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Chapter 2 Ethical and Legal Issues
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Ethics in Nursing Ethics is the science related to moral principles or standards that govern conduct Nurses work with ethical issues every day Nurses must understand their own values before making ethical decisions Values – personal beliefs about the worth of an idea, object, or behavior Affect how the world is interpreted
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Values Clarification Process of self discovery
Identify own values and prioritize them Three steps to value clarification Choosing from alternatives Prizing the chosen value Acting on chosen value Integrity is acting on one’s values
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Importance of Understanding Personal Values
Nurses who understand their values Act professionally with clients Personal issues don’t interfere with client care Less judgmental and more considerate Can modify own behavior Some personal values are never acceptable in the practice of nursing
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Importance of Understanding Personal Values
Values of profession supersede values of individual nurse Nurses do not need to agree with behavior of clients
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Standard Of Care Ethical and legal expectations for practice
Level of work quality considered adequate Standard skills and knowledge commonly possessed by nurses Ordinary and reasonable care to avoid harm Standards may be: Internal – policies and procedures of organization External – set by state and national organizations Nurses are expected to know and adhere to standards of care
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Ethical Principles Justice Beneficence Nonmaleficence Autonomy
Paternalism Veracity Fidelity
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Ethical Dilemmas An ethical dilemma exists when there are conflicting moral alternatives to consider Complicating factors Conflicting ethical principles Resources available Culture and values of persons involved Who the decision maker is Possible consequences of actions
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Ethical Decision Making
The client is the decision maker in health care if they are competent to do so The nursing process can be used as a decision making model
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The Nursing Process in Decision Making
Assessment Collect data Who is the decision maker? What are the needs of the people involved?
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The Nursing Process in Decision Making
Diagnosis/Planning/Implementation Formulate ethical questions List all possible courses of action Identify benefits and problems of each action Support decision maker
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The Nursing Process in Decision Making
Evaluation Was the desired outcome achieved? Were client’s needs met? Is there something to be learned?
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Legal Aspects of Mental Health Nursing
Types of law Statutory law Common law Both have civil and criminal components
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Nurse Practice Acts Statutory laws
Legal definition of nursing Scope of practice of nursing Nurses must understand their responsibilities when they practice nursing
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Nurse Practice Acts Laws vary from state to state but usually include
Definitions of nursing Types of nurses Requirements for education Conditions for revoking license Statement about agency with jurisdiction
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Requirements for Malpractice
Duty to the client Breach of duty Foreseeability Injury Causation
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Avoiding Malpractice Know the state standards of care and scope of practice Adhere to standards Follow institutional policies and procedures Maintain current knowledge Keep accurate and complete records Maintain client confidentiality Put the client’s well-being first Develop a trusting nurse-client relationship
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Hospital Admission Voluntary Client makes the choice to be admitted
Client maintains civil rights Client is decision maker
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Hospital Admission Involuntary Hospitalized without client consent
Committed via emergency hospitalization or civil commitment State laws regulate commitment Dangerous to self or others In need of treatment Unable to provide for own basic needs
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Outpatient Commitment
Court ordered Client must take medication and comply with treatment plan as a condition of release Benefits Reduces rehospitalization Increases client compliance with medications Decreases violence Not available in all states
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Conditional Release Released from hospital on condition they participate in treatment in the community Available in some states Can be a day treatment or medication management program Failure to comply leads to rehospitalization
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Legal Rights for Mental Health Clients
Vulnerable to abuse and mistreatment Universal Bill of Rights for Mental Health Patients passed by Congress to protect rights Right to least restrictive treatment Limits to restraint and seclusion Right to refuse treatment Right to confidentiality
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Competency Legal assessment that a person is able to make reasonable judgments and decisions Foundation of legal rights of people with mental illness Incompetence determined by a court
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Right to Informed Consent
Clients have the right to freedom from potentially hazardous treatment unless they give informed consent The treatment must be explained by the physician in terms the client understands Diagnosis Description and purpose of proposed treatment Risks and benefits of treatment Alternatives to treatment
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Right to Informed Consent
The nurse witnesses signature only The physician answers client’s questions
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Americans with Disability Act
Unlawful to discriminate in employment against a qualified person with mental or physical disability Disability defined as a person with a physical or mental impairment that substantially limits one or more major life activities, has a record of such impairment, or is regarded as having such an impairment A history of mental illness cannot be used to deny a person employment
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Advance Care Directives
Instructions from clients Documented when they are well Details what should be done if they are unable to speak for themselves Opportunity for people with mental illness to designate a spokesperson is a recent development Available in some states
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Nursing Documentation in Mental Health Nursing
Documentation for medication administration Situation and assessment when administering PRN medications Include client behavior Less restrictive treatment alternatives tried Client response to routine and PRN medications Side effects and adverse drug reactions Frequent assessment and documentation of clients at risk for suicide Documentation of behavior especially important
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Resources President’s New Freedom: Commission on Mental Health This website addresses the goal of eliminating disparities in mental health services based on culture. American Mental Health Counselors Association This website provides the code of ethics of the American Mental Health Counselor’s Association.
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