NUR 114
EXAM 1 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Exam 1 content from the
Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 114 – Exam 1 Study Guide
1. Legal/ Ethical Issues
Ethical Dilemma: results when there is a conflict between two or more courses of action, each carrying
with them favorable or unfavorable consequences. How we respond to these dilemmas is based partly on
our own morals and values.
Ethics: study of the philosophical beliefs about what is considered right or wrong in a society.
Bioethics: more specific term that refers to the ethical questions that arise in health care. Five basic
principles of bioethics include:
Beneficence: duty to act so as to benefit or promote the good of others
Autonomy: respecting the rights of others to make their own decisions
Justice: duty to distribute resources, or care equally, regardless of personal attributes
Fidelity (nonmaleficence): maintaining loyalty and commitment to the patient and doing no
wrong to the patient
Veracity: duty to communicate truthfully
People with mental health illness are guaranteed the same rights under federal and state laws as any other
citizen. Most states prohibit any person from being deprived of their civil rights, and psychiatric patient’s
rights include the right to humane care and treatment. Mental health patients also should always receive
medical, dental, and psychiatric care in accordance with the prevailing standards of care accepted in these
professions.
If a patient has been involuntarily committed they have the right to due process (fair treatment through the
judicial system). In most states, a patient can challenge commitments through a writ of habeas corpus
(“formal written order to free the person”) which means that the patient can challenge unlawful detention
by the government.
Least restrictive alternative doctrine: mandates that the least drastic means be taken to achieve a specific
purpose.
Criteria for admission to the hospital:
Well-defined psychiatric problem must be established based off of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5).
Presenting illness should also be of such nature that it causes an immediate crisis or that other less
restrictive alternatives are inadequate or unavailable
Voluntary admission: sought by the patient or the patient’s guardian through a written application to the
facility. They have the right to demand and obtain release from the facility. Some states and facilities
require written notice of them wanting to be released.
Involuntary admission: made without the patients consent. Generally needed if a person is in need of
psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs.
Requires the patient retain freedom from unreasonable bodily restraints as well as the right to informed
consent and the right to refuse medications, including psychotropic or antipsychotic medications. There
are three different commitment procedures that are commonly available:
- Judicial determination
- Administrative determination
, - Agency determination
Additionally, a specified number of physicians must certify that a person’s mental health status justifies
detention and treatment. Involuntary admission can be further categorized based upon the nature/purpose
of the involuntary admission:
- Emergency involuntary hospitalization: also known as civil commitment for a specialized period
(1-10 typically) to prevent dangerous behaviors that could harm self/others. Police officers,
physicians, and mental health specialists may be designated by law to authorize the detention of
the mentally ill individual.
- Observation or temporary involuntary hospitalization: longer duration than emergency visits.
Primary purpose is observation, diagnosis, and treatment for those who have mental illness or
pose a danger to self/others. Guardian, family member, physician, or other public health officer
may apply for this type of admission.
- Long-term or formal commitment: primary purpose is extended care and treatment of the
mentally ill. Those who undergo extended hospitalization are committed through medical
certification, judicial, or administrative action. Typically lasts 60-180 days but may be an
indeterminate period.
- Involuntary outpatient commitment: Preventative measure that allows a court order before the
onset of a psychiatric crisis that would result in an inpatient commitment. This order is typically
tied to receipt of goods and services provided by social welfare agencies, including disability
benefits and housing. To have access to these goods, the patient is mandated to attend treatment
and may face inpatient admission if he or she fails to participate in treatment.
Discharge from the hospital: release from the hospital depends on the patient’s admission status. Patients
who are voluntary or informal admission have the right to request release. Some states/facilities require
conditional release, which enables the treating physician or administrator to order continued treatment on
an outpatient basis if the clinical needs of the patient warrant further care.
- Conditional release: requires outpatient treatment for a specified period to determine the patient’s
adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into
the community.
- Unconditional release: or discharge, is the termination of patient – institution relationship. This
release may be court ordered or administratively ordered by institutional officials.
- Release against medical advice (AMA): in some case’s there is a disagreement between mental
health care providers and patients
Psychiatric Patient’s Rights Under the Law:
Right to treatment: treatment must meet the following criteria –
- The environment must be safe and humane
- Staff must be qualified and sufficient to provide adequate care
- The plan of care must be individualized
Right to refuse treatment: even if the patient is an IVC they still have the right to refuse treatment
Right to informed consent: must always be documents in the patient’s chart. Competency is
related to the capacity to understand the consequences of one’s decisions. The determination of
legal competency is made by the courts. If found incompetent the court may appoint a legal
guardian or representative who is legally responsible for giving or refusing consent for a person,
the court has found to be incompetent. Guardians have a duty to act in their ward’s best interest.
The person a guardian protects is called that guardians ward. Ward may be either minor children
or incapacitated adults. If family members are not able to serve as a ward then a court approved
social worker representing the county, state, or community may be appointed. Many psychiatric
institutions require informed consent for every medication given so be sure to know your
facilities policy.
Right to have a psychiatric advance directive
, Right to confidentiality/privacy: the patient has a right to have their confidential information kept
private and their personal information should only be disclosed when there is a risk of harm to the
patient, other people, and the public’s health.
Right to least restrictive restraints first: many facilities are trying to transition to restraint free
environments and alternative methods of therapy and cooperation with the patient. Verbal de-
escalation is used first, and if that is not effective typically chemical interventions are considered.
Restraint of seclusion may only be imposed to ensure the immediate physical safety of the
patient, a staff member, or others, and must be discontinued at the earliest time possible. If staff
needs to place a patient in restraints or seclusion immediately to ensure safety, the staff member
must receive a written order for the restraint within an hour. The patient must be assessed at
regular and frequent intervals (q15-30 minutes) for physical needs (food, hydration, toileting),
safety, comfort, and these observations must be documented q15-30 minutes, per facility policy.
Restraints must be removed as soon as possible when the patient is quieter and displays safer
behavior.
Psychotherapists have a duty to warn and protect patient’s potential victims of potential harm.
(Tarasoff case). Nurse must report patient threats of harm against specified victims to the patient’s
management psychotherapist.
Tort Law Applied to Psychiatric Nursing:
Tort: civil wrong for which money damages may be collected by the injured party (the plaintiff) from the
wrongdoer (the defendant). Injury can be to person, property, or reputation.
Intentional tort: defendant executed the wrong doing act on purpose or with intent. Intentional
torts include:
- Assault: attempt to touch or threaten another person unjustifiably
- Battery: willful touching of a person (or persons belongings) that may or may not cause harm
- False imprisonment: unjustifiable detention of a person without legal warrant to confine the
person. Ex. Forceful restraint or threat of restraint is battery
- Invasion of privacy: direct wrong of a personal nature. Injures the feelings of the person and does
not take into account the effect of revealed information on the reputation of the person in the
community
- Defamation: communication that is false or made with a careless disregard for the truth, and
results in the injury to the reputation of the person
- Libel: defamation of character by means of print
- Slander: defamation by spoken word
Unintentional tort: negligence/ professional negligence
- Negligence: misconduct that is below the standard of expected of an ordinary, reasonable, and
prudent person
- Gross negligence: involves extreme lack of knowledge, skill, or decision making that the person
clearly should have known would put others at risk
- Malpractice: “professional negligence” that is negligence that occurs while the person was
performing as a professional. Six elements must be present for a case of nursing professional
negligence to be proven:
o Duty
o Breach of duty
o Foreseeability
o Causation
o Harm or injury
o Damages
EXAM 1 3
STUDY GUIDE
Holistic Health Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 114 at Forsyth Technical
Community College focuses on Exam 1 content from the
Holistic Health Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 114 – Exam 1 Study Guide
1. Legal/ Ethical Issues
Ethical Dilemma: results when there is a conflict between two or more courses of action, each carrying
with them favorable or unfavorable consequences. How we respond to these dilemmas is based partly on
our own morals and values.
Ethics: study of the philosophical beliefs about what is considered right or wrong in a society.
Bioethics: more specific term that refers to the ethical questions that arise in health care. Five basic
principles of bioethics include:
Beneficence: duty to act so as to benefit or promote the good of others
Autonomy: respecting the rights of others to make their own decisions
Justice: duty to distribute resources, or care equally, regardless of personal attributes
Fidelity (nonmaleficence): maintaining loyalty and commitment to the patient and doing no
wrong to the patient
Veracity: duty to communicate truthfully
People with mental health illness are guaranteed the same rights under federal and state laws as any other
citizen. Most states prohibit any person from being deprived of their civil rights, and psychiatric patient’s
rights include the right to humane care and treatment. Mental health patients also should always receive
medical, dental, and psychiatric care in accordance with the prevailing standards of care accepted in these
professions.
If a patient has been involuntarily committed they have the right to due process (fair treatment through the
judicial system). In most states, a patient can challenge commitments through a writ of habeas corpus
(“formal written order to free the person”) which means that the patient can challenge unlawful detention
by the government.
Least restrictive alternative doctrine: mandates that the least drastic means be taken to achieve a specific
purpose.
Criteria for admission to the hospital:
Well-defined psychiatric problem must be established based off of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5).
Presenting illness should also be of such nature that it causes an immediate crisis or that other less
restrictive alternatives are inadequate or unavailable
Voluntary admission: sought by the patient or the patient’s guardian through a written application to the
facility. They have the right to demand and obtain release from the facility. Some states and facilities
require written notice of them wanting to be released.
Involuntary admission: made without the patients consent. Generally needed if a person is in need of
psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs.
Requires the patient retain freedom from unreasonable bodily restraints as well as the right to informed
consent and the right to refuse medications, including psychotropic or antipsychotic medications. There
are three different commitment procedures that are commonly available:
- Judicial determination
- Administrative determination
, - Agency determination
Additionally, a specified number of physicians must certify that a person’s mental health status justifies
detention and treatment. Involuntary admission can be further categorized based upon the nature/purpose
of the involuntary admission:
- Emergency involuntary hospitalization: also known as civil commitment for a specialized period
(1-10 typically) to prevent dangerous behaviors that could harm self/others. Police officers,
physicians, and mental health specialists may be designated by law to authorize the detention of
the mentally ill individual.
- Observation or temporary involuntary hospitalization: longer duration than emergency visits.
Primary purpose is observation, diagnosis, and treatment for those who have mental illness or
pose a danger to self/others. Guardian, family member, physician, or other public health officer
may apply for this type of admission.
- Long-term or formal commitment: primary purpose is extended care and treatment of the
mentally ill. Those who undergo extended hospitalization are committed through medical
certification, judicial, or administrative action. Typically lasts 60-180 days but may be an
indeterminate period.
- Involuntary outpatient commitment: Preventative measure that allows a court order before the
onset of a psychiatric crisis that would result in an inpatient commitment. This order is typically
tied to receipt of goods and services provided by social welfare agencies, including disability
benefits and housing. To have access to these goods, the patient is mandated to attend treatment
and may face inpatient admission if he or she fails to participate in treatment.
Discharge from the hospital: release from the hospital depends on the patient’s admission status. Patients
who are voluntary or informal admission have the right to request release. Some states/facilities require
conditional release, which enables the treating physician or administrator to order continued treatment on
an outpatient basis if the clinical needs of the patient warrant further care.
- Conditional release: requires outpatient treatment for a specified period to determine the patient’s
adherence with medication protocols, ability to meet basic needs, and ability to reintegrate into
the community.
- Unconditional release: or discharge, is the termination of patient – institution relationship. This
release may be court ordered or administratively ordered by institutional officials.
- Release against medical advice (AMA): in some case’s there is a disagreement between mental
health care providers and patients
Psychiatric Patient’s Rights Under the Law:
Right to treatment: treatment must meet the following criteria –
- The environment must be safe and humane
- Staff must be qualified and sufficient to provide adequate care
- The plan of care must be individualized
Right to refuse treatment: even if the patient is an IVC they still have the right to refuse treatment
Right to informed consent: must always be documents in the patient’s chart. Competency is
related to the capacity to understand the consequences of one’s decisions. The determination of
legal competency is made by the courts. If found incompetent the court may appoint a legal
guardian or representative who is legally responsible for giving or refusing consent for a person,
the court has found to be incompetent. Guardians have a duty to act in their ward’s best interest.
The person a guardian protects is called that guardians ward. Ward may be either minor children
or incapacitated adults. If family members are not able to serve as a ward then a court approved
social worker representing the county, state, or community may be appointed. Many psychiatric
institutions require informed consent for every medication given so be sure to know your
facilities policy.
Right to have a psychiatric advance directive
, Right to confidentiality/privacy: the patient has a right to have their confidential information kept
private and their personal information should only be disclosed when there is a risk of harm to the
patient, other people, and the public’s health.
Right to least restrictive restraints first: many facilities are trying to transition to restraint free
environments and alternative methods of therapy and cooperation with the patient. Verbal de-
escalation is used first, and if that is not effective typically chemical interventions are considered.
Restraint of seclusion may only be imposed to ensure the immediate physical safety of the
patient, a staff member, or others, and must be discontinued at the earliest time possible. If staff
needs to place a patient in restraints or seclusion immediately to ensure safety, the staff member
must receive a written order for the restraint within an hour. The patient must be assessed at
regular and frequent intervals (q15-30 minutes) for physical needs (food, hydration, toileting),
safety, comfort, and these observations must be documented q15-30 minutes, per facility policy.
Restraints must be removed as soon as possible when the patient is quieter and displays safer
behavior.
Psychotherapists have a duty to warn and protect patient’s potential victims of potential harm.
(Tarasoff case). Nurse must report patient threats of harm against specified victims to the patient’s
management psychotherapist.
Tort Law Applied to Psychiatric Nursing:
Tort: civil wrong for which money damages may be collected by the injured party (the plaintiff) from the
wrongdoer (the defendant). Injury can be to person, property, or reputation.
Intentional tort: defendant executed the wrong doing act on purpose or with intent. Intentional
torts include:
- Assault: attempt to touch or threaten another person unjustifiably
- Battery: willful touching of a person (or persons belongings) that may or may not cause harm
- False imprisonment: unjustifiable detention of a person without legal warrant to confine the
person. Ex. Forceful restraint or threat of restraint is battery
- Invasion of privacy: direct wrong of a personal nature. Injures the feelings of the person and does
not take into account the effect of revealed information on the reputation of the person in the
community
- Defamation: communication that is false or made with a careless disregard for the truth, and
results in the injury to the reputation of the person
- Libel: defamation of character by means of print
- Slander: defamation by spoken word
Unintentional tort: negligence/ professional negligence
- Negligence: misconduct that is below the standard of expected of an ordinary, reasonable, and
prudent person
- Gross negligence: involves extreme lack of knowledge, skill, or decision making that the person
clearly should have known would put others at risk
- Malpractice: “professional negligence” that is negligence that occurs while the person was
performing as a professional. Six elements must be present for a case of nursing professional
negligence to be proven:
o Duty
o Breach of duty
o Foreseeability
o Causation
o Harm or injury
o Damages
