 1

What other options should the nurse consider before using seclusion or restraints?

-Verbal intervention (asking patient for cooperation; without threats of seclusion or restraint) -Reduce stimulation -Active listening -Provide diversion -Offering PRN medications

Which of the following clients retains the right to give informed consent? 1. A 21-year-old client who is hearing and seeing things that others do not. 2. A 32-year-old voluntarily admitted client who is severely mentally retarded. 3. A 65-year-old client declared legally incompetent. 4. A 14-year-old client with attention-deficit disorder (ADD).

1. A 21-year-old client who is hearing and seeing things that others do not. - a diagnosis of psychosis does not mean patient is unable to consent to treatment 2. A patient with mental retardation is not legally allowed to give informed consent 3. A legally declared incompetent patient is not allowed to give informed consent 4. Minors are not allowed to give informed consent; but it is not because of patient's diagnosis.

Which action should be taken by the clinician when there is reasonable certainty that a client is going to harm someone? Select all that apply. 1. Assess the threat of violence toward another. 2. Identify the person being threatened. 3. Notify the identified victim. 4. Notify only law enforcement authorities to protect confidentiality. 5. Consider petitioning the court for continued commitment.

1. Assess the threat of violence toward another. -important to assess pt's potential for violence toward others 2. Identify the person being threatened. -necessary to confirm identification of intended victim 3. Notify the identified victim. 5. Consider petitioning the court for continued commitment. -due to the patient being a danger toward others, the court should petition for continued involuntary commitment

What are the rights of psychiatric advance directives

1. Designation of preferred physician & therapists 2. Appointment of someone to make mental health treatment decisions 3. Medication preferences- to take or to not 4. Consent or not for ECT 5. Consent or not for admission Into a psychiatric facility 6. Preferred facilities 7. People they do not want to visit (LMAOO)

What are the 4 rules (criteria) for involuntary admission process?

1. Diagnosed w mental illness 2. Danger to self or others 3. Unable to provide for basic needs 4. In need of treatment

What are the 5 elements to prove negligence

1. Duty 2. Breach of duty 3. Cause in fact 4. Proximate cause 5. Damages

What are examples of negligence

1. Failure to question a physician's order 2. Failure to protect patient from self harm 3. failure to provide patient teaching

What does the right to treatment entail?

1. Free of unnecessary medications 2. Right to privacy and dignity 3. Right to least restrictive environment 4.

In which situation is there the potential for an advanced directive not to be honored? Select all that apply. 1. In an emergency situation where the advanced directive document is not readily available. 2. When the advanced directive states that there "will be no heroic measures used." 3. When the health-care proxy is unsure of the client's wishes. 4. When a client can no longer make rational decisions about his or her health care. 5. When a state does not recognize the advanced directive or durable power of attorney

1. In an emergency situation where the advanced directive document is not readily available. - if document is not readily available, it may not be honored by the health-care team for the patient 2. When the advanced directive states that there "will be no heroic measures used." - advanced directors must be specific in directions related to care; that statement is vague and may be challenged 3. When the health-care proxy is unsure of the client's wishes. - if healthcare proxy is unsure, the advanced directive can be challenged

Beyond emergency situations, after a court hearing, a person can be medicated if ALL of what criteria are met?

1. Patient has serious mental illness 2. The patient's functioning is diminishing, if they are suffering or showing threatening behavior 3. Benefits of treatment outweigh harm 4. Patient lacks ability to make a reasonable decision regarding treatment 5. Less-restrictive measures have been tried and not found adequate.

A client has the right to treatment in the least restrictive setting. Number the following restrictive situations in the order of hierarchy from least restrictive to most restrictive. ___ Restriction of the ability to use money and control resources. ___ Restriction of emotional or verbal expression (censorship). ___ Restriction of decisions of daily life (what to eat, when to smoke). ___ Restriction of body movement (four-point restraints). ___ Restriction of movement in space (seclusion rooms, restrictions to the unit).

2,1,3,5,4 1- Least restrictive: ___ Restriction of emotional or verbal expression (censorship). 2. ___ Restriction of the ability to use money and control resources. 3. ___ Restriction of decisions of daily life (what to eat, when to smoke). 4.___ Restriction of movement in space (seclusion rooms, restrictions to the unit). 5.- Most Restrictive: Restriction of body movement (four-point restraints).

The phone rings at the nurse's station of an in-patient psychiatric facility. The caller asks to speak with Mr. Hawkins, a client in room 200. Which nursing response protects this client's right to autonomy and confidentiality? 1. "I am sorry you cannot talk to Mr. Hawkins." 2. "I cannot confirm or deny that Mr. Hawkins is a client admitted here." 3. "I'll see if Mr. Hawkins wants to talk with you." 4. "I'm sorry, Mr. Hawkins is not taking any calls."

2. "I cannot confirm or deny that Mr. Hawkins is a client admitted here." - This option gives no indication if the patient is at the facility or not Option 1, 3, 4 is stating that the caller could not speak to Mr.Hawkins, the nurse has informed the caller that Mr.Hawkins is on the unit

Which situation may put a nurse on an in-patient unit in legal jeopardy for battery? 1. A nurse threatens a client with bodily harm if the client refuses medications. 2. A patient is injured while forcibly placed in a four-point restraints because of low staffing 3. A nurse gives three times the ordered medication dosage because of a calculation error and does not report the incident, resulting in harm to the client. 4. A client is held against his or her will because of medication noncompliance.

2. A patient is injured while forcibly placed in a four-point restraints because of low staffing - Battery is the touching of another person without consent

On an in-patient locked psychiatric unit, a newly admitted client requests to leave against medical advice (AMA). What should be the initial nursing action for this client? 1. Tell the client that, because the client is on a locked unit, the client cannot leave AMA. 2. Check the admission status of the client, and discuss the client's reasons for wanting to leave. 3. In a matter-of-fact way, initiate room restrictions. 4. Place the client on one-on-one observation.

2. Check the admission status of the client, and discuss the client's reasons for wanting to leave. - it is important for nurse to know admission status of this pt. If pt is voluntarily committed then they may leave AMA- UNLESS TREATMENT TEAM HAS DETERMINED THEM DANGER TO SELF OR OTHERS

A client has been deemed a danger to self by a court ruling. Which might the court mandate for this client? 1. Voluntary commitment to a locked psychiatric facility. 2. Involuntary commitment to an outpatient mental health clinic. 3. Declaration of incompetence with mandatory medication administration. 4. Declaration of emergency seclusion.

2. Involuntary commitment to an outpatient mental health clinic. - this is an option of the court when pt has been seen as a danger to self. If they do not show up to regularly scheduled appts, pt can be seized & committed involuntarily to inpatient facility

A client has been involuntarily committed to the acute care psychiatric unit. During the delivery of the evening dinner trays, the client elopes from the unit, gets on a bus, and crosses into a neighboring state. Which nursing intervention is appropriate in this situation? 1. Call the psychiatric facility located in the neighboring state and have them try to involuntarily admit the client to their facility. 2. Notify the client's physician, document the incident, and review elopement precautions. 3. Send a therapeutic assistant out to relocate the client and bring him or her back to the facility. 4. Notify the police in the neighboring state and have them pick the client up and readmit the client to the facility.

2. Notify the client's physician, document the incident, and review elopement precautions. - elopement occurs when a pt leaves hospital without permission. when this happens, nurse notifies the pt's physician & document the incident. - it is not within the scope of practice for therapeutic assistant to search for missing pt and bring back to facility - Court ruling only applies in original state that issued ruling

The right to determine one's own destiny is to autonomy as the duty to benefit or promote the good of others is to: 1. Nonmaleficence 2. Justice. 3. Veracity. 4. Beneficence.

4. Beneficence. - Beneficence is the duty to benefit or promote the good of others

When a client makes a written application to be admitted to a psychiatric facility, which statement about this client applies? 1. The client may retain none, some, or all of his or her civil rights depending on state law. 2. The client cannot make discharge decisions. These are initiated by the hospital or court or both. 3. The client has been determined to be a danger to self or others. 4. The client makes decisions about discharge, unless he or she is determined to be a danger to self or others.

4. The client makes decisions about discharge, unless he or she is determined to be a danger to self or others. - a voluntary admitted pt can make decisions about discharge, unless declared as danger to self or others; if deemed a danger- pt attends court hearing- admission status is determined then.

A wrongful act, intentional or intentional or accidental, resulting in injury to another is called

A Tort

What risk is a nurse at by following institutional policies and procedures

A hospital's policy might be substandard; putting nurse at risk for legal trouble for following the institution's guidelines but not the state's - Ex: an institution might allow patients to be in seclusion for up to 6 hours based on physician orders; but the state's law could be maximum seclusion time of only 4 hours.

A person in the community asks, "Why aren't people with mental illness kept in state institutions anymore?" What is the nurse's best response? A. "Less restrictive settings are available now to care for individuals with mental illness." B. "There are fewer persons with mental illness, so less hospital beds are needed." C. "Most people with mental illness are still in psychiatric institutions." D. "Psychiatric institutions violated clients' rights."

A. "Less restrictive settings are available now to care for individuals with mental illness." - the community is a less restrictive alternative than hospitals for treatment of mentally ill people. - the other options participate in the stigma of mental illness

Which action by a psychiatric nurse best applies the ethical principle of autonomy? A. Exploring alternative solutions with the client, who then makes a choice. B. Suggesting that two clients who were fighting be restricted to the unit. C. Intervening when a self-mutilating client attempts to harm self. D. Staying with a client demonstrating a high level of anxiety.

A. Exploring alternative solutions with the client, who then makes a choice. - autonomy is the right to self-determination, for one to make their own decisions. Exploring alternatives, the client is better equipped to make informed autonomous decision.

In order to release information to another health care facility or third party regarding a client diagnosed with a mental illness, the nurse must take what action? A. Obtain a signed consent by the client for release of information stating specific information to be released. B. Secure a verbal consent for information release from the client and the client's guardian or next of kin. C. Get permission from members of the health care team who participate in treatment planning. D. Secure approval from the attending psychiatrist to authorize the release of information.

A. Obtain a signed consent by the client for release of information stating specific information to be released. - Nurses have an obligation to protect patient privacy and confidentiality. Clinical information should not be released without patient signed consent for release

A client in alcohol rehabilitation reveals to the nurse, "I feel terrible guilt for sexually abusing my 6-year-old before I was admitted." What is the nurse's most appropriate, initial action? A. Reporting the abuse to the local child protection agency. B. Reply, "I'm glad you feel comfortable talking to me about it." C. File a written report with the agency's ethics committee. D. Respect nurse-client relationship confidentiality.

A. Reporting the abuse to the local child protection agency. - Federal law supersede state law; prohibiting disclosure without a court order except in instances in which report can be made anonymously or without identifying abuser

When private insurance will not pay for continued private hospitalization of a mentally ill client, he family considers transferring the client to a public hospital but expresses concern that the client will not get any treatment if transferred. What is the nurse's most helpful reply? A."By law, treatment must be provided. Hospitalization without treatment violates clients' rights." B. "All clients in public hospitals have the right to choose both a primary therapist and a primary nurse." C. "You have a justifiable concern because the right to treatment extends only to provision of food, shelter, and safety." D. "Much will depend on other clients, because the right to treatment for a psychotic client takes precedence over the right to treatment of a client who is stable."

A."By law, treatment must be provided. Hospitalization without treatment violates clients' rights." - The right to medical and psychiatric treatment is conferred on all patients hospitalized in public mental health hospitals under federal law.

Which scenario best demonstrates an example of a tort A. The plan of care for a client is not completed within 24 hours of the client's admission. B. A nurse gives a prn dose of an antipsychotic drug to an agitated client because the unit is short-staffed. C. An advanced practice nurse recommends hospitalization for a client who is dangerous to self and others. D. A client's admission status changed from involuntary to voluntary after the client's hallucinations subside.

B. A nurse gives a prn dose of an antipsychotic drug to an agitated client because the unit is short-staffed. - A Tort is a civil wrong against a person that violates their rights. Giving unnecessary medication for the convenience of staff controls behavior in a manner similar to secluding the patient- possible false imprisonment charge

Which action by a nurse constitutes a breach of a client's right to privacy? A. Documenting the client's daily behavior during hospitalization B. Releasing information to the client's employer without consent C.Discussing the client's history with other staff during care planning D.Asking family to share information about a client's pre-hospitalization behavior

B. Releasing information to the client's employer without consent - the other options are acceptable nursing practices

A nurse is preparing to give an IM medication; as the nurse swabs the site, the patient shouts "Stop! I do not want the medication anymore. I hate the side effects." What is the nurse's best action? A. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary. B. Stop the medication administration procedure and say to the client, "Tell me more about the side effects you've been having." C. Proceed with the injection but explain to the client that there are medications that will help reduce the unpleasant side effects. D. Say to the client, "Since I've already drawn the medication in the syringe, I'm required to give it, but let's talk to the doctor about delaying next month's dose."

B. Stop the medication administration procedure and say to the client, "Tell me more about the side effects you've been having." - mentally ill patients retain civil rights unless there is clear, and convincing evidence of danger. The patient in this situation presents no evidence of danger. As an advocate and educator, the nurse should seek more information about the patient's wish to and not force the medication.

A client diagnosed with schizophrenia believes a local minister has stirred evil spirits and threatens to bomb a local church. The psychiatrist notifies the minister based on what rationale? A. The psychiatrist may release information at their discretion. B. The psychiatrist demonstrated the duty to warn and protect. C. The psychiatrist has no obligation concerning the client's confidentiality. D. The psychiatrist is immune from charges of malpractice.

B. The psychiatrist demonstrated the duty to warn and protect. - it is the healthcare professional's duty to warn or notify an intended victim after a threat of harm has been made. This is a legal responsibility.

Two hospitalized clients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both clients to be secluded to keep them from injuring each other. What would be the outcome of this assertion? A. reinforcement of the autonomy of the two clients. B. violation of the civil rights of both clients. C. commission of an intentional tort of battery. D. Correct placement on emphasis on safety.

B. violation of the civil rights of both clients. - patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion could result in a charge of false imprisonment; seclusion violates patient autonomy.

A client experiencing psychosis asks a psychiatric technician, "What's the matter with me?" The technician replies, "Nothing is wrong with you. You just need to use some self-control." On what basis should the nurse who overheard the exchange A. The technician's unauthorized disclosure of confidential clinical information B. violation of the patient's right to dignity and respect C. The nurse's obligation to report caregiver negligence D. The patient's right to social interaction

B. violation of the patient's right to dignity and respect - the comment disregards the seriousness of the patient's illness. The Code Of Ethics for Nurses requires intervention. This has been patient emotional abuse; not negligence

What is "the duty to act in the interest of the patient or promote health and well being of others"

Beneficence - spending extra time with an anxious patient even if you have a lot of charting to catch up on

Not meeting standard level of care that nurses are expected to perform is known as

Breach of Duty

A voluntarily hospitalized client tells the nurse, "Get me the forms for discharge. I want to leave now." What is the nurse's best response? A. "I will get the forms for you right now and bring them to your room." B. "Since you signed your consent for treatment, you may leave if you desire." C. "I will get them for you, but let's talk about your decision to leave treatment." D. "I cannot give you those forms without your health care provider's permission."

C. "I will get them for you, but let's talk about your decision to leave treatment." - a voluntarily admitted pt has the right to demand and obtain release. HOWEVER, as a pt advocate, the nurse is responsible for weighing factors related to pt wishes and best interest; by asking for information, the nurse may be able to help pt reconsider.

In which situations would a nurse have the duty to intervene and report? (Select all that apply) A. A peer has difficulty writing measurable outcomes B. A healthcare provider gives a telephone order for a medication C. A peer tries to provide client care in an alcohol-impaired state. D. A team member violates relationship boundaries with a client. E. A client refuses medication prescribed by a licensed healthcare provider.

C. A peer tries to provide client care in an alcohol-impaired state. D. A team member violates relationship boundaries with a client. - both of these responses are events that jeopardize patient safety.

After leaving work, a nurse realizes documentation of administration of a prn medication was omitted. This off-duty nurse telephones the nurse on duty and says, "Please document administration of the medication for me. My password is alpha1." What action should the nurse receiving the call take? A. Fulfill the request ASAP B. Document caller's password C. Refer the matter to the charge nurse D. Report request to pt's HCP

C. Refer the matter to the charge nurse - fraudulent documentation may be grounds for discipline by state board of nursing. Referring matter to charge nurse will allow observance of hospital policy while ensuring that documentation occurs

Which individual diagnosed with a mental illness may need involuntary hospitalization? A. The individual who has a panic attack after her child gets lost in a shopping mall. B. The individual who with visions of demons emerging from cemetery plots throughout the community. C. The individual who takes 38 acetaminophen tablets after the person's stock portfolio becomes worthless. D. The individual diagnosed with major depression who stops taking prescribed antidepressant medication.

C. The individual who takes 38 acetaminophen tablets after the person's stock portfolio becomes worthless. - involuntary admission protects pt's who are dangerous to themselves or others. An overdose indicates dangerousness to self.

Which action by the nurse violates the civil rights of a psychiatric client? The nurse (Select all that apply.) A. performs mouth checks after overhearing a client say, "I've been spitting out my medication." B. begins suicide precautions before a client is assessed by the health care provider. C. opens and reads a letter a client left at the nurse's station to be mailed. D. places a client's expensive watch in the hospital business office safe. E. restrains a client who uses profanity when speaking to the nurse.

C. opens and reads a letter a client left at the nurse's station to be mailed. - the patient has the right to send and receive mail without interference. E. restrains a client who uses profanity when speaking to the nurse. -Restraints are not necessary when a patient curses; there are less restrictive measures that can be taken first.

How is capacity different from competency?

Capacity is "ability" to make an informed decision, while Competency is a legal term related to degree of mental soundness patient has to make decisions or carry out specific actions. - If found "incompetent" from a legal standpoint, pt is able to be appointed to a legal guardian or representative who is responsible for for giving or refusing consent

What is the ethical responsibility of healthcare professionals that prohibits disclosure of privileged information

Confidentiality

What is an ethical dilemma?

Conflict between 2 or more options; each with pro's and con's- the healthcare worker has to "pick the lesser of 2 evils" for lack of better words

What is the legal significance of a nurse's action when a client verbally refuses medication and the nurse gives the medication over the client's objection? A. negligence B. Malpractice C. Standard of Care D. Battery

D. Battery - Battery is an unintentional tort in which an individual violates the rights of another through touching without consent. Forcing a patient to take medication after the med was refused constitutes battery

A family member of a client with delusions of persecution asks the nurse, "Are there any circumstances under which the treatment team is justified in violating a client's right to confidentiality?" What is the nurse's best response? A. Under no circumstances. B. At the discretion of the psychiatrist. C. When questions are asked by law enforcement. D. If the client threatens the life of another person.

D. If the client threatens the life of another person. - the duty to warn a person whose life has been threatened by a psychiatric patient overrides the pt''s right to confidentiality.

Which patient meets criteria for involuntary hospitalization for psychiatric treatment? A. The client who is noncompliant with the treatment regimen. B. The client who fraudulently files for bankruptcy. C. The client who sold and distributed illegal drugs. D. The client who threatens to harm self and others.

D. The client who threatens to harm self and others. - involuntary admission protects patients who are dangerous to themselves or others; cannot care for their own basic needs. Involuntary admission protects other persons in society.

Which behavior demonstrated by an individual diagnosed with mental illness may require emergency or involuntary admission? A. Resuming the use of heroin while still taking naltrexone. B. Reports hearing angels playing harps during thunderstorms. C. Not keeping an outpatient appointment with the mental health nurse. D. Throwing a heavy plate at a waiter at the direction of command hallucinations.

D. Throwing a heavy plate at a waiter at the direction of command hallucinations. - this is evidence of harm/ danger to others. This meets involuntary admission criteria for mental illness.

In a team meeting a nurse says, "I'm concerned about whether we are behaving ethically by using restraint to prevent one client from self-mutilation, while the care plan for another self-mutilating client requires one-on-one supervision." Which ethical principle most clearly applies to this situation? A. Beneficence B. Autonomy C. Fidelity D. Justice

D. justice - the nurse is concerned about justice; fair distribution of care including treatment with the least restrictive methods for both patients

Giving a patient the wrong medication that increased sleepiness is an example of

Damage -This could result in permanent damage to the patient, or permanent disability

What is "proximate cause"

Determined by if event was foreseeable - A nurse who abusing substances at work knows that she can harm a patient

What is an exception to confidentiality; what is the term for duty to warn 3rd parties if they are at danger from a patient

Duty to Warn - this is an obligation to warn 3rd parties they might be in danger from a patient

What is it called when a therapist is required legally to call an intended victim, victim's family or the police

Duty to protect

What is the goal of pharmacogenetic testing?

Eliminate trial and error period to prescribing antidepressants and improve recovery time.

Ethics vs Bioethics

Ethics is what is right or wrong in a society; while bioethics is a study of specific ethical questions arising in healthcare.

Leaving a suicidal patient alone in a room on the 6th floor with an open window is an example of

Failure to Protect Patient - unreasonable judgement on the part of a nurse

A patient being confined to a limited area or within an institution is

False imprisonment

What protects a patient's rights to receive treatment and have medical records kept confidential

Health Insurance Portability and Accountability Act (HIPAA)

Who are staff nurses obligated to report patient threat's to

If a patient states specific threats against a person, or group of people- staff nurses are required to report to other members of the treatment team - APRN'S who have their own private practice are obligated to warn the endangered parties themselves

The duty to "distribute care and resources equally, regardless of personal attributes" is defined as

Justice - right for pt to be treated equally despite of race, sex, medical diagnosis, social standing, economic standing or religious views.

What is the time limitation for restraints/ seclusion to be renewed for children under 9 years old

Limited to be in restraints or in seclusion for 1 hour.

What is the time limitation for restraints/ seclusion to be renewed for children 9-17 years old

Limited to be in restraints or in seclusion for 2 hours

Fidelity is the duty to maintain ________ to the patient (asking definition of fidelity)

Maintain loyalty and commitment; do no wrong to the patient

The least restrictive alternative doctrine mandates what

Mandates care providers take least drastic measure for pt's specific purpose. - if pt can be treated safely for depression in an outpatient facility- hospitalization would be too restrictive

What is the consequence for not reporting suspected abuse, neglect or exploitation of an disabled adult

May result in misdemeanor crime

Are patient's medical records allowed to be shared after a patient has expired?

No. Nothing that can be shared while a patient is alive, can also not be shared after death. (In a courtroom, the dead man statute protects information of expired individual since the person cannot speak for themselves) - we are not responsible for the courtroom statute but it assists with understanding

Do "restraints" only mean limiting mobility of arms, legs, body and head?

No. Restraints can even be putting up side rails on a bed if the nurse is using them to prevent the patient from getting out of the bed. - Holding a patient, restricting their movement is also considered a restraint -Restraints can also be chemical

Does custom as a standard of care protect you as a nurse if a patient presses charges that their right has been violated; or that harm has been caused by the staff's common practices. Even if the hospital you work for approved these policies

No. Substandard customs that do not align with state laws do not protect you in a court of law - it is up to the nurse to speak up that the standard is not legally compliant and he/she is only obligated to follow state laws.

Can patients who admit themselves voluntarily always leave the facility on their own terms?

No. They can request release unlike involuntarily admitted pt's; but they require a reevaluation- which could initiate involuntary commitment

Are nurses legally allowed to put patient in restraints or seclusion?

ONLY in emergency situations, a verbal or written order from a physician must be obtained as soon as possible

Federal legislation providing equality in terms of payment for people who are mentally ill to improve access to mental health facilities is known as

Parity - mental health and addiction care are covered at the same level of other medical conditions

Who is seclusion limited to

Patient demonstrating violent behavior toward themselves or jeopardizes the safety of others

Who initiates voluntary admission

Patient or legal guardian

What do "damages" include?

Physical damages, if something was stolen, or broken, property damage. As well as pain and suffering

What preventive measures MUST be taken as a nurse to protect a patient in restraints

Prevent strangulation while patient is in restraints Protect patient from other patients rape has occured by other patients while a patient was in restraints

What is the state board of nursing's primary goal; how do they implement it

Protect the health of the public by overseeing the safe practice of nursing. - They license nurses and also obtain ability to revoke the license.

What can a nurse do to promote safety for a patient with their family if they are exhibiting violent, or controlling behaviors

Remaining calm listening carefully assuring family members the importance of their contributions to patient's welfare

How is seclusion different from a timeout

Seclusion is defined as an order put in by medical staff, preventing a patient from leaving a room; a timeout is when a patient chooses or accepts a suggestion to spend time alone in a specific area. - The patient is allowed to leave timeout whenever they want.

What is an example of a verbal threat

Telling a patient "you will never get out of here"

What is unconditional release?

Termination of the legal patient-institution relationship. - this can be ordered by treating psychiatrist or it can be court ordered

What is the time limitation for restraints/ seclusion to be renewed for an adult 18 and up

They can only be put in seclusion/restraints for a maximum of 4 hours (checked on every 15-30 minutes for basic human needs such as food, water, toilet)

What criteria would allow a pt to leave AMA?

Treatment seems beneficial but no outstanding reason (danger to self or others)- pt can be released AMA. - this puts the physician in an ethical dilemma; between patient autonomy to refuse treatment and clinician beneficence to support the well being/ protect pt.

What is the general first option regarding restraints

Use the least restrictive, for the shortest amount of time.

What does a conditional release typically require

Usually requires outpatient treatment for a specific period of time with follow up evaluation.

A nurse has the duty to communicate the purpose and side effects of a medication to a patient; in a non-misleading way... this is called _____

Veracity - the duty to communicate truthfully

What can patients file if they feel they are being held against their will

Writ of habeas corpus - formal written order to free the person, this is used to challenge unlawful commitment by the government.

If a patient's door is not locked, but healthcare staff has made "threats" to the patient if they leave their room- is this considered seclusion?

Yes. - seclusion is confining patient in a room prohibiting them from leaving

Are patients allowed to withhold consent of their medical records or medication?

Yes. At any time, even if they are involuntarily committed . - they can retract previous consent and care providers MUST RESPECT THIS WISH - This can be a verbal or written retraction

Nonmaleficence is...

do no harm to the patient - protect confidential information of patient

Assault is classified as

intentional threat; designed to make another person fearful that you will cause them harm

who is emergency commitment used for?

people who are so confused they cannot make decisions on their own people who are so ill they need emergency admission

What is Autonomy?

respecting the right of the patient to make their own decision (within reason; if they are capable)

What is a patients "capacity"

the ability to make informed decisions

What is unintentional tort what is the most common way this happens

unintended acts against another person that result in injury or harm - Negligence --failure to use ordinary care in any professional or or personal situation where there is duty to do so

What is an intentional tort

willful or intentional acts that violate another person's rights or property - Ex: assault, battery, false imprisonment