Assignment 2-Practicum Journal Entry

Assignment 2-Practicum Journal Entry

Analyze salient ethical issues in psychiatric mental health practice

Compare ethical dilemmas with state health laws and regulations

Analyze ethical decision-making processes Assignment 2-Practicum Journal Entry

To prepare:

Review literature for moral/ethical issues encountered by a PMHNP.

Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Write a 2-page paper in which you do the following:

Summarize the moral/ethical issue in the article (no more than 1 paragraph).

Describe the moral and ethical dilemmas surrounding the issue.

Analyze the ethical issue and compare them to the state health laws and regulations in your state.

Outline the process of ethical decision making you would use to address this ethical dilemma.

Analyzing an Ethical Decision

A summary of the moral/ethical issue in the article

Zheng, C., Li, S., Chen, Y., Ye, J., Xiao, A., Xia, Z., Liao, Y., Xu, Y., Zhang, Y., Yu, L., Wang, C., & Lin, J. (2019). Ethical consideration on use of seclusion in mental health services. International Journal of Nursing Sciences, 7(1), 116-120.

Seclusion is commonly utilized as a coercive intervention in psychiatric settings, but the intervention is surrounded by several ethical issues. In mental health services, seclusion is defined as involuntary isolation of a person posing disruptive or aggressive behavior in limited spaces, like a closed area or a secured room. Although seclusion is clinically aimed at preventing an aggressive patient from causing harm to self or others, mental health providers should pay more attention to how seclusion n adversely affects patients.  The utilization of seclusion causes unanticipated emotional burden toward both the medical personnel and the patient, such as negative experience, panic, and traumatic experience.  Also, the clinical use of seclusion deteriorates the relationship between the nurse and the patient by causing a feeling of distrust in patients (Zheng, et al., 2019). Assignment 2-Practicum Journal Entry


Moral and ethical dilemmas surrounding seclusion

The ethical and moral dilemmas that PMHNPs encounter regarding seclusion relates to the bioethical principles of respect for patients’ autonomy, beneficence, and nonmaleficence. Autonomy is the ability of individuals to make decisions according to personal values. Zheng, et al. (2019) indicate that when secluding patients, psychiatric nurses assume the responsibility of protecting the patients from harming themselves or others, but at times such protection is against the will of the patients. Additionally, autonomy is a coercive intervention that is against patient-centered care, since is against the will of patients and negatively affects patients.

Beneficence involves the execution of measures to benefit patients.   According to Zheng et al. (2019),  seclusion is intended to guarantee patients’ safety. Nevertheless, there is an ethical dilemma for nurses when performing seclusion regarding the way to balance the interest of the aggressive person and other individuals.   When dealing with aggressive patients, it is necessary and reasonable for nurses to conduct seclusion, but seclusion should be carried out in a less harmful way.

Nonmaleficence implies no harm, which requires psychiatric nurses to balance side effects and therapeutic goals. From this aspect, there is a conflict between the non-maleficence principle and applying seclusion. Nevertheless, seclusion aims at ensuring patients’  safety, which corresponds to the principle of non-maleficence and beneficence.  Thus, the ethical dilemma is the way to balance the therapeutic goal and the adverse effects of seclusion. Nurses should ensure that the therapeutic object of seclusion outweighs its side effects (Zheng et al., 2019).

Analyzing seclusion and comparing it to the state health laws and regulations in my state

The clinical use of seclusion is intended to lessen injury caused by disruptive and aggressive behavior. Although seclusion breaches patient’s will, it is a crucial intervention that guarantees the safety of both medical personnel and patients.  Under Colorado state law, a health facility or hospital might only apply seclusion in cases of emergency as defined in section 26-20-102(3), C.R.S.  and if there is an imminent, probable, or serious threat to bodily harm to others or self and after other less restrictive alternatives have failed or after it has been determined that such alternatives would be unsuccessful or inappropriate under the situations. An agency or facility that utilizes seclusion should use seclusion only for preventing the renewal or continuation of emergency and only for a duration required to accomplish its purpose.  Seclusion should never be utilized as a disciplinary sanction or punishment; as a scheme of coercion by medical personnel and for the convenience of medical personnel (Crisis Prevention Institute, 2020).Assignment 2-Practicum Journal Entry

The process of ethical decision making I would use to address the ethical dilemma

The ethical decision-making process will be based on my knowledge and experience and guided by ethical principles of autonomy, beneficence, and non-maleficence.  The process of decision-making will begin with assessing if it is appropriate to seclude the patient, followed by making the actual decision.  I would assess the patient’s condition to establish if she/he poses a serious threat of harming self or others. When it is apparent that the patient can harm self or others, and when other interventions that are less restrictive will be inappropriate or ineffective, I will apply seclusion.


Crisis Prevention Institute. (2020). Colorado Regulation Rewriting Existing Chapter of Standards for Hospitals and Health Facilities 6CCR 1011-1 Chapter 2.

Zheng, C., Li, S., Chen, Y., Ye, J., Xiao, A., Xia, Z., Liao, Y., Xu, Y., Zhang, Y., Yu, L., Wang, C., & Lin, J. (2019). Ethical consideration on use of seclusion in mental health services. International Journal of Nursing Sciences, 7(1), 116-120. doi: 10.1016/j.ijnss.2019.10.001

Assignment 2-Practicum Journal Entry