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SUBJECT: CLINICAL SPECIALTY PSYCHIATRY- II
GUIDE: MRS.ASHA KUMARI; ASST. PROFESSOR
PRESENTED BY: UDAYA SREE.G; M.Sc. (N) II YEAR
UNIT XXII: LEGAL AND ETHICAL ISSUES IN MENTAL HEALTH
NURSING
SEMINAR ON
LEGAL AND ETHICAL ISSUES IN MENTAL HEALTH NURSING
INTRODUCTION
Nurses are constantly faced with the challenge of making difficult
decisions regarding good and evil or life and death. Nurse who works in
the mental health setting is responsible for practicing ethically,
competently, safely, and in a manner consistent with all local, state, and
federal laws
TERMINOLOGY
Ethics: is the science that deals with the rightness and wrongness of
actions
Bioethics: is the term applied to these principles when they refer to
concepts within the scope of medicine, nursing, allied health.
Moral behaviour: is defined as conduct that results from serious
critical thinking about how individuals ought to treat others
Moral behavior reflects the way a person interprets basic respect
for other persons, such as the respect for autonomy, freedom, justice,
honesty, and confidentiality
Values: are ideals or concepts that give meaning to the individuals life
Right: is absolute when there is no restrictions whatsoever on the
individuals entitlement
ETHICAL CONSIDERATIONS
Theoretical Perspectives
An ethical theory is a moral principle or a set of moral principles
that can be used in assessing what is morally right or morally wrong.
These principles provide guidelines for ethical decision-making
i.
ii.
iii.
iv.
v.
vi.
LAW
Definition
The sum total of rules & regulations by which a society is
governed. As such, law is created by people & exists to regulate all
persons.
Law is a rule or standard of human conduct established &
enforced by authority, society, or custom
Functions of the Law in Nursing
It provides a framework for establishing which nursing actions in
the care of clients are legal.
It diferentiates the nurses responsibilities from those of other
health professionals.
It helps establish the boundaries of independent nursing action.
It assists in maintaining a standard of nursing practice by making
nurses accountable under the law.
Types of law
Types of law that are of most concern to nurses, these laws are
identified by their source or origin
Constitutional law
Legislation law (Statutory law)
Administrative law
Common law
1. Constitutional Law: The supreme law of a country, it creates legal
rights & responsibilities and a foundation of a system of justice.
2.
Civil law
Civil law protects the private and property right of individuals and
business. Private individuals or groups may bring a legal action to court
for breach of civil law. These legal actions are of two basic types: torts
and contracts
Torts: A tort is a violation of a civil law in which an individual has
been wronged. In a tort action, one party asserts that wrongful
conduct on the part of the others has caused harm, and seeks
compensation for harm sufered.
Tort may be intentional or unintentional.
Eg: Unintentional torts are malpractice and negligence actions.
Intentional tort is the touching of another person without that
persons consent. Intentional touching (e.g. a medical treatment)
without the clients consent can result in a charge of battery, an
intentional tort.
Contracts: In a contract action, one party asserts that the other
party, in failing to fulfil an obligation, has breached the contract, and
compensation or performance of the obligation is sought as remedy.
eg. an action by a mental health professional whose clinical
privileges have been reduced or terminated in violation of an implied
contract between the professional and a hospital
Criminal Law
Criminal law provides protection from conduct deemed injurious of
those found to have engaged in such conduct, which commonly include
imprisonment, parole conditions, a loss of privilege (such as license), a
fine, or any combination of these.
Definition
It refers to the commission or omission of an act, pursuant to a duty,
that a reasonably prudent person in the same or similar circumstances
would or would not do, and acting or the non-acting of which is the
proximate cause of injury to another person or his property.
The Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) defines negligence as a "failure to use such care as a
reasonably prudent and careful person would use under similar
circumstances."
NEGLIGENCE ISSUES
Six major categories of negligence issues that prompted
malpractice lawsuits. Documentation describing the negligent behavior
often used terms such as failure to, lack of, incomplete, inefective, and
improper. The categories of negligence are: failure to follow standards
of care, failure to use equipment in a responsible manner, failure to
communicate, failure to document, failure to assess and monitor, and
failure to act as a patient advocate
Failure to follow standards of care
Standards such as hospital policies have evolved to protect
consumers from substandard care. In defining acceptable levels of
care-the ordinary and reasonable care required to ensure that no
unnecessary harm comes to patients
Failure to use equipment in a responsible manner
Nurses must know the safety features, capabilities, and limitations of
any equipment they use, as well as its hazards. Nurses must follow the
manufacturers' usage recommendations and refrain from modifying the
equipment. The Safe Medical Devices Act of 1990 requires that all
medical device-related adverse incidents that result in death or serious
illness or injury be reported to the manufacturer and the Food and Drug
Administration within 10 working days.
Failure to assess and monitor and failure to communicate
Changes in the health status of a patient can be gradual or sudden
and nurses are usually the first to see the changes and take action. A
nurse's accuracy in assessing and monitoring and her timely reporting
of changes in health status to a physician can often mean the
diference between life and death. Vital aspects of communication
besides timeliness in reporting the change include persistence in
notifying the physician of the change, and accuracy in communicating
the nature and degree of the change.
Failure to document
MALPRACTICE
JCAHO defines malpractice as "improper or unethical conduct or
unreasonable lack of skill by a holder of a professional or official
position; often applied to physicians, dentists, lawyers, and public
officers to denote negligent or unskilful performance of duties when
professional skills are obligatory. Malpractice is a cause of action for
which damages are allowed."
SUMMARY
Apply knowledge of mental health when discussing civil rights and
ethical issues as they apply to clients in the mental health setting.
Identify treatment options/decisions with the client/family/significant
other/staf. Inform clients regarding their right to treatment, right to
refuse treatment, and right to informed consent. Maintain client
confidentiality in the mental health facility. Identify the clients rights as
they apply to seclusion and restraint issues. Evaluate and document
care provided to ensure client safety.
BIBLIOGRAPHY
Varcarolis, E. M., Carson, V. B., & Shoemaker, N. C. (2006).
Foundations of Psychiatric mental health nursing: A clinical
approach (5th ed.)
St. Louis, MO: Saunders. NANDA International (2004). NANDA
nursing diagnoses: Definitions and classifcation2005-2006.
Philadelphia: NANDA.
Dr. Bimla Kapoor (2009) Text book of Psychiatric nursing, 2 nd
edition, Kumar publishers, Delhi
K.P. Neeraja (2004) Essentials of mental health and Psychiatric
nursing, 1st edition, Jaypee publications, New Delhi
R. Sreevani (2010) a guide to mental health and Psychiatric
nursing 3rd edition, Jaypee medical publishers, New Delhi
S. M. Raju (2010) Psychiatry and mental health nursing 1 st
edition, Jaypee medical publishers, New Delhi
Prameela (2009) principles and practices of Psychiatry nursing,
Vol-1, Maruthi publications
B.T. Basavanthappa (2007) Psychiatric and mental health
nursing 1st edition, Jaypee brothers medical publishers; New Delhi
Gail W. Stuart (2009) Principles and practices of Psychiatric
nursing, 9th edition, Elsevier publishers, India
Mary. Varghese (2006) essentials of Psychiatry and mental health
nursing, 3rd edition, Elsevier publishers, India
Mary C. Townsend (2007) Psychiatric mental health nursing 5 th
edition, Jaypee publications, New Delhi
o Definition
o Functions Of The Law In Nursing
o Types Of Law
Constitutional Law
Legislation Law (Statutory Law)
Administrative Law
Common Law
o Civil Law
o Torts
o Contracts
o Criminal Law
C) Universal Bill Of Rights for Mental Health Patients
D) Resources for Solving Ethical Client Issues
8) Mental Health Facility Policies
A) Types of Commitment to a Mental Health Facility
1. Voluntary Commitment
2. Involuntary Commitment
3. Emergency Commitment
9) Legal Liabilities in Nursing Practice
A) Definition of Professional Liability
B) Negligence
C) Malpractice
D) Reducing Potential Liability
10)
Summary
11) Bibliography