Ethical concepts
· Ethics is the study of philosophical belief of what is considered right or wrong in a society. Ethical belief are generally very personal belief that arise from one’s experiences in society. Judgments made about the ethical beliefs of another are often unfounded. Its important for psychiatric nurses to be consciously aware of their own ethical belief. The terms bioethics is used in relation to ethical dilemmas surrounding patient care. Bioethics in psychiatric nursesing is the application of ethical principles within the scope of the psychiatric nursing practice setting.
· Ethecs is the branch of philosophy thet considers how principles guiding human interactions can be analyzed and set.
Ethical issues in psychiatric nursing
Many real- life situations are higly emotional and people cannot always asses their option an choices dispassionately. Even when truly dispassionate reflection is possible, reasonable individuals do not always come to the same decision.
· Confidentiality
Except where disclosure is required by law, the group therapist legally and ethically gives information about the group members to others only after obtaining appropriate patient consent. The therapist is obligate to take appropriate steps to be responsible to society, as well as to patients. Although the group members, as well as the therapist , should protect rhe identity of the group members and maintain confidentiality, the group members are not legally bound to do so. During the preparation of the prospective members to keep all material discussed in the group confidential. Theorically, in a legal case one member of a group can be asked to testify against another, but such as a situation has not yet occurred.
· Violence and aggression
Although reports of violence and aggressions are rare, a group member may physically attack another patient or a therapist. The attack may occur within the group or outside the group. Patient with demonstratedtial for violence should not be placed in a group.
· Sexual intercourse
For therapist, sexual intercourse with a patient or a former patient is unethical; in many states such behavior is considered a criminal act. However, the issues is complicated in group psychotherapy because members may engage in sexual activities with one another. The issues of pregnancy, rape, tansmission ofAIDS by group are open question.if a patient is injured as a result of sexual activity by group members, the therapist could be held ccountable for nit preventing such behavior.
The four principles of bioethics are:
1. Beneficience
Beneficience is the doing of good. An example of beneficence is the decision to remain by the bedside of an extremely anxious patient to be supportive, even if the shift has ended.
2. Autonomy
Autonomy is the respect for other’s right to make decisions. An example of autonomy is respecting conform with the recommendation of the staff.
3. Justice
Justice is the reating of other fairly and equality. An example of justice is ensuring that equal staff attention is given to the depressed, disgruntled, disagreeable patient .
4. Fidelity
Fidelity is the strictest observance of loyalty and commitment to the patient. An example of fidelity is demonstated by nurse’s commitment to clinical expertise through participation in continuing education.
Because ethical decisions involve morals and values thet may differ widely among decisions makers. It is important to respect and protect the patient’s autonomy and the patient’s right to be the ultimate decision makers about decisions that affect the patient’s life. The nuese must avoid trying to impose his or her personal morals and values on the patient.
Making ethical decisions
The nurse must give plausible and rational arguments for each decision. Completing the analysis of facts, the nurse must arrive at a tebtative value decision and go on to test the value principle implied in that decision by hypothetically putting self in the position of all persons involved with decision.
steps of value analysis mode
1. Indentify and clarify the valye question
2. Assemble purported facts
3. Assess the truth of purported facts
4. Clarify the relevance of the facts
5. Arrive at a tentative value decision
6. Test the value principle implied by the decision.
· Does the value principle fit in the current situation
· Does the value principle fit in other, similar situations?
· Etc.
Ethical standard, although lacking the clarity and power of law, do serve as afields guide for decision making.
The distinction between legal and ethical issues is often vague. However, there is an important distintion when the nurse relies on ethical guiding principles instead of on guiding principles of law. The nurse is bound to comply with the laws, and even though the nurse may feel morally obligated to follow ethical guidelines, these guiding principles should not override laws.
Ethics and law
Nurses should recognize that conflict between the law and ethics may be unavoidable. Involuntary psychiatric commitment, a seemingly essential menas to prevent harm to a mentally ill individual or other around him, is provoded for by the laws of every state but flagrantly violates the principle of autonomy.
Legal issues in psychiatric mental health nursing
Law has relevance in nearly all aspects of nursing practice, but in no other area of nursing is the law more intimately involved than in psychiatric mental health nursing.
Patient’s right
In 1973 the American Hospital Association issued a patient’s Bill of Right that many hospitals and community- based settings throughout the United States have adopted.
1. Right to communate with people outside the hospital through correspondence, telephone, and personal visits.
2. Right to keep clothing and personal effects with them in the hospital
3. Right to religious freedom
4. Right to be employed if possible
5. Right to manage and dispose of property
6. Right to execute wiils
7. Right to enter into contractual relationships
8. Right to make purchases
9. Right to education
10. Right to habes corpus
11. Right to independent psychiatric examination
12. Right to civil service status
13. Right to retain licenses, privilages, or permites established by law, such as driver’s or professional lecense
14. Right to sue or be sued
15. Right to marry and divorce
16. Right not to be subject to unnecessary mechanical restrains
17. Right to periodic review of status
18. Right to legal represantion
19. Right to privacy
20. Right to informed consent
21. Right to treatment
22. Right to refuse treatment
Legal role of the nurse
Professional nursing practice is not determined by simply following patient’s right. Rather, it is an interplay between the right of patient, the legal role of the nurse and concern for quality psychiatry care.
· Nurse as provider
· Nurse as employee
The role of employee is less frequently studied but also very important. It involves the praticioner’s right and responsibilities in relation to employers, partners, consultans, and other professional colleagues. As employees, nurse have the responsibility to supervise and evaluate those under their authority for the quality of care given
· Nurse as citizen
This is particularly significant because all other roles, right, responsibilities, and privileges are awarded because of inherent right og citizenship.
Referrences:
Frisch, Noreen Evan, Lawrence E. Frisch (2006). Psychiatric mental health nursing(3th). Thomson de mal Learning: Kanada.
Kaplan, Harold I, Benjamin J. Sadock( 1995). Comprehensive textbook of psychiatric. (4th). William& Wilkins: U.S
Stuart and sundeen(1995). Principles & practice of psychiatric nursing. (6th Ed). Mosby: U.S
Varcarolis, Elizabeth M( 1994). Foundoutions of psychiatric health nursing. (2nd). WB Sounders Company:U.S
Yosep, iyus. 2009. Keperawatan jiwa edisi revisi. Bandung: rafika media.
http://fds.oup.com/www.oup.co.uk/pdf/he/helawcat08/medical.pdf, diunduh tanggal 14 Desember 2009
http://web.ebscohost.com/ehost/resultsadvanced?vid=3&hid=113&sid=4c58b882-6bac-46f8-8052-, diunduh tanggal 14 Desember
