Older Adults Legal & Ethical Basis for Practice

Settings for Psychiatric Care

Chapters 25, 26, 27

Increased proportion of older adults has altered the socioeconomic condition in America & transformed health care

By 2030, 23% US pop, will be > 65 yrs age Ageism: bias against individual due to age Assessment and communication strategies

Geropsychiatric nurses work with older adults and are knowledgeable about meds, normal aging and chronic disease

Elderspeak Adults speaking to elders as though they are children

Chapter 25: Older adults

Psychiatric disorders in older adults

Older adults with mental disorders are inappropriately diagnosed and receive inadequate treatment

Depression; most common disorder in >65 yrs Antidepressant therapy: emphasis is on avoidance side effects

rather than efficacy Psychotherapy: individual or group therapy

Suicide: highest of any age group Assessment for suicide risk Right to die

Alcoholism and substance abuse AIDS and AIDS related dementia

Use of Restraints: ethical, legal & safety concern Physical restraints: manual methods or mechanical devices Chemical restraints: drugs to inhibit behavior or movement

Omnibus Budget Reconciliation Act (OBRA) Declares each nursing home pt has the right to be free from

unnecessary drugs or physical restraints Control of Decision Making Process

Patient Self Determination Act Advance Directive/ Living Will Directive to Physician Durable Power of Attorney for Health Care Nursing Role in Decision Making Process

Legal and ethical issues affecting the older adult

Chapter 26: Legal and ethical basis for practice Ethical dilemma: results when there is a conflict between 2 or

more courses of action both favorable and unfavorable outcomes

Legal and Ethical Concepts Ethics: study of philosophical beliefs about what is right and wrong in

society Bioethics: ethical questions arise in healthcare, 5 basic principles

Beneficence Autonomy Justice Fidelity Veracity

Mental Health Laws Civil rights: pts with mental illness have same rights

Due process in civil commitment Admission to hospital

Voluntary admission Involuntary admission

3 different commitment procedures: judicial determination, administrative determination and agency determination

Emergency involuntary hospitalization Observational involuntary hospitalization Long term commitment Involuntary outpatient commitment

Discharge from hospital Conditional release Unconditional release AMA

Admissions and discharge procedures

Right to treatment Right to refuse treatment Right to informed consent Rights surrounding involuntary commitment & psychiatric advance

directives Rights regarding restraint and seclusion Patient Confidentiality

Ethical Considerations Legal Considerations: HIPPA

Patients employers Rights after death Patient Privilege and HIV Exceptions to Rule Child and Elder abuse reporting statutes

Patients rights under the law

Torts are category of civil law applies to health care

Tort is civil wrong for which money damages may be collected by injured party from the wrongdoer Common Liability Issues

Protection of patients -#1 priority Violence Negligence/malpractice: act or omission of act that

breaches the duty of care and results in or is responsible for persons injuries

Tort law applied to psychiatric settings

Standards of care established by ANA Guidelines for Nurses who suspect negligence Duty to report and intervene Unethical and Illegal practices Documentation of care

Purpose of medical records Facility use of medical records Medical records as evidence Nursing guidelines for computerized charting

Forensic Nursing

Determination of standard of care

Chapter 27: Settings for psychiatric care 46% of population will be diagnosed with mental

health disorder over lifetime 80% will seek treatment but the delay can take

years Current treatment includes inpatient and

outpatient Outpatient Care; PCPs are 1st choice, psychiatric

care, CMHC, psych home care, IOP’s PHP Inpatient Care; 24 hr nursing care in safe setting Therapeutic milieu- positive holistic setting

Treatment settings

State Acute Care General Hosp & Private Psych Acute Care Pediatric Psych Care Geriatric Psych Care VA Forensic Psych Care Alcohol and Drug Abuse Treatment Self-help Options Mental Health Parity Law (1996); illegal to limit annual or

lifetime mental health benefits unless they do so for medical care

Thank you!