Ethical and Legal Foundations of PMHNP Care Across the Lifespan

In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.

Learning Objectives

Students will:

· Analyze salient ethical and legal issues in psychiatric-mental health practice

· Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing

· Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*

*Assessed in Week 3 Assignment

Learning Resources

Required Readings (click to expand/reduce)

https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-only/

http://www.apa.org/ethics/code/

https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_portal/aacap_code_of_ethics_2012.pdf

https://www.apna.org/i4a/pages/index.cfm?pageID=3846

https://www.jaacap.org/action/showPdf?pii=S0890-8567%2812%2900500-X

https://search.ebscohost.com/login.aspx?direct=true&db=cat06423a&AN=wal.EBC5108631&site=eds-live&scope=site&authtype=shib&custid=s6527200

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.

· Chapter 19, “Legal Issues in the Care and Treatment of Children with Mental Health Problems”

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

· Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam”

Reminder: Keep Your Library of Advanced Practice Nursing Texts at Your Fingertips

Several textbooks are assigned in multiple courses in your program. That is, you will see reading assignments from the books assigned in the Learning Resources of more than one course. You should, however, keep all prior textbooks—not just the ones explicitly assigned—readily accessible. The expectation is that you will independently consult these prior textbooks to synthesize information needed to complete your final courses. This is your time to “put it all together” and to more fully embrace the advanced practice nursing role. Part of the responsibility of advanced practice is developing information literacy skills to know where to locate needed information for your clinical practice.

Discussion: Ethical and Legal Foundations of PMHNP Care

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

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For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

To Prepare

· Select one of the following ethical/legal topics:

· Autonomy

· Beneficence

· Justice

· Fidelity

· Veracity

· Involuntary hospitalization and due process of civil commitment

· Informed assent/consent and capacity

· Duty to warn

· Restraints

· HIPPA

· Child and elder abuse reporting

· Tort law

· Negligence/malpractice

· In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.

RESPOND TO THIS DISCUSSION PAGE. I PAGE OF FACTS AND NOT REPETITION USING AT LEAST TWO REFERENCES

The topic I selected for this week’s discussion is “Restraints.” Restraints involve any method of restricting an individual’s freedom of movement or physical activity. Patients with mental health disorders sometimes become very agitated and may engage in behavior that can pose certain risks to themselves and others. During crisis management, healthcare workers usually utilize alternative approaches like de-escalation techniques to calm down agitated patients. However, if these techniques are not effective, healthcare workers can implement physical and manual restraints to alleviate the critical risks posed by these patients. The application of physical restraints involves many legal and ethical issues, and it is crucial for healthcare workers to follow all policies and procedures properly (Ye et al., 2019).

Ethical Considerations Related to Restraints for Adults

Physical restraints are often used to ensure the safety of patients. However, the decision about the use of physical restraints are associated with several ethical dilemmas, and providers must need to weigh the outcomes of the use of restraints against the outcomes of not using them. Healthcare authorities are expected to develop evidenced based guidelines for physical restraint use and must develop and implement programs and educate nurses about ethical and legal problems associated with physical restraint use (Salehi, Najafi, Hajibabaee, & Joolaee, 2020). As we know that physical restraints are used to reduce the patient’s mobility in the bed or can reduce their ability to freely move their hands, feet, or head. It affects the patient’s freedom and can also cause some side effects like increased blood pressure and heart rate, impaired circulation, aspiration, damage to skin tissues, etc. According to the ethical principles of autonomy, the patients must have the power to make decisions about their care and therapeutic interventions, including the use of physical restraints. When using restraints, the ethical principle of patient autonomy can be affected, and healthcare workers may ignore the patient’s rights. However, due to the possibility of self-harm and impaired consciousness, providers are allowed to use a paternalistic approach and make decisions about the use of physical restraints to provide safe care (Salehi, Najafi, Hajibabaee, & Joolaee, 2020)

Ethical Considerations Related to Restraints for Children/Adolescents

In mental health settings, restraints and seclusions are often used for children in crisis management. According to the practice standards, restraints or controlled measures are supposed to be used only in exceptional cases. These measures should only be utilized when all other less restrictive interventions are proven ineffective. However, the use of such interventions can raise significant ethical concerns. Studies have shown that children view these types of controlling practices as abusive and these interventions negatively impact the trusting relationship between children and healthcare providers (Montreuil, Thibeault, McHarg, & Carnevale, 2020).

Legal Considerations Related to Restraints for Adults

There are many legal considerations when applying any form of physical restraints on adult patients. Physical restraints can only be used to protect the individual from harm and provide safe care. Studies have shown that people with intellectual disabilities and older populations with dementia are sometimes locked or restrained in residential service care. Restricting the person’s free exit affects human rights and common law principles of liberty and security. However, under the common law of defense of medical emergency, it is lawful to provide treatment and save a patient’s life and prevent serious harm (Chandler, White, & Wilmott, 2016).

Legal Considerations Related to Restraints for Children/Adolescents

When using restraints for children and adolescents, Federal law provides guidelines about monitoring, investigating, and pursuing legal remedies. These Federal laws also mandate every state to designate an organization for the Protection and Advocacy system (Nelson, 2017). In healthcare, restraints may be needed when children or adolescents become very agitated or aggressive and pose a risk to their or others’ safety. These interventions can help healthcare providers to provide immediate and necessary care safely. Every state has specific laws and regulations regarding the use of restraints, especially for children, which must be followed properly. The Federal office of Special Education Program has emphasized the use of positive behavioral interventions and has discouraged the use of restraints for children and adolescents. Therefore, based on these laws, restraints can only be applied by trained staff when the immediate safety of children and adolescents is compromised (Nelson, 2017).