Jennifer Butler

College of Science, Technology and Health – St. Thomas University

NUR 620 – Psychiatric Management I

Dr. Adma G. Wilson-Romans

Mau 18th, 2023

Patient Care

Citing the Baker Act Law:

The article by Szmukler (2020) discusses the evolution of mental health legislation, including the Baker Act. The Baker Act in Florida authorizes involuntary testing and treatment of mentally ill people who may harm themselves or others. The Baker Act protects mentally sick people. It allows 72-hour psychiatric evaluation and stabilization custody. To maintain safety and prevent harm, an involuntary inspection can require subsequent treatment. The statute balances individual rights with providing care to mentally ill people who cannot make their own decisions. K.W.’s dumpster eating, drinking from an old hose, and neglecting personal hygiene may suggest self-neglect, weak judgment, or mental illness. These acts may endanger her physical and mental health, underlining the necessity for a mental health assessment. Mental health specialists can use the Baker Act to diagnose a mental disorder, assess her self-harm, and prescribe treatment.

Supporting Position from the Ethical Considerations Article

The article by Manderius et al., 2023) focuses on the ethical considerations of using coercive measures in mental health care. Although it doesn’t directly address the Baker Act, it sheds light on the ethical dilemmas psychiatric mental health nurses (PMHNs) face in situations involving patient restraint. The qualitative interview study by Manderius et al., 2023) delves into the experiences and perspectives of psychiatric mental health nurses (PMHNs) regarding the ethical considerations surrounding the use of coercive measures in mental health care. The findings shed light on the intricate balance that PMHNs must navigate between promoting patient autonomy and ensuring safety.

The study revealed that PMHNs grapple with the ethical dilemmas inherent in decision-making concerning coercive measures like restraint or seclusion. Participants emphasized preserving the therapeutic alliance between the healthcare provider and the patient. Establishing a trusting and collaborative relationship is crucial to maintaining the dignity and overall well-being of the care recipient. PMHNs recognized the potential negative consequences of using coercive measures, such as the potential for retraumatization, loss of trust, and compromised therapeutic relationships. They expressed the importance of seeking alternatives to restraint whenever possible and employing de-escalation techniques, communication skills, and environmental modifications to create a less restrictive and more therapeutic environment.

The results emphasize the virtue of benevolence because PMHNs work to protect patients’ interests while reducing harm. To achieve a balance that respects the autonomy and dignity of the individual, it is necessary to consider the advantages and disadvantages of coercive methods. The study also highlighted the necessity of thorough examination and documentation when considering employing coercive tactics. PMHNs underlined the value of undertaking continuing assessments, working with multidisciplinary teams, and, whenever possible, getting patient feedback. The basis for ethical decision-making should be a complete comprehension of the patient’s particular circumstances, as influenced by cultural, societal, and personal variables.

The results of this study are consistent with the more general ethical standards of mental health care, stressing the value of person-centered strategies and customized therapy. To ensure their decisions align with moral principles and the industry’s best practices, PMHNs must constantly evaluate their methods and pursue continued professional development. These results highlight the necessity for the PMHNP to consider alternatives to coercive tactics in the instance of K.W. Collaborative and person-centered approaches should guide the assessment and intervention process. The PMHNP can support a therapeutic alliance that puts K.W.’s dignity, well-being, and safety first by encouraging open communication, honoring her autonomy, and including her in the decision-making process as much as is practical.

The PMHNP should consider the ethical ramifications of helping K.W. by applying the article’s results to her case. To guarantee a comprehensive approach to her care, communication with other healthcare team members is essential, such as social workers, psychologists, and perhaps even legal experts. Together, they can thoroughly evaluate K.W.’s mental health, investigating any underlying causes of her behavior and evaluating her capacity for reasoned decision-making. As K.W. is unwilling to live in an apartment and says she wants to “live off the fat of the land,” it is crucial to develop good communication with her to comprehend her viewpoint and ease her anxieties. Respect for autonomy and patient-centered treatment are ethical values in line with this procedure. The PMHNP can create a mutually acceptable solution that prioritizes K.W.’s safety and well-being while preserving her autonomy to the greatest extent by having an open discourse and developing a therapeutic relationship.

References

Manderius, C., Clintståhl, K., Sjöström, K., & Örmon, K. (2023a). The Psychiatric Mental Health Nurse’s ethical considerations regarding the use of coercive measures – a qualitative interview study. BMC Nursing, 22(1). https://doi.org/10.1186/s12912-023-01186-z

Szmukler, G. (2020). Involuntary detention and treatment: Are we edging toward a “Paradigm shift”? Schizophrenia Bulletin, 46(2), 231–235. https://doi.org/10.1093/schbul/sbz115