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Module 6 (Psych Mental Health) > Legal Ethics > Flashcards

Legal Ethics Flashcards

(78 cards)

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1
Q

Ethics

A

study of beliefs about what is right or wrong
- mortality through different approaches

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2
Q

Bioethics

A

ethical questions arise in healthcare

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3
Q

Laws tend to reflect

A

ethical values of society

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4
Q

Standards of Practice for Nurses

A
  • assess
  • nursing dx
  • outcome what
  • plan
  • implement
  • intervention
  • evaluate
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5
Q

Code of Ethics in Nursing

A

Ethics, advocacy, respectful, and equitable practice communicate, elaborate, continue education, scholarly inquiry, quality of practice, stewardship, professional practice

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6
Q

the goal of psychiatric care is to

A

to balance the rights of the psychiatric patient and the rights of society

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7
Q

The ethical dilemma is the

A

moral conflict between two or more courses of action

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8
Q

What are the 9 codes of ethics for nurses?

A
  1. Compassion and respect for every person
  2. commitment to the patient
  3. advocacy and protect their rights and safety
  4. responsibility, decision-making, consistent
  5. maintain personal self-care
  6. improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care
  7. research
  8. teamwork
  9. Uphold nursing policies
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9
Q

Beneficence

A

duty to act to benefit or promote the good of others
- spend extra time to calm an extremely anxious pt

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10
Q

Autonomy

A

Respecting the rights of others to make their own decisions
- right to refuse medication

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11
Q

Justice

A

duty to distribute resources or care equally regardless of person attributes
- devote equal attention to all patients regardless

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12
Q

Fidelity (Nonmaleficence)

A

Maintaining loyalty and commitment to the patient and doing no wrong to the patient
- maintain expertise through education

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13
Q

Veracity

A

One’s duty to communicate truthfully
- no misleading

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14
Q

Community Mental Health Center Act 1963 by JFK for Rosemary

A

Widespread use of psychotropic drugs enabling people to integrate into the community instead of living in asylums
- insurance coverage for mental health or substance abuse

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15
Q

Civil Rights for the mentally ill

A
  • vote
  • civil service ranking
  • granting, forfeit, or denial of license
  • purchases/contracts unless incompetent
  • press charges
  • personal/religious expression
  • humane care and tx
  • courts for nonviolent cases with mental illness
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16
Q

Hx of inhumane tx

A

segregated in asylums not to tx or cure
“social deviants” - divine punishment
hydrotherapy to lower agitation
restraints
forced to expel “demons”
infected so removing body parts

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17
Q

Tx environment order

A

Outpt - PCP, specialty, clinics
Psych home care, day programs,(PHP&IOP), ACT
Inpt - emergency care hold, crisis stabilization, locked unit

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18
Q

Admission/D/C Procedures

A
  • Due process for commitment
  • Admission to hospital (least restrictive to most)
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19
Q

Due process

A

fair procedures before depriving someone of life, liberty, or property

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20
Q

Voluntary patient in TX mental health laws

A

seeks tx and has right to request discharge

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21
Q

Involuntary patient in TX mental health laws

A

brought in for eval against their will
- application for emergency detention (family)
- order of insurance of mental health warrant (court)

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22
Q

Voluntary Inpatient Admission

A

adult (younger than 18 than parent)
- request admission in writing
- right to request d/c (in writing and be reevaluated
- released unless risk of harm

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23
Q

InVoluntary Inpatient Admission

A

admitted w/o consent can’t request D/C
- Tx and danger to self/others/UNABLE TO MEET own basic needs
- legal process

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24
Q

For a family member to involuntary sign patient for hospitalization, what legal process occurs?

A

Bench warrant if reasonable cause - detainment
- Physician must provide a medical certificate within 24 and Order of Protective Custody signed by a judge with 48 hours
- Probable cause hearing within 72 hours
- Certificate of Medical Exam by 2 physicians w/in 2 weeks
- Commitment hearing: judge, attorney, witness, pt, physician
D/C or committed for 60-180 days

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25
If an involuntary pt refuses tx, should you still make them take the medication.
No, they have a right to refuse medication even psychotropic meds
26
The pt's right to treatment
environment humane qualified staff and sufficient to provide adequate tx an individual plan of care
27
Right to Informed Consent
presence of psychotic symptoms not mean pt is incompetent to incapable of understanding - legally competent until declared not
28
Competency
capacity to understand the consequences of one’s decisions
29
Medicine Commitment Hearing
forced by law to take medicine
30
Bench Warrant
forensic study to determine competency
31
Furlough
conditional release with appointments
32
Conservatorship
patient is found incompetent, a guardian is appointed to speak for the patient
33
An incompetent pt can not
provide his or her shelter, food, and clothing; cannot act in his or her own best interests; cannot run his or her own business and financial affairs.
34
Acute Hospitalization Goals (6)
**Prevention selfharm** **Prevent harm to others** **Stabilization** of crisis with return to community programs Psychotropic medications Brief, specific **problem-solving** Rapid establishment of output tx
35
Safety Issues and Precautions for Psych patients
Searches (remove contraband) Milieu Prevent self-injury Manage aggressive/violent behavior Prevent elopement/escape Manage emergencies **Assualt and Elopement Precautions**
36
What to do in a safety search?
2 staff (1 as the same gender) No cavity searches Belongings. pockets of clothing searched Safe items returned If unsafe - secured till D/C **Policy**
37
Unsafe Items include
sharp objects medications/drugs alcohol strings, belt lighters/matches
38
When a pt becomes aggressive, how many people communicate with the pt?
only 1
39
What should the nurse avoid wearing,
dangling earrings stethoscope lanyard watch eyeglasses - know layout of area
40
When addressing an aggressive pt stand
10 ft away and to the side - avoid confrontation
41
Agitation
acute behavioral emergency requiring immediate interventions (least restrictive)
42
What is the best practice when dealing with agitation?
verbal de-escalation (engage, relationship) - ensure safety pt and others - help pt manage emotions/control - Avoid restraints and coercive interventions
43
Traditional Interventions for agitation
involuntary medication or seclusion/restraint
44
Anger
Emotional response to frustration of desires, threat to one’s needs (physical or emotional), or a challenge
45
Aggression
Action or behavior that results in a verbal or physical attack
46
Violence
Intentional use of force that results in, or has potential to result in, injury to another person
47
Predictive Factors for Violent Outcomes
**Recent acts of violence** Angry, irritable affect Pacing, restless, slamming doors Clenched jaw or fist, tense expression Verbal abuse, profanity, arguing Loud voice or stone silence Suspicious or paranoid ETOH or drug intoxication Possession of weapon Milieu conducive to violence (loud, crowded, staff inexperience or controlling, poor limit setting)
48
De-escalation Technique Interventions
pt's self-esteem and dignity calm and clear voice - respond ASAP to assess pt and situation - immediate need - personal 10 ft space - avoid verbal struggles - set limits - communication skills(don't stare) - safety - injection if forced
49
Rights regarding restraint and seclusion
- least restrictive for shortest amount of time - 1st verbal and cooperation - 2nd medications - Emergency, staff restrain/seclude and retain order within 1 hour - Pt can request seclusion
50
The psychiatrist needs to assess the patient how long after sedation?
1 hour
51
Tx for acute anger and aggression are
antipsychotics and antianxiety
52
What medications can be added in an emergency situation to reduce extrapyramidal side effects?
Diphenhydramine or benztropine
53
Antipsychotics for Anger and aggression acute episodes
Haloperidol (Haldol) Ziprasidone (Geodon) Olanzapine (Zyprexa)
54
Antianxiety for Anger and aggression acute episodes
Lorazepam (benzo)
55
Seclusion:
involuntary confinement in specially constructed, room where person is prevented from leaving (lock door)
56
Restraint
any manual method or physical or mechanical device that immobilizes the ability of person to move
57
Seclusion/Restraint Interventions
**Use of least restrictive means of restraint for the shortest duration of time** - harmful to self/others - less restrictive are insufficient - decrease sensory stim required - request seclusion
58
Behavioral Seclusion/Restraint order need
written order of physician time limited reason listed Seclusion: assess/doc every 15 minutes Restraint: 1:1 with them food, toilet, hydration, comfort, safety NEVER USE FOR PUNISHMENT/CONVENIENCE
59
Restraints/Seclusion is contraindicated for
fractures
60
Time limit of seclusion/restraint if 18+
4 hours
61
Time limit of seclusion/restraint if 9-17
2 hours
62
Time limit of seclusion/restraint if less than 9
1 hour
63
Confidentiality
HIPAA duty to warn and protect 3rd party - **protective privilege ends where public peril begins” Notify who is threatened** - notify potential victim, family, and police -discharge by therapist
64
Duty to protect and report
- suspected **child/elder/disabled abuse, neglect, exploitation**
65
When the abuser is in drug/alcohol tx disclosure cannot be made until
Court order is obtained Report can be made without identifying abuser Report can be made anonymously
66
Intentional Torts
bullying, theft, physical assault, sexual misconduct, exploitation, or fraud - **Battery, Assualt, False Imprisonment**
67
Battery
purposeful touching of another person resulting in physical or emotional harm
68
Assault
verbal or physical action that causes a reasonable belief of immediate harm
69
False Imprisonment
Intentional restriction of movement without justification or consent - May carry criminal penalties - Punitive damages awarded - Not covered by professional insurance
70
What are the 4 elements to **prove negligence**?
- duty to provide a specific level of care - **Breach** BY FAILING TO ACT - Causation (purpose and proximate/legal) - Damages/pain/suffering
71
Breach is a
conduct that exposes the patient to an unreasonable risk of harm through actions for failure to act
72
Causation
- Cause in fact /purpose “but for the nurse’s action, would this injury have occurred” - Proximate cause or legal cause “was there unforeseeable, intervening actions or inactions that were the actual cause of harm to the patient (indirect)
73
Guidelines to Avoid Liability
Patient's rights and welfare first within scope of practice go by practice standards policy and procedures documentation
74
Protection of Patient - legal issues r/t failure to protect patients
Suicidal left alone with means to harm themselves prevent harm when restrained protect from other violent/abusive patients Abuse of therapist-patient relationship (sexual misconduct)
75
Guidelines for Nurses Suspecting Negligence
art and take action regarding incompetent, unethical, illegal practices that place rights in jeopardy - communicate your concerns to person immediately
76
As a patient advocate, if a nurse believes an order needs to clarified or changed, it is their duty to
intervene and protect the patient.
77
Patient abandonment –
nurse does not leave a patient safely reassigned to another health care professional when leaving - pass off has no occurred - no follow through care
78
3 Unethical or illegal practices
diversion of drugs sexual misconduct with patients report colleague as a pt advocate

Module 6 (Psych Mental Health) (12 decks)

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