INTRODUCTORY MENTAL HEALTH NURSING Introduction Legal Ethical Issues

INTRODUCTORY MENTAL HEALTH NURSING Introduction Legal & Ethical Issues

Defining Mental Health • State of emotional well-being in which one “functions comfortably within society and is satisfied with their achievements in the areas of work, play, love and relationships. ”

Components of Mental Health • Self-control with socially acceptable behavior • Inner values • Growth-oriented • Tolerates uncertainty and stress with flexibility • Reality-oriented, sound judgment and decision-making • Experiences meaningful work • Humor • Optimistic • Spontaneity • Satisfying relationships • Ability to give and receive

Current Issues • Community-based care • Legislation – OBRA (Omnibus Budget Reform Act) – prevents inappropriate placement into nursing homes – Mental Health Act of 1983 – client rights – National Mental Health Parity Act (1996) – Lack of funds, cost to communities, families • Closing of psychiatric units, where do clients go?

Being a Psychiatric Nurse • Clients do not need us personally as friends or companions…they need us to teach them, and model HOW to have friendships and relationships outside of treatment in society as a whole

What About Change? • YOU WILL CHANGE • YOU CANNOT MAKE A CLIENT CHANGE – CHANGE IS THE CLIENT’S CHOICE • Client does the choosing, does the changing, and TAKES CREDIT when change occurs. WE LIVE WITH OUR CHOICES

ETHICS – a set of principles or values that provides dignity and respect to clients LEGAL ISSUES IN PSYCHIATRIC NURSING • Client Rights – Nursing Responsibility – Right to Appropriate Treatment – Right to know qualifications of those involved in treatment process – Right to receive explanations of treatment – Right to be involved in planning of own care – Right to refuse to be a part of experimental treatment methods – Right to understand the effects of prescribed medication – Right to treatment in least restrictive environment – Right to refuse treatment- decide which treatment option is best for them

Informed Consent • Explanation of client rights and unit policies to client/guardian • Signed statement of understanding/refusal to receive treatment • Explanation of insurance benefits or payment options/third-party reimbursement

Confidentiality • Client’s right – prevent written or verbal communications from being disclosed to outside parties without authorization • Required by Nurse Practice Act • HIPAA (Health Insurance Portability and Accountability Act of 1996 (2003)) – ensures that security procedures protect the privacy and confidentiality of information – client has right to know what information is disclosed, to whom, and for what purpose

Required Disclosure of Client Information • Intent to commit a crime • Duty to warn endangered persons • Evidence of child abuse • Initiation of involuntary hospitalization • Infection by HIV

Ensuring Privacy • Conduct nursing shift report in confidential area where others cannot hear what is being said • Do not discuss one client with another • Do not discuss client information via telephone (done only if privacy defined) • Always think before you act

Appeals & Grievances • Right to be informed of means to channel complaints about care/professionals providing treatment • Procedure to be followed to file a complaint to a professional board • Address of contact and procedure to appeal payment decisions

Nursing Accountability • Responsibility for own actions • Standard of Care for practice level (Nurse Practice Act) • Documentation • Client Advocate

Client Admissions- Considerations for Treatment – Client’s history – Current situation – Treatment and care needed – Inpatient vs. outpatient services – Residential facilities – Voluntary admission – Involuntary commitment • Order for Protective Custody • Court mandate (substance-abuse programs)

Seclusion and Restraint • Seclusion – placement of client in controlled environment to treat a clinical emergency • Physical restraint – use of mechanical devices to provide limited movement by client • Chemical restraint – use of medication to calm client and prevent need for physical restraint

Legal Implications • Qualifications and training of person initiating action • Physician’s order is a necessity • Facility rules and state laws • Liability for false imprisonment • Liability for assault and battery • KNOW LIMITATIONS OF THE LAW!