NRNP 6665 Ethical and Legal Foundations of PMHNP Care Essay

NRNP 6665 Ethical and Legal Foundations of PMHNP Care Essay

NRNP 6665 Ethical and Legal Foundations of PMHNP Care Essay

Psychiatric-mental health nurse practitioners (PMHNPs) make critical decisions concerning patient care daily. These decisions must mirror principles of good and bad and consider the choices that confer benefits to patients based on biomedical principles. As such, ethical and legal decision-making scenarios are seldom direct (Kraft et al., 2020). Therefore, PMHNPs require a deeper appreciation of ethical models and legal components that create the base from where they make considerations to protect themselves and their patients. For purposes of this assignment, the paper selects informed consent as a topic when dealing with patients across age continuum, right from children, adolescents and adults getting treatment for mental health conditions from PMHNP.

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Informed Consent

Concerns about informed consent in mental health are critical since it carries both legal and ethical tenets. Psychiatric-mental health nurse practitioners (PMHNPs) need informed consent to carry out any treatment interventions in clinical practice. In their study, Farmer and Lundy (2017) observe that patients have an ethical right to self-determination. Patients also have a right to shared decision-making about their healthcare. The concept of informed consent is also anchored in laws at both state and federal government levels. Based on this concept, PMHNPs have a duty to offer and disclose all information to their adult patients concerning their medical conditions and the possible interventions. Informed consent is part of patient’s autonomy. Based on information offered a patient has the right to decline suggested psychotherapeutic intervention (Kraft et al., 2020). However, children and adolescents do not have autonomy and their informed consent is exercised by their parents or guardians. The implication is that parents have the legal right to consent to the suggested treatment intervention for their minors.

Summary of the Articles

The articles are explicit that informed consent has both legal and ethical perspectives, right from children to adolescents, and adults. In their study, Bieber et al. (2020) observe the critical role that parents play at both legal and ethical level to make medical decisions for the minors in any medical process. The author advances that children and adolescent psychiatrists should appreciate ethical considerations when they override parental medical decision-making. In their study, Darby and Weinstock (2018) emphasize the need for informed consent in psychotherapy despite possible limitations. The authors note that while PMHNPs can ignore getting informed consent in certain situations, they must understand it remains a core aspect of legal and ethical requirements. For instance, psychiatrists should not breach doctor-patient confidentiality since the legal systems have mandated reporting or when they want to avoid serious risk due to adverse effects that such decisions can have on minors’ treatment processes.

The articles by Bipeta (2019) and Blease et al. (2020) highlight the need for practitioners to differentiate minor patients and adults when seeking informed consent. Blease et al. (2020) assert that practitioners need to understand reasons and justifications for informed consent and the process of getting one. Confidentiality is a core aspect of getting informed and the articles assert that it limits the ability of practitioners to engage patients comprehensively.

Ethical Considerations of Informed Consent in PMNP

A scenario that requires ethical consideration is when an adult patient requires positive treatment outcomes and the PMNHP focuses on beginning the procedure. The PMHNP offers a legal consent form but the patient understands the plan and considers it not effective. Here, the psychiatric practitioner encounters ethical dilemma. While the practitioner considers the intervention most appropriate in the case, the patient’s compromised decision-making capacities does not approve of the plan. The implication is that the practitioner needs to provide detailed information about the plan and its effects on the patient to get informed consent.

In the case of a child or an adolescent, parents and guardians make the decision concerning the treatment intervention. The parents may not allow the child to know the treatment offered by the psychiatric practitioner. In most cases, parents make decisions based on their evaluations and perspectives; a situation that present ethical challenges to the psychiatric nurse to attain the ethical considerations of informed consent. It is unethical to offer therapeutic interventions without the consent of the patient.

Legal Considerations for Informed Consent

Two articles, one by Darby et al. (2018) and Bieber et al. (2020) discuss the legal aspects of informed consent for both children and adults. Bieber et al. (2020) consider the care of psychiatrically ill adolescents and advance that the underlying ethical issues have legal perspectives and implore psychiatric practitioners to consider these issues as a patient’s reaction to a proposed treatment plan may have negative effects in providers and even themselves. Despite such limitations, PMHNPs cannot avoid the legal implications of informed consent.

The legal frameworks consider children and adolescents as incompetent in decision-making when accessing health interventions, including psychotherapy. However, the parents’ legal rights ensure that they make decisions based on informed consent. Refusal of psychiatric treatment by minors due to changes, even with informed consent, is unethical and illegal (Bieber et al., 2020). Psychiatric nurse practitioners have no legal mandate to make decisions on the behalf of the minor’s parents.

Application in Clinical Practice

Clinical practice provides PMHNP nurses and students the opportunity to apply legal and ethical considerations when making decisions concerning patient care interventions. As such, I can apply the legal and ethical considerations of informed consent concerning therapeutic interventions for children and adults coming to the setting. Through a review of these article, and based on Georgia’s legal requirements, I can address ethical dilemmas that present to the practice in a more informed manner. The legal requirements in Georgia include mental health nurse practitioners making full disclosure and obtaining informed consent from the psychiatric patients. Obtaining consent from all patients is legally and ethically essential for effective psychiatric treatment and outcomes.

Conclusion

PMHNPs need to understand different aspects of informed consent, especially the legal and ethical considerations, to offer effective care across age continuum. As illustrated, various laws and regulations in Georgia and even other states require informed consent for effective care and protection of both patients and practitioners.

References

Bieber, E. D., Edelsohn, G. A., McGee, M. E., Shekunov, J., Romanowicz, M., Vande Voort, J.

L., & McKean, A. J. S. (2020). The Role of Parental Capacity for Medical Decision-Making in Medical Ethics in the Care of Psychiatrically Ill Youth: Case Report. Frontiers in Psychiatry, 11, 1094. https://doi.org/10.3389/fpsyt.2020.559263

Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian Journal of

Psychological Medicine, 41(2), 108–112. https://doi.org/10.4103/ijpsym.ijpsym_59_19

Blease, C. R., Arnott, T., Kelley, J. M., Proctor, G., Kube, T., Gaab, J., &Locher, C. (2020).

Attitudes About Informed Consent: An Exploratory Qualitative Analysis of UK

Psychotherapy Trainees. Frontiers in Psychiatry, 11. doi:10.3389/fpsyt.2020.00183

Darby, W. C., & Weinstock, R. (2018). The Limits of Confidentiality: Informed Consent and

Psychotherapy. FOCUS, 16(4), 395–401. https://doi.org/10.1176/appi.focus.20180020

Farmer, L., & Lundy, A. (2017). Informed consent: Ethical and legal considerations for

advanced practice nurses. The Journal for Nurse Practitioners, 13(2), 124-130. https://doi.org/10.1016/j.nurpra.2016.08.011

Kraft, S. A., Porter, K. M., Duenas, D. M., Sullivan, E., Rowland, M., Saelens, B. E., … & Shah,

209296. K. (2020). Assessing parent decisions about child participation in a behavioral health intervention study and utility of informed consent forms. JAMA network open, 3(7), e209296-e209296. https://doi.org/10.1001/jamanetworkopen.2020.9296

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Discussion: Ethical and Legal Foundations of PMHNP Care
Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.

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For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.

To Prepare
Select one of the following ethical/legal topics:
Autonomy
Beneficence
Justice
Fidelity
Veracity
Involuntary hospitalization and due process of civil commitment
Informed assent/consent and capacity
Duty to warn
Restraints
HIPPA
Child and elder abuse reporting
Tort law
Negligence/malpractice
In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.
By Day 3 of Week 2
Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.