Chapter 9 MH

clients retain al civil rights afforded to all people -> right to refuse treatment, send and recieve mail, have or refuse visitors
except right to leace hospital in case of involunatry commitment

to be informed abaout benefits, qualifications of all providers, available treatment options and appeals and grievance procedures
least restrictive environment to meet needs
confidentiality
choice of providers
treatment determined by professionals, not third-party payers
parity
nondiscrimination
all benefits witin scope of benefit plan
treatment that affords greatest protection and benefit
fair and valid treatment review processes
treating professionals and payers held accountable for any injury caused by gross incompetence, negligence, or clinically unjustifiable decisions

health care professionals respect client's wishes not to be treated unless danger to self or others -> committed until no longer a danger
state laws govern civil commitment process
all other client rights remain intact
person can be detained in psychiatric facility for 48 to 72 hours on emergency basis
hearing conducted to determine further treatment need
similar laws for people with susbtance abuse issuses

voluntary hospitalization: right to request discharge at any time -> release unless danger to self or others; if such danger is present, then commitment proceesings instituted
involuntary -> can still refuse meds unless actively harming themself, aggressive behavior, or verbally aggressive towards nurse
committed client may:
- take medications and improve rapidly
- become dangerous again if medication ceased after release
mental health clincians may be held liable for criminal actions of client

continued participation in treatment on involuntary basis after release
- taking prescribed medications
- keeping appointments with health care providers for follow-up
- attending specific treatment programs or groups
clients given several opportunities for voluntary compliance

preferred person is family but will be court appointed if not possible
legal gardianship; separate from civil committment
loss of right to enter into contracts
consent to be obtained from legal guardian who speaks for client
conservator sometimes refers to person who manages client's financial affairs

grave disability
incompetency
inability to provide self with food, clothing, or shelter
inability to act in own best interests

right to treatment in least restrictive environment appropriate to meet client's needs
free of restraint or seclusion unless necessary
voluntary seclusion = open seclusion with door open if pt overwhelmed in the general environment

direct appliaction of physical force to person without permission to restrict freedom or movement
human -> staff members physically control client and move to seculsion room
mechanical -> ankle and wrist fastened to bed

invoulntaryconfinement in specially constructed, locked room equipped with security window or camera for direct visual monitoring

seclusion and restraints are never used as a punishment
restraint/seclusion only for shortest amount of time necessary
permitted only when client is imminetly aggressive/dangerous
shorrt-term use of restraints and seclusion
- face-to-face evaluation within 1 hour and then every 8 hours (every 4 hours for children)
- physician's order every 4 houors (every 2 hours for children)
- documented assessment by nurse every 1 to 2 hours for patient safety -> pt could get skin breakdown, twist, choke, pt can still get up regardless of restraints
- close supervision of client, one-to-one monitoring for the first hour
- debriefing session within 24 hours after release from seclusion or restraint

Health Insurance Portability and Accountability Act (HIPPA) -> includes oral, written or electronic
civil (fines) and criminal (prison sentences) penalties for violation of client privacy

duty to warn third parties
going to harm someone with specifics

legal meaning but no medical definition
public doesn't agree with it sometimes
due to mental disease/defect

ANA's code of ethics
ANA's scope and standards of practice
standards of care
state nurse practice acts
federal agency regulation
agency policies or procedure
job descriptions
civil and criminal law
ex: icu should not be floated to nicu = not in scope of practice

practice within the scope of state lawas and nurse practice act
collaborate with colleagues to determine the best course of action
use established practice standards to guide decisions and actions
always put the client's rights and welfare first.
develop effective interpersonal relationships with clients and families
accurately and thoroughly document all assessment data, treatments, interventions and evaluations of the client's reponse to care

legal word for a wrongful act resulting in injury, loss or damage

negligence -> failing to do what a reasonable and prudent person would do in similar circumstances, didn't mean to do it but did unintentionally
malpractice -> type of negligence that refers to professionals such as nurses and physicians

duty -> legally reconized relationship existed, nurse had duty to client to act in capacity of a nurse
breach of duty -> failed to conform to standards of care, failing existing duty, nurse did not act as responsible prudent nurse would have acted
injrury or damage -> client suffered some type of loss, damage, or injury, if nurse acted in responsible, prudent manner it wouldn't have happened

assault -> any action that causes a person to feat being toucehd in a way that is offensive, insulting, or physically injurious without consent or authority
battery -> laying hands on, harmful or unwanted contact with a client; actual harm or injury may not have occured
false imprisionment -> unjustifiable detention of a client, inappropriate use of restraint or secluson, telling someone they are involuntary but are really voluntary

willful, voluntary act
intention to bring about consequences or injury
act was a substantial factro in injury or consequences

branch of biolosophy dealing with values of human conduct related to
- rightness or wrongness of actions
goodness or badness of motives and ends of such action

decisions based on the greatest good for the greatest number

decisions based on whether action is morally right or wrong, with no regard for consequences

autonomy
beneficence
nonmaleficence
justice
veracity
fidelity

right to self-determination, independence
right to refuse medications

duty to benefit others or promote good
giving meds on time

requirment to do no harm
not using restraints/least restrictive

fairness
treats all pt same

honesty, truthfulness
telling the truth
end stage pt -> not telling them they will be okay

obligation to honor commitments and contracts
go back to give meds when you said you would
responsibility to continue education or practice within scope

conflict of ethical prinicipals
no one clear course of action
many dilemmas in mental health involve client's right to autonomy, utilitarianism
ex: client who refuses meds or treatment is allowed to do so on prinicipal of autonomy

compassion, respect, human dignity, and worth
primary commitment to patients
responsible, accountable provision of care
progessional growth, integrity, and competence of the nurse
promotion of safe, ethical health care/work environment
advancement of the nursing profession
collaboration with others
maintain integirty of profession, include social justice

this is how you maintain the highest ethical standards
talk to colleagues or seek professional supervision
spend time thinking about ethical issues; determine your values and beliefs regarding situations before they occur
be willing to discuss ethical concerns with colleagues or managers
see something, say something -> if pt is not being reated ethically being silent condones the behavior