Ethical and Legal Foundations of PMHNP Care

Topic: Informed assent/consent and capacity
Physicians have a moral and legal duty to get informed permission from their patients, even if their expert care does not fulfill this requirement. It mandates that the doctor tell the patient all relevant information, such as the risks involved, the procedure’s nature and goal, and available options. The patient should be informed at once of this information rather than using consent forms. The physician should document the patient’s consent circumstances in their chart to reduce the likelihood of accusations of inadequate disclosure. Informed permission is a moral and legal necessity for PMHNPs practicing mental health to perform psychotherapy. To support the patient’s autonomy, it gives information about the patient’s mental health and suggested therapies. However, parents and guardians of minors have the legal authority to approve the proposed treatment plan (Bipeta, 2019).
Article Summary
The articles used addressed every facet of informed consent, including legal and ethical considerations, regarding children, adolescents, and adults making decisions about specific psychotherapies. The papers detail how medical professionals and nurse practitioners feel about specific ethical and legal concerns about informed consent. Research-based evidence supports the reasons and justifications for considering informed consent before any medical operation. The study articles cover the boundaries of confidentiality and moral conundrums surrounding informed consent usage in psychotherapy settings. Presenting that Clinical trials should include individuals with mental health conditions to protect them from excessive risks. The first step is to assess their capacity to consent, with researchers well-trained to conduct capacity assessments. Decisions about permission for those lacking decisional capacity should be context-dependent and based on local or national regulations. Ongoing assessments should be conducted regularly, with participants with decisional ability completing an advance directive at the time of research enrollment. Research with adults who cannot give informed consent is essential for identifying effective interventions, but it raises ethical concerns. Impaired competence is common in medical and surgical inpatient units, with schizophrenia showing a more potent association with impaired capacity than depression (Blease et al., 2020) . The four publications that were chosen for this study provide enough information about the application of moral and legal requirements for informed consent in psychiatric mental health procedures, with more details on some of the most significant moral and legal concerns about kids, teens, and adults.
Ethical Considerations of Informed Consent in Psychiatric Mental Health Practices
There are still ethical questions about compromised consent in biotechnological advancements, and these should be addressed as soon as possible while adhering to the law and ethical standards. Ensuring the well-being of individuals with mental health problems (MHCs) and promoting moral research that could help future generations are the main goals of mental health research. Comprehensive rules for safeguarding research subjects, including mentally ill individuals, are provided by the US Council of Medical Research (Ali et al., 2019Links to an external site.). Adult patients may receive assent to a treatment plan from a psychiatric nurse practitioner (PHN). However, because of their impaired decision-making capacity, they may consider the plan more helpful. Informed consent is an ethical consideration that is violated when a practitioner withholds information from a patient about the entirety of the therapy. To ensure informed consent, the PMHNP must navigate ethical conundrums presented by parents’ and guardians’ tendency to make decisions for children and adolescents based only on their viewpoint. Making decisions about treatment interventions for children and adolescents without sufficient knowledge is unethical because it violates the ethical principle of informed consent in psychotherapies.
Legal Considerations of Informed Consent in Psychiatric Mental Health Practices
As a legal requirement for mental health professionals (PHNs) and in the ethical-deontological domain, informed consent has grown significantly. Making decisions for adult patients with severe mental illnesses can be difficult because of the potential for the patients’ reactions to hurt caregivers, other people, or even the patient. Informed consent has legal ramifications that PMHNPs in clinical practice cannot ignore. The legal rights of adolescents give them the ability to decide what psychiatric therapy to receive and to give informed permission (Lamont et al., 2019). Nevertheless, regardless of the efficacy of the therapy, it becomes unethical and illegal for the nurse practitioner to continue with the same treatment plan when teenage clients refuse or alter treatment plans on informed consent. Thus, Legal issues prevent the psychiatric nurse practitioner from acting in the patient’s best interests.
Application to My Clinical Practices
I work as a Psych nurse at an outpatient mental health clinic and county jail setting in California. In my clinical context as a mental health nurse practitioner, I may use the moral and legal implications of informed consent when treating children and adolescents. In a similar vein, I would be more equipped to handle the moral enigmas in my therapeutic practice after reading these articles. Psychiatric patients in my state provide their full informed permission to mental health nurse practitioners. Maximum client involvement in treatment is necessary for child and adolescent psychotherapies. In addition to being necessary from a legal and moral standpoint, the child or teenage client’s permission, as guided by legal parents, is also necessary for successful psychiatric treatment outcomes. The onus is on the mental health practitioner to be knowledgeable about clinical, legal, and ethical issues to reach a responsible and competent conclusion for their client, though, as the role is sensitive and there are no clear limitations. (California Informed Consent Form Guidelines, 2012).
In Synopsis… Research shows that most patients with mental illness in inpatient units could make treatment decisions like those with medical illnesses. However, judgment of competence is specific to each decision, making psychiatric consultation helpful in complex cases or when mental illness is present. Empirical studies show that most mentally ill inpatient patients possess the ability to make treatment decisions akin to those with physical illnesses. Psychiatric advice is beneficial in difficult instances or when mental disease is present, as each decision’s competence must be evaluated individually (Darby & Weinstock, 2018).
Ali, F., Gopi Gajera, Gowda, G. S., Preeti Srinivasa, & Mahesh Gowda. (2019). Consent in current psychiatric practice and research: An Indian perspective. Indian Journal of Psychiatry, 61(10), 667.
Bipeta, R. (2019). Legal and ethical aspects of mental health care. Indian Journal of Psychological Medicine, 41(2).
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 Psychotherapy Trainees. Frontiers in Psychiatry, 11(183).
California Informed Consent Form Guidelines. (2012, January 18). State of California – Department of Justice – Office of the Attorney General.
Darby, W. C., & Weinstock, R. (2018). The limits of confidentiality: Informed consent and psychotherapy. FOCUS, 16(4), 395–401.
Lamont, S., Stewart, C., & Chiarella, M. (2019). Capacity and consent: Knowledge and practice of legal and healthcare standards. Nursing Ethics, 26(1), 71–83.

Post #2

Writer: E.A
Ethical and Legal Foundations of PMHNP Care
Autonomy is associated with the patient’s capacity to make decisions concerning their own treatment. There are ethical and legal issues linked to autonomy as they concern psychiatric-mental health practice for adults and children. The ethical considerations related to the autonomy of adults include balancing good and harm as a result of coercive care intended to improve the adult patient’s mental well-being. Hem et al. (2018) indicate that promoting the individual’s best interest is the most vital justification for coercive care. Patient autonomy violation is a key element of coercion. When coercive care is used, a key ethical challenge is to evaluate the balance between causing harm and promoting good. Coercive care can promote good by leading to the improvement in the adult patient’s mental health. However, it can lead to feelings of vulnerability, lack of self-confidence, and feelings of humiliation. The legal considerations related to autonomy for adults are charges of malpractice due to imminence criteria for mental health patients subjected to involuntary hospitalization. Borecky et al. (2019) asserts that continued violation of patient autonomy through involuntary hospitalization of suicidal patients is attributed to legal pressures, with clinicians required to keep suicidal patients until they are no longer at high risk to ensure they avoid malpractice charges. Such requirements put clinicians in a highly precarious position.
The ethical consideration concerning autonomy for children and adolescents is balancing between the minor’s mental health and feelings of shame, stigma, and humiliation associated with seeking mental health services. In Maryland, minors who are 12 years and older are allowed to make decisions concerning mental health treatment. Grady et al. (2019) indicate that stigma, shame, and fear of being judged discourage minors requiring mental health treatment from seeking such services. The stigma can lead to the deterioration of the minor’s mental well-being. The legal consideration related to the issue of autonomy for children and adolescents is malpractice charges due to involuntary hospitalization of high-risk minor patients. Nyttingnes et al. (2018) indicate that adolescent patients may be subjected to coercive treatment to prevent harm to them. However, coercive care may lead to the violation of the minor’s right to autonomy, which leads to legal problems for clinicians. The information about the ethical and legal issues related to autonomy is likely to influence my clinical practice in Maryland. There is a need to involve stakeholders, including legal professionals, before making decisions about coercive care.
Borecky, A., Thomsen, C., & Dubov, A. (2019). Reweighing the ethical tradeoffs in the involuntary hospitalization of suicidal patients. The American Journal of Bioethics, 19(10), 71-83. to an external site.
Grady, M. D., Levenson, J. S., Mesias, G., Kavanagh, S., & Charles, J. (2019). “I can’t talk about that”: Stigma and fear as barriers to preventive services for minor-attracted persons. Stigma and Health, 4(4), 400. to an external site.
Hem, M. H., Gjerberg, E., Husum, T. L., & Pedersen, R. (2018). Ethical challenges when using coercion in mental healthcare: a systematic literature review. Nursing Ethics, 25(1), 92-110. to an external site.
Nyttingnes, O., Ruud, T., Norvoll, R., Rugkåsa, J., & Hanssen-Bauer, K. (2018). A cross-sectional study of experienced coercion in adolescent mental health inpatients. BMC Health Services Research, 18(1), 1-10. to an external site.

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