NR 326 Exam 1 Active Learning Template

Student Name

Chamberlain University

NR-326: Mental Health Nursing

Prof. Name

Date

Actions the Nurse Should Take to Prevent Lawsuits

Nurses play a critical role in preventing legal actions by adhering to both ethical principles and legal standards of practice. The foundational ethical principles in nursing include autonomy, beneficence, justice, and nonmaleficence.

Autonomy emphasizes the patient’s right to make healthcare decisions based on personal beliefs and values. Nurses must respect these choices, even if they differ from professional recommendations.

Beneficence requires that nurses act with compassion and actively promote the well-being of patients, focusing on interventions that are in their best interest.

Justice ensures equitable treatment of all patients, regardless of gender, religion, age, insurance status, or sexual orientation. Nurses must consistently provide care without bias or discrimination.

Nonmaleficence underscores the principle of “do no harm,” guiding nurses to avoid actions that could cause physical, emotional, or psychological damage to patients.

In addition to ethical principles, nurses must understand key legal concepts:

Assault: The act of causing a patient to fear unwanted physical contact.
Battery: Actual non-consensual physical contact.
False imprisonment: Confinement of a patient without legal authority, such as restraining a voluntary patient against their will.

Legal Issues in Psychiatric Nursing

Confidentiality

Patient confidentiality is essential in psychiatric nursing. Disclosure of patient information outside the treatment team requires written consent. In emergencies, if information is shared without consent, documentation must include:

Documentation Requirement	Example
Date of disclosure	March 10, 2024
Recipient	Law enforcement
Reason for disclosure	Patient posed immediate threat
Reason written consent not obtained	Patient unconscious
Specific information disclosed	Details of suicidal plan

Medical Records

Medical records are a vital component in defending against malpractice claims. Nurses should ensure documentation is objective, specific, and nonjudgmental. Comprehensive records should include detailed care plans, interventions, patient responses, and evaluations.

Duty to Warn

Nurses and healthcare workers have a legal obligation to report threats of harm to the psychiatrist or treatment team. Failure to report potential danger may result in claims of negligence or criminal liability.

Informed Consent

Informed consent is a cornerstone of patient autonomy. Patients must receive clear, written information about their treatment, understand risks and benefits, and be aware of available alternatives. Exceptions include situations where:

The patient is mentally incompetent and treatment is necessary to preserve life.
Refusal of treatment endangers others.
Consent is obtained from a legal guardian.

Patients can withdraw consent at any time, and this decision must be respected.

Restraints and Seclusion

Restraints are a last resort and should only be used when less restrictive interventions fail. Proper staff training is essential, and restraints should be discontinued as soon as possible. Renewal intervals are age-specific:

Age Group	Renewal Interval
Adults (18+)	Every 4 hours
Children (9–17)	Every 2 hours
Children (<9)	Every 1 hour

Voluntary and Involuntary Hospitalization

Voluntary admission occurs when a patient requests services and can leave at any time unless deemed a danger to self or others.

Involuntary admission follows legal protocols, typically when a patient is suicidal, homicidal, or gravely disabled.

Emergency commitment may be initiated for dangerous behavior, usually lasting up to 72 hours, after which a court hearing determines whether further hospitalization is necessary.

Types of Lawsuits in Psychiatric Nursing

Nurses may face legal action for breaches in care or ethical standards:

Legal Issue	Example
Breach of confidentiality	Revealing patient case details without consent
Defamation (libel/slander)	Making harmful written or spoken statements about a patient
Invasion of privacy	Searching a patient without probable cause

Phases of the Nurse-Client Relationship

Phase	Description	Example
Preinteraction	Nurse gathers information and reflects on personal biases	Reviewing patient medical records before the first meeting
Orientation	Trust and rapport are established	Collaboratively setting treatment goals with the patient
Working	Goals are addressed; resistance is managed	Exploring coping strategies and implementing interventions
Termination	Review of progress and discharge planning	Summarizing patient achievements and discussing follow-up care

Types of Therapeutic Communication

Effective therapeutic communication requires rapport, trust, and empathy:

Rapport: Mutual acceptance and trust (e.g., showing genuine interest in patient concerns).
Trust: Confidence in the nurse’s reliability and consistency (e.g., following through on promises).
Empathy: Understanding a patient’s perspective without losing professional objectivity.
Veracity: Honest and transparent communication.
Manipulation: Occurs when a patient attempts to avoid separation or control the relationship.

Common Psychiatric Medications

Phenothiazines – First Generation Antipsychotics

Phenothiazines and haloperidol are effective in treating schizophrenia and other psychotic disorders. These medications reduce positive symptoms, such as hallucinations and delusions, but may exacerbate negative symptoms like apathy or social withdrawal. Their introduction significantly advanced mental health treatment and patient care outcomes.

Zoloft (Sertraline)

Zoloft is a selective serotonin reuptake inhibitor (SSRI) used to treat obsessive-compulsive disorder (OCD).

Dosage: 50–100 mg daily (higher doses for OCD)
Side effects: Sleep disturbances, headaches, restlessness

Stress and the Autonomic Nervous System

Stress activates the autonomic nervous system, specifically the sympathetic and parasympathetic divisions. The hypothalamic-pituitary-adrenal (HPA) axis and sympathetic adrenomedullary system mediate physiological responses, triggering a fight-or-flight response that includes pupil dilation, increased cardiac output, and elevated blood pressure.

Conversion Disorder (Somatic Symptom Disorder)

Conversion disorder presents with physical symptoms lacking organic cause, often linked to psychological conflict. Common manifestations include aphonia, anosmia, or pseudocyesis, particularly in young women.

Nursing interventions:

Encourage emotional expression.
Provide health education and coping strategies.
Support patient in accepting the diagnosis to facilitate recovery.

Anger vs. Aggression

Concept	Definition
Anger	Emotional response to frustration, hurt, or fear; may lead to health problems if suppressed
Aggression	Behavior intended to threaten or injure another’s self-esteem or safety

Cognitive Therapy

Cognitive therapy helps patients identify dysfunctional thought patterns and modify behaviors. It is effective in treating depression, anxiety, OCD, PTSD, bipolar disorder, eating disorders, and schizophrenia. Successful therapy involves monitoring thoughts, linking them to behaviors, and observing symptom reduction.

Lithium

Lithium is a mood stabilizer used in bipolar disorder management.

Therapeutic range: 0.6–1.2 mEq/L
Monitoring: Serum levels checked 12 hours after last dose
Toxicity risks: Increased with sodium depletion; decreased effectiveness with excess sodium
Early toxicity signs: Vomiting, diarrhea

Involuntary vs. Voluntary Commitment

Commitment Type	Key Features
Voluntary	Patient consents to treatment and may request discharge
Involuntary	Patient is dangerous, mentally ill, or gravely disabled; admission follows legal protocols

Types of Amnesia

Type	Definition
Localized	Inability to recall events from a specific period
Selective	Recalls only certain events
Generalized	Loss of entire identity and history
Retrograde	Inability to recall events preceding trauma

Guided Imagery

Guided imagery combines deep breathing, mindfulness, and visualization to reduce anxiety. Therapists may also use Socratic dialogue to help patients examine and restructure dysfunctional thinking patterns.

Obsessive-Compulsive Disorder (OCD)

OCD is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) that impair daily functioning. Patients are encouraged to identify triggers and implement relaxation or exercise techniques to manage anxiety and break the compulsive cycle.

Defense Mechanisms

Mechanism	Definition
Compensation	Using strengths to offset weaknesses
Rationalization	Justifying behavior with logical reasons
Denial	Refusal to accept reality
Reaction formation	Acting contrary to true feelings
Displacement	Redirecting emotions toward a safer target
Regression	Reverting to earlier developmental behaviors
Identification	Adopting traits of admired individuals
Intellectualization	Using logic to distance from emotions
Sublimation	Channeling impulses into socially acceptable actions
Introjection	Internalizing others’ values
Suppression	Consciously dismissing unwanted thoughts
Isolation	Separating emotion from events
Undoing	Counteracting guilt through reparative behavior
Projection	Attributing personal faults to others

Electroconvulsive Therapy (ECT)

ECT is a treatment for severe depression, bipolar mania, or treatment-resistant schizophrenia.

Key considerations:

Education: Importance of nutrition and adherence to provider instructions
Medications: Anticholinergics (reduce secretions), anesthetics, muscle relaxants (methohexital, propofol)
Goal: Symptom relief
Side effects: Headache, nausea, confusion, fatigue, memory loss

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.

Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.