Name
Chamberlain University
NR-326: Mental Health Nursing
Prof. Name
Date
Nurses can prevent lawsuits by adhering to ethical principles and following legal standards of practice. The core ethical principles in nursing are autonomy, beneficence, justice, and nonmaleficence.
Autonomy emphasizes the patient’s right to make healthcare decisions based on personal values and beliefs.
Beneficence requires that nurses act out of compassion to promote well-being.
Justice ensures fair and impartial treatment of all patients, regardless of gender, religion, age, insurance status, or sexual orientation.
Nonmaleficence emphasizes interventions that benefit patients while avoiding harm.
In addition, nurses must understand the following legal terms:
Assault is causing genuine fear of unwanted physical contact.
Battery refers to actual non-consensual touching.
False imprisonment is unauthorized confinement, such as restraining a voluntary patient against their will.
Patient confidentiality requires written consent before sharing health information outside the treatment team. In emergencies, if disclosure occurs, 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 are vital in malpractice cases. Documentation should be objective, specific, and nonjudgmental, including detailed care plans, interventions, and evaluations.
Healthcare workers must report threats of harm to the psychiatrist and treatment team. Failure to report may result in negligence or criminal liability.
Informed consent upholds autonomy. Patients must receive written information, understand risks and benefits, and know available alternatives. Consent is not required when:
The patient is mentally incompetent and treatment is necessary to preserve life.
Refusal endangers another person.
Consent is obtained from a legal guardian.
Consent can be withdrawn at any time.
Restraints should only be used when less restrictive measures fail. Staff must be trained and should discontinue use promptly. Renewal intervals vary by age:
| Age Group | Renewal Interval |
|---|---|
| Adults (18+) | Every 4 hours |
| Children (9–17) | Every 2 hours |
| Children (<9) | Every 1 hour |
Voluntary admission: Patient requests services and may leave at will unless considered a danger to self or others.
Involuntary admission: Follows state/federal law and is justified if the patient is suicidal, homicidal, or gravely disabled.
Emergency commitment: Initiated for dangerous behavior, usually lasting up to 72 hours, after which a court hearing determines further hospitalization.
Nurses may face lawsuits for breaches such as:
| Legal Issue | Example |
|---|---|
| Breach of confidentiality | Revealing case details without consent |
| Defamation (libel/slander) | Written or spoken harmful statements |
| Invasion of privacy | Searching a patient without probable cause |
| Phase | Description | Example |
|---|---|---|
| Preinteraction | Nurse gathers information and self-reflects | Reviewing medical records |
| Orientation | Trust and rapport are established | Setting goals with patient |
| Working | Goals are addressed, resistance managed | Exploring coping strategies |
| Termination | Review of progress, discharge occurs | Summarizing patient’s achievements |
A therapeutic relationship requires rapport, trust, and empathy.
Rapport: Mutual acceptance and trust (e.g., showing genuine interest).
Trust: Confidence in nurse’s reliability (e.g., following through on promises).
Empathy: Understanding the patient’s perspective (without losing objectivity).
Veracity: Being honest in communication.
Manipulation: When a patient tries to avoid separation or control the relationship.
Phenothiazines and haloperidol treat schizophrenia and psychotic disorders. They reduce positive symptoms (hallucinations, delusions) but may worsen negative symptoms (apathy, withdrawal). These medications historically improved patient functioning and advanced mental health research.
The autonomic nervous system mediates stress, involving sympathetic and parasympathetic divisions. The hypothalamic-pituitary axis and sympathetic adrenomedullary system are key. Stress triggers a fight-or-flight response, which may cause pupil dilation, increased cardiac output, and elevated blood pressure.
Zoloft is an SSRI antidepressant approved for OCD.
Dosage: 50–100 mg daily (higher doses for OCD).
Side effects: Sleep disturbances, headaches, restlessness.
This disorder presents with physical symptoms without organic cause, often tied to emotional conflict. Symptoms may include aphonia, anosmia, or pseudocyesis, and are more common in young women. Many cases resolve once the diagnosis is accepted.
Nursing interventions:
Encourage emotional expression.
Provide health teaching.
Teach coping strategies.
| Concept | Definition |
|---|---|
| Anger | Emotional response to frustration, hurt, or fear; may cause health issues if suppressed |
| Aggression | Behavior intended to threaten or injure another’s self-esteem or safety |
Cognitive therapy helps patients identify dysfunctional thinking and change behaviors. It is effective in disorders such as depression, anxiety, OCD, PTSD, bipolar disorder, eating disorders, and schizophrenia. Effectiveness is seen when patients monitor thoughts, link them to behaviors, and experience symptom reduction.
Lithium stabilizes mood in bipolar disorder.
Therapeutic range: 0.6–1.2 mEq/L.
Monitoring: Serum levels measured 12 hours after last dose.
Toxicity risks: Increased by sodium depletion; reduced effectiveness with excess sodium.
Early toxicity signs: Vomiting, diarrhea.
| Commitment Type | Key Features |
|---|---|
| Voluntary | Patient agrees to treatment, may request discharge |
| Involuntary | Patient is dangerous, mentally ill, or gravely disabled; admission follows legal protocols |
| Type | Definition |
|---|---|
| Localized | Cannot recall events from a specific time |
| Selective | Recalls only certain events |
| Generalized | Loss of entire identity and history |
| Retrograde | Cannot recall events before trauma |
Guided imagery involves deep breathing, mindfulness, and visualization to reduce anxiety. Socratic dialogue may be used by therapists to help patients explore dysfunctional thinking patterns.
Obsessive-compulsive disorder involves obsessions, compulsions, or both that impair daily functioning.
Obsessions: Intrusive, irrational thoughts.
Compulsions: Repetitive behaviors to reduce anxiety.
Patients are encouraged to recognize triggers and use relaxation or exercise to break the cycle.
| Mechanism | Definition |
|---|---|
| Compensation | Using strengths to counter weaknesses |
| Rationalization | Justifying actions with excuses |
| Denial | Refusing to accept reality |
| Reaction formation | Acting opposite to true feelings |
| Displacement | Redirecting anger to safer target |
| Regression | Reverting to earlier developmental stage |
| Identification | Adopting admired traits |
| Intellectualization | Using logic to avoid emotion |
| Sublimation | Channeling impulses into acceptable activity |
| Introjection | Internalizing others’ values |
| Suppression | Consciously dismissing thoughts |
| Isolation | Separating emotion from event |
| Undoing | Reducing guilt with reparative action |
| Projection | Attributing one’s faults to others |
ECT is used for severe depression, bipolar mania, or schizophrenia when other treatments fail.
Teaching: Importance of nutrition, following provider instructions.
Medications given: Anticholinergics (reduce secretions), anesthetics, muscle relaxants (methohexital, propofol).
Goal: Symptom relief.
Side effects: Headache, nausea, confusion, fatigue, memory loss.
American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. ANA.
NR 326 Exam 1 Active Learning Template.
Townsend, M. C., & Morgan, K. I. (2018). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.
