Module 7 Legal and Ethical - Readings: Chapter 6 and 33
Nurse’s primary role
Protection of patients rights
Advocate for patient
Patient is the primary commitment of the nurse
Standards of care
Code of ethics
Professionalism
Franciscan values
Vulnerable populations are:
Persons with mental illness, aging population, homeless persons with mental
illness, incarcerated persons with mental illness
o Persons with mental illness are more vulnerable, may not be aware of
their rights, are in a dependent position and may be taken advantage of
o Protection of rights→ laws are put into place
Vulnerable aging population
o Prone to neglect and abuse
o Advance directives are important
Vulnerable Homeless Population
o 20-25% of homeless population suffer from mental illness
o Mental illness is the third largest cause of homelessness
Vulnerable incarcerated population
o Problem- there is inadequate funds
o Prisoners are forced to stay in their cells
o limited access to therapy
Types of Admission
Voluntary- patient signs self into hospital
o Patient must understand the need for treatment and be willing to
participate in recommended treatment
o Have the right to request and obtain release
o If patient is under 16, there must be a parent or guardian sign for that
patient
o Before being released, re-evaluation may need to occur
o If caregiver feels the patient needs to stay, involuntary commitment may
be initiated
Involuntary- 72 hour hold, petition for court hearing
o Court ordered without patient’s consent
o Criteria includes:
Mentally ill
, Danger to self or others
Gravely disabled
In need of treatment
Informal admission- least restrictive of all admissions
o No formal application
o Person does not pose a threat to self or to others
o patient -caregiver relationship is normal and patient may leave or stay
depending on their needs
Types of commitment
Emergency commitment- temporary admission or emergency hospitalization
o Used for people who are so confused they cannot make decisions on their
own
o For people who are so ill they need emergency admission
o Primary purpose of this is for observation, diagnosis, and treatment of
those who pose danger to themselves or others
o Length of time to be held ranges from 24-96 hours
o Court hearing is held to determine next decision
Assisted outpatient treatment- court ordered outpatient treatment
o Can be preventative measures allowing a court order before the onset of a
psychiatric crisis that would result in inpatient admission
o Patient must participate in treatment to receives disability benefits and
housing
o If they do not participate, inpatient hospitalization may be required
Types of Discharge
Conditional release- requires outpatient treatment for a specified period of time to
determine if the patient follows the medical regimen, can meet basic needs, and
is able to reintegrate with the community
o An involuntarily admitted patient who is conditionally released may be
reinstitutionalized, although the commitment is still in effect without
recommencement of formal admission procedures
Unconditional release- termination of a patient-institution relationship
o May be court ordered or administratively ordered by the institution’s
officials
Release against medical advice- when there is a disagreement between the
mental health care providers and the patient as to whether continued
hospitalization is necessary
o In cases where treatment seems beneficial but there is no compelling
reason (danger to self or others) to seek an involuntary continuance of
stay, patients may be released against medical advice
Rights of the Mentally ill and nurse’s role
, Mentally ill are prone to criminal behavior→ sometimes end up in prison
If mentally ill are incarcerated they have a right to treatment
Definitions→ not listed on study guide but is on pp. under ethics and rights
Moral behavior- conduct that results in serious critical thinking on how to treat
others based on ethical principles
Values-important beliefs about what is desirable
Rights- valid legally recognized claim or entitlement encompassing freedom from
government interference or discriminatory treatment and an entitlement to a
benefit of service
Kantianism- what is motivation on what the action is based on
Utilitarianism- whatever promotes happiness
Christian ethics- focused on the way of love and life of Jesus
Christ- love, forgiveness, honesty
Natural law- decisions versus right and wrong are self evident and determined by
human nature
Benefiance- duty to act to benefit or promote the good of others
o Nursing care follows the standards of care
o Provide safe milieu
o Respectful listening to the patient
o Doing what is best for patient, SAFETY
autonomy - respecting the rights of others to make their own decisions
o Ask patient about goals
o Allow patient to participate in care
o Problem solving: ask patient what would work for them
Justice- duty to distribute equally - resources or care regardless of personal
attributes of the person
o Just care to all patients
Fidelity (nonmaleficence)- maintaining loyalty and commitment to the patient
doing no wrong to the patient
o Giving education
o Going above and beyond
veracity - nurse’s duty to communicate truthfully
o Observing and relating facts
o Factual and thorough documentation
o Standing up for what is right
Ethical issues in mental health:
Labeling
Stigma
boundaries
Confidentiality
Nurse’s primary role
Protection of patients rights
Advocate for patient
Patient is the primary commitment of the nurse
Standards of care
Code of ethics
Professionalism
Franciscan values
Vulnerable populations are:
Persons with mental illness, aging population, homeless persons with mental
illness, incarcerated persons with mental illness
o Persons with mental illness are more vulnerable, may not be aware of
their rights, are in a dependent position and may be taken advantage of
o Protection of rights→ laws are put into place
Vulnerable aging population
o Prone to neglect and abuse
o Advance directives are important
Vulnerable Homeless Population
o 20-25% of homeless population suffer from mental illness
o Mental illness is the third largest cause of homelessness
Vulnerable incarcerated population
o Problem- there is inadequate funds
o Prisoners are forced to stay in their cells
o limited access to therapy
Types of Admission
Voluntary- patient signs self into hospital
o Patient must understand the need for treatment and be willing to
participate in recommended treatment
o Have the right to request and obtain release
o If patient is under 16, there must be a parent or guardian sign for that
patient
o Before being released, re-evaluation may need to occur
o If caregiver feels the patient needs to stay, involuntary commitment may
be initiated
Involuntary- 72 hour hold, petition for court hearing
o Court ordered without patient’s consent
o Criteria includes:
Mentally ill
, Danger to self or others
Gravely disabled
In need of treatment
Informal admission- least restrictive of all admissions
o No formal application
o Person does not pose a threat to self or to others
o patient -caregiver relationship is normal and patient may leave or stay
depending on their needs
Types of commitment
Emergency commitment- temporary admission or emergency hospitalization
o Used for people who are so confused they cannot make decisions on their
own
o For people who are so ill they need emergency admission
o Primary purpose of this is for observation, diagnosis, and treatment of
those who pose danger to themselves or others
o Length of time to be held ranges from 24-96 hours
o Court hearing is held to determine next decision
Assisted outpatient treatment- court ordered outpatient treatment
o Can be preventative measures allowing a court order before the onset of a
psychiatric crisis that would result in inpatient admission
o Patient must participate in treatment to receives disability benefits and
housing
o If they do not participate, inpatient hospitalization may be required
Types of Discharge
Conditional release- requires outpatient treatment for a specified period of time to
determine if the patient follows the medical regimen, can meet basic needs, and
is able to reintegrate with the community
o An involuntarily admitted patient who is conditionally released may be
reinstitutionalized, although the commitment is still in effect without
recommencement of formal admission procedures
Unconditional release- termination of a patient-institution relationship
o May be court ordered or administratively ordered by the institution’s
officials
Release against medical advice- when there is a disagreement between the
mental health care providers and the patient as to whether continued
hospitalization is necessary
o In cases where treatment seems beneficial but there is no compelling
reason (danger to self or others) to seek an involuntary continuance of
stay, patients may be released against medical advice
Rights of the Mentally ill and nurse’s role
, Mentally ill are prone to criminal behavior→ sometimes end up in prison
If mentally ill are incarcerated they have a right to treatment
Definitions→ not listed on study guide but is on pp. under ethics and rights
Moral behavior- conduct that results in serious critical thinking on how to treat
others based on ethical principles
Values-important beliefs about what is desirable
Rights- valid legally recognized claim or entitlement encompassing freedom from
government interference or discriminatory treatment and an entitlement to a
benefit of service
Kantianism- what is motivation on what the action is based on
Utilitarianism- whatever promotes happiness
Christian ethics- focused on the way of love and life of Jesus
Christ- love, forgiveness, honesty
Natural law- decisions versus right and wrong are self evident and determined by
human nature
Benefiance- duty to act to benefit or promote the good of others
o Nursing care follows the standards of care
o Provide safe milieu
o Respectful listening to the patient
o Doing what is best for patient, SAFETY
autonomy - respecting the rights of others to make their own decisions
o Ask patient about goals
o Allow patient to participate in care
o Problem solving: ask patient what would work for them
Justice- duty to distribute equally - resources or care regardless of personal
attributes of the person
o Just care to all patients
Fidelity (nonmaleficence)- maintaining loyalty and commitment to the patient
doing no wrong to the patient
o Giving education
o Going above and beyond
veracity - nurse’s duty to communicate truthfully
o Observing and relating facts
o Factual and thorough documentation
o Standing up for what is right
Ethical issues in mental health:
Labeling
Stigma
boundaries
Confidentiality
