Feature Article. In considering Anita’s wishes and agreeing a management plan to care for the wound incorporates both principles of Anita’s autonomy and the nurse’s obligation towards beneficence. School of Nursing and Midwifery, University of Dundee, Dundee, UK. Ethical nurses lead the way for health care reform which emphasizes healing even when curing is impossible. Indeed there is an historical context for such intervention which this chapter will explore. To make matters even trickier for nurses, the same ethical dilemma on two different occasions may require a different solution each time. This chapter will explore mental health nursing within an ethics context. Following a wider team discussion around whether Anita understood the severity of the wound, thus having capacity to make a decision to refuse treatment, the Responsible Clinician (RC) spoke to Anita and attempted to persuade her to have the wound sutured. © Springer International Publishing AG 2017, School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK. Beauchamp and Childress (2009) devised four basic moral principles which function as guidelines for professional ethical decision making. The practice of paternalism is now generally discouraged in health care (Butts & Rich) and is considered unjustifiable in cases where the patient has capacity to make a decision (Edwards 2009, Beauchamp & Childress 2009). In accordance with this the name of the patient has been changed and permission has been sought from the patient to use them in the case study (Appendix 1). For instance, a RN working in the PICU may be asked to care for a child who has been a victim of child abuse and be asked to also be kind and impartial to the parents at their child's bedside who are suspected, but not convicted, with the crime. In response to a students question regarding choosing a psychiatric specialty, a charge nurse states, Mentally ill clients need special care. However, the nurse’s ability to critically appraise risks and benefits will help them to make decisions that are beneficial to the patient involved. Lakeman (2009) points out that an ethical dilemma occurs when there are a multitude of alternative courses of action to deal with a particular situation. So the nurse who mislabeled the normal saline upheld the principle of self determination by following the patients wishes, while violating the principle of beneficence by not providing necessary treatment. The difficulty of the situation is exacerbated by the fact that the patient's family is also resisting pain medication for the patient because they regard suffering as spiritually edifying. In contrast, the correctional nurse may face ethical situations daily. Then there are three stories describing everyday interactions in an acute psychiatric unit. Topic # 2 Legal and Ethical Issues in Mental Health Nursing. When someone goes to see a mental health professional, they have legal and ethical rights that are meant to protect them. Conflicting moral principles may create difficult ethical dilemmas for nurses by having to contravene one moral obligation to uphold another (Beauchamp & Childress 2009). The NMC Code of Professional Conduct is clear in stating that nurses have an obligation to both protect and promote the “health and wellbeing” of patients as their primary consideration (NMC 2008:2) and this is no different for mental health nurses working with patients who self-harm. An involuntary commitment to care, or a decision made by a family member on behalf of the patient, is often made to protect the patient from harming … Ethical and Legal Issues in Psychiatric/Mental Health Nursing Chapter 26 Fast forward to the twenty first century and these doors are now routinely locked. Ethical discourse about mental health treatment has typically focused on paradigmatic concepts of individual autonomy, competence, paternalism, and appropriate justifications for overriding individual decision-making and restricting individual liberty. Examples include diverse topics such as staffing ratios, and end of life care. Ethical dilemmas in community mental health care is the focus of this article. Helpful? Applying ethical principles in nursing management Pages: 5 (1190 words) Use of Ethical Principles to Combat Stigma in Psychiatric Nursing Pages: 8 (1752 words) Ethical Issues in Mental Health Nursing Pages: 8 (1835 words) Ethical Issues in Mental Health Nursing Pages: 8 (1832 words) Restricting services users’, Over 30 years ago the main ward door on an acute mental health ward in the English health system was not routinely locked. To prepare: • Review literature for moral/ethical issues encountered by a PMHNP. However with collaborative working practices this case study has shown that solutions can be found in even the most complicated of nursing dilemmas. Ethics can be seen as the study of human conduct and morality (Buka 2008). Firstly the practitioner needs to ascertain whether the person being assessed has some sort of disturbance of the mind and, if such a disturbance exists then it “must affect their ability to make decisions when they need to” (Department of Constitutional Affairs (DoCA) 2007:45). Ethics regards standards of moral judgement and professional conduct. This article described how relational ethics is a powerful guide to ethical and effective nursing practice. Which raises the principle of Nonmaleficence (doing no harm), in this instance to the therapeutic relationship, wellbeing and care of Anita. 9 0. Indeed, the very nature of psychiatric illnesses can raise challenging questions about patient autonomy. What is unusual is that they are kept locked all the time, which in some ways can be seen as a return to the restrictive practices of the past (Ashmore. Reference this. This relationship is built upon trust as well as purposeful and effective communication (Buka 2008) and is considered to be the cornerstone of nursing care (Lakeman 2009, Pryjmachuk 2011).Therefore the nurses would need to consider future risk as part of the ethical decision making process. They are in charge of coordinating and integrating multidisciplinary mental care services, while providing comprehensive family psychiatric mental health education. Copyright © 2003 - 2020 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. Before a medical procedure takes place, it is the nurse’s responsibility to obtain informed consent. It is about people reasoning, thinking and applying a process of reflection (Adshead 2010); however these people may have opposing views, values and experiences on which to base their moral judgements to define what is the right and wrong course of action (Hendrick 2009) and the principles used to decide this, not only by the individual but also within social groups and societies. 1st Jan 1970 Nursing Reference this Disclaimer: This work has been submitted by a university student. It is similar to the medical model of ethics in that it deals with life and death issues. Which can make the nurses ethical dilemma difficult to manage due to balancing the two valid ethical principles of autonomy (respecting and supporting decisions making) and beneficence (relieving or minimising harm in the best interest of the patient) (Hendrick 2004, Beauchamp & Childress 2009). Start studying Ethical Issues in Mental Health Nursing. Whether a nurse works in a hospital, doctors office or medical clinic, she likely will find that she is faced with a tough decision at least once a day if not once an hour. Print . Course. This chapter explores mental health nursing practice within an ethics context. In complex healthcare settings, nurses have a responsibility to ensure their patients get the best care while grappling with sensitive ethical issues. There are three primary duties for nurses, among many others, which are the duty of autonomy, confidentiality, and duty of care to all patients. Ethical dilemmas are especially difficult because there is usually not a clear cut right or wrong answer. For example, the WHO estimates that in the United States, the return on investment for improving mental health care delivery is roughly 4 to 1 [5]. This is not an example of the work produced by our Essay Writing Service. Examples of Ethical Dilemmas that Nurses Deal with on a Regular Basis •Dealing with the pro-life and pro-choice debate. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the UKDiss.com website then please: Our academic writing and marking services can help you! From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation. Mental health counselors face ethical issues in honestly assessing their level of skill and competency. According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s … Therefore the principle of respecting autonomy concerns the nurse’s acknowledgement of, and obligation in respecting, Anita’s decision over her own life. But, ethical dilemmas in nursing aren't all the same. The nursing model is one of individual patient empowerment. The paper begins with a brief statement about the centrality of autonomy or self governance as a core ethical value in the interaction between health care worker and patient. University. Patient safety may be compromised, resulting in injury and lawsuits. 963 results for legal and ethical practice in mental health nursing. using a case study, the author analyses the patient’s right to autonomy and the nurse’s duty of care. Inappropriate Medication Orders This may indicate that Anita was under a great deal of distress at the time, which could have affected her capacity to make sound decisions; however her later decision of continuing to refuse treatment was based on her own morals and values towards her body that may have included these thoughts of self-loathing and the need to be punished. Beneficence could be interpreted to incorporate the patient’s autonomous choice as “the best interests of the patient are intimately linked with their preferences … [from which]… “are derived our primary duties towards them” (Beauchamp & Childress 2009:207). This chapter explores mental health nursing practice within an ethics context. Volume 24, Issue 3. Nurses are highly accountable to patients, the public, employers, and the entire profession. These are used to help unravel ethical issues relating to patient autonomy. Upon admission, the team at the Mental Health Centre had difficulty obtaining informed consent from this patient; partially due to English being the patient’s second language, but also because of the patient’s differing perception of mental health and well-being. This is not an example of the work produced by our Essay Writing … Ethical issues are wide-ranging, from organ donation, genetic engineering, assisted suicide, withholding treatment in end-of-life care, or. Introduction. The existing literature, however, does not identify strategies that support the practice of relational ethics in this way. Respect for autonomy flows from the recognition that all persons have unconditional worth, each having the capacity to determine his or her own moral destiny. This collaborative approach allowed Anita opportunities to explore her emotions, thoughts and feelings and promote her autonomy whilst still allowing her to decide to have the wound sutured should she change her mind. The main legal and ethical dilemmas that can be extracted from this case study are whether the Anita’s capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. The discussion will also consider the legal, ethical and professional issues surrounding covert medication. The health-care community is composed of physicians, nurses, assistants, pharmacists, therapists, researchers, dietitians, and others whose primary role is to provide the services and tools to promote the health of patients. The conflicting principles of autonomy and beneficence that have been presented within this case study would both be ethically and morally correct courses of action to take. The decision to manage the wound on the ward and allow Anita time to calm and consider her options is, in the author’s opinion, the correct course of action to take. The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. If I were in that position, Id want a caring nurse also. To achieve this aim the author will examine a case study of a patient whose care he was involved with whilst in placement. The decision to covertly administer the medication will be critically assessed in this assignment. Chapter 5. Ethical issues in mental health care Nurses working in the care for psychiatric patients daily face dilemma’s concerning respect for autonomy versus paternalistic behavior. The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. No plagiarism, guaranteed! ). This is not an example of the work produced by our Nursing Essay Writing Service. knowledge for psychiatric and mental health nurses. The case-study part of the chapter will consider how in these difficult circumstances mental health nurses can control and potentially restrict service user freedoms in a way that reduces moral distress and is beneficent and sensitive. For example, the WHO estimates that in the United States, the return on investment for improving mental health care delivery is roughly 4 to 1 [5]. While all of the above effect both telehealth and tele mental health, there are additional ethical challenges to consider when using tele mental health. It may be that Anita is already feeling a loss of autonomy or disempowerment by the very nature of being a patient upon a secure ward and being under the Mental Health Act (GB 2007) and the restriction of her basic autonomous decisions such as when to eat, sleep or who she resides with. When Anita had calmed the nurse had a discussion surrounding the implications of not having the wound sutured such as infection, Anita’s possible need to attack the wound in the future and pain relief issues, However Anita maintained her decision not to have the wound sutured. The practice of locking the main ward door is not in itself unusual. 5 - Lecture notes 5 Mental Status Terminology Seek and Find Exam Review 2017, answers … However this may not feel entirely comfortable for the nurse. In encouraging autonomy for Anita involves taking risks on the part of the nurses’ which may go against their principles of Nonmaleficence and beneficence. Share. [1,8] Ethical issues related to PMH nursing in the literature can be summarized as: obtaining informed consent from the patient; compulsory treatment and hospitalization; using seclusion and restraint; respect for patients’ privacy and confidentiality; and research in psychiatric medicine. A challenge for the contemporary mental health nurse is to know how to wield this power in a way that acknowledges their societal responsibilities while at the same time respecting the rights of the individuals they are required to control. ... coercive practice and felt that integration of theory and clinical skills performance is easier but application of ethical principles in nursing care is difficult. Directions: In order to write a paper of 750-1,000 words on professional ethical boundaries and practices, complete the steps below: Write from the perspective that you are a mental health professional in the field. It is important to recognise that restricting freedoms through the use of sanctioned coercion can be a good thing, however this is dependent on coercion being used by the mental health nurse in a way that is sensitive to the needs of the mental health service user. The nurse has an ethical duty to keep her patients safe. From this we can surmise that ethics is a complex system of reflective thinking, which is used in the search for a standard that can be used to judge your own actions, or the actions of others, within your own moral code. This article will examine some of the ethical and legal issues correctional nurses must address in their practice. This research described the occurrence of ethical iss … Harris et al. Ethical dilemmas can affect both nurse and patient, none more so than issues of mental health. List of issues Latest articles Partial Access; Volume 41 2020 Volume 40 2019 Volume 39 2018 Volume 38 2017 Volume 37 2016 Volume 36 2015 Volume 35 2014 Volume 34 2013 Volume 33 2011-2012 Volume 32 2011 Volume 31 2010 Volume 30 2009 Volume 29 2008 Volume 28 2007 Volume 27 2006 Volume 26 2005 Volume … Ethical and Legal Issues in Psychiatric/Mental Health Nursing ; 2 Introduction. The issue of patients’ rights to and in health care, discussed in the previous chapter, has obvious relevance and application for people with mental illness admitted to hospital for the care and treatment of non-psychiatric conditions (e.g. This chapter will explore mental health nursing within an ethics context. Anita presented with a laceration to the inside of her thigh which was deep enough to expose the adipose tissue beneath, however was not deemed by the medical staff to be life threatening. Legal, Ethical and Professional Issues in Nursing. Staff explained to Anita that the wound was deep enough to require stitching although not life threatening and advised her that she would need to attend the minor injuries unit of the local general hospital for assessment of the wound. Ethical issues experienced by mental health nurses in the administration of antipsychotic depot and long‐acting intramuscular injections: A qualitative study . Ethical nursing principles include ensuring confidentiality, obtaining consent, veracity and honesty, always acting in a fair manner and ensuring justice, and the intention of always doing good and not causing harm. EXAM 2 Study Guide MGT-434 Ch. There are a variety of potential issues to consider including the potential for unclear quality control and standards, clinician’s reluctance, technophobia and anxiety which can all make implementing tele mental health care even more challenging (Langarizadeh et al., 2017). Beauchamp & Childress (2009: 103) after Kant. From which ethical framework is the charge nurse operating? It will tease out the ethics of mental health nursing practice, presenting common ethical challenges mental health nurses face on a daily basis, providing a case-study example which will highlight potential solutions to those challenges. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance. 11th Feb 2020 Nursing Essay Reference this Tags: nursing. Do you have a 2:1 degree or higher in nursing or healthcare? Nurses are highly accountable to patients, the public, employers, and the entire profession. [1,5,7,10] Turkey’s Mental Health System The job of the keeper was to look after the institution, control the ‘inmates’, and where required be a servant to the doctor who was in charge of the asylum (Nolan, With the change of title from attendant to nurse there was a greater emphasis on the delivery of good basic care. moral/ethical issues encountered by a PMHNP essay example. Company Registration No: 4964706. We will look at how, after an episode of self-harm, the patient refused any medical treatment for the wound and how this posed an ethical dilemma for the nursing staff involved in their care. In real world nursing ethical decisions are made by following the money. iThese d… Ethical discourse about mental health treatment has typically focused on paradigmatic concepts of individual autonomy, competence, paternalism, and appropriate justifications for overriding individual decision-making and restricting individual liberty. Learn vocabulary, terms, and more with flashcards, games, and other study tools. 2017/2018 Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). It will explore how ethical decisions are reached and how they can directly influence patient care. The nursing model is one of individual patient empowerment. Home • Get Ahead • Professional Ethics; Nurses adhere to certain ethical principles when caring for patients. Applying ethical principles in nursing management Pages: 5 (1190 words) Use of Ethical Principles to Combat Stigma in Psychiatric Nursing Pages: 8 (1752 words) Ethical Issues in Mental Health Nursing Pages: 8 (1835 words) Ethical Issues in Mental Health Nursing Pages: 8 (1832 words) As Anita was still refusing to have the wound sutured the RC decided that an assessment would need to be carried out to ascertain whether Anita had the capacity to decide to refuse treatment. This statement clearly incorporates the principle of beneficence and shows that the nurses in the case study are considering whether Anita should have medical treatment for the wound enforced upon her due to the principle of beneficence as described due to the worries of the wound becoming infected if not sutured. Ethical issues happen when choices need to be made, the answers may not be clear and the options are not ideal. Porter (, The standards of care in these facilities varied greatly irrespective of whether they were funded privately or by charitable donations. Grand Canyon University. This ethical tight-rope is walked by nursing professionals on a daily basis; how they handle these ethical dilemmas will vary. The discussion will also consider the legal, ethical and professional issues surrounding covert medication. Autonomy is “the freedom and ability to act in a self determined manner” (Butts & Rich 2008: 42) and the right of a rational person to achieve personal decisions without any outside interference. At this time Anita, due to her mental state, could not fully appreciate the nature of the wound and felt that she needed to punish herself further by refusing treatment. Legal and ethical issues are prevalent in the health care industry, and in particular for the nursing practice, where nurses have daily individual contact. Topics: Ethics, ... 2005). Although this appeared to be an unwise decision, which felt uncomfortable to the team, it was agreed to monitor the wound, keep it clean and dry and continue to talk to Anita about her thoughts and feelings surrounding getting medical treatment for the wound. Upon completion of the assessment it was decided that Anita did have capacity to make decisions surrounding treatment at that time, within the framework of the Mental Capacity Act (GB 2005). What legal Dilemma can be hypothesised as underpinning the decision making process of the mental health professionals in this case? Psychiatric Mental Health Nursing (NSG323) Academic year. Topic # 2 Legal and Ethical Issues in Mental Health Nursing. Professional, Legal and Ethical issues in person-centred care For the purpose of this assignment the student will be discussing and analysing the professional, legal and ethical issues that influenced how person-centred care was delivered to a patient in an acute psychiatric hospital where the student was working. In addition to the personal health issues nurses experience when faced with continued ethical dilemmas, patient care suffers when staffing levels go down. Browse the list of issues and latest articles from Issues in Mental Health Nursing. During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. Should the decision to treat Anita for her self harm regardless of her wishes have gone ahead, there may have been a risk of impacting on the nurse-patient therapeutic relationship. Corresponding Author. 2899 words (12 pages) Nursing Essay. Therefore, clinicians should be familiar with … Ethical issues in geriatrics: a guide for clinicians Mayo Clin Proc. On a daily basis mental health nurses make clinical decisions. The Mental Health … If the nurse’s obligation to act beneficently is informed by the patient’s choices and preferences, then the respect for the patient’s autonomy will ultimately override any paternalistic actions on the part of the nurse (Beauchamp & Childress 2009). This infringement is “supported by the principle of beneficence, which is the argument frequently used to impose treatment on patients whether they want it or not” (Buka 2008: 29). Read Summary. In the mental health sector, medication non-adherence remains a serious health-care problem with far-reaching ramifications for patients, their relatives and health-care professionals. You can view samples of our professional work here. In deciding that the decision could be made at a later time not only complies with the Act but also promotes Anita’s autonomy. The following are several common ethical dilemmas that nurses face while on the job. You can view samples of our professional work here. It places quality of life in the forefront. Please sign in or register to post comments. Critically analyse how ethical, professional and legal issues underpin nursing practice. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions. Self-harm has been strongly associated with borderline personality disorder (Motz 2008) where thoughts of self-loathing and self-punishment are common precipitators; the act of self harm can be seen as a symptom of internal turmoil, an expression of internal pain or as controlling factor to maintain a level of care (Grocutt 2009). Ten facts on mental health: fact 2. | Sort by Date ... Critical care decisions in fetal and neonatal medicine : ethical issues (PDF) Published by Nuffield Council on Bioethics, 01 November 2006 This report looks at decision making in fetal and neonatal medicine and the ethical dimensions of this. These decisions have an ethical dimension, however this ethical dimension is not always acknowledged (Smith, …. Nurses are constantly faced with the challenge of making difficult decisions regarding good and evil or life and death. Nursing Essay Every patient has… These beneficial actions fall under the heading of beneficence. Topic # 2 Legal and Ethical Issues in Mental Health Nursing. (Adshead 2010). Psychiatry has always been an area of medicine with unique ethical challenges. In Anita’s case, the nurses worry that the consequences of the wound becoming infected is driving their desire to treat the wound irrespective of Anita’s wishes. This chapter explores ethical issues in mental health policy from a public health perspective, with a focus on the United States. As the wound was neither life threatening or of such a degree that it could not be safety managed upon the ward enabled the staff to consider the possibility of allowing Anita to make an autonomous choice. As such the therapeutic session concentrated on exploring her feelings surrounding her impulses, alternative coping mechanisms to manage her thoughts of self-harm and strategies to help maintain her safety upon the ward. Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of NursingAnswers.net. In the Nursing and Midwifery Order 2001, the Nursing and Midwifery Council (NMC) must establish minimum standards and requirements for nursing education in professional and ethical issues. This chapter explores ethical issues in mental health policy from a public health perspective, with a focus on the United States. Legislation determines what is right or good within a society. To be incapacitated due to trauma or mental ill-health (for example) means that practitioners will often work in your best interests (Kukla, 2005). For mental health nurses having the power to control and being expected to control people diagnosed with a mental disorder can be morally distressing, especially where situations do not always have clear outcomes. 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