Rnur134:chapter 4

Front 1

____ is the science that deals with the rightness and wrongness of actions.

Back 1

Ethics

Front 2

____ is the term applied to these principles when they refer to concepts within the scope of medicine, nursing, and allied health.

Back 2

Bioethics

Front 3

_____ behvior is defined as conduct that results from serious critical thinking about how individuals ought to treat others. Reflect the way a person interprets basic respect for other persons.

Back 3

Moral behavior

Front 4

____ are ideals or concepts that give meaning to the individuals life.

Back 4

Values

Front 5

A situation that requires an individual to make choices between two equally unfavorable alternatives causes what?

Back 5

Ethical dilemma

Front 6

What is the process of self-exporation through which individuals identify and rank their own personal values?

Back 6

Values clarification

Front 7

In ____, the 96th Congress of the United States passed the Mental Health Systems Act, which includes the Patient’s Bill of Rights-read these client rights on your own. Look for a signed copy of these rights in your psychiatric client’s chart.

Back 7

1980 Read Box 4-3

Front 8

1)____ is the science that deals with the rightness and wrongness of actions
2)____is the term applied to ethics within the concept of medicine, nursing, and allied health.
Bioethics or Ethics

Back 8

1)Ethics
2)Bioethics

Front 9

____ is the conduct that results from serious critical thinking about how individuals ought to treat others

Back 9

Moral behaviors

Front 10

_____ are ideals or concepts that give meaning to an individual’s life

Back 10

Values

Front 11

_______ _______is process of self-exploration through which individuals identify and rank their own personal values-

Back 11

Value clarification

Front 12

______ is a valid, legally recognized claim or entitlement, encompassing both freedom from government interference or discriminatory treatment and entitlement to a benefit or service

Back 12

Right

Front 13

______ is a right on which the society has agreed and formalized into law eg.5th Amendment

Back 13

Absolute right

Front 14

______ is when there is no restriction whatsoever on the individual’s entitlement

Back 14

Legal right

Front 15

__________whatever benefits society the most (greatest good)-Focus is on numbers of people

Back 15

Utilitarianism

Front 16

What motivates the choice (morally right or wrong)

Back 16

Kantianism

Front 17

______ ______treat others with respect, equally
(Do unto others as you would have them do unto you)

Back 17

Christian Ethics

Front 18

_____ law-humans are able to choose good versus evil

Back 18

Natural

Front 19

Ethical _______what is best in the individual’s interest

Back 19

Ethical egoism

Front 20

Who determines what is “right” or “good” within a society?

Back 20

Legislation

Front 21

When do ethical dilemmas occur?

Back 21

Ethical dilemmas occur when moral appeals can be made for taking either of two opposing courses of action

Front 22

1)_____ law enacted by a legislative body
2)_____ law-derived by decisions in previous cases
3)_____ law-protects property and private rights of the citizen or business
Tort-violation of civil law
Contract-implied agreement
breach of contract
4)____ law provides protection deemed injurious to public welfare
(Common, Statutory, Civil, Criminal)

Back 22

1)Statutory law
2)Common law
3)Civil law
4)Criminal law

Front 23

1)Inpatient Hospitalization

2)Outpatient Therapy-1hr/wk

3)Day Hospital/Partial Hospitalization-8 hr/day

4)Intensive Outpatient Program-4hr/day

(Most, less, least)

Back 23

1)Most
2)Least
3)Less
4)Less

Front 24

False Imprisonment

Back 24

deliberate and unauthorized confinement of a person within fixed limits by threat or force. Putting a voluntary client into restraints or seclusion when it is not a psychiatric emergency.

Front 25

Right to freedom

Back 25

from restraint( leather) or seclusion(locked room) except in an emergency situation-danger to self or others -usually violent behavior.

Front 26

What 3 things must a nurse be aware of to avoid false imprisonment.

Back 26

1)Nurse has to be cognizant of whether patient meets criteria for psych admission
2)No taking away clothes unless an elopement risk
3)No locking in room

Front 27

In 1992 AHA Patient Bill of Rights states: In psychiatry, the client has the right to refuse psych medications
Except when?

Back 27

1)in an emergency
2)client is a danger to self/others

Front 28

In 1851 the court ruled on the Cognitive Standard McNaughton Rule –stating some people “did not understand right from wrong” – which lead to what?

Back 28

insanity plea

Front 29

The following cases on lead to court to decisions that impacted mental health how?
Rouse v Cameron – pled insane to a charge of carrying a dangerous weapon and later argued in court that he was not receiving treatment

Whitree v State of New York – “lack of adequate treatment”

Wyatt v Stickney - Alabama state sued “lack of treatment - humane environment”

Back 29

Right to treatment for the mentally ill

Front 30

_______protection of client’s records and communication about hospitalization, diagnoses, lab work, etc.

Back 30

Confidentiality

Front 31

Most psychiatric hospitals never release whether the client is in the hospital except with what?

Back 31

a confidentiality number or if client has given written permission to talk to people in their charts

Front 32

Who may refuse to reveal privileged information?

Back 32

Priests
Lawyers
Psychiatrists
psychologists, nurses (in some states, but not in Missouri or Kansas)
* Not in Missouri

Front 33

Breeching Confidentiality- IS INDICATED when?

Back 33

Psych Emergency
Suicide Intent
Homicide Intent
(University of California Board of Regents vs. Tarasoff-Duty to warn 3rd parties)
Child and/or Elder Abuse is reported

Front 34

_____-is the right of an individual not to have his hospitalization acknowledged without written consent to a outside caller

Back 34

Privacy

Front 35

_____- is the right of an individual to assume that his case will not be discussed outside the bounds of the healthcare system- written records or verbal communication

Back 35

Confidentiality-In an emergency-pertinent information may be released

Front 36

In an emergency info can be released when? And nurses must do what?

Back 36

May suspend When a psychiatric emergency exists and when it is in the patient’s best interest (safety)
***Nurses must document why and when patient rights were violated for legal reasons

Front 37

Most common type of admission to a psychiatric facility is?
.

Back 37

Voluntary

Front 38

*Client fills out admission form.
*Agrees to receive treatment.
*Child under 16, parent signs consent for treatment (This is not being held against “their” will)
*Client acknowledges problems.
*Adult client can sign self out of treatment (only if not a danger to self or others- immediate harm
What type of admission?

Back 38

Voluntary admission

Front 39

If a voluntary client tells you , the psychiatric nurse that he wants to leave, what should be done?

Back 39

*Explore the reasons for the client wnating to leave, but do not try to convince them to stay!
* You must inform him of the protocol for requesting to leave, i.e., filling out a written request to his psychiatrist.
*You must immediately contact the client’s psychiatrist and inform him of the client’s wish to leave.

Front 40

*Admission does NOT originate with the client.
*Not synonymous with incompetence
*Patient who has legal competence to request treatment refuses to do so
*The patient is detained and treated without that person’s consent
*Not preferable but oftentimes is unavoidable due to dangerous behavior on patient’s part
What type of admission?

Back 40

Involuntary admission

Front 41

Patients have the right to reject treatment or accept it-they accept it by?

Back 41

signing the informed consent

Front 42

INFORMED CONSENT MUST BE SIGNED BY THE PATIENT OR LEGAL GUARDIAN UPON ADMISSION---otherwise the care provider could face?

Back 42

assault and battery unless in a psychiatric emergency

Front 43

It is a nurses job to witnessess the signature of informed consent, what must we assess?

Back 43

Must assess whether patient has made decision with:
Knowledge
Competency
Free Will
*Should report to physician, APN if client does not understand the pros/cons of the procedure
*See conditions for emergency treatment without informed consent on page 68

Front 44

COMMITMENT process is done by who?

Back 44

Varies from state to state but the leagl system is always involved. The court will usually commit the client for a specified time, usually 7 to 21 days. May be as long as a year of inpatient treatment.

Front 45

Interventions-go in order of least restrictive, list in order?
When intervening with an agitated client who is escalating one begins with a?

Back 45

Verbal Techniques
Behavioral Techniques
Chemical Interventions
Mechanical Restraints

1)verbal intervention, i.e. stop that.
2)A behavioral intervention, such as a fifteen minute room restriction is called for next.
3)A chemical intervention, such as a prn of medicine is called for next.
4)The last resort is to seclude someone in a quiet room by locking the door or to place the client in leather restraints.
Laws regarding proper usage of restraints exist to protect the psychiatric client from being falsely imprisoned.

Front 46

Definition: Being placed in a locked room, with a mattress and blanket-Room may be padded.
Indications: The client is a danger to others and other less restrictive methods have been tried unsuccessfully.

Back 46

Seclusion

Front 47

Can a nurse initiate the seclusion?

Back 47

A nurse can but:
*MD must write or give verbal order within 1 hr
*MD must perform a physical assessment on the patient within an hour
*Time limits:
(4) hours for adult
(2) hours adolescent
(1) pre-adolescent

*Nursing staff has to perform 15 min checks while person in seclusion or observe by remote TV/ face-to-face observation
*MD has to d/c seclusion order
Cautions:
Patient may start hitting head and seclusion may need to be broken and patient put into mechanical restraints

Front 48

What are the contents of a seclusion room?

Back 48

Seclusion room-only mattress on floor (should be uncovered)

Front 49

What are the time limits for a seclusion room?

Back 49

*Time limits:
(4) hours for adult
(2) hours adolescent
(1) pre-adolescent

Front 50

How often should often are the checks for a client in seclusion?

Back 50

Nursing staff has to perform 15 min checks while person in seclusion or observe by remote TV/ face-to-face observation

Front 51

What is the definition and indications for physical restraints?

Back 51

Definition: Putting a client in leather restraints that lock at various joints.
Indications: For the client who is an immediate danger to himself or others and when all other lesser restrictive measures have been attempted.

Front 52

Can a nurse initiate a physical restraint?

Back 52

A nurse may initiate the physical restraint

Front 53

With physical restranits should the mattress be covered or uncovered?

Back 53

*Mattress on floor (should be covered)

Front 54

How long with a physical restraint before a MD must give order?

Back 54

MD must write or give verbal order within 1 hr and perform a physical assessment

Front 55

Nursing staff checks should be done when and how with physical restraints?

Back 55

Nursing staff has to perform 15 min checks while person in restraints or observe by face-to-face only
MD has to d/c restraint order

Front 56

What are the time limits with physical restraints?

Back 56

Time limits: (4) hours for an adult; (2) hours for adolescent; (1) hour for pre-adolescent

Front 57

If an RN re-evaluates and feels it to be necessary for physical restraint after order has expired what must be done?

Back 57

If the RN deems necessary she must obtain another order for an additional 4 hours.
At the end of 4 hours, the MD must come and perform reassessment. The MD may then reorder restraints for up to 4 more hours

Front 58

What is the care of the client in restraints?

Back 58

*Must be on constant observation
*Monitor Vital signs in the event that client’s temperature rises (due to not sweating from antipsychotics); cardiac complications
*Hydrate client and offer sustenance
*Must provide passive ROM to all extremities
*DOCUMENT STATUS OF CLIENT q 15 minutes while in restraints

Front 59

____is the failure of one rendering professional services to conform to practice standards with the result of injury, loss, or damage to the recipient.

Back 59

Malpractice

Front 60

_______ is the action is weighed against what a reasonably prudent professional would have done under similar circumstances

Back 60

Negligence

Front 61

What must a patient demonstrate for an involuntary commitment?

Back 61

The patient must demonstrate behavior that is clearly and imminently dangerous to self or others

Front 62

Who can initiate involuntary commitment?

Back 62

Initiated by friends, police, court, or health care professional (must being willing to testify in court – testimony is in the form of an affidavit

Front 63

With involuntary commitment there must be a court hearing within what amount of time?

Back 63

Must have a court hearing within a specified period of time (96 hours)

Front 64

If it is found that there was not a legal reason to detain the patient, who is liable?

Back 64

The healthcare provider/ facility is liable

Front 65

Emergency care and evaluation in the state of Missouri, is called a “96 hour hold” for individuals who are?

Back 65

*dangerous to SELF
*dangerous to OTHERS
*gravely disabled
*Nurses must adhere to time constraints or could be held liable for false imprisonment

Front 66

When an individual is unable to take care of his basic personal needs. Is unable to provide food, clothing, and shelter for oneself. The psychotic individual can fall into this category.
This person would be considered?

Back 66

Gravely disabled-- often means that the patient is declared “legally incompetent”

Front 67

Conservatorship

Back 67

*The patient is appointed a legal guardian or conservator/DPOA

*Nurses must gain conservator’s consent for treatment

*May be called a Legal Guardian

Front 68

Missouri additionally has an outpatient commitment law (usually for ETOH)
the client can be conditionally released from an inpatient facility to an outpatient facility by the judge for up to 180 days of outpatient detention
if the client does not keep outpatient appointments he/she can be?

Back 68

court mandated to the inpatient psychiatric setting

Front 69

Libel

Back 69

written defamation of character

Front 70

Slander

Back 70

oral defamation of character

Front 71

False imprisonment

Back 71

intent to confine a person to a specific area ** if client wants to leave hospital

Front 72

harmful or offensive touching of another

Back 72

Battery

Front 73

no physical contact- must have opportunity & ability to carry out a threat

Back 73

Assault

Front 74

Tarasoff Warning (1976)

Back 74

A stalking case leading to homicide

Front 75

If a nurse is aware of a patient threating to harm themselves or another what should be done?

Back 75

*Nurses who are aware of threats by patients to harm themselves or others have a legal duty to warn
*Must document the threat
*Must immediately inform psychiatrist and/or patient’s therapist.

Front 76

How can a psychiatric nurse prevent lawsuits?

Back 76

A. Follow all safety / suicide precautions according to hospital policy
B. Medications, careful administration and recording.
C. Clear, concise documentation - all areas.*If it is not documented it is not done !
D. Good communication with client and healthcare team.
E. Practice within scope of nurse practice act.
F Follow accepted standards of practice.
H. Know rights of clients.
I. Maintain client confidentiality.
J. Seek legal counsel if necessary.
K. Consider Malpractice Insurance