1

ROLEOFNURSEI
NLEGALPSYCHI
ATRY

Innoot herty
peofnur si
ngarethelegalandethi
calconsi
derati
onsofpracti
cesocruci
alas
i
npsy chiat
ri
cnursi
ng.Thus,knowledgeoft hel
awregardingpsychiat
ryi
ntheareawherethe
nurseispract
ici
nghelpshertoprotecthersel
ffr
om li
abil
i
tyandt hepati
entf
rom
unnecessarydet
enti
onandmi streat
ment .

Acodeofet
hicsf
orpsy
chi
atr
ist
s

TheIndi
anPsy
chi
atr
icSociet
y(I
PS)hasr
ecommendedacodeofet
hicsf
orpsy
chi
atr
ist
s
(1989)whi
chi
ssummarisedher
e:

Pr
inci
ples

1.Apsy
chi
atr
isthasacl
earsoci
alr
esponsi
bil
i
ty.

2.Apsychi
atr
istmustmaintai
nhi
ghst
andar
dsofpr
ofessi
onal
compet
enceandensur
e
cont
inui
ngself-
educat
ion.

3.Benev
olenceandpat
ienti
nter
estpr
ecedesel
f-
int
erest
.

4.Apsy
chi
atr
istmustmai
ntai
nhi
ghmor
alst
andar
ds.

5.Pati
entwelf
arei
sofparamountconcer
nt oapsychi
atr
ist
.Iti
ncl
udesnott
reat
ingcases
whicharenotinhi
sdomain,t
erminat
ingt
reatmentwhencannothel
pthepat
ient
,and
tr
eati
ngwiththebestoft
heabil
it
y.

6.Confident
ial
i
tyoft
hepat
ientr
ecor
dsmustbemet
icul
ousl
ymai
ntai
ned.

Recommendat
ions

1.Treatmentshouldbegivenwi thpat i
ent’
sconsent .Everypersonwhoi samaj oranddoes
notappeartohav el
ostabili
tyofreasoni scapabl eofconsent.Ifthepat ientcannotgiv
e
consentduetoment alil
l
ness, consentshoul dbet akenfrom aper soncloset othepati
ent
whoappear stobeclearl
yinterestedinpatient’swelfar
e.Howev er, t
reat
mentcanbegi ven
wit
houtconsentinanemer gencysi t
uati
oni nvolv
ingimmedi atethreattot heli
feorhealthof
pati
entorothers.Forresearchpur poses,consentshoul dbeent i
relyvoluntary.Thepati
ent
canwi t
hdrawconsentatanyst age,withoutthisaffect
ingpatient’
si nt
erest.

2.Hospi
tal
isati
onshouldbeforpat
ient’
swelf
are,keepi
ngi
nvi
ewt
hel
egal
and
admini
str
ativ
econstrai
nts,
andsocialappr
opri
ateness.

3.Psychi
atr
ict
reat
mentshoul
dbestart
edonlyoncli
nicalconsi
der
ati
onforpati
entwelf
are
andshouldbehumaneandneverpuni
ti
ve.Nopsychi
atri
stshouldr
efuset
otreatinan
emergency.

4.Nogi
ft
sandgr
ati
ficat
ionsshoul
dbeaccept
edf
rom pat
ient
sundert
reat
ment
.

5.Anysexual
adv
ancet
owar
dsanypat
ienti
sunet
hical
.
 2

6.I
ncaseofdoubtand/
orunconv
ent
ional
treat
mentpr
ocedur
esasecondopi
nionmustbe
obt
ained.

7.I
tisunet
hical
tof
orceacont
ractonapat
ientdur
ingt
reat
ment
.

8.Eveni
fthepati
entisref
err
edbylegal
oradmi
nist
rat
iveaut
hori
ty,pat
ient’
swelf
areis
paramountandpati
entshoul
dbeinformedoft
hepurposeforwhichhei stobeexamined.

9.Thebasi
chumanr
ight
sofment
all
yret
ardedshoul
dnotbeunet
hical
l
yabr
idged.

10.Intheint
erestoft
hepati
entandt hesociety,
drugabuser
swhoref
usetogi
veconsent
maybet reatedwit
htheconsentoftheirr
elati
ves.Ef
for
thastobemadetomoti
vat
ethem
foraccepti
ngtreat
mentvol
untari
ly
.

Rol
eoft
heNur
sei
nAdmi
ssi
onPr
ocedur
e

 Amostimport
antfeat
ureoftheadmi
ssi
onprocedureinvol
vesset
tl
ingt
hepati
entin
t
heward.I
tbeginswit
hint
roduci
nghi
mt ot
heot herst
affmembersandpat
ients.

 Beforeassi
gninghim abedconsi
derhi
sbiologi
cal
andemot i
onalneeds.I
fheseems
tobenurtur
ingsuici
dali
deati
onorisfl
ori
dlypsy
choti
c,heshoul
dbel ocat
edi
na
placewherehecanbecl osel
yobser
ved.

 Heshoul
dbeshownv
ari
ousf
aci
l
iti
esl
i
keeat
ing,
recr
eat
ion,
bat
hroom f
aci
l
iti
eset
c.

 Acquai
nthim wi
thsomeofthewar
drules,
e.g.meal
time,war
dacti
vit
ies,
visi
ti
ng
hour
s,howtomakeappoint
mentstoseestaffmembers,
timi
ngsofanygroup
meeti
ngs,et
c.

 Thepat ientandhisrelat
ivesar el
ikel
yt ohaveallsor
tsofanxieti
esaboutvarious
procedur esandinvesti
gations.Thenur seneedstobesensiti
vetothesefeeli
ngs,and
gi
v eenought imeandat tentionandallowthem toexpresstheirf
eel
ingsaboutt he
patient'
sconditi
on,treat
mentandout come.Al l
infor
mationshouldbeprovidedas
appr opr
iate.

Rol
eoft
heNur
sei
nPar
ole

Parol
eistheper
missi
ongi
vent
opat
ient
stoper
for
m cer
tai
nri
tual
sorat
tendcer
tai
nfami
l
y
funct
ions.

 Rel
ati
vesar
ecl
ear
lyi
nstr
uct
edaboutthepurposef
orwhi
cht
hepat
ienti
sbei
ngsent
homeandwhenheshoul
dbebroughtback.

 I
nstr
uctt
herel
ati
vesast
ohowtheyshoul
dconver
seorbehav
ewi
tht
hement
all
yil
l
per
sonaccor
dingtot
hei
nst
ruct
ionsgi
venbyt
hedoct
or.

 I
fthepati
enti
sreceiv
inganymedi
cat
ions,
insi
stonregul
ari
tyandgi
venecessar
y
i
nstr
ucti
onstothefamil
ymembersaboutdosage,
side-
eff
ectset
c.

Rol
eoft
heNur
sei
nDi
schar
gePr
ocedur
e

 Nur
semustensur
ethatt
hepat
ientl
eav
est
heuni
twi
thal
lbel
ongi
ngsandper
sonal
 3

eff
ect
s,hast
heappropr
iat
emedi
cat
ionswi
thhi
m,andappoi
ntmentf
orf
oll
ow-
uphas
beenmadeandunderst
ood.

 Al
lnecessar
yinst
ruct
ionsespeci
all
yregardi
nghi
smedi
cat
ionr
egi
men,
side-
eff
ect
s
et
c.mustbeclear
lygi
v ent
othepatientandhisf
ami
l
ymembers.

 Anypaperwork,si
gni
ngofdocument
sshouldbecomplet
ed.Thehospi
tal
fil
eal
ong
wit
hallchar
tsandnotesshoul
dbesentt
othemedical
recor
dssecti
on.

 Thenur
seshoul
dascer
tai
nhi
str
avel
planandof
ferassi
stancei
fnecessar
y.

 Thenursemustbearinmi ndthatt
hepat
ientmayhavemixedfeeli
ngsaboutleav
ing
thehospit
alandgoingbacktohishomeenvir
onment.Sheshouldhel
phim copewit
h
anydist
ressaboutsepar
atingfr
om hi
snewfoundf
riendsandstaffmembers.

Nur
singMal
pract
ice

Whenapr udentnur seexpectedtomeett henormal st

andar dsofcar e,causesabreach
bydeviatingfr
om t henorms, i
tistermedasnur singmalpractice.Suchbr eachofactcan
i
nvokel egalproceedingsagainstthenur sefornotdischargingherdut ydi l
i
gentl
yandin
goodfai t
h.Ift
hemal pr
acticesuithastost andandbedecr eedinf avouroftheaggri
eved
pati
ent,hewi l
lhavet oprov evar
iousfacet swhichcontri
but edtothebr each.Howeverit
i
stobenot edthatt heburdenofpr oofl
ieswi t
ht hepati
entwhoi nt hi
scasei st
he
pl
ainti
ff.

Thev
ari
ousf
acet
sincl
ude:

 Thenur
sehadadut
ytodi
schar
geduest
andar
dsofcar
etot
hepat
ient

 Thenurse'
sper
for
mancewaswel
lbel
owt
heexpect
edst
andar
ds,
thuscausi
nga
breach

 Substandar
dcar
eprov
idedshoul
dbeconst
ruedt
ohav
eadv
ersel
yaf
fect
edt
he
pati
entandfami
ly

 Theact
ual
proofofadv
erseef
fect
s/i
njur
ycaused.

I
nfor
medConsent

Inthecour seofnormal tr
eatmentaser iesofinteract
ionsresultbet weenapat i
entanda
physician.Duringsuchint
eractionsthepat i
entisal l
owedt of ul
lyconsiderandcompr ehend
theinformat i
onaboutthepr oposedt reatment.Suchconsenti stermedasi nfor
medconsent .
Iti
ncludest hemodeofadmi nisteri
ngt hetr
eatment ,prognosis,side-eff
ectsandt herisks.
Howev er ,i
nthecaseofpsy chiatri
cpat i
entstheabi l
it
ytogiv einformedconsentasr egardsa
procedur eishighl
ydebatableduet ot henatureoft heproblem.Thoughmostoft hepat i
ents
perceiveandacti nthei
rownbesti nterest
s,somemaynotbecapabl eofgivi
ngav al
id
consent .Duetosuchv ari
ati
ons, thepat i
entshav etobescr eenedf orthefoll
owing:

 whet
hert
hepat
ienti
scompet
entt
ogi
vei
nfor
medconsent

 whet
heri
nfor
mat
ionpr
ovi
dedt
othepat
ienti
sassi
mil
atedonar
egul
arbasi
sand
 4

under
stood

 whet
herenoughopportuni
tyandf
reedom ar
evestedwit
hthepat
ientt
orej
ect
/
r
evoketheconsentdur
ingaspeci
fi
ccourseoftr
eatment.

Subst
it
utedConsent

Wheni ti
sdeemedt hatapati
entisincapableofgivi
nginfor
medconsent,
healt
hservi
ce
provi
dersshoul
dobt ai
nsubsti
tut
edconsentf ortheprocedureort
reat
ment.I
tref
erst
oan
author
izat
iongi
venbyanotherindiv
idual,bei
ngaguar di
anappoint
edbythecourtort
heki
th
andkinonbehalfofthepati
ent.

Conf
ident
ial
it
y

Duringthenurse-pati
entrelat
ionshipalotofinf ormati
onisgather
edt hroughdirectand
i
ndirectsources,whichisbothv erbalandwr i
tten.Keepinginvi
ewt heethicsofthenur si
ng
practi
ce,suchinformationgatherediskeptconf i
dent
ialandbestusedf orprovi
ding
enhancedcar eratherthanforotherpurposessuchasgossi porpersonal gai
n.Anybr each
ofconfidenti
ali
tycouldjeopardi
z ethebestinterestsofthepati
ent,beitsocialoreconomi cal
,
keepinginviewt hesocialsti
gmaat tachedtoment al
ill
ness.

Recor
dKeepi
ngNur si
ngnotesandprogressrecor
dsconsti
tut
elegaldocumentsandhence
shoul
dbemaint
ainedcar
efull
y.Theyshouldbenon-j
udgementalandthestat
ementsmade
shoul
dbeobj
ecti
veinnatur
e.

I
CMRgui
del
inesf
orr
esear
ch,
2000

I
n2000, t
heIndianCounci lofMedi
calResearch(ICMR)hasr el
eased‘Ethi
calguidel
i
nesfor
biomedicalresear
chi nhumansubj ect
s’.Theseguidel
inesarever
ysimilart
ot heGCP( Good
Clini
calPracti
ce)guidel
inesandtheprev al
enti
nternat
ionalgui
del
ines.Theseguidel
ines
regulat
eallbiomedicalresearchi
nhumansubj ectsinIndi
a.