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64 Cards in this Set
- Front
- Back
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what is the main act for mental health in nz? |
Mental Health Act 1992 |
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what is the act for in summary? |
- a tool to protect people from themselves, and the public from harm - protects client's rights - allows for reviews and judicial enquiries - force people to have assessment/treatment when they have little understanding of the need for it |
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what do we need to be aware of as nurses when unwillingly putting someone under the act? |
- loss of autonomy - disempowerment - loss of control - feeling rejected by family or friends - feeling useless |
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patients under the act have the same rights as anyone else as per the... |
Code of Rights |
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what can be done under specific circumstances if that is not appropriate? |
with hold some rights under the MHA92 |
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what is section 2 of the MHA about? |
legal definition of mental disorder |
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what criteria must be met under section 2? |
must meet definition of mental disorder to a degree that it a) poses a serious danger to the health or safety of that person or others or b) seriously diminishes capacity to take care of themselves |
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what is section 4 about? |
excluding circumstances unrelated to mental health |
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such as? |
a. political, religious, cultural beliefs b. sexual preferences c. criminal or delinquent behaviour d. substance abuse e. intellectual disability |
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what is section 8a? |
application for assessment |
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implication of 8a? |
- any person over 18 can fill out form - must've seen potential patient in last 36 hours - must state relationship, and grounds for application |
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what is section 8b? |
issue of medical certificate |
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implication of 8b? |
must not be related and must be a medical doctor |
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what is 9? |
notice to attend an examination |
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implications of 9? |
- told to present for assessment by DAHMS or DAO - assessment carried out by psychiatrist approved under DAHMS - can take to a secure place |
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what is section 10? |
cert. of preliminary assessment |
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implications of 10? |
- certificate proposes further assessment - copy must be given to pt., welfare guardian, applicant, principal caregiver, and gp |
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what are section 11/12 about? |
further assessment for up to 5 days |
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implications of 11/12? |
- decision made to assess as inpatient or outpatient - can be directed to stay at home or go to hospital for assessment period - can grant leave of up to 8 hours in this period - can decide they don't need compulsory treatment |
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what is section 13? |
further assessment and treatment for 14 days |
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what are implication of section 13? |
same as 11/12 but can introduce compulsory treatment |
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what is section 14? |
cert. of final assessment |
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implications of 14? |
- must be completed before expiry of s. 13 - applies to court for compulsory treatment order or releases - copies given to all involved |
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what is section 15? |
status of pt. pending determination of application |
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implications of 15? |
continued assess and treatment for further 14 day until reviewed by a judge |
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what is 16 |
review of condition by judge |
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implications of 16 |
- family court judge consult with clinician and RN usually - judge decide to apply for compulsory treatment order or release - if cto app. made it goes to district court udge |
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what is 29? |
community treatment order |
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what is a community treatment order? |
- pt must attend place of residence or some other place for treatment - allows for drs and nurses to enter residence to administer treatment - cant be directed to hosp. for 14 days if relapse and reassessed under 13 and 14 |
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what is 30? |
in-patient treatment order |
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implications of 30? |
- pt. must reside in hospital as in-patient - after 6 months can be made indefinite order (pt. doesn't have to attend judge's reviews unless they ask for one). - responsible clinician can review and change to 29 or discharge at any time. - involuntary status |
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what is s31? |
leave for in-patients. |
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implications of s31? |
- leave for up to 3 months - can be cancelled at any time by responsible clinician if pt. safety/deterioration becomes of concern |
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what is s59? |
consent treatment while subject to a CTO |
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implications of 59 |
- consent sought although treatment is authorised against will |
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what is s79 |
clinical reviews |
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implications of 76 |
- review of compulsory status no later than 30 days after order put in place - thereafter at intervals of no later than 6 months |
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what is s79? |
tribunal reviews |
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implications if 79? |
- pt. can apply for tribunal review of CTO - can be declined if pt. been seen in last 3 months |
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what is s111? |
powers of the nurse |
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implications of 111? |
- allows RN's to restrain and seclude in-patients (informal) who are assessed as being at serious risk to self and/or others as per s.2 - not currently under the Act |
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what does informal mean? |
person is there of their own free will and having assessment and treatment voluntarily, not under MHA 1992 and can leave freely |
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what could you do if you have an informal client wanting to leave but they appear very confused, experiencing bad thoughts, and want to harm themselves? |
two ways to manage in in-client setting: - begin MHA proceedings with sections 8 to 10 being implemented immediately - use section 111 of MHA |
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what are some of the nurse's responsibilities (2.1) under the Act? |
- ensure family informed of admission (where applicable) - gain disclosure info from client - observe privacy - explain situation/orientate - check for pets/dependents - ensure they are aware of rights - check for cultural/spiritual sensitivities - ensure accurate documentation |
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cont... |
- find out what will make them comfortable - maintain safety of client and others - be aware of their legal status (informal vs. formal) |
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what are some of the 2.2 patient's rights? |
- rights to information - respect for cultural identity - right to treatment - right to be informed about treatment - right to independent psychiatric advice - right to legal advice - right to company, and seclusion |
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cont.. |
- right to receive visitors and make phone calls - right to receive post - right to send post - right to complain |
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under special circumstances what can we do with these rights? |
revoke some of them with consideration for beneficence |
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what is another important act in mental health? |
Privacy Act 1993 |
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do client's have the right to refuse disclosure of information to family/Whanau? |
yes |
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can this be overruled? and if so, in what instance |
if it's in the best interest of the client
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what is ethics concerned with? |
human action what we should do, and what our beliefs are about right and wrong |
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what is beneficence? |
doing good |
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definition of restraint? |
the use of any intervention by a staff member that limits a consumers normal freedom of movement |
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what are some examples of types of restraint? |
- personal restraint - physical restraint - environmental restraint - seclusion - chemical restraint |
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what is personal restraint? |
staff member uses their body to intentionally limit the movement of a consumer eg. being held
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what is physical restraint? |
use of mechanical restraints such as handcuffs, straight bed bars etc. |
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what is environmental restraint? |
locked buildings, where the client cannot freely exit the building/environment |
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what is seclusion? |
where a client cannot freely exit a room |
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what is chemical restraint? |
the use of medication to specifically sedate a person |
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when is the only times seclusion may be used legally? |
- when safety is a serious concern - patient is psychotic, or extremely angry with potential to be violent to others - must be let out of seclusion when the no longer pose risk of harm |
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when should seclusion NOT be used? |
- a routine for admission - with people feeling suicidal - as a sin bin - as punishment or threat - in cases where known physical health is of concern |
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how can seclusion feel for a patient? |
- frightening - disempowering - degrading - overwhelming - sometimes like a sanctuary |
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how can we as nurses reduce the feeling of powerlessness that is often associated with seclusion |
- stay calm, talk through process, use minimal force - be respectful - explain staff goals - explain reasons for seclusion |
