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.
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.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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.
Upload a copy of your discussion writing to the draft Turnitin for plagiarism check. Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.
Read a selection of your colleagues’ responses.
Joshua
Ethical and Legal Foundations of PMHNP Care: Child and Elder Abuse Reporting
According to Thapar et al. (2015), abuse is a prevalent risk associated with illness, socio-economic disadvantage, and crime; in which patients exposed to these adverse experiences have their rights violated. Abuse Reporting is a critical responsibility for us as PMHNPs, involving both legal and ethical considerations consisting of requirements for identifying and reporting abuse to protect vulnerable populations as well as comply with practice standards and state laws.
Literature Review
The articles I selected by Saghafi et al. (2019) and Walsh et al. (2024) discuss the ethical and legal considerations related to elder abuse; while Dayal et al. (2018), Ho, et al. (2017), and Schultz et al. (2023) address these issues within the context of children and adolescents.
Legal and Ethical Implications of Abuse Reporting
Schultz et al. (2023) state that the ethical obligation to protect vulnerable populations from harm include principles of autonomy, beneficence, and justice; however, situations involving abuse are not always clear cut. The reviewed literature discussed how abuse reporting among vulnerable populations (child and older adults) must consider both legal requirements and ethical imperatives to effectively balance the need to protect individuals, the professional, and the public. The articles discussed how children typically present with more legal issues than adults; as there may be questionable authority and or autonomy within their situations (Ho, et al., 2017). The articles further discussed the importance of considering developmental stages for children, as well as health disparities and disability within older adults to accurately identify situations of abuse (Dayal et al., 2018; Saghafi et al., 2019). With this, the literature agrees on the biological, psychological, medical, legal, and ethical consequences of abuse; necessitating the need for informed guidelines and disclosing relevant confidential information to statutory agencies. By understanding the literature’s recommendations of keeping the patients’ best interests in mind to guide decisions related to abuse reporting, nuanced situations that require careful advocacy for well-being and public safety may be better addressed. The literature emphasizes the necessity of established, evidence-based reporting guidelines through state agencies that ensure a balance of patient confidentiality with the duty to protect (Dayal et al., 2018; Saghafi et al., 2019). When considering abuse reporting, it is crucial to respect autonomy, involving the patient in decisions about their care as much as possible, however, also taking necessary protective actions when warranted (Carlson, 2024; Thapar et al., 2015). The literature on this topic found that ethically, the safety and well-being of both children and older adults takes priority; justifying the need to report any suspected occurrence and follow the mandated laws pertaining to abuse even when there are negative feelings about disclosure.
Reporting in Arizona
My state of Arizona has clear expectations in regards to abuse, requiring that any person who reasonably believes that a minor or elder is a victim of abuse, must report to Child Protective Services (CPS), Adult Protective Services (APS), or local law enforcement in attempt to responsibly protect that individual (Arizona Department of Child Safety, 2024; Arizona Legislature, n.d.). This mandatory reporting is found through Arizona Revised Statutes A.R.S. § 13-3620 for child abuse and A.R.S. § 46-454 for elder abuse; in which suspected abuse must be reported immediately when there is reasonable belief (Arizona Legislature, n.d). The failure to do so can result in legal consequences that include criminal charges and professional disciplinary actions through respected regulatory boards (Arizona Legislature, n.d.; Carlson, 2024). With this, the literature further mentions how abuse is often missed and reporting fails to reach appropriate levels. Therefore, the ongoing training and recognition of abuse is essential for healthcare professionals; including a knowledge of signs of abuse, appropriate assessments to conduct, and being updated on current state laws (Dayal et al., 2018; Walsh et al., 2024).
Abuse Reporting within Clinical Practice
Understanding the legal and ethical facets of abuse is crucial for PMHNPs, particularly in Arizona, where there are specific state laws that guide mandatory reporting. Additionally, the literature discloses how abuse is often missed, therefore, requiring prudent attention from healthcare professionals within various settings. While it is important to protect ourselves by being knowledgeable about abuse and how to deal with it, it is arguably just as important to consider the damage that can be done to the patient when there is failure to appropriately identify or report an abusive experience. After all, we are professionals who adhere to ethical codes set forth to protect our patients. Therefore, by utilizing sound judgement in our practice, updating our information brought forth by agencies such as the US Child Welfare/US Department of Health and Human Services, and adhering to our professional ethical principles, we may follow the laws pertaining to abuse reporting and advocate for our patient’s well-being. As the literature has addressed, it is imperative to stay informed through continuous education and utilization of appropriate services that address the implications of abuse. With these considerations discussed, healthcare as a whole can stay committed to not only legal compliance, but also enhanced safety and trust within vulnerable individuals and our community.
Scholarly References and PDFs of Selected Articles
The references included within this discussion are considered to be scholarly sources as they are characterized by an appropriate review process, acknowledged within fields related to mental health and the topic of discussion, and have been made available through the Walden Library, an evidence-based research engine. PDFs of selected articles are attached and available for viewing below.
PDFs:
Dayal et al., (2018)..pdfDownload Dayal et al., (2018)..pdf
Ho et al., (2017)..pdfDownload Ho et al., (2017)..pdf
Saghafi et al., (2019).pdfDownload Saghafi et al., (2019).pdf
Schultz et al., (2023)..pdfDownload Schultz et al., (2023)..pdf
Walsh et al., (2024)..pdfDownload Walsh et al., (2024)..pdf
References
Arizona Department of Child Safety. (2024). Report Child Abuse or Neglect. https://dcs.az.gov/report-child-abuse#:~:text=Children%20often%20tell%20a%20person,888%2D767%2D2445).Links to an external site.
Arizona Legislature. (n.d.). Duty to report. https://www.azleg.gov/ars/46/00454.htmLinks to an external site.
Carlson, K. (2024). Understanding a Nurse’s Role as a Mandated Reporter. NurseJournal. https://nursejournal.org/resources/understanding-nurses-role-as-a-mandated-reporter/Links to an external site.
Dayal, R., Kalokhe, A., Choudhry, V., Pillai, D., Beier, K., & Patel, V. (2018). Ethical and definitional considerations in research on child sexual violence in India. BMC Public Health, 18(1), 1–13. https://doi.org/10.1186/s12889-018-6036-yLinks to an external site.
Ho, G. W., Gross, D. A., & Bettencourt, A. (2017). Universal Mandatory Reporting Policies and the Odds of Identifying Child Physical Abuse. American journal of public health, 107(5), 709–716. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388942/pdf/AJPH.2017.303667.pdfLinks to an external site.
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of Medical Ethics & History of Medicine, 12(1), 1–18. https://eds.p.ebscohost.com/eds/pdfviewer/pdfviewer?vid=5&sid=8742a6b8-f3e2-4895-a26a-aeb66cb0f50b%40redisLinks to an external site.
Schultz, M. L., Winn, M., Derse, A. R., Kaczor, F., & Levas, M. N. (2023). Interactions With Police in the Emergency Care of Children: Ethical and Legal Considerations. Pediatric emergency care, 39(4), 226–229. https://doi.org/10.1097/PEC.0000000000002908Links to an external site.
Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
Walsh, C. A., Dukart, A., Roger, K., & Goodridge, D. (2024). Disclosure and reporting of abuse against older adults: Perspectives of older adults with abuse histories and service providers in Alberta, Canada. Journal of Gerontological Social Work. https://www.tandfonline.com/doi/epdf/10.1080/01634372.2024.2339990?needAccess=trueLinks to an external site.
Pearl
Informed Assent/Consent and Capacity
Informed consent is both an ethical and legal consideration in medical field and research, and this principle urges practitioners/investigators to respect the autonomy rights of patients/ participants.The first article “Ethics in psychiatric research” by ” Jain et al., discusses the ethical principles underlying informed consent for psychiatric treatment in adults. It emphasizes the importance of respecting patient autonomy by ensuring patients have decision-making capacity and are adequately informed about risks, benefits, and alternatives. However, it also notes ethical tensions that can arise when capacity is impaired due to mental illness. The second article “Assent and Consent in Pediatric and adolescent research ” by Al-Sheyab et al., (2019) examines ethical issues around assent and consent for mental health treatment in minors. It discusses the developing autonomy of children/adolescents and the need to involve them in decision-making to the extent possible based on age and cognitive abilities, balanced against the ethical principle of beneficence and the rights/responsibilities of parents.
The third article “Informed Consent in adult psychiatry” by Amer (2013) provides an overview of legal standards for informed consent in psychiatric care of adults across the United States. It covers requirements for capacity assessments, information disclosure standards, and legal exceptions allowing treatment over objection due to lack of capacity or potential harm. The fourth article “Informed Consent in the mature minor” by Boceta et al., (2021) discusses the Child & the legal frameworks and state laws regarding minor consent to mental health treatment. It also discusses the evolving ability of minors to provide assent/consent based on age and decision-making capability.
Implications for Clinical Practice:
As a PMHNP, I must follow the state laws regarding informed consent standards and determination of decision-making capacity, which generally align with the principles discussed in the above articles. In adults, I would thoroughly assess capacity using accepted evaluation methods. If capacity is intact, I would ensure the patient understands all relevant information to make an informed choice about treatment through a thorough disclosure process. If capacity is impaired, I would involve authorized legal representatives in the consent process as required. With children/adolescents, in addition to parental permission, I would seek assent from the minor in developmentally appropriate language based on their age and cognitive abilities, in line with the ethical guidance from King and Adair (2021). Ongoing assent should be re-evaluated, not just a one-time event. Upholding ethical principles like autonomy, beneficence, justice and veracity is crucial. Detailed documentation of capacity assessments, information disclosed, and the consent/assent process is vital from both ethical and legal standpoints.
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