Chapter 06: Legal and Ethical Guidelines for Safe PracticeMULTIPLE CHOICE1. A psychiatric nurse best applies the ethical principle of autonomy by:a.exploring alternative solutions with a patient, who then makes a choice.b.suggesting that two patients who were fighting be restricted to the unit.c.intervening when a self-mutilating patient attempts to harm self.d.staying with a patient demonstrating a high level of anxiety.ANS: AAutonomy is the right to self-determination, that is, to make one’s own decisions. By exploring alternatives with the patient, the patient is better equipped to make an informed, autonomous decision. The distracters demonstrate beneficence, fidelity, and justice.2. A nurse finds a psychiatric advance directive in the medical record of a patient experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should:
The nurse has an obligation to honor the right to self-determination. An advanced psychiatric directive supports that goal. Since the patient is currently psychotic, the terms of the directive now apply.3. Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion:Patients have a right to treatment in the least restrictive setting. Safety is important, but less restrictive measures should be tried first. Unnecessary seclusion may result in a charge of false imprisonment. Seclusion violates the patient’s autonomy. The principle by which the nurse is motivated is beneficence, not justice. The tort represented is false imprisonment.4. In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision.” Which ethical principle most clearly appliesto this situation?
The nurse is concerned about justice, that is, fair distribution of care, which includes treatment with the least restrictive methods for both patients. Beneficencemeans promoting the good of others. Autonomyis the right to make one’s own decisions. Fidelityis the observance of loyalty and commitment to the patient.
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- Spring '17
- Psychiatry, Involuntary commitment, Psychiatric hospital, attending psychiatrist