Main Post

Child and Elder Abuse Reporting

           I chose child and elder abuse reporting as my topic to discuss. The mistreatment of children and older adults has a profound impact on the health and psychological well-being of victims and results in losses of dignity, human rights, and even life (Herrenkohl et al., 2021). Abuse of children and older adults can come in various forms, such as physical abuse, emotional abuse, sexual abuse, and neglect. Older adults are also vulnerable to another type of abuse known as financial exploitation (O’Hara, 2018). Children and older adults are often abused by people they know, such as family members, significant others, or caregivers (Warren et al., 2024).

Summary of Articles

           In the first article by Herrenkohl et al. (2021), the authors discussed the various ways abuse occurs in children and older adults, who the abuser commonly is, and how depression and substance use problems play a role in abuse. Evidence suggests that abusers are usually a family member or a caregiver. Research indicates that adults who were abused as children are significantly at greater risk than others for abuse and being abused by an intimate partner. Research also suggests that depression and substance use problems are the most common disorders for those who commit abuse of older adults, as well as those who are victimized. Depression and substance abuse are also consequences of child abuse and neglect (Herrenkohl et al., 2021).

In the second article by O’Hara (2018), the author discussed the types of abuse in children and older adults, the importance of taking thorough history and physical exams, and when to report abuse. The author stresses the significance of thoroughly assessing patients for abuse and neglect and how to differentiate bruises from conditions such as Mongolian spots and vasculitis or cultural therapies such as cupping. Detecting abuse early and responding will lead to early interventions and better outcomes for our patients (O’Hara, 2018).

           In the third article by Warren et al. (2024), the authors discussed the types of abuse in children, adults, and older adults. The authors also examined how abuse operates differently across the lifespan. The forms of abuse include physical abuse, emotional abuse, sexual abuse, neglect abuse, and financial abuse. Research shows that anyone who experiences violence in childhood and adulthood is more likely to become a perpetrator or victim (Warren et al., 2024).

In the fourth article by Roeders et al. (2024), the authors discussed child abuse as a global problem and how healthcare professionals and teachers can build awareness to identify abuse. The back and bottom are common body sites for signs of abuse. Abused children are at a higher risk for developing drug abuse, a mental disorder, sexually transmitted infections, suicide attempts, risky sexual behavior, or abuse of their children as adults. Abuse is a vicious cycle, and identifying it will lead to proper interventions and decrease the risk of long-term consequences. Once child abuse is suspected, professionals should report it to agencies such as Child Protective Services or the police. NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

How this Information Applies to Clinical Practice

As a healthcare professional, it is crucial to identify and report abuse when it is suspected. Reporting suspected abuse is law in all 50 states of America (O’Hara, 2018). All practitioners are held to this standard and must report if abuse is suspected. Good faith reports are protected from civil liability. In some states, failure to report carries penalties. Suspected cases of children or older adults should be reported by contacting local law enforcement, child protective services, adult protective services, or ombudsmen. I live in the state of California, and reporting abuse is mandatory for nurses. A failure to report suspected abuse can result in disciplinary actions (Board of Registered Nursing, 2024).

References

Board of Registered Nursing. (2024). Abuse reporting requirements. State of California

Department of Consumer Affairs. https://www.rn.ca.gov/pdfs/regulations/npr-i-23.pdfLinks to an external site.

Herrenkohl, T. I., Roberto, K. A., Fedina, L., Hong, S., & Love, J. (2021). A prospective

study on child abuse and elder mistreatment: Assessing direct effects and associations with depression and substance use problems during adolescence and middle adulthood. Innovation in Aging, 5(3), igab028. https://doi.org/10.1093/geroni/igab028Links to an external site.

O’Hara, M. A. (2018). Identifying and responding to child and elder abuse: All

healthcare professionals, including technicians, are mandated reporters. Ophthalmology Times, 1–9. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=rzh&AN=128897461&site=ehost-live&scope=siteLinks to an external site.

Roeders, M., Pauschek, J., Lehbrink, R., Schlicht, L., Jeschke, S., Neininger, M. P., &

Bertsche, A. (2024). Early identification and awareness of child abuse and neglect among physicians and teachers. BMC Pediatrics, 24(1), 302. https://doi.org/10.1186/s12887-024-04782-3Links to an external site.

Warren, A., Blundell, B., Chung, D., & Waters, R. (2024). Exploring categories of family

violence across the lifespan: A scoping review. Trauma, Violence & Abuse, 25(2), 965–981. https://doi.org/10.1177/15248380231169486Links to an external site.

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NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE Sample 2

Fidelity

Fidelity in nursing is essential. It is defined as a faithfulness to a person, cause or belief demonstrated by ongoing loyalty and support (Oxford Dictionary, 2024). As nurses, this is an unspoken understanding and action we demonstrate through patient care. As MHNP’s we continue to instill fidelity in our care with this vulnerable population.

Summary of Articles

The most consistent and salient aspect of all the articles I found about fidelity in mental health nursing is that it is a non-negotiable principle in all facets of research, patient care and practice. In several studies, the implementation of fidelity was critical to positive patient outcomes and success. One study discussed a program that was implemented in a rural area with children with severe mental health issues and how fidelity was one of the main reasons the program had such a great outcome providing effective help for children in this area. Success of the Wraparound program was highly successful due to the implementation of fidelity in the training process of all involved (Bartlett & Freez, 2019). The Care and Developmental Model was created by the Norwegian government of Child and Welfare services to help high risk adolescents for mental health disorders have a better chance at higher quality of life outcomes. Fidelity was a large motivation in the efforts used to create this service to provide better outcomes in residential living of adolescents (Espenes, Waaler, Keles & et al, 2023). Children and adolescents are vulnerable groups and certain ethical and legal practices such as fidelity should never be compromised when providing care.

ORDER ORIGINAL WORK HERE

One of the ways that we know if an intervention is effective in patient care is through fidelity. Patient outcomes in psychotherapy are measured by the clinician knowing that treatment was rendered as intended which supports the fidelity principle. Another article that was found discussed how a fidelity scale was used to develop a program to administer the appropriate treatment for mental health patients in prison. The fidelity tool allowed a clear demonstration of how to implement interventions and strategies in a realistic setting for this complex environment (Givens, Francis, Wilson & et al, 2021).

In general, for all practices of patient care, fidelity is a ethical and legal consideration. In Maryland,     Ethical and legal issues are inevitable to arise when caring for mental health patients and is essential to maintain ethical and legal fidelity to prevent harm and maleficence to patients. To protect ones own practice and philosophy fidelity must be at the forefront of care (Maryland Board of nursing, 2023).

Resources

Bartlett, N.& Freeze, T. Examining Wraparound Fidelity for Youth with Mental Health Needs: An Illustrative Example of Two Rural Canadian Schools. International Journal of Special Education, [s. l.], v. 33, n. 4, p. 846–868, 2019. https://search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=eric&AN=EJ1219408&site=eds-live&scope=siteLinks to an external site..

Givens, A.; Francis, A.; Wilson, A.; Parisi, A.; Phillips, J.; & Villodas, M. Community Mental Health Journal, Oct2021; 57(7): 1288-1299. 12p. (Journal Article – research, tables/charts) ISSN: 0010-3853

Espenes, K., Waaler, P., Keles, S., Helland, S., Schmidt III, H., Kjøbli, J., & Tørmoen, A.Residential Treatment for Children & Youth. 2023, Vol. 40 Issue 2, p132-155. 24p. 3 Charts, 1 Graph. DOI: 10.1080/0886571X.2022.2090481.

Maryland Board of Nursing. (2023). Retrieved from https://mbon.maryland.govLinks to an external site.

Oxford University Dictionary. Retrieved from https://www.oed.com

Week 2 Discussion

Main Discussion

The subject of discussion in this post is the ethical and legal issues surrounding the use of restraints in mental health. In psychiatric-mental health practice, for patients who present a severe risk to themselves or others, the use of both pharmacological and physical restraints is employed. However, using them with vulnerable populations, including children, adolescents, and adults, presents several ethical and legal issues.

Summarized Articles

            The article by Ye et al. (2018), titled “Physical Restraints: An Ethical Dilemma in Mental Health Services in China,” discusses a study conducted to address ethical dilemmas based on the ethical principles of autonomy, beneficence, fairness, and non-maleficence. The study aimed to gather and compile pertinent ethical data and propose comparable guidelines for nursing practice in China that are appropriate to address the safety of patients and nurses in a workforce with inadequate nurses and a poorly developed mental health care system. 

The second article by Nielson et al. (2020), titled “Physical Restraint of Children and Adolescents in Mental Health Inpatient Services: A Systematic Review and Narrative Synthesis.” discusses a study conducted to review the use of physical restraints on children as well as adolescents receiving mental health treatments in inpatient mental health facilities. The data utilized in the study within the article were from various English language publications, with studies addressing experiences with physical restraints among individuals less than 18 years of age during their stay in inpatient mental health facilities.

The third article by Jang et al. (2024), titled “Is Physical Restraint Unethical and Illegal? A Qualitative Analysis of Korean Written Judgments.” is a qualitative analysis study done to analyze and investigate ethical and legal scenarios regarding the use of physical restraints considering the four bioethical principles (autonomy, beneficence, non-maleficence, and justice), and exploring methods of applying physical restrictions from a moral and legal standpoint so that health professionals can use these findings to make morally and legally sound decisions about the use of physical restraints to protect both themselves and the people they are providing care. NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

The final article by Lombart et al. (2019), titled “Caregivers Blinded by the Care: A Qualitative Study of Physical Restraint in Pediatric Care.“, addresses a quantitative study done to learn more about the attitudes and practices of medical professionals regarding the use of forceful physical restraint in pediatric care, as well as the factors that influence its application, and the need for more research on the differences between forceful restraints and restraints used as a safety measure during procedures or treatments.

Ethical and Legal Issues Related to Restraints in Psychiatric-Mental Health Practice for Children/Adolescents and Adults.

The four articles above address ethical and legal issues related to the use of restraints (pharmacological and physical) on adults, children, or adolescents in mental health practices, with the primary considerations being safety, dignity, autonomy, and the possibility of abuse. According to the author Oh (2021), rather than prioritizing one over the other, it is crucial to establish a balance between the patients’ “autonomy and dignity” and “health and safety,” as these are significant aspects of their fundamental human rights and require ethical preservation.

            In ethical considerations, children or adolescents might not fully comprehend or agree to the usage of restrictions; hence, moral concerns regarding autonomy and the requirement to consult parents or guardians before making decisions are essential. For kids and teenagers, the concept of beneficence is of benefit to the patient, and non-maleficence (avoidance of harm) is especially important. If possible, restraint use should only occur with the least restrictive techniques when required. It is imperative from an ethical and justice perspective that minors receive an equal amount of care and protection and are not unreasonably confined. For minors, obtaining informed permission can be challenging. Hence, involvement from parents or guardians is required, and consent from the child is also essential when feasible.  Considerations that have impacted the choice to restrain a child include the need to continue the process, its nature, the child’s safety, their level of agitation, their age, the parent’s perspective, the security of the healthcare team, and the ability to get the child’s agreement (Lombart et al., 2019).

The ability for autonomy is higher in adults. Patients experience a violation of their autonomy when placed on restraints against their will; therefore, it is critical to demonstrate the immediate and apparent hazards associated with such measures. Like children or adolescents, the same guidelines apply to adults as well. However, adults frequently focus more on determining the immediate risk of injury rather than the possible psychological effects of applying restraints. In beneficence and non-maleficence, the same guidelines apply to children, adolescents, and adults; however, evaluating the present risk of injury rather than the possible psychological effects of applying restraints is frequently given more weight. According to Jang et al. (2024), ethical behavior is more challenging when one is providing care for someone with limited cognitive ability; therefore, educating health professionals (improving their knowledge and attitudes) on human rights and the guidelines surrounding the usage of physical restraints could put a stop to the improper use of physical restraints.

In the areas of legal considerations, laws frequently include extra protections for minors, such as obligatory debriefings, frequent reviews of the use of restraints by impartial organizations, and the engagement of child advocacy agencies. Adults also have the legal right to information regarding their care, the right to challenge the application of restraints, and the right to legal counsel if they believe there is an infringement on their rights. Every incidence of using restraints in healthcare requires appropriate and thorough documentation, including the reason(s), length of the incident, and steps taken to defuse the situation. These requirements apply to both adults and children or adolescents.

The Application of Ethical and Legal Issues Related To The Use of Restraints In Clinical Practice, and Implications For Practice Within Texas.

In professional practice, handling ethical and legal concerns carefully and sensitively while working with restraints, particularly in psychiatric-mental health settings, is crucial. It is essential to fully explain the rationale for any restraints used on the patient and, if applicable, to their family before putting them into place. Doing this demonstrates respect for patients’ autonomy regarding their care. Utilizing interventions that provide maximum benefits and minimum harm is vital. Therefore, as providers, restraints should only be used as a last treatment option when less restrictive methods have failed and an evident and imminent risk of harm is present, ensuring that each patient receives equitable and fair treatment. Evaluating and implementing the ethical and legal problems surrounding the use of restraints ensures that one’s clinical practice adheres to the highest standards of care.

            The use of restraints within Texas has rules and regulations that guide ethical and evidenced practices within health care.  According to Texas Health and Human Services (n.d.), the regulation on the use of restraints within healthcare facilities specifies that the imposition of chemical or physical restraints used for convenience, discipline, or not required for medical treatment purposes should is not allowed on residents with the facilities; if restraint is required, the least confining treatment option for, used for a minimal amount of time is ideal, and documentation of ongoing re-evaluation of the restraint need is required.

Conclusion

 In conclusion, there are several ethical and legal issues surrounding the use of restraints in psychiatric and mental health practices, especially when working with children and adolescents. While legal concerns center on following regulations, providing the most minor restrictions possible, protecting rights and safeguards, and having the proper paperwork, ethical considerations emphasize respect for autonomy, beneficence, non-maleficence, fairness, and informed consent. A cautious, patient-centered approach is needed to balance these worries, ensuring that restraints are only applied when required and in the most polite, safe way possible.

References

Texas Health and Human Services. (n.d.). Evidence-based best practices: Physical restraints. https://www.hhs.texas.gov/sites/default/files/documents/ebbp-physical-restraints.pdfLinks to an external site.

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/s12912-024-01781-8Links to an external site.

Lombart, B., De Stefano, C., 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.

Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2020). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care, 25(3), 342–367. https://doi.org/10.1177/1367493520937152Links to an external site.

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.

Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2018). Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 5(1), 68–71. https://doi.org/10.1016/j.ijnss.2017.12.001Links to an external site.

ebbp-physical-restraints.pdf Download ebbp-physical-restraints.pdf ijerph-18-10078.pdf  Download ijerph-18-10078.pdf 

lombart-et-al-2019-caregivers-blinded-by-the-care-a-qualitative-study-of-physical-restraint-in-pediatric-care.pdfDownload lombart-et-al-2019-caregivers-blinded-by-the-care-a-qualitative-study-of-physical-restraint-in-pediatric-care.pdf

s12912-024-01781-8.pdf Download s12912-024-01781-8.pdfPhysical restraints- an ethical dilemma.pdfDownload Physical restraints- an ethical dilemma.pdf

nielson-et-al-2020-physical-restraint-of-children-and-adolescents-in-mental-health-inpatient-services-a-systematic.pdfDownload nielson-et-al-2020-physical-restraint-of-children-and-adolescents-in-mental-health-inpatient-services-a-systematic.pdf

                                                    Ethical and Legal Foundations of PMHNP Care

Autonomy is the capacity to lead a self-determined and meaningful life by making the right decisions as per their beliefs and morals (Bergamin et al., 2022). Autonomy is a vital ethical principle, especially in mental health because it can alleviate the burden of mental health illness on many psychiatric patients. A disruption in autonomy may increase the risk of developing mental disorders, the intensity of symptoms, and the persistence of these conditions. The interaction between autonomy and mental illness may vary among individuals and may exhibit distinct patterns across different disorders (Bergamin et al., 2022). For patient autonomy, patients should be educated about their mental health conditions along with their treatment plans to make informed consent and make decisions.

Ethical Consideration for Children

As a psychiatric mental health nurse practitioner (PMHNP), the autonomy of children and youth is a priority. Autonomy is the main principle in the decision-making of any patient but for children, it’s their parent’s making decisions for them. For example, the parents or caregivers already give consent for their children’s treatment, but it takes time for a child to give consent and build rapport. The developing autonomy in children is delicate and needs careful support to encourage effective decision-making. Any action that undermines their sense of agency and autonomy can negatively affect their physical and mental health development. PHMNP has to take special care to promote and protect the autonomy of children and adolescents, especially those who are very vulnerable due to trauma, abuse, or maltreatment (Young & Kenny, 2022). These children may already have had their sense of agency significantly suppressed, silenced, or undermined. Providers like PHMNP, psychiatrists, and psychologists should work to foster new beginnings in these areas, requiring a high degree of developmental sensitivity by building rapport, respecting them, and treating children with the highest ethical and moral principles (Young & Kenny, 2022).

Legal Consideration for Children

The legal considerations for children for autonomy are decision-making, giving consent for treatment, and maintaining confidentiality. Though parents may bring the children for mental health assessment, children may not agree with their parent’s decision. The World Health Organization (WHO) outlines adolescents as individuals aged 10-19, while the United Nations Convention on the Rights of the Child (UN CRC) sets the limit at 18 years, aligning with the legal age of the majority of the countries (Michaud et al.,2023). The UN CRC, with its 54 articles, provides a legal framework that heavily influences how societies support children and adolescents’ autonomy in health-related decisions. The emphasis is mostly on the importance of consent and protection, highlighting that decisions concerning education, well-being, and health should be made in the child’s best interest. The right to participation, as stated in the CRC, allows children to freely express their views and have them considered according to their developmental stage (Michaud et al., 2023). In a few cultures, minors cannot provide consent independently, especially for mental health and reproductive services. Therefore, healthcare professionals must understand the legal principles of children and maintain their autonomy.

Ethical Consideration for Adult

Respecting the patient’s autonomy and privacy is a crucial ethical principle worldwide. Making their health care decisions in terms of their religion, culture, and values is a priority in mental health treatment. For example, few patients are against psychotropic medications due to their beliefs. Therefore, patients should be educated about the mental health condition, treatment options, risks and benefits. In China, the pressure between international ethical norms and local culture is crucial (Zhang et al., 2021). While upholding the core principles of informed consent for autonomy, cultural backgrounds and specific situations may require adjustments in methods and processes (Zhang et al., 2021). Similarly, respecting positive values and discarding outdated concepts are essential for safeguarding patient privacy (Zhang et al., 2021). Western countries have more developed systems for protecting patients’ rights and addressing ethical issues, making them a valuable legislative reference for China to enhance its bioethics framework.

Legal Consideration for Adult

The legal consideration for adults for autonomy in mental health is to make sure patient’s rights are protected by educating them about the disease condition, treatment options, risk and benefits. While patients are fully aware of their disorder but still refuse the treatment while they are risking their health, dilemmas the legal consideration. Many times, they might refuse the treatment options due to their culture and beliefs, would not appear for follow up appointments or even leave psychiatric wards without permission when they are admitted. When patients abscond from closed psychiatric wards, it places a significant burden on hospital staff, both legally and ethically (Bipeta, 2019). The absence of published data on this topic in India may be due to concerns about the potential negative perception of hospital staff and administrators (Bipeta, 2019). The refusal of treatment can compromise safety of themselves and others. Few of the strategies to increase the compliance would be participating on decision making, educating on disease condition, its risk, benefits, rationalizing pharmacotherapy.

Application to clinical practice & Implication For Practice

All the peer- reviewed information game me more insight on the ethical and legal implications on children and adults. I can apply this information in everyday of my clinical practice. Respecting patient’s decision, their culture, values and beliefs can increase the adherence to treatment plans and medication compliance. Educating patients about their rights, informed consent, disease condition, respecting their rights and decision is important is promoting patient-centered care. This also builds trust and rapports between providers and patients and enhance open communication with the goal of improving mental health.

The specific implication for practice in my state California is understanding and abiding by the state rules, law and regulations of mental health care. This includes patient’s right, safety, confidentiality, informed consent by ensuring highest standard of PMHNPs for effective treatment and improving the mental health in the family, community, state and the whole nation. As a PMHNP, it is imperative to protect patient health from any misconduct, reflecting on and taking responsibility for workplace ethics (Phoenix et al., 2020). We are responsible for fostering ethical discussions to improve the quality of care and developing an ethical compass among the staff.

    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.

Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2), 108–112. https://doi.org/10.4103/IJPSYM.IJPSYM_59_19Links to an external site.

Michaud, P.-A., Takeuchi, Y.-L., Mazur, A., Hadjipanayis, A. A., & Ambresin, A.-E. (2023). How to approach and take care of minor adolescents whose situations raise ethical dilemmas? a position paper of the European academy of pediatrics. Frontiers in Pediatrics, 11, 1120324. https://doi.org/10.3389/fped.2023.1120324Links to an external site.

Phoenix, B. J., & Chapman, S. A. (2020). Effect of state regulatory environments on advanced psychiatric nursing practice. Archives of Psychiatric Nursing, 34(5), 370–376. https://doi.org/10.1016/j.apnu.2020.07.001Links to an external site.

Young, G., & Kenny, M. C. (2022). Focusing the APA Ethics Code to Include Development: Applications to Abuse. Journal of Child & Adolescent Trauma, 16(1), 109–122. https://doi.org/10.1007/s40653-022-00484-zLinks to an external site.

Zhang, H., Zhang, H., Zhang, Z., & Wang, Y. (2021). Patient privacy and autonomy: A comparative analysis of cases of ethical dilemmas in China and the United States. BMC Medical Ethics, 22. https://doi.org/10.1186/s12910-021-00579-6Links to an external site.

Zhang et al., 2021.pdfDownload Zhang et al., 2021.pdf

Michaud et al.,.pdfDownload Michaud et al.,.pdf

Young et al., .pdfDownload Young et al., .pdf

Bipeta. pdf.pdfDownload Bipeta. pdf.pdf

Bergamin et al.,.pdfDownload Bergamin et al.,.pdf

Phoenix et al.,.pdfDownload Phoenix et al.,.pdf

NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE Sample 5

Main Post:

Inform assent/consent and Capacity.

Ethical and legal considerations are the fundamental aspect of the provider in which the provider must take into consideration the Responsibility, obligation and moral duties in his or her practice when dealing with the clint entrusted in his/her care. The provider must render service to client with respect, compassion and be empathetic, making sure client rights are protected. As professionals we have the almost obligation in recognizing child/adolescent and adults’ mental health when it comes to recognizing ethical and legal issues (AACAP, 2014).  One of the roles PMHNP must deal with is to make sure the patient gives his or her consent for treatment (Martel et al., 2018). NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

Summary of the selected Articles

Informed consent and capacity are different when it comes to treating adults and child/adolescent. When it comes to informed consent of a child /Adolescent, the psychiatry will involve the child parents/guardians and care gives due to the child growth development.  The child is not able to think or understand a given procedure because of their underdeveloped cognition. For an adult who has his or her mental capability to understand a given procedure when the psychiatry has educated the adults on the type of procedure that he or she is to carry out. Adults who are mentally fit can make decisions on life issues as such they are able to sign their consent for treatment (Nepi, 2019).  As far as children/adolescents are concerned, the provider will educate them on the kind of treatment but will require the parent or care giver to sign the consent form for treatment, because a child/adolescent are considering minors. The child or adolescent lack the does not have the adult developmental capacities to consent for treatment.  According to Martel et al, 2018 the child or adolescent is considered as minor, they cannot fully understand and be aware of the nature of their treatment. As far as legal issue   the child or adolescent has the right to maintain his autonomy, the provider has to speak to him in normal voice, the child or adolescent just like an adult right for an assessment, while carrying out the assessment, the provider should make sure, the assessment is done in the present of the child parents, care givers or legal guardian (Rajendran et al., 2022).

How this information will apply in my clinical practice.

This information will help me in my clinical practice. As a provider, I will abide by the rules and regulations governing my state with a holistic approach to manage patient care, obtaining patient present and past psychiatry history. I will make sure the adult patient understands the treatment offer. For the child or adolescent treatment option consent must be signed by the child’s parent or guardian. The adult patient has the mental capacity to understand his or her treatment options including risks and benefits of the treatment (Zakhari, 2020). The state of Arizona requires psychiatry to report any unethical practices.

References:

American Academy of Child & Adolescent Psychiatry. (2014). Code of ethicsLinks to an external site.Links to an external site.. https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_portal/aacap_code_of_ethics_2012.pdfLinks to an external site.

Martel, M. L., Klein, L. R., Miner, J. R., Cole, J. B., Nystrom, P. C., Holm, K. M., & Biros, M. H. (2018). A brief assessment of capacity to consent instrument in acutely intoxicated

emergency department patients. American Journal of Emergency Medicine, 36(1), 18–23. https://doi.org/10.1016/j.ajem.2017.06.043Links to an external site.Links to an external site.

Nepi, L. (2019). Ethical Issues Concerning the Informed Consent Process in Paediatric Clinical Trials: European Guidelines and Recommendations on Minor’s Assent and Parental Permission. BioLaw Journal-Rivista di BioDiritto, 16(1S), 53-63.

Rajendran, K., Petersilka, M., Henning, A., Shanblatt, E. R., Schmidt, B., Flohr, T. G., Ferrero, A., Baffour, F., Diehn, F. E., Yu, L., Rajiah, P., Fletcher, J. G., Leng, S., & McCollough, C. H. (2022). First Clinical Photon-counting Detector CT System: Technical Evaluation. Radiology, 303(1), 130–138. https://doi.org/10.1148/radiol.212579Links to an external site.Links to an external site.

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

Attached File: 5-EthicalIssuesConcerningtheInformedConsentProcessinPaediatricClinicalTrials (1).pdf

NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE Sample 6

Main Post

Autonomy is a fundamental ethical notion in healthcare that grants patients the right to act and make decisions per their own ideas and values. Ensuring patient autonomy can be intricate in the field of psychiatry. Patients possess the lawful entitlement to decline medical intervention, even if it may not align with their optimal welfare. Individuals suffering from a drug use disorder may exhibit a reluctance to accept assistance in addressing their addiction, irrespective of the adverse medical, psychological, economic, and societal ramifications. As healthcare practitioners, we lack the authority to compel mentally capable people to use psychiatric medicine or engage in other therapies, irrespective of our personal viewpoints. The objective of psychiatric treatment is to enhance the patient’s symptoms, autonomy, and overall quality of life. Psychopathology impacts patients’ self-perception, their interaction with the surrounding environment, and their inclination towards seeking therapy. Patients suffering from social anxiety frequently engage in self-imposed isolation, so restricting their participation in activities and diminishing their overall life satisfaction. Bergamin et al. (2022) contend that those who are able to get enjoyment from life despite their mental illness exhibit more motivation and dedication towards their therapy.

Ethical Consideration Adults

An important ethical concern for mentally ill persons is respecting their autonomy in decision-making. While children often lack the ability to make healthcare decisions, most adults possess the capacity to do so, regardless of whether those choices are beneficial or detrimental. However, for certain individuals, adhering to these decisions might be challenging. There may be instances where the patient’s family or healthcare practitioner disagree with their treatment selections and resort to coercive tactics in order to obtain compliance. Healthcare practitioners may face ethical and moral challenges when resorting to coercive techniques, including as persuasion, inducements, interpersonal leverage, and threats, in order to obtain cooperation from mentally ill patients (Manderius, Clintståhl, Sjöström & Ormon, 2023). These tactics, in addition to the use of physical and pharmacological restraints, have the potential to infringe upon the autonomy and dignity of those with mental illness and result in both physical and psychological suffering. Collaborative decision-making is crucial in the treatment of individuals with mental illness, and it is important to prioritize the use of methods that impose the least amount of restrictions. Adults with mental illness are susceptible and should be evaluated for indications of coercion, neglect, and mistreatment. According to Manderius et al. (2023), insufficient ethical awareness results in engaging in unethical behaviors, experiencing moral anguish, and a decline in the therapeutic relationship.

Legal Considerations of Adults

Psychiatric crises are a legal concern for adults, occurring when a patient poses an imminent danger to oneself or others. This is the sole legal circumstance in which patients can get medicine without their consent (Becker & Forman, 2020). Administering medications without consent in a non-emergency situation is considered battery, which is the act of causing injury or objectionable physical contact to someone without their agreement. According to Becker and Forman (2020) hospitals lack the authority to hold or chemically restrain agitated or mentally ill patients without initiating involuntary commitment procedures, since this would be seen as wrongful imprisonment. By default, it is presumed that all patients are competent and possess the necessary competence, unless there is evidence to the contrary. Healthcare practitioners demonstrate respect for patients’ autonomy by obtaining informed permission, and it is crucial to have a comprehensive understanding of restraint laws to avoid infringing against the patient’s rights.

Ethical considerations for children

An obstacle encountered in the provision of psychiatric treatment for children and adolescents is the promotion of their autonomy. Adults possess the cognitive ability to make healthcare decisions, in contrast to small children. While children and adolescents have the ability to voice their ideas and desires about their care, the ultimate decision-making authority is with their parents. Children and adolescents have the ability to undergo therapy and are eager to do so, but they lack the mental or legal competence to provide permission (Disla de Jesus et al., 2022). Parents has the authority to supersede their child’s desires and compel them to undergo psychiatric intervention. The patient’s perspective on their mental health and symptoms may diverge from that of their parents, leading to potential resistance towards therapy. Striking a balance between promoting the child’s autonomy and respecting the parents’ preferences is a delicate task. Although parents hold the authority to make decisions, it is crucial to involve the kid in the decision-making process to the greatest extent feasible, taking into account their capacity to comprehend their choices and articulate their preferences (Disla de Jesus et al., 2022). Establishing a therapeutic connection with both the patient and their parents is crucial while providing care for minors and addressing this matter. Psychiatric treatment for children and adolescents may be more effective if they feel acknowledged and empowered to participate in their healthcare decisions.

Legal Consideration for Children

An important legal aspect to address while providing care for teenagers is obtaining consent for treatment. Parents frequently schedule appointments when there is discord at home or school, and around two-thirds of appointments for young adults aged 18 are arranged by their parents (Stocker, Théron & Reven, 2023). Adolescent patients who possess the legal capacity to provide permission or decline treatment may hold differing opinions from their parents regarding the matter and the recommended treatment plan. Although individuals have the legal right to decline medical care, they may experience parental influence that compels them to comply with their parents’ desires, particularly if they are still financially reliant on them. It is important for the healthcare practitioner to be aware of the legal age of consent for psychiatric treatment in their state and actively support their patient’s rights. Nevertheless, despite the teenager possessing the legal competence to make decisions, the healthcare professional must evaluate the influence of their mental health symptoms. When the patient is exhibiting poor decision-making, it is crucial to determine if this is due to their adolescence and consequent lack of maturity, or whether it is a result of their mental illness affecting their cognitive functioning. According to Stocker et al. (2023) the paramount consideration in all healthcare choices, particularly for minors who are susceptible and reliant on others to safeguard their rights and self-governance, should be the patient’s well-being.

Clinical Implications

This knowledge has the potential to greatly influence my future practice, as I intend to treat people of all ages. To safeguard my license and ensure the well-being of my patients, I must possess a comprehensive understanding of the ethical and legal implications surrounding autonomy and the provision of care for individuals across different age groups, including children, adolescents, and adults. Although children are legally considered minors, they should nevertheless have a significant say in determining their medical treatment. According to Sec. 572.001 in Texas minors that are aged at least sixteen or older can seek being admitted to an outpatient or inpatient behavioral/mental health facility by submitting a formal request to the facility administration (Health and safety code chapter 572, 2013). A legal guardian of an individual under the age of sixteen has the authority to willingly admit an incompetent person to a mental hospital, whether it is publicly or privately owned, in order to provide them with necessary care and treatment (Office of the Texas Governor, n.d.). The individual’s guardian has the authority to willingly admit an impaired individual to a residential care facility for either respite care or emergent care. A doctor must promptly conduct a thorough examination of the individual within a maximum of 12 hours after the individual is brought to a facility by a law enforcement officer or conveyed for emergency detention by their legal guardian (Office of the Texas Governor, n.d.). Individuals who are younger than 18 are not permitted to decline the use of psychoactive medicine that has been approved by their parent or guardian. They also cannot leave a voluntary facility if their guardian or parent opposes to it. Administering psychiatric medication to a client being given mental health services is not allowed if the client refuses, unless certain conditions are met. These conditions include the individual experiencing an emergency that is medication-related, the patient being under sixteen years of age, or the client being under eighteen years of age and admitted for mental health services that are voluntary with consent from their parent, guardian, or managing conservator. Another condition is if the client’s representative, approved by law to make decisions on the client’s behalf, has given consent .

If the client is in voluntarily, they possess the entitlement to request a release. Upon receiving the request, promptly informing the physician within a maximum of 4 hours is imperative. Subsequently, the physician is required to grant permission for your release prior to the completion of the 4-hour duration unless they possess “reasonable cause” to suspect that you may qualify for involuntary care (Disability Rights Texas, 2018). The physician must inform you if they want to extend your detention beyond the first 4-hour period or if they plan to get an order for involuntary treatment. Suppose the physician determines that you are not yet prepared for discharge. In that case, they must do a follow-up examination within 24 hours to ascertain any additional mental health treatments that you may require, if necessary (Disability Rights Texas, 2018).

References

Becker, S. H. D., & Forman, H. (2020). Implied consent in treating psychiatric emergencies. Frontiers in Psychiatry, 11, Article e127. https://doi.org/ 10.3389/fpsyt.2020.00127     Bergamin, J., Luigjes, J., Kiverstein, J., Bockting, C. L., & Denys, D. (2022). Defining autonomy in psychiatry. Frontiers in Psychiatry, 13, Article 801415.       https://doi.org/10.3389/fpsyt.2022.801415

Disability Rights Texas. (2018). Voluntary Patient Rights. Disability Rights Texas. https://disabilityrightstx.org/en/handout/voluntary-patient-rights/

Disla de Jesus,V., Liem, A., Borra, D., & Appel, J. M. (2022). Who’s the boss? Ethical dilemmas in the treatment of children and adolescents. Focus, 20(2), 215-219. https://doi.org/10.1176/appi.focus.20210037

HEALTH AND SAFETY CODE CHAPTER 572. VOLUNTARY MENTAL HEALTH SERVICES. (2013). Statutes.capitol.texas.gov. https://statutes.capitol.texas.gov/Docs/HS/htm/HS.572.htm#:~:text=(d)%20The%20administrator%20of%20an

Manderius, C., Clintståhl, K., Sjöström, 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(23). https://doi.org/10.1186/s12912-023-01186-z

Office of the Texas Governor. (n.d.). Mental Health Resources and Protections. Gov.texas.gov. Retrieved June 6, 2024, from https://gov.texas.gov/organization/disabilities/mental_health_protections#:~:text=A%20guardian%20of%20a%20personLinks to an external site.

Stocker, S., Théron, S., & Revet, A. (2023). The concept of autonomy in adolescent psychiatry healthcare: A philosophical, legal and medical perspective. Neuropsychiatrie de l’Enfance et de l’Adolescence, 71(1), 1-7. https://doi.org/10.1016/j.neurenf.2022.12.003 NRNP-6665 Week 2: Discussion – ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE