1 RAK Medical and Health Sciences University RAK College of Nursing RN-BSN Bridge Program Ethical Issues in Mental Health Nursing Mrs.Vimala Edwin MSc N,PGDHM Lecturer RAK College of Nursing
2 Learning objectives At the end of the class the student will be able to 1. Discuss the ethical themes 2. Explain about different types of restraints used in psychiatric ward 3. List the nurses obligation in restraining the patient 4. Discuss Legal and ethical responsibilities of psychiatric nurses
3 Introduction When dealing with person with mental health disorders,the nurses action and ethical obligations related to the basic ethical themes may be affected by legislation as well as the social stigma associated with mental health disorders.
4 Ethical themes 1. Confidentiality 2. Truth telling 3. Advocacy
5 1. Confidentiality Confidentiality is the guarding of private information. Anonymity is keeping a persons name unknown to a third person. Due to the social stigma, diagnosis of a mental illness, extra measures are often implemented to protect not only the confidentiality of persons with mental illness, but also their anonymity.
6 When a child is admitted to an in-patient child psychiatric unit, parents will receive a code word for identification purposes. If parents want to visit their child in child psychiatric unit, they must provide her name as well as the code word. The intention behind the use of a code word is to minimize the possibility that an unauthorized person would become privacy to the knowledge that a specific child was receiving psychiatric care.
7 Therapeutic relationships, especially those between a person receiving mental health services and a nurse, are based on trust. Nurses need to maintain professional boundaries when interacting with patients. When maintaining professional boundaries, the focus is on the patient and thus the nurse does not discuss personal details or beliefs. Failure to maintain professional boundaries may result in negative consequences for the patients recovery.
8 Eg) if the nursing student shares her eating disorder history with the patient, He might think how can this nursing student can help me? She had just about the same problem as I do. Eg) when the nurse faced with a request to maintain secrecy. As a nurse, I have the legal obligation to report actions. But I can promise you that I will not disclose information to people who are not involved in your treatment.
9 When respecting autonomy, the nurse respects and supports the patients right to make decisions. Eg ) A patient with cancer may decide not to have chemotherapy despite the fact that the treatment has a 95% success rate for curing that form of cancer.
10 A competent patients right to refuse treatment continues even if he or she is receiving mental health services, as long as there is no evidence of significant immediate harm to self or others.
11 An ethical issue can occur when a person with an mental health disorder refuses treatment or refuses to listen to a health care professionals explanation of the persons condition or treatment options.
12 According to US Govt, the Mental health disorder patients cannot make informed decisions regarding his/her illness. The professional nurse must understand the definitions and state laws that are applicable to his or her work setting.
13 Restraints The practice of restraining is implemented as a means for promoting safety. In health care situations, the practice of restraining a patient is only ethically justifiable based on a commitment to doing nonmaleficence or doing no harm. Restraining a patient will limit the patients ability to act voluntarily.
14 1. Physical restraints A variety of physical restraints are used in health care institutions, including soft and hard limb restraints, mitten restraints and belt restraints. Physical restraints are used to limit the potential that the patient will cause physical harm to himself.
15 2. Seclusion The practice of secluding a patient often in a safe room, which may include padded walls and floor, is used to limit harm to the patient by decreasing environmental stimuli. 3. Chemical restraints Chemical restraints are a greater threat to patient autonomy than physical restraints or seclusion because the patients cognitive abilities are affected.
16 Because the length of time a person loses his or her autonomy due to chemical restraints, they should be used only when all other, less restrictive efforts have failed. Chemical restraints are often administered during intense moments when the patient is especially vulnerable.
17 Nursing obligations When any form of restraint is being considered or has been implemented The nurse must realize that the patients behavior may be related to a physiological or psychological problem. Conduct a thorough and ongoing assessment including the patients physical and emotional status responses to intervention and potential for new or further harm.
18 The nurse has the obligation to remove or minimize the level of restraint as early as possible. use only devices approved for use by the institution unapproved restraint devices may result in harm to the patient or others.
19 Nurse need to know the National Institute of Mental Health Act Should be qualified to work in psychiatric settings Should be aware of admission and discharge procedure of mentally ill patients She should be aware of rights of the patients Should obtain informed consent for treatment and procedure
20 Always explain the procedure to the patient and relatives Inform about the therapy, advantages and risk involved Always bear in mind that the patient can refuse treatment or withdraw the consent for the procedures like ECT Maintain the confidentiality of the information and the records and should be in safe custody. Maintain the standards of nursing care.
21 The patient who is not taking his medications The patient who engages in frequent selfmutilating behavior The patient who threatens violence toward clinic staff The patient who demands discharge from the hospital.
22 Steps in Managing Difficult Patients Step 1: Understand yourself Be aware of your own biases and responses Understand why certain types of patients upset you Realize you re not a bad nurse if you have negative feelings about it.
23 Step 2: Understand your patient Every difficult behavior is a form of communication Every difficult patient is trying to express real fears and needs
24 Step 3: Think, don t react Remember your duty to help and not harm Focus on medical and psychiatric issues you can treat Strive to be empathic, consistent, and stable Step 4: Form an alliance Find something you can agree upon Educate the patient about your limits and responsibilities Reinforce positive behavior; don t reward negative behavior
25 Step:5 Treat whatever is treatable Screen for medical conditions Use therapy and medication to treat problems Step 6 Avoid the traps Of wanting to punish the patient Of doing anything to help the patient so he won t hurt himself
26 Step 7: Get help Seek consultation Foster team consensus Encourage patient to participate in support groups Step 8: Handle your emotions Find constructive ways of venting frustration Prepare yourself for seeing difficult patients See managing difficult patients as a clinical skill to master
27 Accept and Respect for persons Spend time with the patient Understand the patients values and goals
28 By protecting the confidential patient information, the professional nurse builds the foundation for a trusting nurse-patient relationship. Confidentiality is essential to psychiatric treatment, in part because of the special nature of psychiatric therapy. A psychiatrist may release confidential information only with the patient s authorization or under proper legal compulsion
29 Do not release a patient s information to parties who are not in the circle of confidentiality such as family members, attorneys representing the patient, and law enforcement personnel unless you ve first obtained the patient s consent. The nurse should believe that there is a duty to protect a third party, by disclosing the harmful information.
30 1. Through therapeutic communication, the nurse could educate the patient on the importance of preventing harm to others by disclosing pertinent information, such as suicidal ideations and harm to other people. Confidentiality is not broken if the patient either disclose the information or provides permission for the health care professional to disclose.(pinals&gutheil,2001)
31 2.Nurses as well as all health care professionals need to know the current state and national laws related to mandatory reporting 3.Nurses need to be active participants in their clinical setting in developing protocols related to the use of communication technology and transmission of confidential information.
32 References 1.Marcia Sue, The Ethical Component of Nursing Education,2007,Lippincott Williams & Wilkins 2.Robert and dyer Fall 2003, Vol. I, No. 4 focus the journal of lifelong learning in psychiatry
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