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Ethical and Legal Implications for Adults and Children for PMHNP Practice
Introduction
This discussion will discuss the topic of “The Informed Consent and Capacity” for Psychiatric-Mental Health Nurse Practitioner (PMHNP) practice. Informed consent can be denoted as a process that guarantees patients with the material, they need in order to get to know their treatment options, risks, benefits as well as alternatives. This process will allow them to make their own decisions without restrictions. Capacity on the other hand implies patient’s understanding and appreciation of the information presented to them along with their decision implications. With this regard, informed consent and capacity are fundamental aspects ensuring the ethical principles and legal necessities.
Ethical Considerations for Adults
Faison, M. C. (2018). Nurse’s Role Within the Informed Consent Process: A Systematic Review of the Literature (Doctoral dissertation, Walden University).
This source deliberates on the ethical considerations on informed consent and competency for adults inside psychiatric hospitals. It highlights the significance of maintaining patients’ autonomy and providing them the opportunity to make reasoned choices about their care. Therefore, the protocol also addresses the ethical challenges associated with informed consent. As per (Faison, 2018), the most crucial ethical concerns are revealed in this regard, for instance clarity in communication, respect for patients’ wishes and evaluating decision-making capability in patients with mental illness.
Ethical Considerations for Children/Adolescents
Dulcan, M. K. (Ed.). (2021). Dulcan’s textbook of child and adolescent psychiatry. American Psychiatric Pub.
This article specializes in professional aspects of ethical children’s and adolescents’ psychiatry. It raises a question of the level of informed consent for minors in this case and also shows that their capacity, developmental stage and even involvement of parents or legal guardians should be considered when making a treatment decision (Dulcan, 2021). Ethical dilemmas can occur when children oppose their parents’ suggestions or when the child doubt may be raised connected with the data understanding level.
Legal Considerations for Adults
Evans, et al. (2020). Processes of consent in research for adults with impaired mental capacity nearing the end of life: systematic review and transparent expert consultation (MORECare_Capacity statement). BMC medicine, 18, 1-55.
This next resource discusses the legal framework with regard to informed consent and capacity of psychiatric care in adults. It recounts the legal requirements, judicial decision requirements, and professional standards that underpin this process. According to (Evans, et al., 2020), the legal problems examined are the inform-consent capacity assessments, the paperwork requirements, and the possible risk of liability for the lack of consent. In Florida, the specific statutes and regulations may determine whether informed consent is done the way or the standard is followed in psychiatric practice.
Legal Considerations for Children/Adolescents
Sugiura, K., Pertega, E., & Holmberg, C. (2020). Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals. International journal of law and psychiatry, 73, 101645.
This resource goes to the legal considerations of informed consent and the capacity of children and adolescents who are receiving psychiatric care. It discusses state laws on minors’ right to freely consent to the treatment and parental consent rules. It also deals with the cases when minors are able to provide consent for themselves, for instance, in emancipation situations or when the minor is of mature age (Sugiura et al., 2020). In dealing with Florida laws regulating the mental health consent of minors, PMHNPs need to be familiar with the possibility of the legal requirements different from those for adults, thus making them navigate through complex legal architecture.
Implications for Practice
Informed Consent and Capacity
In the state of Florida, mental health nurse practitioners must be aware of the informed consent and assess capacity in order to provide the best treatment. They must abide by ethical standards as well as the legal requirement when getting permission from adult patients and children minor. PMHNPs should employ unambiguous and culture visualizing communication techniques to represent meaning and to give patients their rights of autonomy.
Differences in Care for Adults vs. Children/Adolescents
Although the elements of consent and capacity are no less important for adults and minors alike, there are distinct challenges arising from the differences in practice. PMHNPs have to consider developmental stages, parental involvement, and legislative regulations in order to get consent properly from the youth. The knowledge of the Florida law which dictates that a minor`s consent for mental health treatment is key to prevent ethical and legal challenges while providing mental health care.
References
Dulcan, M. K. (Ed.). (2021). Dulcan’s textbook of child and adolescent psychiatry. American Psychiatric Pub.
Evans, et al. (2020). Processes of consent in research for adults with impaired mental capacity nearing the end of life: systematic review and transparent expert consultation (MORECare_Capacity statement). BMC medicine, 18, 1-55.
Faison, M. C. (2018). Nurse’s Role Within the Informed Consent Process: A Systematic Review of the Literature (Doctoral dissertation, Walden
Hang. (. Restraint
The medical industry is not without perils for healthcare professionals. In the pursuit to provide aid to those in need of help, these same individuals may become agitated and aggressive. Patient aggression can occur in any healthcare setting; therefore, practitioners must be prepared to lower the risk of injury to patients and healthcare personnel. Restraint should only be used as a last resort as these may have severe detrimental effects on patients. The four core ethical precepts of healthcare – beneficence, non-maleficence, justice, and autonomy – must be upheld by healthcare professionals. Healthcare providers must ensure that the application of restraint is limited to dire situations and upholds the values of nonmaleficence, doing no harm, and beneficence, doing good (Parkes & Tadi, 2022).
Legal and Ethical Implications for Adults
Within the context of mental health care, restraint is the act of limiting a patient’s range of motion in order to keep them from hurting themselves or others. As a result, restraint is only utilized as a last-ditch effort when it is deemed essential to protect the patients and other individuals. Goals of restraint are to “control” and “protect.” As previously noted, restraint is intended to safeguard both the patients and other people. However, it also inevitably turns into a means of limiting patients’ free will, thus infringing upon their fundamental human rights (Oh, 2021).
Mental health practitioners have a duty to do more than merely apply restraint in accordance with the law. As advocates and moral agents, mental health practitioners should treat patients as humans, fostering both mental and physical health prior to as well as following the judgment to exercise restraint. They should also take ethical concerns about restraint into consideration. More specifically, patients with unclear boundaries resulting from mental illness must have their personhood protected in order to safeguard and advance their human rights to the greatest extent feasible (Oh, 2021).
Individuals undergoing restraint are sentient individuals with distinct personalities. One of the fundamental principles of human rights is respect; personality is deemed to have the most significant moral standing; and a choice is not morally justified if it violates the free will of the individual. Restraint, as perceived by the patients, is an experience of having their autonomy over their body taken away from them. As a result, they are left vulnerable and forced to make decisions based on the opinions of others (Oh, 2021).
As is the same is true for all medical interventions, including restraint: informed consent must always be acquired. Only in dire circumstances may it be waived. This consent needs to be provided by the individual or, in the even of an incapacity, by the legal guardian. Should this not be the case, the individual’s most significant benefit must be taken into consideration while making a decision. Since the process of restraint limits the patient’s freedom, it is morally wrong to immobilize someone without their agreement (Cortinhal, Correia, & Fernandes, 2024).
Legal and Ethical Implications for Children
Obligations are broken when mentally ill children are restrained without receiving the necessary support and care to address the behavioral hazards associated with psychosocial disorders. The use of restraints on children is made more complicated by the fact that, similar to other pediatric mental health interactions, the decision-making process for the use of restraints should involve collaboration from healthcare personnel, parents, and children. Even though healthcare personnel must obtain the approval of parents and the assent of the child before using restraints, the sudden urgency and imperative components imposed on restraint activities defy a child’s will and exclude parents from engaging on an equal footing with healthcare personnel (Pertega & Holmberg, 2023).
It is worthwhile to carefully examine the moral basis for the application of restraint. The harm principle justifies interference with a person’s freedom and autonomy, regardless of age. Healthcare providers and parents must determine whether restraint is necessary for children who are considered too young or developmentally delayed to make decisions about what is best for them. If an older child is being restrained, it is necessary to do a thorough evaluation of the child’s mental state and consciousness in order to justify the use of restraint because what constitutes a serious threat is ambiguous.
There are numerous core tenets that serve as restraint guidelines. First and foremost, restraint must be necessary for the patient’s immediate safety, health care, and welfare. It is rarely acceptable to employ mechanical restraint on minors, and handcuffs specifically ought to never be utilized. It is always important to prioritize the patient’s safety and dignity by using a less harsh method when possible. Verbal de-escalation and giving the patient time to calm down should also be considered. Secondly, any other less restrictive possibilities ought to be taken into account and should only be rejected for strong clinical justifications. Third, practices ought to adhere to the most recent recommendations and be founded on reliable clinical protocols and principles. Lastly, there must be clear procedures for the governance of hazards such as aspiration, pressure injuries, psychological harm, and airway obstruction. As soon as it is clinically practicable, restraint should be reduced, scaled back, or eliminated for both safety and dignity’s safe. Maintaining the right of young people to be free from undue injury by caregivers, including well-meaning ones, is imperative to show respect for those who have needed boundaries placed on their personal freedom (Preisz & Preisz, 2019).
Implications for Practice
As mentioned above, informed constraint for the use of restraint must always be obtained (Cortinhal et al., 2024. Medical professionals face potential legal consequences related to false imprisonment, batter, and obligation to do no harm when they opt to treat a patient involuntarily, as is the case for most patient restraints. Because of this, medical professionals need to ensure that their choice to use restraint is well-reasoned and supported by documentation (Parkes & Tadi, 2022).
References
Cortinhal, V. S. J., Correia, A. S. C., & Fernandes, S. J. D. (2024). Nursing ethical decision making on adult physical restraint: A scoping review. International Journal of Environmental Research and Public Health, 21(1), 10078. doi: 10.3390/ijerph21010075
Oh, Y. (2021). A new perspective on human rights in the use of physical restraints on psychiatric patients – Based on Merleau-Ponty’s phenomenology of the body. International Journal of Environmental Research and Public Health, 18(19), 10078. doi: 10.3390/ijerph181910078
Parkes, D., & Tadi, P. (2022). Patient restraint and seclusion. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK565873/
Pertega, E., & Holmberg, C. (2023). A systematic mapping review identifying key features of restraint research in inpatient pediatric psychiatry: A human rights perspective. International Journal of Law and Psychiatry, 88, 101894. https://doi.org/10.016/ijlp.2023.101894
