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Med Surg I Chapt 9
Mental Health
| Term | Definition |
|---|---|
| Assault involves any action that causes a person to fear being touched in a way that is offensive, insulting, or physically injurious without consent or authority. | Threats |
| Autonomy a person’s right to self-determination and independence. | |
| Battery involves harmful or unwarranted contact with a client; actual harm or injury may or may not have occurred. | touching |
| Beneficence one’s duty to benefit or to promote the good of others. | to take actions that promote the client’s health (beneficence) |
| Breach of Duty The nurse (or primary provider) failed to conform to standards of care, thereby breaching or failing the existing duty. | |
| Causation The breach of duty was the direct cause of the loss, damage, or injury. In other words, the loss, damage, or injury would not have occurred if the nurse (or primary provider) had acted in a reasonable, prudent manne | |
| Deontology is a theory that says decisions should be based on whether an action is morally right with no regard for the result or consequences. | |
| Duty A legally recognized relationship (i.e., primary provider to client, nurse to client) existed. | |
| Duty to Warn- mental health clinicians may have a duty to warn identifiable third parties of threats made by clients, even if these threats were discussed during therapy sessions otherwise protected by privilege | |
| Ethical Dilemma a situation in which ethical principles conflict or when there is no single clear course of action in a given situation. | the client who refuses medication or treatment is allowed to do so on the basis of the principle of autonomy. |
| Ethics is a branch of philosophy that deals with values of human conduct related to the rightness or wrongness of actions and to the goodness and badness of the motives | |
| False Imprisonment is defined as the unjustifiable detention of a client, such as the inappropriate use of restraint or seclusion. | inappropriate use or restraints or seclusion |
| Fidelity the obligation to honor commitments and contracts. keeping promises | |
| Injury or Damage The client suffered some type of loss, damage, or injury. | |
| Justice fairness, treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs. | |
| Least Restrictive Environment the client must be free of restraint or seclusion unless it is necessary. | a client does not have to be hospitalized if they can be treated in an outpatient setting in a group home. |
| Malpractice is a type of negligence that refers specifically to professionals such as nurses and primary provider | unintentional tort Malpractice is negligence by health professionals in cases in which they have a duty to the client that is breached, thereby causing injury or damage to the client |
| Mandatory Outpatient Treatment or Legally Assisted means client must continue treatments after hospital release such as | taking prescribed medications, keeping follow up appointments, and attending treatment programs |
| Negligence is an unintentional tort that involves causing harm by failing to do what a reasonable and prudent person would do in similar circumstances. | unintentional tort |
| Nonmaleficence the requirement to do no harm to others either intentionally or unintentionally. | do not harm the client (nonmaleficence). |
| Restraint is any method (chemical or physical) of restricting the freedom of movement of an individual for the purpose of managing their behavior. | |
| Seclusion is the involuntary confinement of a person in a specially constructed, locked room equipped with a security window or camera for direct visual monitoring. | |
| Standards of Care means the care provided to clients meets set expectations | Standards of care are developed from professional standards, state nurse practice acts, federal agency regulations, agency policies and procedures, job descriptions, and civil and criminal laws. |
| Tort is a wrongful act that results in injury, loss, or damage. | |
| Utilitarianism is a theory that bases decisions on “the greatest good for the greatest number.” Decisions based on utilitarianism consider which action would produce the greatest benefit for the most people. | |
| Veracity the duty to be honest or truthful. | |
| clients with mental illness had few rights and were subjected to institutionalization, warehousing, and inhumane treatment | |
| Clients receiving mental health care retain all civil rights afforded to all people, except the right to leave the hospital in the case of involuntary commitment | |
| They have the right to refuse treatment, to send and receive sealed mail, and to have or refuse visitors. | |
| Any restrictions (e.g., mail, visitors, clothing) must be made for a verifiable, documented reason. | |
| These restriction decisions can be made by a court or a designated decision-making person, for example, a primary nurse or treatment team | |
| The American Psychiatric Association (APA) developed Principles for the Provision of Mental Health and Substance Abuse Treatment Services. | |
| Many states, patient advocacy groups, and treatment centers have developed their own bill of rights based on these principles. | |
| Civil commitment or involuntary hospitalization curtails the client’s right to freedom (the ability to leave the hospital when they wish). All other client rights, however, remain intact. | |
| A person can be detained in a psychiatric facility for 48 to 72 hours on an emergency basis until a hearing can be conducted to determine whether they should be committed to a facility for treatment for a specified period. | |
| Many states have similar laws governing the commitment of clients with substance use problems who represent a danger to themselves or others when under the influence. | |
| Clients admitted to the hospital voluntarily have the right to leave, provided they do not represent a danger to themselves or others. | |
| They can sign a written request for discharge and can be released from the hospital against medical advice. | |
| If a voluntary client who is dangerous to themself or to others signs a request for discharge, the psychiatrist may file for a civil commitment to detain the client against their will until a hearing can take place to decide the matter. | |
| While in the hospital, the committed client may take medications and improve fairly rapidly, making them eligible for discharge when they no longer represent a danger. | |
| Legally assisted or mandatory outpatient treatment is the requirement that clients continue to participate in treatment on an involuntary basis after their release from the hospital into the community. | |
| The three states that do not have assisted outpatient treatment are Connecticut, Maryland, and Massachusetts | |
| Benefits of mandated treatment- shorter inpatient hospital stays, reduced mortality risk for clients considered dangerous to themselves or others; and protection of clients from criminal victimization by others. | |
| after an initial financial investment, assisted outpatient treatment is more cost-effective than repeated involuntary hospital stays. | |
| Voluntary clients may sign a written request for discharge against medical advice. | |
| Mandated outpatient treatment is sometimes also called conditional release or outpatient commitment | |
| Court-ordered outpatient treatment is most common among people with severe and persistent mental illness who have had frequent and multiple contacts with mental health, social welfare, and criminal justice agencies | |
| The appointment of a conservator or legal guardian is a separate process from civil commitment. | |
| severe disabilities are found to be incompetent by the legal system; cannot provide food, clothing, and shelter for themselves even when resources exist; and cannot act in their own best interests may require appointment of a conservator or legal guardian | |
| the court appoints a person to act as a legal guardian who assumes many responsibilities for the person, such as giving informed consent, writing checks, and entering contracts. | |
| The client with a guardian loses the right to enter into legal contracts or agreements that require a signature (e.g., marriage or mortgage). | |
| the nurse must obtain consent or permission from the guardian | |
| In some states, the term conservator refers to a person assigned by the court to manage all financial affairs of the client. | |
| Some states distinguish between conservator of the person (synonymous with legal guardian) and conservator of financial affairs only—also known as power of attorney for financial matters. | |
| Clients have the right to treatment in the least restrictive environment appropriate to meet their needs. | |
| This concept was central to the deinstitutionalization movement | |
| deinstitutionalized means a client does not have to be hospitalized if they can be treated in an outpatient setting or in a group home. | |
| the client must be free of restraint or seclusion unless it is necessary. | |
| The Joint Commission develops and updates standards for restraint and seclusion as part of their accreditation procedures. (every 2yrs) | |
| The physical restraint may be human, mechanical, or both. | |
| Human restraint occurs when staff members physically control the client and move them to a seclusion room. | |
| Mechanical restraints are devices, usually ankle and wrist restraints, fastened to the bed frame to curtail the client’s physical aggression, such as hitting, kicking, and hair pulling. | |
| Chemical restraint is medication used to restrict the client’s movement or interaction with their environment | |
| Seclusion decreases stimulation, protects others from the client, prevents property destruction, and provides privacy for the client. | |
| Short-term use of restraint or seclusion is permitted only when the client is imminently aggressive and dangerous to self or to others and all other means of calming the client have been unsuccessful | |
| For adult clients, use of restraint and seclusion requires a face-to-face evaluation by a licensed independent practitioner within 1 hour of restraint or seclusion and every 8 hours thereafter | |
| a primary provider’s order every 4 hours, documented assessment by the nurse every 1 to 2 hours, and close supervision of the client for ADULT restraint or seclusion | |
| For CHILDREN, the primary provider’s order must be renewed every 2 hours, with a face-to-face evaluation every 4 hours. | |
| Staff must continuously monitor a client in restraints on a one-to-one basis for the duration of the restraint period. | |
| A client in seclusion is monitored one-to-one for the first hour and may then be monitored by audio and video equipment. | |
| If a client remains in restraints for 1 to 2 hours, two staff members can free one limb at a time for movement and exercise. | |
| It also provides an opportunity for the nurse to reassure the client that restraint is a restorative, not a punitive, procedure | |
| Following release from seclusion or restraint, a debriefing session is required within 24 hours. | |
| Clients who have not been secluded often describe the seclusion of others in more positive terms, such as helpful, caring, fair, and good. | |
| clients who have been secluded report feeling angry, agitated, bored, frustrated, helpless, and afraid while in seclusion. | |
| secluded clients perceive seclusion as a punishment and receive the message that they were “bad.” | |
| Protected health information is any individually identifiable health information in oral, written, or electronic form. | |
| One exception to the client’s right to confidentiality is the duty to warn, based on the California Supreme Court decision in Tarasoff vs. Regents of the University of California | |
| Decisions about the duty to warn third parties are usually made by psychiatrists, the treatment team, or by qualified mental health therapists in outpatient settings. | |
| Four tests of the insanity defense. When the person meets the criteria, they may be found not guilty by reason of insanity. M’Naghten rule Irresistible impulse Substantial capacity test Durham | |
| M’Naghten rule—the defendant did not know the nature or quality of the act or did not know it was wrong because of a mental disease or defect. | |
| Irresistible impulse—the defendant could not control their conduct owing to mental disease or defect. | |
| Substantial capacity test—the defendant lacks substantial (but not total) capacity to appreciate their conduct as wrong or cannot conform their conduct to the law. Also known as Modal Penal Code. | |
| Durham—the defendant’s criminal conduct is excused when it is caused by a mental disease or defect. | |
| Four states—Idaho, Kansas, Montana, and Utah—have abolished the insanity defense, although all but Kansas will allow a verdict of guilty but insane | |
| Intentional Torts. Psychiatric nurses may also be liable for intentional torts or voluntary acts that result in harm to the client. Examples include assault, battery, and false imprisonment. | |
| Many ethical dilemmas in mental health involve a conflict between the client’s autonomy and concerns for the public good (utilitarianism). | |
| The client who is involuntarily committed to an inpatient psychiatric unit loses which right... | Right to freedom |
| The nurse says, “If you don’t take this pill, I’ll get an order to give you an injection.” The nurse’s statement is an example of | assault. |
| the nurse decides to put the client in seclusion. The client has made no threatening gestures or statements to anyone. The nurse’s action is an example of | false imprisonment. |
| indicates a duty to warn a third party... | A client states, “If I can’t have my girlfriend back, then no one can have her.” |
| Which elements are essential in a clinician’s duty to warn? | Client makes threatening statements Potential targets(s) are identifiable. Threat of harm is serious. |
| Which elements are necessary to prove liability in a malpractice lawsuit? | Client is injured. Injury caused by breach of duty Recognized relationship between client and nurse Failure to conform to standards of care |
| The ethical aspect of an action involves what is “right” or what a person should do | Ethical points of view are influenced by values, opinions, and beliefs. |
| Many dilemmas in mental health involve the client’s right to self-determination and independence (autonomy) and concern for the “public good” (utilitarianism) | |
| There are challenges in providing privacy and security while offering telehealth services Risk factors can be environmental, technologic, and operational. | |
| The nurse is obligated to engage in self-awareness by clearly identifying and examining their own values and beliefs, so they do not become confused with or overshadow a client’s. | |
| Clients can be involuntarily hospitalized if they present an imminent threat of harm to themselves or others. | |
| The use of seclusion (confinement in a locked room) and restraint (human, mechanical, or chemical) falls under the domain of the patient’s right to the least restrictive environment. | |
| Short-term use is permitted only if the client is imminently aggressive and dangerous to self or others. | |
| Mental health clinicians have a legal obligation to breach client confidentiality to warn a third party of direct threats made by the client. | |
| Nurses have the responsibility to provide safe, competent, legal, and ethical care as outlined in nurse practice acts, the Scope and Standards of Psychiatric–Mental Health Nursing Practice, and the Code of Ethics for Nurses. | |
| Ethical theories are sets of principles used to decide what is morally right or wrong, such as | utilitarianism (the greatest good for the greatest number) and deontology (using principles such as autonomy, beneficence, nonmaleficence, justice, veracity, and fidelity), to make ethical decisions. |
| Torts can be intentional or unintentional | |
| unintentional torts are negligence and malpractice | |
| intentional torts are assault, battery, and false imprisonment | |
| Deontology- morally right actions regardless of the consequences | |
| Principles of Deontology are Autonomy, Beneficence, Nonmaleficence, Justice, Veracity, Fidelity | |
| Ethical dilemmas are no clear course of action- client refuses medication (autonomy) imminent threat to others (nonmaleficence) ivc-(utilitarianism) | |
| Legal- clear answer based on the law Ethical- what is right based on values and beliefs | |
| Common dilemmas in mental health are clients right to self-determination (autonomy) public good- (utilitarianism) | |
| APA= American Psychiatric Association developed principles for the provision of mental health and substance abuse treatment services | |
| if clients state I don't want to wake up any more this requires IMMEDIATE suicide assessment |
Created by:
Daarina Jones