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Rules for restraints
use only when all other interventions have failed
1:1 observation needed
assess every 15 minutes
doc must come in to see patient within 1 hr
orders must be renewed every 4 hours
can initiate without an order in an emergency; you then go get the order
emergency admissions
96 hr holds
patients are acting in a way that indicates they are mentally ill and may be a threat to self or others
can still refuse medications
HIPAA
healthcare information is legally protected
regulates the use and release of patient healthcare information
must be authorized by the patient unless it involves treatment, payment, and healthcare administrative operations
guilty but mentally ill (GBMI)
criminal conviction and will go to prison
mental illness considered a factor, but not to the extent that the person was incapable of knowing right from wrong or controlling actions
false imprisonment
detention of patient against will
beneficience
principle of doing good
justice
duty to treat all fairly
What criteria do you need to meet to force meds without consent
must exhibit behavior that is dangerous to self and others
medication ordered must have a reasonable chance to providing help to patient
those who refuse meds must be judged incompetent to be able to evaluate the benefits of the treatment in question
involuntary admissions
21 day holds
patients are mentally ill and refuse hospitalization or treatment, but pose a danger to self or others
these holds are ordered by the court
cannot refuse mediations
duty to warn/disclose
most states have some provision to warn a potential victim of threat of violence
some do not: Maine, Nevada
Mandatory: Missouri
permissive: kansas
what is the nurse practice act
each state has its own
defines nursing, scope of practice, defines nursing limits
it outlines the minimum expectations of safe nursing care
the judicial system looks to them during cases of malpractice litigation
what is the nursing code of ethics
principles that serve as codes of conduct about right and wrong behaviors to guide actions
nonmaleficence
duty to cause no harm
competency
the degree to which the patient can understand and appreciate the information given during the consent process
should be able to communicate choices, understand relevant information, appreciate situation and its consequences, and use logical thought process to compare risks and benefits of treatment
privacy
part of a person's life not governed by society's laws and government intrusion
Unfit to stand trial
admitted involuntarily to a psychiatric facility for a statutorily defined evaluation period; can't be unfit forever they usually get a year
patient is unable to understand the nature and the purpose of proceedings or is unable to assist in the defense
negligence
breach of duty of reasonable care for a patient for whom the nurse was responsible and resulted in injury
when was the nursing code of ethics developed
in 1950 and has had 6 revisions since then; the most recent one was in 2015
paternalism
knowledge and education authorize professionals to make decisions for the good of the patient
like mandatory use of seatbelts or motorcycle helmets
how is competency different from rationality
competency is the ability to process and make the decision
rationality is actually making the decision
confidentiality
ethical duty of nondisclosure
fit to stand trial
patient is able to consult with a lawyer with a reasonable degree of rational understanding of the facts and the legal proceedings
assault
threat of force to inflict bodily harm on another
2001 nursing code of ethics revisions
return to the word patient
explains that the nurse's most fundamental accountability is to the patient
emphasizes a safe work place
addresses the duties of nurses to themselves
veracity
duty to tell the truth
voluntary admissions
they can technically leave at any time since they have full legal rights, but are typically placed on a 96 hr hold in a mental health setting
breaches of confidentiality
release of patient information without the patient's consent in the absence of legal compulsion or authorization
not guilty by reason of insanity (NGRI)
don't know right from wrong
unable to control actions at time of crime
institutionalized in forensic hospital for time equal to sentence of guilty verdict
less than 1%
battery
laying hands on another without consent
autonomy
right to make one's own decisions
does not apply to children, people in comas, or people experiencing severe mental illness
fidelity
faithfulness to duties, obligations, and promises
an example would be following through with your promises
is an important component to building therapeutic relationships