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  1. 5 Basic principles of ethics?
    • Beneficence - Do benefit for others
    • Autonomy - Pt right to make decisions
    • Justice - Treat all equally
    • Fidelity - (nonmaleficence) nursing skill up-to-date
    • Veracity - speak truthfully
  2. Michigan Involuntary Outpatient Admission - time frame?
    Must have appt within 2 weeks at a community health clinic
  3. Right to treatment at PUBLIC hospitals (never clearly defined by U.S. Supreme Court) requires:
    • humane environment
    • qualified and sufficient staff
    • individualized care plan
  4. Informed consent consists of an explanation of:
    • nature of problem
    • nature and purpose of proposed Tx
    • risks and benefits of Tx
    • alternative Tx options
    • probability that Tx will work
    • risks of not consenting to Tx
  5. After 15 days, a patient is released from an inpatient treatment unit where he had been committed by a judge for a period of 90 days. Upon discharge, in return for placement in a mental health group home, the patient is required to attend weekly appointments with his case manager and counselor, take all ordered medications, and meet twice monthly with his psychiatrist. He is told that the judge has ordered that the patient be readmitted to the inpatient facility if he fails to follow these requirements. This scenario includes examples of which of the following type(s) of admissions and/or releases? Select all that apply.

    1. Involuntary admission
    2. Long-term involuntary admission
    3. Unconditional release
    4. Conditional release
    5. Involuntary outpatient admission

    Although the patient had been admitted involuntarily to the inpatient unit, it was by ajudge’s order for a period of greater than 60 days, and thus it was a long-term involuntary admission (a regular involuntary admission by definition is for a period of 60 days or less). An unconditional release places no requirements on the patient after discharge; in this case there were requirements placed on the patient, making this a conditional release. This case also illustrates an involuntary outpatient admission (known in some locales as an outpatient commitment), which is defined as being required to participate in treatment as a condition of receiving specific benefits or other considerations (in this case, his being offered housing in the group home).
  6. A patient incidentally shares with you that he has difficulty controlling his anger when around children because their play irritates him, leading to resentment and fantasies about attacking them. He has a history of impulsiveness and assault, escalates easily on the unit, and has a poor tolerance for frustration. This weekend he has an overnight pass, which he will spend with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brother because he usually helps her watch the children, and she has to work this weekend and needs him to babysit. The patient becomes visibly apprehensive upon hearing this. Which of the following responses would best reflect appropriate nursing practice relative to the conflict this situation presents between safety and thepatient’s right to confidentiality?

    A. Suggest that the sister make other arrangements for child care, but withhold the information the patient shared regarding his concerns about harming children.
    B. Speak with the patient about the safety risk involved in babysitting, seeking his permission to share this information and advising against the pass if he declines to share the information.
    C. Cancel the pass without explanation to the sister, and reschedule it for a time when babysitting would not be required of the patient.
    D. Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger towards children and the resultant risk that his babysitting would present.
    D. Meet with the patient’s sister, sharing with her the patient’s previous disclosure about his anger towards children and the resultant risk that his babysitting would present.

    In this situation, it is clear that allowing the patient to babysit at the present time would present a risk to the children. At the same time, the patient has a reasonable expectation that clinical information about him will generally not be shared without his permission, an expectation that is a legally-identified patient right under most circumstances. One clear exception to this rule, however, exists when the information to be shared involves a risk to others. In such cases, the Tarasoff ruling mandates that potential victims must be protected, and the patient’s right to confidentiality must yield when sharing confidential information is necessary to provide for the protection of potential victims. Most states have enacted legislation requiring notification of potential victims in such cases. In this case, there is a risk to the sister’schildren and as a result, the patient’s right to privacy is forfeited in the interest of protecting the children. Therefore, the patient’s sister must be told of the risk so that she can take whatever actions she reasonably deems necessary to protect her children. Thus the sister should be informed of the patient’s disclosure of hostile impulses towards children and of his fear that he would lose control in their presence. Obtaining the patient’s permission to share the information would preserve the therapeutic relationship, but if he declined and opted to proceed with the pass against the nurse’s recommendation, the risk to the children would remain, and the sister’s righto the information needed to protect her children (under Tarasoff and related legislation) would be violated. Further, this failure to perform one’s duty to warn would likely represent negligence on the nurse’s part. Simply rescheduling or canceling the pass would reduce the immediate risk but would not address any future instances wherein the patient might be with children and harm them. The only situation in which this would be acceptable would be if the patient could not obtain any passes until his risk to children was deemed to have been corrected. Although possible in long-term settings, in most treatment situations, this would not be a realistic plan. In effect, canceling the pass without sharing the information about the patient’s risk to children would simply delay the eventual risk to the children rather than prevent it.
    (this multiple choice question has been scrambled)
  7. After the death of a client what, if any, rules regarding confidentiality should be followed by nurses who have cared for the client?

    A. Disclose nothing that would have been kept confidential before death.
    B. Confer with next of kin before divulging confidential, sensitive information.
    C. Only HIV status continues to be protected and privileged.
    D. Confidentiality is now reserved to immediate family.
    A. Disclose nothing that would have been kept confidential before death.
    (this multiple choice question has been scrambled)
Card Set:
2013-03-16 13:15:53
nur210e1 Legal Ethical Guidelines Safe Practice

Legal and Ethical Guidelines for Safe Practice
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