Mental Health Exam 1

Define self-determinism and its implication in mental health care. - Self-determinism: right to choose one's own health related behaviors Decisions can be different from those recommenced by health professionals Right to refuse treatment and seek a second opinion - promotes internal motivation and empowerment - allows for personal autonomy Describe the rights of the client in a psychiatric setting: Self-Determination Act. - SelfDetermination Act: Provides information on advanced care documents, question on admission about advanced care documents, information on rights to complete advanced health care documents. Describe the rights of the client in a psychiatric setting: Advanced Care Directives - Advanced Care Directives: written instructions for health care when individuals are incapacitated Living wills - specifies what treatment should be omitted or refused in the event that a person is unable to make those decisions Durable power of attorney - a proxy that makes health care decisions on an individual's behalf if they are incapacitated Psychiatric advanced directives - allows patients, while competent, to document their choices of treatment and care (has to be made in advance, be signed, and have two witnesses) Describe the rights of the client in a psychiatric setting: Bill of Rights - Bill of Rights (shortened and simplified version; See Box 3.1 on page 18-19 for full version in textbook) - To receive services that take into account the best available research evidence on what has been shown to work - To consider how that evidence may or may not fit with your personal goals and values - To decide whether any given mental or behavioral health service aligns with your own developmental, cultural, and community needs and strengths - To understand how your progress will be measured - To understand how you and your provider will know that services are working - To ask for changes to the services to increase the chances that they will work for you - To ask your provider about what services they're trained to give and options that other providers may be able to offer to help you get better Describe the rights of the client in a psychiatric setting: Competency - Competency: - Degree to which client can understand and appreciate the information given during the consent process - Cognitive ability to process information at a specific time - Different from rationality - Competent client can refuse any aspect of the treatment plan Assessment of Competency includes the ability to: - Communicate choices - Understand relevant information - Appreciate situation and consequences - Use a logical thought process to compare risks and benefits of treatment options Describe the rights of the client in a psychiatric setting: Informed Consent - Informed Consent: - Legal procedure to ensure that the client knows the benefits and costs of treatment - Mandate of state laws - Complicated in mental health treatment --> Competency necessary to give consent --> Decision-making ability often compromised in mental illness Describe the rights of the client in a psychiatric setting: Least Restrictive Environment - Least Restrictive Environment: - Larger concept underlying client's right to refuse treatment - A person cannot be restricted to an institution when he or she can be successfully treated in the community - Medication cannot be given unnecessarily - Use of restraints or locked room only if all other "less restrictive" interventions have been tried first Describe the rights of the client in a psychiatric setting: Seclusion and Restraint - Use as a last resort. Never use it for convenience. Never used for punishment. Assess for safety. Seclusion: - Involuntary confinement in a room or area where the person is physically prevented from leaving - Used for purposes of safety or behavioral management - Contains mattress and blanket, usually padded walls, environmentally safe (no hanging devices,electrical outlets, or accessible windows) - Individual observed at all times - Extremely negative client experience; many facilities have abandoned practice - Outcomes may be worse if used Restraint: - Any manual (physical or mechanical) method which immobilizes or reduces ability to move - Must choose least restrictive type to keep client safe (Wrist, Walking or ankle, Fourpoint, Five-point, Chemical) - Last resort if client continues to be danger to self or others - Documentation must reflect careful assessment and all previously tried unsuccessful interventions - Promptly removed when client regains control over his or her behavior - Requires continued close observation after removal - Use can result in psychological harm and physical injury Describe the rights of the client in a psychiatric setting: Involuntary Treatment - Involuntary Treatment: - Involuntary commitment: court ordered; without person's consent - Three common elements: --> Mentally disordered --> Dangerous to self or others --> Unable to provide for basic needs - Right to receive treatment; possible right to refuse treatment Provisions for emergency short-term hospitalization of 48 to 96 hours Describe the rights of the client in a psychiatric setting: Voluntary Treatment - Voluntary Treatment: - Voluntary admission or commitment - Person retains full civil rights - Treatment strategies are recommended and agreed on by both provider and client - Free to leave at any time, even against medical advice Describe the legal determination of competency. - Assessment of Competency includes the ability to: - Communicate choices - Understand relevant information - Appreciate situation and consequences - Use a logical thought process to compare risks and benefits of treatment options Describe the issues related to privacy and confidentiality relevant to the mental health setting including HIPAA & duty to warn (mandate to inform). - Privacy: part of person's life not governed by society's laws and government intrusion Confidentiality: ethical duty of nondisclosure (provider has information about client and should not disclose it) Breach of confidentiality: release of client information without the client's consent in the absence of legal compulsion or authorization HIPPA: Health Insurance Portability Accountability Act - Client authorization necessary for the release of information with the exception of that required for treatment, payment, and health care administrative operations - American Recovery and Reinvestment Act (2009): Provisions for managing health information & focus on maintaining privacy of electronic transfer and storage of health information and communication Duty to warn (mandate to inform) - legal obligation to report breach of confidentiality - judgment that the client has harmed someone or who is about to injure someone Identify nursing actions that pose legal liability issues and nursing actions to avoid liability issues. - Malpractice: duty, breach of duty, cause in fact, cause in proximity, damages (must meet all 5 criteria to be malpractice) Continues...