NRNP 6665 Ethical and Legal Foundations of PMHNP Care
Ethical and Legal Foundations of PMHNP Care
PMHNPs’ professional work is influenced by several ethical concepts and values that provide the basis for their decision-making. Coercing informed consent is the practice of securing permission with complete awareness of all possible consequences (Levine et al., 2022). Every practitioner must understand the ethical and legal considerations that impact PMHNP practice while dealing with adults and children/adolescents. The discussion below focuses on the ethical and legal issues surrounding obtaining informed permission from adults and children in psychiatric-mental health practice.
Summary of Articles
Ethical and Legal Considerations in Children/Adolescents
The distinction between informed consent and sanction of therapy is becoming more pronounced among mental health practitioners. Disla de Jesus et al. (2022) assert that the patient must be formally competent in deliberating on the proposed intervention to provide consent. Given informed consent, only competent clients of legal age may do so. Levine et al. (2022) state that the minimum age required to provide informed consent for psychiatric interventions varies by state. Patients who are 18 years of age or older are exempt from the legal requirement of parental consent for medical treatment; in some countries, the age limit is even lower at 15 years.
Ethical and Legal Considerations in Adults
Consent is defined differently in adult mental health. As stated by Dalal (2020), impairments in reasoning, comprehension, attention, emotion, and understanding may potentially influence the decision-making capacity aspect of psychiatric disorders. It has been noted that some patients undergoing psychiatric treatment are incapable of providing consent entirely. Occasionally, ethical principles must be applied to act in the best interests of a patient who lacks mental capacity. Therapeutic privilege affords physicians the autonomy to determine the extent of information sharing; nevertheless, the underlying course of treatment ought to consistently be disclosed.
Becker and Forman (2020) state that medical care can be administered without a patient’s assent in the United States if delaying would endanger the patient’s life or health. Legally speaking, informed consent focuses on the individual’s volition or free will to decide, assuming the individual can reason and make decisions regarding their treatment. Due to the legal authority that a medical professional possesses over the patient, an intervention performed in the patient’s best interest without obtaining adequate informed consent may still be deemed negligent.
Conclusion/Psychiatric-Mental Health Practice
The ability to make informed decisions is a prerequisite for the informed consent process; however, severe mental illness can render many patients admitted to psychiatric hospitals incapable of exercising such capacity (Levine et al., 2022). They might be oblivious to the fact that they have a condition and require treatment. The individual is unable to provide informed assent if they encounter difficulties understanding the information or engaging in a meaningful discussion. Consent, in which the patient is given the medication despite not understanding it, is the prevailing approach utilized in such circumstances within the state of Texas. Upon the restoration of the individual’s capacity, they will be able to offer informed assent. In alternative scenarios, the court receives a petition for involuntary treatment and medication commitment. The medication is administered without the patient’s assent if it is approved.
References
Becker, S. H. D., & Forman, H. L. (2020). Implied consent in treating psychiatric emergencies. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00127
Dalal, P. K. (2020). Consent in psychiatry – concept, application & implications. Indian Journal of Medical Research, 151(1), 6. https://doi.org/10.4103/ijmr.ijmr_1518_19
De Jesus, V. D., Liem, A., Borra, D., & Appel, J. M. (2022). Who’s the Boss? Ethical Dilemmas in the Treatment of Children and Adolescents. Focus, 20(2), 215–219. https://doi.org/10.1176/appi.focus.20210037
Levine, S. B., Abbruzzese, E., & Mason, J. M. (2022). Reconsidering informed consent for Trans-Identified Children, Adolescents, and young adults. Journal of Sex & Marital Therapy, 48(7), 706–727. https://doi.org/10.1080/0092623x.2022.2046221
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Ethical and Legal Foundations of PMHNP Care
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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
Learning Resources
Required Readings
- American Nurses Association. (2015). Code of ethics for nurses with interpretive statements
- Links to an external site.. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of-ethics-for-nurses/coe-view-onlyLinks to an external site.
- American Psychological Association. (2017). Ethical principles of psychologists and diagnostic formulation
- Links to an external site.. http://www.apa.org/ethics/codeLinks to an external site.
- American Academy of Child & Adolescent Psychiatry. (2014). Code of ethics
- Links to an external site.. https://www.aacap.org/App_Themes/AACAP/docs/about_us/transparency_portal/aacap_code_of_ethics_2012.pdfLinks to an external site.
- American Psychiatric Nurses Association. (2020). APRN psychiatric-mental health nursing practice
- Links to an external site.. https://www.apna.org/i4a/pages/index.cfm?pageID=3846Links to an external site.
- Anderson, S. L. (2012).Practice parameter on gay, lesbian, or bisexual sexual orientation, gender nonconformity, and gender discordance in children and adolescents
- Links to an external site.. American Academy of Child and Adolescent Psychiatry , 51 (9). 957–974. https://www.jaacap.org/action/showPdf?pii=S0890-8567%2812%2900500-XLinks to an external site.
- Hilt, R. J., & Nussbaum, A. M. (2025). DSM-5-TR pocket guide for child and adolescent mental health . American Psychiatric Association Publishing.
- Chapter 9, “Taking Six Steps to Differential Diagnosis” (pp. 207 – 211)Links to an external site.
- Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
- Chapter 19, “Legal Issues in the Care and Treatment of Children with Mental Health Problems”
- Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual . Springer.
- Chapter 1, “Preparing to Pass the Psychiatric-Mental Health Nurse Practitioner Certification Exam”
To Prepare
- Select one of the following ethical/legal topics:
- Autonomy
- Beneficence
- Justice
- Fidelity
- Veracity
- Involuntary hospitalization and due process of civil commitment
- Informed assent/consent and capacity
- Duty to warn
- Restraints
- HIPPA
- Child and elder abuse reporting
- Tort law
- Negligence/malpractice
- In the Walden library, locate a total of four scholarly, professional, or legal resources related to this topic. One should address ethical considerations related to this topic for adults, one should be on ethical considerations related to this topic for children/adolescents, one should be on legal considerations related to this topic for adults, and one should be on legal considerations related to this topic for children/adolescents.
By Day 3 of Week 2
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.
Upload a copy of your discussion writing to the draft Turnitin for plagiarism check. Your faculty holds the academic freedom to not accept your work and grade at a zero if your work is not uploaded as a draft submission to Turnitin as instructed.
Read a selection of your colleagues’ responses.
By Day 6 of Week 2
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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
NRNP_6665_Week2_Discussion_Rubric
| Criteria | Ratings | Pts |
|---|---|---|
| This criterion is linked to a Learning Outcome Main Posting:Response to the Discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources. | 44 to >39.0 pts Excellent Thoroughly responds to the Discussion question(s)… Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources… No less than 75% of post has exceptional depth and breadth… Supported by at least three current credible sources
39 to >34.0 pts Good Responds to most of the Discussion question(s)… Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module… 50% of the post has exceptional depth and breadth… Supported by at least three credible references 34 to >30.0 pts Fair Responds to some of the Discussion question(s)… One to two criteria are not addressed or are superficially addressed… Is somewhat lacking reflection and critical analysis and synthesis… Somewhat represents knowledge gained from the course readings for the module… Post is supported by fewer than two credible references 30 to >0 pts Poor Does not respond to the Discussion question(s)… Lacks depth or superficially addresses criteria… Lacks reflection and critical analysis and synthesis… Does not represent knowledge gained from the course readings for the module… Contains only one or no credible references |
44 pts |
| This criterion is linked to a Learning Outcome Main Posting:Writing | 6 to >5.0 pts Excellent Written clearly and concisely… Contains no grammatical or spelling errors… Adheres to current APA manual writing rules and style
5 to >4.0 pts Good Written concisely… May contain one to two grammatical or spelling errors… Adheres to current APA manual writing rules and style with minor errors 4 to >3.0 pts Fair Written somewhat concisely… May contain more than two spelling or grammatical errors… Contains some APA formatting errors 3 to >0 pts Poor Not written clearly or concisely… Contains more than two spelling or grammatical errors… Does not adhere to current APA manual writing rules and style |
6 pts |
| This criterion is linked to a Learning Outcome Main Posting:Timely and full participation | 10 to >8.0 pts Excellent Meets requirements for timely, full, and active participation… Posts main Discussion by due date
8 to >7.0 pts Good Posts main Discussion by due date… Meets requirements for full participation 7 to >6.0 pts Fair Posts main Discussion by due date 6 to >0 pts Poor Does not meet requirements for full participation… Does not post main Discussion by due date |
10 pts |
| This criterion is linked to a Learning Outcome First Response:Post to colleague’s main post that is reflective and justified with credible sources | 9 to >8.0 pts Excellent Response exhibits critical thinking and application to practice settings… Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 to >7.0 pts Good Response has some depth and may exhibit critical thinking or application to practice setting. 7 to >6.0 pts Fair Response is on topic, may have some depth. 6 to >0 pts Poor Response may not be on topic, lacks depth. |
9 pts |
| This criterion is linked to a Learning Outcome First Response:Writing | 6 to >5.0 pts Excellent Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in standard, edited English.
5 to >4.0 pts Good Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources… Response is written in standard, edited English. 4 to >3.0 pts Fair Response posted in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited. 3 to >0 pts Poor Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited. |
6 pts |
| This criterion is linked to a Learning Outcome First Response:Timely and full participation | 5 to >4.0 pts Excellent Meets requirements for timely, full, and active participation… Posts by due date
4 to >3.0 pts Good Meets requirements for full participation… Posts by due date… 3 to >2.0 pts Fair Posts by due date 2 to >0 pts Poor Does not meet requirements for full participation… Does not post by due date |
5 pts |
| This criterion is linked to a Learning Outcome Second Response:Post to colleague’s main post that is reflective and justified with credible sources | 9 to >8.0 pts Excellent Response exhibits critical thinking and application to practice settings…. Responds to questions posed by faculty… The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.
8 to >7.0 pts Good Response has some depth and may exhibit critical thinking or application to practice setting. 7 to >6.0 pts Fair Response is on topic, may have some depth. 6 to >0 pts Poor Response may not be on topic, lacks depth. |
9 pts |
| This criterion is linked to a Learning Outcome Second Response:Writing | 6 to >5.0 pts Excellent Communication is professional and respectful to colleagues…. Response to faculty questions are fully answered, if posed…. Provides clear, concise opinions and ideas that are supported by two or more credible sources… Response is effectively written in standard, edited English.
5 to >4.0 pts Good Communication is mostly professional and respectful to colleagues…. Response to faculty questions are mostly answered, if posed…. Provides opinions and ideas that are supported by few credible sources… Response is written in standard, edited English. 4 to >3.0 pts Fair Response posed in the Discussion may lack effective professional communication…. Response to faculty questions are somewhat answered, if posed…. Few or no credible sources are cited. 3 to >0 pts Poor Responses posted in the Discussion lack effective communication…. Responses to faculty questions are missing…. No credible sources are cited. |
6 pts |
| This criterion is linked to a Learning Outcome Second Response:Timely and full participation | 5 to >4.0 pts Excellent Meets requirements for timely, full, and active participation… Posts by due date
4 to >3.0 pts Good Meets requirements for full participation… Posts by due date 3 to >2.0 pts Fair Posts by due date 2 to >0 pts Poor Does not meet requirements for full participation… Does not post by due date |
5 pts |
Total Points: 100