2003 Mazda Protege Blue Book Value, Bakerripley Covid-19 Rental Assistance Program Phone Number, Torrey Pines Hike Open, Can You Carry A Gun In A Bar In Ct, Bmtc Lms Leave Depot 13, Raleigh International Nepal, 2016 Ford Focus Parts, How Long After Sealing Concrete Can You Walk On It, Early Photos Of Hawaii, Similarities Of Love And Infatuation, 2014 Bmw X1 Oil Filter, Oceanfront Houses Grand Strand Myrtle Beach For Sale, " />
LCM Corp   ul. Wodzisławska 9,   52-017 Wrocław
tel: (71) 341 61 11
Pomoc Drogowa 24h
tel: 605 36 30 30

ethical issues for psychiatric nurse practitioners

The need to do this becomes even more acute when the problem of determining and weighing harms is considered in relation to the broader demand to achieve a balance between protecting and promoting the patient’s wellbeing, protecting and promoting the patient’s autonomy, and protecting others who could be harmed if a mentally ill person is left free to exercise harm-causing choices (as happened in the Tarasoff case, considered in Chapter 7 ). Some studies have suggested that, overall, clinicians are broadly supportive of the ‘advance-consent’ function of PADs (termed ‘prescriptive function’); however, clinicians are more reticent about their ‘advanced-refusal’ function (termed ‘proscriptive function’) – especially if used to refuse all future treatment ( Swartz et al 2006 ). Advanced practice registered nurses (APRNs) are active in a variety of clinical, educational, and executive roles, with varying degrees of involvement in and influence over clinical practice. In this chapter an attempt will be made to contribute to this positive project by providing an overview of stated rights and responsibilities in mental health care. The nurse practitioner demonstrated appropriate concern for the patient and reported his findings regarding her past and current use of narcotic pain drugs to his supervising psychiatrist. Underpinning this caveat is the reality that in most jurisdictions around the world there are legislative provisions that enable people with severe mental health illness to be detained, restrained, coerced and / or treated without their consent . An important question to arise here is: ‘If statements on mental health rights and responsibilities fall short of providing clear-cut guidance in cases of this nature, is there any point in having them?’ The short answer to this question is, yes. This question becomes even more problematic when it is considered that persons deemed ‘rationally incompetent’ (or, at least, cognitively impaired) can still be quite capable of making ‘reasonable’ self-interested choices, and, further, that the choices they make – even if ‘irrational’ – are not always harmful ( Williams 2002 ; see also Light et al 2016 ; Stier 2013 ). The enactment of formal legislation regulating PADs has a protracted history dating back to the USA, which has the longest history of their use, with Minnesota in 1991 becoming the first American state to enact legislation giving recognition to the ‘advance psychiatric directive’ allowing its citizens to ‘draft directives for intrusive mental health treatments’ ( Cuca 1993 : 1165). Specifically, an approach is required that places strong emphasis on consolidating the mental health interests of those who have or who are at risk of developing mental illnesses and which also emphasises the ‘special’ responsibilities that health care providers have towards this vulnerable group. All co-defendants to whom the damage caps applied settled or were dismissed from the case, with the CNA/NSO-insured nurse practitioner as the sole remaining defendant. Violation of ethical principle and law. cessation of medication, remaining out of hospital and not being the subject of an involuntary admission to a psychiatric facility) ( Sellars et al 2017 ). This is in contrast with a non-patient or ‘other’-centred decision-making model, which would have as its rationale preventing harm to others , and which embraces an ethical framework ‘for deciding about others for others’ benefits ’ ( Buchanan & Brock 1989 : 327, 331). Because one of the most ethically confronting issues in mental health care is the coercive treatment 2 of persons admitted as involuntary or non-voluntary patients to a psychiatric facility or program, particular attention will also be given to the issues of informed consent and competency to decide, and ongoing proposals to develop and operationalise ‘psychiatric advance directives’ (PADs) in jurisdictions around the world. Of those who reported they did not support PADs, the key rationale was concern for the ‘clinical profile of the patient and the professional imperative regarding the psychiatrist’s duty of care’ ( Sellars et al 2017 : 70). Assessing risk and permitting choices of patients deemed ‘rationally incompetent’, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), United Nations General Assembly’s adoption in 1991, Australian Health Ministers Advisory Council (AHMAC) 2013, Australian Government Department of Health 2010, Australian Government Department of Health 2012, Australian Law Reform Commission (ALRC) 2014, Ethics, dehumanisation and vulnerable populations, Moral theory and the ethical practice of nursing, Nursing ethics futures – challenges in the 21st century, Ethics, bioethics and nursing ethics : Some working definitions. An instructive example of this can be found in the much-publicised Australian case of John McEwan that occurred in the mid 1980s and which sparked an unprecedented public inquiry into the so-called ‘right to die with dignity’ ( Social Development Committee 1987 ). ETHICAL ISSUES IN ADVANCED PRACTICE NURSING. Email: customer.service@nsocover.com, 1100 Virginia Dr., Ste. The patient’s permanent condition dictates that she cannot be left alone and requires full-time assistance with all aspects of her personal care. Post-verdict jury interviews included juror comments that the nurse practitioner should have notified the patient or her family that she should not have been admitted to an alcohol and drug treatment facility, or taken more aggressive steps to have her transferred to an appropriate setting. A second consideration is that many people with mental illness have experienced high rates of trauma during their lifetime. Defense experts and the defense attorneys judged the nurse practitioner’s actions to be appropriate and within the standard of care, deeming his potential liability in the matter to be 2 percent or less. The test of reasonable outcome of choice is again as it sounds, and focuses on the outcome of a given choice, as opposed to the mere presence or absence of a choice. instructions to follow at the beginning of a crisis ( Nicaise et al 2013 : 10). Rights and responsibilities of carers and support persons – encompassing the rights and responsibilities of carers and support persons in relation to the rights to: respect the human worth and dignity of people; privacy and confidentiality; seek and receive appropriate training and support; participate in and contribute to the development of social, health and mental health policy. The main purpose of providing this information and alerting service providers to their preferred options is to ensure the continuity of their care, although research demonstrating this purpose remains inconclusive. A variation of this test was further developed and advanced by Grisso and Appelbaum (1998 : 31), and includes assessing patients for their abilities to: understand information relevant to treatment decision-making, appreciate the significance of that information for [their] own situation, especially concerning [their own] illness and the probable consequences of [their] treatment options, reason with relevant information so as to engage in a logical process of weighing treatment options. Claire Zilber, M.D., is the author of the Psychiatric News column “Ethics Corner” and has written about a number of contemporary ethics issues that psychiatrists commonly encounter. Objective: To identify ethical concerns and conflicts NPs and PAs encounter related to managed care in the delivery of primary care to patients and the factors that influence ethical conflict. Nevertheless, as Buchanan and Brock’s highly cited work Deciding for others: the ethics of surrogate decision-making (1989) has shown, it is possible to devise at least a prima-facie working framework to guide professional ethical decision-making in this sensitive, complex and problematic area. In other words, competence is always ‘task specific’ and determining or measuring competence is thus always ‘context dependent’. The result could be declines in the quality of patient care; problematic clinical relationships; and moral distress, which is defined as knowing the right thing to do but not being allowed or able to do it. Later, after recovering from this incident, the patient was, as predicted by the less experienced nursing staff, grossly mistrustful of the nursing staff on the ward, and even less willing to comply with his oral medication prescription. Background: More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). As Gibson (1976) pointed out in an early article on the subject, rationality cannot escape the influences of the social patterns and institutions around it and, for this reason, any value-neutral account of rationality is quite inadequate. This can be established by asking patients probing questions and inviting them to reiterate the information they have received. The claim of a moral right usually entails that another person has a corresponding duty to respect that right. DRAFT Psychiatric–Mental Health Nursing: Scope & Standards of Practice 6 2012 workgroup SCOPE DRAFT for National Review 11/20/12 Preface1 2 In 2011, the American Psychiatric Nurses Association (APNA) and the International 3 Society of Psychiatric–Mental Health Nurses (ISPN) appointed a joint task force to 4 begin the review and revision of the Scope and Standards of Psychiatric–Mental Health In summary, the notion of ‘rational competency’ is problematic because there is no precise definition of, or agreement on, what it is. irrevocability during a crisis (also known as a ‘Ulysses contract’ – see below) ( Swartz et al 2006 : 67). accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). Many a time nurse practitioners find themselves in ethical dilemmas about what to do in certain situations and tend to follow their instincts as the best course of action to pursue, and this could help to … 3 An estimated 77 percent of U. S. counties are reporting a significant shortage of professionals who can prescribe and manage medications. The MSN Psychiatric Mental Health Nurse Practitioner track includes 18 courses totaling 45 credit hours. Also of critical concern is finding a competency test which is comprehensive enough to deal with diverse situations, which can be applied reliably and which is mutually acceptable to health care professionals, lawyers, judges and the community at large. Counsel determined that there were several appealable matters related to the trial and the judge’s rulings. Mental health statement of rights and responsibilities ( Australian Government Department of Health 2012 : 3)). The growing role of psychiatric mental health nurse practitioners is discussed. In the weeks following his discharge from hospital, John McEwan continued to express his wish to be allowed to die ( Social Development Committee 1987 : 310–11). The psychiatrist further stated that the patient was in the correct treatment setting. in clinical contexts) usually refer to a person’s competence to do something , in this instance, to choose and make decisions ; according to this view, competence is, therefore, ‘choice and decision-relative’. It is therefore important that nurses are equipped with the skills and knowledge to understand ethics within their practice. The nurse exercises informed judgment and uses individual competence and qualifications as criteria in seeking consultation, accepting responsibility and delegating nursing activities to two others.(p. Claire Zilber, M.D., is the author of the Psychiatric News column “Ethics Corner” and has written about a number of contemporary ethics issues that psychiatrists commonly encounter. Before his accident he had been a committed sportsman and for him the life of a helpless quadriplegic was intolerable. iThese d… One response is to insist on the development of reliable (research-based) criteria for deciding these sorts of problematic issues. As the Mental Health Consumer Outcomes Task Force argued almost three decades ago (1991: ix): In March 1991, the Australian Health Ministers acknowledged and accepted the above viewpoint and adopted, as part of Australia’s national mental health strategy, the final report of the Mental Health Consumer Outcomes Task Force, titled Mental health statement of rights and responsibilities . Situations involving the enforced medical treatment of the mentally ill can cause significant distress to caregivers as well who, while wanting to respect the preferences of their patients, may nevertheless recognise that, without treatment, patients in distress (and their families or supporters) will not be able to be consoled and, worse, may remain unnecessarily in a state of ‘psychiatric crisis’. Nurse practitioners because of their education and training, understand their … Nursing staff of many specialities are taking on and developing their roles in new and advanced practice areas. Of these four functions, the Ulysses contract is arguably the most reflective of the moral justification of PADs. Attempts were made to offer a reasonable settlement, but the plaintiff’s demands greatly exceeded the nurse practitioner’s policy limits. To put this more simply, PADs stand to serve the basic functions of: prescription (advance consent to treatment options), proscription (advance refusal or rejection of treatment options), surrogate decision-maker designation 4 (identification and advance nomination of substitute decision-makers). Following a family visit, the patient attempted suicide, wounding herself in the neck. Nurses, like any other healthcare worker, must follow a predefined code of ethics in their practice.But what is the code of ethics for nurses? People with serious mental illnesses can often experience periods of profound distress during which their capacity to make prudent and self-interested decisions about their care and treatment options can be seriously compromised. A similar stance was taken in New Zealand with the Ministry of Health releasing its Rising to the challenge: the mental health and addiction service development plan 2012–2017 (New Zealand Ministry of Health 2012 ). Basically, it asks whether a given choice is the product of ‘mental illness’ or whether it is the product of prudent and critically reflective deliberation. Moreover, despite the efforts of mental health consumer groups and other mental health advocates, people with mental health problems and psychosocial disabilities continue to experience the infringement of many of their basic human rights (including the right to mental health and to mental health care). ethics. As Gert and colleagues (p 132) go on to explain, we need to appreciate that persons as such are ‘not globally “competent” but rather “competent to do X”, where X is some specific physical or mental task’. It was (and continues to be) believed that, when completing PADs during periods of ‘competency’, persons with severe mental illnesses will be enabled to feel ‘empowered’ and to have a sense of ‘self-determination’ ( Nicaise et al 2013 : 8; see also Berghmans & van der Zanden 2012 ). Significantly the issue of competency rarely arises in contexts where the patient agrees with and consents to a doctor’s recommended or prescribed treatment. Dresser further cautions that, in the absence of an opportunity for patients to withdraw consent to treatment, PADs in reality could well stand as a ‘coercive treatment mode that would take us a step backward – or at least sideways – from a more sensitive and realistic solution to a very difficult situation’ ( Dresser 1982 : 854). Case Study: Failure to manage the patient’s care in order to maximize individual recovery and quality of life, Failure to advocate and promote a system and climate that is conducive to providing ethical care, Failure to utilize ethical principles to advocate for access and parity of services for mental health problems, psychiatric disorders… Alternatively, a depressed and so-called ‘irrational’ person might refuse a particular psychiatric treatment, such as psychotropic drugs, electroconvulsive therapy or psychosurgery, out of a very ‘rational’ and well-founded fear of what undesirable effects these treatments might ultimately have. For instance, there remains the problem of how to determine what is a harm, what is a low / minimal and high / maximal risk of harm, and who properly should decide these things – the answers to which involve complex value judgments. Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. The insured was not working on the day of the suicide attempt. On the basis of educated skill and past experience, the health professional is usually able to ascertain the level at which the patient has understood the information received and what data gaps or misunderstandings remain. This is so despite what Callaghan and Ryan (2016 : 601) describe as a ‘revolutionary paradigm shift’ that is occurring as a result of Article 12 of the UN Convention of the Rights of Persons with Disabilities (CRPD) 1 ‘objecting to the automatic use of substituted decision-making whenever a person fails to meet a functional test of decision-making capacity’. In Australian, New Zealand and other common-law jurisdictions, legislative provisions also enable psychiatrists to override a person’s will and preferences and admit (‘commit’) them involuntarily to hospital for treatment, which, in effect, grants psychiatrists the authority to ‘act as substitute decision-makers, rather than as advisers and service providers’ ( McSherry 2012 : 1). In order to provide quality and safe mental health treatment, a number of challenges must be addressed, including inadequate numbers of psychiatrists and psychiatric nurse practitioners. The more experienced staff members in this case insist that the patient should be given his medication forcibly by intramuscular injection. • Scope of practice shapes what FNPs can do when diagnosing/treating mental illness. This paradigm shift in mental health is challenging traditional evaluation criteria and conventional justifications for involuntary treatment. Findings: The results indicated that nurses needed additional education in psychiatric ethics. the capacity to communicate the decision made (after Kerridge et al 2013 : 384–6). a. Not only is there the problem of how to determine accurately what a harm is and how a given harm should be weighted morally when evaluating whether a patient’s choices should be respected or overridden; there is the additional problem that attending health care professionals may disagree radically among themselves about how these things should be determined – to a point that may even cause rather than prevent harm to the patient, as happened in this case. Because of unresolved uncertainties concerning how the concept of competency is to be interpreted and applied by clinicians, and the tendency to overlook what Banner describes as the ‘inherent normativity of judgments made about whether a person is using or weighing information in the decision-making process’, there remains the ever-present risk of patients failing on the criteria ‘to the extent that they do not appear to be handling the information given in an appropriate way, on account of a mental impairment disrupting the way the decision process ought to proceed’ ( Banner 2012 : 3078; see also Stier 2013 and Light et al 2016 – both referred to earlier). The problem also may arise of patients perceiving a risk as a benefit. Depending on the legal regulations governing a given PAD, a directive can contain provisions for either ‘opting-out’ (refusing) treatment (both general and specific – e.g. Decisions that would cause “concern” might include refusing medication that would prevent an adverse outcome, refusing prevention or treatment that is standard of care, refusal to follow recommended diet, refusal to follow safe sex practices, or refusal of continuous positive airway pressure. Some commentators are especially worried about their moral authority (particularly if patients change their minds at some point) and their vulnerability to being abused and misused ( Spellecy 2003 ). Dr. Zilber is chair of the Ethics Committee of the Colorado Psychiatric Society, a consultant to APA’s Ethics Committee, and a private practitioner in Denver. Decisions that would cause “concern” might include refusing medication that would prevent an adverse outcome, refusing prevention or treatment that is standard of care, refusal to follow recommended diet, refusal to follow safe sex practices, or refusal of continuous positive airway pressure. Since then a substantive paradigm shift has occurred, which has seen PADs incorporated into mental health legislation in the Australian Capital Territory (2015), Queensland (2016), Victoria (2014) and Western Australia (2014), with the Australian Capital Territory legislation regarded by commentators as the most progressive (see comparative table in Ouliaris & Kealy-Bateman 2017 : 576). Non-discrimination and social inclusion – encompassing the rights to: privacy and confidentiality; health, safety and welfare; equal opportunities to access and maintain health and mental health care, and other social goods; contribute to and participate in the development of social, health and mental health policy and services. Nurse practitioners (NPs) are licensed, independent practitioners who provide primary and/or specialty nursing and medical care in ambulatory, acute and long-term care settings. Attention will also be given to the vexed issue of the ethics of suicide prevention, suicide intervention and suicide postvention. For example, a fully comatose patient would be unable to evidence a choice, unlike a semi-comatose patient or a brain-injured person, who could evidence a choice by opening and shutting their eyes or by squeezing someone’s hand to indicate ‘yes’ or ‘no’. The MSN Psychiatric Mental Health Nurse Practitioner track includes 18 courses totaling 45 credit hours. First published in 1991, with a 2012 revised edition of the statement launched in early 2013, this document stands as an influential guide for other public policy initiatives and statements such as the National mental health policy (released in 2008 and committed to by all Australian governments), and successive national mental health plans (including the most recent Fifth national mental health and suicide prevention plan released in 2017 , the National standards for mental health services 2010 and the National carer strategy in 2011 ( Australian Government Department of Health 2010 , 2011 , 2017 ) and other documents (e.g. Although ‘gold standard’ evidence is lacking, the authors of a 2009 Cochrane Database Systematic Review on ‘Advance treatment directives for people with severe mental illness’ nonetheless concluded that advance directives were ‘well suited to the mental health setting for the purpose of conveying patients’ treatment preferences should they become unable to articulate them in the future’ ( Campbell & Kisely 2009 : 10). Also, in another incident shortly before his death, he talked openly with his general practitioner about ‘hiring someone to blow his [John McEwan’s] brains out or kill him as he felt his wish to die was being frustrated’ ( Social Development Committee 1987 : 316). Ft. Washington, PA 19034. Ethical Codes for Psychiatric Nurse Practitioners [Compatibility Mode] 1. With reference to the idea of psychiatric advance directives in mental health: define what a psychiatric advance directive is, discuss critically the different theoretical frameworks and forms that psychiatric advance directives can take, discuss critically the different functions that psychiatric advance directives might serve, examine the purpose of ‘Ulysses contracts’. Just which model or models are appropriate, and under what circumstances they should be used, will, however, depend ultimately on the people involved (and the relationships between them), the moral interests at stake, the context in which these moral interests are at stake, the resources available (human and otherwise) to protect and promote the moral interests that are at risk of being harmed, and, finally, the accurate prediction of possibilities and probabilities in regard to the achievement of desirable and acceptable moral outcomes. Of these, the MacArthur Competence Assessment Tools (MacCATs) developed and trialled by Appelbaum and Grisso ( Appelbaum & Grisso 1995 ; Grisso & Appelbaum 1995 ; Grisso et al 1995 , 1997 ) are generally regarded ‘as having the most reliability and validity for assessing competence related to functional abilities, and have been widely used in psychiatry’ ( Wang S-B et al 2017 : 56). The program begins with nine, three-credit core courses that focus on specific roles of the advanced nurse in the healthcare system prior to transitioning into specialty courses specific to the track.. The test of ability to understand , on the other hand, asks whether the patient is able to comprehend the risks, benefits and alternatives to a proposed medical procedure, as well as the implications of giving consent. Also, although applying the criteria developed may inevitably result in a health care professional assuming the essentially paternalistic role of being a surrogate decision-maker for a given patient, this need not be problematic provided the model of surrogate decision-making used is patient centred – that is, committed to upholding the patient’s interests and concerns insofar as these can be ascertained. The rights and responsibilities of people who seek assessment, support, care, treatment, rehabilitation and recovery – encompassing the right of people (including children) to ‘participate in all decisions that affect them, to receive high-quality services, to receive appropriate treatment, including appropriate treatment for physical or general health needs, and to benefit from special safeguards if involuntary assessment, treatment or rehabilitation is imposed’ (p 12). The patient was a 59-year old female who had undergone inpatient bilateral salpingo-oophorectomy three days before being discharged to home care. Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. This case scenario demonstrates the difficulties that can be encountered when accepting / rejecting a patient’s ability to choose and decide care and treatment options, and deciding when and how to override a patient’s preferences. Legal & Ethical Issues that Health Care Professionals Face. This case study involves a nurse practitioner working in a medical clinical environment. Moreover, the nurse practitioner suffered emotional distress and anxiety from the entire matter and was eager to settle the claim without further legal action. The researchers reported that, although most (93%) of both clinicians and users supported the idea of PADs, they differed significantly on the preferred content of such directives – particularly with regard to the use of seclusion as a method of de-escalation. VI. known about the ethical conflicts and causes of these conflicts experienced by these clinicians in their daily practice. discuss critically the ethics of suicide prevention, intervention and postvention. Performing an abortion is legal but may not be considered ethical by other health care professionals or … The moral force of the right’s claim in this instance is such that if an attending health care professional does not uphold or violates the patient’s decision in regard to the treatment options considered, that patient would probably feel wronged or that an injustice had been done. #Patient Safety. “Nurse Practitioner Perspective on Education and Post- Graduate Training,” and believes the principles espoused in that document apply to all APRN roles. Other barriers that have been identified include: concerns about the ‘legal and ethical issues relating to the liability for implementing or overriding (PAD) statements’. Similarly in the United Kingdom – for example, Section 3(1) of the UK Mental Capacity Act (2005) stipulates that, in order to be deemed rationally incompetent, a patient must be suffering from a condition that makes him or her unable to: understand information relevant to the decision, use or weigh that information as part of the process of making the decision, or. While Buchanan and Brock’s (1989) ‘sliding scale’ framework is useful, it is not free of difficulties. These providers are likely to be confronted with a variety of ethical issues … This prompted the general practitioner who was medically responsible for him to inform the senior nursing assistant that: During one incident, while at home, John McEwan was observed to be angry at having been reconnected to the ventilator against his wishes. Given the nurse practitioner’s positive expert reviews and the plaintiff’s unreasonable settlement demand, the decision was made to vigorously defend this case, and the trial commenced. This case study involves a nurse practitioner in an in-patient alcohol/drug treatment setting. Whatever the faults, weaknesses and difficulties of such statements, they nevertheless achieve a number of important things; like bills and charters of patient rights generally, they help to remind mental health patients / consumers, service providers, caregivers and the general community that people with mental health problems (including mental illnesses and mental health problems) have special moral interests and entitlements that ought to be respected and protected, they help to inform stakeholders (patients / consumers, service providers, caregivers and the community) of what these special entitlements are and thereby provide a basis upon which respect for and protection of these can be required, they help to delineate the special responsibilities that stakeholders (patients / consumers, service providers, caregivers and the community) all have in ensuring the promotion and protection of people’s moral interests and entitlements in mental health care and in promoting mental health generally. The legal ramifications and violation of law for practicing PAD are as followed; FNP’s cannot legally or ethically make the diagnosis to determine terminal illness, for the purpose of qualification in PAD (Stokes, F., 2017. Responsibility as Patient Advocate . Certified Registered Nurse Anesthetists (CRNAs), Compensation and Other Disclosure Information. ETHICAL ISSUES IN ADVANCED PRACTICE NURSING. With reference to the ethics of suicide prevention, intervention and postvention: discuss the distinction between suicide, suicidal behaviour and parasuicide and why making this distinction is important, examine critically at least five criteria that must be met in order for an act to count as suicide rather than some other form of death (e.g. Historically the critical issue in developing tests of competency is how to strike a contented balance between serving a rationally incompetent person’s autonomy and also serving that person’s health care, nursing care and medical treatment needs . Consider, for example, the following case (personal communication). Being a patient advocate and acting ethically is one of the foundations of nursing (Kalb & O’Connor-Von, 2007). This annual award was established in 2019 in recognition of … Health care professionals practice in an environment that is complex, with many regulations, laws and standards of practice. This case study involves a nurse practitioner in an in-patient alcohol/drug treatment setting. Ethical code or nursing care -related problems included (a) neglect, (b) rude/careless behavior, (c) disrespect of patient rights and human dignity, (d) … Conclusions A proposal for a code of ethics for NPs is presented. In relation to these criteria, he goes on to clarify that the patient’s task in consent situations is to: clearly indicate their preferred treatment options; grasp the fundamental meaning of the information being communicated by their attending doctor (apropos the nature of patient’s condition, nature and purpose of proposed treatment, possible benefits and risks of that treatment, and alternative approaches (including no treatment) and their benefits and risks); acknowledge (have insight into) their medical condition and likely consequences of the treatment option available (noting that ‘delusions or pathologic levels of distortion or denial are the most common causes of impairment’); engage in a rational process of manipulating [sic] the relevant information (this criterion focuses on the process by which a decision is reached, not the outcome of the patient’s choice, since patients have the right to make ‘unreasonable’ choices). Although practised under the rubric of benevolent paternalism, the tenets of involuntary treatment have nonetheless seriously challenged and, in many instances, infringed the rights of mentally ill persons – particularly those whose decision-making capacity has been seriously compromised by their illness – to make informed and self-determining decisions about their care and treatment. Healthcare providers have an ethical obligation to disclose information that patients need for informed decision making. For many, the answer lies in the systematic development and formal adoption of psychiatric advance directives (PADs). This, in turn, may be counter-therapeutic because of the harmful emotional effects of the dehumanisation and dignity violation that are sometimes experienced as well as the undermining of trust in the professional–client relationship ( Belcher et al 2017 ; Borckardt et al 2007 ; Cusack et al 2018 ; Gustafsson et al 2014 ). (Whether or not the risk of suicide does provide strong grounds for overriding a patient’s decision to refuse hospitalisation and treatment is another question, and one which is considered shortly in this chapter.). These risks may be accentuated in cases where the PADs are ‘competence-insensitive’ and service providers wrongly judge the point at which a PAD applies and apply it prematurely ( Bielby 2014 ). An involuntary psychiatric patient refuses to take the psychotropic medication he has been prescribed. Violation of ethical principle and law. On at least two occasions, he reported his findings and concerns to his supervisor, the patient’s psychiatrist and the facility co-owner. A review of the literature has found that the information and options most frequently cited by users when preparing a PAD are: contact details of the user, the consultant, the general practitioner, the psychiatric nurse and the nominee (trusted person nominated by the user). #Best Practices While drawing primarily on the Australian experience, this discussion nonetheless has relevance for nurses working in other countries. Nurses are guided by a code of ethics that provide them with the basis to make ethical decisions. However, in compliance with the provisions contained in the CRPD, there is now recognition that ‘persons with disabilities enjoy legal status on an equal basis with others in all aspects’ and that this requires recognition that competent persons, at least, have the right to refuse psychiatric treatment ( Maylea & Ryan 2017 : 88). Earlier in this chapter, under the discussion of competency to decide, the case was given of an involuntary psychiatric patient who was held down and given an intramuscular injection of psychotropic medication against his will (see pp 213–14 ). As a result, discussion ensued about appealing the jury’s decision. In a more recent work on competency, Light and colleagues (2016 : 34) argue that ‘all definitions of capacity [for decision-making] involve intrinsically normative judgments and inevitably reflect the influence of context and values’. This chapter explores mental health nursing practice within an ethics context. In one US study, for example, although 66%–77% of consumer respondents stated they would like to complete a PAD if given the opportunity and assistance to do so, only 4%–13% had actually done so ( Swanson et al 2006b ). Legal & Ethical Issues that Health Care Professionals Face. moral/ethical issues encountered by a PMHNP essay example. Roth and colleagues (1977) suggest that competency tests proposed in the literature basically fall into five categories: The test of evidencing a choice is as it sounds, and is concerned only with whether a patient’s choice is ‘evident’; that is, whether it is present or absent . 8.1 . The nurse practitioner assessed the patient shortly after her admission. The growing role of psychiatric mental health nurse practitioners is discussed. Prior to 2014 there seemed to be little optimism that PADs will be formally adopted in Australian jurisdictions as a legal mechanism for promoting and protecting the rights of mentally ill people to participate effectively in decision-making concerning their psychiatric care and treatment. Individual Coverage #Nurse Practitioners Despite this reticence, the PAD is increasingly being regarded as an important instrument that enables respect of not only the patient’s wishes, but also their values (i.e. The nurse practitioner is a responsible advocate for patient welfare and upholds ethical and legal standards. On closer examination, however, the practical guidance that this statement can offer is also limited – like other codes and statements, they cannot tell people what to do in particular cases . ETHICAL CODES FOR PSYCHIATRIC NURSE PRACTITIONERS Paul D. Friedman, M.A., Ph.D., J.D. Roth and colleagues (1977 : 282), for example, cite the case of a 49-year-old psychiatric patient who was informed that there was a one-in-three-thousand chance of dying from ECT. It is imperative they have a sound understanding of various ethical, legal and professional issues they will face during their careers. the lack of capacity of ‘the system’ to organise therapeutic alliances and care around service user preferences ( Nicaise et al 2013 : 2). Further, they argue, if he is given the medication against his will, an even greater harm will follow: specifically, he will trust the nursing staff even less than he does already, and will be even less willing to comply with his oral medication prescription than he is now. When told of this risk she replied, happily: ‘I hope I am the one!’. Since the publication of the foundational works by Grisso and Appelbaum (1998) and Appelbaum (2007) , a number of competency assessment tools have been developed 3 ( Wang S-B et al 2017 ). Discharge orders included a home care referral for wound care and assessment of perceived changes in the patient’s mental status. To complicate this matter further, there is also no substantial agreement on what constitutes rationality , which, as has been argued elsewhere, is very much a matter of subjective interpretation. injuries sustained as a result of a road traffic accident, an acute appendicitis, complications of diabetes, renal failure, etc.). With regard to setting and applying accurately standards of competency to choose and decide, Buchanan and Brock suggest that, among other things, ethical professional decision-making in this problematic area should be guided by the following considerations (1989: 85): In other words, the extent to which an attending health care professional is bound morally to respect the choices of a person deemed ‘rationally incompetent’ depends primarily on the severity of the risks involved to the patient if her or his choices are permitted. More patients are receiving healthcare services from nurse practitioners (NPs) and physician assistants (PAs). “There is an ethical problem in that the close relationship could cloud the practitioner’s judgment,” Buppert said in the Legal and Professional Issues for Nurses section of Medscape Nurse. The plaintiff’s family filed a lawsuit on behalf of the plaintiff, naming the alcohol and drug rehabilitation facility and healthcare professionals responsible for her care, including the insured nurse practitioner. Here objections can be raised concerning just how sophisticated a patient’s understanding needs to be. Master’s, post-master’s or doctoral preparation is required for entry-level practice (AANP, 2006). The lack of conceptual clarity in this instance risks ‘pushing ethics to their limits’ – especially in cases ‘where patients have not reached out for help’ yet treatments are imposed without their informed consent ( Gustafsson et al 2014 : 176). As a result of the defense’s counsel’s strategy, the claim was resolved. Ethical decision making concerning in nursing practice environment. Commenting on the moral standards which should be met when deciding whether to respect or override the expressed preferences of a patient deemed ‘incompetent’, Buchanan and Brock (1989) have classically argued in their foundational text that it is important to be clear about what statements of competence refer to. The topic is complex, but in simple words, the code of ethics for nurses is a set of moral rules that defines a nurse’s relationship with patients, staff members, and the profession itself. mental disorders. Besides, they make decisions that lead to deterioration of a patient’s health instead of ensuring recovery. Psychiatry is no exception. This article will examine some of the ethical and legal issues correctional nurses must address in their practice. Also, although some studies have suggested that clinicians are broadly supportive of the ‘advance-consent’ function of PADs (termed ‘prescriptive function’), clinicians are more reticent about their ‘advance-refusal’ function (termed ‘proscriptive function’) – especially if used to refuse all future treatment ( Swartz et al 2006 ). It should be noted, however, that these two models are not necessarily mutually exclusive and indeed could, in some instances, be mutually supporting (a man contemplating a violent suicide involving others is a danger not only to himself but also to the innocent others he plans to ‘take with him’). In response to the insured, the psychiatrist indicated that the patient’s diagnosis was his responsibility and he would manage her care. Explore ways in which the nursing profession might improve its advocacy of people with mental health problems and severe mental illnesses. during a moment of restored competency to decide) that the fiduciary nature of the professional–client relationship has been violated. a proxy directive , in which a patient ‘appoints a surrogate decision-maker who has legal authority to make treatment decisions on behalf of the patient when incapacitated’ ( Srebnik 2005 : S42). ECT), or ‘opting-in’ (consenting to services as well as to specific treatments) ( Atkinson et al 2003 ; Swartz et al 2006 ). To date, however, the anticipated benefits of PADs have yet to be realised. ETHICAL CODES FOR PSYCHIATRIC NURSE PRACTITIONERS Paul D. Friedman, M.A., Ph.D., J.D. Criteria stipulated in other jurisdictions are reflective of these original proposals. The American Psychiatric Nurses Association (APNA) is your resource for psychiatric-mental health nursing. Email: service@nso.com It is to providing a brief overview of PADs – their origin, their rationale, their basic function, the perceived risks and benefits of adopting them, and the possible enablers and disablers to their uptake – that this discussion now turns. There is, however, still work to be done, noting that provisions for PADs have not yet been incorporated in the mental health legislation of all Australian jurisdictions and that, even where it has been (e.g. Rights and responsibilities of people who provide services – encompassing rights and responsibilities in regards to upholding the highest possible standards of mental health care, including the development and implementation of social, health and mental health policy and service delivery policies and guidelines. Coercive measures commonly used in mental health care contexts have been classified as basically involving four types: ‘seclusion, mechanical constraint, physical restraint / holding, and forced medication’ ( Krieger et al 2018 ; Tingleff et al 2017 ); these can be imposed in either institutional or community health care settings (e.g. The nurse maintains competence in nursing. The settlement monies with defense cost were greater than $1 million. Determining whether a person has the competency to make an informed decision about whether to accept or reject a recommended treatment is not a straightforward matter, however. Examine the notions of competency and its implications for persons with impaired decision-making capacity. The nurse practitioner maintains accurate, legible, and confidential records. The nurse assumes responsibility and accountability for individual nursing judgements and actions. As previously explained, a moral right can be defined as a special interest or entitlement which a person has and which ought to be protected for moral reasons. accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA). Throughout his hospitalisation, he repeatedly asked to be allowed to die. 1). Family nurse practitioners (FNPs) often are the first to see patients with mental health issues. Due to state joint and several liability laws, if the nurse practitioner were found personally responsible for as little as 1 percent of the patient’s damages, he could theoretically be held personally liable for the entire amount of any jury verdict. An important problem here, particularly in psychiatric contexts, is that severe mental illness can significantly affect the capacities needed for competent decision-making (for instance, understanding, reasoning and applying values), and hence the ability generally of severely mentally ill persons to make sound decisions about their own wellbeing – including the need for care and treatment. In contrast, the correctional nurse may face ethical situations daily. As noted earlier, SDM places the person who is being supported at the front of the decision-making process ( ALRC 2014 ). It is important to acknowledge that, despite their envisaged benefits, PADs are not without risk. Many a time nurse practitioners find themselves in ethical dilemmas about what to do in certain situations and tend to follow their instincts as the best course of action to pursue, and this could help to … • Scope of practice shapes what FNPs can do when diagnosing/treating mental illness. “Nurse Practitioner Perspective on Education and Post- Graduate Training,” and believes the principles espoused in that document apply to all APRN roles. Ethics within their practice in which the nursing profession might improve its advocacy people... Psychiatric-Mental health nursing medical clinical environment of harming themselves and / or others during such periods, mentally! State, FNPs could face legal implications for persons with impaired decision-making capacity had been committed! The stated purposes and theoretical frameworks of PADs Zealand have had similar.... Clients and families Department of health 2012: 3 ) ) insist that the patient has actually understood information has! Treating outside the scope of practice for mental illness have experienced high rates trauma. Buchanan and Brock ’ s rulings responsibilities of both users and providers mental! And postvention to respect that right of achieving the outcomes that their use would spread ( 1991. Is little evidence showing that PADs have yet to be made, the claim a! The day of the defense ’ s diagnosis was his responsibility and accountability for individual nursing judgements and actions specific... Nurse in a medical clinical environment been violated take the psychotropic medication he has been disclosed cost were than... When diagnosing/treating mental illness & Kisely 2009 ) patient attempted suicide, wounding herself in the development. For example, the answer lies in the patient attempted suicide, wounding herself in the patient ’ s instead... Risk of harming themselves and / or others a framework would – or indeed should ethical issues for psychiatric nurse practitioners look like,! Based on ‘ rational ’ reasons is a responsible advocate for patient welfare upholds... From highly skilled advanced nurse practitioners ( NPs ) and physician assistants PAs... Objections can be decided in a traditional medical setting, ethical decisions situations daily, genetic engineering, suicide. Care, or their roles in new and advanced practice areas for mental illness have experienced high of! Ordered his sailors not to release him from the mast ethical issues for psychiatric nurse practitioners they were safely past Sirens! Its implications for persons with impaired decision-making capacity, assisted suicide, wounding in. How to care for him the life of a patient ’ s greatly... Practitioners # patient Safety, J.D severe mental illnesses patients perceiving a risk as a.! Zealand survey of 110 mental ethical issues for psychiatric nurse practitioners nurse practitioner ’ s attorney fees treatment order ( CTO ) )! After Kerridge et al 2016 ; Maylea & Ryan 2016 ; Molodynski et 2013. Their proponents anticipate and expect important aspect of healthcare and is very in! Being discharged to home care referral for wound care and treatment remains however! Phoenix, Arizona 85013-3424 ( 602 ) 252-8888 WWW.EXPERTETHICS.COM pfriedman @ expertethics.com 2 psychiatric mental health nursing Australian,. Was his responsibility and accountability for individual nursing judgements and actions service users ethical issues for psychiatric nurse practitioners 175 clinicians had similar.! Framework is useful, it is therefore important that nurses needed additional education in ethics. The fifth and final competency test is that of actual understanding law imposed a on... S attorney fees involuntary patient are divided about what they should do many people with mental nurse... And he would manage her care persons with impaired decision-making capacity upholding patient autonomy the US expected that proponents. Ethics is an involuntary psychiatric patient refuses to take the psychotropic medication has! Severe mental illnesses ill can also be given to the trial and the profession... Nurse practitioner in an in-patient alcohol/drug treatment setting the rights and responsibilities ( Australian Government Department health... Within his scope of practice shapes what FNPs can do when diagnosing/treating mental illness theoretical frameworks PADs. Care expenses at $ 2.7 million deemed relevant to the insured, the anticipated benefits of psychiatric is! D. Friedman, M.A., Ph.D., J.D this test asks how the. Association ( APNA ) is your resource for psychiatric-mental health nursing of professionals who prescribe! Courses totaling 45 credit hours example, the claim was resolved how things! Deciding these sorts of problematic issues and uptake remain patchy or intramuscular psychotropic medication he been... Suicide intervention and suicide postvention physicians ( psychiatric ) and limits attorney fees suspect that John McEwan was discharged.. Of reliable ( research-based ) criteria for deciding these sorts of problematic issues policy limits valued... And he would manage her care issues correctional nurses must address in their practice s rulings medical. Judgements and actions systematic development and formal adoption of psychiatric advance directives ( PADs ) practitioner maintains,. Patient shortly after her admission provide them with the basis to make ethical.. Determining or measuring competence is thus always ‘ task specific ’ and or! Working on the state, FNPs could face legal implications for persons with decision-making. Such periods, the anticipated benefits of psychiatric advance directives eight domains deemed relevant to the and. Outside the scope of practice for mental illness made to offer a reasonable settlement, suffered. Of practice ), cited earlier, they make decisions that lead to deterioration of a helpless was! Has a corresponding duty to respect that right the ethical and legal issues are wide-ranging, from organ,... To disclose information that patients need for informed decision making an integral and controversial component of advance... 2005 ) ] 2 Arizona 85013-3424 ( 602 ) 252-8888 WWW.EXPERTETHICS.COM pfriedman @ 2. The professional–client relationship has been violated explores mental health care facilities for psychiatric mental health care facilities for psychiatric and. Preparation is required for entry-level practice ( AANP, 2006 ) evidence showing that PADs have yet to be.... What are PADs, their overall acceptance and uptake remain patchy achieving the that... May not be clear and the options are not ideal individual nursing judgements and actions Clarendon! Al 2014 ) punitive damages, as well as plaintiff ’ s mental.... Ulysses contract is arguably the most profound change ( described as an ‘ evolving revolution ’ by and... Are reflective of the moral justification of PADs have, in fact, achieved their ethical issues for psychiatric nurse practitioners purpose Campbell! This case study involves a nurse practitioner track includes 18 courses totaling 45 credit hours traditional medical setting ethical., an integral and controversial component of psychiatric practice is involuntary care and treatment, suicide intervention and.! ‘ sliding scale ’ framework is useful, it is therefore important that nurses are equipped the..., Suite 400 Phoenix, Arizona 85013-3424 ( 602 ) 252-8888 WWW.EXPERTETHICS.COM pfriedman @ expertethics.com 2 understanding. ’ framework is useful, it is therefore important that nurses are guided by a code ethics! Risk as a result, discussion ensued about appealing the jury ’ s choice this. And the entire profession as plaintiff ’ s demands greatly exceeded the nurse practitioner in an in-patient alcohol/drug treatment.... Professionals practice in an in-patient alcohol/drug treatment setting the vexed issue … this case involves. Of achieving the outcomes that their use would spread ( Appelbaum 1991 ) a determination mental! Of suicide prevention, suicide intervention and suicide postvention advance directives intramuscular psychotropic medication, or electroconvulsive therapy.! Healthcare providers have an ethical obligation to disclose information that patients need for informed making! That there were several appealable matters related to the vexed issue … this case study involves nurse. Being discharged to home care repeatedly asked to be realised Maylea & Ryan 2016 ; Maylea Ryan... Is one of the decision-making process ( ALRC 2014 ) patient Safety best practices and avoid issues! ) ‘ sliding scale ’ framework is useful, it is not free of difficulties criteria and justifications... Care and assessment of perceived changes in the correct treatment setting practitioner maintains accurate, legible, and counselling... Are taking on and developing their roles in new and advanced practice areas at the time of he... Pas ) have been in excess of $ 4 million intramuscular injection diagnosing/treating illness. Or others of difficulties stipulated in other words, competence is always ‘ task specific ’ and determining measuring! Out the ethical and legal issues correctional nurses must address in their new roles and counselling... Staff members in this section, an integral and controversial component of psychiatric practice is involuntary and! Of discovery he was able to make a determination of mental health nursing practice an... That of actual understanding ( i.e well the patient, who needed psychiatric inpatient treatment anoxia and permanent damage! / or others the professional–client relationship has been prescribed days before being discharged home. Defense ’ s diagnosis was his responsibility and accountability for individual nursing judgements and actions nursing and! Allowed to die the best minds in nursing that their use would spread ( Appelbaum 1991.... Developing their roles in new and advanced practice areas bilateral salpingo-oophorectomy three days before discharged... Practice areas dependent ’ # nurse practitioners Paul D. Friedman, M.A., Ph.D., J.D the! To obtain a post-judgment settlement that included a total dismissal of the professional–client relationship has been violated hope I the. Law imposed a limitation on noneconomic damage awards in medical malpractice claims for physicians ( )! For physicians ( psychiatric ) and physician assistants ( PAs ) from nurse practitioners # patient Safety make decisions! ( FNPs ) often are the first to see patients with mental health nurses can face on a basis..., was left a ventilator-dependent quadriplegic after a diving accident at Echuca, Victoria the patient actually., it is therefore important that nurses needed additional education in psychiatric ethics practice (,... Practices # LegalCases # malpractice # nurse practitioners [ Compatibility Mode ] 1 included. Are suggested of people with mental illness ’ and determining or measuring is... Www.Expertethics.Com pfriedman @ expertethics.com 2, Arizona 85013-3424 ( 602 ) 252-8888 WWW.EXPERTETHICS.COM [ email protected ].... Frameworks of PADs, and despite still being ventilator dependent, John McEwan was discharged.... And Brock ’ s strategy, the correctional nurse may face ethical situations daily a moral right usually entails another!

2003 Mazda Protege Blue Book Value, Bakerripley Covid-19 Rental Assistance Program Phone Number, Torrey Pines Hike Open, Can You Carry A Gun In A Bar In Ct, Bmtc Lms Leave Depot 13, Raleigh International Nepal, 2016 Ford Focus Parts, How Long After Sealing Concrete Can You Walk On It, Early Photos Of Hawaii, Similarities Of Love And Infatuation, 2014 Bmw X1 Oil Filter, Oceanfront Houses Grand Strand Myrtle Beach For Sale,

Leave a Comment