Chapter 4
Ethical and Legal Issues
Introduction
Nurses are constantly faced with the challenge of
making difficult decisions regarding good and evil or life and death.
Nurses must know the legal and ethical issues
regarding care of the mentally ill
Legal Considerations
Nurse Practice Act defines the legal parameters of
professional and practical nursing
Types of Laws
Statutory law
Common law
Review
Definitions
Ethics
Bioethics
Moral behavior
Values
Right
Absolute right
Legal right
Review Ethical Theories
Utilitarianism
Kantianism
Christian Ethics
Natural Law Theories
Ethical Egoism
Review Ethical Principles
Autonomy
Beneficence
Nonmaleficence
Justice
Veracity
A Model for Making Ethical Decisions
Assessment
Problem identification
Plan
Implementation
Evaluation
Principles Guiding the Care of the
Mentally Ill
Client autonomy and liberty must be ensured- treatment
in the least restrictive setting with active client participation in treatment.
Clients are considered
legally competent unless legally judged incompetent.
Confidentiality- share only with staff and instructor.
Let client know you will be sharing with those involved in his care.
Informed consent.
Ethical Issues in Psychiatric/Mental
Health Nursing
The right to refuse medication
The right to the least restrictive
treatment alternative
Legal Issues in Psychiatric/Mental
Health Nursing
Confidentiality and right to privacy
Doctrine of privileged communication
Informed consent
Restraints and seclusion
False imprisonment
Legal Issues in Psychiatric/Mental
Health Nursing (cont.)
Commitment issues
Voluntary commitment
Involuntary commitment
Emergency commitment
The mentally ill person in need of treatment
Involuntary outpatient commitment
The gravely disabled client
Legal Issues in Psychiatric/Mental
Health Nursing (cont.)
Malpractice and negligence
Types of lawsuits that occur in psychiatric nursing
Breach of confidentiality
Defamation of character
Libel
Slander
Invasion of privacy
Assault and battery
False imprisonment
Nursing Actions to Avoid Liability
Responding to the patient
Educating the patient
Complying with the
standard of care
Supervising care
Adhering to the nursing
process
Documentation
Follow-up
Principles
Guiding the Care of the Mentally Ill
Client autonomy and liberty must be
ensured by treatment in the least restrictive setting with active client
participation in treatment
Clients are considered legally competent unless legally judged
incompetent
Confidentiality- share only with
staff and instructor. Let client know
Informed consent
How Does the Client Enter the Mental
Health System?
Types of
admissions:
Voluntary-
a client consents to hospitalization for the purpose of evaluation and
treatment and signs a document indicating this
If the client decides to change his mind, he
must do so in writing and give the staff time to prepare a discharge plan.
If staff feels the client is a danger to self
and others, commitment proceedings may be started
How Does the Client Enter the Mental
Health System?
Involuntary admission or commitment
Detaining a
client in a psychiatric facility against
his will, usually due to considering the
client a danger to self or others
In Florida it is
called the Baker Act- client may be held up to 72
hours for the purpose of evaluation
If after 72
hours, it is felt that the client needs
to stay longer and client is not in agreement,
there must be court hearing date set
up
Involuntary Admission for Substance Abuse
Reporting Laws
In Florida, we must report suspected cases of child or
elder abuse or neglect
Mandatory reporting is also required when licensed
nurses are known to have violated the Nurse Practice Act (Intervention
Project for Nurses)
1-800-840-2720.
Duty to disclose if the client has made a credible
threat to to kill someone.
The Criminalization of Mental Illness
Many clients
who were previously cared for in long term psychiatric facilities are
now homeless or in jail due to lack of community support
Crimes often are misdemeanors related to their psychiatric symptoms
Resources