1. Older Adults Legal & Ethical Basis for Practice Settings for Psychiatric Care Chapters 25, 26, 27

2. Increased proportion of older adults has altered the socioeconomic condition in America & transformed health care By 2030, 23% US pop, will be > 65 yrs age Ageism: bias against individual due to age Assessment and communication strategies  Geropsychiatric nurses work with older adults and are knowledgeable about meds, normal aging and chronic disease Elderspeak  Adults speaking to elders as though they are children Chapter 25: Older adults

3. Psychiatric disorders in older adults Older adults with mental disorders are inappropriately diagnosed and receive inadequate treatment Depression; most common disorder in >65 yrs  Antidepressant therapy: emphasis is on avoidance side effects rather than efficacy  Psychotherapy: individual or group therapy Suicide: highest of any age group  Assessment for suicide risk  Right to die Alcoholism and substance abuse AIDS and AIDS related dementia

4. Use of Restraints: ethical, legal & safety concern  Physical restraints: manual methods or mechanical devices  Chemical restraints: drugs to inhibit behavior or movement Omnibus Budget Reconciliation Act (OBRA)  Declares each nursing home pt has the right to be free from unnecessary drugs or physical restraints Control of Decision Making Process  Patient Self Determination Act  Advance Directive/ Living Will  Directive to Physician  Durable Power of Attorney for Health Care  Nursing Role in Decision Making Process Legal and ethical issues affecting the older adult

5. Chapter 26: Legal and ethical basis for practice Ethical dilemma: results when there is a conflict between 2 or more courses of action both favorable and unfavorable outcomes Legal and Ethical Concepts  Ethics: study of philosophical beliefs about what is right and wrong in society  Bioethics: ethical questions arise in healthcare, 5 basic principles Beneficence Autonomy Justice Fidelity Veracity  Mental Health Laws Civil rights: pts with mental illness have same rights

6. Due process in civil commitment Admission to hospital  Voluntary admission  Involuntary admission 3 different commitment procedures: judicial determination, administrative determination and agency determination  Emergency involuntary hospitalization  Observational involuntary hospitalization  Long term commitment  Involuntary outpatient commitment Discharge from hospital  Conditional release  Unconditional release  AMA Admissions and discharge procedures

7. Right to treatment Right to refuse treatment Right to informed consent Rights surrounding involuntary commitment & psychiatric advance directives Rights regarding restraint and seclusion Patient Confidentiality  Ethical Considerations  Legal Considerations: HIPPA Patients employers Rights after death Patient Privilege and HIV Exceptions to Rule Child and Elder abuse reporting statutes Patients rights under the law

8. Torts are category of civil law applies to health care Tort is civil wrong for which money damages may be collected by injured party from the wrongdoer  Common Liability Issues Protection of patients -#1 priority  Violence  Negligence/malpractice: act or omission of act that breaches the duty of care and results in or is responsible for persons injuries Tort law applied to psychiatric settings

9. Standards of care established by ANA Guidelines for Nurses who suspect negligence Duty to report and intervene Unethical and Illegal practices Documentation of care  Purpose of medical records  Facility use of medical records  Medical records as evidence  Nursing guidelines for computerized charting Forensic Nursing Determination of standard of care

10. Chapter 27: Settings for psychiatric care 46% of population will be diagnosed with mental health disorder over lifetime 80% will seek treatment but the delay can take years Current treatment includes inpatient and outpatient  Outpatient Care; PCPs are 1 st choice, psychiatric care, CMHC, psych home care, IOP’s PHP  Inpatient Care; 24 hr nursing care in safe setting  Therapeutic milieu- positive holistic setting

11. Treatment settings State Acute Care General Hosp & Private Psych Acute Care Pediatric Psych Care Geriatric Psych Care VA Forensic Psych Care Alcohol and Drug Abuse Treatment Self-help Options Mental Health Parity Law (1996); illegal to limit annual or lifetime mental health benefits unless they do so for medical care

13. Thank you!