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Legal and Ethical Issues in

Psychiatric Nursing

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Patients Bill of Rights

Civil Rights

Client Consent

Communication

Freedom from Harm

Dignity and Respect Confidentiality

Participation in Their Treatment Plan

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Admission to the Hospital

Voluntary

Involuntary

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Clients Rights Under the Law

Right to Treatment

Right to Refuse Treatment

Right to Informed Consent

Rights Regarding Restraint and Seclusion

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Right to Treatment

Clients have the right to receive treatment

for psychiatric problems

Rx must meet the following criteria: The environment must be humane

Staff must be qualified and sufficient to provide

adequate Rx

The plan of care must be individualized

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Right to Refuse Treatment

When forcible medication is used to prevent

violence to third parties, to prevent suicide, or to

preserve security, the court noted that the med isbeing used as a chemical restraintchanges from

individual rx to public protection

If it is deemed that an individual is unable to make

a competent, informed, and voluntary decision re:

rx,courts have stated that the med determinations

and rx plans are best left to the professionals

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Rights Regarding Seclusion and

Restraint Legally, behavioral restraint and seclusion are

authorized as an intervention when:

The particular behavior is physically harmful to theclient or a 3rd party The disruptive behavior presents a danger to the facility

Alternative or less restrictive measures are insufficientin protecting the client and others from harm

When a decrease in sensory over stimulation (seclusiononly) is needed

When a client requests seclusion

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Rights Regarding Seclusion and

Restraint (cont) The use of seclusion and restraint is permitted

only:

On the written order of a physician Must be face-to-face exam by MD within 1 hr of the

application

Next 4 hrs can have phone order

Next 4 hrs need to have face-to-face exametc Clients should be assessed q 15 min

Restraints must be rotated q2h

Food and fluids should be offered at least q2h

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Rights Regarding Seclusion and

Restraint (cont) Documentation

Should reflect that lesser restrictive methods

were tried

The behavior leading to restraint/seclusion

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Tort Law

Torts are civil wrongs for which money damagesare collected by the injured party (plaintiff) from

the wrongdoer (defendant) Civil liability for nsg practice falls in the area of

tort law

3 types of torts:

Intentional Quasi-intentional Unintentional

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Intentional

Assault An act resulting in a persons apprehension of an

immediate harmful or offensive touching (battery) Battery

Harmful or offensive touching

False imprisonment An act with intent to confine a person to a specific area

The use of seclusion or restraint that is not defensible as

being necessary or in the pts best interest

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Quasi-Intentional

Defamation is made up of 2 torts: Slander or oral communication

Libel or written communication

Breach of confidentiality

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Unintentional

Professional negligence Involves harm resulting from the failure of a person to

conduct himself or herself in a reasonable and prudentmanner

4 items needed to prove negligence are: Dutymeasured by standard of care

Breach of dutyconduct that exposes the client to anunreasonable risk of harm

Proximate causeIntervening actions or persons thatwere, in fact, the causes of harm to the client

Damagespain and suffering

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Duty to Warn Third Parties

Tarasoff case of 1976

A duty to warn third parties exists when a

therapist determines that the pt presents a

serious physical danger to another person