The essay aims to address a two-fold objective to wit: (1) to identify and describe at least one ethical or legal issue related to their nursing care in your journal; and (2) to summarize at least three articles, comparing and contrasting each article and how it affected your thoughts, feelings, values, or actions in your practice…
The Mentally Ill A. Journal Writings I am a psychiatric nurse from a local community hospital and was taking care of Patient X (not the real name to protect confidentiality of patient information). Patient X was diagnosed with schizophrenia and was treated with clozapine (Clozaril), an atypical psychotropic drug used to treat psychotic symptoms, hallucinations, and breaks with reality (NIMH, 2012, 6). For a period of four weeks, I usually give Patient X a 200 mg oral preparations of clozapine twice a day as ordered. After series of inpatient medication regimen, Patient X’s symptoms of schizophrenia decreased and the patient is now stabilized. With this, Patient X requested to be discharged and be treated through outpatient commitment. I told Patient X that I will relay his request to the health care team and will inform him of the decision made. Upon discussing it with the health care team, we were put in a dilemma whether to grant Patient X’s request to respect his autonomy and independence or denied it to uphold the principle of nonmaleficence because the client might not take medications on time or not take medications at all and may result to an imminent threat or danger to self or to others due to relapse of schizophrenic symptoms. In addition, putting Patient X, who is receiving clozapine, on an outpatient commitment may present a serious harm as a WBC check every week or two is necessary to avoid occurrence of agranulocytosis or loss of the white blood cells that help a person fight infection. B. Ethical Dilemma In responding to a psychiatric patient’s request of discharge and treatment on an outpatient commitment, which ethical and legal principle should be considered – the legal right of a patient and the ethical principle of autonomy and independence or the professional responsibility of the nurse to do no harm and practice paternalism? C. Ethics Paper Summaries. Elbogen and Tomkins authored the article entitled “From the Psychiatric Hospital to the Community: Integrating Conditional Release and Contingency Management” in 2000. The article proposed involuntary outpatient commitment with therapeutic jurisdiction as one possible solution for psychiatric recidivism in the community. The article also emphasized that clinicians find it hard to discharge patients and are often put in a dilemma whether the discharge decision will benefit the patient or will end up in a relapse of chronic mental illness. In addition, discharge from the psychiatric hospitals also corresponds in legal status changes which might predispose the individual to heightened stress and independent living (Elbogen & Tomkins, 2000, 428). Thus, the article had raised a question whether outpatient commitment can provide continuity of care and reduce incidence of rehospitalization. Elbogen & Tomkins (2011) found therapeutic jurisprudence framework as the key to analyze legal and beneficial mental health interventions for the individual, conflicting values, and generated or implemented laws, policies and practice (p. 429). In patients with chronic mental illness, therapeutic jurisprudence preferred a discharge plan that maximizes convergence between self-determination, individual well-being, and public safety through integration of risk assessment technology and effective rehabilitative treatment, particularly contingency management. Absolute discharge might be the best promoter of self-determination as there are no strings attached; however it predisposed the patient for rehospitalization unlike outpatient commitment that discharged patient with therapeutic jurisprudence and reduced incidence of reho ...
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