Legal and Ethical Guidelines for Safe Practice

Ethical Concepts Ethical dilemma: Conflict between two or more courses of action, each with favorable and unfavorable consequences Ethics: The study of philosophical beliefs about what is considered right or wrong in a society Bioethics: Used in relation to ethical dilemmas surrounding health care

Five Principles of Bioethics 1. Beneficence: The duty to promote good 2. Autonomy: Respecting the rights of others to make their own decisions 3. Justice: Distribute resources or care equally 4. Fidelity (nonmaleficence): Maintaining loyalty and commitment; doing no wrong to a patient 5. Veracity: One's duty to always communicate truthfully 6. Nonmalefincence

Civil Rights of Persons with Mental Illness Guaranteed same rights under federal and state laws

Due Process in Involuntary Commitment Probable Cause Hearing Writ of habeas corpus Least restrictive alternative doctrine

Admission Procedures Informal Admission – sought by patient Voluntary Admission – sought by patient or guardian Informed consent Client retains all rights Client has a right to demand and obtain release Temporary Admission Person confused or demented So ill they need emergency admission

Admission Procedures Continued Involuntary admission – without patient’s consent Criteria: Dangerous to self (DTS) Danger to others (DTO) Gravely Disabled (Unable to provide for basic needs due to Mentally illness)

Involuntary Commitment hour-hold (DTS, DTO, GD) day hold (DTS, DTO, GD) Consecutive 14 day hold for DTS day hold (GD) day hold for (DTO) Temporary Conservatorship - GD LPS Conservatorship - GD

Admission Procedures Continued Long -Term Involuntary Admission Medical certification Judicial review Administrative action Involuntary Outpatient Admission

Medication Capacity Riese Petition (Medication Capacity Hearing)

Which individual with mental illness may need involuntary hospitalization? a. A person with alcoholism who has been sober for 6 months but begins drinking again b. An individual with schizophrenia who stops taking prescribed antipsychotic drugs c. An individual with bipolar disorder, manic phase, who has not eaten in 4 days d. Someone who repeatedly phones a national TV broadcasting service with news tips

Discharge Procedures Conditional release Unconditional release Release against medical advice (AMA)

Patients’ Rights Under the Law Right to treatment Right to refuse treatment Right to informed consent Rights surrounding involuntary commitment and psychiatric advance directives Rights regarding restraint and seclusion Right to confidentiality

Patient Confidentiality Legal considerations Health Insurance Portability and Accountability Act (HIPAA) Confidentiality after death Confidentiality of professional communications Confidentiality and human immunodeficiency virus (HIV) status

Patient Confidentiality Continued Exceptions to the rule Duty to warn and protect third parties Child and elder abuse reporting statutes

Tort Law Tort – A civil wrong for which money damages may be collected by the injured party (plaintiff) from the responsible party (the defendant) Intentional tort – Willful or intentional acts that violate another person’s rights or property Battery Assault False imprisonment Invasion of privacy Defamation of character (slander or libel)

Tort Law Unintentional tort – unintended acts against another that produce injury or harm Negligence Malpractice

Five Elements to Prove Negligence Duty Breach of duty Cause in fact Proximate cause Damages

Guidelines for Ensuring Adherence to Standards of Care Negligence, irresponsibility, or impairment Unethical or illegal practices Duty to intervene and duty to report

Common Sources of Liability in Psychiatric-Mental Health Services Client suicide Improper treatment Misuse of psychotropic medications Breach of confidentiality False imprisonment Injuries or problems related to ECT Sexual contact with a client Failure to obtain informed consent Failure to report abuse Failure to warn potential victims

Documentation of Care A record’s usefulness is determined by evaluating— when the record is read later—how accurately and completely it portrays the patient’s behavioral status at the time it was written.

Medical Records Used by the facility Used as evidence Electronic documentation

Therapeutic Groups and Environment

Therapeutic Factors Common to All Groups Instillation of hope Universality Imparting of information Altruism Orienting client and family Safety and the structural environment Supportive social climate Spirituality Client and family education

Therapeutic Factors Common to All Groups Continued Development of socializing techniques Imitative behavior Interpersonal learning Group cohesiveness Catharsis Existential resolution

Phases of Group Development Orientation phase Working phase Termination phase

Group Member Roles Task roles Maintenance roles Individual roles

Which of the following comments made by members of a group best demonstrates a task role? a. “I want to tell how my problems started. I’m having more trouble than anyone else in this group.” b. “Three people were late for this group. Everyone is supposed to arrive on time.” c. “I can’t believe you’re talking about your failed romantic relationships again.” d. “We started out talking about guilt, but we have strayed from that subject.”

Group Leadership Responsibilities Initiating Maintaining Terminating

Styles of Leadership Autocratic leader Democratic leader Laissez-faire leader

Basic Level Registered Nurse Psychoeducational groups Medication education groups Health education groups Dual-diagnosis groups Symptom-management groups Stress-management groups Support and self-help groups

Advanced Practice Nurse Group psychotherapy Psychodrama groups Dialectical behavior treatment

Dealing with Challenging Member Behaviors Monopolizing member Complaining member who rejects help Demoralizing member Silent member

Community Support Programs Crisis stabilization Emergency Acute inpatient care General health care Vocational programs Americans with Disabilities Act Day treatment, partial hospitalization programs Family and support network Advocacy – NAMI resources

High-Risk Clients Concurrent substance related disorders Homeless and mentally ill Frequent readmissions and relapse Frequent criminal justice system involvement