NRNP-6665 Week 2: Discussion

NRNP-6665 Week 2: Discussion Sample 1

Ethical & Legal Foundations of PMHNP Care with Autonomy

The perception of autonomy in psychiatric and mental health care is pivotal for understanding and improving patient outcomes. This principle, deeply rooted in ethical practice, underscores the necessity of respecting patients’ self-governance, particularly in managing their health conditions. Recent studies, including the discussions on psychiatric advance directives (PADs), the influence of capacity-based mental health legislation in Norway, the measurement of autonomy through the Autonomy Scale Amsterdam (ASA), and innovations in autonomy via peer-facilitated interventions, each contribute subtle perspectives to this discourse. These articles collectively explore how autonomy can be both compromised by mental health conditions and potentially restored through innovative legal frameworks, validated scales, and peer support methodologies. They provide a comprehensive view of the challenges and opportunities within mental health practices aimed at enhancing autonomy, crucial for aligning treatment with the values and preferences of those with psychiatric disorders.

Autonomy

Autonomy in psychiatric and mental health care, particularly at the level of advanced practice such as that undertaken by Psychiatric-Mental Health Nurse Practitioners (PMHNPs), embodies a crucial principle in both ethical and clinical dimensions. The concept of autonomy signifies to the capability and right of patients to make knowledgeable and intentional decisions about their individual health care (Manderius et al., 2023). This is particularly distressing in psychiatric settings where patients may face challenges related to mental health conditions that can affect their decision-making capabilities (Manderius et al., 2023). Advanced practice professionals, like PMHNPs, navigate these complex waters by employing a patient-centered approach that emphasizes respect for the patient’s values and preferences while ensuring that decisions are made competently and with full understanding of the consequences.

In practice, fostering autonomy means that mental health practitioners must be adept in communicating complex medical information in an accessible manner, assessing the patient’s capacity to understand their condition and treatment options, and supporting their decision-making process. This can often involve a delicate balance of providing guidance and support without overstepping the patient’s right to self-determination, even when their choices raise ethical concerns or differ from clinical recommendations (Manderius et al., 2023). Furthermore, the extension of autonomy in mental health also includes advocacy for patient rights with larger health care systems and society, challenging stigmatization, and promoting access to necessary health care services.

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Moreover, the role of autonomy extends beyond individual patient interactions. At a systematic level, PMHNPs and other mental health professionals must navigate policies and regulations that impact patient autonomy, such as involuntary treatment laws. These professionals must also contend with the ethical dilemmas that arise from these practices, advocating for policies that maximize respect for patient autonomy while ensuring safety and public health (Manderius et al., 2023). As such, autonomy in psychiatric and mental health care represents a foundational ethical principle that influences every level of clinical practice and policy-making, demanding continuous evaluation and adaptation in response to changing societal norms and medical advancements.

“Defining Autonomy in Psychiatry”

The article “Defining Autonomy in Psychiatry” by Jessy Bergamin et al. focuses on the impact of mental illnesses on personal autonomy, defined as the capacity to live a significant life of one’s own creation. The authors argue that mental disorders disrupt personal autonomy in various ways, affecting patients’ quality of life and their motivation to seek treatment. The paper discusses how different psychiatric conditions, including Major Depressive Disorder (MDD), Substance-use Disorders (SUDs), Obsessive Compulsive Disorder (OCD), Anorexia Nervosa, and Schizophrenia, specifically influence autonomy (Bergamin et al., 2022). These influences are characterized by two dimensions: competence being the aptitude to form and act on intentions, and genuineness, which is the alignment of actions with true personal values and desires. The article underscores the importance of considering these disruptions in clinical practice to enhance differential diagnosis, treatment, and patient recovery.

The ethical issues highlighted revolve around respecting patient autonomy in clinical settings, which involves recognizing and supporting patients’ decision-making capabilities even when these are compromised by mental illness. This respect is crucial for consent to treatment and for engaging patients actively in their care plans (Bergamin et al., 2022). Legally, the challenge is ensuring that patients who may not fully comprehend their condition or treatment options are still provided with opportunities to make informed decisions to the extent possible. This involves continual assessment of decision-making capacity and, potentially, the involvement of legal frameworks for those deemed incapable of making informed decisions, such as in cases of severe mental disorders.

In Florida, as in other states, practitioners including PMHNPs must navigate these ethical and legal landscapes carefully. Applying insights from the article could involve developing more subtle approaches to assessing and supporting autonomy in patients with mental disorders. This could include tailored interventions that enhance competence and authenticity, possibly through therapeutic techniques that foster self-reflection, self-awareness, and decision-making skills. For example, in the case of adolescents with mental health issues, enhancing autonomy could also involve working closely with families to support the young patient’s developing capacity for self-determination in line with ethical guidelines and state laws regarding minor consent.

Practically, these considerations imply adopting a more individualized approach to treatment planning that counts for the patient’s level of autonomy impairment. This could involve using tools and scales developed to assess autonomy specifically in psychiatric settings. Integrating strategies that focus not just on symptom management but also on enhancing the patient’s self-efficacy and authentic self-expression. Advocating for policy changes that support comprehensive approaches to mental health care, ensuring that legal standards in Florida regarding patient rights and consent procedures are rigorously applied and reflect the latest psychiatric insights. Such practices not only align with ethical and legal standards but also potentially improve treatment outcomes by aligning interventions more closely with each patient’s unique context and needs, ultimately supporting a more personalized and respectful approach to mental health care.

“Increased Autonomy with Capacity-based Mental Health Legislation in Norway: A Qualitative Study of Patient Experiences of Having Come Off a Community Treatment Order”

The qualitative study by Nina Camilla Wergeland and colleagues examines the impact of the 2017 capacity-based mental health legislation in Norway, specifically its effect on patients who were previously under community treatment orders (CTOs) but had them rescinded following assessments of their competence to consent. The study involved in-depth interviews with twelve individuals to explore their experiences post-revocation (Wergeland et al., 2022). The findings indicate that while patients continued to receive similar health care, their involvement in treatment decisions and sense of autonomy increased significantly. However, some still felt insecure and lacked initiative due to preceding coercive understandings.

A central ethical issue discussed in the article is the right to autonomy versus the need for protective care in mental health settings. Ethically, the legislation aims to respect patients’ self-determination and minimize coercion by ensuring that only those lacking the capacity to consent can be subjected to involuntary treatment (Wergeland et al., 2022). Legally, the challenge lies in accurately assessing a patient’s decision-making capacity and balancing this with the potential risk they may pose to themselves or others (Wergeland et al., 2022). The shift towards capacity-based consent aligns with international human rights standards, particularly the UN Convention on the Rights of Persons with Disabilities (CRPD), by advocating for equal treatment of individuals with mental disorders (Wergeland et al., 2022). As practitioners, it is our duty to abide what is legally and ethically right to the patient.

Implementing similar capacity-based principles in Florida could enhance the patient-centeredness of psychiatric care by prioritizing consent and capacity assessments. For practitioners, especially PMHNPs like myself, this approach would require careful evaluation of a patient’s understanding and decision-making ability regarding their treatment options. In Florida, where mental health laws also need to protect patients and the public, integrating capacity assessments could help tailor interventions more closely to individual needs and reduce reliance on involuntary treatment measures.

Specific implications for practice include enhanced training, policy advocacy, patient-centered care models, and continuous evaluation. Health care providers, including PMHNPs, may need additional training in techniques for assessing capacity, understanding patient rights under mental health laws, and engaging in ethical decision-making (Wergeland et al., 2022). Advocating for legislation in Florida that incorporates capacity-based criteria for involuntary treatment could improve mental health care practices and better align them with CRPD principles. Implementing care models that emphasize patient autonomy and informed consent, even within the constraints of existing laws that allow for involuntary treatment, could foster more collaborative and respectful relationships between patients and providers. Regularly assessing the effectiveness of these practices through qualitative feedback from patients could help refine approaches and ensure they meet ethical and legal standards while addressing patient needs effectively. In summary, adopting capacity-based mental health care practices could significantly impact the ethical delivery of psychiatric services, enhancing patient autonomy and aligning clinical practices with broader human rights frameworks.

“Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation”

Nicole Karasik’s article discusses the role of Psychiatric Advance Directives (PADs) in protecting the autonomy of patients with severe mental illness (SMI). The article highlights the low uptake of PADs despite their potential benefits in preemptively expressing patients’ treatment preferences, thereby ensuring that these preferences are respected during episodes where patient may lack decision-making capacity (Karasik, 2023). Karasik proposes the use of a peer-support model to facilitate the creation and execution of PADs, arguing that peer facilitators can overcome barriers at multiple levels: systematic (resource constraints), professional (deficiency of knowledge and distress of complete treatment refusal), and user-level (lack of trust and support).

The primary ethical issue revolves around the autonomy of patients with SMI and their right to participate actively in their treatment planning, especially when they are competent to make decisions. The legal landscape, underpinned by the Patient Self-Determination Act, mandates that healthcare facilities respect advance directives but has not effectively ensured their widespread adoption among patients with SMI (Karasik, 2023). This raises concerns about both ethical and legal compliance in respecting patient autonomy and the principle of beneficence, which seeks to act in the best interest of the patient without causing harm (Karasik, 2023). There is also an ethical imperative to ensure that the facilitation of PADs does not come under undue provider influence, which can undermine the authenticity of the patient’s own choices and preferences.

Implementing peer-facilitated PAD programs in Florida could enhance how mental health services respect and integrate patient autonomy, particularly for those with SMI. As a PMHNP, integrating such a model could help address ethical concerns about autonomy and informed consent by enhancing patient engagement, improving compliance and outcomes, and reducing coercive practices (Karasik, 2023). Utilizing peer facilitators can make patients feel more understood and supported, given the shared experiences. This could increase their willingness to engage in the PAD process, ensuring that their treatment preferences are documented and respected. Patients are more likely to adhere to treatment plans that they have actively participated in formulating, potentially leading to better health outcomes (Karasik, 2023). By respecting patients’ advance directives, involuntary treatments could be minimized, aligning practice with legal standards and ethical obligations to respect patient autonomy. Together these applications could make a significant difference in clinical practice.

For special implications for practice in Florida, initiating training programs and integrating them, policy advocacy, collaboration and monitoring, and resource allocation are significant to be aware of for the state of Florida. As a practitioner, initiating or participating in training programs for peer supporters could be vital. These programs should focus on equipping peers with the necessary skills to facilitate PAD discussions effectively. Advocating for state policies that support the implementation of peer-facilitated PAD programs could help standardize the practice across Florida, ensuring that all patients with SMI have the opportunity to benefit from such initiatives. Establishing collaborative practices between healthcare providers and trained peer facilitators can help monitor the effectiveness of PADs in enhancing patient autonomy and treatment outcomes. Regular reviews and adjustments to the PADs based on ongoing patient feedback and changes in their health status would be crucial (Karasik, 2023). Pushing for adequate funding and resources from healthcare organizations and state health departments to support the training and deployment of peer support specialists in mental health settings. In conclusion, Karasik’s proposal for peer-facilitated PADs offers a promising approach to enhance the autonomy and treatment outcomes of patients with SMI in Florida, aligning with both ethical principles and legal requirements (Karasik, 2023). This model not only respects the autonomy of patients but also potentially improves their engagement and satisfaction with the mental health care system, thereby fostering better health outcomes and reducing the reliance on coercive treatment methods.

“Development and Validation of the Autonomy Scale Amsterdam”

The article “Development and Validation of the Autonomy Scale Amsterdam (ASA)” by Jessy Bergamin and colleagues presents the creation and evaluation of a new scale designed to quantify autonomy in a psychiatric context. The study outlines the process of developing the ASA, which consists of 21 items across six dimensions: self-integration, engagement with life, goal-directedness, self-control, external constraints, and social support (Bergamin et al., 2024). The scale was validated using three separate samples from the general population, totaling 856 participants. Validation processes confirmed the scale’s strong psychometric properties, including reliability and both convergent and discriminant validity. The ASA was shown to have incremental validity over a remaining quantity of autonomy in predicting mental health outcomes, underscoring its potential utility in both research and clinical settings.

The ethical principle of autonomy, especially in mental health practice, emphasizes the right of individuals to make informed decisions about their own care. The ASA’s focus on measuring various aspects of autonomy can help clinicians understand the extent to which mental health issues might impair a patient’s ability to make informed decisions, which is crucial for ethical treatment planning and obtaining valid consent (Bergamin et al., 2024). As for patient rights and empowerment, by quantifying elements of autonomy, the ASA can guide interventions that aim to enhance patients’ self-governance and engagement with life. This aligns with ethical guidelines that prioritize patient-centered care and empowerment, a cornerstone of contemporary mental health ethics.

As a PMHNP, applying the ASA in your practice could enhance your ability to asses and address autonomy in patients with mental health disorders. This is particularly relevant in Florida, where understanding the subtle impact of cultural, social, and individual factors on autonomy can inform tailored therapeutic interventions. Specific implications include enhanced assessment, tailored interventions, and legal compliance (Bergamin et al., 2024). Using the ASA to assess autonomy levels in patients could help in identifying specific areas where interventions might be needed to improve autonomy, such as enhancing social support or goal-directed behaviors. Understanding a patient’s autonomy profile could guide personalized treatment plans that focus not only on symptom relief but also on enhancing life engagement and self-governance, leading to potentially better treatment outcomes (Bergamin et al., 2024). In Florida, as in other states, legal standards require that patients receive care that respects their autonomy, which is vital for legal compliance, especially when making decisions about the use of involuntary treatments or when there are concerns about a patient’s capacity to consent. Incorporating the ASA into your practice can provide a comprehensive tool to assess and enhance autonomy among your patients, aligning with both ethical considerations and legal requirements in mental health care. This approach not only aids in complying with patient rights standards but also supports the ethical mandate to treat patients as active participants in their own care, promoting their overall well-being and recovery.

Conclusion

In conclusion, the exploration of autonomy within psychiatric and mental health care, as discussed in the reviewed articles, highlights the critical intersection of ethical considerations, legislative frameworks, and clinical practices. The implementation of psychiatric advance directives, the transformative impact of capacity-based legislation in Norway, the psychometric validation of the Autonomy Scale Amsterdam, and the empowering potential of peer-support models, all underline the importance of fostering autonomy in mental health contexts. These studies collectively advocate for a paradigm shift towards more patient-centered care, where respecting and enhancing individual autonomy not only associates with ethical imperatives but also supplies to more effective and humane treatment outcomes. As such, these discussions reinforce the necessity for ongoing research, policy development, and clinical training focused on empowering patients within the mental health system, thereby ensuring that treatment plans are both respectful of personal autonomy and conducive to recovery.

References

Bergamin, J., Luigjes, J., Kiverstein, J., Bockting, C. L., & Denys, D. (2022). Defining autonomy in psychiatry. Frontiers in Psychiatry, 13, 801415. https://doi.org/10.3389/fpsyt.2022.801415Links to an external site..

Bergamin, J., Hoven, M., van Holst, R. J., Bockting, C. L., Denys, D., Nevicka, B., & Luigjes, J. (2024). Development and validation of the autonomy scale Amsterdam. Comprehensive Psychiatry, 131, 152466. https://doi.org/10.1016/j.comppsych.2024.152466Links to an external site..

Karasik, N. (2023). Protecting the autonomy of patients with severe mental illness through psychiatric advance directive peer-facilitation. Voices in Bioethics, 9, 1-9. https://doi.org/10.52214/vib.v9i.11800Links to an external site..

Manderius, C., Clintstahl, K., Sjostrom, K., & Ormon, K. (2023). The psychiatric mental health nurse’s ethical considerations regarding the use of coercive measures – a qualitative interview study. BMC Nursing, 22(1), 23. https://doi.org/10.1186/s12912-023-01186-zLinks to an external site..

Wergeland, N. C., Fause, A., Weber, A. K., Fause, A. B. O., & Riley, H. (2022). Increased autonomy with capacity-based mental health legislation in Norway: A qualitative study of patient experiences of having come off a community treatment order. BMC Health Services Research, 22(1), 454. https://doi.org/10.1186/s12913-022-07892-9Links to an external site.

Ethical considerations.pdf Download Ethical considerations.pdf

Development and validation of the Autonomy Scale Amsterdam.pdf Download Development and validation of the Autonomy Scale Amsterdam.pdf

Protecting the Autonomy of Patients with Severe Mental Illness.pdf Download Protecting the Autonomy of Patients with Severe Mental Illness.pdf

Increased Autonom with Capacity-Based Mental Health Legislation in Norway.pdf Download Increased Autonom with Capacity-Based Mental Health Legislation in Norway.pdf

Defining Autonomy in Psychiatry.pdf

NRNP-6665 Week 2: Discussion Sample 2

Literature Review: Ethical and Legal Considerations of Using Restraints in Psychiatry

The utilization of restraints poses a multifaceted ethical and legal concern. Restraints, whether they are physical or chemical, are frequently used as a final option to control violent or destructive behaviors displayed by individuals with mental illness. Restraints are designed to be utilized in situations to ensure the safety of patients. While the intention may be to prevent harm, initiating restraints can lead to negative consequences, such as retraumatization of the patients. The purpose of this literature review is to explain the ethical and legal complications associated with the use of restraints in psychiatric care. Enhanced comprehension by the psychiatric mental health nurse practitioner (PMHNP) can facilitate a secure and patient-centered approach.

Article #1- Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff’s perceptions and assessments

According to Bachmann et al. (2022), the study utilized a qualitative descriptive strategy. This study aims to investigate the perspectives and evaluations of nurses and ward personnel regarding patient care during the implementation of mechanical restraints. A qualitative description allows for gaining direct responses to topics that are particularly important to practitioners. It involves presenting the findings using the language often used by practitioners in their daily work. A qualitative descriptive design seeks to provide conclusions that closely align with the data and enables an investigation into the experiences and perspectives of the participants, to obtain detailed descriptions of the phenomenon under study. A group of 18 nurses and ward staff, ranging in age from 22 to 45 years old, with prior experience in implementing mechanical restraints, reported that their evaluations of the patients’ physical and mental states differed. Management-qualified professionals have shown a distinct disparity in their approach to handling circumstances both before and during the application of mechanical coercive measures. The research mostly examined the psychological effects, which were predominantly negative and associated with trauma or re-traumatization. This study determined that enhancing education and training is optimal when personnel are utilizing restraints. Notably, there are limitations to this study. The results should be taken cautiously due to the small number of health professionals who took part, their varying professional positions, and the fact that they were selected from only two small geographic locations in Norway.

Article #2 Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review

According to Chieze et al. (2019), compared to previous reviews, this systematic review includes a larger range of outcomes and study designs in its search for data regarding the impact of seclusion and restraints on psychiatric inpatients. Following PRISMA principles, a systematic search was carried out, yielding 35 publications out of 6,854 data entries. Research on the impact of isolation and restriction in adult psychiatry encompasses a broad spectrum of findings and methodologies. The estimated incidence of post-traumatic stress disorder following intervention ranges from 25% to 47%, indicating that it is a significant issue, particularly for patients who have experienced prior trauma. In terms of research, examining the literature makes it abundantly evident that finding meaningful findings regarding the consequences of restraint and seclusion in adult psychiatry is still challenging. The difference in the comparative issue and the difficulty of developing study designs for individuals who are upset appear to be contributing factors. These findings make it difficult to fully have an understanding of what negative effects follow patients and staff after seclusion and restraints are implemented on an inpatient unit.

Article #3 Is Physical Restraint Unethical and Illegal?: A Qualitative Analysis of Korean Written Judgments

According to Jang et al. (2024), physical restraint (PR) guarantees the security of individuals receiving care. Nevertheless, this difficulty arises due to conflicting principles of autonomy and dignity for the beneficiaries, and the need for health practitioners to provide appropriate treatment. The objective of this study was to examine legal and ethical scenarios about the utilization of public relations through published court decisions. This study was employed using a qualitative retrospective design. A qualitative content analysis was conducted on written judgments from South Korea. A cumulative total of 38 cases spanning from 2015 to 2021 were classified and grouped accordingly. An analysis was conducted to evaluate the various categories of court rulings and ethical dilemmas by the four principles of bioethics. The judgments rendered by the courts were then compared. It was concluded that in these cases assessing the necessity for PR and identifying the appropriate timing for its implementation. Nevertheless, the issue lies in the lack of clarity regarding the methodology used to determine these factors. In any case, the use of PR must be properly documented and show necessity and never be used in cases related to overstaffing or out of convenience to medical staff.

Article #4 Restraints and seclusion in psychiatry: striking a balance between protection and coercion.

According to Zammi et al. (2020), the utilization of restraint and seclusion (R&S) techniques in psychiatric settings is prevalent, even though there is a dearth of scientific data supporting their efficacy. Coercive interventions have intricate medical, ethical, and legal repercussions. International treaties, supranational agencies, scientific institutes, legislative authorities, and tribunals have established benchmarks for research and standards. Their use has been influenced by changes in norms, civil rights enforcement, judicial rulings, and the availability of new therapeutic choices. Healthcare professionals should adhere to precautionary guidelines and take into account the efficacy of R&S in achieving therapeutic objectives. Demonstrating the utilization of R&S as a component of a therapy regimen can aid in preventing negligence litigation.

Washington State Code (WAC) 246-322-180 specifically pertains to the utilization of restraints in healthcare establishments, particularly in mental environments. The regulations encompass several crucial aspects, including reasoning for restraints and other measures tried. Staff must promptly inform and obtain approval from a physician, physician assistant, or psychiatric advanced registered nurse practitioner within one hour of commencing patient restraint or seclusion. Assessments must be completed by a registered nurse and 15-minute checks must be implemented on all patients which include offering bathrooms to patients. Seclusion and restraint may not be applied in an outpatient office the PMHNP must be aware of the trauma that is caused by restraints and have conversations with patients that they are treating on an outpatient basis.

Conclusion

The research highlights the intricate interaction between ethical and legal factors related to the use of restraints in psychiatric care. Although restraints are commonly used to promote patient safety, they might result in adverse consequences such as retraumatization and ethical quandaries about patient autonomy and dignity. The qualitative investigations emphasized the significance of education and training for healthcare personnel to guarantee the prudent and empathetic utilization of restrictions. Furthermore, the systematic review uncovered the difficulties in evaluating the effects of restraint and seclusion on psychiatric inpatients, highlighting the necessity for additional study to fully comprehend the repercussions for both patients and staff.

Reference

Bachmann, L., Vatne, S., & Mundal, I. P. (2022b). Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff’s perceptions and assessment. Journal of Clinical Nursing, 32(3–4), 438–451. https://doi.org/10.1111/jocn.16249Links to an external site.

Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00491

Jang, S. G., Lee, W., Ha, J., & Choi, S. (2024). Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01781-8

WAC 246-322-180: (n.d.). https://app.leg.wa.gov/wac/default.aspx?cite=246-322-180

Zaami, S., Rinaldi, R., Bersani, G., & Marinelli, E. (2020). Restraints and seclusion in psychiatry: striking a balance between protection and coercion. Critical overview of international regulations and rulings. 55(1), 16–23. https://doi.org/10.1708/3301.32714

NRNP-6665 Week 2: Discussion Sample 3

USE OF RESTRAINTS

Ethical and Legal Foundations of PMHNP Care: Use of Restraints

Restraints are often used to ensure the safety of a patient, other patients, and the staff in psychiatric care settings. The practice involves restricting a patient’s mobility by tying their hands and legs to their bed using leather restraints. While the practice has been considered inevitable, particularly as a last resort among patients with violent tendencies, it has ethical and legal implications (Oh, 2021). In this paper, the author examines the subject of restraints in mental health practice by reviewing and summarizing four articles on the ethical and legal considerations related to restraints. The synthesis also outlines how the ethical and legal aspects influence the work of psychiatric mental health nurse practitioners (PMHNP).

Ethical Considerations for Restraints Use in Adults

In hospitalized adults, restraints are coercive measures that mental health practitioners take to protect and control patients. Cortinhal et al. (2024) scoping review indicated restraints are used in adult psychiatric settings, especially for aggressive and violent patients. The researchers noted the effects of the decision on the person and the nurse. The patient can have physical, psychological, and social impacts after being placed under restraints, such as high blood pressure, laceration, anger, anxiety, and social isolation. Also, the nurse may experience guilt and anxiety. The researchers identified ethical considerations for the nurses when deciding on using restraints. They urge mental health nurse practitioners to weigh the harms versus benefits. The nurses should also consider patient autonomy, which is mainly limited when coercive measures are used. Another ethical consideration is the protection of human dignity (Cortinhal et al., 2024). Overall, physical restraints in adult patients are beneficial, but a thorough examination of the harms and ethical issues is essential.

Ethical Considerations for Physical Restraints in Children and Adolescents

Additionally, physical restraints are used in children and adolescents. Lombart et al. (2020) observed that restraints are applied to children and adolescents. The restrictive practice allows the nurses to conduct some procedures to help pediatric patients. However, controversy surrounds the decision and amounts to ethical issues. It breaches the patient’s autonomy. Furthermore, restraining children could be counterproductive as the patients resist the action. The restrained children may distrust their care providers, threatening efforts to build therapeutic alliances (Lombart et al., 2020). Just as in adults, mental health practitioners should ensure the decision to restrain a child or adolescent is justified to avert the negative consequences.

Legal Considerations for Adults

There are legal considerations to make when applying restraints on adult patients. Donovan et al. (2023) noted that the unjustified or indiscriminate use of physical restraints is a violation of human rights. The law requires physical restraints to be used as a last resort after healthcare practitioners explore the least restrictive measures. A patient or family may sue a healthcare professional if they feel the restraining was not justifiable. Mental health practitioners should understand the legal guidelines for using restraints on adult patients to prevent associated ramifications.

Legal Considerations for Children/Adolescents

In children and adolescents, healthcare practitioners should use physical restraints cautiously. Preisz and Preisz (2019) explained that restraining children and adolescents for usual medical procedures has been a mainstay practice. However, the authors cautioned healthcare practitioners against using restrictive measures unless they are justified. Restraints are associated with harm to the patients and, in extreme cases, death through asphyxiation. Also, they go against the patient’s right to autonomy, human dignity, and privacy. If healthcare practitioners consider restraints for their pediatric patients, they should examine the pros and cons. It is also critical to inform the parents or guardians (Preisz & Preisz, 2019). Just as for adults, healthcare professionals should use physical restraints based on the guidelines of one’s practice jurisdiction.

Application to PMHNP Practice in New Jersey

New Jersey legislation allows physical restraints’ application on adults, adolescents, and children but under specific conditions. The state expects healthcare organizations to have a protocol that outlines the guidelines for applying physical restraints. However, PMHNPs are not allowed to order restraints. A physician designated to the patient is the only professional who can write a physical restraint for nurses to consider. However, the consequences of executing the restrictive measure affect the nursing professionals. The law recommends regular assessment of the patients to identify and manage physical distress, examine clinical status, and respond to basic needs. Also, healthcare providers should remove the devices as soon as they accomplish the intended goal (New Jersey Department of Health and Senior Services, 2005). Familiarizing oneself with the legislation on restraints’s use in nursing care can ensure that PMHNPs meet relevant ethical and legal obligations.

References

Cortinhal, V. S. J., Correia, A. S. C., & Fernandes, S. J. D. (2024). Nursing ethical decision making on adult physical restraint: A scoping review. International Journal of Environmental Research and Public Health, 21(1), 75. https://doi.org/10.3390/ijerph21010075Links to an external site..

Donovan, A. L., Petriceks, A. H., Paudel, S., Vyas, C. M., & Stern, T. A. (2023). Use of physical restraints in the emergency department: rationale, risks, and benefits. The Primary Care Companion CNS Disord, 25(3), 22f03320. https://doi.org/10.4088/PCC.22f03320Links to an external site..

Lombart, B., Stefano, C. D., Dupont, D., Nadji, L., & Galinski, M. (2019). Caregivers blinded by the care: A qualitative study of physical restraint in pediatric care. Nursing Ethics, 27(1), 230-246. https://doi.org/10.1177/0969733019833128Links to an external site..

New Jersey Department of Health and Senior Services. (2005). N.J.A.C. Title 8 Chapter 43G Hospital Licensing Standards. Sub-Chapter 18: Nursing care: Use of restraints. New Jersey, NJ: New Jersey Gov. https://www.nj.gov/health/forms/NJAC%20%20%208%2043G%20licensing%20standards.pdf.

Oh, Y. (2021). A new perspective on human rights in the use of physical restraint on psychiatric patients based on Merleau-Ponty’s phenomenology of the body. International Journal of Environmental Research and Public Health, 18(19), 10078. https://doi.org/10.3390/ijerph181910078Links to an external site..

Preisz, A., & Preisz, P. (2019). Restraint in pediatrics: A delicate balance. Journal of Pediatrics and Child Health, 55(10), 1157-1290. https://doi.org/10.1111/jpc.14607Links to an external site..

NRNP-6665 Week 2: Discussion Sample 4

Restraints

A restraint is any measure that reduces a person’s movement or action/behavior used in a healthcare setting to protect a patient from self-harm or harming others and keep people safe. However, restraining a patient is considered a high-risk intervention, and hence, it is the last resort in medical settings. There are different types of restraints, such as physical restraints such as vests, mitts, and side rails; chemical restraints like sedatives and tranquilizers; environmental restraints and seclusion. Healthcare workers need to consider legal and ethical considerations when determining a patient’s restraint, as there is an ethical dilemma between the autonomy and dignity of the patient. As a future PMHNP, using the best professional judgment, including ethical and legal concerns, is vital when giving restraint orders.

Ethical considerations or issues related to restraining children/adolescents:

Article: “Caregivers Blinded by the Care: A qualitative study of physical restraint in pediatric care.”

Physical restraints on the pediatric population can raise ethical issues in healthcare, schools, and mental health settings. The healthcare staff should use all alternatives before choosing a restraint. The decision to use restraints should be after careful assessment, consideration of other options, and adherence to legal and ethical guidelines. Study reveals that physical restraints cause negative consequences for a child’s mental and physical well-being. Restraints can also cause distress, fear, anger, anxiety, and traumatic psychological damage. In the article “Caregivers Blinded by the Care: A qualitative study of physical restraint in pediatric care.” Physical restraint in pediatric care is ethical because it challenges professionals with the dilemma of using force for the child’s best interest (Lombart et al., 2019). In mental health care settings, physical restraints of children and adolescents are used as a reactive behavior management approach, which results in physical injury and even death. As an advanced practice nurse, a PMHNP should consider some ethical aspects such as autonomy, respect, safety, communication, and harm before giving an order to restrain a patient. It is vital to respect the patient’s autonomy; hence, it is essential to get consent from the patient or the parents and explain the rationale for restraint; otherwise, it is against the law that we do not respect the patient’s autonomy. Though restraints are a safety measure for the patient or others, they can harm the patient, so proper assessment and care are essential and should be documented (Manderius et al., 2023).

Ethical considerations or issues related to restraining the Elderly:

Article: “Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments”.

The article discusses the analysis of ethical situations related to using physical restraints in older people. In 2014, an incident happened in a South Korean long-term care hospital where several elderly patients died due to a fire broke out. Investigation reports reveal that many elderly patients were found tied to their beds without being rescued. Further analysis of the situation by the court using the four principles of biomedical ethics discloses that the reasons for using the restraints on patients were not ethical. Many patients on restraint do not have consent, and they do not meet the Principle of autonomy. Numerous patients had adverse outcomes, such as falls and some deaths in the psychiatric unit, hence not meeting the Principle of non-maleficence. Some patients had restraints for unethical purposes such as punishment, staff convenience, and staff shortages, ignoring the Principle of beneficence and justice (Jang et al., 2024). As a PMHNP, it is essential to consider the ethical dilemma while ensuring the patient’s safety, dignity, and autonomy. Restraint should be individualized and least restrictive by respecting the patient’s privacy and dignity. Older people have decreased physical and mental capacity and are more prone to harm. It is essential to get consent, a legal document (Carrero-Planells et al., 2021).

Legal considerations or issues related to restraining children/adolescents:

Article: “Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis”

Restraint use in children or adolescents is one of the most debatable practices in mental health as they are the most vulnerable population. Restraints and seclusions can result In negative patient consequences and should be the last resort in treatment. The advanced practice nurse should follow the four fundamental ethical principles: autonomy, justice, beneficence, and non-maleficence, before considering the restraint option. In the case of chemical restraints, which are more common in mental health facilities, the provider should only prescribe medications that have a rapid onset with minimal side effects as a last resort in emergent situations. It is vital to monitor the patient for side effects and document how the problem was emergent and how the patient benefited from the restraint. The provider must check whether the patient or the legal guardian signs the consent to treatment to avoid common legal implications such as false imprisonment, potential liability for improperly detaining patients, false imprisonment, and related claims and properly document which demonstrates the need for restraint legally (Ye et al., 2019).

Legal considerations or issues related to restraining Elderly

Article: “Interface of Law and Psychiatric Problems in the Elderly.”

In a mental health setting, patients with aggressive behaviors who are at high risk for self or others are placed on restraints. Restraints can cause dire consequences on the physical and mental health of older adults. Improper use of restraint is a violation of law. Some legal considerations when restraining older people include, as a provider or PMHNP, it is essential to place the order only after getting consent and a proper explanation, as physical restraint is a violation of human rights. Legally, the provider should respect patients’ autonomy, dignity, and rights, and Breaching this duty can lead to liability for the facility and individual caregivers(Sivakumar et al., 2022).

Legal and Ethical implication in PMHNP Practice and Texas State Law

The advanced practice nurse must understand the code of ethics. The PMHNP practice is guided by ethical and legal codes, which help guide clinical decision-making. When restraints in psychiatric mental health facilities, it is important to consider legal implications, such as battery and false imprisonment. The provider should use professional judgment to determine if they are clinically necessary and adequately document the indication and the benefits for the patient. The ethical considerations include getting consent after a proper explanation and using the least restrictive method for the shortest time. According to Texas health behavior health policy, limit restraint used when other alternatives have failed and in emergencies, protect patient rights and dignity when restraints are unavoidable, use the least restrictive method and as a temporary intervention, use approved devices for restraining, and discontinue as early as possible, proper assessment and documentation every 15 minutes is essential (Mental Health Resources and Protections, n.d.).

Reference:

Carrero-Planells, A., Urrutia-Beaskoa, A., & Moreno-Mulet, C. (2021). The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health, 18(14), 7509. https://doi.org/10.3390/ijerph18147509

Lombart, B., De Stefano, C., Dupont, D., Nadji, L., & Galinski, M. (2019b). Caregivers blinded by the care: A qualitative study of physical restraint in pediatric care. Nursing Ethics, 27(1), 230–246. https://doi.org/10.1177/0969733019833128

Manderius, C., Clintståhl, K., Sjöström, K., & Örmon, K. (2023c). The psychiatric mental health nurse’s ethical considerations regarding the use of coercive measures – a qualitative interview study. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01186-z

Mental health resources and protections. (n.d.). https://gov.texas.gov/organization/disabilities/mental_health_protections

Sivakumar, P., Mukku, S. R., Tiwari, S., Varghese, M., Gupta, S., & Rathi, L. (2022). Interface of law and psychiatric problems in the elderly. Indian Journal of Psychiatry/Indian Journal of Psychiatry, 64(7), 163. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_47_21

Ye, J., Wang, C., Xiao, A., Xia, Z., Yu, L., Lin, J., Liao, Y., Xu, Y., & Zhang, Y. (2019). Physical restraint in mental health nursing: A concept analysis. International Journal of Nursing Sciences, 6(3), 343–348. https://doi.org/10.1016/j.ijnss.2019.04.002

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Caregivers blinded by the care_ A qualitative study of physical restraint in pediatric care.pdf Download Caregivers blinded by the care_ A qualitative study of physical restraint in pediatric care.pdf

Mental Health Protections _ Office of the Texas Governor _ Greg Abbott.pdf Download Mental Health Protections _ Office of the Texas Governor _ Greg Abbott.pdf

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NRNP-6665 Week 2: Discussion Sample 5

MAIN POST

Discussion: Involuntary Hospitalization and Due Process of Civil Commitment

The legal process of involuntary hospitalization, also known as civil commitment, allows for the confinement of a person in a psychiatric hospital for treatment of a treatable mental disorder despite their objection (Aluh et al, 2023). This process involves a host of legal differences and thus needs a careful assessment of the need for involuntary hospitalization.

Ethical Considerations of Involuntary Hospitalization for Adult Patients

The article by Laureano et al. (2024) examines ethical issues that arise due to involuntary psychiatric treatment for adults. One of the ethical concerns is the tension that arises when faced with respecting the patient’s autonomy and the need for treatment. According to Laureano et al. (2024), mental health professionals are faced with ethical challenges when they have to use coercive measures since they raise ethical concerns due to its impact on patient’s autonomy and freedom.

Ethical Considerations of Involuntary Hospitalization for Children and Adolescent

The article by Walker et al. (2021), examines involuntary psychiatric hospitalization in children and adolescents. According to Walker et al. (2021), several factors are associated with involuntary hospitalizations and they include diagnoses of psychosis, substance misuse, and intellectual disability. The article argues that adolescents who presented a danger to themselves or others were more likely to be involuntarily hospitalized. The article explains that several ethical difficulties surround involuntary psychiatric hospitalization. While involuntary hospitalization is a potentially life-saving measure to restore mental health, it also raises concerns about potential trauma and infringement on individual autonomy. For example, it pits society’s need to protect vulnerable individuals (paternalism) against their right to make their own choices (autonomy). According to Walker et al. (2021), involuntary treatment, while it intends to assist and help patients often feels traumatic and discourages future engagement with mental healthcare. Additionally, due to the use of restrictive measures like seclusion and restraint, the use of involuntary hospitalization often raises further ethical concerns.

Legal Considerations of Involuntary Hospitalization for Adults

The article by Silva et al. (2021) look at factors associated with involuntary psychiatric hospitalization. It explores trends in involuntary hospitalization rates and examines the need to balance individual rights and public safety. According to Silva et al. (2021), there are several factors associated with involuntary hospitalization, such as psychosis diagnosis, lack of social support, and being admitted during economic crisis years. The article explains that the very nature of involuntary admission raises significant legal concerns that apply to adults in psychiatric care. One of the legal concerns is the principle of personal freedom and fundamental human rights. Involuntary admission often restricts a person’s freedom to choose their treatment thus raising concern about the violation of patient autonomy (Silva et al., 2021). It also raises the legal issue of adequate treatment and public safety. For example, it argues that involuntary admission should only be used when necessary to protect the patient or others from harm. Involuntarily hospitalizations represent a deprivation of personal liberty and as well the suspension of legal capacity for patients thus conflicting with the right to personal autonomy and the ability to make sound decisions about one’s treatment.

Legal Considerations of Involuntary Hospitalization for Children and Adolescent

The article by Schölin et al. (2024) examines the legal considerations surrounding involuntary detainment of children and adolescents for mental health evaluation and treatment. The article argues that the UN Convention on the Rights of the Child (UNCRC) and the UN Convention on the Rights of Persons with Disabilities (CRPD) emphasize the need for strong justification for detaining minors. These conventions advocate for respecting a child’s evolving capacities, avoiding arbitrary detentions, and ensuring non-discriminatory practices. To avoid unrecorded detentions, parents or guardians may consent to detainment on behalf of a child, raising ethical concerns if the child lacks understanding or is against it. According to Scholin et al., (2024), the increasing number of detentions globally highlights the need for legislative reform to establish clearer criteria for the detainment of children with mental health issues.

Implications of the Ethical and Legal Considerations of Administration of Involuntarily Hospitalizations to a Practice in Maryland State

The information on involuntary admissions can be instrumental and applicable to clinical practice. For example, it allows for a better understanding of the laws, procedures, and regulations governing involuntary commitment. The articles highlight factors influencing involuntary admissions beyond the patient (Silva et al., 2021). This helps understand that mental health providers should play a role by advocating for increased mental health funding and promoting mental health awareness within the communities, thus reducing reliance on involuntary commitment. Another ethical dilemma explored is balancing patient autonomy with safety. This meant that mental health professionals should be aware of these conflicts and strive to make decisions that minimize coercion while ensuring the well-being of the patient and potentially others at risk. It highlights the importance of understanding the ethical considerations, legal framework, and available resources in Maryland State, allowing mental health professionals to make informed decisions regarding involuntary admission. For example, prioritizing alternative interventions and collaborating with relevant parties to help ensure patient rights are protected while at the same time promoting positive patient outcomes.

References

Aluh, D. O., Aigbogun, O., Ukoha-Kalu, B. O., Silva, M., Grigaitė, U., Pedrosa, B., … & Caldas-de-Almeida, J. M. (2023, July). Beyond patient characteristics: A narrative review of contextual factors influencing involuntary admissions in mental health care. In Healthcare 11 (14), p. 1986). MDPI. https://doi: 10.3390/healthcare11141986Links to an external site.

Laureano, C. D., Laranjeira, C., Querido, A., Dixe, M. A., & Rego, F. (2024, February). Ethical issues in clinical decision-making about involuntary psychiatric treatment: A scoping review. In Healthcare 12 (4), p. 445). MDPI. https://doi.org/10.3390/healthcare12040445Links to an external site.

Silva, M., Antunes, A., Azeredo-Lopes, S. (2021). Factors associated with involuntary psychiatric hospitalization in Portugal. Int J Ment Health Syst 15, 37. https://doi.org/10.1186/s13033-021-00460-4Links to an external site.

Schölin, L., Tucker, Z.,& Chopra, (2024). Detention of children and adolescents under mental health legislation: a scoping review of prevalence, risk factors, and legal frameworks. BMC Pediatr 24, 12. https://doi.org/10.1186/s12887-023-04464-6Links to an external site.

Walker, S., Barnett, P., Srinivasan, R., Abrol, E., & Johnson, S. (2021). Clinical and social factors associated with involuntary psychiatric hospitalization in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. The lancet child & adolescent health, 5(7), 501-512. https://doi:10.1016/S2352-4642(21)00089-4Links to an external site.

NRNP-6665 Week 2: Discussion Sample 6

Main Discussion

Introduction

Psychiatric-mental health nursing presented its self as having some significant relationship with both Ethical and Legal issues. These principles ensure that patients are independent in various decisions concerning their care, all their rights and self-respect are upheld. Among the areas I consider to be most pivotal in this practice is informed assent/consent and the subsequent evaluation of a patient’s capacity. It is essential to understand and agree with the treatment to be provided in a health care facility hence making this process crucial. This paper aims to examine the issues of informed assent/consent and capacity within ethical and legal framework in psychiatric-mental health nursing practice where decision-making is made between healthcare professionals and adults or parents with decisional capacity for children and young people. In order to ponder over these issues and the consequences they pose for the subsequent practice of clinical psychological work, this discussion will draw from the materials of scholarly publications and requirements of legal norms.

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Ethical Considerations for Adults

Article 1: Anderson (2012)

Informed consent is a fundamental principle of medical professionalism but also the critical idea that patients must be knowledgeable and willing to accept the procedures or treatments they are about to embark on. Anderson (2012) reports on the typical psychological disorders LGBT children and adolescents, focusing on the concept of the rights of personal autonomy and privacy. Although the emphasis is made regarding younger generations, it will be relevant to the adults, as well. Informed consent in adults is a rigorous process whereby the patient is given all the necessary information disclosed with the true-picture of the situation encompassing the various risks, benefits and various options available other than the recommended course of treatment.

From an ethical perspective, it is equally acceptable that healthcare providers ought to guarantee that the consent of the patient was willingly given and made with adequate information. This involves explaining the matter to the patient and trying to establish if the patient comprehends the information provided to him/her. The exact concept of ethical principle of autonomy is your decision about your healthcare and it is imperative as patients may lack capacity in the mental health cases. These professional dynamics require practitioners to balance the process to respect the patient’s self-determination, at the same time as obtaining the patient’s appropriate treatment.

Ethical Considerations for Children/Adolescents

Article 2: Zakhari (2020)

Where children and adolescent are concerned consent issues becomes more challenging since young people are not equal in their ability to comprehend through the considerations of ethics. Zakhari (2020) stressed the importance of the continued need to seek assent from the children and consent from their parents or guardians. Consent means making the child understand the treatment that is going to be offered, thus making him/she willing to undergo it.

On every front of child and adolescent care, it is ethically necessary to inquire and educate the child as much as possible about their treatment options. This involvement also allows them to have a understanding of the kind of patients they are becoming and enhances the ability in the management of their treatment by feeling they have been involved in decision making process. Assentingly, ability differs with age maturity alongside focal ethical requirement that expects the practitioners to work smart in order to understand the specific developmental level of each child. It is especially important to honour the principles of autonomy when treating adolescents who are on the verge of becoming adults, as ethical practice implies their ability to make decisions independently.

Legal Considerations for Adults

Article 3: Thapar et al. (2015)

This paper’s legal aspects on informed consent for adults are based on human rights and legal standing. This accords with the legal theories for the capacity of individuals and the conditions of informed consent in mental health practice as outlined by Thapar et al. (2015). In the eyes of the law, individuals who are in their legal adulthood are assumed to have the ability to make these decisions in case they did not. This presumption implies that mental health practitioners are under a duty to furnish adequate information on those available treatments and also prove that the patient’s consent given was voluntary.

When an adult cannot make decisions for himself, this legal reference guides practitioners in the process of evaluating the competency of the adult. These assessments are very important in the preservation of some rights of patients and guarantee the proper treatment of patients. Inability cannot also violate the patient’s wishes when making decisions about his or her treatment echoing the legal autonomy principle that holds users to patient self-determination.

Legal Considerations for Children/Adolescents

Article 4: Hilt and Nussbaum (2016)

In the case of children and adolescents, legal aspects include both the liberties and the obligations of the child / teenager and his guardian. Hilt and Nussbaum (2016) have also addressed equalities–based aspects of diagnosis and capacity assessments in an Informed consent. Fraser E. Legally there is a requirement to obtain permission from the parents or guardians for a child who is below the age of majority to receive treatment but the child’s permission is also required.

Policies and regulations help to make sure that the patient or their parent/ legal representative has adequate information about the treatment proposed, to protect their best interest. It is important for the reader to know that although minors may be legally incompetent due to their age, the law understands their evolving capacity, and the rules may differ depending on the state. Certain states have exact guidelines on how the consent process must be done especially in situations where the patient is close in age to the legal adult age of emancipation and is thus capable of making his or her own decisions in healthcare. Legal requirements for mental health care providers should not be arbitrary and alien to the clinicians since the regulations aim at protecting the patients’ rights.

Application to Clinical Practice

Nurses’ consciousness and practice in ensuring ethical and legal perspectives in obtaining informed assent/consent and a capacity of clients need complete understanding and appropriate implementation in psychiatric mental health care (ANA, 2015). In my clinical practice, I would take a multifaceted approach to uphold these principles:In my clinical practice, I would take a multifaceted approach to uphold these principles:

Assessing Capacity: I would evaluate children and adolescents’ competency to consent the treatment, when they cannot consent for themselves and involve parents or lawful guardians; however when the pediatric patient is older and capable of making decisions for him or herself, I would uphold the patient’s autonomy by allowing them to consent to the treatment on their own accord. This assessment is to consider the patient’s cognitive assessment in the process of analysis of information concerning his treatment.
Thorough Documentation: Some important points that would require documentation are the capacity evaluation and discussions held with the key stakeholders for the informed consent/assent process. This documentation serves as an indication of the consent that the patient or the guardian has granted to the various procedures to be done as well as offers legal evidence of the whole process.
Staying Updated: To point out the key requirements for the position, the following points would be crucial when dealing with the legal and ethical considerations: • Long-term commitment to maintaining awareness of the legal and ethical standards trending in the state in question, as well as continuous education in the field. Keeping an updated knowledge on changes to the regulation and being familiar with standard concepts in the field is important towards making my practice meet all the regulatory requirements and ethical standards.
Consulting Experts: Additional input from fellow practitioners and lawyers for specialized or multiple dependant cases would serve as an extra safety measure to guarantee that I uphold the highest standards of getting reacquainted with the next patient. This working together assists in handling certain contingencies and may aid in making the right decisions on moral dilemmas.
Adhering to State Regulations: The following laws or regulations pertaining to informed consent and assessment of capacity in children and adolescents are crucial to be aware of or adhere to in the specific state where one practices: The legal regulations may be quite diverse across the states; hence, it is crucial to identify the specifics of these state requirements for legal compliance as well as to be able to provide adequate patient care.

In general, it has been ascertained that meeting the legal requirements and embracing ethical values is critical in addressing the needs of children, teenagers, and adults who require psychiatric-mental health services.

Conclusion

The topic of ethical and legal issues in psychiatric-mental health nursing practice is vast and encompasses informed assent/consent as well as capacity. This paper has also pointed down the chief active ethical standards and legal protocols that practitioners should follow when seeking permission from the adults and the minors with a view to treating them. This paper presents several principles that mental health professionals should be aware of in order to protect the rights of a patient and abide by the law while attending to them. This approach taken is not only improving the quality of the care that is delivered but it also shields the practitioners as well as the patients. One of the more general approaches is to read what contemporary novelists have to say about their work and, if necessary, seek an expert’s advice to adhere to the highest ethical and legal standards in practice.

References

American Academy of Child & Adolescent Psychiatry. (2014). Code of ethicsLinks to an

external site.. https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_portal/aacap_Links to an external site. code_of_ethics_2012.pdfLinks to an external site.

American Nurses Association. (2015). Code of ethics for nurses with interpretive

statementsLinks to an external site.. https://www.nursingworld.org/practice-Links to an external site. policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/Links to an external site.

Anderson, S. L. (2012).Practice parameter on gay, lesbian, or bisexual sexual orientation, gender

nonconformity, and gender discordance in children and adolescentsLinks to an external

site.. American Academy of Child and Adolescent Psychiatry, 51(9). 957–974. https://www.jaacap.org/action/showPdf?pii=S0890-8567%2812%2900500-XLinksLinks to an external site. to an external site.

Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental

healthLinks to an external site.. American Psychiatric Association Publishing.

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual.

Springer.

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aacap_code_of_ethics_2012.pdf Download aacap_code_of_ethics_2012.pdf

PIIS089085671200500X.pdf Download PIIS089085671200500X.pdf

dsm-5-pocket-guide-for-child-and-adolescent-mental-health.pdf