Civil Commitment Principles

- **Due process**: Fair legal proceedings before depriving someone of their rights. - **Writ of habeas corpus**: A way for a patient to contest involuntary confinement; a "formal written order" to "free the person." It takes a while and sometimes evaluation is already done. - **Least restrictive alternative doctrine**: - All patients have the right to be admitted in the least restrictive setting. - Applies to medications (e.g., give PO instead of IM if sufficient). - Applies to restraints.

Admission at the patient’s request; must meet criteria.

Involuntary admission (1013)

Occurs without patient’s consent; due to danger to self or others, inability to care for themselves, or self-neglect. Determined by a qualified provider and may involve two people before a judge.

Types of Discharge: Conditional release, Unconditional release, Released against medical advice (AMA)

- Conditional release: Involves medications and activities of daily living (ADLs). - Unconditional release: No conditions attached. - Released against medical advice (AMA): Patient chooses to leave despite medical advice.

Medical and psychiatric care must be provided to everyone admitted to a public hospital. Treatment must meet the following criteria: - Humane environment - Qualified and sufficient staff to provide adequate treatment - Individualized plan of care

Right to Refuse Treatment

Individuals have the right to refuse treatment, including therapy and medication.

Exception to Refusing Treatment

The exception is when individuals are endangering themselves or others at that moment.

Right to Withhold Consent

Individuals can withhold consent for therapy and medication.

Right to Withdraw Consent

Consent can be withdrawn at any time.

Right to Retract Consent

Individuals have the right to retract consent.

Right to being informed of risk and complications of all treatment

Patients have the right to be informed about the risks and complications associated with all treatments.

Involuntary admitted patients' rights

Involuntary admitted patients have the right to informed consent if they are competent. If deemed incompetent, a guardian may sign for them.

Implied consent for less risky procedures

Implied consent is sufficient for less risky procedures, such as taking blood pressure or administering medications. Written consent is not necessary.

HIPAA: Sharing Patient Information

Only share patient information on a need-to-know basis without the patient’s consent.

HIPAA: Inclusion of Family and Staff

Includes family members, employers, and staff that do not have a need to know.

HIPAA: Continuation After Death

Patient information confidentiality continues after death.

HIPAA: Exceptions for Sharing Information

Exceptions include child, elder, or dependent adult abuse, and potential harm to another person (duty to warn and protect).

Timeline of the Duty to Warn and Protect

The timeline shows key rulings by the California Supreme Court regarding the duty of psychotherapists to warn and protect potential victims, specifically in the Tarasoff case.

1974 California Supreme Court Ruling

In 1974, the California Supreme Court ruled in Tarasoff v. Regents of University of California that psychotherapists have the duty to warn a patient’s potential victim.

1976 California Supreme Court Ruling

In 1976, the California Supreme Court issued a second ruling in the Tarasoff case, expanding the duty to include the duty to protect.

Duty to Warn and Protect

Duty to warn usually includes: - Assessing and predicting a patient’s danger of violence toward another - Identifying specific individual(s) being threatened - Identifying appropriate actions to protect victim(s)

Negligence/Malpractice

Unintentional tort involving an act, or failure to act, that breaches the duty owed to a patient by a provider.

Areas to prove negligence

1. Breach of duty 2. Causation - was it caused by... 3. Damages - pain and suffering and/or actual

Intentional Tort: Assault

Assault involves a non-physical threat.

Intentional Tort: Battery

Battery involves purposeful touching.

Intentional Tort: False Imprisonment

False imprisonment involves the restriction of movement.

False Imprisonment in Nursing

In nursing, false imprisonment can involve restraints and seclusion without orders.

Less restrictive alternatives must be tried first.

Verbal de-escalation and other methods should be attempted before using restraint or seclusion.

Conditions for using seclusion and restraint.

Must have a written order from a physician. Confined to specific, time-limited periods (e.g., 2 to 4 hours); never PRN.

Frequency of reviewing a patient's condition.

The patient's condition is reviewed and documented regularly, typically every 15 minutes.

Review and reauthorization of restraint or seclusion.

Typically conducted every 24 hours.

Specification required for restraint.

Must specify the type of restraint being used.

Image of a person in a hospital bed with restraints.

Visual representation of physical restraint in a medical setting.

The ANA Code of Ethics involves reporting unethical, illegal, and incompetent or impaired nursing practices. Even when done appropriately, this may present substantial risk to the nurse, but it does not eliminate the obligation to address serious threats to patient safety.

Guidelines on Reporting Practices

The American Nurses Association (ANA) provides guidelines on reporting incompetent, unethical, or illegal practices.

When the safety or well-being of the patient or another person is obviously at risk. Be the patient’s advocate for what is right.

When accurate, timely, and thorough reporting has not occurred or when follow-through of patient care, on which the patient is relying, has not occurred.

Reporting impaired colleagues. Reporting abusive behavior.

Bioethics and Mental Health Flashcards

Student preview

48 questions

Show all answers

1.

FLASHCARD QUESTION

Front

Basic principles of bioethics

Back

Explain the fundamental concepts and ethical considerations in bioethics.

2.

FLASHCARD QUESTION

Front

Types of admissions and discharges in mental health settings

Back

Describe the various types of admissions and discharges in mental health care.

3.

FLASHCARD QUESTION

Front

Legal responsibility of nurses and common liability issues

Back

Discuss the legal responsibilities of nurses and common liability issues they may face.

4.

FLASHCARD QUESTION

Front

HIPAA and its exceptions

Back

Define HIPAA and explain its exceptions.

5.

FLASHCARD QUESTION

Front

Important factors for restraints and seclusion

Back

Describe the key factors to consider when using restraints and seclusion.

6.

FLASHCARD QUESTION

Front

Beneficence

Back

Duty to do good

7.

FLASHCARD QUESTION

Front

Autonomy

Back

Right to make own decision

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