Copyright © 2014. F.A. Davis Company Ethical and Legal Issues in Psychiatric/ Mental Health Nursing...

Copyright © 2014. F.A. Davis Company

Ethical and Legal Issues in Psychiatric/Ethical and Legal Issues in Psychiatric/Mental Health NursingMental Health Nursing

Chapter 5Chapter 5


IntroductionIntroduction

• Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death.

• Legislation determines what is “right” or “good” within a society.


Core ConceptsCore Concepts

• Ethics is a branch of philosophy that deals with distinguishing right from wrong.

• Bioethics is a term applied to ethics when they refer to concepts within the scope of medicine, nursing, and allied health.


Core Concepts Core Concepts (cont.)(cont.)

• Moral behavior is conduct that results from serious critical thinking about how individuals ought to treat others.

• Values are personal beliefs about what is important and desirable.

• Values clarification is a process of self-exploration by which people identify and rank their own personal values.


Core Concepts Core Concepts (cont.)(cont.)

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

• Absolute right is when there is no restriction whatsoever on the individual’s entitlement.

• Legal right is a right on which thesociety has agreed and formalizedinto law.


Ethical ConsiderationsEthical Considerations

Theoretical Perspectives

• Utilitarianism is an ethical theory that promotes action based on the end result that produces the most good (happiness) for the most people.

• Kantianism suggests that decisions and actions are bound by a sense of duty.


Ethical Considerations Ethical Considerations (cont.)(cont.)

Theoretical Perspectives (cont.)•Christian ethics emphasize doing unto others as you would have them do unto you.•Natural law theories refer to doing good and avoiding evil. Human knowledge of the difference between good and evil directs decision making.•Ethical egoism refers to decisions that are based on what is best for the individual making the decision.



1. An operating room nurse asks a psychiatric nurse, “How can you work with the mentally ill day in and day out?” The psychiatric nurse replies, “It's just the right thing to do.” The psychiatric nurse is operating from which ethical framework?

A. KantianismB. Christian ethicsC. Ethical egoismD. Utilitarianism



• Correct answer: A– Kantianism focuses on the morality of actions.

Actions are judged as right or wrong based on ethical principles. The nurse’s response indicates a Kantian perspective.


Ethical DilemmasEthical Dilemmas

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

• Taking no action is considered an action taken.


EthicalEthical PrinciplesPrinciples

• Autonomy emphasizes the status of persons as autonomous moral agents whose rights to determine their destinies should always be respected.

• Beneficence refers to one’s duty to benefit or promote the good of others.


EthicalEthical Principles Principles (cont.)(cont.)

• Nonmaleficence is abstaining from negative acts toward another, includes acting carefully to avoid harm.

• Justice is a principle based on the notion of a hypothetical social contract between free, equal, and rational persons. The concept of justice reflects a duty to treat all individuals equally and fairly.

• Veracity is a principle that refers to one’s duty to always be truthful.


A Model for Making Ethical DecisionsA Model for Making Ethical Decisions

• Assessment• Problem identification• Plan• Implementation• Evaluation


Ethical Issues in Psychiatric Mental Ethical Issues in Psychiatric Mental Health NursingHealth Nursing

• The right to refuse medication• The right to the least restrictive treatment

alternative


Legal ConsiderationsLegal Considerations

• The Nurse Practice Act defines the legal parameters of professional and practical nursing.

• Types of Laws– Statutory law– Common law


Classifications Within Statutory and Classifications Within Statutory and Common LawCommon Law

• Civil law protects the private and property rights of individuals and businesses.– Torts– Contracts

• Criminal law provides protection from conduct deemed injurious to the public welfare.


Legal Issues in Psychiatric Mental Legal Issues in Psychiatric Mental Health NursingHealth Nursing

• Confidentiality and Right to Privacy- HIPAA- Doctrine of privileged communication- Exception: A duty to warn

• Informed Consent• Restraints and Seclusion

- False imprisonment


Legal Issues in Psychiatric Mental Legal Issues in Psychiatric Mental Health Nursing Health Nursing (cont.)(cont.)

• Commitment Issues– Voluntary admissions– Involuntary commitments

• Emergency commitments• The mentally ill person in need of treatment• Involuntary outpatient commitment• The gravely disabled client



Nursing Liability• Malpractice and negligence• Types of lawsuits that occur in psychiatric

nursing—Breach of confidentiality—Defamation of character

• Libel• Slander



Nursing Liability (cont.)• Invasion of privacy• Assault and battery• False imprisonment



2. As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, “I’ll sue you for assault and battery.” The unit manager determines that the nurses are protected under which condition?

A. The client is voluntarily committed and poses a danger to others on the unit.

B. The client is voluntarily committed and has a history of being a danger to others.

C. The client is involuntarily committed because of a history of violent behavior.

D. The client is involuntarily committed and is refusing treatment.



• Correct answer: A– As a threat to others, the client can be restrained

despite objections and voluntary commitment.



3. A nurse gave a client 5 mg of haloperidol (Haldol) for agitation. The client’s chart was clearly stamped “Allergic HALDOL.” The client suffered anaphylactic shock and died. How would the nurse’s actions be labeled?

A. Intentional tortB. NegligenceC. BatteryD. Assault



• Correct answer: B– The nursing action was an unreasonable and

careless act. The nurse was negligent and could be held liable for the client’s death.


Avoiding LiabilityAvoiding Liability

• Respond to the client.• Educate the client.• Comply with the standard of care.• Supervise care.• Adhere to the nursing process.• Document carefully.• Follow up as required.• Develop and maintain a good interpersonal

relationship with client and family.

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Copyright © 2014. F.A. Davis Company Ethical and Legal Issues in Psychiatric/ Mental Health Nursing...

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