Mental Notes 1-26-2021

Chapter 3: Ethical and Legal Issues

 ANA Code of Ethic for Nurses: Code that guides any nursing practice irrespective of practice area
 Ethics: the science that deals with rightness and wrongness of actions
 Bioethics: term applied to ethics within the concept of medicine, nursing, and allied health
 Core Ethical Concepts
o Moral behavior: conduct that results from serious critical thinking about how individuals
ought to treat others
o Values: ideals or concepts that give meaning to a persons life
o Values clarification: a process of self-exploration through which individuals identify and
rank their own personal values
o Right: legally recognized claim or entitlement
o Absolute right: when there is no restriction whatsoever
o

Theoretical Perspectives

1. Utilitarianism: an ethical theory that promotes actions based on the end results that produce
the most good for the most people
2. Kantianism:  is defined as a branch of philosophy that follows the works of Immanuel Kant who
believed that rational beings have dignity and should be respected. 
3. Christian ethics: do unto others as you would have them do unto you
4. Natural law theories: do good and avoid evil; evil acts are never condoned, even if they are
intended to advance the noblest of ends
5. Ethical egoism: decisions are based on what is best for the individual making the decision
6. Autonomy: they have rights to do what they want to do
7. Beneficence: refers to ones duty to benefit or promote the good of others
8. Non-maleficence: abstaining from negative acts toward another; includes acting carefully to
avoid harm at all costs
9. Justice: based on the notion of a hypothetical social contract between free, equal, and rational
persons; concept of justice reflects a duty to treat all individuals equally and fairly.
10. Veracity: refers to ones duty to always be truthful.

Ethical Dilemmas

 These occur when moral appeals can be made for taking either of two opposing courses of
action
 Taking no action is considered an action taken – if you see someone do something and do
nothing about it, you are just as responsible
A Model for Making Ethical Decisions

 Assessment
 Problem Identified
 Plan
 Implementation
 Evaluation
 Review Box 3-2

Ethical Issue in Psychiatric/Mental Health Nursing

 All clients that a nurse attends to has the following rights:

a. The right to treatment
b. The right to refuse treatment (including meds
i. only force if judge orders it or if they are at imminent harm to themselves or
others
ii. 1992 AHA Patient Bill of Rights
iii. Do not threaten patients to take meds – this violates their rights
iv. Make sure to verbally de-escalate the client, then move them to a different
environment, then offer them a PRN. If nothing else then maybe force meds?
c. The right to the least restrictive treatment: if there is a way for them to be treated
without restricting their freedoms, then we have to do that.
i. Type of setting: inpatient hospitalization is most restrictive and they have to be
a danger to themselves/others or gravely disabled
ii. Day Hospital/Partial Hospitalization – 8 hrs a day, less restrictive.
iii. Intensive Outpatients: 4 hours a day
iv. Outpatient Therapy: 1 hour a week

Legal Issues

 Confidentiality and Right to privacy

o HIPPA
o Doctrine of privileged communication
o Exception: Duty to warn
o Exception: Suspected child and elder abuse
 Informed Consent: patient gives permission. ECT needs this.

 Seclusions and Restraints (pg 51-52)

o Must be on constant observation
o Monitor vitals due to not sweating or cardiac complications (temp, bp, pulse etc)
o Hydrate the client and offer sustenance
o Must provide passive ROM to all extremities
o Document status of client q15 minutes while in restraints
 o Don’t take them out of restraints for bathroom – give bedpan

Civil and Criminal Law

 Civil Law: protects the private and property rights of individuals and businesses (torts and
contracts)
 Criminal Law: provides protection from the conduct deemed injurious to the public welfare.

Types of Admissions

 Voluntary (substance abuse treatment etc)

o Client fills out admission form and agrees to treatment
o Child under 16, parent signs consent
o Client acknowledges problems
o Retain civil rights
o Can be discharged if a request is made in writing
o If the patient is found to be a danger to self or others they can be placed on an
involuntary hold
o Or Patient can leave AMA (Against Medical Advice)
 Involuntary
o Emergency commitment
o The mentally ill person in need of treatment
o Involuntary outpatient commitment
o The gravely disabled client ( can include senior adults that are confused ): presents
serious risk of physical harm to selves or others
o Client must demonstrate behavior that is clearly dangerous to self/others
o Initiated by friends, police, court, but must be willing to testify in court because
testimony is in the form of an affidavit
o Must have a court hearing within a specified period of time (96 hours)

Legal Issues Cont.

 Malpractice:
 Negligence
 Lawsuits
o Invasion of Privacy
o Assault and battery
o False imprisonment