Legal and Ethical Issues
By: hossam-M , Lecturer Mental
Health Nursing
Learning Objectives
@ The general objective of the lecture is to get
information's about the legal and ethical issues in mental health.
@ The specific
objectives : at the end of this lecture the students should be able to:
·
Identify the development of mental health laws.
·
Identify the
Federal Legislation for psychiatric patients.
·
Explain the critical for voluntary and
involuntary admission to a psychiatric facility .
·
Discuss the legal and ethical issues related to
seclusion and restraint.
·
Define
nursing ethics .
·
Discuss the Ethical issues in psychiatric
nursing.
·
Introduction
·
The
development of mental health laws : federal and state legislation, along with
significant case law , provides the basis for psychiatric practice . All state legislate their own laws to direct
the treatment of mentally ill persons.
Several federal law have been passed to protect the basic rights of
mentally ill and physically challenged
U.S. Citizens. In 1976 the supreme court
of California found that a therapist must warn others when a mentally ill
client poses a serious danger or threat to them; the ''duty to warn'', has
since adopted as law in many states.
·
T Federal Legislation (Bill of rights for
psychiatric patients)T
·
The
right to appropriate treatment in the least restrictive setting.
·
The
right to participate in planning of
treatment.
·
The
right to refuse treatment except in an emergency or as permitted by law.
·
The
right to freedom from restraint or seclusion except in an emergency.
·
The
right to a humane treatment environment
that affords reasonable protection from harm and appropriate privacy.
·
T Federal Legislation (Bill of rights for
psychiatric patients)T
·
6.
The right of access to use of the telephone, personal mail, and visitors ,
unless deemed inappropriate for treatment purpose.
·
7.
Right to purchases.
·
8.
Right to marry or divorce.
·
9.
Right to education.
·
10
Right to be employed.
·
T
State commitment laws T
·
laws
to determine types of admission for psychiatric treatment . Clients are either
admitted voluntary or committed involuntarily, Mandatory outpatient treatment.
·
T
State commitment laws T
·
Voluntary
admission: The client willingly enters
and consents to treatment. Clients retain all of their civil rights and may
discontinue treatment whenever they choose (some states require the client to
sign a 72 –hours' notice of intent to leave.
·
T
State commitment laws T
·
2.
Involuntary admission: the admission and detention, for at least 72 hours, of a
client who poses a threat to self or others ,those who lack the capacity
for meeting basic needs, and those who
are seriously mentally ill but fail to seek treatment .
·
T
State commitment laws T
·
3.
Legally mandatory
outpatient treatment( MOT): Is the requirement that
clients continue to participate in treatment on an involuntary basis after
their release from the hospital into the community. This may involve taking
prescribed medication, keeping appointments with health care providers for
follow-up, and attending specific treatment programs or groups.
·
T
conti….T
·
Benefits of MOT : shorter inpatient hospital
stays, although these individuals may be hospitalized more frequently ; reduced
mortality risk for clients considered dangerous to self or other and protection
of clients from criminal victimization by others .
·
T Least Restrictive Environment (LRE) T
·
Restraint : is the direct application of physical force to
a person, without patients permission,
to restrict his or her freedom of movement. The physical force may be human,
mechanical, or both. Human Restraint is
when staff members physically control the client and move him or her to a
seclusion room.
·
T Least Restrictive Environment (LRE) T
·
Seclusion : is the involuntary confinement of a
person in a specially contracted, locked room equipped with a security window
or camera for direct visual monitoring. For safety, the room often has a bed
bolted .
·
T Least Restrictive Environment (LRE) T
·
Notice : any sharp or potentially dangerous
objective, such as pens, glasses , belts , are removed from the client .
·
The
Goals use Seclusion : seclusion
decreases stimulation , and provides privacy for the client . The goals is to
give the client the opportunity to regain physical and emotional self-control.
short term use of restrain or seclusion is permitted only when the client is
imminently aggressive and dangerous to himself or herself or to other.
·
T The Principal
use of Restrain and Seclusion T
·
Face to
face evaluation by licensed independent
practitioner within 1 hours,
·
Documented assessment by nurse every 1-2 hours
and close supervision of the client. the
nurse assessment the client for any injury and provides treatment as needed .
·
Staff must monitor a client in restraints
continuously on a 1 basis for the duration of the restraint period .
·
A client in seclusion is monitored 1 for the
first hour and may by monitored by audio and video equipment.
·
The nurse monitors and documents the clients’
skin condition, blood circulation in the hands and feet ( for the client in
restraints) and emotional well-being (assessed every 10 to 15 minutes ).
·
The nurse
observes the client closely for side effect of medication, which may be
given in large dose in emergency .
·
Debriefing session within 24 hours after
release from R and S
·
T Ethical Issues Psychiatric NursingT
·
Nursing Ethical : If refers to the analysis of
ethical issues that emerge in the practice of nursing.
·
Ethical issues in Psychiatric Nursing :
·
Nursing use a holistic body mind spirit view of
individuals.
·
Nurses are ethical bound to honor a clients'
spiritual beliefs and to incorporate them, whenever possible, into the clients'
plan of care.
·
Due to widespread acceptance of complementary
and alternative medicine (CAM), spurred by the consumer movement and the
public's' desire to maintain greater control over health care, nurses are
ethically bound to consider a clients' treatment choice when planning care.
·
Example of CAM include acupuncture, herbal
medicine, meditation, relaxation, and massage therapy.
· Shieves, L.R.: Basic Concept of
Psychiatric Mental Health Nursing, 7th ed, Philadelphia: Lippincott
Company William and Wilkins,2008.
· Townsend,M.: of
Psychiatric Mental Health Nursing, 3th ed, Philadelphia: Lippincott
Company William and Wilkins,2005.
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