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Ethical and Legal Issues in the Delivery of Nursing Care and Mental Health Jeffrey B. Viernes NURS 220: Health and Illness 1- Spring 2012 March 27, 2012 Sally Tazelaar, MSN, RN

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Ethical and Legal Issues in the Delivery of Nursing Care and Mental Health Todays health care system is surrounded with multitude of ethical issues and dilemmas that health care professionals face on a daily basis. The various ethical issues that medical team encounter in every clinical setting frequently lead to nurses moral distress. Nurses in particular faces day-to-day ethical challenges in delivering quality nursing care. In a medical viewpoint, ethical and legal issues include significant standards that must be followed by health care professionals during the care of the clients. Through research, Ulrich et al. (2010) claimed that the most frequently occurring ethical issues affecting the delivery of nursing care are protecting patients rights, patients confidentiality or right to privacy, end of life decision making, and autonomy and informed consent to treatment. In most occasions, ethical dilemmas can frequently arise in the psychiatric setting. Patients suffering from mental disorders are particularly involved in various ethical issues because most of them lack the ability to reason and decide for themselves. Nurses who work in the psychiatric setting are responsible for practicing ethically unbiased nursing actions to provide the highest quality level of care. Along with the advancement of medical science and technology, the health care system is contemporarily facing one of the biggest issues in the health care field, that is patients privacy. Even though computerization of patients medical records improves the accessibility of data, there is a greater possibility of threat to patients privacy and confidentiality. According to the article written by Love (2011), As our society becomes more technical, the issues arises as to who may have the right to access the patients information, and what information, if any a physician can disclose. Nurses play a very important role in protecting the patients right to privacy by controlling the dissemination of personal information to authorized personnel only. Violating the patients right to privacy disrupts the nurse-client relationship and trust.

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Another issue affecting the delivery of care is informed consent to treatment. According to a study included in The American Journal of Surgery (2009), in order for patients to efficiently exercise their right to voluntarism, provision of adequate information is an important prerequisite in the process of informed consent. Paul Clark (2007) also stated that patients must be given a clear explanation of the patients condition and any proposed treatments as well as any potential benefits and risk in order to achieve informed, autonomous treatment decision. In order for a competent individual to sign the informed consent without coercion, it is the physicians duty to provide appropriate information regarding the medical procedure to be performed. Another health care ethical issue that poses challenge to health care professionals is the end of life decision-making. The population of patients suffering from chronic illnesses continues to incline dramatically, however with the advantages of advance technology, life can be supported and prolonged. Critically ill patients are commonly unable to think and participate in decisions, as they may be sedated, intubated, or ventilated with life sustaining devices. Life sustaining devices in some instances provides beneficial therapy for the patient. In contrast, many patients deteriorate and fail to survive even with the presence of this equipment. As a health care provider, we still need to ensure the continuity on the delivery of care for people who are terminally ill to maintain clients dignity. Mentally incompetent patients are subjected to various ethical dilemmas that continuously pose challenge to the health care providers. Among this ethical dilemmas are discrimination, protection of patients rights, autonomy, and confidentiality. Patients with Alzheimers disease, schizophrenia, bipolar disorder, and other mental disorders affecting the human population are examples of people that may be subjected to such ethical and legal issues.

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Friendship House is a voluntary clubhouse-modeled program for adults with serious mental and behavioral illnesses. The main purpose of this psychiatric rehabilitation program is to integrate the members back into the community, allowing them to become self sufficient and productive members of our society. One ethical issue that caught my attention was the possibility of violating members rights to privacy and confidentiality. Patients medical records and information were virtually compiled in their computers at their office. However, each member can access these computers and can have the possibility to open confidential documents and information. The staffs need to balance their own ethical beliefs while establishing a safe place for all the members. They must be able to acknowledge patients rights to confidentiality and informed consent to maintain the nurse-client relationship. The sky rocketing cost of care to patients with cognitive disabilities also poses ethical dilemma. According to David Jordan, a vocational coordinator of the Friendship House, although they want to become a member, they cannot join if they are not registered with Kauai Community Mental Health Center and referred by someone by the center, or if they do not have medical coverage. Legal and ethical issues play an important role in the health care system. These issues that currently exists in the health care system include the protection of patients rights, promotion of autonomy, and the consent to treatment. Health care providers are continuously being challenged with what is ethically right and wrong to do in these ethical dilemmas surrounding the health care system. The primary role of nurses in such ethically challenging situations is often to be patients advocate in a nonpaternalistic manner. Health care providers are responsible for ensuring that each client mentally competent or not should have equal access to healthcare services to meet their needs as well as maintaining the stability of their own ethical belief system.

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References Clark, P. A. (2007). Intensive care patients evaluations of the informed consent process. Dimensions of Critical Nursing, Volume 26(5), 207-209. Retrieved from http://www.stritch.luc.edu/depts/bioethics/Files/pdf/Informed Consent - Clark.pdf Falagas, M., Korbilla, I., Giannopoulou, K., Kondilis, B., & Peppas, G. (2009). Informed consent: how much and what do patients understand?. The American Journal of Surgery, Volume 198(3), 420-435. Retrieved from http://www.cinj.org/documents/InformedConsentahowmuchandwhatdopatientsunderstan d.pdf Love, J. (1996). Who should have access to your medical record? Privacy protection or legalized prowling?. Business And Health, 14(2), 59-60.

Ulrich, C. M., Taylor, C., Soeken, K., O'Donnell, P., Farrar, A., Danis, M., & Grady, C. (2010). Everyday ethics: ethical issues and stress in nursing practice. Journal Of Advanced Nursing, 66(11), 2510-2519. doi:10.1111/j.1365-2648.2010.05425.x