Mental health professionals must also respect patients' rights to informed consent and understand the issues of voluntary or involuntary admissions. As Anita was still refusing to have the wound sutured the RC decided that an assessment would need to be carried out to ascertain whether Anita had the capacity to decide to refuse treatment. Beauchamp and Childress (2009) devised four basic moral principles which function as guidelines for professional ethical decision making. In encouraging autonomy for Anita involves taking risks on the part of the nurses’ which may go against their principles of Nonmaleficence and beneficence. taymaida. Copyright © 2003 - 2020 - UKEssays is a trading name of All Answers Ltd, a company registered in England and Wales. What legal Dilemma can be hypothesised as underpinning the decision making process of the mental health professionals in this case? PDF | On Mar 1, 2019, Rajshekhar Bipeta published Legal and Ethical Aspects of Mental Health Care | Find, read and cite all the research you need on ResearchGate 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. Beauchamp & Childress (2009: 103) after Kant. Ethical and Legal Issues in Psychiatric/Mental Health Nursing Chapter 26 Finally, for mental healthcare facilities, it is essential to establish an ethics committee to address these issues. A phenomenological research method guided by Max van Manen's human science approach describes and interprets the ethical … From simple essay plans, through to full dissertations, you can guarantee we have a service perfectly matched to your needs. 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). Self-harm has been strongly associated with borderline personality disorder (Motz 2008) where thoughts of self-loathing and self-punishment are common precipitators; the act of self harm can be seen as a symptom of internal turmoil, an expression of internal pain or as controlling factor to maintain a level of care (Grocutt 2009). A paternalistic approach is frequently used to infringe upon a person’s right to autonomy. A registered nurse experienced in psychiatric nursing should know all the legal rights and responsibilities of a psychiatric nurse, the legal and ethical issues … 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). Thus, for example, the lifetime prevalence of schizophrenia, the most severe and enduring of mental … Do you have a 2:1 degree or higher in nursing or healthcare? 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). taymaida. This month's issue explores critical social, cultural, and ethical dimensions of mental illness. 433 pp. 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. 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). The ethical issues experienced by mental health nurses in administering antipsychotic depot and long‐acting intramuscular injections (LAI) were explored in the present study. To achieve this aim the author will examine a case study of a patient whose care he was involved with whilst in placement. 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. 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). All work is written to order. 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. The nursing regulatory body, the Nursing and Midwifery Council requires all registered nurses to have an understanding of the ethical and legal principles which underpin all aspects of nursing practice(NMC,2010). 2016;18(6):567-571. doi: 10.1001/journalofethics.2016.18.6.fred1-1606. 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. 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. (Adshead 2010). 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. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance. 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. Topic # 2 Legal and Ethical Issues in Mental Health Nursing. To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. Filter Toggle filter panel Evidence type Remove filter for Guidance and Policy (264) Remove filter for Guidance (184) … During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. Addiction 6 37 terms. In deciding that the decision could be made at a later time not only complies with the Act but also promotes Anita’s autonomy. Binghamton, NY: The Haworth Maltreatment and Trauma Press, 2005. 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. Topic # 2 Legal and Ethical Issues in Mental Health Nursing. Do you have a 2:1 degree or higher? The findings suggest that mental health nurses face ethical challenges in administering LAI. Although mental health and substance use disorders are the leading cause of disability worldwide [1], World Health … Although this appeared to be an unwise decision, which felt uncomfortable to the team, it was agreed to monitor the wound, keep it clean and dry and continue to talk to Anita about her thoughts and feelings surrounding getting medical treatment for the wound. To help determine whether Anita has capacity, The Mental Capacity Act (2005) sets out a two stage functional approach. From this we can surmise that ethics is a complex system of reflective thinking, which is used in the search for a standard that can be used to judge your own actions, or the actions of others, within your own moral code. 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. 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). 2204 Ethical and Legal Issues in Psychiatric/Mental Health Nursing 28 terms. 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. 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. Mental … Registered Data Controller No: Z1821391. 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. We've received widespread press coverage since 2003, Your UKEssays purchase is secure and we're rated 4.4/5 on reviews.co.uk. It teases out the ethical challenges that mental health nurses can face on a daily basis. Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of UKEssays.com. Clinical and Social Contexts of Ethical Issues in Mental Health Care. Later in the shift Anita approached staff and stated that she had overwhelming urges to self-harm and that she had acted upon them. 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. Learn legal ethical issues mental health with free interactive flashcards. Some ethical dilemmas are specific to mental health nursing and are seen rarely in other areas of practice 2. 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. We're here to answer any questions you have about our services. amanduhmo . 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]… “are derived our primary duties towards them” (Beauchamp & Childress 2009:207). Choose from 500 different sets of legal ethical issues mental health flashcards on Quizlet. Autonomy is “the freedom and ability to act in a self determined manner” (Butts & Rich 2008: 42) and the right of a rational person to achieve personal decisions without any outside interference. 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. Conflicting moral principles may create difficult ethical dilemmas for nurses by having to contravene one moral obligation to uphold another (Beauchamp & Childress 2009). The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. These are used to help unravel ethical issues relating to patient autonomy. Free resources to assist you with your nursing studies! However, the nurse’s ability to critically appraise risks and benefits will help them to make decisions that are beneficial to the patient involved. 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. A large proportion of moral and ethical dilemmas that are faced by nurses stem from the conflicting principles of autonomy and beneficence. These beneficial actions fall under the heading of beneficence. Beauchamp and Childress (2009) devised four basic moral principles which function as guidelines for professional ethical decision making. 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). Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare… and …[is therefore]… a moral obligation to act for the benefit of others. 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 scope of the policy on safe and supportive observations of the service that was caring for her (Oxford Health 2010). Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). taymaida. A short case-study highlights potential solutions to those challenges. 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. *You can also browse our support articles here >. 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. Georges and Gryphon (2002) state that nurses often fail … We've received widespread press coverage since 2003, Your NursingAnswers.net purchase is secure and we're rated 4.4/5 on reviews.co.uk. From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation. The Mental Capacity Act (GB 2005) is clear in expressing that capacity is time and decision specific. Anita’s ability to make autonomous decisions surrounding her care should outweigh the nurse’s obligation towards beneficence. Beneficence can be seen as actions to benefit and promote the welfare of others (Butts & Rich 2008). This is not an example of the work produced by our Essay Writing Service. This statement clearly incorporates the principle of beneficence and shows that the nurses in the case study are considering whether Anita should have medical treatment for the wound enforced upon her due to the principle of beneficence as described due to the worries of the wound becoming infected if not sutured. taymaida. This decision was reached due to Anita being able to understand the information being given to her, being able to retain the information and weigh it up to make a decision to refuse treatment. If this is not the case then the person cannot be seen as lacking capacity under the Act (GB 2005, DoCA 2007). A comprehensive understanding of current legal and ethical frameworks facilitates … VAT Registration No: 842417633. 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. This raises the principle of Nonmaleficence (doing no harm), in this instance to the therapeutic relationship, wellbeing and care of Anita. 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. 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. There is a need for nurse education providers and organizations to provide opportunities for mental health nurses … These beneficial actions fall under the heading of beneficence. Although this appeared to be an unwise decision, which felt uncomfortable to the team, it was agreed to monitor the wound, keep it clean and dry and continue to talk to Anita about her thoughts and feelings surrounding getting medical treatment for the wound. 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). 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). In intellectual disability services, nurses face difficult decisions in caring for clients when managing challenging behaviour. 11th Feb 2020 Psychiatric Mental Health Nursing (NSG323) Academic year. She was taken to the clinic room where the wound could be cleaned and assessed. 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, This in turn will promote empowerment and hope which will improve the potential for recovery and discourage overly oppressive practices. 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). 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). The patient might contest this decision. 20 Downloads; Abstract . 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 answer the question we need to examine how the dilemma sits within an ethical theory and the principles that apply. This statement clearly incorporates the principle of beneficence and shows that the nurses in the case study are considering whether Anita should have medical treatment for the wound enforced upon her due to the principle of beneficence as described due to the worries of the wound becoming infected if not sutured. 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. Disclaimer: This work has been submitted by a student. She was taken to the clinic room where the wound could be cleaned and assessed. As such the therapeutic session concentrated on exploring her feelings surrounding her impulses, alternative coping mechanisms to manage her thoughts of self-harm and strategies to help maintain her safety upon the ward. To achieve this aim the author will examine a case study of a patient whose care he was involved with whilst in placement. Our academic experts are ready and waiting to assist with any writing project you may have. Therefore the principle of respecting autonomy concerns the nurse’s acknowledgement of, and obligation in respecting, Anita’s decision over her own life. This is not an example of the work produced by our Nursing Essay Writing Service. Disclaimer: This work has been submitted by a university student. As such the therapeutic session concentrated on exploring her feelings surrounding her impulses, alternative coping mechanisms to manage her thoughts of self-harm and strategies to help maintain her safety upon the ward. Authors; Authors and affiliations; Kevin Gournay; Chapter. The emphasis of contemporary mental health nursing practice is to be evidence-based and to be ethical, which includes abiding by the nursing profession’s ethical rules (Smith 2012; NMC 2015). Ann Gallagher is a reader in nursing ethics, director of the International Centre for Nursing Ethics, University of Surrey, and editor of Nursing Ethics. Morality requires not only that we treat persons autonomously and refrain from harming them, but also that we contribute to their welfare… and …[is therefore]… a moral obligation to act for the benefit of others. Copyright © 2003 - 2020 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. You can view samples of our professional work here. 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. If this is not the case then the person cannot be seen as lacking capacity under the Act (GB 2005, DoCA 2007). University. 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). The principles of autonomy (freedom to act on your own belief), Nonmaleficence (obligation to avoid doing harm), Beneficence (providing benefits and help) and Justice (fair distribution of benefits, risk and cost) which are derived from a duty based theory of Emmanuel Kant (1724-1804) (Beauchamp & Childress 2009). (Adshead 2010). 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. 129 - Ch. 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). 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. Mental health nurses face ethically‐difficult situations when administering these medications. Search results Jump to search results. 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. ShadeRN. 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. Study for free with our range of university lectures! From this we can surmise that a morally correct course of action may involve two opposing principles being applicable in any one situation. 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. Company Registration No: 4964706. 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 … However this may not feel entirely comfortable for the nurse. 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. The legal issue includes the outcome of insanity, psychiatrist appearing in the court, absconding behavior among patients with mental … 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. Tort Law Applied toPsychiatric Settings• Protection of patients: legal issues common inpsychiatric nursing are related to failure toprotect safety of patients• Protection of self– Nurses must protect themselves in bothinstitutional and community settings– Important for nurses to participate in settingpolicies that … Which raises the principle of Nonmaleficence (doing no harm), in this instance to the therapeutic relationship, wellbeing and care of Anita. 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 … Ethical dilemmas in community mental health care is the focus of this article. 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. From this we can surmise that ethics is a complex system of reflective thinking, which is used in the search for a standard that can be used to judge your own actions, or the actions of others, within your own moral code. We're here to answer any questions you have about our services. 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. mtburns89. 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). 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. This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. Chapter 4: Ethical and Legal Issues Practice Questions 19 terms. 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. 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. 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 … That does not mean that interventions which confine and conform do not take place or that some treatments are not controversial, such … Reference this. To its credit, this new edition of Fundamental Aspects of Legal, Professional and Ethical Issues in Nursing offers many practical signposts to good practice, but does not claim these are always ‘the answer’. Autonomy is “the freedom and ability to act in a self determined manner” (Butts & Rich 2008: 42) and the right of a rational person to achieve personal decisions without any outside interference. Every decision that a nurse makes concerning the care of a patient needs to be considered from an ethical base. $59.95 hard cover; $39.95 soft … 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. During a one-to-one therapeutic session Anita disclosed that she was having strong urges to self-harm. Taken as a whole, … Are large proportion of moral and ethical dilemmas that are faced by nurses stem from the conflicting principles of autonomy and beneficence. In deciding that the decision could be made at a later time not only complies with the Act but also promotes Anita’s autonomy. No plagiarism, guaranteed! To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the UKDiss.com website then please: Our academic writing and marking services can help you! Ethics can be seen as the study of human conduct and morality (Buka 2008). Later in the shift Anita approached staff and stated that she had overwhelming urges to self-harm and that she had acted upon them. However with collaborative working practices this case study has shown that solutions can be found in even the most complicated of nursing dilemmas. This approach was agreed in collaboration with Anita and the wider team as a way of her taking responsibility for her own decisions. Study for free with our range of nursing lectures! Grand Canyon University. Although a person, under part four of the 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 or treatment is deemed to be in their best interests under the auspice of the Mental Capacity Act (GB 2007, MIND 2009). In considering Anita’s wishes and agreeing a management plan to care for the wound incorporates both principles of Anita’s autonomy and the nurse’s obligation towards beneficence. Citation. 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. Then there are three stories describing everyday interactions in an acute psychiatric unit. 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). PDF Altmetric Psychiatry is a critical yet often neglected area of medicine. 1st Jan 1970 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). Therefore the principle of respecting autonomy concerns the nurse’s acknowledgement of, and obligation in respecting, Anita’s decision over her own life. 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. In the case where Marianne, a 79-year-old woman … 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. In considering Anita’s wishes and agreeing a management plan to care for the wound incorporates both principles of Anita’s autonomy and the nurse’s obligation towards beneficence. We will look at how, after an episode of self-harm, the patient refused any medical treatment for the wound and how this posed an ethical dilemma for the nursing staff involved in their care. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. To answer the question we need to examine how the dilemma sits within an ethical theory and the principles that apply. The protection and safety of the service user is of utmost importance and includes: legal considerations regarding professional duty of care and consent; political matters of advocacy and power; human rights; and ethical … Anita initially made her decision to refuse treatment shortly after self-harming. 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. 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. What legal dilemma can be hypothesised as underpinning the decision making process of the mental health professionals in this case? In 2013, the cost for treating mental illness in the US topped the list for all medical conditions. 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 … 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]… “are derived our primary duties towards them” (Beauchamp & Childress 2009:207). You can view samples of our professional work here. Any decision made from this ethical viewpoint has a higher probability of producing the best outcome under any given circumstance. Every patient has… 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). Nursing 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). 2017/2018 A paternalistic approach is frequently used to infringe upon a person’s right to autonomy. We will look at how, after an episode of self-harm, the patient refused any medical treatment for the wound and how this posed an ethical dilemma for the nursing staff involved in their care. Course. 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. The nurses on duty cleaned and bandaged the wound and allowed Anita time to consider the implications of her decision further. *You can also browse our support articles here >. Ethical Issues in Mental Health Nursing. Addiction - Test 2A 40 terms. Every decision that a nurse makes concerning the care of a patient needs to be considered from an ethical base. As Anita was still refusing to have the wound sutured the RC decided that an assessment would need to be carried out to ascertain whether Anita had the capacity to decide to refuse treatment. 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. 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. 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. All work is written to order. 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. This chapter explores mental health nursing practice within an ethics context. VAT Registration No: 842417633. If you need assistance with writing your essay, our professional essay writing service is here to help! It will explore how ethical decisions are reached and how they can directly influence patient care. The principles of autonomy (freedom to act on your own belief), Nonmaleficence (obligation to avoid doing harm), Beneficence (providing benefits and help) and Justice (fair distribution of benefits, risk and cost) which are derived from a duty based theory of Emmanuel Kant (1724-1804) (Beauchamp & Childress 2009). However this may not feel entirely comfortable for the nurse. 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. 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. No plagiarism, guaranteed! Marguerite Reid Schneider . Ethics can be seen as the study of human conduct and morality (Buka 2008). LEGAL AND ETHICAL ISSUES IN MENTAL HEALTH AND PSYCHIATRIC NURSING BY EUNICE KATUNGWA  Legal issue are those that pertain to Law  Law is sanctioned /established by parliament,can be changed to meet the welfare of the society/public e.g.. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. This assignment aims to critically appraise an ethical conflict in relation to the care provided to a patient. At this time Anita, due to her mental state, could not fully appreciate the nature of the wound and felt that she needed to punish herself further by refusing treatment. The paper begins with a brief statement about the centrality of autonomy or self governance as a core ethical value in the interaction between health care worker and patient. In mental health nursing, autonomy is sometimes overridden in the interests of promoting the principle of beneficence (Lakeman 2009). Using the application of the Mental Capacity Act (MCA) (Great Britain (GB) 2005) and an established model for ethical decision making, we will look at how the decision of whether or not to enforce treatment for the wound was formulated and implemented. The nurses on duty cleaned and bandaged the wound and allowed Anita time to consider the implications of her decision further. 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