DB1: Response (200 words) without references included. 2-3 references peer review articles
publication within 5 years.
After reading and reviewing the information, please discuss issues you think will be unique to mental
health.
Ethics is a topic that is relevant to all nursing practice. All nursing students study ethics, starting in
undergraduate programs or certified-nurse-aid training. It is something we are all familiar with
regardless of what area of nursing we practice. Mental health, however, does face some unique
challenges regarding ethics. One such challenge, for example, is informed consent. Friedman (n.d)
discusses informed consent as giving the patient enough information to make an intelligent choice. The
practitioner has an ethical obligation to help patients make their own educated choices. Informed
consent is part of a patients ethical right to autonomy. In their discussion on ethics, Robertson and
Walter (2016) talk about what they refer to as Principle-Based ethics. In this discussion they talk about
four guiding principles: respect for autonomy, beneficence, non-maleficence, and justice. Respect for
autonomy essentially means that the provider should respect decision making capacity of patients and
helping them to make good choice through informed consent. Mental Health providers often face
challenges regarding these four principles, especially in regard to involuntary treatment. Mental health
patients sometimes have poor insight and are unable to rationally consider the risks or benefits to
treatment. Beneficence comes in to play for these patients, where the provider must weigh the risks and
benefits to the treatment, especially if they are unable to consent. Ultimately the choice is made to
involuntarily commit a patient when they are a threat to themselves or other, or to relieve suffering
from psychotic symptoms. One study conducted among 109 nurses working in psychiatry clinics found
that patients autonomy and beneficence were among the top self-reported ethical concerns (Er & Ersoy,
2017). This study supports the understanding that mental health providers have regarding ethical
concerns of caring for a population of patients who are often disadvantaged. The Code of Ethics for
Nurses with Interpretive Statements from the American Nurses Association is also important for mental
health providers. For instance, the psychiatric nurse practitioner must recognize and understand that
they are working with a population that often have maladaptive behaviors and attitudes that affect
individuals and their treatment (American Nurses Association [ANA], 2014). This is often unique to
mental health because mental health providers must balance this understanding of potential for poor
insight and maladaptive coping behaviors with their commitment to healthcare and respect for the
individual .This is particularly important when considering restraints, seclusion, or involuntary
treatment.
References
American Nurses Association (2014). Psychiatric-mental health nursing: scope and standards of practice.
Silver Spring, MD.
Er, R. A., & Ersoy, N. (2017). Ethical problems experienced by nurses who work in psychiatry clinics in
Turkey. Journal of Psychiatric Nursing. doi: 10.14744/phd.2017.97720
Friedman, P. (n.d) Ethical Codes for Psychiatric Nurse Practitioners [PowerPoint Slides]. Retrieved March
16, 2020 from https://nku.instructure.com/courses/28947/files/2727999?module_item_id=977364
999?module_item_id=977364
DB2: Response (200 words) without references included. 2-3 references peer review articles
publication within 5 years.
After reading and reviewing the information, please discuss issues you think will be unique to mental
health.
According to Robertson & Walter (2014), there are four core principles of ethics that are followed when
caring for individuals in the mental health field as well as in the overall medical field: respect for
autonomy: knowing and allowing individuals/patients to make their own decisions regarding their care;
beneficence: making sure that the benefits outweigh the risks for the patients; nonmaleficence: not
causing intended harm to the patient, or the least harm possible; and justice: treating patients in a
similar fashion as others. It is very important with the mental health population, to build a relationship
with the clients and earn their trust, before proceeding with treatment. Compassion, respect for
confidentiality, warmth, and sensitivity are necessary traits that all mental health professionals should
acquire (Robertson & Walter, 2014). According to Koocher & Keith-Spiegel (2016), there are many core
principles that mental health professionals need to adapt in order to provide the most adequate care to
our patients:
Do no harm
Respect autonomy
Act justly (treat patients how you’d like to be treated)
Act faithfully (clients need to feel safe)
Accord dignity (understand and respect cultural diversity)
Act benevolently (provide care and compassion)
Pursue excellence (provide the best care possible)
Act accountably (taking responsibility for our actions)
Act courageously (follow code of ethics)
As future practitioners in the mental health field, we will come across difficult situations and patients
that are not getting better or making better choices despite what we say in treatment; thus I feel it’s
extremely important to always utilize our available resources, such as therapists, counselors, social
workers, as well as families and school teachers.
References
Koocher, G. P., & Keith-Spiegel, P. (2016). Ethics in psychology and the mental health professions:
Standards and cases. Oxford University Press.
Robertson, M., & Walter, G. (2014). Ethics and mental health: The patient, profession and community.
CRC Press.
DB3: Response (200 words) without references included. 2-3 references peer review articles
publication within 5 years.
Discuss an area that you found interesting from this week’s readings
A topic that I found very interesting from this week’s readings was a case example that was presented
by Robertson & Walter (2016). In this case, a patient had previously served in the military and was
struggling with depression, alcoholism and PTSD once he had been discharged. He continued to see a
Psychiatrist for his symptoms, where he was also diagnosed with bipolar disorder. The psychiatrist noted
that this patient clearly has been struggling with mood and behavioral issues prior to joining the military,
as well as being charged with assault beforehand. The psychiatrist assumed that this patient would be
covered under his veteran benefits, but soon learned that he was turned away due to the pre-existing
condition of bipolar disorder. The psychiatrist attempted to make a diagnosis of PTSD in order to have
him qualify for veteran benefits, even though the patient did not meet all the criteria for this diagnosis.
The psychiatrist was stuck in a position that posed an ethical dilemma of either lying in order to allow his
patient to receive military benefits for his mental illness, or lose him as a patient since he cannot pay for
his treatments, therefor forcing him to forgo any further treatment for his mental illnesses. This is such a
huge ethical dilemma, as I’m sure this is happening all over the country everyday where patients are
turned away and are not appropriately treated due to a shortage of benefits or financial strain. This is
why I chose this field. I want to somehow be part of the change that our country and these patients so
greatly need.
References
Robertson, M. D., & Walter, G. (2016). Ethics and mental health: the patient, profession and
community. Boca Raton: CRC Press.
DB4: Response (200 words) without references included. 2-3 references peer review articles
publication within 5 years.
Discuss an area that you found interesting from this week’s readings
I found the readings on ethical challenges in working with human diversity very interesting from this
week’s readings. It is very important for mental health professionals to be culturally competent in order
to build a good, trusting relationship with our clients. There are six key elements linked to being
culturally competent and those are pursuit of a worthwhile goal, that requires personal strength or
virtues, which in turn are informed by knowledge of virtues, expressed through consistent actions,
motivated by a sincere desire to seek the goals, and pursued wisely (Koocher & Keith-Spiegel, 2008).
There are many things that can culturally cause an issue in the client provider relationship including how
to interact with clients from different cultures, how to convey respect or concern, and even the
difference of word meanings. The readings discussed how the word schizophrenia can mean something
different to many different cultures. This shows that when we are interacting with clients we need to be
as direct and concise as possible when describing diagnoses and treatment plans, because without the
clinical knowledge that we have, our clients can easily misunderstand our medical terminology (Koocher
& Keith-Spiegel, 2008).
References
Koocher, G. P., & Keith-Spiegel, P. (2008). Ethics in psychology and the mental health professions:
Standards and cases. Oxford University Press
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