Nursing / Psych: Legal Implications

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Advocacy Role of Nurses : 

2/26/2010 1 Advocacy Role of Nurses To help clients to obtain, maintain, and fully utilize mental health services Nurses need to consider their legal and ethical responsibilities when there is pressure to limit or deny client access to treatment

Commitment: Least restrictive alternative : 

2/26/2010 2 Commitment: Least restrictive alternative Voluntary commitment Emergency commitment– clear and convincing evidence 72 hour hold (5150) 14 day hold (5250) Conservatorships

Lanterman- Petris-Short (LPS) Act of 1969 : 

2/26/2010 3 Lanterman- Petris-Short (LPS) Act of 1969 Evaluation period of 72 hours for individuals who on the basis of mental disorder are judged to be: Danger to self Danger to others Gravely disabled – unable to provide or use food, clothing or shelter for themselves

State of CaliforniaWelfare and Institutions Code : 

2/26/2010 4 State of CaliforniaWelfare and Institutions Code Section 5151 (72 hour hold), 5585 minor Section 5250 (14 day hold) Section 5260 (additional 14 day hold) Section 5270.15 (additional intensive treatment 30 day hold) – gravely disabled Section 5300 (180 day post certification) Riese Petition – incapable of giving informed consent for medication Psychiatric Advance Directives

Confidentiality : 

2/26/2010 5 Confidentiality Privileged Communication Duty to Warn and Protection: Tarasoff Tarasoff vs. Regents of the Univ. of CA - 1976 “Protective privilege ends where the public peril begins”

Rights of Clients: Seclusion and Restraint : 

2/26/2010 6 Rights of Clients: Seclusion and Restraint 1999 U.S. Centers for Medicare & Medicaid (CMS) declared “the patient’s right to be free of restraint is paramount” 1 hour rule Family must be notified Continuous in-person observation in restraints

Rights of Clients: Treatment and Refusal of Treatment : 

2/26/2010 7 Rights of Clients: Treatment and Refusal of Treatment Right to Treatment Right to Refuse Treatment – Voluntary and Involuntary patients have the right to refuse medication Electroconvulsive Therapy Research

Americans with Disabilities Act : 

2/26/2010 8 Americans with Disabilities Act A person can not be asked about a prior history of mental illness as a part of an application process for employment If a person’s mental condition is stabilized, there is no disability Assessment of risk must be based on behavior, not on the mental disability

Forensic Evaluations : 

2/26/2010 9 Forensic Evaluations Competency to Stand Trial Criminal Responsibility Guilty but Mentally Ill

Malpractice: Negligence : 

2/26/2010 10 Malpractice: Negligence Legal Duty Breach of Duty Testimony of Expert Witnesses But For Test – damages (injuries) would not have occurred but for negligence Substantial Factor Test Documentation

Ethical Issues : 

2/26/2010 11 Ethical Issues Autonomy – Respect for self-determination Beneficence – Bring about good, not harm Distributive Justice – Comparative (fair) treatment

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