Legal and Ethical Aspects for the Mental Health Nurse (Nursing)

by Brenda Marshall, EdD, MSN, RN

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    00:01 Let's take a minute to consider the fact that it's not just the codes in the hospital.

    00:07 It's just not our scope of action and our scope of nursing that we have to be responsible to.

    00:15 We have to be responsible to federal and state laws.

    00:20 Our patients have rights.

    00:22 Psychiatric patients have special rights.

    00:26 They have patient rights, that are going to protect them.

    00:31 They have the right of self-determination.

    00:33 Just because we might think something is good for them does not mean that they must do what we tell them to do.

    00:41 They have self-determined behavior.

    00:44 If they want to refuse some treatment, they have the right to refuse.

    00:50 If they want to refuse a medication, they have the right to refuse.

    00:57 If we want to do a specific kind of therapy or something else with them, we must get informed consent even more about that.

    01:11 It's not just legal.

    01:13 It's ethical.

    01:16 And when we think of ethics, we're thinking about moral issues of what is right and what is wrong.

    01:24 And there are rules, regulations, and laws to make sure that as caregivers, we are providing care that is not only legal but ethical.

    01:39 Meaning, there's a level of autonomy that our patient has over his or her life over their person, over their future, that we are going to act in their best interest.

    01:54 We are going to act with beneficence.

    01:57 We are going to do no harm.

    02:01 We are going to do good.

    02:04 And we are going to be just.

    02:07 We are going to be just.

    02:09 We are not going to say this person has no insurance.

    02:12 Therefore, I'm going to make sure that this person doesn't get onto that nice floor that has flowers.

    02:20 And I'm going to make sure this person goes to a different hospital because there's no insurance, or perhaps they don't have legal status.

    02:29 Justice means every patient is treated the same bias, that we are not passing a judgment on someone because of their race, religion, income, social standing.

    02:46 And veracity.

    02:47 We're going to tell the truth.

    02:49 We're going to make sure that what we are telling our clients and our patients is the truth that we are going to stay on the right side of ethics.

    03:02 Anything a patient says to us as a professional is considered privileged communication.

    03:11 In certain situations, that privileged communication between you and the patient takes a second seat.

    03:21 And that means if there's a duty to warn.

    03:26 If a person tells you that they're going to leave the hospital and they're going home to kill their husband who has been abusive.

    03:35 You have a duty to warn.

    03:38 You have to make sure that that person before they are ever discharged is reevaluated and that someone warns the person who is going to be the victim of a crime.

    03:55 If it is a child or an elderly person who is telling you, if a child says, "Yes, my cousin touched me inappropriately and had sex with me." And that child is only six years old.

    04:15 You want to protect that child, that child needs protection from that adult.

    04:20 And by bringing that to the adult who has molested the child or to someone who has hurt a child.

    04:31 You might actually be increasing that child's likelihood of being further hurt.

    04:38 And so, in that we have a duty to warn the law.

    04:43 We have to protect that child.

    04:46 At that point, we call in our social worker.

    04:49 We make sure the social worker comes in and does a full evaluation.

    04:55 Same thing, if it's an elderly person who is being abused, either in a home or in an extended care facility.

    05:04 As soon as you see any kind of bruises, anything that might tell you that this child or this older person is in need of an evaluation for abuse, you call in the specialty team for abuse.

    05:23 We must be able to get informed consent if a person is going to go for electroconvulsive therapy, for example, ECT.

    05:33 They must sign consent for that because it is an invasive procedure.

    05:40 When we are going to have to use restraints on someone or we are going to have to put someone in seclusion, it's very important to know both your hospital policy as well as your state policy.

    05:56 Because in different places, there are different policies and laws.

    06:02 And you want to make sure that whatever the restraints are that you're using that they meet code.

    06:08 You want to make sure that that person is being evaluated on the timeframe that is required by law and that the seclusion is being done in a way that is safe.

    06:21 Remember, safe, this is all about safety.

    06:24 You want to keep that patient safe while in restraints, also, while in seclusion.

    About the Lecture

    The lecture Legal and Ethical Aspects for the Mental Health Nurse (Nursing) by Brenda Marshall, EdD, MSN, RN is from the course Accessing Acute Psychiatric Care (Nursing).

    Included Quiz Questions

    1. Justice
    2. Autonomy
    3. Beneficence
    4. Veracity
    1. The adult client who states, "I have a plan on killing my father."
    2. The client who endorses engaging in an affair with the neighbor.
    3. The client who reports, "I have a plan on divorcing my spouse."
    4. The adult client who verbalizes, "My friend hit me but I don't want to take any action at this time."

    Author of lecture Legal and Ethical Aspects for the Mental Health Nurse (Nursing)

     Brenda Marshall, EdD, MSN, RN

    Brenda Marshall, EdD, MSN, RN

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