2 Mental health clients with all civil rights afforded to all people Rights of ClientsMental health clients with all civil rights afforded to all peopleExcept right to leave hospital in case of involuntary commitmentPrinciples for Provision of Mental Health and Substance Abuse Treatment Services (American Psychiatric Association [APA])As mental health client’s bill of rights (Box 9.1)
3 Involuntary Hospitalization Civil commitmentLaws determined by each stateKnowledge of laws of state of practice necessaryPersons held without consent presenting with imminent danger to self or othersProven at hearing if person is to be committed
4 Involuntary Hospitalization (cont’d) Detention in facility for 48 to 72 hours on emergency basisThen hearing to determine possible commitment to facility
5 Release from the Hospital Voluntary hospitalization: right to request discharge at any timeRelease unless danger to self or others; if such danger present, then commitment proceedings institutedClients no longer dangerous discharged from hospital
6 Mandatory Outpatient Treatment Conditional release or outpatient commitmentContinued participation in treatment on involuntary basis after release from hospital into communityExamples: taking prescribed medications, keeping appointments with health care providers for follow-up, attending specific treatment programs or groups
7 Legal guardianship; separate from civil commitment for hospitalization ConservatorshipLegal guardianship; separate from civil commitment for hospitalizationGrave disabilityIncompetencyInability to provide self with food, clothing, shelterInability to act in own best interestsConsent to be obtained from conservator who speaks for client
8 QuestionTell whether the following statement is true or false:Mental health clients who are hospitalized voluntarily give up their right to leave the hospital.
9 AnswerFalseMental health clients who are hospitalized voluntarily retain all the civil rights afforded to any person, including the right to leave the hospital.However, clients hospitalized involuntarily give up this right.
10 Least Restrictive Environment Right to treatment in least restrictive environment appropriate to meet client’s needsFree of restraint or seclusion unless necessaryCentral philosophy to deinstitutionalization of large state hospitals, move to community- based care and services
11 Least Restrictive Environment (cont’d) Restraint: application of physical force to person without permissionHumanMechanicalSeclusion: involuntary confinement in specially constructed, locked room equipped with security window or camera for direct visual monitoringRestraint/seclusion only for shortest time necessary
12 Least Restrictive Environment (cont’d) Short term use of restraints and seclusionFace-to-face evaluation in 1 hour, every 8 hours (every 4 hours for children)Physician’s order every 4 hours (every 2 hours for children)Documented assessment by nurse every 1-2 hoursClose supervision of clientDebriefing session within 24 hours after release from seclusion or restraint
13 ConfidentialityHealth Insurance Portability and Accountability Act (HIPAA) of 1996Civil (fines) and criminal (prison sentences) penalties for violation of client privacyDuty to warn third parties: exception to client confidentiality
14 Insanity Defense Insanity Legal meaning but no medical definition Person unable to control his or her actions or understand the difference between right and wrong at time of crime (M’Naghten rule)
15 Insanity Defense (cont’d) Four states abolished insanity defenseThirteen states with ‘guilty, but insane’ verdictArgument that verdict absolves legal system of responsibilityPeople do not always receive needed psychiatric treatment
16 QuestionTell whether the following statement is true or false:A nurse is required to maintain client confidentiality unless the client threatens a specifically identified individual or group.
17 AnswerTrueIn cases where a client threatens an identifiable third party, the nurse has a duty to warn that third party.
18 Nursing LiabilityResponsibility for providing safe, competent, legal, ethical care
19 Nursing Liability (cont’d) Meeting standards of care developed from:ANA’s Code of Ethics for Nurses with Interpretive StatementsANA’s Scope and Standards of Psychiatric-Mental Health Nursing PracticeState nurse practice acts/federal agency regulationsAgency policies and procedures/job descriptionsCivil, criminal laws
20 Torts Wrongful act resulting in injury, loss, damage Unintentional tortsNegligenceMalpracticeElements to prove malpracticeDutyBreach of dutyInjury or damageCausation
21 3 elements to prove liability Torts (cont’d)Intentional tortsAssaultBatteryFalse imprisonment3 elements to prove liabilityWillful voluntary actIntention to bring about consequences or injuryAct as substantial factor in injury or consequences
23 QuestionWhich of the following would be considered an unintentional tort?MalpracticeAssaultBatteryFalse imprisonment
24 Malpractice is an unintentional tort. AnswerMalpracticeMalpractice is an unintentional tort.Assault, battery, and false imprisonment are intentional torts.
25 Ethical IssuesEthics: branch of philosophy dealing with values of human conduct (rightness and wrongness of actions) and goodness or badness of motives and ends of such actionsUtilitarianism: theory that bases decisions on greatest good for greatest numberDeontology: decisions based on whether action is morally right or wrong, with no regard for consequences
26 Deontological Principles Autonomy: right to self-determination, independenceBeneficence: duty to benefit others or promote goodNonmaleficence: requirement to do no harmJustice: fairnessVeracity: honesty, truthfulnessFidelity: obligation to honor commitments, contracts
27 Ethical Dilemmas in Mental Health Conflict of ethical principlesNo one clear course of actionMany dilemmas in mental health involving client’s right to self-determination and independence (autonomy) and concern for ‘public good’ (utilitarianism)ANA Code of Ethics for Nurses guides choices about ethical actions
29 QuestionTell whether the following statement is true or false:The greatest good for the greatest number reflects the deontologic ethical theory.
30 AnswerFalseDeontologic theory bases decisions on whether an action is morally right or wrong, without regard for the consequences.Utilitarianism bases decisions on the “greatest good for the greatest number.”
31 Self-Awareness Issues Talk to colleagues or seek professional supervisionSpend time thinking about ethical issues, determine your values and beliefs regarding situations before they occurBe willing to discuss ethical concerns with colleagues or managers