1. Legal and Ethical Issues in Psychiatric Nursing

2. Patient’s Bill of Rights
Civil Rights
Client Consent
Communication
Freedom from Harm
Dignity and Respect
Confidentiality
Participation in Their Treatment Plan

3. Admission to the Hospital
Voluntary
Involuntary

4. Client’s Rights Under the Law
Right to Treatment
Right to Refuse Treatment
Right to Informed Consent
Rights Regarding Restraint and Seclusion

5. Right to Treatment
Clients have the right to receive treatment for psychiatric problems
Rx must meet the following criteria:
The environment must be humane
Staff must be qualified and sufficient to provide adequate Rx
The plan of care must be individualized

6. Right to Refuse Treatment
When forcible medication is used to prevent violence to third parties, to prevent suicide, or to preserve security, the court noted that the med is being used as a chemical restraint—changes from individual rx to public protection
If it is deemed that an individual is unable to make a competent, informed, and voluntary decision re: rx,courts have stated that the med determinations and rx plans are best left to the professionals

7. Rights Regarding Seclusion and Restraint
Legally, behavioral restraint and seclusion are authorized as an intervention when:
The particular behavior is physically harmful to the client or a 3rd party
The disruptive behavior presents a danger to the facility
Alternative or less restrictive measures are insufficient in protecting the client and others from harm
When a decrease in sensory over stimulation (seclusion only) is needed
When a client requests seclusion

8. Rights Regarding Seclusion and Restraint (cont)
The use of seclusion and restraint is permitted only:
On the written order of a physician
Must be face-to-face exam by MD within 1 hr of the application
Next 4 hrs can have phone order
Next 4 hrs need to have face-to-face exam…etc
Clients should be assessed q 15 min
Restraints must be rotated q2h
Food and fluids should be offered at least q2h

9. Rights Regarding Seclusion and Restraint (cont)
Documentation—
Should reflect that lesser restrictive methods were tried
The behavior leading to restraint/seclusion

10. Tort Law
Torts are civil wrongs for which money damages are collected by the injured party (plaintiff) from the wrongdoer (defendant)
Civil liability for nsg practice falls in the area of tort law
3 types of torts:
Intentional
Quasi-intentional
Unintentional

11. Intentional Assault Battery False imprisonment
An act resulting in a person’s apprehension of an immediate harmful or offensive touching (battery)
Battery
Harmful or offensive touching
False imprisonment
An act with intent to confine a person to a specific area
The use of seclusion or restraint that is not defensible as being necessary or in the pt’s best interest

12. Quasi-Intentional Defamation is made up of 2 torts:
Slander or oral communication
Libel or written communication
Breach of confidentiality

13. Unintentional Professional negligence
Involves harm resulting from the failure of a person to conduct himself or herself in a reasonable and prudent manner
4 items needed to prove negligence are:
Duty—measured by standard of care
Breach of duty—conduct that exposes the client to an unreasonable risk of harm
Proximate cause—Intervening actions or persons that were, in fact, the causes of harm to the client
Damages—pain and suffering

14. Duty to Warn Third Parties
Tarasoff case of 1976
A duty to warn third parties exists when a therapist determines that the pt presents a serious physical danger to another person

15. Defense Mechanisms

16. Repression: the active unconscious process of keeping out or ejecting from the consciousness ideas or impulses that are unacceptable to the person
Denial: refusal to perceive or face reality as it actually exists
Acting out: the use of actions versus reflection or true experiencing of feelings to deal with stress or conflict
Rationalization: use of a contrived, socially acceptable and logical explanation to justify unpleasant material and to keep it out of consciousness

17. Projection: attributing one’s own unacceptable motives or characteristics to another person or group
Displacement: the discharge of pent-up feelings onto something or someone else in the environment that is less threatening than the original source of the feelings
Reaction formation: prevention of awareness or expression of unacceptable desires by adoption of opposite behaviors in an exaggerated way

18. Intellectualization: the overuse of abstract thinking or generalizations to control or minimize painful feelings
Undoing: atonement for or attempt to dissipate unacceptable acts or wishes
Compensation: counterbalance for deficiencies in one area by excelling in another area
Identification: incorporation of the image of an emulated person, then acting, thinking, and feeling like that person

19. Introjection: treating something outside the self as if it actually exists inside the self
Regression: returning to an earlier level of adaptation
Sublimation: modification of an instinctual but socially unacceptable impulse into a constructive acceptable behavior
Suppression: the conscious inhibition of an impulse, idea, or affect; the person has full awareness of the behavior
Humor: emphasis on ironic or amusing components of a crisis, conflict, or stressor

20. Splitting: compartmentalization of opposite-affect states and failure to to integrate positive and negative aspects of self or others, resulting in polarized images of self and others as all good or all bad
Self-Observation: reflection on one’s own behavior, thoughts, or feelings, followed by appropriate response
Self-assertion: expression of thoughts and feelings in direct ways that are not manipulative or intimidating
Altruism: devotion of self to serving others as a way to mange conflict and stress

21. Affiliation: turning to others for support and help when stressed or conflicted, without attempting to make others responsible for taking care of the person
Anticipation: anticipating consequences of events yet to come thinking of options, solutions, and alternatives
Help-Rejecting Complainer: repeated requests for help, suggestions, or advice that is then rejected
Passive Aggression: expression of aggression toward others in indirect or nonassertive ways; covert hostility and resentment masked by over-compliance

22. Omnipotence: feeling or acting superior to others or as if one has special abilities or powers
Isolation of Affect: separation of feelings from thoughts and ideas that are originally associated with them
Fantasy: gratification of frustrated desires, achievements, and relationships by substituting them with daydreams and imagery