Legal and Ethical Issues Related to Psychiatric Emergencies

The diagnosis of psychiatric emergencies can include a wide range of problems—from serious drug reactions to abuse and suicidal ideation/behaviors. Regardless of care setting, the PMHNP must know how to address emergencies, coordinate care with other members of the health care team and law enforcement officials (when indicated), and effectively communicate with family members who are often overwhelmed in emergency situations. In their role, PMHNPs can ensure a smooth transition from emergency mental health care to follow-up care, and also bridge the physical–mental health divide in healthcare.

In this week’s Assignment, you explore legal and ethical issues surrounding psychiatric emergencies, and identify evidence-based suicide and violence risk assessments. 

To Prepare

• Review this week’s Learning Resources and consider the insights they provide about psychiatric emergencies and the ethical and legal issues surrounding these events.

The Assignment

In 2–3 pages, address the following:

• Explain your state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.
• Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in your state.
• Explain the difference between capacity and competency in mental health contexts.
• Select one of the following topics, and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: patient autonomy, EMTALA, confidentiality, HIPAA privacy rule, HIPAA security rule, protected information, legal gun ownership, career obstacles (security clearances/background checks), and payer source.
• Identify one evidence-based suicide risk assessment that you could use to screen patients.
• Identify one evidence-based violence risk assessment that you could use to screen patients.
•  five references within last 5 years.

Instructions: Response should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Must be grammatically correct.

Gastrointestinal Function:
R.H. is a 74-year-old black woman, who presents to the family practice clinic for a scheduled appointment. She complains of feeling bloated and constipated for the past month, some-times going an entire week with only one bowel movement. Until this episode, she has been very regular all of her life, having a bowel movement every day or every other day. She reports straining most of the time and it often takes her 10 minutes at a minimum to initiate a bowel movement. Stools have been extremely hard. She denies pain during straining. A recent colonoscopy was negative for tumors or other lesions. She has not yet taken any medications to provide relief for her constipation. Furthermore, she reports frequent heartburn (3–4 times each week), most often occur-ring soon after retiring to bed. She uses three pillows to keep herself in a more upright position during sleep. On a friend’s advice, she purchased a package of over-the-counter aluminum hydroxide tablets to help relieve the heartburn. She has had some improvement since she began taking the medicine. She reports using naproxen as needed for arthritic pain her hands and knees. She states that her hands and knees are extremely stiff when she rises in the morning. Because her arthritis has been getting worse, she has stopped taking her daily walks and now gets very little exercise.

Case Study Questions

1. In your own words define constipation and name the risk factors that might lead to develop constipation. List recommendations you would give to a patient who is suffering from constipation. You might use a previous experience you might have.
2. Based on the clinical manifestations on R.H. case study, name and explain signs and symptoms presented that are compatible with the constipation diagnosis. Complement your list with signs and symptoms not present on the case study.
3. Sometimes as an associate diagnosis and a complication, patients with constipation could have anemia. Would you consider that possibility based on the information provided on the case study?

Endocrine Function:
C.B. is a significantly overweight, 48-year-old woman from the Winnebago Indian tribe who had high blood sugar and cholesterol levels three years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed that her fasting blood sugar was 141 and her cholesterol was 225. However, she felt “perfectly fine at the time” and could not afford any more medications. Except for a number of “female infections,” she has felt fine until recently. Today, she presents to the Indian Hospital general practitioner complaining that her left foot has been weak and numb for nearly three weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. However, she reports that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 65 pounds since her last pregnancy 14 years ago, 15 pounds in the last 6 months alone.

Case Study Questions

1. In which race and ethnic groups is DM more prevalent? Based on C.B. clinical manifestations, please compile the signs and symptoms that she is exhibiting that are compatible with the Diabetes Mellitus Type 2 diagnosis.
2. If C.B. develop a bacterial pneumonia on her right lower lobe, how would you expect her Glycemia values to be? Explain and support your answer.
3. What would be the best initial therapy non-pharmacologic and pharmacologic to be recommended to C.B?

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

1. New practice approaches
2. Interprofessional collaboration
3. Health care delivery and clinical systems
4. Ethical considerations in health care
5. Practices of culturally sensitive care
6. Ensuring the integrity of human dignity in the care of all patients
7. Population health concerns
8. The role of technology in improving health care outcomes
9. Health policy
10. Leadership and economic models
11. Health disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Many cultures have ethno-etiologies that provide explanations for illness that are not based in science. From a biomedical perspective, the non-scientific medical treatments provided in these cultures have a low likelihood of success. Despite this, people tend to believe that the treatments are working.

• Why do you think people tend to be satisfied with the effectiveness of the treatments they receive that are based on the ethno-etiologies? 
• In transcultural nursing practice, why would it be important for nurses to understand such ethno-etiologies when nurses interact with patients of different cultures? 

Jill,

Consider the scenario above to address the following.

1. Do you recommend that the data analyst examine aggregate data, detailed data, or both, to investigate this quality issue? Please explain your rationale.

Aggregate data is a summary of the population being evaluated and does not consider individualized data. Detailed data evaluates individualized information, which can eliminate potential biases that may exist in aggregated data. Tierney et al. (2020) concluded that aggregate data were more likely to agree with detailed data when the information size was large. Since this is a quality issue and the information provided does not state the sample size, I recommend evaluating the aggregate and detailed data to ensure enough information is captured.

1. Do you recommend that the data analyst use a retrospective data warehouse, clinical data store, or both, to investigate the mortality rate? Please explain your rationale.

To investigate the mortality rate, the analyst should evaluate the retrospective data warehouse. The retrospective data warehouse provides aggregate and detail-level data, whereas the clinical data store manages operational and clinical data to assist clinicians at the point of care. Aggregate data in the retrospective data warehouse may contain a mortality rate, risk-adjusted mortality rate, and risk of mortality for specific patient populations (McBride, 2019).

1. What type of tools or analytic approaches is relevant for use by this analyst? Please explain your rationale.

First, this analyst will need a spreadsheet, such as Microsoft Excel, that allows the data to be organized and sorted into various charts and graphics. BI tools are software applications that assist in the multidimensional analysis of clinical data in organizations (McBride, 2019). Statistical packages assist the analyst in organizing the data, performing data cleaning, and validating the data. Statistical tests such as t-test, correlations, and regression are often used.

Now, conduct a search for evidence. Select three scholarly sources of information describing the challenges of utilizing data in the clinical setting.

Data utilization in the healthcare industry presents many challenges. One challenge is proprietary or determining who owns the data, the facility, or the patient (Kruse et al., 2016). The patient’s ability and ease of accessing their information is another concern. Patient security is a significant challenge in data management (Galetsi et al., 2019; Kruse et al., 2016; Ristevski & Chen, 2018). According to Galetsi et al. (2019), future research is directed towards the standardization of data systems to allow for the safe extraction of patient data from all relevant organizations. Advanced encryption algorithms and pseudo-anonymization of personal data should be used to avoid patient security and privacy issues (Ristevski & Chin, 2018; Galetsi et al., 2019).

References

Galetsi, P., Katsaliaki, K., & Kumar, S. (2019). Values, challenges and future directions of big data analytics in healthcare: A systematic review. Social Science & Medicine, 241, 112533. https://doi.org/10.1016/j.socscimed.2019.112533 (Links to an external site.)

Kruse, C., Goswamy, R., Raval, Y., & Marawi, S. (2016). Challenges and opportunities of big data in health care: A systematic review. JMIR Medical Informatics, 4(4), e38. https://doi.org/10.2196/medinform.5359 (Links to an external site.)

McBride, S. (2019). Nursing informatics for the advanced practice nurse: Patient safety, quality, outcomes, and interprofessionalism (2nd ed.). Springer Publishing Company.

Ristevski, B., & Chen, M. (2018). Big data analytics in medicine and healthcare. Journal of Integrative Bioinformatics, 15(3). https://doi.org/10.1515/jib-2017-0030 (Links to an external site.)

Tierney, J. F., Fisher, D. J., Burdett, S., Stewart, L. A., & Parmar, M. B. (2020). Comparison of aggregate and individual participant data approaches to meta-analysis of randomised trials: An observational study. PLOS Medicine, 17(1), e1003019. https://doi.org/10.1371/journal.pmed.1003019