What is competence?
List 4 assessment areas used to determine competency.
patient’s degree to understand and appreciate the information given during the consent process
- communicate choices
- understand relevant information
- appreciate situation and its consequence
- weigh risks and benefits
What are 3 forms of admission into psych unit?
- Voluntary
- 939 Emergency involuntary
- Involuntary commitment
What is voluntary admission?
patient maintains all civil rights and is free to leave at any time, even if dr. doesnt recommend
What is 9.39 Emergency Involuntary?
person thought to have mental illness that needs immediate care and treatment. person may cause harm to self or others
What is involuntary commitment?
confined hospitalization without person’s consent but with court order
3 reasons why a person is admitted involuntarily? What are they admitted as?
- found to be danger to self/others
- Axis 1 diagnosis
- cannot meet basic needs: ADLs or can’t get meds
*Admitted as an 939 involuntary - Axis 1
For 939 emergency involuntary patients
- how long can they be held in hospital?
- what happens on 15th day?
- what right do they lose?
- NYS can retain for up to 15 days
- discharge patient, convince pt to sign voluntary admission form, go to court where 2 psychs assess pt and judge decides based on evidence what to do
- loses right to request discharge (no 72 hr note). They CAN request another court date
What is involuntary committed admittance? What are 2 characteristics?
- someone petitions the court and requests psychiatric involuntary admission
- -patient comes in w/ court order already in place
- specific cause and duration already issued by court
What 5 client behaviors indicate readiness for discharge?
- Get up, get out of bed, take a shower
- Takes meds
- Go to group
- Talk about feelings with staff
- No longer be a risk to self/others
Why do these 5 behaviors indicate readiness?
if youre compliant and can take care of yourself and we know what your feelings are, then we can judge where you stand and that you are no longer a risk to self/others
What is Tarasoff Law?
psychotherapists and nurses are mandated to warn potential victims if there are clear threats of violence made towards others
List 3 patient rights under Self-Determination Act
- Be provided with info about advanced care documents
- Be asked at admission or enrollment whether they have an advance care document and that this fact be recorded in medical record
- Be provided with information on their rights to complete advance care documents and refuse medical care
What is the AOT Law? A.K.A?
Authorization of Outpatient Treatment
A.K.A “Kendra’s Law”
- If someone is not in the hospital and NOT following med/treatment plan, then anyone can petition the court and the court can issue outpatient treatment
- If patient is an acute threat to self/others and refuses meds, hospital is allowed to force meds JUST ONCE. After, you must get a court order/case
What is confidentiality and should you promise patients “exclusive confidentiality”?
ethical duty of nondisclosure
No, tell them “info is shared amongst the team but nothing leaves the area.
What is an AXIS I diagnosis?
Primary psych diagnosis:
bipolar, schizophrenia, psychotic disorders, substance abuse, adjustment disorder, anxiety disorder, cognitive disorder
What is an AXIS II diagnosis?
Personality disorder:
antisocial, borderline, narcissistic,
Developmental disorders
(MRD - mental retardation)
What is an AXIS III diagnosis?
physical; all med surg problems
What is an AXIS IV diagnosis?
Psychosocial and socio-cultural problems:
homelessness (nondomicidal), jobless, unemployed, divorced
What is an AXIS V diagnosis?
GAF (Global Assessment of Function) <50 = admitted to hospital
What is the number one cause of recividism (going back to hospital)?
patient stops taking meds
What is privacy?
part of an individual’s personal life that is not governed by society’s laws and govt intrusion
Who’s responsibility is it to protect pt’s privacy?
health care providers
What is confidentiality?
ethical duty of nondisclosure
What is breach of confidentiality?
release of patient information without the patient’s consent
