PMHNP Care Across the Lifespan I

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. Tennessee

 

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

 

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.

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Solution

Legal/Ethical Topic

Use of Physical restraint in mental health care

Physical restraint is commonly used in adult and children/adolescent mental health care to prevent patients from harming themselves or others.  Despite the potential to ensure staff and patient safety, there are legal and ethical issues associated with its application in mental health care, including exposure to psychological and physical injury and violation of patients’ basic human rights.

Summary of articles

Hammervold, U. E., Norvoll, R., Aas, R. W., A, &  Sagvaag, H. (2019).  Post-incident review after restraint in mental health care -a potential for knowledge development, recovery, promotion, and restraint prevention. A scoping review.  BMC Health Services Research, 19, 235.

The use of physical restraint in mental health care is controversial because of potential negative consequences, including psychological and physical harm to care providers and patients and infringement on patients’ liberty and autonomy.  Health care practice should be based on respect for human rights, preservation of patients’ integrity and dignity, and treatment of patients with respect and care (Hammervold, 2019).

Oh, Y. (2021). A New Perspective on Human Rights in the Use of Physical Restraint on Psychiatric Patients-Based on Merleau-Ponty’s Phenomenology of the Body. International Journal of Environmental Research and Public Health, 18(19), 1078.

Physical restraint aims at protecting patients themselves and others, but it becomes a scheme of restricting the free will of the patients, hence compromising their fundamental human rights. This is to means that the use of physical restraint for safety generates psychological and physical problems in patients and also poses a significant question about value-judgment t concerning the autonomy and dignity of people with unique and distinctive personalities (Oh, 2021).

Ye, J., Zeng, J., Xiao, A., Xia, Z., Dai, L., & Wang, C. (2021).  Attitudes and practice toward physical restraint among psychiatric nurses in Guangdong, China: a cross-sectional survey. Frontiers in Nursing, 8(1), 59-68.

Physical restraint is a commonly used approach for ensuring patient and nursing staff safety in psychiatric settings. Nevertheless, the application of physical restraint is regarded as controversial practice since it causes legal and ethical issues that violate patients’ dignity and autonomy. It also causes harmful psychological and physical effects on both nurses and patients (Ye et al., 2021).

How the information could apply to my clinical practice

Since the safety and health of patients along with their dignity and autonomy are significant parameters, it is necessary to balance between them, rather than choosing one over the other.   Nurses need to apply physical restraint when less restrictive alternatives fail.  As indicated by Ye et al. (2019),  mental health nurses apply alternative interventions such as crisis management and de-escalation techniques, to ease risks caused by patients with severe mental illness. However, compulsory intervention like physical intervention is implemented when alternatives do not succeed to resolve the conflict.

Under Tennessee law (Section 0940-05-16-.21) restraint must not be imposed as a convenience for staff, punishment, or a substitute for a rehabilitative program.  Restraint should only be used to prevent injury to others or self. Restraint must be stopped when less-restrictive alternatives will give the same results.

 

References

Hammervold, U. E., Norvoll, R., Aas, R. W., A, &  Sagvaag, H. (2019).  Post-incident review after restraint in mental health care -a potential for knowledge development, recovery, promotion and restraint prevention. A scoping review.  BMC Health Services Research, 19, 235. https://doi.org/10.1186/s12913-019-4060-y

Oh, Y. (2021). A New Perspective on Human Rights in the Use of Physical Restraint on Psychiatric Patients-Based on Merleau-Ponty’s Phenomenology of the Body. International Journal of Environmental Research and Public Health, 18(19), 1078. doi: 10.3390/ijerph181910078

Ye, J., Zeng, J., Xiao, A., Xia, Z., Dai, L., & Wang, C. (2021).  Attitudes and practice toward physical restraint among psychiatric nurses in Guangdong, China: a cross-sectional survey. Frontiers in Nursing, 8(1), 59-68. DOI: 10.2478/fon-2021-0007

Ye, J., Wang, C., Xiao, A., Xia, Z., Yu, L., Lin, J., Liao, Y., Xu, Y., & Zhang, Y. (2019). Physical restraint in mental health nursing. International Journal of Nursing  Sciences, 6(3), 343-348. doi: 10.1016/j.ijnss.2019.04.002

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