NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care
The manifestation of disturbances in individuals’ thoughts, emotions, and behaviors that lead to impairments in their daily functioning serves as the hallmark of mental disorders. Globally, an estimated half a billion people have received diagnoses of at least one mental disorder, and approximately 25% of the world’s population will grapple with such conditions at some point in their lives (Wong et al., 2020). Effectively managing mental disorders, particularly in patients who exhibit non-conforming or aggressive behaviors, necessitates a multifaceted approach involving prevention, anticipation, and, controversially, restraint. This last strategy, involving physical restraint, triggers a myriad of ethical and legal complexities, the implications of which vary among different populations. In this discussion, we will explore the pertinent literature to critically assess the diverse ethical and legal concerns associated with the practice of restraining patients in psychiatric care, both in the context of pediatric and adult care.
Indigenous Nurses Worth Knowing About
Ethical and Legal Concerns in Adult Care
Vergallo and Gulino undertook an exploration of strategies aimed at systematically phasing out the use of restraints in psychiatric care settings, with a focus on protecting the health and safety of patients (2021). They scrutinized the failure to implement necessary measures, which often results in legal actions and lawsuits targeting psychiatrists and healthcare institutions. Additionally, the researchers emphasized the lack of alignment between restraint practices and the international legal frameworks governing human rights. This incongruence infringes upon patients’ personal liberty and exposes them to the risk of injuries that can lead to legal actions. Such incidents occur frequently, with at least 20 out of every 100 restraint cases resulting in legal repercussions (Vergallo & Gulino, 2021). In response, Vergallo and Gulino propose imposing significant penalties on healthcare providers and institutions that endorse restraint and cause harm to patients (2021). This recommendation serves as an incentive to encourage a more cautious and conscientious approach when employing restraint. The insights garnered from this article advise psychiatric providers to either consider a restraint-free model for managing patients with acute behavioral issues or meticulously adhere to organizational, regulatory, and legal guidelines to mitigate legal challenges.
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Delving into the Ethical and Legal Quandaries of PMHNP Practice
Haugom et al. conducted a review of ethical concerns related to the use of restraints in psychiatric patient care, employing exploratory and descriptive approaches to investigate restraint incidents across 57 wards (2019). Through quantitative content analysis, the researchers unearthed several ethical considerations linked to this practice. One notable revelation was that patients generally had negative experiences when subjected to restraint (Haugom et al., 2019). This points to the ethical dilemma posed by restraining psychiatric patients against their will and desires, which contravenes the principle of respecting autonomy. Even in cases of voluntary restraint, patients perceived the practice as coercive, lacking a specific legal basis. The findings from this study provide valuable insights for Psychiatric-Mental Health Nurse Practitioners (PMHNPs) regarding the range of ethical concerns tied to the use of restraints in clinical settings.
Ethical and Legal Considerations in Pediatric Care
In a systematic review and narrative synthesis, Nielson and colleagues sought to investigate the practice of physical restraint in pediatric inpatient mental healthcare services (2019). The researchers scrutinized sixteen quantitative studies that met their inclusion criteria, which focused on inpatient psychiatric patients under the age of eighteen who had experienced physical restraints. The reviewed studies established a connection between physical restraint and patients’ aggressive behaviors and identified intrinsic and extrinsic factors as determinants of restraint use in adolescent psychiatric care. The review spotlighted several ethical issues associated with this practice, with a central concern being the risk of harm resulting from the use of restraints. This ethical predicament overshadows the perceived value of maintaining the safety of the restrained patient (Nielson et al., 2019). Furthermore, the practice is susceptible to abuse, leading to another ethical concern, which is the disproportionate use of force in restraining patients. Such excessive force can result in psychological harm, including fear, anxiety, and trauma, which can have enduring consequences. The authors recommend that physical restraint should be employed in pediatric mental care as a last resort to eliminate the associated risks to patients and minimize the violation of professional ethics by PMHNPs. The information derived from this research is vital for practitioners as it sheds light on the potential ethical hazards of restraining children in psychiatric care. The intervention presents the risk of maleficence by exposing patients to physical and psychological harm, which runs counter to the principles of ethical healthcare practice.
Nunno et al. presented the findings of a time series study spanning over two decades that investigated restraint-related fatalities in children’s mental healthcare and disability services in the United States (2021). The researchers utilized internet search systems to access and compile data on pediatric restraints in the U.S. from 1993 to 2018 (Nunno et al., 2021). The results revealed a total of at least seventy-nine fatalities linked to restraint use. The reviewed restraint cases led to civil, criminal, and regulatory consequences, with law enforcement agencies taking action based on the specific circumstances surrounding each incident. For instance, care agencies reporting fatalities stemming from restraints faced regulatory and civil investigations by child protective authorities for violating legal and regulatory frameworks, while individuals under suspicion were subject to criminal investigations for negligence in ensuring safety and failing to adhere to established
References
Haugom, W. E., Ruud, T., & Hynnekleiv, T. (2019). Ethical challenges of seclusion in psychiatric inpatient wards: A qualitative study of the experiences of Norwegian mental health professionals. BMC Health Services Research, 19(879): 2019.
Nielson, S., Bray, L., Carter, B. & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatients services: A systematic review and narrative synthesis. SAGE Journal of Child Health Care, 25(3): 342-367.
Nunno, A. M., McCabe, A. L., Izzo, V. C., Smith, G. E., Sellers, E. D. & Holden, J. M. (2021). A 26-year study of restraint facilities among children and adolescents in the United States: A failure of organizational structures and processes. Child & Youth Care Forum. Retrieved from https://doi.org/10.1007/s10566-021-09646-w
Vergallo, M. G. & Gulino, M. (2021). Physical restraint in psychiatric care: Soon to fall out of use? Psychiatry and Clinical Psychopharmacology 2021; 31(4):468-473
Wong, H. A., Ray, M. J. & Rosenberg, A. (2020). Experiences of individuals who were physically restrained in the emergency department. JAMA Network Open, 3(1): e1919381
NRNP 6665 Week 2 Discussion: Ethical and Legal Foundations of PMHNP Care
Discussion: 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.
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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.
To Prepare
- Select one of the following ethical/legal topics:
- Autonomy
- Beneficence
- Justice
- Fidelity
- Veracity
- Involuntary hospitalization and due process of civil commitment
- Informed assent/consent and capacity
- Duty to warn
- Restraints
- HIPPA
- Child and elder abuse reporting
- Tort law
- Negligence/malpractice
- In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.
By Day 3 of Week 2
Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.
Read a selection of your colleagues’ responses.
By Day 6 of Week 2
Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.
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 “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 2 Discussion Rubric
Post by Day 3 of Week 2 and Respond by Day 6 of Week 2
To Participate in this Discussion:
Week 2 Discussion
Name: Discussion Rubric
| Excellent90–100 | Good80–89 | Fair70–79 | Poor0–69 | ||
| Main Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. | 40 (40%) – 44 (44%)Thoroughly responds to the Discussion question(s).
Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. No less than 75% of post has exceptional depth and breadth. Supported by at least three current credible sources. |
35 (35%) – 39 (39%)Responds to most of the Discussion question(s).
Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module. 50% of the post has exceptional depth and breadth. Supported by at least three credible references. |
31 (31%) – 34 (34%)Responds to some of the Discussion question(s).
One to two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Cited with fewer than two credible references. |
0 (0%) – 30 (30%)Does not respond to the Discussion question(s).
Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible references. |
|
| Main Posting:Writing | 6 (6%) – 6 (6%)Written clearly and concisely.
Contains no grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
5 (5%) – 5 (5%)Written concisely.
May contain one to two grammatical or spelling errors. Adheres to current APA manual writing rules and style. |
4 (4%) – 4 (4%)Written somewhat concisely.
May contain more than two spelling or grammatical errors. Contains some APA formatting errors. |
0 (0%) – 3 (3%)Not written clearly or concisely.
Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. |
|
| Main Posting:Timely and full participation | 9 (9%) – 10 (10%)Meets requirements for timely, full, and active participation.
Posts main Discussion by due date. |
8 (8%) – 8 (8%)Meets requirements for full participation.
Posts main Discussion by due date. |
7 (7%) – 7 (7%)Posts main Discussion by due date. | 0 (0%) – 6 (6%)Does not meet requirements for full participation.
Does not post main Discussion by due date. |
|
| First Response:Post to colleague’s main post that is reflective and justified with credible sources. | 9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting. | 7 (7%) – 7 (7%)Response is on topic and may have some depth. | 0 (0%) – 6 (6%)Response may not be on topic and lacks depth. | |
| First Response:Writing | 6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.
Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.
Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)Response posed in the Discussion may lack effective professional communication.
Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)Responses posted in the Discussion lack effective communication.
Response to faculty questions are missing. No credible sources are cited. |
|
| First Response:Timely and full participation | 5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.
Posts by due date. |
4 (4%) – 4 (4%)Meets requirements for full participation.
Posts by due date. |
3 (3%) – 3 (3%)Posts by due date. | 0 (0%) – 2 (2%)Does not meet requirements for full participation.
Does not post by due date. |
|
| Second Response: Post to colleague’s main post that is reflective and justified with credible sources. |
9 (9%) – 9 (9%)Response exhibits critical thinking and application to practice settings.
Responds to questions posed by faculty. The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives. |
8 (8%) – 8 (8%)Response has some depth and may exhibit critical thinking or application to practice setting. | 7 (7%) – 7 (7%)Response is on topic and may have some depth. | 0 (0%) – 6 (6%)Response may not be on topic and lacks depth. | |
| Second Response: Writing |
6 (6%) – 6 (6%)Communication is professional and respectful to colleagues.
Response to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. |
5 (5%) – 5 (5%)Communication is mostly professional and respectful to colleagues.
Response to faculty questions are mostly answered, if posed. Provides opinions and ideas that are supported by few credible sources. Response is written in standard, edited English. |
4 (4%) – 4 (4%)Response posed in the Discussion may lack effective professional communication.
Response to faculty questions are somewhat answered, if posed. Few or no credible sources are cited. |
0 (0%) – 3 (3%)Responses posted in the Discussion lack effective communication.
Response to faculty questions are missing. No credible sources are cited. |
|
| Second Response: Timely and full participation |
5 (5%) – 5 (5%)Meets requirements for timely, full, and active participation.
Posts by due date. |
4 (4%) – 4 (4%)Meets requirements for full participation.
Posts by due date. |
3 (3%) – 3 (3%)Posts by due date. | 0 (0%) – 2 (2%)Does not meet requirements for full participation. Dont wait until the last minute.Provide your requirements and let our native nursing writers deliver your assignments ASAP. Does not post by due date. |
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| Total Points: 100 | |||||