LEGAL & ETHICAL ISSUES IN
PSYCHIATRIC NURSING
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.
RIGHTS OF MENTALLY ILL
RIGHT TO TREATMENT
How treatment must be given
 By adequate staff
 In least restrictive setting
 In privacy
 In facility that provides comfortable bed,
adequate diet, and recreational facilities
 With patient's informed consent before
unusual treatment
 With payment for work done in facility,
outside of program activities
 According to individual treatment plan
RIGHT TO REFUSE TREATMENT
A patient can't be kept in a hospital against
his will, nor can he be denied the right to
refuse treatment.
CRITERIA FOR COURT-ORDERED
TREATMENT
 Need has been clearly established
 Patient poses danger to himself or
others
 Physician and treatment team
demonstrate need for continued
inpatient treatment
RIGHT OF MINORS
 legal responsibility must be established
immediately (Parent)
 CONSERVATORSHIP
RIGHT TO INFORMED CONSENT
 Admitting provider's responsibility
 The nurse should refuse to participate in
procedures for which informed consent
hasn't been obtained
RIGHT TO PRIVACY
CIRCUMSTANCES FOR DISCLOSURE OF
CONFIDENTIAL INFORMATION
 Suspected drug abuse
 Criminal cases
 Government requests
 When public has a right to know
 Is patient is imminent risk to himself or
others
DUTY TO WARNN THIRD PARTIES
 Is the client dangerous to others?
 Is the danger the result of mental
illness?
 Is the danger serious?
 Are the means to carry out the threat
available?
 Is the danger targeted at identifiable
victims?
 Is the victim accessible?
REPRODUCTIVE AND SEXUAL RIGHTS
 Right to marry
 Right to have children
 Right to use contraception or
sterilization, if desired
 Right to follow lifestyle of their own
choosing
TYPES OF ADMISSION
Voluntary Admission
The client willingly enters and consents to
treatment.
Clients retain all of their civil rights and may
discontinue treatment whenever they
choose.
If the treatment team disagrees with a
client’s decision treatment, the client signs a
form acknowledging that he has been
discharged AMA, or the treatment team may
decide to seek involuntary commitment of
the client.
INVOLUNTARY INPATIENT A legal guardian is appointed by the court to
COMMITMENT make decisions for him.

The client is institutionalized against his will. SECLUSION & RESTRAINT

Conditions: Methods of preventing a client from harming

a. Those who pose a threat to self or
others.
b. Those who lack the capacity for meeting
basic needs
c. Those who are seriously mentally ill but
fail to seek treatment.
INVOLUNTARY/MANDATORY
OUTPATIENT TREATMENT
Involves treatment mandated by a court
order.
This option has been used as
DEINSTITUTIONALIZATION has progressed.
Conditions:
a. Substance-impaired individuals
b. Homeless mentally ill persons
c. Sex offenders
KEY LEGAL CONCEPTS
CONFIDENTIALITY
Client information is considered privileged.
INFORMED CONSENT
Ensures that he received adequate
information about his care and treatment
prior to his consenting to treatment
RIGHT TO REFUSE TREATMENT
All clients (including those committed
involuntarily)
In emergency situations, a client can be
given medication or confined by seclusion or
restraints.
CLIENT INCOMPETENCE
The inability to legally make decisions
regarding one’s health care, finance, and
property.
himself or others during a violent outburst
Both methods are regulated by specific legal
and ethical guidelines.
***The guiding principle of managing client
acting-out behaviour is the use of LEAST
RESTRICTIVE MEASURES.
CRITERIA FOR USING RESTRAINTS
 Examination of patient by physician to
determine need
 Written physician's order that's placed in
patient's medical record before restraints
are applied
 Application of restraints for specified
duration
NURSING IMPLICATIONS
 Monitored 1:1 for the first hour
 Monitors & documents the client's skin
condition, blood circulation in hands &
feet, and emotional well-being
 Monitors for side-effects of medications
 Implements & documents offers of food,
fluids, and also opportunities to use the
bathroom
LEAST RESTRICTIVE MEASURES
 The nurse attempts to calm the client
before advancing to interventions that
require seclusion or restraint.
 LIMIT SETTING, VERBAL
INTERVENTIONS, OFFERING
MEDICATIONS.
 When initial measures fail or are
inappropriate  client may be
involuntarily confined (secluded) in a
room/area to prevent him from
physically leaving.
M'NAGHTEN RULE (Defense of
Insanity)

The person accused of the crime is NOT

GUILTY because the person cannot control
his/her actions or cannot understand the
wrongfulness of the act.

Used only 0.9% (9 in 1000) of all criminal

cases and is successful in 20% of those
cases.

ETHICAL PRINCIPLES

AUTONOMY

The client’s freedom to make choices about

his life.

E.g. making decision for himself

BENEFICIENCE

Acting in ways that benefit the client. “To do

the most good for the patient”

E.g. resuscitating a drowning victim

NONMALIFICIENCE

Acting in manner to avoid causing harm to

the client. “Do no harm”

E.g. avoiding negligent care of a patient

CONFIDENTIALITY

Nondisclosure of information with which one

is entrusted.

JUSTICE

Acting out in a fair, equitable, and Right-Left

appropriate manner.
Considerate, traditional, indirect type
FIDELITY
Can instinctly read other's emotion, and
Faithfulness and the practice of keeping respond friendly by natures. Although not
promises. very into taking initiatives in moving
forward, but this person will always take a
VERACITY step back in supporting others. Stable
Nurses must not withhold the whole truth personality and considerate, give others a
from clients even when it may lead to being protected feeling. But the weakness is
patient distress they cannot say no; regardless how unwilling
they are, they will take care of others.
HUMAN BRAIN
Right-Right
The female brain
Loves challenges type

Straightforward. Once they decided on one

thing, will take action right away.
Very curious, and love challenges. Dare to SPEECH
face dangers without thinking through
Broca’s area is where we formulate speech
(sometimes foolishly). Their weakness is
and the area of the brain that sends motor
they don’t listen to others, will filter in only
instructions to the motor cortex.
what they want to hear in a conversation,
and very subjective. Injury to Broca’s area can cause difficulty in
speaking. The individual may know what
However, because of their straightforward
words he or she wishes to speak, but will be
attitude, they tend to be fairly popular.
unable to do so.
Left-Left

Dedicated, cold, perfectionist

Very logical in all aspects. The only way to

defeat (or win over) him/her is through
reasons. Has a lot of prides, and feeling
strongly about doing the right thing. If they
are your friends, they are very trustworthy.
However, if they are your opponents, they
will be very tough to deal with. Because they
can be very "anal" as a perfectionist, they
usually leave a bad impression of being hard
to deal with when first met.
LANGUAGE
Left-Right
Wernicke’s area is a specialized portion of
Likes to take care of others, leader type the parietal lobe that recognizes and
understands written and spoken language.
Has a cool and keen observation ability to
see through situations, yet still can be Wernicke’s area surrounds the auditory
considerate in others needs. Because of their association area.
cool and calm nature, and strong sense of
Damage to this part of the brain can result
responsibility, they tend to become head of
in someone hearing speech, but not
a group.
understanding it.
Popular among people. However, they may
not be able to help themselves in meddling
because they want to take care of others too
much.

HEARING

There are two auditory areas of the brain:

• The primary auditory area (brown
circle) is what detects sounds that are
transmitted from the ear. It is located in
the sensory cortex.
• The auditory association area (purple
circle) is the part of the brain that is
used to recognize the sounds as speech,
music, or noise.
 a technique that uses magnetic fields
and radio waves to produce computer-
generated images that distinguish
among different types of soft tissue;
allows us to see structures within the
brain

ELECTROENCEPHALOGRAM (EEG)

 an amplified recording of the waves of

electrical activity that sweep across the
brain’s surface these waves are
measured by electrodes placed on the
scalp

CT (computed tomography) Scan

 a series of x-ray photographs taken

from different angles and combined
by computer into a composite
representation of a slice through the
body; also called CAT scan

PET (positron emission

tomography) Scan

 a visual display of brain activity that

detects where a radioactive form of
glucose goes while the brain
performs a given task

MRI (magnetic resonance imaging)