ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE DISCUSSION
Ethical and Legal Issues: Child and Elderly Abuse Reporting
Both child abuse as well as elderly abuse are quite common. Child abuse refers to when a child is physically, emotionally and/or sexually abused. It can also refer to neglect. For example, if parents of a child do not feed the child properly, it is neglect and can be called child abuse. Child abuse can occur once, or it can appear a pattern of behaviors. Elderly abuse can also be physical abuse, such as hitting or beating up the older adult, and can also be emotional and psychological, such as shouting at the elderly, disrespecting them, etc. Elderly abuse can also be if the caregiver takes advantage of the elderly’s trust in them. Abuse causes harm or distress to the victims. For social workers as well as for medical practitioners, it is important to report abuse if they see a patient or client experience it. However, there are various ethical and legal issues that pertain to both child abuse reporting as well as elderly abuse reporting.
Summaries of Articles
Resnik & Randall (2018) talk about the ethical issues reporting suspected abuse or neglect in children that participate in research. Reporting child maltreatment can include several ethical dilemmas since the rights of the children as well as the rights of their adult caregivers can conflict with each other. Determination of abuse and neglect can also be depicted as socially constructed judgements and they depend on several different circumstances. For example, in some cultures, hitting a child for misbehaving might be culturally acceptable and normal while other cultures might consider it abuse. In this regard, the authors argue that it is important for investigators to report their suspicions of child abuse to Child Protective Services when reporting is legally mandated. The authors also argue that even when reporting is not legally mandated, the investigators still have an ethical obligation to report so that any more maltreatment can be prevented. It is also important to train the staff to be able to recognize any instance of evidence of child abuse or neglect so that such aspects can be appropriately reported to the proper agencies.
Mathews (2019) writes about the diverse ways in which child sexual abuse can be reported. The author talks about how child sexual abuse remains undisclosed for many reasons and people tend to be resistant to change in terms of changing such behaviors. The role of the public in revealing cases of sexual abuse to the authorities is invaluable. Other than that, professionals, such as teachers, social workers, nurses, as well as other medical professionals who come into close contact with children, also play a vital role in such disclosure. Many ways in which the duties to disclose cases of child sexual abuse can take place and describe several legal duties that exist in civil law, child protection law, and criminal law. Some of these duties apply to all the citizens, while others are only applicable to managers in organizations, and others to professionals who tend to deal with children in their work. These duties must be used to ensure that the cases are detected as soon as possible, as well as to prevent such cases from happening in the first place. Therefore, even though it is the ethical duty of the citizens and other publics to report child sexual behavior, it is also the legal duty for many to do the same.
Saghafi et al. (2019) examines the ethical challenges in managing elder abuse. The authors talk about how elder abuse can result in many ethical issues for the caregivers and they conducted a systematic review to find that even though elder abuse is quite common, there is no common definition as well as there being no legislation related to elder abuse. The ethical principles related to the reporting of elder abuse were also found to be different from community to community and was based on the ethical and legal understanding of elder abuse within that community. The main reason why there are no common definitions and legislations for elder abuse is because of cultural and religious differences. This is something that can be problematic in providing protection for the rights of elderly people. Nevertheless, it is important for the healthcare professionals to report elder abuse if they suspect it, as that is the ethical thing to do ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE DISCUSSION.
Application of Information to Clinical Practice
The aforementioned information from the three articles can be applied to clinical practice in several diverse ways. For example, it is important for the clinicians to be able to recognize signs of abuse in both children and elder patients. Moreover, signs of sexual abuse in children should also be recognized. This is something that can be done by providing the clinicians with the appropriate training to recognize such signs. Once these signs have been identified and confirmed, it is the ethical duty of the clinicians to report the abuse to the relevant authorities. In some cases, it would be legally mandated; however, even if it is not, it is the ethical duty to report them so that the abuse can be stopped, and protection be provided to the victims. Even though some aspects of abuse can be socially constructed, there are some obvious forms of abuse that are universally accepted as abuse, such as child sexual abuse, which is why such actions must always be absolutely reported to the relevant authorities.
Mathews, B. (2019). A taxonomy of duties to report child sexual abuse: Legal developments
offer new ways to facilitate disclosure. Child Abuse & Neglect, 88, 337–347. https://doi.org/10.1016/j.chiabu.2018.12.003Links to an external site.
Resnik, D. B., & Randall, D. C. (2018). Reporting suspected abuse or neglect in research
involving children. Journal of Medical Ethics, 44(8), 555. https://doi.org/10.1136/medethics-2017-104452Links to an external site.
Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019).
Examining the ethical challenges in managing elder abuse: A systematic review. Journal of Medical Ethics and History of Medicine, 12. https://doi-org/10.18502/jmehm.v12i7.1115
Advanced practice nursing in all specialties is guided by codes of ethics that put the care, rights, duty, health, and safety of the patient first and foremost. PMHNP practice is also guided by ethical codes specifically for psychiatry. These ethical codes are frameworks to guide clinical decision making; they are generally not prescriptive. They also represent the aspirational ideals for the profession. Laws, on the other hand, dictate the requirements that must be followed. In this way, legal codes may be thought to represent the minimum standards of care, and ethics represent the highest goals for care.
For this Discussion, you select a topic that has both legal and ethical implications for PMHNP practice and then perform a literature review on the topic. Your goal will be to identify the most salient legal and ethical facets of the issue for PMHNP practice, and also how these facets differ in the care of adult patients versus children. Keep in mind as you research your issue, that laws differ by state and your clinical practice will be dictated by the laws that govern your state.
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
Briefly identify the topic you selected. Then, summarize the articles you selected, explaining the most salient ethical and legal issues related to the topic as they concern psychiatric-mental health practice for children/adolescents and for adults. Explain how this information could apply to your clinical practice, including specific implications for practice within your state. Attach the PDFs of your articles.
Read a selection of your colleagues’ responses.
Respond to at least two of your colleagues on 2 different days by sharing cultural considerations that may impact the legal or ethical issues present in their articles.
Ethical and Legal Foundations of PMHNP Care Across Lifespan
The legal principle of duty to protect involves the duty to warn victims of potential threats by the patient. PMHNPs have to protect third parties from potential harm. The legal implications of this principle are in the breach of the patient’s right to confidentiality. Depending on the laws of every jurisdiction, PMHNPs are protected against breach of privacy when attempting to protect third parties from harm (Chapman et al., 2019). The patient has to precisely identify their intended victim, relay their intentions of causing damage, and have a history of violence.
The ethical consideration on duty to warn adults is fidelity and honesty. Nurse practitioners must protect the intended victims through an honest approach to the situation (Barloon & Hilliard, 2016). The judgment that the nurse makes depends on their moral reasoning and perspective. Adult patients have a right to confidentiality that may be considered unethical if breached. The patient may lose trust in the practitioners and refrain from seeking psychological help. It will, however, prevent the loss of life that may also be attributed to negligence on the part of the nurse practitioner.
The ethical considerations for children are the right to make sensible decisions. The children in question may be minors who intend to cause harm to others. To avoid legal implications, the PMHNP must inform the intended victim and other authority figures in the child’s life. The law will protect the nurse practitioner since the child cannot make sensible decisions (Kumar et al., 2020). The duty to warn is an ethical principle that the practitioners must follow and judge from them.
The legal consideration of the adult patient concerning the duty to warn is the breach of the right to confidentiality. The adult patient may have a history of violence that puts the third party and others at risk. The practitioner may bear the legal implication when they fail to warn the intended victim. The consideration for children also lies in their inability to distinguish right from wrong and end up putting others at risk. For example, the Tarasoff decision in the 1970s established that the practitioner has to protect the intended victim from harm (Barloon & Hilliard, 2016). The case involved a college student who murdered another student after telling their therapist about it, and the therapist failed to take any action. In this case, the practitioner would be liable and answerable to the law for failing to uphold their duty to protect ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE DISCUSSION.
Massachusetts state passed a law that allowed nurse practitioners to work on their own. The ethical and legal considerations for PMHNP practice must be upheld to avoid legal liabilities. Nurses must be aware of their practice’s legal requirements that will guide their decisions when handling patients. The mandate to work independently allows them to make informed decisions alone (Balestra, 2018). Ethical principles ensure that the best services are offered to patients honestly while adopting best practices. The legal principles enable the PMHNP to work within the law while respecting the patient’s rights.
The scope of practice, as guided by state laws, allow PMHNPs to diagnose, treat, order diagnostic tests, and offer prescriptions without physician supervision. The licensure authority of the State Board of Nursing supports this since there is increased demand for PMHNPs (Balestra, 2018). The legal and ethical considerations that guide the practice of PMHNP will be of great use in the health sector. The ability of nurse practitioners to understand their duties and perform them ethically and according to the law will ensure effective healthcare delivery for mental health patients. It will foster collaboration and partnership among PMHNPs, the legal system, and other regulatory agencies.
chapman2019.pdf Download chapman2019.pdf
kumar2020.pdf Download kumar2020.pdf
Balestra, M. L. (2018). Liability Risks for Psychiatric Mental Health Nurse Practitioners. The Journal for Nurse Practitioners. doi: 10.1016/j.nurpra.2018.08.005.
Barloon, L. F., & Hilliard, W. (2016). Legal Considerations of Psychiatric Nursing Practice. Nursing Clinics of North America, 51(2), 161–171. DOI: 10.1016/j.cnur.2016.01.002.
Chapman, S. A., Toretsky, C., & Phoenix, B. J. (2019). Enhancing Psychiatric Mental Health Nurse Practitioner Practice: Impact of State Scope of Practice Regulations. Journal of Nursing Regulation, 10(1), 35–43. doi:10.1016/s2155-8256(19)30081-x
Kumar, A., Kearney, A., Hoskins, K., & Iyengar, A. (2020). The role of psychiatric mental health nurse practitioners in improving mental and behavioral health care delivery for children and adolescents in multiple settings. Archives of Psychiatric Nursing. doi:10.1016/j.apnu.2020.07.022.
Child and Elder abuse
As healthcare professionals we take an oath to have ethical obligation to the population we serve. To avoid conflicts or dilemmas there are organizations including the American Psychological Association, The American Counseling Association, and the American Evaluation Association all have published ethical guidelines to follow relevant to the policy evaluation (Milstead & Short, 2019). The American Academy of Child and Adolescent Psychiatry (AARP)recognizes that a code of ethics cannot anticipate all circumstances, but instead cover the dynamic entity that is likely needed for modification (AACP, 2014).
Child maltreatment can include all kinds of abuse and neglect that is a concern. One in every five children in the United States has been a victim of child maltreatment. On a federal law level child abuse and neglect means at a minimum any recently act or failure to act on part of a parent or caretaker that results in death, serious physical or emotional harm, or sexual abuse (Sadock et al., 2015). Child abuse is a serious crime in the state of Arkansas incidents include abandonment, extreme and repeated cruelty that is non-justifiable including discipline a child by striking on the face or with a closed fist or shaking a child should be reported to the Department of Human Services and is a class C misdemeanor (findlaw.com, 2016). Personally, I have reported several cases to Child Protective Services (CPS) due to abuse and neglect.
Elder abuse can be a little bit trickier to report. An estimated 10 percent of persons above 65 years old are abused (Sadock, et al., 2015). While it can be thought of as elder abuse as hitting, slapping or kicking; Elder abuse is also considered withholding medications, food, or clothing. While in the hospital setting it can be a little bit more difficult for the nurses to assess for elder abuse especially because the patient is usually reluctant to disclose mistreatment if their caregiver is their family member (Harrrison, et al., 2022). In a home health setting it is easier to assess for elder abuse, I personally have reported a patient’s family member to the ethical board because I believed with my whole heart that they were keeping their mother alive for the Social Security Disability check they collected every month. Without their mother’s money they would not be able to pay their bills. Again, both the victim and the perpetrator tend to diminish or deny any accusations of abuse, but if found true there is assistance and interventions such as proving legal services, housing, medical assistance, and social services (Sadock, et al., 2015).
I think as healthcare professionals it is learned from the beginning to assess the situation within minutes of walking into a room. As the professional it is noted that we can feel and see things others may not sense. I believe child and elder abuse happens more than what we know due to the dilemma of not the victim not wanting to report the abuse or get their loved ones in trouble.
Adult maltreatment. Arkansas Department of Human Services. (2021, August 6). Retrieved December 6, 2022, from https://humanservices.arkansas.gov/divisions-shared-services/aging-adult-behavioral-health-services/adult-protective-services/adult-maltreatment/
Arkansas Child abuse laws. Findlaw. (2016, June 21). Retrieved December 6, 2022, from https://www.findlaw.com/state/arkansas-law/arkansas-child-abuse-laws.html
Code of ethics – AACAP. (2014, September). Retrieved December 7, 2022, from https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_portal/aacap_code_of_ethics_2012.pdf
Harrison, G., De Ruiter, A. M., Masters, A. G., Jamieson, S. L., & Wilson, J. (2022). Nurses’ perspectives on responding to elder abuse in a hospital setting. Collegian, 29(1), 16–21. https://doi.org/10.1016/j.colegn.2021.03.004
Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide. Jones & Bartlett Learning.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Synopsis of Psychiatry Behavioral Sciences, clinical psychiatry. Wolters Kluwer ETHICAL AND LEGAL FOUNDATIONS OF PMHNP CARE DISCUSSION.