PREPARED PRESENTED BY Instructor Safi Dakhil Nawam University
PREPARED & PRESENTED BY Instructor /Safi Dakhil Nawam University of Karbala / college of nursing 2016 -2017 Psychiatric–Mental Health Nursing FIFTHEDITION Instructor / Safi Dakhil Nawam/College of nursing/ University of Karbala 1 6/12/2021
CORECONCEPTS • • • 2 Bioethics Moral behavior Values clarification Right Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Objectives After reading this chapter, the student will be able to: 1. Differentiate among ethics, morals, values, and rights. 2. Discuss ethical theories including utilitarianism, Kantianism, Christian ethics, natural law theories, and ethical egoism. 3. Define ethical dilemma. 4. Discuss the ethical principles of autonomy, beneficence, non-maleficence, justice, and veracity. 5. Use an ethical decision-making model to make an ethical decision. 6. Describe ethical issues relevant to psychiatric/mental health nursing. 7. Define statutory law and common law. 8. Differentiate between civil and criminal law. 9. Discuss legal issues relevant to psychiatric/ mental health nursing. 10. Differentiate between malpractice and negligence. 11. Identify behaviors relevant to the psychiatric/ mental health setting for which specific malpractice action could be taken. 3 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Core concept • • • 4 Ethics Bioethics Moral behavior Values clarification A right Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
1. Ethics is the science that deals with the rightness and wrongness of actions (Aiken, 2004). 2. Bioethics is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health. 3. Moral behavior is defined as conduct that results from serious critical thinking about how individuals ought to treat others. Moral behavior reflects the way a person interprets basic respect for other persons, such as the respect for autonomy, freedom, justice, honesty, and confidentiality (Pappas, 2003). 4. Values are ideals or concepts that give meaning to the individual’s life (Aiken, 2004). 5 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
5. Values clarification is a process of self-exploration through which individuals identify and rank their own personal values. This process increases awareness about why individuals behave in certain ways. Values clarification is important in nursing to increase understanding about why certain choices and decisions are made over others and how values affect nursing outcomes. 6. A right is defined as, “a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and an entitlement to a benefit or service. ” (Levy and Rubenstein, 1996). A right is absolute when there is no restriction whatsoever on the individual’s entitlement. A legal right is one on which the society has agreed and formalized into law. Both the National League for Nursing (NLN) and the American Hospital Association (AHA) have established guidelines of patients’ rights. Although these are not considered legal documents, nurses and hospitals are considered responsible for upholding these rights of patients 6 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical considerations theoretical perspectives • An ethical theory is a moral principle or a set of moral principles that can be used in assessing what is morally right or morally wrong (Ellis & Hartley, 2004). These principles provide guidelines for ethical decision making. Utilitarianism • The basis of utilitarianism is “the greatest-happiness principle. ” • This principle holds that actions are right in proportion, as they tend to promote happiness, and wrong as they tend to produce the reverse of happiness. • Thus, the good is happiness, and the right is that which promotes the good. • Conversely, the wrongness of an action is determined by its tendency to bring about unhappiness. • A second principle of utilitarianism is “the end justifies the means. ” An ethical decision based on the utilitarian view would look at the results of the decision. Action is taken based on the results that produced the most good (happiness) for the most people. 7 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Kantianism • Named for philosopher Immanuel Kant, Kantianism is directly opposed to utilitarianism. • Kant argued that it is not the consequences or end results that make an action right or wrong; rather it is the principle or motivation on which the action is based that is the morally decisive factor. • Kantianism suggests that our actions are bound by a sense of duty. • This theory is often called deontology (from the Greek word deon, which means “that which is binding; duty”). • Kantian-directed ethical decisions are made out of respect for moral law. • For example, “I make this choice because it is morally right and my duty to do so” (not because of consideration for a possible outcome). 8 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Christian Ethics • A basic principle that might be called a Christian philosophy is that which is known as the golden rule: “Do unto others as you would have them do unto you” and, alternatively, “Do not do unto others what you would not have them do unto you. ” The imperative demand of Christian ethics is to treat others as moral equals and to recognize the equality of other persons by permitting them to act as we do when they occupy a position similar to ours. 9 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Natural Law Theories • The most general moral precept of the natural law theory is “do good and avoid evil. ” Natural law theorists contend, then, that ethics must be grounded in a concern for the human good. • Although the nature of this “human good” is not explained, catholic theologians view natural law as the law inscribed by god into the nature of things— as a species of divine law. • It is with this ability to reason that humans are able to choose “good” over “evil. ” In natural law, evil acts are never condoned, even if they are intended to advance the noblest of ends. 10 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Egoism • Ethical egoism promotes that what is right and good is what is best for the individual making the decision. • An individual’s actions are determined by what is to his or her own advantage. • The action may not be best for anyone else involved, but consideration is only for the individual making the decision. 11 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Dilemmas An ethical dilemma is a situation that requires an individual to make a choice between two equally unfavorable alternatives (Catalano, 2006). 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems. 2. The nurse’s primary commitment is to the patient whether an individual, family, group or community. 3. The nurse promotes, advocates for and strives to protect the health, safety and rights of the patient. 12 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Dilemmas cont. • The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care. • The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence and to continue personal and professional growth. • The nurse participates in establishing, maintaining and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. 13 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Dilemmas cont. • 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. • 8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs. • 9. The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice and for shaping social policy. Source: Reprinted with permission from American Nurses Association. • Code of Ethics for Nurses with Interpretive Statements, © 2001 American Nurses Publishing, American Nurses 14 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Principles Ethical principles are fundamental guidelines that influence decision-making. The ethical principles of: • Autonomy • Beneficence • Non-maleficence • Veracity • Justice are helpful and used frequently by health care workers to assist with ethical decision-making. 15 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Autonomy • The principle of autonomy arises from the Kantian duty of respect for persons as rational agents. • This viewpoint emphasizes the status of persons as autonomous moral agents whose right to determine their destinies should always be respected. • This presumes that individuals are always capable of making independent choices for themselves. • Health care workers know this is not always the case. • Children, comatose individuals, and the seriously mentally ill are examples of clients who are incapable of making informed choices. • In these instances, a representative of the individual is usually asked to intervene and give consent. • However, health care workers must ensure that respect for an individual’s autonomy is not disregarded in favor of what another person may view as best for the client. 16 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Beneficence • Beneficence refers to one’s duty to benefit or promote the good of others. • Health care workers who act in their clients’ interests are beneficent, provided their actions really do serve the client’s best interest. • In fact, some duties do seem to take preference over other duties. • For example, the duty to respect the autonomy of an individual may be overridden when that individual has been deemed harmful to self or others. • Aiken (2004) states, “The difficulty that sometimes arises in implementing the principle of beneficence lies in determining what exactly is good for another and who can best make the decision about this good. ” 17 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Beneficence cont. • Peplau (1991) recognized client advocacy as an essential role for the psychiatric nurse. • The term advocacy means acting in another’s behalf—being a supporter or defender. • Being a client advocate in psychiatric nursing means helping the client fulfill needs that, without assistance and because of illness, may go unfulfilled. • Individuals with mental illness are not always able to speak for themselves. • Nurses serve as advocates to protect the client’s rights and interests. • Strategies include educating clients and their families about their legal rights, ensuring that clients have sufficient information to make informed decisions or to give informed consent, and assisting clients to consider alternatives and supporting them in the decisions they make. • In addition, nurses may act as advocates by speaking on behalf of individuals with mental illness to secure essential mental health services. 18 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Non-maleficence • Nonmaleficence is the requirement that health care providers do no harm to their clients, either intentionally or unintentionally (Aiken, 2004). • Some philosophers suggest that this principle is more important than beneficence; that is, they support the notion that it is more important to avoid doing harm than it is to do good. • In any event, ethical dilemmas often arise when a conflict exists between an individual’s rights (the duty to promote good) and what is thought to best represent the welfare of the individual (the duty to do no harm). • `An example of this conflict might occur when administering chemotherapy to a cancer patient, knowing it will prolong his or her life, but create “harm” (side effects) in the short term. 19 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Justice • The principle of justice has been referred to as the “justice as fairness” principle. • It is sometimes referred to as distributive justice, and its basic premise lies with the right of individuals to be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief (Aiken, 2004). • The concept of justice reflects a duty to treat all individuals equally and fairly. • When applied to health care, this principle suggests that all resources within the society (including health care services) ought to be distributed evenly without respect to socioeconomic status. • Thus, according to this principle, the vast disparity ﺗﺒﺎﻳﻦ ﻭﺍﺳﻊ in the quality of care dispensed to the various classes within our society would be considered unjust. 20 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
ﺍﻟﺼﺪﻕ Veracity • The principle of veracity refers to one’s duty to always be truthful. • Aiken (2004) states, “Veracity requires that the health care provider tell the truth and not intentionally deceive ﻏﺎﻟﻂ or mislead ﺧﺪﻉ clients. ” • There are times when limitations must be placed on this principle, such as when the truth would knowingly produce harm or interfere with the recovery process. • Being honest is not always easy, but lying is rarely justified. ﻣﺒﺮﺭ • Clients have the right to know about their diagnosis, treatment, and prognosis. 21 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
A Model for Making Ethical Decisions The following is a set of steps that may be used in making an ethical decision. These steps closely resemble the steps of the nursing process. 1. Assessment. Gather the subjective and objective data about a situation. Consider personal values as well as values of others involved in the ethical dilemma. 2. Problem Identification. Identify the conflict between two or more alternative actions. 3. Plan. (a) Explore the benefits and consequences of each alternative. (b) Consider principles of ethical theories. (c) Select an alternative. 4. Implementation. Act on the decision made and communicate the decision to others. 5. Evaluation. Evaluate outcome. 22 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Issues in Psychiatric/ Mental Health Nursing • The Right to Refuse Medication • • • 1. 2. 23 “The patient has the right to refuse treatment to the extent permitted by law, and to be informed of the medical consequences of his action. ” In psychiatry, refusal of treatment primarily concerns the administration of psychotropic medications. “To the extent permitted by law” may be defined within the U. S. Constitution and several of its amendments (e. g. , the First Amendment, which addresses the rights of speech, thought, and expression; The Eighth Amendment, which grants the right to freedom from cruel and unusual punishment; and the Fifth and Fourteenth Amendments, of law and equal protection for all). Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Issues in Psychiatric/ Mental Health Nursing cont. In psychiatry, “the medical consequences of his action” may include such steps as: • Involuntary commitment • legal competency hearing • Client discharge from the hospital. • Although many courts support a client’s right to refuse medications in the psychiatric area, some limitations do exist. Weiss-Kaffie and Purtell (2001) state: The treatment team must determine that three criteria be met to force medication without client consent. 1. The client must exhibit behavior that is dangerous to self or others 2. The medication ordered by the physician must have a reasonable chance of providing help to the client 3. The clients who refuse medication must be judged incompetent to evaluate the benefits of the treatment in question. 24 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Ethical Issues in Psychiatric/ Mental Health Nursing cont. The Right to the Least-Restrictive Treatment Alternative • Health care personnel must attempt to provide treatment in a manner that least restricts the freedom of clients. • The “restrictiveness” of psychiatric therapy can be described in the context of a continuum, based on severity of illness. • Clients may be treated on an outpatient basis, in day hospitals, or in voluntary or involuntary hospitalization. • Symptoms may be treated with verbal rehabilitation techniques and move successively to behavioral techniques, chemical interventions, mechanical restraints, or electroconvulsive therapy. • The problem appears to arise in selecting the least restrictive means among involuntary chemical intervention, seclusion, and mechanical restraints. 25 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
LEGAL CONSIDERATIONS • In 1980, the 96 th Congress of the United States passed the Mental Health Systems Act, which includes a Patient’s Bill of Rights, for recommendation to the States. 26 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Bill of Rights for Psychiatric Patients 1. The right to appropriate treatment and related services in the setting that is most supportive and least restrictive to personal freedom. 2. The right to an individualized, written treatment or service plan; the right to treatment based on such a plan; and the right to periodic review and revision of the plan based on treatment needs. 3. The right, consistent with one’s capabilities, to participate in and receive a reasonable explanation of the care and treatment process. 4. The right to refuse treatment except in an emergency situation or as permitted by law. 5. The right not to participate in experimentation in the absence of informed, voluntary, written consent. 6. The right to freedom from restraint or seclusion except in an emergency situation. 27 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Bill of Rights for Psychiatric Patients cont. 1. 2. 3. 4. 5. 6. 7. 28 The right to a humane treatment environment that affords reasonable protection from harm and appropriate privacy. The right to confidentiality of medical records (also applicable following patient’s discharge). The right of access to medical records except information received from third parties under promise of confidentiality, and when access would be detrimental to the patient’s health (also applicable following the patient’s discharge). The right of access to use of the telephone, personal mail, and visitors, unless deemed inappropriate for treatment purposes. The right to be informed of these rights in comprehensible language. The right to assert grievances if rights are infringed. The right to referral as appropriate to other providers of mental health services upon discharge. Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Nurse Practice Acts The legal parameters of professional and practical nursing are defined within each state by the state’s nurse practice act. These documents are passed by the state legislature and in general are concerned with such provisions as the following: 1. The definition of important terms, including the definition of nursing and the various types of nurses recognized 2. A statement of the education and other training or requirements for licensure and reciprocity 3. Broad statements that describe the scope of practice for various levels of nursing (APN, RN, LPN) 4. Conditions under which a nurse’s license may be suspended or revoked, and instructions for appeal 5. The general authority and powers of the state board of nursing (Fedorka & Resnick, 2001). 29 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Types of law There are two general categories or types of law that are of most concern to nurses: • statutory law • common law These laws are identified by their source or origin. 30 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Statutory Law A statutory law is a law that has been enacted by a legislative body, such as a county or city council, state legislature, or the Congress of the United States. • An example of statutory law is the nurse practice acts. 31 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Common Law Common laws are derived from decisions made in previous cases. • These laws apply to a body of principles that evolve from court decisions resolving various controversies. • Because common law in the United States has been developed on a state basis, the law on specific subjects may differ from state to state. • An example of a common law might be how different states deal with a nurse’s refusal to provide care for a specific client. 32 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Classifications Within Statutory and Common Law Broadly speaking, there are two kinds of unlawful acts: civil and criminal. Both statutory law and common law have civil and criminal components. • Civil Law • Civil law protects the private and property rights of individuals and businesses. • Private individuals or groups may bring a legal action to court for breach of civil law. • These legal actions are of two basic types: 1. Torts 2. Contracts 33 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Legal Issues in Psychiatric/ Mental Health Nursing Confidentiality and Right to Privacy • An individual’s privacy is protected by the Fourth, Fifth, and Fourteenth Amendments to the U. S. Constitution. • Most states have statutes protecting the confidentiality of client records and communications. • The only individuals who have a right to observe a client or have access to medical information are those involved in his or her medical care. 34 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Right to confidentiality • The right to confidentiality is a basic one, and especially so in psychiatry. • Although societal attitudes are improving, individuals have experienced discrimination in the past for no other reason than for having a history of emotional illness. • Nurses working in psychiatry must protector the privacy of their clients with great diligence ﺣﺪ. 35 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Informed Consent • According to law, all individuals have the right to decide whether to accept or reject treatment (Guido, 2006). • A health care provider can be charged with assault and battery for providing life-sustaining treatment to a client when the client has not agreed to it. • The rationale for the doctrine of informed consent is the protection and of individual autonomy in determining what will and will not happen to the person’s body (Guido, 2006). 36 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Informed Consent cont. • Informed consent is a client’s permission granted to a physician to perform a therapeutic procedure, before which information about the procedure has been presented to the client with adequate time given for consideration about the pros and cons. • The client should receive information such as what treatment alternatives are available; why the physician believes this treatment is most appropriate; the possible outcomes, risks, and adverse effects; the possible outcome should the client select another treatment alternative; and the possible outcome should the client choose to have no treatment. • An example of a treatment in the psychiatric area that requires informed 37 Assistant teachertherapy. / Safi Dakhil consent is electroconvulsive (ECT) Nawam/College of nursing/ University of Karbala 6/12/2021
Informed Consent cont. There are some conditions under which treatment may be performed without obtaining informed consent. A client’s refusal to accept treatment may be challenged under the following circumstances: 1. When a client is mentally incompetent to make a decision and treatment is necessary to preserve life or avoid serious harm. 2. When refusing treatment endangers the life or health of another. 3. During an emergency, in which a client is in no condition to exercise judgment. 4. When the client is a child (consent is obtained from parent or surrogate). 5. In the case of therapeutic privilege. In therapeutic privilege, information about a treatment may be withheld if the physician can show that full disclosure would hinder or complicate necessary treatment, cause severe psychological harm, or be so upsetting as to render a rational decision by the client impossible. 38 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Restraints and Seclusion • In psychiatry, the term restraints generally refers to a set of leather straps that are used to restrain the extremities of an individual whose behavior is out of control and who poses an inherent risk to the physical safety and psychological well-being of the individual and staff Restraints are never to be used as punishment or for the convenience of staff. • Other measures to decrease agitation, such as “talking down” (verbal intervention) • Chemical restraints (tranquilizing medication) are usually tried first. • If these interventions are ineffective, mechanical restraints may be instituted. 39 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Seclusion • Seclusion is another type of physical restraint in which the client is confined alone in a room from which he or she is unable to leave. • The room is usually minimally furnished with items to promote the client’s comfort and safety. 40 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
False imprisonment ﺍﻟﺴﺠﻦ ﺍﻟﺒﺎﻃﻞ • False imprisonment is the deliberate and unauthorized confinement of a person within fixed limits by the use of verbal or physical means (Ellis & Hartley, 2004). • Health care workers may be charged with false imprisonment for restraining or secluding— against the wishes of the client—anyone having been admitted to the hospital voluntarily. 41 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Commitment Issues Voluntary Admissions • Each year, more than 1 million persons are admitted to health care facilities for psychiatric treatment, of which approximately two-thirds are considered voluntary. • To be admitted voluntarily, an individual makes direct application to the institution for services and may stay as long as treatment is deemed necessary. • He or she may sign out of the treatment facility at any time, unless the health care professional determines, following a mental status examination, that the client may be harmful to self or others and recommends that the admission status be changed from voluntary to involuntary. • Although these types of admissions are considered voluntary, it is important to ensure that the individual comprehends the meaning of his or her actions, has not been coerced in any manner, and is willing to proceed with admission. 42 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Involuntary Commitment • Involuntary commitments are made for various reasons. Most states commonly cite the following criteria: ● In an emergency situation (for the client who is dangerous to self or others) ● For observation and treatment of mentally ill persons ● When an individual is unable to take care of basic personal needs (the “gravely disabled”) 43 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Nursing Liability • Mental health practitioners—psychiatrists, psychologists, psychiatric nurses, and social workers—have a duty to provide appropriate care based on the standards of their professions and the standards set by law. • Malpractice and Negligence The terms malpractice and negligence are often used interchangeably. • Negligence has been defined as: The failure to exercise the standard of care that a reasonably prudent person would have exercised in a similar situation • Black’s Law Dictionary defines malpractice as: An instance of negligence or incompetence on the part of a professional. • To succeed in a malpractice claim, a plaintiff must also prove proximate cause and damages. 44 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Nursing Liability cont. Marchand (2001) cites the following basic elements of a nursing malpractice lawsuit: • The existence of a duty, owed by the nurse to a patient, to conform to a recognized standard of care • A failure to conform to the required nursing standard of care • Actual injury • A reasonably close causal connection between the nurse’s conduct and the patient’s injury 45 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Types of Lawsuits that Occur in Psychiatric Nursing malpractice Most malpractice suits against nurses are civil actions; that is, they are considered breach of conduct actions on the part of the professional, for which compensation is being sought. • The nurse in the psychiatric setting should be aware of the types of behaviors that may result in charges of malpractice. 46 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Types of Lawsuits that Occur in Psychiatric Nursing breach of confidentiality Basic to the psychiatric client’s hospitalization is his or her right to confidentiality and privacy. • A nurse may be charged with breach of confidentiality for revealing aspects about a client’s case, or even for revealing that an individual has been hospitalized, if that person can show that making this information known resulted in harm. 47 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Invasion of privacy is a charge that may result when a client is searched without probable cause. • Many institutions conduct body searches on mental clients as a routine intervention. • In these cases, there should be a physician’s order and written rationale showing probable cause for the intervention. 48 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Types of Lawsuits that Occur in Psychiatric Nursing Assault • Assault is an act that results in a person’s genuine fear and apprehension that he or she will be touched without consent. • Battery is the touching of another person without consent. • These charges can result when a treatment is administered to a client against his or her wishes and outside of an emergency situation. • Harm or injury need not have occurred for these charges to be legitimate. 49 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
Avoiding Liability Hall and Hall (2001) suggest the following proactive nursing actions in an effort to avoid nursing malpractice: ● Responding to the patient ● Educating the patient ● Complying with the standard of care ● Supervising care ● Adhering to the nursing process ● Documentation ● Follow-up 50 Assistant teacher / Safi Dakhil Nawam/College of nursing/ University of Karbala 6/12/2021
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