NRNP 6665 Week 2 Ethical and Legal Foundations of PMHNP Care Across the Lifespan
Ethical and Legal Foundations of PMHNP Care
Advanced nursing practice is governed by codes of ethics that prioritize patient care, rights, duty, health, and safety. PMHNP practice strictly adheres to psychiatry’s ethical standards. These codes act as guidelines for clinical decision-making and represent the profession’s aspirational principles instead of strict mandates. In contrast, legal codes establish mandatory requirements that define the basic essential standards of care, whereas ethical codes represent the highest aspirations in healthcare. Improving adherence in an evolving healthcare system requires patient participation as collaborators in care planning.
Healthcare professionals must work closely with those they treat, involving them in formulating care plans and implementing agreed-upon solutions. Patient autonomy, the right to make medical care decisions without unwarranted interference from providers, is essential (Molina-Mula & Gallo-Estrada, 2020). This analysis will examine the legal and ethical dimensions of this issue of autonomy. Therefore, adhering to legal standards and pursuing moral ideals empowers healthcare practitioners to offer excellent treatment that respects patients’ rights and promotes meaningful decision-making partnerships.
Autonomy in Adults
Ethical Considerations
The scoping study conducted by (Ventura et al., 2020) examines human rights and ethical issues in mental illness nursing care. The study emphasizes the significance of integrating mental health, ethics, and human rights to improve the well-being of those with mental illness. The findings suggest that mental health nurses play a vital role in guaranteeing interventions based on ethics and human rights. However, they frequently grapple with ethical dilemmas and paternalism, compromising their patients’ autonomy. The review calls for a discussion on these ethical conflicts’ resolutions to allow nurses to operate in a morally acceptable way. It places the individual at the center of the ethical discourse in mental health care by emphasizing the need for healthcare professionals, particularly nurses, to accomplish their ethical obligations, protect patients from unfair treatment, and safeguard their human rights.
Legal considerations
Compliance with the legal system of nursing practice is essential for averting legal issues during healthcare delivery. Adult autonomy is a complex legal issue involving the rights and freedoms of people to make decisions regarding their own lives (Daas, 2020). In several legal systems, adults are deemed capable of practicing autonomy, which includes decisions regarding personal relationships, medical care, and financial matters. However, there are circumstances in which autonomy may be restricted. In cases where a person lacks the mental capacity to make informed decisions, a legal guardian or power of attorney may be assigned to represent their best interests. In addition, laws may exist to safeguard the autonomy of individuals against coercion or maltreatment (Daas, 2020). Achieving a balance between individual autonomy and societal interests and protecting vulnerable individuals is a delicate task for legal systems, necessitating careful consideration and constant review of laws and regulations.
Autonomy in Children/Adolescents
Ethical considerations
Although patient autonomy is regarded as one of the most important ethical principles that enable effective healthcare decision-making, the concept differs between minors and adults. The study “The Depiction of Autonomy and Shared Decision-Making by Children and Adolescents in Medical Television” by (Golden et al., 2022) examines the depiction of pediatric patients’ autonomy and participation in shared decision-making in medical television dramas. The researchers discovered, studying four popular series, that pediatric patients’ involvement in medical decision-making increased over time. 57.5 percent of the 238 recorded medical decisions were made by pediatric patients (Golden et al., 2022).
The study underlines the impact of media on viewers’ impressions of healthcare and stresses the significance of accurate depictions of patient participation. The results indicate that medical dramas depict pediatric patients as increasingly autonomous, fully involved in their healthcare, and expressive about their preferences. However, the study admits limitations, such as a small sample size, and calls for additional research on the effect of televised medical depictions on real-world decision-making. Participation of pediatric patients in making decisions is crucial and should be proportional to their age and ability.
Legal considerations
The legal definition of age determines the legal aspects of autonomy. (Alderman et al., 2019) Adolescents, unlike infants, have undergone extensive brain development, enhancing their ability to make sound decisions. However, until they reach the majority, they remain bound by their parents and guardians to make important healthcare decisions. According to Alderman et al. (2019), power of attorney or parentage authorizes a guardian or parent to make medical decisions on behalf of a minor. Despite this, the article demonstrates that some states allow children the privilege of confidentiality and consent for certain medical services, such as contraception and treatment for sexually transmitted infections.
NRNP 6665 Week 2 Ethical and Legal Foundations of PMHNP Care Across the Lifespan References
Daas, A. (2020, November 3). Mental illness and medico-legal aspects. Legal Desire Media and Insights. https://legaldesire.com/mental-illness-and-medico-legal-aspects/
Golden, M. E., Ekpa, N., Rafferty, B., & Olympia, R. P. (2022, May 2). The Depiction of Autonomy and Shared Decision-Making by Children and Adolescents in Medical Television. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9158253/pdf/cureus-0014-00000024662
Molina-Mula, J., & Gallo-Estrada, J. (2020). Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health, 17(3), 835. https://www.mdpi.com/1660-4601/17/3/835
Unique needs of the adolescent. (2019, December 1). American Academy of Pediatrics. https://publications.aap.org/pediatrics/article/144/6/e20193150/37985/Unique-Needs-of-the-Adolescent?autologincheck=redirected
Ventura, C. A., Austin, W., Carrara, B. S., & De Brito, E. S. (2020). Nursing care in mental health: Human rights and ethical issues. Nursing Ethics. https://journals-sagepub-com.huaryu.kl.oakland.edu/doi/pdf/10.1177/0969733020952102
NRNP 6665 Week 2 Ethical and Legal Foundations of PMHNP Care Across the Lifespan
In your role as a PMHNP, you will regularly encounter situations that require your ability to make sound judgments and practice decisions for the safety and well-being of individuals, families, and communities. There may not be a clear-cut answer of how to address the issue, but your ethical decision making must be based on evidence-based practice and what is good, right, and beneficial for patients. You will encounter patients who do not hold your values, but you must remain professional and unbiased in the care you provide to all patients regardless of their background or worldview. You must be prepared to critically analyze ethical situations and develop an appropriate plan of action.
- Analyze salient ethical and legal issues in psychiatric-mental health practice
- Analyze the impact of cultural considerations on ethical/legal decision making in advanced practice nursing
- Evaluate mastery of nurse practitioner knowledge in preparation for the nurse practitioner national certification examination*
Week 2 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.
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 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!
Example Discussion NRNP 6665 Week 2 Ethical and Legal Foundations of PMHNP Care Across the Lifespan
Ethical and Legal Foundations of PMHNP Care – Autonomy
Autonomy in medical practice is the right of competent adults to make decisions on their own healthcare based on information from medical professionals. The principle of autonomy requires healthcare professionals to acquire consent from the patient before engaging in any investigations or treatments.
Typically, a decision is considered autonomous when two conditions are met; the individual must have all relevant mental capacity to make rational decisions and must be unaffected by external constraints (Chapman, Toretsky, & Phoenix, 2019). In the healthcare field, a decision is viewed as autonomous when the patient has sufficient information, the capacity to make a decision and arrives at a decision voluntarily.
According to Chapman, Toretsky and Phoenix (2019), medical practitioners are expected to respect the principle of autonomy by disclosing medical information including the available treatment options to allow patients to make their own decisions.
The principle of autonomy is not applicable to people who do not have the capacity or competence to make autonomous decisions such as infants and young children and patients who lack competence due to mental, developmental, or physical disorders (Chapman, Toretsky, & Phoenix, 2019). To make informed consent, there are several requirements; the patient must have the capacity to understand and decide based on the information provided to them, understand the disclosure, and acts voluntarily to give consent.
According to the article by Gómez-Vírseda, De Maeseneer and Gastmans (2020), patients have the legal right to make decisions as long as they are in their right mental status. Patients can decide whether or not to get treatment even if their decisions do not align with the physicians’ recommendations. Legal precedents have advanced the necessary requirements for patient autonomy such that patient autonomy is now the dominant principle instead of the physician’s beneficence.
McGee, Dingle, & Edelsohn, (2016), note that the welfare and health of children are maintained by their guardians. However, children and adolescents should also be involved in the decision-making process on the types of treatment they receive. Medical professionals should explain the medical issues and possible treatment options in a way that both the children/ adolescent patient and the guardian can understand. The child
/adolescent should then be allowed to participate in decisions about the care they will receive to the best of their abilities to act rationally and comprehend their options. Children or adolescents have the right to agree or disagree with the treatment options presented to them. The guardians of the children or adolescents have the right of proxy consent where they can make decisions for the minors under their care.
In some jurisdictions, the consent of adolescents of a certain age is required. The psychiatrist of the child/ adolescent is required to obtain the minor’s assent whenever it is reasonable as well as the legal guardian’s consent before any medical actions take place. However, as noted by McGee, Dingle and Edelsohn (2018). There are some provisions for emergencies and in the case of emancipated minors.
During emergency medical care, medical professionals are allowed to consider assent and consent as secondary considerations in order to provide urgent medical care to the minor patient. Emancipated minors are legally responsible for their own care and their consent must be obtained before any actions take place. In some jurisdictions, minors involved with sexually-related situations, minors are allowed to make autonomous decisions regarding their care.
Song et al. (2020) argue that there are cases when the decisions of the child or adolescent and the guardians are in conflict. In situations where the guardian consents to treatment while the minor dissents, medical practitioners may opt to treat the minor patient in spite of their dissent. It is up to the minor patient’s psychiatrist to determine the consequences of treating the patient without their consent and encourage the minor and guardians to collaborate to enhance the health of the minor.
Psychiatrists and all medical professionals have the ethical responsibility to maintain their patient’s autonomy through providing the all necessary information and allowing them to make their own decision. In my practice, I will strive to maintain my patient’s autonomy and in cases where my ethical responsibilities conflict with the law or other governing legal authority, I will take the necessary steps to resolve the conflicts using the Ethical Standards of Ethics Code and General Principles. I will also ensure that I never use any conflicts or standards to violate my patients’ right to autonomy.
NRNP 6665 Week 2 Ethical and Legal Foundations of PMHNP Care Across the Lifespan References
- Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing psychiatric mental health
- nurse practitioner practice: impact of state scope of practice regulations. Journal of Nursing Regulation, 10(1), 35-43. https://doi.org/10.1016/S2155-8256(19)30081-X.
- Gómez-Vírseda, C., De Maeseneer, Y., & Gastmans, C. (2020). Relational autonomy in end-of- life care ethics: a contextualized approach to real-life complexities. BMC Medical Ethics, 21, 1-14. https://doi.org/10.1186/s12910-020-00495-1
- McGee, M. E., Dingle, A. D., & Edelsohn, G. A. (2018). Review of the revised 2014 American Academy of Child and Adolescent Psychiatry code of ethics. Journal of the American Academy of Child and Adolescent Psychiatry, 55(4), 257-261. https://doi.org/10.1016/j.jaac.2015.12.017
- Song, S. Y., Wang, C., Espelage, D. L., Fenning, P., & Jimerson, S. R. (2020). COVID-19 and school psychology: Adaptations and new directions for the field. School Psychology Review, 49(4), 431-437. https://doi.org/10.1080/2372966X.2020.1852852