LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021
1
A PATIENT’S BILL OF RIGHTS
Note: Para mas madali ada pagmemorize hit bill of rights,
feel ko an mga nakaunderline la ito it ilalakip ha quiz ni
Dean HAHAHAH skl bye
1. The patient has the right to considerate and
respectful care.
Bisan ito mga buang, naenjoy la gihap hira hit ira mga
rights. Bisan hira buang, tawo la gihap hira na may rights.
They still need and deserve care.
2. The patient has the right and is encouraged to
obtain from physicians and other direct caregivers
relevant, current, and understandable information
concerning diagnosis, treatment, and prognosis.
3. The patient has the right to make decisions about
the plan of care prior to and during the course of
treatment and to refuse a recommended treatment
or plan of care to the extent permitted by law and
hospital policy and to be informed of medical
consequences of this action. In case of such
refusal, the patient is entitled to other appropriate
care and services that the hospital provides, or
transfer to another hospital. The hospital should
notify patients of any policy that might affect
patient choice within the institution
They still have the right to make decisions, unless they are
schizophrenic.
4. The patient has the right to have an advance
directive (such as a living will, health care proxy, or
durable power of attorney for health care)
concerning treatment, with the expectation that the
hospital will honor the intent of that directive to the
extent permitted by law and hospital policy.
Advance directive meaning -- a living will. Example kun in a
coma an patient, igCPR pa ba hiya kun mag V-tach (or DNR
– Do Not Resuscitate), mapaintubate pa ba hiya, kun
mapa-tracheostomy pa ba, or hayaan nala until their last
breath.
5. The patient has the right to every consideration of
privacy. Case discussion, consultation, examination,
and treatment should be conducted so as to protect
each patient’s privacy.
6. The patient has the right to expect that all
communications and records pertaining to his or
her care will be treated as confidential by the
hospital, except in cases such as suspected abuse
and public health hazards, when reporting is
permitted or required by law. The patient has the
right to expect that the hospital will emphasize the
confidentiality of this information when it releases it
to any other parties entitled to review information
in these records.
Except la sugad kun may covid, igsusumat ito kay para
maaram it, example, neighbor. Also kun suicidal, isusumat
mo ha higher authorities. Kay kun mag-suicide ngane iton,
somehow sasayupon ka or somehow may sala ka.
7. The patient has the right to review the records
pertaining to his or her medical care and to have
the information explained or interpreted as
necessary, except when restricted by law.
When you explain something to the patient, do not use
medical terms. Explain using a language they can
understand.
8. The patient has the right to expect that, within its
capacities and policies, a hospital will make a
reasonable response to the request of a patient for
ENDRIANO, ESCULTOR, ESPLANADA
appropriate and medically indicated care and
services.
9. The patient has the right to ask and be informed of
the existence of business relationships among the
hospital, educational institutions, other health care
providers, or payers that may influence the
patient’s treatment and care.
10. The patient has the right to consent or decline to
participate in proposed research studies or human
experimentation affecting care and treatment or
requiring direct patient involvement, and to have
those studies fully explained prior to consent. A
patient who declines to participate in research or
experimentation is entitled to the most effective
care that the hospital can otherwise provide.
11. The patient has the right to expect reasonable
continuity of care when appropriate and to be
informed by physicians and other caregivers of
available and realistic patient care options when
hospital care is no longer appropriate.
12. The patient has the right to be informed of hospital
policies and practices that relate to patient care,
treatment, and responsibilities. The patient has the
right to be informed of available resources for
resolving disputes, grievances, and conflicts, such
as ethics committees, patient representatives, or
other mechanisms available in the institution. The
patient has the right to be informed of the
hospital’s charges for services and available
payment methods.
Any restrictions (e.g., mail, visitors, clothing) must be made
by a court or physician’s order for a verifiable, documented
reason. Examples include the following:
• A suicidal client may not be permitted to keep a
belt, shoelaces, or scissors kay bangin gamiton niya
paghikog or pag self-harm.
• A client who becomes aggressive after having a
particular visitor may have that person restricted
from visiting for a period of time. Hagi damo nga
chika pero an summary; an client nga makadamo
na kahulog ha medicine na kurso nag surit iya self
tapos naresent hiya iya parents kay bibinusaan nga
pirmi daw hulog, asya ginbawalan an parents
pagbisita la anay ha ICU kay bangin maging
aggressive utro.
• A client making threatening phone calls to others
outside the hospital may be permitted only
supervised phone calls until his or her condition
improves.
RESTRAINT
- is the direct application of physical force to a
person, without his or her permission, to restrict his
or her freedom of movement. The physical force
may be human, mechanical, or both.
- Human restraint is when staff members
physically control the client and move him or her to
a seclusion room.
- Mechanical restraintsare devices, usually ankle
and wrist restraints, fastened to the bed frame to
curtail the client’s physical aggression such as
hitting, kicking, and hair pulling. There should be
court order, and physician’s order. And the order
should be reviewed every 12 hours kay diri pwede
hin maiha nga mechanical restraint.
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 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021
1
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 (JCAHO, 2000). For safety the room
often has a bed bolted to the floor and a mattress.
Any sharp or potentially dangerous objects such as
pens, glasses, belts, and matches are removed
from the client as a safety precaution. Bisan taklap
waray daw bisan mahagkot kay bangin gamiton
paghikog. Seclusion decreases stimulation, protects
others from the client, prevents property
destruction, and provides privacy for the client. The
goal is to give the client the opportunity to regain
physical and emotional self-control.
- Use of restraint and seclusion requires a physician’s
order every 12 hours, assessment by the nurse
every 2 to 4 hours, and close supervision of the
client. The nurse assesses the client for any injury
and provides treatment as needed. He or she
checks the client at least every 10 to 15 minutes in
person and may monitor the client continuously via
video camera as well. The nurse monitors and
documents the client’s skin condition, blood
circulation in hands and feet, and emotional well-
being.
- Short-term use of restraint or seclusion is permitted
only when the client is imminently aggressive and
dangerous to himself or herself or others.
INSANITY DEFENSE
- One legal issue that sparks controversy is the
insanity defense with insanity having a legal
meaning but no medical definition.
- The argument that a person accused of a crime is
not guilty because that person cannot control his or
her actions or understand the difference between
right and wrong is known as the M’Naghten rule.
TORTS
- A tort is a wrongful act that results in injury, loss,
or damage. Torts may be either unintentional or
intentional.
Example nag-administer ka medication sayop an dosage
tapos may damage, you can be charged with Tort. Or nag
operate ka ha pasyente tapos may nabilin na foreign
material ha sakob tapos may epekto, tort.
Unintentional Torts: Negligence and Malpractice.
- NEGLIGENCE is an unintentional tort that involves
causing harm by failing to do what a reasonable
and prudent person would do in similar
circumstances.
Example: a prudent nurse should check the wheelchair if
madig-on pa before gamiton kay bangin pag-gamit tapos
nagcollapse, nagcause hin more damage ha patient.
- MALPRACTICE is a type of negligence that refers
specifically to professionals such as nurses and
physicians.
An nurse nagturi, malpractice ito.
For a malpractice suit to be successful, that is, for the
nurse, physician, and/or hospital/agency to be liable, the
client or family needs to prove the following four elements
of negligence (Wysoker, 2002):
Ig-memorize ine na four kay bagat iya ine guin-
emphasize during lecture
1. Duty: A legally recognized relationship, i.e.,
ENDRIANO, ESCULTOR, ESPLANADA
physician to client, nurse to client, existed. The
nurse had a duty to the client, meaning that the
nurse was acting in the capacity of a nurse.
2. Breach of duty: The nurse (or physician) failed to
conform to standards of care, thereby breaching or
failing the existing duty. The nurse did not act as a
reasonable, prudent nurse would have acted in
similar circumstances.
3. Injury or damage: The client suffered some type
of loss, damage, or injury.
4. Causation: The breach of duty was the direct
cause of the loss, damage, or injury. In other
words, the loss, damage or injury would not have
occurred if the nurse had acted in a reasonable,
prudent manner.
Intentional Torts. Psychiatric nurses also may be liable
for intentional torts or voluntary acts that result in harm to
the client. Examples include assault, battery, and false
imprisonment.
Wa ko nala butangi bagat explanation didi kay iya la gin-
waray an definition :)
- Assault involves any action that causes a person
to fear being touched in a way that is offensive,
insulting, or physically injurious without consent or
authority.
- Battery involves harmful or unwarranted contact
with a client; actual harm or injury may or may not
have occurred.
- False imprisonment is defined as the
unjustifiable detention of a client such as the
inappropriate use of restraint or seclusion. Proving
liability for an intentional tort involves three
elements:
1. The act was willful and voluntary on the
part of the defendant (nurse).
2. The nurse intended to bring about
consequences or injury to the person
(client).
3. The act must be a substantial factor in
causing injury or consequences.
ETHICAL ISSUES
Ethics
- a branch of philosophy that deals with values of
human conduct related to the rightness or
wrongness of actions and to the goodness and
badness of the motives and ends of such actions.
Ethical theories are sets of principles used to decide
what is morally right or wrong.
Utilitarianism
- a theory that bases decisions on “the greatest good
for the greatest number.” Decisions based on
utilitarianism consider which action would produce
the greatest benefit for the most people.
Example hit greatest good for the greatest number is
vaccination. Bisan ka diri naruruyag, kun need nah in police
force pagpirit, mapa-vaccine ka kay bangin ikaw it maging
rason pagkalat hit sakit.
Deontology
- a theory that says decisions should be based on
whether or not an action is morally right with no
regard for the result or consequences.
Mayda duwa na pasyente: riko ngan pobre. An una na
umulpot ha ER an pobre. Pero an imo guin-timangnuan
dayun an sangkay han mayor kay riko, for the sole reason
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 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021
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na riko hiya or likeable. Pero shempre before magjudge if
morally right or wrong, mag-triage ka anay. If life-
threatening bisan diri nauna pag-ulpot, uunahon
pagtimangno.
Principles used as guides for decision-making in
deontology include:
• Autonomy refers to the person’s right to self-
determination and independence.
• Beneficence refers to one’s duty to benefit or to
promote good for others.
• Non-maleficence is the requirement to do no
harm to others either intentionally or
unintentionally.
• Justice refers to fairness; that is, treating all
people fairly and equally without regard for social
or economic status, race, sex, marital status,
religion, ethnicity, or cultural beliefs.
• Veracity is the duty to be honest or truthful.
• Fidelity refers to the obligation to honor
commitments and contracts.
LEGAL ISSUE
THREE BASIC SOURCES OF LAW:
1. Common law, derived from judicial decisions;
2. Statutory or legislative law created by the national
federal and state; legislation (Diri ak sure why THREE pero
2 la an nakabutang ha ppt ni dean, pero adi an pic han ppt
for reference. Bangin LEGISLATION it ika-tulo.)
Common law
- is applied to the body of legal principles that has
evolved and continues to evolve and expand from
actual court cases.
- M'Naghten rule (1843) states that individuals who
do not understand the nature and implications of
murderous actions because of insanity cannot be
held legally accountable for murder.
- This ruling was based on the case of Daniel M'
Naghten, a Scotsman who felt persecuted by the
ruling political party and attempted to kill the prime
Minister.
- Although he failed to kill the Prime Minister, he did
shoot the Prime Minister's secretary. He was ruled
not guilty by reason of insanity and was committed
to an asylum. This case has provided a basis for
legal decisions in American courts since 1851.
SOURCE OF LAW AFFECTING PSYCHIATRIC
NURSING
1. Philippine Constitution of 1987
2. Individual state and federal statutes
1. 3.Precedent setting legal cases
3. Department of Heafth/The Joint Commission on
Accreditation of Healthcare Organization (JCAHO)
4. National Health Insurance Program Act of 1995
ENDRIANO, ESCULTOR, ESPLANADA
➢ A person is not criminally responsible at the time of an
act if, because of mental "disease or defect," the
person did not know the nature and quality of the act,
or if the person did know it, he or she did not know
that the act was wrong.
o Clinical Example:
▪ Pedro Pandacan dropped building material off
overpasses, then began shooting at
automobiles on a major highway. He was
behind 12 shootings and 200 acts of
vandalism in Tondo, Manila, Area in 2003 and
2004. He has pleaded innocence by reason of
insanity to murder and 23 other counts. He
Said voices called him a "wimp"
The court ruled that the Alabama mental health
system must do the following at each institution:
• Stop using patients for hospital labor needs
• Ensure a humane environment.
• Develop and maintain minimal staffing standards.
• Establish institutional human rights committees.
• Provide the least restrictive environment for each
patient.
➢ Rogers v. Okin, 478 F Supp (D Mass 1979),
determined the right to refuse treatment. The ruling
prohibited Boston State Hospital from forcing
nonviolent patient to, take medications against their
will.
➢ Patients or their guardians to give informed consent
before drug treatment could begin
o Tame V. The Regents of the University of
California, ruled that mental health professionals
have a duty to warn of threats of harm to others.
➢ In case, a patient confided to the therapist that he
intended to kill an unnamed but readily identifiable girl
when she returned from spending the summer in Brazil.
The nurse should inform the head nurse, the nurse
supervisor, or someone with authority, that the patient is
intending to kill someone to prevent such event from
happening, like para ma-warn an target na sugad hito and
prevent the patient from doing so.
Legislative Law
- A written law developed from a legislative body,
such as the national policy-making body or any
local ordinances.
TIPS FOR MONITORING CONFIDENTIALITY
1. Keep all patient records secure
2. Carefully consider the content of all written entries
3. Release information only with written consent.
4. Disguise clinical material when it is used for
educational purposes
5. Share information only with people who need to
know, not with friends or in public areas.
6. Guard written material taken outside the clinical
area.
7. Do not access written or electronic information out
of curiosity.
8. Note that fax transmissions to unsecured areas in
which a receipt error is a possibility might be
prohibited.
9. Know to whom you are talking when relating
patient information on the phone; “Family” might
be reporter, boss, or insurance attorney. Now, I tell
you, even in your own home, when you are from
the hospital and you have this kind of patient nga
mga weird it mga history, you are not allowed to
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 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021

1 discuss, when you are in the dining table you are

not allowed. Pwede ka la sumiring: Patient A,
Patient B. But you do not mention the place, the
hospital, kun taga diin an pasyente, kun kakano na
admitted, you are not allowed
➢ Philippine Nursing Act of 2002 was enacted by the
Senate and the House of Representative of the
Philippines during the Twelfth Congress. Children not attending school uh, they should have a
daycare
➢ This law declared the policy of the state to assume
the responsibility for the protection and
improvement of the nursing profession by
instituting measure that will result in relevance to
nursing practice, nursing education, humane
working conditions, better career prospects, and a
dignified existence for our nurses.
Administrative Law or Executive Order
What is an Administrative Law? It bata, diri pwede kastiguhon (igkikiha ka hin corporal
➢ Administrative Law is public law issued by punishment), diri pwede exploitation, diri pwede igkuan,
administrative agencies authorized by statueto human trafficking nga baga pimp ka tapos, diba may mga
administer the enacted laws of the government. bata, mga bata pa 12 years old, 13, 14 siguro
This branch of law controls the administrative pinangugutom so nag succumb nala hira gin, didto hira hin
operations of government. One example of these usa nga lugar nagbaligya hira hin mga kuan. Maupay nala
agencies is State Boards of Nursing. Obviously, damon NBI, gin raid. That’s human trafficking, child
monitoring. trafficking.
➢ For example, Boards of Nursing have been created
to issue guidelines for nursing practice, licensure,
and compliance monitoring in the interest of public
safety.

TESDA
Solo Parent Welfare Act – mayda hinin mga naka--meaning
usa ka la na nagbubuhi hit imo anak, usa ka la nga
nagpapa eskwela, mayda solo parent welfare act.

Labor Code – this protects workers

Government Service Act – to protect workers in the
government, again 1997
National Health Insurance Act – that’s the PhilHealth.
Medicare ito hadto and Philhealth yana
Senior Citizens Act in 1992 – Mapalit ka hin medisina, may
ada 20% discount. Makadto ka ha restaurant, you enjoy a
20% discount pero an imo la kinaon diri han kinaon han
bugos na pamilya it ig 20%. Diri, an imo la, an imo plato la. Anti-sexual harassment act – diri pwede mayda dinhi
Not the whole ha. An imo la plato, an kanan senior citizen employee nga baga may mga sexual innuendos yung
la. director. Ay kay natanggal an director. Mga magtetext
Retirement Law in 1993 - maretire ka at 60, 65. haimo hin mga nude kuan, mga languages, di ngani
kinakaptan ka, kinakaptan imo suso. So may ada anit
sexual harassment.
Magna Carta for Disabled Person – meaning may ada iton
nae enjoy it mga disabled person hin 20% hospitalization,

ENDRIANO, ESCULTOR, ESPLANADA 4

 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021

1
20% ha transportation, ha medication tapos all buildings
kinhanglan may rampa, kinhanglan accessible it mga
building hit mga disabled.
Anti-Violence against Women and Children –diri pwede
hitong mga battered women, battered wives, battered
children. Mapipriso it asawa.

It aton pag memorya hinin kay 9+1=10, 7+3=10, 1010. RA

9173. Para ka maka memorya hinin.
Act of 2002 but before that, an aton Nursing Act was in
1991. After 11 years, it was amended.
Duty to Care
Negligence ➢ Duty is defined as a legal obligation of care,
➢ Negligence is described as the failure to do or not performance, or observance imposed on a person
to do what a reasonably careful person would do who is in a position to safeguard the rights of
under the circumstances. What a reasonably others. What is duty to care? Legal obligation. It is
prudent person would do under the circumstances. your legal obligation to take care of a patient. For
That is negligence. Ano it karugsigngon: example, the doctor. Ha hospital diri ka pwede
Reasonably prudent person. For example, ikaw it magtaboy hin pasyente. Kinahanglan kun puno na
nurse, you should be a prudent person who during it imo hospital, imo anay an pasyente, you will treat
that time in the hospital, ikaw iton gin the emergency for emergency purposes. Igkakadto
mamanduhan to do such kind of duty. anay hiya ha emergency room. Kun stabilized na
As I’ve said there are four elements which I already hiya, waray na hemorrhage, okay na it iya
discussed kanina: breathing, okay na it iya oxygen, saka na hiya
igttransfer ha iba nga hospital kun punuan. That’s
duty to care.
➢ The duty to care can arise from a telephone
conversation or it can arise out of a voluntary act of
assuming the care of patient.
➢ Duty can also be stablished by statue or contract
between the physician and patient.
➢ A nurse, for example, who assumes the care of
patients has the duty to exercise a standard of
Laws Governing the Practice care, which is the degree of skill, care, and
knowledge ordinarily possessed and exercised by
other nurses in the care and treatment of patients.
Dapat kay naka gradwar ka na, mayda ka degree of
skill, care and knowledge. Now, kun iton nurse
ginpinalit mo la an imo diploma, didto kan eskwelahan
na mga diploma mill, salit nag apply ka hin job ha
hospital, di ka ngani maaram mag suction, di ka ngani
maaram magbutang hin oxygen, diri ka maaram mag
Agidaw, waray inin bail. Maiihaan ka hinin ha prisohan kay assess, diri ka maaram mag catheterize, you have not
waray inin, di inin pwede piyensa hinin. even catheterized a male or female patient. Salit an
pag catheterize mo imbes ha urethra gin kadto mo ha
vagina kay di ka nasabot kun hain an urethra. You can
be sued for negligence. Why? Because you have a duty
to exercise a standard of care. You have a duty that
you should have done the necessary skill, care,
knowledge. This is the reason why I did not allow my
May ada minimum employment age. Diri ka pwede mag fourth year to graduate because they still lack 200
hire hin household help before 14 years. Kun mayda kamo hours of intensive nursing practicum. Hira mismo diri
ha iyo mga balay below 14 years old, kinahanglan gin papa hira, nasiring man ako, I cannot in conscience affix my
eskwela, pinapakaon, diri hard labor. signature in their diploma when I know diri pa hira
kaya. I could just imagine, ambot ano it konsensya hit
iba na Deans, an ira mga estudyante gin pa gradwar
nira. Waray pa intensive practicum…
Breach of Duty
➢ Breach of duty is the failure to conform to or the
departure from a required duty to care owed to a
person.
➢ The obligation to perform according to a standard
of care might encompass either doing or refraining
from doing a particular act.
An pasyente nanganak, nag bbleeding, gin bayaan mo.

ENDRIANO, ESCULTOR, ESPLANADA 5

 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021
1
Ano’t breach of duty? An pasyente nanganak, tumalikod ka
nga an baby nakada han tiyan han nanay, waray mo kapti.
An nanay, tuliro pa. Nahulog an baby. Mayda ka breach of
duty. While you are doing anthropometric measurements in
a table ta kay dapat iton table mayda dapat iton barrier.
Nahulog an baby, you go to jail. Why? Because you
violated, it was a breach of duty. You failed to conform with
the standard. Linga ka, linga. Waray mo gamita imo utok.
Diri ka naghuna huna ano it consequence hit imo actions.
An kuri inin ha pagpa anak, kuan iton precipitate delivery
na baga lat santol na gin luwa. Ta kay madanlog because
of the vernix caseosa, an doctor ngan nurse waray.
Nahulog an bat ana balde ta kay nagbounce pa ha slog tas
nag bounce pa. Ada kay regular na ito it brain damage.
There was breach of duty.
Clinical example:
➢ A patient was admitted to a psychiatric facility late
at night from a general hospital emergency room
½ hours away.
➢ The patient was known to have overdosed on a
long-acting opioid drug.
➢ Although pronounced medically stable by the first
hospital, the patient was noted to be semi-
conscious and incoherent, with an irregular
respiration rate of 12 breaths/min.
➢ The patient’s respiratory irregularity did not
improve, but neither the physician on call nor the
paramedics were called.
➢ The patient died before morning of respiratory
arrest.
➢ The nurses did not carry out their obligation to
meet the standard of care.
The nurse failed to call the physician. What is the standard
of care? Maaram ka nga it respiratory rate diri na within the
normal range. You can be sued for negligence.
➢ The fourth element requires that a reasonable,
close, and causal connection or relationship exists
between the defendant’s negligent conduct and the
resulting damages suffered by the plaintiff.
➢ The defendant’s negligence must be a substantial
factor causing the injury.
➢ Foreseeability, as an element of negligence, is the
reasonable anticipation that harm or injury is likely
to result from an act or an omission to act.
Magdedeliver ka ngani huna-hunaa nga it bata pwede
lumusot. So andam ka na pagtapo. It imo tiil ig kuan, it imo
tiyan igsugad, it imo kamot igsugad.Kun iton nanay pagkita
mo crowning na iton baby, di iton pwede bayaan. Kay usa
nala ka ugdo, baga iton liso hin santol, pwede na ito iluwa. When delegating, the nurse at a minimum should:
Malpractice
➢ Nurse’s failure to take measures to prevent harm to
patients or a failure to maintain the standard of
care of nurses in the community.
➢ Lapses in attention to specific legal issues related
to nursing practice can result in liability and suits
against the nurse and the nurse’s employer.
Failure to maintain standard, you can be sued for
malpractice.
Areas of concern that can lead to suits include:
➢ Inappropriate dissemination of confidential Duty to Warn Others
information.Kun sumiring an pasyente na may gin
tanom niya na bomba. Iton na bomba, mabuto,
damo it mapatay. Maundang ka la? Ma keep quiet
kay nasiring na pasyente na don’t relay this
information. No. If this involves a greater number
ENDRIANO, ESCULTOR, ESPLANADA
of people. You should divulge.
➢ Illegal confinement. Aw diri pwede ig priso kay
waray makabayad hin hospital bills. Salit it iba
because of that illegal detention, makita kat
hospital damo ngadto it electric fan, kun ano it
aada ira balay, or rice cooker. Kun ano it aada ha
ira balay, amo it ira gin kukuan, maibanan la it ira
baraydan.
➢ Failure to obtain consent for medication and
other treatments, inadequate treatment. Part
of your responsibility, number 1: Explain the
procedure. Number 2: Consent should be signed
before any treatment, before any procedure,
consent should be signed.
➢ Medication errors.It para kan Juan na medisina,
ayaw ighatag kan Pablo. It para kan Pablo, ayaw
ihatag kan Juan. It kan Juan, ihatag kan Juan.
➢ The breach of duty to warn of threatened
suicide or harm to others.If magyakan an
pasyente na mag susuicide hiya, kailangan igyakan.
Bisan pa sumiring an pasyente na ayawn aringasa.
No, you have to inform the nurse, nurse supervisor,
up until the highest ladder.
➢ Employer is responsible for the acts of the
employee (Respondeat superior) as long as the
employee is acting within the scope and authority
of employment.
➢ A nurse who exceeds clinical boundaries or fails to
act as a reasonable and prudent nurse would, in
the same or similar circumstances, incurs liability to
the employer.
➢ When a nurse delegates, the authority to carry out
the act on behalf of the nurse is conveyed to the
assistant; however, When you delegate the
authority to carry out some actions, be sure that
the person delegated is capable to perform such
act. Now, giving of medications, in some hospitals
you notice that it is the midwife or the institutional
worker or the hospital aid that gives. Makita kat
mga hospital, adto gilid gilid, giving of medication
should not be delegated. To tell you, giving of
medication should not be delegated to other
persons. It is our responsibility. An principle
nasiring: Whoever prepares the medicine is the one
responsible in giving the medicine.
➢ The nurse remains accountable for the
consequences of the act and for the adequate
supervision of the assistant.
1. Ensure that UAPs assigned have been fully trained
and are qualified to carry out the task they are
expecting to perform. Make sure that the significant
others have been fully trained
2. Know the limitations responsibilities of nursing
practice of his or her state. As I’ve said you do not
delegate injection, you do not delegate medication.
Pwede pa siguro vital signs pero if an patient may
ada erratic na BP, the nurse should see to it na
ikaw it nakuha hin BP.
➢ Another area of importance to psychiatric nurses is
the “duty to warn of threatened suicide or harm.” It
is your duty to inform other healthcare provider.
➢ Landmark case of Tarasoff v. The Regents of the
University of California in 1976, the California
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 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021
1 Supreme Court issued the Tarasoff ruling, which
states that failure to warn, coupled with
subsequent injury to the threatened person,
exposes the mental health professional to civil
damages for malpractice.
➢ The mental health professional must balance a duty
to protect confidentiality with a responsibility to
warn society of possible danger.
Nursing Implications
➢ A nurse who is aware of a patient’s intention to
cause harm to self or others must communicate
this information to other professionals and take
steps to protect the potential recipient of harm.
➢ Documentation in the patient’s record is crucial for
effective communication of this information. The
nurse who fails to take prudent action can be held
liable. What is not written in the chart, you have
not done it.
Clinical example
➢ Biboy, a balut vendor with a history of mental
illness began hearing voices telling him to kill other
balut vendors. After several complaints, his family
decided to bring him to an in-patient psychiatric
facility.
➢ In the emergency room, Biboy started to get
agitated. He verbalized, “Hindi ako baliw. Ayoko
nang bumalik diyan!” The nurse-on-duty upon
hearing his screams said “Kapag hindi ka
tumahimik, itatali kita!” (Assault)
➢ Assault is the apprehension of physical contact or
the person’s mental scrutiny, and battery is the
actual physical contact. An assault is deliberate
threat coupled with the apparent ability to do
physical harm to another.
➢ No actual contact is necessary. Verbally threatening
a patient that you are going to force him or her to
take medication against patients will constitutes an
assault.
➢ Battery is an intentional touching of another
person, in a socially impermissible manner, without
that person’s consent.
➢ Battery is intentional conduct that violates the
physical security of another. A clinical example of
battery would be the force used in unlawful
detention of a patient.
➢ False imprisonment is the unlawful restraint of an
individual’s personal liberty or the unlawful restraint
or confinement of an individual.
Example include:
1. Excessive force used to restrain a patient: false
imprisonment and battery.
2. Preventing a patient from leaving a health care
facility: false imprisonment.
3. Wrongfully committing a patient to a
psychiatric facility: false imprisonment.
Voluntary Patients
➢ The vast majority of people with mental health
problems are voluntary patients that is, they seek
help voluntarily. Individuals or their therapists
request admission and patients sign the appropriate
documents, including a consent to treatment.
➢ Most states have a grace period of 48 to 72 hours
to allow professional staff the time and opportunity
to assess patients before they leave voluntarily.
➢ Involuntary treatment means that an individual
ENDRIANO, ESCULTOR, ESPLANADA
who has the legal capacity to consent to mental
health treatment refuses to do so.
➢ Individuals who are considered dangerous to self or
others because of a mental disorder can be
involuntarily treated for that mental disorder.
➢ Prove that a person is both mentally ill and
dangerous. Failure to comply with these guidelines
can render a commitment illegal.
1. Emergency Care
2. Short-term observation and treatment
3. Long-term commitment (3, 6, or 12 months)
Emergency Care
➢ Individuals who meet any one of these three
criteria (i.e., dangerous to self, dangerous to
others, or gravely disabled) can be detained
involuntarily for evaluation and emergency
treatment in most states
➢ The length of the involuntary status 48 to 72 hours
is the average.
Clinical Example:
• Ruben, a 64-years-old messenger was fired
from his job of 30 years. This greatly
affected him. Within a few weeks, he
stopped bathing and shaving. He would
wear his office uniform and would go to his
cubicle.
One day, the security guard refused to let
him in the office, then he started screaming
that he will kill everyone in the building and
that he has a bomb. The police were called
and Ruben was taken to the state hospital.
He was involuntarily committed.
Short-Term Observation and Treatment
➢ For example, a person who is hearing voices telling
her to kill herself meets this criterion, whereas
someone who is simply angry and threatening to
kill someone might not.
➢ Probable cause statement is written, indicating that
the person is a danger to self or others or is gravely
disabled. Probable cause means that known facts
would lead an ordinary person detained is mentally
disordered and is a danger to self.
Long-Term Commitment
➢ Long-term commitment is reserved for persons who
need prolonged psychiatric care but refuse to seek
such help voluntarily. Hospitalizations can last from
about 90 days to much longer.
Commitment of Incapacitated Persons
➢ The system in the United States maintains that,
although a person might be undergoing severe
mental and emotional upheaval that person is
nonetheless recognized as competent.
➢ The person who is identified as being gravely
disabled, viewed by the last legal system as
incompetent. The individual loses rights such as the
right to marry, vote, drive a car, and enter into
contracts.
➢ Gravely disabled is defined as the inability to
provide food, clothing, and shelter for oneself
because of a mental illness. People with money in
their pockets who cannot negotiate arrangements
for food or shelter are gravely disabled.
Conservators and Guardians
➢ An appointed conservator or guardian can be given
broad powers including the right to order the
7
 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021

1 conservatee to receive psychiatric treatment. • Mr. Tindal although confused at time, is

➢ The nurse must obtain consent from conservators able to feed himself, bathe without
for decisions that are otherwise made by patients. assistance, and self-manage toileting needs
A nurse who forgets to obtain conservator approval on admission. As do many men older than
face legal consequences. 60 years, Mr. Tindal experiences nocturia
➢ People with mental health problems have the right most nights.
to treatment of their problems in the least • Because the staff is concerned about falling
restrictive environment using the least restrictive and consequent broken bones, Mr. Tindal
means. has been “legally” restrained. Immediately,
Clinical Example: he begins wetting the bed, something he
➢ Jhun-Jhun is a former OFW from a war-torn had not done since childhood. Within 2
country. After repatriation, he would weeks, Mr. Tindal is not able to feed and
experience flashbacks and periods of bathe himself, and is described in his chart
depression. After a flashback, he would roam as incontinent.
the barangay looking for coworkers that he lost • Nurses who are aware of the potential
during the war. negative physical, psychological, and legal
➢ Jhun-Jhun has no relative and lives by himself. consequences associated with restraint and
Barangay officials, fearing for his safety, seclusion are more apt more to look for
referred him to a social worker. The social alternate strategies.
worker found a facility for him providing • Nurses administer medications to patients.
temporary placement and crisis intervention. Nurses must be sure that coaxing does not
Right to Confidentiality of Records escalate to the point of forcing medications
➢ The rule of confidentiality is not absolute. For on a patient.
example, information about a patient at risk for • Tempting to hide medications in food or
self-harm must be made available to appropriate liquid when patients refuse them, these
individuals. actions are considered forcing. The
➢ Consent form must first be signed. deception is also counterproductive when
➢ Psychiatrist is not obliged to reveal the contents of trying to establish a therapeutic nurse
sessions with the patient, based on the patient relationship.
understanding of the need that trust between
physicians and patients. NURSING PROGRESS
Clinical Example: RECORD
➢ Students frequently find themselves in TIME FORMAT
following situation. After developing a 0210 Patient continues to
relationship with a patient, the student might pace hallway, dayroom,
hear, “I want to tell you something, but I don’t and room; at 0245, asks
want anyone else to know” for sleep medications;
➢ What is the proper responses? Is it a breach of patient states that
the patient’s right to confidentiality to tell walking is the best way
others or to record what is said in the patient’s to get well.
chart? The student must let the patient know 0315 Patient refuses to go to
that anything said within the context of the room and tries to resist
nurse-patient relationship will be shared with paces dayroom and at
other team members when appropriate. time kneels as if in
Right to Freedom from Restraints and Seclusion prayer.
➢ Restraint is a broad term used to characterize any 0430 Patient is asleep on top
form of limiting a person’s movement or access to of bed, naked; door is
his or her own body. open.
➢ Limits can be the result of physical holds, bed rails, 0830 Patient refuses
lap trays, restraint devices, or medications. medication; appears
Seclusion is defined as the process of isolating a very agitated.
person in a room in which they are physically 0930 Patient is very agitated;
prevented from living. tears up another
➢ The 1987 Omnibus Reconciliation Act (OBRA) patient’s magazine and
placed stringent limits on the use of physical and throws it into the trash;
chemical restraints (e.g., antipsychotics, patient is placed in
benzodiazepines) in nursing homes to ensure that seclusion.
their use is limited to medical necessity, not staff 0945 Paces in room while
convenience. praying loudly
Clinical Example 1000 Patient increases
• Mr. Buck Tindal, 75 has been admitted to pacing and
the geropsychiatric unit of large teaching intermittently hits
hospital for observation and treatment walls.
related to recent behaviors suggestive of
1015 Patient’s agitation is
dementia.
escalated when staff

ENDRIANO, ESCULTOR, ESPLANADA 8

 LEGAL CONSIDERATIONS: RIGHTS OF CLIENTS AND RELATED ISSUES
10 NCM 117: Psychiatric Nursing
Dr. Socorro Salvacion-Gasco, DM-HRM, MAN, RN• April 29, 2021
1 goes into room to check
on the patient, she
swings at staff and
attempts to bite the
nurse; patient is placed
in four-point restraint
by four female and two
male staff members;
patient states that she
is being “raped” and
that “Christ lives in
me”, Haldol 5 mg IM
Congentin 2 IM are
given.
Suspension of Patient Right
➢ Suicidal patient’s right to access personal belonging
might be suspended because it is believed that
such a patient might attempt to harm himself or
herself with those objects. The nurse must
document the concern and suspension of this right Three categories of commitment include:
in the nurse’s notes.
➢ Through the use of living wills and health care
directives Medicare or Medicaid patients to provide
each of their adult patients with written information
regarding their right to make decisions about their
medical care.
➢ Patients are also made aware of the right to
execute a living will or a durable power of attorney.
Living will and the health care directive list specific
actions that the patient can choose to implement or
not under a life-threatening medical condition, such
as mechanical ventilator support or artificial
nutrition
➢ Durable power of attorney is a written document in
which one person (the principal) authorizes another
person (the attorney in fact) to act on the
principal’s behalf in the event the principal becomes
unable to act on his or her own behalf secondary to
a physical or mental disability.
➢ Directives about treatment in a number of
areas,
1. The use of specific medications, including
dose and route
2. The use of specific treatment options, such
as electroconvulsive therapy (ECT)
3. The use of behavior management including
restraint, seclusion, and sedation;
4. A list of the individuals who are to be
notified and allowed to visit;
5. A consent to contact health care providers
and obtain treatment records; and
6. Willingness to participate in research
studies (Srebnid and Lafond, 1999)
The following actions are also important to ensure
that the patient’s right to self-determination is
exercised:
1. Documentation in the medical record of either
properly executed forms or a statement or signed
waiver must be made indicating that the patient
chooses not to exercise his or her right to provide
advance directives.
2. The attorney in fact chosen by the patient is
ENDRIANO, ESCULTOR, ESPLANADA
consulted before making decisions regarding the
patient in areas specified by the document
3. All members of the health care team are made
aware of advance directives and that they are
considered in treatment planning.
THE FEAR FACTOR OF INCARCERATED
For the incarcerated Fear as a way of life
individuals Fear of being harassed
Fear of being raped
Fear of being hurt
Fear of having dignity
taken away
“You can make me a
zombie”
For the psychiatric staff “Don’t get caught down
the hall yourself”
“I have Contact
outside”
a. Voluntary patient: the person requests
hospitalization and voluntarily agrees to be
admitted.
b. Commitment of an incapacitated person: treatment
of a person who does not have the legal capacity to
consent to treatment
c. Involuntary commitment: a person with the legal
capacity to consent refuses to do so and is treated
against his or her will.
➢ Patients under psychiatric care have many rights
guaranteed by the Philippine Constitution and the
constitutions of individual states.
➢ Seclusion and restraint are special procedures for
coping with assaultive and dangerous patient;
➢ Involuntarily admitted patients, must give informed
consent before they are given psychotropic drugs
and retain the right to refuse medication.
➢ Involuntarily admitted patients cannot be given
medication against their will without judicial
approval.
➢ Psychiatric patients have the right to be treated in
the least restricted alternative or least restrictive
environment.
➢ Mentally ill prisoner has a right to appropriate
medical and nonmedical treatment while
incarcerated.
- THE END-
9