The document discusses holistic patient care in psychiatry. It defines holistic care as considering biological, psychological, social, and spiritual aspects to gain a deeper understanding of mental health conditions. The biopsychosocial model views mental health issues as resulting from a combination of biological, psychological, and social factors. Implementing holistic care includes comprehensive assessments, interdisciplinary collaboration, personalized treatment plans, and evidence-based interventions. This leads to improved outcomes, patient satisfaction, and empowerment.

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Ethical and Legal Issues in Psychiatric/
Mental Health Nursing
Chapter 5

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Introduction
• Holistic patient care recognizes the
interconnectedness of physical, mental,
emotional, and social well-being.
• Essential in psychiatry due to the complex
nature of mental illnesses.

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Definition of Holistic Patient Care
• In psychiatry, holistic care considers biological,
psychological, social, and spiritual aspects.
• Offers a deeper understanding of mental
health conditions and personalized treatment.
• Acknowledges that mental health is
influenced by multiple dimensions.

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The Biopsychosocial Model
• The biopsychosocial model considers biology,
psychology, and social factors.
• Mental health issues result from a
combination of these factors.
• Helps in understanding and treating
underlying causes effectively.

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Components of Holistic Patient Care
 Biological Dimension
• Focuses on physical health, medication, and
lifestyle's impact on mental health.
• Includes medical assessments, monitoring for drug
interactions, and lifestyle considerations.

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Ethical Considerations
 Psychological Dimension
• Addresses mental health conditions and emotional
well-being.
• Involves assessments, psychotherapy, and
evidence-based treatments for mental health
disorders.

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Ethical Considerations (cont.)
Social Dimension:
• Impact of social factors on mental health
Assessment of social support systems and family
dynamics
• Consideration of cultural influences on well-
being
• Tailored treatment plans based on social
context

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Ethical Considerations (cont.)
 Spiritual Dimension:
• Acknowledgment of beliefs and values in mental
health
• Incorporation of spirituality as a coping
mechanism
• Integration of mindfulness or meditation
• Supportive discussions on existential questions

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Benefits of Holistic Patient Care in
Psychiatry
• Improved treatment outcomes and patient
satisfaction
• Enhanced overall well-being and quality of
life
• Increased engagement and empowerment
in the treatment process
• Comprehensive understanding of patients'
needs and personalized care

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• Holistic patient care considers the social and
spiritual dimensions
• Tailored treatments lead to improved
outcomes and patient satisfaction
• Active patient engagement fosters
empowerment and adherence
• Comprehensive understanding allows for
personalized care based on individual
circumstances.

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Implementing Holistic Patient Care
1.Collaborative and Interdisciplinary Approach
 Objective: Ensure a comprehensive approach to
patient care.
 Strategy:
• Foster collaboration among healthcare professionals.
• Include psychiatrists, psychologists, nurses, social workers, and
specialists.
• Develop comprehensive treatment plans leveraging diverse
expertise.

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A Model for Making Ethical Decisions
 2.Comprehensive Assessments
 Objective: Establish a foundation for holistic
understanding.
 Strategy:
• Conduct thorough medical and psychiatric evaluations.
• Perform psychosocial assessments for social context.
• Consider cultural factors for culturally competent care.
• Address individual needs across various dimensions.

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Ethical Issues in Psychiatric Mental
Health Nursing
3. Tailoring Treatment Plans
 Objective: Provide personalized care.
 Strategy :
• Integrate information from comprehensive
assessments.
• Develop personalized plans considering lifestyle
modifications, psychotherapy, pharmacology, and
social support services.

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Legal Considerations
 4. Incorporating Evidence-Based
Interventions
 Objective : Ground holistic care in proven
practices.
 Strategy :
• Integrate interventions scientifically
validated for physical and mental health.
• Focus on improving patient outcomes.

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Classifications Within Statutory and
Common Law
• Civil law protects the private and property
rights of individuals and businesses.
– Torts
– Contracts
• Criminal law provides
protection from conduct
deemed injurious to the
public welfare.

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Legal Issues in Psychiatric Mental
Health Nursing
• Confidentiality and Right to Privacy
- HIPAA
- Doctrine of privileged communication
- Exception: A duty to warn
• Informed Consent
• Restraints and Seclusion
- False imprisonment

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
• Commitment Issues
– Voluntary admissions
– Involuntary commitments
• Emergency commitments
• The mentally ill person in need of treatment
• Involuntary outpatient commitment
• The gravely disabled client

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
Nursing Liability
• Malpractice and negligence
• Types of lawsuits that occur in psychiatric
nursing
—Breach of confidentiality
—Defamation of character
• Libel
• Slander

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
Nursing Liability (cont.)
• Invasion of privacy
• Assault and battery
• False imprisonment

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
2. As a last resort, an agitated, physically aggressive
client is placed in four-point restraints. The client
yells, “I’ll sue you for assault and battery.” The unit
manager determines that the nurses are protected
under which condition?
A. The client is voluntarily committed and poses a
danger to others on the unit.
B. The client is voluntarily committed and has a history
of being a danger to others.
C. The client is involuntarily committed because of a
history of violent behavior.
D. The client is involuntarily committed and is refusing
treatment.

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
• Correct answer: A
– As a threat to others, the client can be restrained
despite objections and voluntary commitment.

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
3. A nurse gave a client 5 mg of haloperidol
(Haldol) for agitation. The client’s chart was
clearly stamped “Allergic HALDOL.” The client
suffered anaphylactic shock and died. How
would the nurse’s actions be labeled?
A. Intentional tort
B. Negligence
C. Battery
D. Assault

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Legal Issues in Psychiatric Mental
Health Nursing (cont.)
• Correct answer: B
– The nursing action was an unreasonable and
careless act. The nurse was negligent and could
be held liable for the client’s death.

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Avoiding Liability
• Respond to the client.
• Educate the client.
• Comply with the standard of care.
• Supervise care.
• Adhere to the nursing process.
• Document carefully.
• Follow up as required.
• Develop and maintain a good interpersonal
relationship with client and family.