ATI Mental Health Review: Legal & Ethical Concepts in Admissions
Mental health review ATI
Mental Health – Legal & Ethical Concepts
Admissions & Commitments
Voluntary Admission:
• Patient requests admission and may leave at any time.
• Patient is considered competent and has the right to refuse medication or
treatment.
Involuntary Admission:
• Patient admitted against their will for treatment.
• Criteria: Danger to self/others, or inability to meet basic needs.
• Patient can request legal review of admission.
• Limited to 60 days, then review by legal authorities.
• Patient is still considered competent unless legally determined otherwise.
• Psychiatric admission laws vary by state.
Patient Rights
• Confidentiality (HIPAA): Information shared only with healthcare team.
• Duty to Warn: Must notify potential victims or authorities if the patient poses a
threat (Tarasoff Law).
• Rights Include:
o Informed consent
o Refusal of treatment
o Confidentiality
o Written plan of care and discharge plan
o Communication with others (visits, calls, mail)
o Safety from harm (no restraints or seclusion without cause)
o Religious and civil rights maintained
Informed Consent
Definition:
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
,ATI Mental Health Review: Legal & Ethical Concepts in Admissions
• Patient’s voluntary decision to undergo a procedure or intervention.
Provider’s Role:
• Explain diagnosis, purpose, risks, benefits, alternatives, and prognosis if refused.
Nurse’s Role:
• Witness the signature.
• Ensure the patient received full information and voluntarily consented.
Special Notes:
• Patients under influence, confused, or psychotic cannot consent.
• If a patient changes their mind, respect the decision.
Ethical Principles
Principle Definition Example
Autonomy Right to choose/refuse Respect patient’s decision to refuse meds
Volunteering to stay with a patient during a panic
Beneficence Promote good
attack
Nonmaleficence Do no harm Refraining from giving unnecessary meds
Fair and equal
Justice Providing care regardless of background
treatment
Fidelity Keep promises Returning with requested information
Veracity Tell the truth Honestly explaining side effects of medication
Intentional Torts
Definition: Willful acts that violate a patient’s rights.
• Assault: Threat of harm that causes fear.
• Battery: Touching a patient without consent.
• False Imprisonment: Unjustified restraint (e.g., seclusion without order).
• Invasion of Privacy: Sharing patient info without consent.
• Defamation of Character: Making derogatory remarks that harm reputation.
Unintentional Torts
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
,ATI Mental Health Review: Legal & Ethical Concepts in Admissions
Definition: Acts that cause harm unintentionally.
• Negligence: Failure to provide reasonable care.
• Malpractice: Professional negligence (e.g., med error, not preventing injury).
• Example: Not assessing wound properly → infection or sepsis.
Restraints & Seclusion
Indications:
• Non-Violent: Protect from interference with medical devices.
• Violent: Protect patient/staff from harm.
Types:
• Physical: Hand mitts, vests, side rails.
• Chemical: Benzodiazepines, antipsychotics (e.g., lorazepam, haloperidol).
Order Requirements:
• Provider must assess within 24 hours.
• Renewal:
o Adults: q4h
o Adolescents (9–17 yrs): q2h
o Children (<9 yrs): q1h
• 24-hour written order limit.
• Restraints never used as punishment or for staff convenience.
Nursing Care:
• Assess skin, hydration, elimination, circulation, ROM.
• Offer fluids, toileting, and safety checks every 15 min.
• Use least restrictive methods first.
Nurse–Client Relationship
Phases:
1. Pre-Orientation: Self-awareness and preparation before meeting the patient.
2. Orientation: Establish trust, define roles, set goals.
3. Working: Promote insight, problem-solving, and adaptive coping skills.
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
, ATI Mental Health Review: Legal & Ethical Concepts in Admissions
4. Termination: Evaluate goal achievement, discuss closure, and prepare for
discharge.
Key Points:
• Maintain professional boundaries.
• Avoid giving personal contact info or gifts.
• Encourage independence — don’t foster dependence.
• Therapeutic communication is essential.
Transference & Countertransference
• Transference: Patient projects feelings about someone from their past onto the
nurse (e.g., nurse reminds them of a parent).
• Countertransference: Nurse projects personal feelings onto the patient.
o Example: Nurse feels overly protective or irritated by patient.
• Both can interfere with care — recognize and maintain boundaries.
Mental Health Nursing – Foundational
Concepts
Therapeutic Communication
Technique Example
Active Listening “I’m paying attention to what you’re saying.”
Offering Self “I’ll stay with you until you feel calmer.”
Open-ended
“Can you tell me more about that?”
Questions
Patient: “I can’t sleep.” → Nurse: “You’re having trouble
Restating
sleeping?”
Reflecting “You seem angry about that situation.”
Focusing “Let’s look more closely at what upset you.”
Presenting Reality “I don’t see anyone else in the room.”
Silence / Touch Allows expression of feelings, conveys empathy.
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
Mental health review ATI
Mental Health – Legal & Ethical Concepts
Admissions & Commitments
Voluntary Admission:
• Patient requests admission and may leave at any time.
• Patient is considered competent and has the right to refuse medication or
treatment.
Involuntary Admission:
• Patient admitted against their will for treatment.
• Criteria: Danger to self/others, or inability to meet basic needs.
• Patient can request legal review of admission.
• Limited to 60 days, then review by legal authorities.
• Patient is still considered competent unless legally determined otherwise.
• Psychiatric admission laws vary by state.
Patient Rights
• Confidentiality (HIPAA): Information shared only with healthcare team.
• Duty to Warn: Must notify potential victims or authorities if the patient poses a
threat (Tarasoff Law).
• Rights Include:
o Informed consent
o Refusal of treatment
o Confidentiality
o Written plan of care and discharge plan
o Communication with others (visits, calls, mail)
o Safety from harm (no restraints or seclusion without cause)
o Religious and civil rights maintained
Informed Consent
Definition:
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
,ATI Mental Health Review: Legal & Ethical Concepts in Admissions
• Patient’s voluntary decision to undergo a procedure or intervention.
Provider’s Role:
• Explain diagnosis, purpose, risks, benefits, alternatives, and prognosis if refused.
Nurse’s Role:
• Witness the signature.
• Ensure the patient received full information and voluntarily consented.
Special Notes:
• Patients under influence, confused, or psychotic cannot consent.
• If a patient changes their mind, respect the decision.
Ethical Principles
Principle Definition Example
Autonomy Right to choose/refuse Respect patient’s decision to refuse meds
Volunteering to stay with a patient during a panic
Beneficence Promote good
attack
Nonmaleficence Do no harm Refraining from giving unnecessary meds
Fair and equal
Justice Providing care regardless of background
treatment
Fidelity Keep promises Returning with requested information
Veracity Tell the truth Honestly explaining side effects of medication
Intentional Torts
Definition: Willful acts that violate a patient’s rights.
• Assault: Threat of harm that causes fear.
• Battery: Touching a patient without consent.
• False Imprisonment: Unjustified restraint (e.g., seclusion without order).
• Invasion of Privacy: Sharing patient info without consent.
• Defamation of Character: Making derogatory remarks that harm reputation.
Unintentional Torts
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
,ATI Mental Health Review: Legal & Ethical Concepts in Admissions
Definition: Acts that cause harm unintentionally.
• Negligence: Failure to provide reasonable care.
• Malpractice: Professional negligence (e.g., med error, not preventing injury).
• Example: Not assessing wound properly → infection or sepsis.
Restraints & Seclusion
Indications:
• Non-Violent: Protect from interference with medical devices.
• Violent: Protect patient/staff from harm.
Types:
• Physical: Hand mitts, vests, side rails.
• Chemical: Benzodiazepines, antipsychotics (e.g., lorazepam, haloperidol).
Order Requirements:
• Provider must assess within 24 hours.
• Renewal:
o Adults: q4h
o Adolescents (9–17 yrs): q2h
o Children (<9 yrs): q1h
• 24-hour written order limit.
• Restraints never used as punishment or for staff convenience.
Nursing Care:
• Assess skin, hydration, elimination, circulation, ROM.
• Offer fluids, toileting, and safety checks every 15 min.
• Use least restrictive methods first.
Nurse–Client Relationship
Phases:
1. Pre-Orientation: Self-awareness and preparation before meeting the patient.
2. Orientation: Establish trust, define roles, set goals.
3. Working: Promote insight, problem-solving, and adaptive coping skills.
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
, ATI Mental Health Review: Legal & Ethical Concepts in Admissions
4. Termination: Evaluate goal achievement, discuss closure, and prepare for
discharge.
Key Points:
• Maintain professional boundaries.
• Avoid giving personal contact info or gifts.
• Encourage independence — don’t foster dependence.
• Therapeutic communication is essential.
Transference & Countertransference
• Transference: Patient projects feelings about someone from their past onto the
nurse (e.g., nurse reminds them of a parent).
• Countertransference: Nurse projects personal feelings onto the patient.
o Example: Nurse feels overly protective or irritated by patient.
• Both can interfere with care — recognize and maintain boundaries.
Mental Health Nursing – Foundational
Concepts
Therapeutic Communication
Technique Example
Active Listening “I’m paying attention to what you’re saying.”
Offering Self “I’ll stay with you until you feel calmer.”
Open-ended
“Can you tell me more about that?”
Questions
Patient: “I can’t sleep.” → Nurse: “You’re having trouble
Restating
sleeping?”
Reflecting “You seem angry about that situation.”
Focusing “Let’s look more closely at what upset you.”
Presenting Reality “I don’t see anyone else in the room.”
Silence / Touch Allows expression of feelings, conveys empathy.
ATI Mental Health Review: Legal & Ethical Concepts in Admissions
