Ethical

and Legal Guidelines for

Safe Practice in Psychiatric
Nursing

NURS 417
Fall 2021 - 2022
 Outlines

n Important definitions
n Ethical principles
n Ethical issues in psychiatric/mental health nursing
n Legal issues in psychiatric/mental health nursing
n Commitment issues
n Nursing liability

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 Learning Outcomes
By the end of this lecture, students will:

n Differentiate between ethics, bioethics, values, and rights.

n Analyze ethical principles.
n Describe ethical issues relevant to psychiatric/mental health
nursing practice.
n Illustrate legal issues in psychiatric/mental health nursing
practice.
n Discuss commitment issues.
n Differentiate between malpractice and negligence.

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 Introduction
n Nurses facing many challenges in making difficult
decisions concerning patient care.
n Acknowledging the ethical and legal issues concepts
related to psychiatric nursing practice will help the
nurse to make the right decisions and at the mean
time will protect the nurse from any legal
accountability.
n Legislation determines what is “right” or “good”
within a society.

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 Clinical Example
n An old man with signs and symptoms of depression,
refused to receive his antidepressant medication, the
nurse believe that the patient needs this medication,
so she dissolved it in juice and gave it to him without
his knowledge.

How do you evaluate the nurse’s action?!

Wrong action
She forced and deceiving him

The patient has the right to

refuse the meds
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 Definitions
n Ethics: branch of philosophy that deals with
systematic approaches to distinguishing right from
wrong behavior.

n Bioethics: is the term applied to those principles

when they refer to concepts within the scope of
medicine, nursing, and allied health.

n Moral behavior: the conduct that results from

serious critical thinking about how individuals ought
to treat others.
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 Definitions (cont.)
n Values: are ideals or concepts that give meaning to the
individual’s life.

n Values clarification: is a process of self-exploration by

which people identify and rank their own personal
values.

n Right: a valid, legally recognized claim or entitlement,

encompassing both freedom from government
interference or discriminatory treatment and an
entitlement to a benefit or service.
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 Ethical Principles

Fundamental guidelines that influence decision-

making.
n Autonomy

n Beneficence

n Nonmaleficence

n Justice/equity

n Veracity

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 Autonomy

n Self- determination is the underlying principle that

allows patients to make decisions for themselves.

n Individuals have the right to make decisions that

affect their lives and do not violate the rights of
others.

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 Beneficence

n Is to act in the patient's welfare by preventing harm

and doing no harm.
n One’s duty to benefit or promote the good of others.

Ex. Nurses serve as advocate to educate the patients

and their families about their legal rights.

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 Nonmaleficence

n Is abstaining from negative acts toward another,

includes acting carefully to avoid harm.

Ex. Showing the commitment to clinical expertise by

participating in continuing education.

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 Justice
n All people should be treated equally and fairly
regardless of race, gender, marital status, medical
diagnosis, social standing, economic level, or religious
belief.
n People with mental disorders have the same
fundamental civil rights as all citizens, and should not
be discriminated against on the basis of their mental
illness.
n They should receive the same quality and standards of
care as those with other illnesses.

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 Veracity

n Refers to one’s duty to always tell the truth.

n Patients have the right to know about their
diagnosis, treatment and prognosis.
n Sometimes, there are some limitations related to
veracity, such as when the truth would knowingly
harms the patient or interferes with his/her
prognosis.

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 A Model for Making Ethical Decisions

1. Assessment
2. Problem identification
3. Planning
4. Implementation
5. Evaluation
 Standards of Nursing Care
n Are the ethical and legal expectations for practice,
they are the level of work quality considered
adequate by the profession and are based on nursing
process.

n Patients with mental health problems retain all of

the civil rights afforded to all persons, except the
right to leave hospital in case of involuntary
commitment. forsedendorsement anyotherpatiententers
causing
harmtohimself Byhimself canleave
want
whenever
or to others

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Ethical and Legal Issues in
Psychiatric Mental Health
Practice

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 The Right to Treatment
Beneficaces

n Anyone who admitted to a hospital has the right to

high quality treatment while hospitalized in a clean
and safe environment and to be involved in their
care while their privacy is well maintained.

n Psychiatric patient can not legally be hospitalized

and then denied appropriate treatment.
as long as enters should take thetreatment
you cant didnt givethemeet

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 The Right to Refuse treatment
(Including Medication)
Violent toward himself
or others automany
n All persons have the right to receive or to refuse
treatment for a mental disorder unless, by refusing
treatment, they represent a danger to themselves or
others. if havesuicidal or behavior sshould
agressive giveeven if refuse
danger to himselfor to others v automayto refusehere
n Nurses need to be aware of institutional policies
regarding the hospitalization of a person against his will.
n Institutions and agencies have established policies for
the emergency administration of medication.
violent toward himself or to others
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 ****

The Right to Refuse treatment

(Including Medication)
The treatment team must determine that three criteria be
met to force medication without patient consent:
en id and
n Patient must exhibit behavior Text that is dangerous to self or
others. snow aclanger act

n The medication ordered by physician must have a reasonable

chance of providing help for the patient. reduce risk for thebehavior
n Patients who refuse medication must be judged incompetent to
evaluate the benefit of the medication.
cant provide insert consent
cant understandthe benefitof the meds

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 The Right to the Least - Restrictive
Treatment Alternative seclusion
restrain or

n All individuals undergoing treatment for mental disorders have

the right to the least restrictive environment that is appropriate
to meet their needs, this means that a patient does not have to
be hospitalized if he/she can be treated in an outpatient setting.
unless need it t hissucinal giantwithit justtoothersharm
n Patient must be free of restraint or seclusion o unless it is
necessary. theleastdegreeof the needed restrain
n Health care personnel must attempt to provide treatment in a
manner that least restricts the freedom of patients.
n The “restrictiveness” of psychiatric therapy can be based on
severity of illness. hospitalzertion dueto reaps andharmingothers
notpunishment
n Restraint and seclusion should be used as intervention when
needed if the patient considered as physically harmful to other
patients and staff, or when the patient requests seclusion.
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 Legal Issues in
Psychiatric/Mental Health
Practice

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 Confidentiality and Right to Privacy

hardtoadmithavingmentalillness ssoneedhighlycondientality
n The stigma of mental illness is such that knowledge of a
person's hospitalization may affect the individual's
employment or professional standing.
n Nurses are responsible for protecting patient's right to
confidentiality and keep it available only to those health
care professionals who are directly involved into the
patient care.
n patients must provide written consent for health care
information to be shard with anyone outside the current
treatment team. Cant other'sQuestion
answer

withoutinterncorset

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 Confidentiality and Right to Privacy
(cont.)

n Important medical information may be released without

consent in life-threatening situations, in this case, nurse
must record in the patient’s record: date of disclosure,
person to whom information was disclosed, reason for
disclosure, reason written consent could not be
Lotsobtained, and the specific information disclosed.
others
if to himself causingharm or to
underconfidentality
informabouteverything
others
unless this isharmingyou or

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 Informed Consent
n Informed consent is the process of sharing
knowledge/information with the patient regarding the
proposed treatment. mustbe adatTamped voulantry
n The patient must be competent to understand the
information provided, and the consent must be
voluntary.
n This right for determining the treatment is based on the
principle of autonomy.
n Nurses' role vary according to the organization policy
(witness, advocate)

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 Informed Consent (cont.)
Exceptions
1. When a patient is incompetent to make a decision and treatment
is necessary to preserve life or avoid serious harm (legal guardian).
2. When refusing treatment endangers the life or health of another.
3.
exercise judgment.o
During an emergency in which a patient is in no condition to

4. Children (legal guardian).

5. In the case of therapeutic privilege: information about a treatment
may be withheld if the physician can show that full disclosure
would:
1. Hinder or complicate necessary treatment.
2. Cause severe psychological harm.
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 ****
therpoetic intention
Restraints and Seclusioneye

n Seclusion is the involuntary confinement of a person in

a specially constructed, locked room, equipped with a
security window or camera for direct visual monitoring
of the patient.

n A restraint is the direct application of physical force to a

person, without his/her permission, to restrict his/her
freedom of movement.

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 ****

Restraints and Seclusion (cont.)

n The physical force may be human, a mechanical device,

or a combination.
n Human/physical restraint is when staff members
physically control the patient and move him/her to a
seclusion room.
n Mechanical restraints are devices, usually ankle and
wrist restraints, that are fastened to the bed frame to
limit the patient's physical aggression, such as hitting,
kicking, and hair pulling.
psychotropicheels chemical

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 Restraints and Seclusion (cont.)
n Restraints and seclusion should never be used as forms of
punishment.
lastSaluation
n They should be used only as a last resort after all other therapeutic
interventions have failed.
Ect
n This therapy must only be employed to prevent patients from
harming themselves, or others.
n The use of seclusion and restraint when written order of a
physician is obtained.
n patient should be checked each 15 minuets and food and other
basic needs should be provided. to Prenetinjuryharm checkcirculation
n Documentation of the time and restrictive methods and the
reasons that lead to restraint/ seclusion.
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 Restraints and Seclusion (cont.)
The nurse needs to be aware of the negative
consequences of using restraints on patients with a
history of sexual abuse.

n patients who have been sexually abused have been

placed in positions where they were unable to resist
their abuser.
n Restraints can bring back terrible memories of the
past when escape was impossible.
n Seclusion is indicated, rather than restraints for
patients with a history of sexual abuse.

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Commitment Issues

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 Voluntary Admissions

To be admitted voluntarily to a mental health agency:

n An individual makes direct application to the hospital or

institution asking for the services and may stay as long
as treatment is deemed necessary.
n patient may sign out of the hospital at any time, unless
determined that he/she is harmful to self or others,
then converted to involuntary commitment.
if entervolunatry can leave voulatery
Inless if stoutto cause
harm to hinder others
t
scant leave
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inculantry desison
 Involuntary Commitment

n Emergency situation (dangerous for self or others).

n Person is unable to take care of basic personal needs necessary for

health and safety as a result of mental illness (gravely disabled)
centProvidebasic care
n Gravely disabled is defined as a condition in which an individual, as
a result of mental illness, is in danger or serious physical harm
resulting from inability to provide for basic needs such as food,
clothing, shelter, medical care and personal safety. It has to be
established by showing the inability to make use of the available
resources rather than the lake of these resources.

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 Discharge
depend on admission
status

n Discharge or release from hospitalization depends on the

patient’s admission status
n Voluntarily admitted patients have the right to request and
receive release unless proven that they became source of danger
(suicide, homicide)
n Involuntarily admitted patients may be conditionally released
and not voluntarily (the patients are released/ discharged based
on their adherence to medication protocols, ability to meet basic
needs and ability to integrate in the community)

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 Categories of Laws
ethical t ligal

Criminal law --- provides protection from conduct

deemed injurious to the public welfare. It provides
for punishment of those found to have engaged in
such conduct. Homicide, theft, sexual assault, illegal
possession of controlled drugs

Civil law --- protects the private and property rights of

individuals and businesses. Negligence and
malpractice, invasion of patient’s privacy, assault and
battery, false imprisonment.

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****

Nursing Liability

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 Liability
Is the quality of state of being legally responsible
for one’s obligations and actions

Ex: the nurse has an obligation to practice and direct the

practice of others under her/his supervision so that
harm or injury to the patient is prevented

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 Negligence and Malpractice
P
Negligence: a misconduct or practice that is below the standard
expected of an ordinary, reasonable and prudent person. Ex: lack
of knowledge, skills or decision making. Any person can be
negligent.

has intension
Malpractice “professional negligence”: failure of a professional
person to act according to accepted professional standards or
failure to act as a reasonable member of the profession would act
– Ex: patient undergoing ECT reported to the ECT nurse that she
already had her breakfast but the nurse accused that patient with
laying and insisting to give her the ECT session which resulted in
aspiration and patent’s death

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Types of Lawsuits that Occur
in Psychiatric Practice

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Either wrong info or right
all consider defamation

Defamation of Character
‫تشهير باملريض‬

n When a nurse share information about that

patient that is determined to be malicious, false
and affect the patient’ reputation.

n Libel: when the information in writing.

n Slander: oral defamation of character.

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 Invasion of Privacy
n When a nurse search the patient without probable
cause.
n Assault: is an act that results in person’s genuine fear and
apprehension that s\he will be touched without consent.
n Battery: is the unconsented touching of another person.
no consent
Theses charges can result when a treatment is
administered to a patient against his\her will and
outside of an emergency situation.

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 Clinical Example
n The patient is very restless and is pacing the hospital
corridor. The psychiatric nurse says to the patient, “
if you do not sit down in the chair and be still, I am
going to put you in restraints”

What is the legal actions might the nurse be charged

because of this action?
Assault, because she did not touch yet , just threatining
and the siutation is not require Restrain ( no any harm)

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 Clinical Example
n A psychiatric nurse is assisting the psychiatrist with
Electroconvulsive therapy (ECT) to a patient who has
refused to give consent.

What is the legal actions might the nurse be charged

because of this action?
Battery, Touching without consent

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 Avoiding Liability
To avoid nursing malpractice, nurses must:

n Respond to the patient.

n Educate the patient.
n Know and comply with the standard of care and all
institutional policies and procedures.
n Maintain current knowledge in the nursing field.
n Supervising the care.
n Documenting carefully.
n Follow up by evaluating the provided care.
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Thank You

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