Ethical and Legal Practice Flashcards

An RPN is caring for a client who was admitted involuntarily under a provincial Mental Health Act. The client is refusing a prescribed antipsychotic medication, stating, 'I don't need that, I'm not sick.' The client is able to explain the risks and benefits of the medication when asked. What is the RPN's most appropriate and legal first action?

Answer: Document the refusal and notify the psychiatrist to formally assess the client's capacity to make treatment decisions.

Involuntary admission status does not automatically remove a client's right to consent to or refuse treatment. Capacity to make healthcare decisions is specific to the decision at hand and must be formally assessed by a physician or authorized practitioner if there is doubt. The RPN's primary role is to respect the client's refusal, document it thoroughly, and communicate with the prescriber who is responsible for assessing capacity.

A Registered Psychiatric Nurse (RPN) is legally and ethically required to breach client confidentiality in which of the following situations?

Answer: The client discloses a specific, credible threat to cause serious bodily harm to an identifiable person.

The duty to protect (also known as the 'duty to warn') is a legal and ethical obligation that overrides the duty of confidentiality when a client communicates a serious threat of physical violence against a reasonably identifiable victim. The other options do not meet the high threshold required to breach confidentiality without client consent.

An RPN has developed a strong therapeutic rapport with a client over several months. On the day of discharge, the client presents the RPN with an expensive watch, stating, 'You saved my life, and I want you to have this.' What is the most professionally appropriate response?

Answer: Politely decline the gift, explain the professional policy about accepting gifts, and therapeutically explore the client's feelings of gratitude.

Accepting significant gifts can blur professional boundaries, create a potential conflict of interest, and alter the nature of the therapeutic relationship. The most appropriate action is to politely decline while acknowledging the client's intent. This provides an opportunity to reinforce the professional nature of the relationship and explore the client's feelings in a therapeutic manner.

According to most provincial Mental Health Acts in Canada, which right is fundamentally retained by a client upon being involuntarily admitted to a psychiatric facility?

Answer: The right to be informed of the reason for admission and to have access to legal counsel.

A core principle of mental health legislation in Canada is to protect the rights of individuals even when their liberty is restricted. Upon involuntary admission, clients must be informed of the reasons for their detention and their right to challenge it, which includes prompt access to legal counsel and a review panel. Other rights, such as leaving the facility or refusing treatment, are subject to specific restrictions and assessments under the Act.

An RPN has placed a highly agitated client in seclusion as a last resort to prevent imminent harm to others. When documenting this intervention, which element is most critical from a legal and ethical standpoint?

Answer: A detailed description of the less restrictive alternatives attempted and their outcomes.

The principle of 'least restraint' requires that seclusion or restraints are used only after all less restrictive measures have been tried and failed. Legally defensible documentation must clearly show what alternatives (e.g., verbal de-escalation, offering PRN medication, reducing stimuli) were attempted and why they were ineffective, thereby justifying the need for a highly restrictive measure.

An RPN is caring for a competent adult client with severe anorexia nervosa who is refusing a feeding tube despite being medically unstable. The nurse feels a strong duty to preserve the client's life but also knows the client has the right to refuse treatment. This situation creates a conflict between which two primary ethical principles?

Answer: Autonomy and Beneficence

This is a classic ethical dilemma. Autonomy is the principle that respects the client's right to make their own decisions about their healthcare, even if those decisions seem unwise. Beneficence is the principle of acting in the best interest of the client and doing good. In this case, the client's autonomous decision to refuse treatment directly conflicts with the nurse's beneficent intention to provide life-sustaining care.