Assignment : Practicum Journal: Voluntary and Involuntary Commitment

PMHNPs may find themselves working in a wide variety of settings—each having their own unique challenges and inherent legal issues. For instance, what do you do in your state of practice when you are providing a therapy/treatment session and a client reports active suicidal ideation? What do you do if you are covering inpatient psychiatric consults and are called to see a patient in the ICU who overdosed on prescription medication requiring intubation? What do you do if you are a PMHNP on an inpatient unit and a client who admitted themselves on a voluntary basis suddenly states that they have decided to sign themselves out of the hospital so that they can go home to kill themselves? These are just some of the legal questions that PMHNPs must know the answers to specific to their state of licensure/practice.

In this Assignment, you investigate your state’s laws concerning voluntary and involuntary commitment. You also analyze a case to determine if the client is eligible for involuntary commitment.

Scenario for Week 7 Case:

You are a PMHNP working in a large intercity hospital. You receive a call from the answering service informing you that a “stat” consult has been ordered by one of the hospitalists in the ICU. Upon arriving in the ICU, you learn that your consult is a 14 year old male who overdosed on approximately 50 Benadryl (diphenhydramine hydrochloride) tablets in an apparent suicide attempt. At the scene, a suicide note was found indicating that he wanted to die because his girlfriend’s parents felt that their daughter was too young to be “dating.” The client stated in the suicide note that he could not “live without her” and decided to take his own life. Although he has been medically stabilized and admitted to the ICU, he has been refusing to talk with the doctors or nurses. The hospital staff was finally able to get in touch with the clients parents (using contact information retrieved from the 14 year old’s cell phone). Unbeknown to the hospital staff, the parents are divorced, and both showed up at the hospital at approximately the same time, each offering their own perspectives on what ought to be done. The client’s father is demanding that the client be hospitalized because of the suicide, but his mother points out that he does not have “physical custody” of the child. The client’s mother demands that the client be discharged to home with her stating that her son’s actions were nothing more than a “stunt” and “an attempt at manipulating the situation that he didn’t like.” The client’s mother then becomes “nasty” and informs you that she works as a member of the clerical staff for the state board of nursing, and if you fail to discharge her child “right now” she will make you “sorry.” How would you proceed?

Learning Objectives

Students will:

• Evaluate      clients for voluntary commitment
• Evaluate      clients for involuntary commitment based on state laws
• Recommend      actions for supporting parents of clients not eligible for involuntary      commitment
• Recommend      actions for treating clients not eligible for involuntary commitment

To Prepare for this Practicum:

• Review      the Learning Resources concerning voluntary and involuntary commitment.
• Read      the Week 7 Scenario in your Learning      Resources.
• Research      your state’s laws concerning      voluntary and involuntary commitment.

The Assignment (2–3 pages):

• Based      on the scenario, would you recommend      that the client be voluntarily committed? Why or why not?
• Based      on the laws in your state, would the      client be eligible for involuntary commitment? Explain why or why not.
• Did      understanding the state laws confirm or challenge your initial recommendation regarding involuntarily committing      the client? Explain.
• If the      client were not eligible for involuntary commitment, explain what actions you may be able to take to support the      parents for or against voluntary commitment.
• If the      client were not eligible for involuntary commitment, explain what initial actions you may be able to take to begin treating the client.

 

After the data have been analyzed, conclusions are made regarding what the findings mean. Then, this information must be shared with your healthcare team.

1. Discuss the findings of the articles. Would you apply the evidence found to your practice? Explain your answer.
2. Translating research into practice is the final and most important step in the research process. Review information you found your nursing clinical issue and explain ways in which you would share the research-based evidence with your peers.
3. Article attached

1.What are the methods a nurse can use to gather cultural information  from patients? How does cultural competence relate to better patient  care? Discuss the ways in which a nurse demonstrates cultural  competency in nursing practice.Two references

2.Discuss why nutrition is a central component in health promotion.  What are some of the nutritional challenges for emerging populations?  What roles do nutritional deficiency and nutritional excess play in disease?Two references

  Please answer ONE of the following DQ’s.  Please provide the questions that is being answered as the heading.  Incomplete answers will be marked as “0.” 

APA style and 3 references.

Chapter 27

A patient with chronic bronchitis is brought into the emergency room with complaints of sudden-onset chest pain, shortness of breath, and coughing up blood. His lab work shows hypoxemia, respiratory acidosis, and elevated red blood cell (RBC) count, white blood cell count, hemoglobin, and hematocrit.

a.            Utilizing your understanding of the process of erythropoiesis, why do you think this patient has elevated RBCs, hemoglobin, and hematocrit?

b.            What is the most likely cause of the patient’s acute symptoms? How do you explain this?

 

Quality Improvement Milestones

Throughout history, major events have influenced quality improvement efforts in health care. For example, the Institute of Medicine’s report To Err is Human: Building a Safer Health System revealed statistics about errors in patient safety that result in thousands of deaths annually. Health care providers must be cognizant of the purpose and philosophy of quality improvement efforts as they lead the charge for improving health outcomes and patient safety. This Discussion is intended to help you understand how various developments have shaped contemporary perspectives and approaches to promoting health care quality.

By tomorrow 11/28/17, write a minimum of 550 words essay in APA format with 3 references from the list below which addresses the level one headings as numbered below:

Post a cohesive scholarly response that addresses the following:

When “To Err is Human” was published in 1999, it marked an important milestone in Quality Improvement Science.

1) Analyze how this milestone has influenced the health care delivery system and nursing practice.

2) Provide an example from your own work history and experience as to how the patient safety movement has affected your practice. 

Required Readings

Joshi, M.S., Ransom, E.R., Nash, D.B., & Ransom, S.B., (Eds.). (2014). The Healthcare Quality Book, 3rd ed. Chicago, IL: Health Administration Press.

• Chapter      1: “Healthcare Quality and the Patient”
• Chapter      2: “Basic Concepts of Healthcare Quality”

Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds). (2000). To err is human: Building a safer health system. Washington, D.C.: National Academy Press. 

Executive summary: Released in 1999, this groundbreaking report provides the rationale for implementing comprehensive improvements in patient safety, an important subset of health care quality. Although only the executive summary is required this week, you are strongly encouraged to read additional sections of this report as you proceed through the course.

Institute of Medicine, Committee on Quality of Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press. 

Executive summary: This report was published by the Institute of Medicine in 2001 to highlight the significant gap between the state of health care quality and where it should be. The report draws attention to the need to improve the U.S. health care delivery system as a whole, and identifies six areas for improvement: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Although only the executive summary is required this week, you are strongly encouraged to read additional sections of this report as you proceed through the course.

Wachter, R. M. (2010). Patient safety at ten: Unmistakable progress, troubling gaps. Health Affairs, 29(1), 165–173.

This article presents an analysis of progress in patient safety since the publication of the IOM report, To Err is Human. As you read this article, evaluate the author’s critique, and consider recent developments that continue to shape patient safety efforts in health care.

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Organizational and systems leadership for quality improvement: Concepts of quality and patient safety. Baltimore: Author. 

This video examines the recent history of the quality improvement movement, including two pivotal IOM reports, To Err is Human and Crossing the Quality Chasm. Dr. Donald Berwick introduces six dimensions of quality: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Other topics addressed include transparency, the prevention of adverse events, and the usefulness of international comparisons for quality assessment and improvement.