Posted: March 25th, 2021

Discussion: Ethical and Legal Foundations of PMHNP Care

NRNP 6665: PMHNP Care Across the Lifespan I
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 objective will be to recognize the most notable legitimate and moral aspects of the issue for PMHNP practice, and furthermore how these features vary being taken care of by grown-up patients versus kids. Remember 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 deliver moral contemplations identified with this theme for grown-ups, one ought to be on moral contemplations identified with this subject for kids/youths, one ought to be on legitimate contemplations identified with this point for grown-ups, 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.

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Sample Essay Question Answer
The topic that I have chosen for this week’s discussion is, “Autonomy”. According Rosenberg (2020), Autonomy gives patient’s the right to make decisions about their healthcare without others. It is necessary for our clients to have some control regarding their healthcare. There are four articles that I am going to briefly discuss in this post.

The first article is regarding the legality of Physician-Assisted Death for Dementia. The main point of this article is asking if individuals with dementia have the mental capacity to request physician assisted death due to their lack of quality of life in advanced dementia. In the Netherlands, individuals are able to sign what is called an AED or Advance Euthanasia Directive (Dresser, 2017). These individuals must be alert and oriented to person, place, time, and situation prior to signing this Directive and it is acceptable to follow through with their wishes should they become incapacitated in their elderly years (Dresser, 2017).

The second article is regarding the ethical considerations of providing in-home psychiatric care to homebound individuals. While mental health care is very important, as is medical care, there are considerations that should be taken into account for providers performing this service. According to Boland (2018), therapy in the home introduces situations that have not been completely covered in ethics research and can place providers in situations that cause professional risk. This can cause an increased unwillingness to provide this type of care. Another important aspect of this article is “boundary crossings that are deviations from the typical client-provider relationships that may be harmful, helpful, or even neutral”. This relationship can, instead of remaining professional, become more friendly or social (Boland, 2018). Another ethical consideration that is important, is the concept of confidentiality and privacy within the home. Quite often, there are family members, friends, roommates, and others who may be present during the therapy session. It is acceptable to ask these individuals to provide privacy for the session (Boland, 2018). Lastly, it is important to remember that clients have the right to “fire” their therapist. In the office setting, this is easy as the client has the ability to stop attending sessions. In the case of home therapy, it is difficult for the client to “fire” their therapist because they are actually the ones traveling to the home to provide services to the client and will always be home (Boland, 2018).

The third article is regarding the legal rights of adolescents to consent to HIV Prevention Research without their parents. According to Bauman, et.al., (2020), “adolescents 14-years-old and older have the ability to understand research and the cognitive ability to make decisions about research participation similar to the same abilities in adults”. There must be, however, certain criterion met in order for parental permission to be waived. These criteria are: the research does not involve more than the minimal risk to subject, the waiver or alteration will not adversely affect the rights and welfare of the subjects, the research could not practicably be carried out without the waiver or alteration, and lastly, whenever it is appropriate, the subjects will be provided with additional pertinent information after participation (Bauman, et. al., 2020). The authors also write that “according to the Office for Human Research Protection, if adolescents are legally able to obtain contraception and PrEP, they are not considered “children” and they can provide their own consent for research” (Bauman, et. al., 2020).

The fourth article is regarding the ethical considerations in determining candidacy for liver transplant in adolescents with suspected intentional drug overdoses. The concern with this concept is that an adolescent who receives a liver transplant after intentionally overdosing will not adhere to a life-long post-transplant treatment regimen (Triplett, et. al., 2018). Ultimately, the writers write that “as long as a patient’s mental illness has potential to be treated, a suicide attempt, suspected or confirmed, should not keep the adolescent from being on the list. Especially if the patient is not voicing active suicidality (Triplett, et. al., 2018).

In my own practice, it will be very important to exercise patient autonomy. Allowing this independence can be beneficial for the clients as they will also be in control of their mental health. While it may not necessarily foster all positive outcomes, it will allow the clients to learn from any mistake that may be made. Giving my clients the ability to call the shots on their own care, gives them the right to take control. However, in the event that there is a potentially dangerous situation, the autonomy will not be possible. It is my goal, as a provider, to build a rapport with the parents first and then with the adolescent. If the parents trust you as the provider, then they will be very comfortable with you taking care of their child.

According to TN.Gov (2013), “adolescents, age 16 and older are deemed mature enough and have the right and maturity to make their own medical decisions, including, mental health care, and sign their own consent forms for procedures and tests”. While this may be true, it is still very important to make sure the parents are informed to the best of the providers legal ability and of course, with the adolescent’s permission.

References

Bauman, L.J., Mellins, C.A., and Klitzman, R. (2020). Whether to Waive Parental Permission in HIV Prevention Research Among Adolescents: Ethical and Legal Considerations. Journal of Law, Medicine & Ethics. 48. 188-201. Doi: 10.1177/1073110520917010. Whether to Waive Parental Permission in HIV Prevention Research Amhttps://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=1&sid=1396a6d8-9e0b-4cba-af8c-7159e5ca1b37%40sdc-v-sessmgr01ong Adole…: @ Walden University Library (waldenulibrary.org)

Boland, K.M. (2018). Ethical Considerations for Providing In-Home Mental Health Services for Homebound Individuals. Ethics and Behavior. 29(4). 287-304. Doi: https://doi.org/10.1080/10508422.2018.1518138. Ethical Considerations for Providing In-Home Mental Health Services for Hom…: @ Walden Univhttps://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=3&sid=2c08a1d0-b3f3-4c28-b08a-b993996baac6%40sessionmgr4008ersity Library (waldenulibrary.org)

Dresser, R. (2017). On Legalizing Physician-Assisted Death for Dementia. The Hastings Center Report. 47(4). 5-6. DOI: 10.1002/hast.731. On Legalizing Physician-Assisted Death for Dementia: @ Walden University Library (waldenulibrary. https://eds-b-ebscohost-com.ezp.waldenulibrary.org/eds/detail/detail?vid=1&sid=182e32fa-13db-45bd-92f7-947b2ee060b9%40sessionmgr102&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=28749056&db=mnhorg)

Rosenberg, S. (2020). Why Ethics in Nursing Matters. Retrieved from https://www.snhu.edu/about-us/newsroom/2018/05/ethics-in-nursinghics in Nursing Matters (snhu.edu)

State of Tennessee. (2013). TDMHSAS Best Practice Guidelines: Obtaining informed consent for Children and Adults. Retrieved from Microsoft Word – CY_BPGs_FINAL_https://www.tn.gov/content/dam/tn/mentalhealth/documents/Pages_from_CY_BPGs_363-366.pdf02-25-2013.docx (tn.gov)

Triplett, K.N., Mayersohn, G.S., Pelley, W., & Desai, D.M. (2018). Adolescents With Suspected Intentional Overdose: Ethical Considerations in Determining Liver Transplant Candidacy. Clinical Practice in Pediatric Psychology. 7(2). 170-178. http://dx.doi.org/10.1037/cpp0000249. Adolescents with suspected intentional overdose: Ethical considerations in …: @ Walden University Library (waldehttps://eds-a-ebscohost-com.ezp.waldenulibrary.org/eds/pdfviewer/pdfviewer?vid=2&sid=8b13efa1-80c3-44c1-99de-bf990b1606b6%40sessionmgr4006nulibrary.org)