Chapter 9: Legal and Ethical Issues

Key Terms:
o Assault: involves any action that causes a person to fear being touched, without consent or
authority, in a way thats offensive, insulting, or physically injurious
o Autonomy: the persons right to self-determination and independence
o Battery: involves harmful or unwanted contact with a client; actual harm or injury may or may
not have occurred
o Beneficence: refers to ones duty to benefit or to promote good for others
o Breach of Duty: the nurse (or physician) failed to conform to standards of care, thereby
breaching, or failing the existing duty; the nurse did not act as a reasonable, prudent nurse
would have acted in similar circumstances
o Causation: action that constitutes a breach of duty and was the direct cause of the loss,
damage, or injury; in other words, the loss, damage, or injury would not have occurred if the
nurse had acted in a reasonable, prudent manner
o Deontology: a theory that says ethical decisions should be based on whether or not an action is
morally right with no regard for the result or consequences
o Duty: existence of a legally recognized relationship, that is, physician to client, nurse to client
o Duty to Warn: the exception to the clients right to confidentiality; when health-care providers
are legally obligated to warn another person, who is the target of the threats or plan by the
client, even if the threats were discussed in therapy sessions otherwise protected by
confidentiality
o Ethical Dilemma: a situation in which ethical principles conflict or when there is no one clear
course of action in a given situation
o Ethics: a branch of philosophy that deals with values of human conduct related to the rightness
or wrongness of actions and to the goodness and badness of the motives and ends of such
actions
o False Imprisonment: the unjustifiable detention of a client such as the inappropriate use of
restraints
o Fidelity: refers to the obligation to honor commitments and contracts
o Injury or Damage: the client suffered some type of loss, damage, or injury
o Justice: refers to fairness, or treating all people fairly and equally without regard for social or
economic status, race, sex, marital status, religion, ethnicity, or cultural belief
o Least Restrictive Environment: treatment appropriate to meet the clients needs with only
necessary or required restrictions
o Malpractice: a type of negligence that refers specifically to professionals such as nurses and
physicians
o Mandatory Outpatient Treatment (Mandated or Assisted Outpatient Treatment): the
requirement that clients continue to participate in treatment on an involuntary basis after their
release from the hospital into the community
o Negligence: an unintentional tort that involves causing harm by failing to do what a reasonable
and prudent nurse would do in similar circumstances
o Nonmaleficence: the requirement to do no harm to others either intentionally or non-
intentionally
o Restraint: the direct application of physician force to a person, without his or her permission, to
restrict his or her freedom of movement
o Seclusion: the involuntary confinement of a person in a specially constructed, locked room
equipped with a security window or camera for direct visual monitoring
 o Standards of Care: authoritys statements by professional organizations that describe the
responsibilities for which nurses are accountable; the care that nurses provide to clients meets
set expectations and is what an nurse in a similar situation would do
o Tort: a wrongful act that results in injury, loss, or damage
o Utilitarianism: a theory that bases ethical decisions on the greatest good for the greatest
number; primary consideration is on the outcome for the decision
o Veracity: the duty to be honest or truthful
Objectives:
o Describe the rights of the client in a psychiatric setting
Retain all civil rights afforded to all people except, the right to leave the hospital in the
case of involuntary commitment
Right to refuse tx
Right to send and to receive sealed mail
Right to have or refuse visitors
The American Psychiatric Association (APA) developed Principles for the Provision of
Mental Health and Substance Abuse Treatment Services
Highlights Of Patients Bill Of Rights Box 9.1 pg 154
Involuntary Hospitalization:
Voluntary: client is willing to seek treatment and agreed to be hospitalized
Civil commitment or involuntary hospitalization curtails the clients right to
freedom (the ability to leave the hospital when her or she wishes)
Release from the Hospital: if a voluntary pt is dangerous to self or others signs a request
for discharge the psychiatrist may file for a civil commitment to detain the client against
their will until a hearing can take place to decide the matter
Mandatory Outpatient Tx:
5 states dont have: Connecticut, Maryland, Massachusetts, New Mexico,
Tennessee
Benefits: shorter hospital stay, reduced mortality risk for those considered
dangerous to self or others, protection of clients from criminal victimization
More cost effective
Also called conditional release or outpatient commitment
Court ordered is most common among persons with severe and persistent
mental illness who have had frequent and multiple contacts with mental health,
social welfare, and criminal justice agencies
Conservatorship and Guardianship:
Appointment of a conservator or legal guardian is a separate process from civil
commitment
Loses right to enter into legal contracts or agreements that require a signature
o Discuss the legal and ethical issues related to seclusion and restraint
The Joint Commission (JTC) develops and updates standards for Restrictive and
Seclusions as part of their accreditation procedures; done every 2 years, with
accreditation manuals provided to facilities/ organizations that are or seek to be
accredited
Restraints:
Human: when staff members physically control the client, and move him or her
to a seclusion room
Mechanical: devices, usually ankle and wrist restraints, fastened to the bed
frame to curtail the clients physical aggression, such as hitting, kicking, hair
pulling ect
 Seclusion:
For safely, the room often has a bed bolted to the floor and a mattress
Decreases stimulation, protects others from client, prevent property destruction,
provides privacy for client
Goal: to give the client the opportunity to regain physical and emotional self-
control
Short-term use of restraint or seclusion is permitted only when the client is imminently
aggressive and dangerous to self or others and all means of calming the client have be
unsuccessful
Requires face to face evaluation by licensed independent practitioner within 1
hour of restraint or seclusion and q8hrs after
A physicians order q4hrs
Documented assessment by nurse every 1-2 hours
Close supervision of client
For children, physicians order q2hrs, face to face eval q4hrs
Monitored 1:1 For first hour then monitored by audio and video equipment
Nurse monitors and documents clients skin conditions, blood circulation in hands
and feet, emotional well-being and readiness to discontinue seclusion or
restraint; observes patient closely for side effects of medications
If client remains in restraints for 1-2 hours, two staff members can free on limb
at a time for movement and exercise
Following release from seclusion or restraint, a debriefing session is required
with in 24 hours
o Discuss the components of malpractice (see key terms above for the following)
For a malpractice suit to be successful, that is, for the nurse, physician, or hospital or
agency to liable, the client or family needs to prove the following four elements: duty,
breach of duty, injury or damage, causation
o Identify pertinent ethical issues in the practice of psychiatric nursing
o Discuss the meaning of standard of care
o Describe the most common types of torts in the mental health setting
Unintentional Torts:
Negligence
Malpractice: see terms and malpractice components above
Intentional Torts:
Assault
Battery
False Imprisonment
Providing liability for an intentional tort involves these elements:
o The act was willful and voluntary on the part of the defendant (nurse)
o The nurse intended to bring about consequences or injury to the person
(client)
o The act was a substantial factors in causing injury or consequences