NRNP 6665 ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CA

NRNP 6665 ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CA

Week 2 Main Discussion Post

In the realm of psychiatric and mental health care, PMHNPs frequently find themselves navigating the intricate web of ethical decision-making. Our practice is firmly anchored in a robust code of ethics that exalts the welfare, rights, responsibilities, health, and safety of the patient as the paramount considerations. These ethical codes provide a guiding framework for clinical decision-making, and they are, by their nature, liberating rather than oppressive. Furthermore, these ethical codes encapsulate the profession’s loftiest aspirations. In contrast, the legal domain delineates the baseline requirement for our field, setting the minimum standards of care. In this dichotomy, the legal codes represent the floor, while the ethical codes signify the ceiling of care (Walden, 2022). In the mental health context, one of the most paramount ethical concerns is the concept of informed consent, an expression of respect for individuals, intricately tied to the ethical principle of autonomy (Bester et al., 2016).

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Professional Nursing Associations in the US

Exploring the Ethical and Legal Pillars of PMHNP Care

Bester et al. (2016) stress the importance of coupling consent with other bioethical principles such as beneficence and nonmaleficence. The application of informed consent may differ when dealing with adults versus children. Specifically, children, due to their lack of legal capacity, depend on their legal guardians or parents to make decisions on their behalf. However, certain circumstances allow children and adolescents to provide informed consent, such as emancipation (Davis & Fang, 2020). This discussion delves into four articles that explore the nuanced aspects of informed consent in the realms of adult and pediatric psychiatry.

Katz et al. (2016) offer invaluable insights regarding informed consent, parental permission, and childhood assent in pediatric psychiatry. The article underscores the standard practice of obtaining informed consent from legal guardians or parents in both the medical and legal domains. Decision-making hinges on legal empowerment and decisional capacity. In this context, the reliance on autonomy and individual liberties may be fraught with challenges, legal constraints, and often proves impractical for pediatric patients. Clinicians are tasked with evaluating the patient’s or their surrogate’s capacity to make informed decisions regarding medical interventions. In this context, parents and legal guardians are aptly positioned to make these decisions, given their comprehensive understanding of their children’s unique needs.

In the realm of adult psychiatry, Bester et al. (2016) confront the issue of informed consent when patients are overwhelmed. The article delves into the ethical dimensions of this challenge, emphasizing the importance of preventing harm and seeking ways to fulfill clinical obligations without resorting to paternalism. While respecting a patient’s autonomy remains a cornerstone, there are situations where clinicians may need to supersede autonomy, particularly when patients grapple with overwhelmed understanding and capacity. The article prescribes a comprehensive approach, involving scrutiny of information-related, patient-related, and communication-related factors when obtaining informed consent becomes arduous. Ultimately, the article posits that assessing the capacity for informed consent should be a multifaceted process, taking into account the interplay of patient-specific, communication-related, and information-related factors.

Davis & Fang (2020) delve into the legal facets of informed consent in pediatric settings. The article crucially outlines the legal boundaries governing informed consent for children and adolescents. While minors typically lack the legal capacity to provide informed consent, emancipation creates a pathway for adolescents to give informed consent. In this scenario, a minor who has reached the legal age of adulthood can provide informed consent. Although the legal doctrine of a “mature minor” exists, it remains unrecognized in a limited number of states. For minors aged twelve and above, there is a presumption of mental maturity that allows them to consent to treatment. However, in the absence of emancipation, clinicians must navigate the delicate balance of preserving the child’s autonomy while respecting the legal limits.

Zhang et al. (2021) delve into the realm of informed consent in adult psychiatry, shedding light on the intricate interplay between informed consent and cultural factors. The study underscores that informed consent is fundamentally rooted in the principle of respecting the autonomy of patients. However, the study contends that cultural factors exert a significant influence on the application of bioethics. It is pointed out that the slow progress and limited adoption of bioethics in China contribute to ethical quandaries for clinicians. When comparing China to the United States, the study identifies a tendency among Chinese healthcare providers to overlook the principle of informed consent due to deep-seated cultural beliefs. Despite these cultural considerations, clinicians remain bound by legal obligations to respect patient autonomy, except in instances where patients lack the capacity to make decisions for themselves.

Collectively, these studies underscore the variability in the application of informed consent in psychiatric and adult mental health settings. Clinicians must possess a profound understanding of the legal limitations surrounding informed consent. Importantly, mental capacity assessment is a pivotal consideration before obtaining informed consent. As psychiatric nurses, we bear the responsibility of practicing with a comprehensive knowledge base that encompasses the impact of existing laws on our practice. We are accountable for our actions in accordance with the current legal frameworks, regulations, and professional standards.

References

Bester, J., Cole, C. M., & Kodish, E. (2016). The limits of informed consent for an overwhelmed patient: clinicians’ role in protecting patients and preventing overwhelm. AMA journal of ethics, 18(9),869–886.https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/peer2-1609.pdf

Davis, M., & Fang, A. (2020). Emancipated Minor.  StatPearls [Internet]. Treasure Island,

FL: StatPearls Publishing.

Katz, A. L., Webb, S. A., and the Committee on Bioethics (2016) used informed consent in decision-making in pediatric practice.  Pediatrics, 138(2). http://dx.doi.org/10.1542/peds.2016-Links to an external site.

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Zhang, H., Zhang, H., Zhang, Z., & Wang, Y. (2021). Privacy and autonomy of patients: a comparison of ethical problems in China and the US BMC Medical Ethic, 22(1), 1–8. https://doi.org/10.1186/s12910-021-00579-6Links to an external site.

Walden University (2022). Minneapolis Minnesota.

ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE

Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!

The role of PMHNPs frequently entails navigating complex situations that demand well-informed ethical decision-making. We, as PMHNPs, are bound by a code of ethics that places the patient’s welfare, rights, responsibilities, health, and safety as our foremost priorities. These ethical codes serve as a guiding framework for clinical decision-making, designed to empower rather than constrain. Moreover, they encapsulate aspirational ideals for our profession. In contrast, legal regulations establish the foundational requirements for our field. In this dichotomy, legal codes set the minimum standards of care, while ethical codes signify the loftiest goals for care (Walden, 2022). Within the domain of mental health, one of the most pivotal ethical concerns remains the concept of informed consent, which underscores a profound respect for individuals and aligns closely with the ethical principle of autonomy (Bester et al., 2016). Bester et al. (2016) emphasize that informed consent should be integrated with other bioethical principles such as beneficence and nonmaleficence. The application of informed consent necessitates different considerations when dealing with adults versus children. Notably, children lack the legal capacity to provide informed consent, necessitating that their legal guardians or parents make decisions on their behalf. Nevertheless, emancipated children and adolescents hold the capacity to provide informed consent (Davis & Fang, 2020). This discussion synthesizes insights from four articles related to informed consent in adult and pediatric psychiatry.

Katz et al. (2016) offer invaluable insights into the realm of informed consent, parental permission, and childhood assent in pediatric psychiatry. The article underscores the standard practice of obtaining informed consent from legal guardians or parents, a commonality in both the medical and legal spheres. Decision-making processes hinge on legal empowerment and decisional capacity. Consequently, relying solely on autonomy and individual liberties may prove legally unviable, challenging, and impractical for pediatric patients. Clinicians, therefore, shoulder the responsibility of evaluating the patient’s or their surrogate’s capacity to make informed decisions regarding medical interventions. Parents and legal guardians, given their intimate understanding of their children’s unique needs, are suitably positioned to make these decisions.

In the realm of adult psychiatry, Bester et al. (2016) address the nuanced issue of informed consent in scenarios where patients feel overwhelmed. The article places a strong emphasis on preventing harm and devising strategies to fulfill clinical obligations without resorting to paternalism when patients’ understanding and capacity are compromised. While upholding a patient’s autonomy remains a cornerstone, there are instances where clinicians must contemplate overriding autonomy. For example, when patients struggle to provide informed consent due to cognitive overwhelm, clinicians should consider information-related factors, patient-related factors, and communication-related factors. The article ultimately posits that evaluating the capacity for informed consent should be a comprehensive process, considering patient-specific, communication-related, and information-related factors.

Davis & Fang (2020) delve into the legal dimensions of informed consent in pediatric settings. The article underscores the legal boundaries governing children and adolescents’ capacity to provide informed consent. Minors typically lack the legal capacity to grant informed consent, with emancipation offering a pathway for adolescents to exercise this right. In cases where a minor has reached legal adulthood, they possess the capacity to provide informed consent. Notably, the legal concept of a “mature minor” exists, albeit with limited recognition across states. For minors aged twelve and older, there is a presumption of mental maturity that enables them to consent to treatment. However, clinicians must navigate the fine balance between preserving a child’s autonomy while respecting the legal constraints in cases where the child is not emancipated.

Zhang et al. (2021) delve into the realm of informed consent in adult psychiatry and shed light on the intricate interplay between informed consent and cultural factors. The study underscores that informed consent is intrinsically tied to respecting the autonomy of patients. However, the study highlights the influence of cultural factors on the application of bioethics. It is noted that the slow development and limited adoption of bioethics in China present ethical challenges for clinicians. In comparing China to the United States, the study reveals that Chinese healthcare providers frequently overlook the principle of informed consent due to deeply ingrained cultural beliefs. Nevertheless, clinicians are bound by legal obligations to uphold patient autonomy unless patients are incapacitated.

Collectively, these studies underscore the nuanced application of informed consent in psychiatric and adult mental health settings. Clinicians must possess a profound understanding of the legal constraints surrounding informed consent. Importantly, a patient’s mental capacity must be thoughtfully considered before obtaining informed consent. As psychiatric nurses, we shoulder the responsibility of practicing with a comprehensive knowledge base that encompasses the impact of existing laws on our practice. We are accountable for our actions in accordance with current legal frameworks, regulations, and professional standards, thus emphasizing the need for a thorough understanding of the legal landscape and its implications.

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