Chapter 3 Ethical and Legal Considerations PDF

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Hello to all nursing students,
This is a chapter from Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition, Karyn I. Morgan & Mary C. Townsend. I wanted to upload notes to help nursing students because nursing school is F***ing stressful. I...

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~~~ Chapter 3: Ethical and Legal Issues~~~ 

Course Objectives o Differentiate among ethics, morals, values, and rights. o Discuss ethical theories including utilitarianism, Kantianism, Christian ethics, natural law theories, and ethical egoism. o Define ethical dilemma. o Discuss the ethical principles of autonomy, beneficence, nonmaleficence, justice, and veracity. o Use an ethical decisionmaking model to make an ethical decision.

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o Describe ethical issues relevant to psychiatric/mental health nursing. o Define statutory law and common law. o Differentiate between civil and criminal law. o Discuss legal issues relevant to psychiatric/mental health nursing. o Differentiate between malpractice and negligence. o Identify behaviors relevant to the psychiatric/mental health setting for which specific malpractice action could be taken.

Introduction Ethical Considerations o Theoretical Perspectives  Ethical Theory: Is a moral principle or set of that can be used to assess what is right or wrong .  ethics is a branch of philosophy that deals with systematic approaches to distinguish from right and wrong behavior .  bioethics is principles that refer to concepts within the medical scope nursing or allied health  moral behavior is conduct that was odd from serious critical thinking about how a person should treat others  reflects a person's basic respect of others in the form of freedom autonomy justice honest and confidentiality  values are personal beliefs about what is important or desirable  values clarification is a process of self exploration through and individuals identify and rank of their own personal values  Right is defined as a valid legal recognition claim or entirely encompassing both freedom from government interference or discriminant Tori treatment an entitlement to a benefit voice service .  right is absolute

Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition.

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legal right is one which the society has agreed and formed into law . Utilitarianism  is the basis of having the greatest happiness principle  this means that actions are right to the degree that they tend to promote happiness and wrong as they tend to produce the reverse of happiness  good is happy and right is whatever promotes good  wrongness of an action is determined by the tendency to bring unhappiness  ethical decisions in the view of utilitarianism looks at the end result of a decision . Kantianism  Immanuel Kant  direct opposite of utilitarianism  can't argue that consequences or end results are not what make an action right or wrong  Kent stated the principle or motivation on which the action is based that is the morally decisive factor.  Actions are bound by sense of duty  Deontology: Is that which binding or duty .  Canton directed ethical decisions are made out of respect for moral law . o I make these choices because it is morally right and my duty to do so not because of consideration Of possible outcome Christian ethics  this approach is ethical decisions focus on the way of life and teachings of Jesus Christ  importance in values are love forgiveness and honesty  do unto others as you would have them do unto you  the imperative demand of Christian ethics is that all decisions about right and wrong should be centered in love for God and in treating others with respect and dignity with which we would expect to be treated . Natural law theory  Saint Thomas Aquinas.  The basis is the ideas that decisions  it advances the idea that decisions about right versus wrong are self-evident and determined by human nature 

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Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition.

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the theory states that as rational human beings we inherently know the difference between right and wrong because of the knowledge received from God and this knowledge directs our decision-making .  ethical egoism  states that right and good is what is best for the individual making the decision  An individual's actions are determined by his or her own advancement  the action is not best for anyone involved but consideration is only for the individual making the decision  Selfishness o Ethical Dilemmas  Is the situation that requires an individual to make choices between 2 equal unfavorable alternatives  the individual who must make the choice experience is conscious conflict regarding the decision .  Not all ethical issues are dilemmas  at the cold dilemmas arise when there is no clear reason to choose one action over the other.  for example, the movie externus is a great example o Ethical Principles  are fundamental guidelines that influence decision-making o what are the 5 types of ethical principles?  autonomy  Arises from Kantian view ( person is an Independent moral agent whose right to determine their own destiny should be respected )  it seems that an individual are always capable of making independent choices for themselves  individuals who are not capable of making informed choices R children comatose individuals and people with serious mental illness  for those cases a representative is given to interview and give consent  as health care workers we need to make sure that an individual's autonomy is not disregarded in favor of what the other person or the assigned person may view is best for the patient  Beneficence  refers to one's duty to benefit or promote the good of others 

Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition.

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health care workers who act in their patients interests are benevolent provided that their actions really do so for the patient's best interest  Advocacy is an essential role for a psychiatric nurse o advocacy means acting on another person's behalf being supportive or a defender  for a psychiatric nurse it means helping patients fulfill needs without assistance of and because of their illness may go unfulfilled  Veracity  One’s duty to always being truthful  Nonmaleficence  Is a requirement that health care providers do not harm their patient either intentionally or unintentionally  an example is when a psych patient refuses anti septic medication Which is consistent with their rights and the nurse must decide how to maintain a patient safety while psychotic symptoms continued.  Justice  Right of individuals to be treated equally and fairly regardless of race, sex, martial status, etic.  What is the model for making ethical decisions.?  1) Assessment  2) Problem Identification  3) Planning  4) Implementation  5) Evaluation  What are the 3 ethical and legal issues in psych nursing?  1) The right to treatment  2) The right to refuse treatment ( including medication)  3) The Right to the least restrictive treatment alternative Legal Consideration o What are the Nursing practice acts?  1) defining nursing  2)a statement of the education and other training/ requirements of license and reciprocity  3)broad statements that describe the scope of practice for various levels of nursing  Conditions under which nursing license may be revoked or suspended and instructions for appeal  The general authority and powers of the state board of nursing 

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Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition.

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o What are the different types of laws?  Statutory law: is a law that has been enacted by a legislative body such as a state or county  Common : from decision made in previous cases. o What is a classification within statutory and common law?  Civil Law : protects the private and property rights of an individuals and business  Torts: is violation of a civil law in which an individual has been wronged. o Unintentional vs intentional  Contracts : one party asserts that the other party in failing to fulfil an obligation has breached the contract and either compensation or performance of the obligation is sought as remedy .  Criminal law provides protection from conduct deemed injurious to the public welfare. o What are legal issues in psych?  Confidently & the right to privacy  HIPPA o Private communication:  Informed Consent : o What is the nurses role in getting informed conset?  Knowledge about decision  Competency of the individual is not impaired  Free will to making the decision without pressure o What are the situation/circumstances where treatment can be given without informed consent?  1. When a client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm  2. When refusing treatment endangers the life or health of another  3. During an emergency in which a client is in no condition to exercise judgment  4. When the client is a child (consent is obtained from parent or surrogate)  5. In the case of therapeutic privilege: Information about a treatment may be withheld if the physician can show that full disclosure would  a. Hinder or complicate necessary treatment, Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition.

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b. Cause severe psychological harm, or c. Be so upsetting as to render a rational decision by the client impossible.  Restraints and Seclusion: o What are some important information to know about Restraints?  They are used as a third intervention  Never used as punishment  They are referred to as a set of leather straps that are used to restrain the extremities of an individual whose behavior is out con control and who poses as an immediate risk to the physical safety and psychological well being of the individual and others. What are the exceptions to confidentiality and right to privacy?  A duty to warn ( Protection of a Third Party):  Suspected child/elder Abuse : What types of hospitalizations are there in mental health?  1) Voluntary  2) involuntary o What is the criteria for involuntary commits?  ■ The person is imminently dangerous to himself or herself (i.e., suicidal intent).  ■ The person is a danger to others (i.e., aggressive, violent, or homicidal).  ■ The person is unable to take care of basic personal needs (the “gravely disabled”). o What are the types of involuntary commits?  Emergency : needed when a pt manifest behjavor that is clearly and immentily dangous to themselves or others.  Mentally ill person in need of treatment  Involuntary outpatient commits :  Gravely disabled client What is nursing liability?  Malpractice : Malpractice may be defined as an act or continuing conduct of a professional that does not meet the standard of professional competence and results in provable damages to his or her client or patient  

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Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition.

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Negligence : failure to exercise the care towards other that a reasonable person would o in the situation or taking actions that a reasonable person would do.  What are the basic elements to nursing malpractice lawsuit?  Duty to the pt existed based on the recognized standard of care  A breach of duty occurred meaning that the care rendered was not consistent with the recognized standard of care.  The client was injured  The injured was directly caused by the breach of a standard of care.  What are the types of lawsuits that occur in psych nursing?  Breach of confidentiality : for revealing aspects about a client’s case, or even for revealing that an individual has been hospitalized,  Defamation of character : shared information is detrimental to the client’s reputation,  Libel : when the information shared to defame a person was written  Slander : oral defamation  Invasion of privacy : charge that may result when a client is searched without probable cause.   Assault : Assault is an act that results in a person’s genuine fear and apprehension that he or she will be touched without consent.  Battery is the unconsented touching of another person.  How does a nurse avoid liability?  Effective communication with pt. and other caregivers  Accurate and complete documentation in medical record.  Complying with standards of care  Knowing the pt.  Practicing within the nurses level of competence and scope of practice. Summary and Key Points Review Questions 

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Morgan, K. I. (2019-10-16). Essentials of Psychiatric Mental Health Nursing Concepts of Care in Evidence-Based Practice, 8th Edition....