Ethics And Professional Practice

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  • Although Aus & Nz college of Mental Health Nurses has developed standards for practice and competencies for advanced practice not yet developed a separate code of ethics for MH nurses Internationally professional nursing organisations have identified the need for a code of ethics to guide practice For interested parties – http://hometown.aol.com/egeratylsw/ethics.html. shows how other organisations have approached ethical codes of practice as well as general info about prof ethics
  • Should be the most fundamental aspect of mental health care delivery under ethical consideration – effects of diagnosis A label often marginalises people from community and jepodises them from regaining social integration Diagnosis is a powerful tool -Used for describing odd or objectionable behaviour or that that is unlawful – in this case the law recognises that mental illness can compromise an individuals free will and can classify them as not legally responsible for their actions – making a diagnosis a positive thing Some of you may consider some behaviours mental illness others may not – psychiatrists diagnosis's sometimes vary Classification systems reflect contemporary beliefs about behaviour rather than objective standards
  • E.g. restraint & seclusion This has meant that acute interventions and containment are the predominant care provided less rehabilitation and comprehensive discharge planning – in this climate patients report boredom and feeling unsafe
  • Rights should include access to effective professional treatment, information concerning side effects, desired effect, contraindications, complications and the freedom to accept or refuse treatment However a patient is able to request a medication review particularly if they are experiencing side effects that are difficult for them to live with
  • If refused a psych has to gain a second opinion
  • Not deemed as treatment but a a management tool by MH Act
  • Now look at scenarios 1-4
  • Ethics And Professional Practice

    1. 1. Ethics and Professional practice <ul><li>Guided by the New Zealand Nurses Organistion (1995) Code of Ethics </li></ul><ul><li>Four Guiding principles of ethical conduct </li></ul><ul><ul><li>Autonomy </li></ul></ul><ul><ul><li>Beneficence </li></ul></ul><ul><ul><li>Non-Maleficence </li></ul></ul><ul><ul><li>Justice </li></ul></ul>
    2. 2. Ethical Issues in Mental health practice <ul><li>Psychiatric Diagnosis </li></ul><ul><li>Effects can cause </li></ul><ul><ul><li>loss of personal freedom </li></ul></ul><ul><ul><li>Imposed medical treatment </li></ul></ul><ul><ul><li>Possibility of being labeled for life </li></ul></ul><ul><li>Consider – </li></ul><ul><ul><li>Who has the right to decide what types of behaviours are mental illness? </li></ul></ul><ul><ul><li>Classification systems differentiate </li></ul></ul>
    3. 3. Psychiatric treatments <ul><li>Nurse-patient relationships considered a core component – but this contact is sometimes limited </li></ul><ul><li>Coercive practices – seen as punishment by nurses </li></ul><ul><li>Worldwide patient length of stay decreased and admission rates increased </li></ul>
    4. 4. Psychopharmacology <ul><li>Drugs prescribed are potent agents </li></ul><ul><ul><li>Often causing major side effects </li></ul></ul><ul><ul><li>Creating problems with toxicity </li></ul></ul><ul><ul><li>Sometimes dependence </li></ul></ul><ul><li>What are a persons rights? </li></ul><ul><li>Rights are limited if under the Mental Health Act </li></ul>
    5. 5. Electroconvulsive therapy <ul><li>Patient can refuse to give consent </li></ul><ul><li>Can then be given under mental health legislation </li></ul><ul><li>Nurses need to ensure that consumers and family are informed of procedure and why consent has been provided </li></ul>
    6. 6. Seclusion <ul><li>Defined as removal of a person to a locked room from which they may not leave, in order that the person may regain control and return to the ward environment </li></ul><ul><li>Not deemed as a treatment </li></ul><ul><li>Enables other treatments – medication or counseling </li></ul><ul><li>Concerns of reports that patients suffer a loss of dignity – a breach of their human rights </li></ul><ul><li>WHO (1996) suggests authorities should pursue the elimination of isolation rooms </li></ul>
    7. 7. Suicidal behaviour <ul><li>Ethical debate centers on the justification for intervening in the persons choice to live or die </li></ul><ul><li>Health care workers have a duty to intervene </li></ul><ul><li>This duty arises from need to abide by the law and moral need to do no harm </li></ul>
    8. 8. Involuntary treatment <ul><li>Places restrictions on the therapeutic nurse-patient relationship </li></ul><ul><li>If hospitalised the nurse can initiate PRN medication, restrain and seclude under medical authority </li></ul><ul><li>Issues of power and control within relationship </li></ul><ul><li>When a person is committed to a mental health facility the major ethical debate centers around legal rights verses moral rights </li></ul>

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