Beauchamp & Childress (2009: 103) after Kant. Ethical issues in mental health care Nurses working in the care for psychiatric patients daily face dilemma’s concerning respect for autonomy versus paternalistic behavior. Every decision that a nurse makes concerning the care of a patient needs to be considered from an ethical base. Thus, for example, the lifetime prevalence of schizophrenia, the most severe and enduring of mental … From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation. Although a person, under part four Mental Health Act (GB 2007) can be treated for mental disorder without their consent, it is important to note that a physical problem can only be treated without consent should the person lacks capacity and treatment is deemed to be in their best interests under the auspice of the Mental Capacity Act (GB 2007, MIND 2009). Finally, for mental healthcare facilities, it is essential to establish an ethics committee to address these issues. Disclaimer: This work has been submitted by a university student. A comprehensive understanding of current legal and ethical frameworks facilitates … Mental … Evidence-based information on legal and ethical practice in mental health nursing from hundreds of trustworthy sources for health and social care. Because one of the most ethically confronting issues in mental health care is the coercive treatment 2 of persons admitted as involuntary or non-voluntary patients to a psychiatric facility or program, particular attention will also be given to the issues of informed consent and competency to decide, and ongoing proposals to develop … These beneficial actions fall under the heading of beneficence. To answer the question we need to examine how the dilemma sits within an ethical theory and the principles that apply. This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions and actions. Mental health nursing is a field that is very complex and difficult to handle since it involves patients with different psychiatric illnesses, and the related ethical and legal issues are also important. Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). This would not only encourage a supportive nurse-patient relationship but also provides care that is holistic, develops Anita’s confidence in being able to negotiate her care and allows her to take greater personal responsibility, thus instilling empowerment and hope, all of which improve the potential for recovery. Ethical and Legal Issues for Mental Health Professionals: A Comprehensive Handbook of Principles and Standards Edited by Steven F. Bucky, PhD, Joanne E. Callan, PhD, and George Stricker, PhD. Study for free with our range of nursing lectures! Contributors consider what caregivers’ responses to patients’ mental health needs and patients’ perceptions of their own mental illness express about the values of our health … Search results Jump to search results. If the nurse’s obligation to act beneficently is informed by the patient’s choices and preferences, then the respect for the patient’s autonomy will ultimately override any paternalistic actions on the part of the nurse (Beauchamp & Childress 2009). Marguerite Reid Schneider . Do you have a 2:1 degree or higher? A large proportion of moral and ethical dilemmas that are faced by nurses stem from the conflicting principles of autonomy and beneficence. taymaida. Psychiatric Mental Health Nursing (NSG323) Academic year. PDF Altmetric Psychiatry is a critical yet often neglected area of medicine. As she felt that the pressure of being constantly watched would unsettle her further, thus not allowing her to manage her own feelings it was initially agreed to place Anita on intermittent observation as opposed to constant within the policy on self harm produced by the service that was caring for her (Oxford Health DATE). Ethical Issues in Mental Health Nursing. Addiction - Test 2A 40 terms. If this is not the case then the person cannot be seen as lacking capacity under the Act (GB 2005, DoCA 2007). In encouraging autonomy for Anita involves taking risks on the part of the nurses’ which may go against their principles of nonmaleficence and beneficence. Staff explained to Anita that the wound was deep enough to require stitching although not life threatening and advised her that she would need to attend the minor injuries unit of the local general hospital for assessment of the wound. Beneficence could be interpreted to incorporate the patient’s autonomous choice as “the best interests of the patient are intimately linked with their preferences … [from which]ââ¬Â¦ “are derived our primary duties towards them” (Beauchamp & Childress 2009:207). Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). Respect for autonomy flows from the recognition that all persons have unconditional worth, each having the capacity to determine his or her own moral destiny. To violate a person’s autonomy is to treat that person merely as a means: that is, in accordance with others’ goals without regard to the persons own goals. As the wound was neither life threatening or of such a degree that it could not be safety managed upon the ward enabled the staff to consider the possibility of enabling Anita to make an autonomous choice. The practice of paternalism is now generally discouraged in health care (Butts & Rich 2008) and is considered unjustifiable in cases where the patient has capacity to make a decision (Edwards 2009, Beauchamp & Childress 2009). When nurses experience the ethical dilemma of having to enforce treatment irrespective of a patient’s right to autonomy, they can be seen as working in a paternalistic manner (Butts & Rich 2008). The main legal and ethical dilemmas that can be extracted from this case study are whether the Anita’s capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. An involuntary commitment to care, or a decision made by a family member on behalf of the patient, is often made to protect the patient from harming herself or others. The findings suggest that mental health nurses face ethical challenges in administering LAI. Copyright © 2003 - 2020 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. To violate a person’s autonomy is to treat that person merely as a means: that is, in accordance with others’ goals without regard to the persons own goals. Every patient has… Addiction 7 16 terms. Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. 433 pp. Various factors related to Ethical Issues in Mental Health which needs to be considered such as lack of appropriate information related to forensic patient as well as mental illness, confidentiality and disclosures, and others. However this may not feel entirely comfortable for the nurse. Anita presented with a laceration to the inside of her thigh which was deep enough to expose the adipose tissue beneath, however was not deemed by the medical staff to be life threatening. 20 Downloads; Abstract . However, although the actions on behalf of nurses is clearly driven by obligations towards beneficence, nurses need to weigh up the harms and benefits of enforcing treatment before acting in such a way as to produce the best outcome for Anita (Edwards 2009). Ethical and Legal Issues in Nursing Nur391 January 14, 2010 Ethical and Legal Issues in Nursing The American Nurse’s Association’s code of ethics provides guidelines to help nurses make ethical decisions with the patient’s needs as the main focus of concern. amanduhmo . Anita presented with a laceration to the inside of her thigh which was deep enough to expose the adipose tissue beneath, however was not deemed by the medical staff to be life threatening. Anita initially made her decision to refuse treatment shortly after self-harming. This may indicate that Anita was under a great deal of distress at the time, which could have affected her capacity to make sound decisions; however her later decision of continuing to refuse treatment was based on her own morals and values towards her body that may have included these thoughts of self-loathing and the need to be punished. Topic # 2 Legal and Ethical Issues in Mental Health Nursing. Ethics can be seen as the study of human conduct and morality (Buka 2008). The decision to manage the wound on the ward and allow Anita time to calm and consider her options is, in the author’s opinion, the correct course of action to take. Looking for a flexible role? 2016;18(6):567-571. doi: 10.1001/journalofethics.2016.18.6.fred1-1606. Staff explained to Anita that the wound was deep enough to require stitching although not life threatening and advised her that she would need to attend the minor injuries unit of the local general hospital for assessment of the wound. Chapter 4: Ethical and Legal Issues Practice Questions 19 terms. Which raises the principle of Nonmaleficence (doing no harm), in this instance to the therapeutic relationship, wellbeing and care of Anita. You can view samples of our professional work here. It is about people reasoning, thinking and applying a process of reflection (Adshead 2010); however these people may have opposing views, values and experiences on which to base their moral judgements to define what is the right and wrong course of action (Hendrick 2009) and the principles used to decide this, not only by the individual but also within social groups and societies. Lakeman (2009) points out that an ethical dilemma occurs when there are a multitude of alternative courses of action to deal with a particular situation. Should the decision to treat Anita for her self harm regardless of her wishes have gone ahead, there may have been a risk of impacting on the nurse-patient therapeutic relationship. Upon completion of the assessment it was decided that Anita did have capacity to make decisions surrounding treatment at that time, within the framework of the Mental Capacity Act (GB 2005). From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. The NMC Code of Professional Conduct is clear in stating that nurses have an obligation to both protect and promote the “health and wellbeing” of patients as their primary consideration (NMC 2008:2) and this is no different for mental health nurses working with patients who self-harm. Ann Gallagher is a reader in nursing ethics, director of the International Centre for Nursing Ethics, University of Surrey, and editor of Nursing Ethics. 2017/2018 VAT Registration No: 842417633. 11th Feb 2020 It may be that Anita is already feeling a loss of autonomy or disempowerment by the very nature of being a patient upon a secure ward and being under the Mental Health Act (GB 2007) and the restriction of her basic autonomous decisions such as when to eat, sleep or who she resides with. The main legal and ethical dilemmas that can be extracted from this case study are whether the Anita’s capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s … In encouraging autonomy for Anita involves taking risks on the part of the nurses’ which may go against their principles of Nonmaleficence and beneficence. In Anita’s case, the nurses worry that the consequences of the wound becoming infected is driving their desire to treat the wound irrespective of Anita’s wishes. Anita is a young woman with a primary diagnosis of emotionally unstable personality disorder borderline type as defined by the World Health Organisation (WHO 2010). This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions. Ethical and legal dilemmas arise when the health care provider and the patient, or the patient’s family, have differing opinions on appropriate care. The different stakeholders are confronted with the following dilemmas: community care versus … This chapter explores mental health nursing practice within an ethics context. This collaborative approach allowed Anita opportunities to explore her emotions, thoughts and feelings and promote her autonomy whilst still allowing her to decide to have the wound sutured should she change her mind. Company Registration No: 4964706. All actions that are performed by nurses can be regarded as having a moral dimension, most of which are for the benefit of the patient (Edwards 2009). Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of NursingAnswers.net. To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. The practice of paternalism is now generally discouraged in health care (Butts & Rich) and is considered unjustifiable in cases where the patient has capacity to make a decision (Edwards 2009, Beauchamp & Childress 2009). The findings raise much needed awareness of the need for mental health nurses and nurse educators to consider the ethical issues experienced while performing the procedure. Mental health professionals must also respect patients' rights to informed consent and understand the issues of voluntary or involuntary admissions. Copyright © 2003 - 2020 - UKEssays is a trading name of All Answers Ltd, a company registered in England and Wales. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance. In order to address the moral theory and moral principles that underpin the ethics of mental health nursing, I intend to demonstrate how clinical decision making mental health nursing is formulated based on the chosen moral principles of beneficence, non-maleficence and ‘respect for autonomy’ (NHS, 2015). We're here to answer any questions you have about our services. This relationship is built upon trust as well as purposeful and effective communication (Buka 2008) and is considered to be the cornerstone of nursing care (Lakeman 2009, Pryjmachuk 2011).Therefore the nurses would need to consider future risk as part of the ethical decision making process. Firstly the practitioner needs to ascertain whether the person being assessed has some sort of disturbance of the mind and, if such a disturbance exists then it “must affect their ability to make decisions when they need to” (Department of Constitutional Affairs (DoCA) 2007:45). In accordance with this the name of the patient has been changed and permission has been sought from the patient to use them in the case study (Appendix 1). In considering whether Anita needed to make the decision around treatment, we can see that, as the wound was not life threatening, it was decided to allow her time to settle and re-approach the question of treatment. This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. Lurch et al (2010) cites Florence nightingales (1859) nursing notes, where she discusses ethical duties of confidentiality, communication, and the centrality of meeting patients’ needs, this reflects the same moral and ethical issues nursing professionals face today. This is not an example of the work produced by our Essay Writing Service. mtburns89. Although mental health and substance use disorders are the leading cause of disability worldwide [1], World Health … The conflicting principles of autonomy and beneficence that have been presented within this case study would both be ethically and morally correct courses of action to take. Company Registration No: 4964706. When nurses experience the ethical dilemma of having to enforce treatment irrespective of a patient’s right to autonomy, they can be seen as working in a paternalistic manner (Butts & Rich 2008). The dilemmas are derived from a discussion of the results of a qualitative research project that took place in five countries of the European Union. Firstly the practitioner needs to ascertain whether the person being assessed has some sort of disturbance of the mind and, if such a disturbance exists then it “must affect their ability to make decisions when they need to” (Department of Constitutional Affairs (DoCA) 2007:45). Before a medical procedure takes place, it is the nurse’s responsibility to obtain informed consent. A phenomenological research method guided by Max van Manen's human science approach describes and interprets the ethical … These are used to help unravel ethical issues relating to patient autonomy. The main legal and ethical dilemmas that can be extracted from this case study are whether the Anita’s capacity to make decisions about her treatment should be overridden by use of the Mental Capacity Act (GB 2005) and whether Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. A registered nurse experienced in psychiatric nursing should know all the legal rights and responsibilities of a psychiatric nurse, the legal and ethical issues … The legal issue includes the outcome of insanity, psychiatrist appearing in the court, absconding behavior among patients with mental … Reference this. awareness of your own values – is the true basis of the best nursing care under conditions of uncertainty. It will explore how ethical decisions are reached and how they can directly influence patient care. The Nursing and Midwifery Council (NMC 2008) stipulates that nurses must respect a patients right to confidentiality at all times and ensure that the patient is informed about how information concerning them is shared. Some ethical dilemmas are specific to mental health nursing and are seen rarely in other areas of practice 2. The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. As the wound could be safely managed in the short term upon the ward the decision to allow Anita time to weigh up the information was the correct one to make. Beauchamp & Childress (2009: 103) after Kant. Enforcing treatment on Anita may produce barriers to the therapeutic relationship such as difficulties in trusting the nurse in the future, disengagement from therapeutic communication, opposition and rejection of future treatment, increased self harming behaviours due to the trauma and hostility towards others (Kettles et al 2007, Byrt 2010), all of which may stop Anita from telling the nursing team when she self-harms in future episodes of distress. Do you have a 2:1 degree or higher in nursing or healthcare? Ethical and Legal Issues in Psychiatric/Mental Health Nursing Chapter 26 In mental health nursing, autonomy is sometimes overridden in the interests of promoting the principle of beneficence (Lakeman 2009). As the wound was neither life threatening or of such a degree that it could not be safety managed upon the ward enabled the staff to consider the possibility of allowing Anita to make an autonomous choice. 1st Jan 1970 Later in the shift Anita approached staff and stated that she had overwhelming urges to self-harm and that she had acted upon them. Questions arise about the use of coercion, e.g., when a patient doesn’t want to take his medicine, refuses treatment or suffers from delusions. Nursing University. 2204 Ethical and Legal Issues in Psychiatric/Mental Health Nursing 28 terms. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance. She was taken to the clinic room where the wound could be cleaned and assessed. Following a wider team discussion around whether Anita understood the severity of the wound, thus having capacity to make a decision to refuse treatment, the Responsible Clinician (RC) spoke to Anita and attempted to persuade her to have the wound sutured. Which can make the nurses ethical dilemma difficult to manage due to balancing the two valid ethical principles of autonomy (respecting and supporting decisions making) and beneficence (relieving or minimising harm in the best interest of the patient) (Hendrick 2004, Beauchamp & Childress 2009). When Anita had calmed the nurse had a discussion surrounding the implications of not having the wound sutured such as infection, Anita’s possible need to attack the wound in the future and pain relief issues, However Anita maintained her decision not to have the wound sutured. In intellectual disability services, nurses face difficult decisions in caring for clients when managing challenging behaviour. All work is written to order. 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