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Ethical/Legal Issues & Culture
Transcript of Ethical/Legal Issues & Culture
Ethical & Legal Issues
Ethical Core Concepts
Ethical Principles: Guide decision-making process
Nurses have topped the Gallup Poll as the "most trusted profession" in the last 12 years, with the exception of 2011, where firefighters were ranked #1. (Gallop Poll, 2012).
ANA Code of Ethics (p. 59)
"Provides a framework from which nurses in any setting can engage in ethical analysis and decision-making," (ANA, 2012)
Ethics is the science of rightness and wrongness of actions
Moral Behavior is conduct that results from critical thinking about how to treat others
Values are ideas or concepts that give meaning to the individual's life
Rights are valid, legally recognized claim or entitlement
Utilitarianism=Happiness for the most people
Kantianism=Actions based on sense of duty (or motivation)
Natural Law=Do good, avoid evil
Ethical egoism=Whatever is right for the individual making the decision
Ethical Dilemma: Choice must be made between unfavorable alternatives
Autonomy: Respect for persons
Beneficence: Promote the good of others (advocacy)
Nonmaleficence: Do no harm
Justice: Treating all individuals equally & fairly
Veracity: Always be truthful
Making Ethical Decisions=Nursing Process
Client Admission & Commitment Issues
"Rights" in Mental Health
Right to Refuse Medication (1992)
Right to Least-Restrictive Treatment (1969)
Bill of Rights for Psychiatric Patients (1980)
Right to Refuse Treatment/Informed Consent (1975)
Right to Aftercare/Follow-up Care
Types of Laws
Nurse Practice Act
Statutory=Enacted by legislation
Common Law=Previous cases
Civil Law: Protects rights of individuals/businesses
Torts: Wrongful action/harm
Contracts: Failing to fulfill obligation
Criminal Law:Protects public welfare
Right to Confidentiality/Privacy=HIPPA (1996)
Exception=Duty to Warn!!! (p. 67)
Mr. P vs. Ms T
Client deemed dangerous to self/others
In need of treatment
Involuntary Outpatient Commitment
Inability to provide/care for self
Guardian appointed by law
Malpractice, Negligence, Defamation of Character, Libel, Slander, Assault, Battery
Most common lawsuits in Mental Health Nursing:
Culture=A society's entire way of living; shared beliefs and values
Culture Differences=Cultural Awareness
Culture in this area?
Spirituality=Human quality that gives meaning and sense of purpose to an individual's existence.
Meaning and Purpose in Life
Religion=Set of beliefs, values, rites and rituals adopted by a group of people
What symptoms does this patient have that meet criteria for depression?
What suicide risk factors and warning signs can you identify?
What additional factors not included in this patient identification would be important to assess for?
What cultural factors impact her care?
What ethical factors impact your care for her?
When asked about the pregnancy, Ayesha admits she has known via a positive pregnancy test 2 weeks ago.
She hopes to continue the relationship with her boyfriend who she states is the father of the baby
She is scheduled to return to Egypt in two months and she is “scared” to go home because her father will “kill” her. He was leery of her coming for this exchange program to begin with.
Ayesha denies use of alcohol, illegal substances and prescription medications.
Benign medical history, nursing assessment WNL
No history of mental illness or previous suicide attempts
Weight loss of 10 lbs in last month
Urine toxicology: Negative
Urine Analysis: Negative
Pregnancy Test: Positive
History and Physical
Ayesha is a 19 year old college exchange student from Egypt who has been coming to class late over the past month and is demonstrating poor academic performance. She looks disheveled and has decreased her social activities. Her boyfriend of 8 months broke off the relationship one month ago. She sought help at with the college counseling services with the recommendation of her physics teacher. The counselor has recommended further evaluation and possible inpatient admission.
When speaking to her during the nursing intake assessment, you observe her to be tearful and have poor eye contact. She reports having insomnia, yet she can’t “get out of bed” and states she “just lying there.” She reports a loss of appetite, disinterested in previous hobbies, declines offers of close friends to “go out.”
She complains of fatigue, memory disturbance and has difficulty concentrating.
Ethics and Culture
Two thirds people seeking psychiatric treatment
Length of stay determined by treatment
May request discharge unless deemed harmful self/others