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الخميس، 19 يناير 2017

Legal and Ethical Issues By: hossam-M , Lecturer Mental Health Nursing

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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