NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Essay

NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Essay

NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Essay

Hello. Thanks for the insightful discussion. From your analysis, I have learned that both adults and children can be subjected to involuntary hospitalization. However, there is the need to adhere to the ethical requirements that have been set. In other words, when adults and children are involuntarily hospitalized, healthcare professionals must ensure that all ethical principles are adhered to (Chieze et al., 2021). At the forefront of these ethical considerations lies non-maleficence, an obligation for healthcare practitioners to understand the potential negative consequences of any action on a patient’s health or well-being, and autonomy, or granting informed decision making to both adults and their caregivers (Chieze et al., 2021). Additionally, they should strongly consider beneficence – actions that are intended to promote the patient’s welfare – before making a decision. It is essential that involuntary hospitalization is used judiciously while ensuring that all ethical obligations are met.

Involuntary hospitalization for both children and adults involve the right of authorities to place them into care if it is thought that they may be a threat to themselves or others. This type of situation requires a highly complex ethical decision-making process, taking into account the present mental state of the person, previous illnesses or behaviors, as well as any family history and current family dynamics (Walker et al., 2021). Generally speaking, the goal of involuntary hospitalization is to provide the necessary level of medical care for individuals who cannot make informed decisions about their own safety due to recent events or long-term conditions (Geng et al., 2020). Ultimately, this process is not used lightly and only serves to ensure a patient’s best chance at getting better in an environment where their personal health and welfare can be closely monitored.

References

Chieze, M., Clavien, C., Kaiser, S., & Hurst, S. (2021). Coercive measures in psychiatry: a review of ethical arguments. Frontiers in psychiatry, 12, 790886. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.790886/full

Geng, F., Jiang, F., Conrad, R., Liu, T., Liu, Y., Liu, H., & Tang, Y. L. (2020). Factors associated with involuntary psychiatric hospitalization of youths in China based on a nationally representative sample. Frontiers in psychiatry, 11, 607464. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.607464/full

Walker, S., Barnett, P., Srinivasan, R., Abrol, E., & Johnson, S. (2021). Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. The Lancet Child & Adolescent Health, 5(7), 501-512. https://www.sciencedirect.com/science/article/pii/S2352464221000894

NRNP 6665 – Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan I Essay

Hello Professor and fellow colleagues,

Involuntary hospitalization and due process of civil commitment

            Involuntary hospitalization/civil commitment is initiated to protect those with mental disorders from harming themselves or others, or from neglecting their basic needs (Burris et al., 2016).  Many with mental disorders lack insight and judgement into their disease process, necessitating states to initiate involuntary hospitalization to provide needed psychiatric care during acute/crisis situations.

 Response to discussion

Ethical and Legal Considerations for Adults

            The ethical roles of non-maleficence, autonomy, and beneficence must be weighed carefully when involuntary hospitalization is utilized.  Patients who clearly present with distorted perceptions, impairing their ability to make decisions regarding necessary care and treatment meet criteria for involuntary hospitalization, and In these cases ethical principles are not being violated.  For those suffering from mental illnesses such as substance abuse, eating disorders, and personality disorders, that do not impact their perception of reality to a degree which they are unable to reasonably care for themselves, the decision to force hospitalization may be more difficult (Testa & West, 2010).  State laws provide guidelines to physicians regarding criteria necessitating involuntary commitment.  In an article by Burris et al. (2016), legal implications of involuntary hospitalizations are discussed.  It explains that those meeting criteria are admitted involuntary, for short periods of time (generally 72 hours in the case of an emergency hold), to receive necessary treatment and stabilization, and cessation of firearm rights (Burris et al., 2016).  It also reveals that adults are entitled to a hearing with legal representation, when commitment must be extended beyond the initial period.  Finally, it stresses that those under involuntary commitment retain rights over their finances and the right to vote.

Ethical and Legal Considerations for Children

            Ethical and legal considerations for children committed to involuntary hospitalization are similar to those of adults with the addition of a few age-specific issues.  An article by Voultsos  et al., (2020) reveals that children and adolescents involuntarily admitted for psychiatric treatment may not be advised of the reasons for admission and are admitted at a disproportionally higher rate than adults.  Concerns related to subsequent readmission to inpatient psychiatric hospitals for “control” of behavior is often misguided and must also be carefully considered (Arbol et al., 2021).  The article highlights psychosocial and environmental factors preceding mental health crisis in children/adolescents; of significant concern is the inability of parents/guardians to “deal with” or accept diagnosis of mental health disorder (Voultsos  et al., 2020).   The article discusses the importance of assessing severity of illness and impairment in children.  According to the author, disorders including gender dysphoria and behavioral/conduct disorders related to neurocognitive disorders do not warrant involuntary hospitalization.  In conclusion, the article stresses that the mere request of a parent or caregiver should not be the sole means of determining need for involuntary hospitalization.

Implications for Practice in Florida

            In the state of Florida, the Baker Act allows for the temporary confinement of those with mental illnesses experiencing crisis to be involuntarily hospitalized for 72 hours while receiving emergency assessment/services.  Criteria for Bake Acting an individual include reason to believe the person is suffering from a mental illness, is unable to determine for themselves that they need care, is likely to neglect self-care needs, or is at substantial risk of harming self or others.  In Florida, a Baker Act can be initiated by a physician, psychiatrist, psychologist, counselor, therapist, social worker, APRN, licensed mental health worker, or law enforcement (State of Florida, statute 394).  Any other individual who has reason to believe that an individual may be at harm may petition the court using an “Ex-Parte” order, in which a judge will decide if an individual meets criterion for confinement.  Upon completion of the 72-hour hold, a psychiatrist must determine whether the individual requires longer-term treatment through the utilization of a court ordered involuntary placement hearing.

Conclusions

            Involuntary hospitalization for the treatment of those with mental health disorders in crisis is meant for emergency treatment and stabilization.  Those treated under these circumstances, both adults and children, should be closely followed in an outpatient setting.  Social service consultants should provide resources for follow up care, including assistance in filing for Medicaid/Medicare when applicable.  Continuous management with psychotherapy and medication management will contribute to better overall quality of life and decreased need for inpatient hospitalization in the future.

References

Arbol, E., Barnett, P., Johnson, S., Srinivasan, R., & Walker, S. (2021). Clinical and social factors associated with involuntary psychiatric hospitalisation in children and adolescents: A systematic review, meta-analysis, and narrative synthesis. The Lancet Child & Adolescent Health. https://www.sciencedirect.com/science/article/pii/S2352464221000894Links to an external site.

Burris, S., Dingman, D., Fisher, W., Hedman, L., Petrila, J., & Swanson, J. (2016). State laws on emergency holds for mental health … – psychiatric services. Psychiatry Online. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201500205Links to an external site.

Kleinman, R., & Morris, N. (2022). Taking an Evidenced-Based Approach to Involuntary Psychiatric Hospitalization. Psychiatry Online. Kleinman, R., & Morris, N. (2022). https://doi.org/10.1176/appi.ps.20220296Links to an external site.

Testa, M., & West, S. G. (2010). Civil commitment in the United States. Psychiatry (Edgmont (Pa. : Township)), 7(10), 30–40.

Voultsos, P., Tsamadou, E., Karakasi, M. V., Raikos, N., & Pavlidis, P. (2020). Involuntary psychiatric hospitalization of children and adolescents in Northern Greece: Retrospective epidemiological study and related ethical issues. Psychiatrike = Psychiatriki, 31(2), 129–139. https://doi.org/10.22365/jpsych.2020.312.129Links to an external site.

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