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50 terms

Psychiatric-Mental Health Nursing

Ethical and Legal Issues
STUDY
PLAY
Doctrine of Charitable Immunity/Good Samaritan Act-1900s
originally provided immunity from prosecution for hospitals, churches, and schools.
Good Samaritan Legislation-1959
California became the first state to enact it.
Health care risk management
a systematic approach to the prevention of financial loss, evolved in the 1970's to decrease liability exposures, integrate risk reduction strategies, and create a risk-free environment.
Ethics
the study of values that conform to moral standards of a group or profession.
4 primary principles to guide ethical decisions when it come to clients rights-ANA-1985
right to autonomy, right to beneficence, right to veracity, principle of fidelity.
Ethical dilemmas most frequently encountered by nurses on a daily or weekly basis
cost containment, end-of-life care, informed consent, incompetent, unethical, illegal practices of colleagues, access to care.
Paternalism
when the nurse thinks he/she knows what is best for the clients, often imposing their own methods for care and treatment decisions.
Violation of state's Nurse Practice Act
Failure to act.
Chally/Loriz-1998-6 step ethical decision-making model for nurses when confronted with ethical dilemmas
clarify the ethical dilemma, gather additional data, identify options, make a decision, act/carry out the decision, evaluate the impact
Genetic testing
the lab analysis of cells for gene products, DNA analysis
Gregor Mendel-1865
a botanist considered to be the founder of genetics
1905
X&Y chromosomes identified
1941
term "genetic engineering" came to be
1982
insulin genetically engineered
1989
gene for cystic fibrosis discovered
August 9, 2001
President George W. Bush announced funding of embryonic stem-cell research
Identify 3 ethical dilemmas the nurse may confront during participation in clinical research
informed consent, documentation of research protocols, client's right to full disclosure
The reason for the Bill of Rights for Registered Nurses-2001
recidivism, right to safe environment, right to advocate freely on behalf of their clients and themselves, right to provide safe ,quality client care
Negligence
conduct that falls below the standard of care established by law for the protection of others
Malpractice
a type of negligence that applies only to professionals
Factors that contribute to the increased number of malpractice cases against nurses
delegation of duties to UAPs, early DC of clients without proper referral to outpatient care, increased workloads, technology requiring technical skills, increased autonomy and responsibility in advanced nursing skills, better-informed consumers, expanded legal definition of liability
"Legal pitfalls"
client falls, failure to follow physician's orders, medication errors, improper use of equipment, failure to remove foreign objects, failure to provide sufficient monitoring, failure to communicate
JCAHO's mission
to improve the quality of care provided at healthcare institutions in the US, grant accreditation, hold institutions accountable for ensuring a safe environment
"Sentinel event"-2002
such an event may result in unanticipated death or major loss of function not related to the client's illness or condition such as suicide or rape in the institution
Intentional torts
willful conduct to do a wrongful act with disregard of the interests of others
Defamation
injury to a person's reputation or character
Slander
oral defamation
Libel
written defamation
Client confidentiality
nondisclosure of private information related by one individual to another
Client privacy
the right to be left alone and free from intrusion or control by the public
1995- ANA House of Delegates
approved a policy titled "Privacy and Confidentiality Related to Access to Electronic Data"
1998- ANA Board of Directors
policy titled "Core Principles of Telehealth"
Failure of duty to warn
Tarasoff decision-1976-Tarasoff v. Regents of UOC, may be emphasized in cases involving sexual abuse and pedophilia
Bill of Rights for Psychiatric-Mental Health Clients
receive treatment, refuse treatment, probable-cause hearing within 3 court days of ADM from involuntary detention if found sane in a court of law (writ of habeas corpus), privacy and confidentiality, communicate freely with others, have personal privileges, maintain civil rights, religious freedom and education, maintain respect, dignity, and personal ID, maintain personal safety and assert grievances, be transferred with continuity of care, access own records, obtain explanation of costs and services, obtain aftercare
1990-Patient Self-Determination Act
gave clients with diagnosis of psychiatric disorders the right to formulate APDs (advanced psychiatric directives)
Voluntary psychiatric hospitalization
have the right to refuse treatment prescribed and may initiate DC at anytime, attending may write AMA (against medical advice)
Involuntary psychiatric hospitalization
client poses threat to himself or others may be admitted and detained for at least 72hrs
After 72hrs, what happens to a client who doesn't sign the voluntary ADM form?
opinions by 2 psychiatrists completed and court hearing set
Civil commitment
client is court-ordered to remain in facility for a specified period
Incompetent/adjudicated
incapable of giving informed consent
Voluntariness hearing
a minor /anyone under 18, who has not been court-ordered to receive treatment has a right to this at the time of ADM
OBRA of 1987 (Omnibus Reconciliation Act)
state that a long-term care facility must not admit as of 1/1/89 any new residents needing active treatment for mental illness or mental retardation
PASARR/preadmission screening and annual resident review
screening document determining whether client requires active psychiatric treatment(for long-term care facility)
Diminished capacity
plea asserting that because of mental impairment/mental retardation, defendant couldn't form the specific mental state required for a particular offense-found guilty of lesser offense
Guilty but mentally ill
plea used by individuals who exhibit clinical symptoms of DSM-IV-TR pstchiatric disorders-pyromaniac
Not guilty by reason of insanity
entered in the presence of a mental disease-delusional disorder
Forensic psychiatry
specialized area of mental health that involves evaluation of an individual's competency and mental condition at the time of an alleged crime
Role of the forensic nurse
staff nurse in ER or corrections, nurse scientist, nurse investigator, expert witness, independent consulting, nurse specialist, health educator, client advocate, counsrlor
Ethical dilemma for the forensic nurse
because of duty to the legal system and not the client could conflict wit the issue of confidentiality
LNC/legal nurse consultant
plays an invaluable role in advocating patient rights and safety, evaluates, renders, analyzes informed opinions on the delivery of health care (forensic nurse)