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chapter 2
A nurse who works in the mental health setting is responsible for practicing ethically,
competently, safely, and in a manner consistent with all local, state, and federal laws.
Nurses must have an understanding of ethical principles and how they apply when
providing care for clients in mental health settings.
Nurses are responsible for understanding and protecting client rights.
Clients who have been diagnosed and/or hospitalized with a mental health disorder are
guaranteed the same civil rights as any other citizen. These include:
The right to humane treatment and care, such as medical and dental care
The right to due process of law, including the right to press legal charges against
another person
Confidentiality
Freedom from harm related to physical or pharmacologic restraint, seclusion, and any
physical or mental abuse or neglect
Provision of care with the least restrictive interventions necessary to meet the clients
needs without allowing him to be a threat to himself or others
Some legal issues regarding health care may be decided in court using a specialized civil
category called a tort. A tort is a wrongful act or injury committed by an entity or person
against another person or another persons property. Torts can be used to decide liability
issues, as well as intentional issues that may involve criminal penalties, such as abuse of a
client.
State laws may vary greatly. The nurse must be aware of specific laws regarding client care
within the state or states in which the nurse practices.
Ethical Principle
Definition
Example
Beneficence
Autonomy
Justice
Fidelity
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Veracity
Definition
Example
Confidentiality
The clients right to privacy is protected by the Health Insurance Portability and
Accountability Act (HIPAA) of 2003.
It is important to gain an understanding of the federal law and of various state laws as they
relate to confidentiality in specific health care facilities.
Information about the client, verbal and in writing, must only be shared with those who
are responsible for implementing the clients treatment plan.
Information may be shared with other persons not involved in the client treatment plan by
client consent only.
Specific mental health issues include disclosing HIV status, the duty to warn and protect
third parties, and the reporting of child and elder abuse.
Facility policies
Other members of the health care team, including facility bioethics committee (if available)
Involuntary (civil) commitment The client enters the mental health facility against her
will for an indefinite period of time. The commitment is based on the clients need for
psychiatric treatment, the risk of harm to self or others, or the inability to provide selfcare. The need for commitment could be determined by a judge of the court or by another
agency. The number of physicians, which is usually two, required to certify that the clients
condition requires commitment, varies from state to state.
Nurses must know and follow federal/state/facility policies that govern the use of restraints.
Use of seclusion rooms and/or restraints may be warranted and authorized for clients in
some cases.
In general, seclusion and/or restraint should be ordered for the shortest duration necessary,
and only if less restrictive measures are not sufficient. They are for the physical protection
of the client and/or the protection of other clients and staff.
A client may voluntarily request temporary seclusion in cases where the environment is
disturbing or seems too stimulating.
Restraints can be either physical or chemical, such as neuroleptic medication to calm the
client.
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When all other less restrictive means have been tried to prevent a client from harming self
or others, the following must occur in order for seclusion or restraint to be used:
The provider must rewrite the order, specifying the type of restraint, every 24 hr or the
frequency of time specified by facility policy.
Nursing responsibilities must be identified in the protocol, including how often the
client should be:
Toileted
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Assessed (including for safety and physical needs), and the clients behavior
documented
The clients current behavior, what foods or fluids were offered and taken, needs
provided for, and vital signs
Medication administration
An emergency situation must be present for the charge nurse to use seclusion or restraints
without first obtaining a providers written order. If this treatment is initiated, the nurse
must obtain the written order within a specified period of time (usually 15 to 30 min).
Although intentional torts can occur in any health care setting, they are particularly likely
to occur in mental health settings due to the increased likelihood of violence and client
behavior that can be challenging to facility staff. Following are examples of torts:
INTENTIONAL TORT
EXAMPLE
False imprisonment
Assault
Battery
Documentation
Example: The client suddenly began to run down the hall with both hands in the
air, screaming obscenities.
Example: The client states, Im going to pound (other client) into the ground.
Client has picked up a chair and is standing 3 ft from other client with chair held
over his head in both hands. Nurse calls for help. Client is immediately told by
nurse, Put down the chair and back away from (the other person). Other client
moved away to safe area. Five other staff members respond to verbal call for
help within 30 sec and stood several yards from client. Client then put the chair
down, quietly turned around, walked to his room, and sat on the bed.
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4. A nurse is caring for a client in restraints. Which of the following is appropriate documentation?
(Select all that apply.)
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