Give a brief summary evaluation of your community’s health, the major strengths of your community, and the hopes for your community in the future. Also, discuss what has resonated with you in this course.
Give a brief summary evaluation of your community’s health, the major strengths of your community, and the hopes for your community in the future. Also, discuss what has resonated with you in this course.
This Discussion allows the students to consider multicultural trends found in a particular diverse cultural group of the United States and to share this experience with other students in the course. Through the actual experience of what it is like to be immersed in a different culture, greater insight will occur into the role of the counselor in developing cultural self-awareness, understanding the role of community, cultural, and family systems, the promotion of social justice and advocacy, and the importance of eliminating biases.
To help with your Discussion Presentation, please review the the resources below as well as the assignment instructions and grading rubric.
This Discussion allows the students to consider multicultural trends found in a particular diverse cultural group of the United States and to share this experience with other students in the course. Through the actual experience of what it is like to be immersed in a different culture, greater insight will occur into the role of the counselor in developing cultural self-awareness, understanding the role of community, cultural, and family systems, the promotion of social justice and advocacy, and the importance of eliminating biases.
To help with your Discussion Presentation, please review the the resources below as well as the assignment instructions and grading rubric.
By signing below, I acknowledge that I have viewed the course information meeting in its entirety and / or course materials and will adhere to the policies that have been set forth.
The professional began the discussion with a direct and compassionate inquiry, laying out the motivation behind the visit and making an opening for Tony to share. The expert kept a non-critical tone throughout the discussion, which was critical in causing Tony to have a real sense of reassurance and perception. The expert efficiently got some information about different side effects of depression and anxiety, for example, anger, sadness, energy levels, and interest in exercises. The professional distinguished and recognized the critical drop in Tony’s school execution and his apathy toward exercises he once delighted in, like basketball. The specialist asked about Tony’s utilization of medications and liquor, which is significant for understanding his strategies for dealing with tough times and potential risk factors. The professional associated Tony’s emotional state and the separation from his girlfriend, recognizing it as a likely trigger for his ongoing side effects. At the point when Tony referenced feelings of outrage and the urge to fight, the professional recognized it and demonstrated an eagerness to investigate this further.
Areas for Improvement:
At the point when Tony appeared to be uncertain about what the expert implied by “how you’re feeling” or “your mood,” the professional might have given more unambiguous models or made sense of these terms all the more obviously to guarantee understanding. The specialist might have offered more verbal approval of Tony’s sentiments throughout the meeting, for example, recognizing how hard it might be to experience these feelings. After hearing Tony’s articulation about not having any desire to be alive, the specialist ought to have promptly evaluated the seriousness and severity of the risk by posing direct inquiries about any plans or means he could have considered for self-hurt. The professional might have gotten some information about Tony’s emotional support network, like family, companions, or other critical connections, which could give further setting and roads to help. Utilizing more open-ended inquiries could urge Tony to expound more on his feelings and encounters, giving a more in-depth understanding of his circumstances.
Compelling Concerns at This Point in the Interview:
Tony’s assertions about not having any desire to be alive and having considerations about harming himself are exceptionally unsettling and warrant prompt consideration. An extensive risk evaluation is needed to decide the degree of impending risk. The new separation from his girlfriend gives off an impression of being a critical stressor and profound trigger for Tony, adding to his depressive side effects and sensations of outrage. The critical drop in Tony’s scholastic execution and loss of interest in homework might demonstrate a more extensive effect of his profound state on his day-to-day functioning. Even though Tony referenced just periodic liquor use, it is critical to investigate this further to grasp the role of substances in his coping.
Next Steps:
Perform an intensive evaluation to decide the immediacy and seriousness of Tony’s suicidal thoughts. This incorporates getting some information about any plans, means, and intent. Devise a safety plan with Tony, which could include distinguishing safe individuals he can contact, eliminating methods for self-harm, and booking follow-up appointments. Keep on investigating Tony’s sensations of outrage, sadness, and anxiety, and talk about ways of dealing with especially difficult times. Include Tony’s family or friends, with his consent, to offer extra help. Consider referring Tony to a psychologist or psychiatrist for additional assessment and treatment, including therapy and perhaps medication if needed.
Next Question:
“Tony, when you say you don’t want to be alive and have had thoughts about hurting yourself, have you thought about how you might do it or made any plans?”
Importance of a Thorough Psychiatric Assessment of a Child/Adolescent
A thorough mental evaluation of a child/adolescent is critical because it gives a thorough comprehension of the child/adolescent’s psychological status, formative level, and psychosocial setting. This is fundamental because multiple factors such as recognizing and resolving mental issues early can improve results significantly and prevent the heightening of symptoms. Children/adolescents are at various formative stages, so side effects and ways of behaving should be deciphered inside the context of their formative level. An intensive evaluation considers different elements, including biological, mental, and social impacts, which are fundamental for accurate diagnosing and successful treatment. Understanding the particular necessities and conditions of the child/adolescent takes into consideration the advancement of customized plans of care that are bound to be effective (Srinath et. al., 2019).
Symptom Rating Scales for Psychiatric Assessment
The Child Behavior Checklist (CBCL):
The CBCL is a generally utilized parent-report survey intended to evaluate a wide scope of conduct and profound issues in kids aged 6-18. It includes things for social capabilities and a great many profound and conduct issues, yielding scores on several syndrome scales (e.g., anxious/depressed, withdrawn/depressed, somatic complaints) and DSM-situated scales. This scale helps in distinguishing explicit trouble areas and following changes after some time, making it important for both analysis and treatment monitoring (Biederman et. al., 2020).
The Pediatric Symptom Checklist (PSC):
The PSC is a concise screening device used to distinguish psychosocial issues in kids aged 4-16. It comprises 35 things that guardians rate as “never,” “at times,” or “frequently” present in their kid’s way of behaving, covering assimilating, externalizing, and attention issues. The PSC is helpful for the early detection of psychosocial issues, directing further evaluation and intercession (Pagano et. al., 2000).
Psychiatric Treatment Options for Children and Adolescents
Play Therapy:
Play treatment uses the normal way children put themselves out there — through play. It permits them to investigate their sentiments, resolve psychosocial hardships, and accomplish ideal turn of events. Particularly for younger kids who might not have the verbal abilities to communicate complex feelings, play treatment gives a protected climate to manage injury, tension, and social issues (Koukourikos et. al., 2021).
Parent-Child Interaction Therapy (PCIT):
PCIT centers around working on the nature of the parent-kid relationship and evolving guardian-child connection designs. This treatment is especially helpful for children with problematic conduct problems. It includes training guardians in real-time interactions with their children, advancing positive ways of behaving, and diminishing negative ones (Vess & Campbell, 2022).
References
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical Practice Guidelines for Assessment
of Children and Adolescents. Retrieved 5/29/2024 from:
Vess, S. F., & Campbell, J. M. (2022). Parent-child interaction therapy (PCIT) with families of children
with autism spectrum disorder. Retrieved 5/30/2024 from:
https://doi.org/10.1177/23969415221140707
NRNP 6665 Week 1: Discussion sample 2
Main Post
Introduction
Psychiatric evaluation of children and adolescents is an essential process in helping to identify their diagnoses and to develop proper treatment plans suitable for each child or adolescent. Children and adolescents are in the process of still developing cognitively, emotionally and socially unlike the adults. This developmental context means that their mental health can only be understood in a more complex manner. An in-depth assessment enables one to understand the other related issues for instance, family and peer relations, and environmental factors which have a bearing on the patient’s health (Hilt & Nussbaum, 2016).
Analysis of the Practitioner’s Techniques
The practitioner demonstrated several effective techniques during the session. Interestingly, he outlined the client’s right to privacy and confidentiality at the beginning; this is crucial as it establishes trust between the therapist and the client (American Psychological Association, 2017). Also, the application of humor as well as the use of active listening to the jokes told by the client also played a crucial role in enhancing the relationship between the two of them. When the practitioner asked about the client’s interests and school, it demonstrated that the practitioner wanted to know more about the client, which is vital in adolescent assessments (Sadock, Sadock & Ruiz, 2014).
However, the following areas of improvement were identified. The practitioner’s body language, for instance, having one foot crossed over the other and shrugging shoulders, was unbecoming and could have been inconsequential to the client. Furthermore, using an aggressive tone and making critical comments about the client’s mother may frustrate the client and impact the communication process negatively. It would have been more professional and helpful for the therapeutic process to remain neutral and avoid negative language (Wheeler, 2014).
Compelling Concerns
Some issues were raised during the session. The client reported a lot of dislike for school, the school environment, academic activities, teachers and peers, which shows that the client is experiencing significant distress in the school context. This can be problems like bullying, academic pressure or lack of friends. The client has some signs of negative affectivity and the ability to manage anger, which can also be a reflection of the presence of anxiety or depression (American Academy of Child & Adolescent Psychiatry, 2012). Another question is that the client seems to seek support from a coach and a girlfriend rather than family members which may imply some problems with family relations.
Next Questions
To further elaborate these concerns, the next questions should shift to the family environment of the client and how the client manages stress. For example: Possible questions may include: “How do you handle your father and siblings?” Here, it is possible to learn more about the support system of the client and possible sources of tensions within the family. Another crucial question is: ”Have you ever contemplated to harm yourself or hurting somebody else?” Considering the client is highly charged emotionally and expressing a lot of anger, it is crucial to check on the possibility of self harm or harm to others for the safety of the client and those around him/her.
Symptom Rating Scales
Two suitable self-rating symptom checklists for children and adolescents are Child Depression Inventory (CDI) and Strengths and Difficulties Questionnaire (SDQ). The CDI is a well-established self-report measure that is commonly used to screen for depression in children between the ages of 7 and 17 and could be helpful for monitoring children’s mood and informing decisions about their care. On the other hand, the SDQ is used to measure behavioral and emotional problems, peer relations, and pro-social behavior which provides a brief overview of the child’s mental health status (Srinath et al. 2019).
Treatment Options
For the pediatric and adolescent population, play therapy and family therapy are some of the most helpful interventions. Play therapy is a type of treatment that uses play as a way for young clients to communicate with their therapist because this can be easier for them than talking. Family therapy is a type of counseling that aims at treating the pathological patterns of interaction within the family and enhance the supportive structures within the family system. These approaches are based on the developmental stages of children and adolescents and are not the same as the general adult therapies which are mostly cognitive behavioral therapies (Thapar et al., 2015).
Role of Parents/Guardians
Parents and caregivers are vital partners in the identification and management of children and young people. They contain crucial historical and descriptive information regarding the child’s behavior, development, and background. It helps to coordinate the care of the child with his or her parents/guardians to make sure that the set treatment plan is embraced by the family and does not go against their beliefs and culture. Young clients are likely to benefit from the improvement in the therapeutic process and outcomes when parents or guardians are involved and communicated with effectively (Wheeler, 2014).
References
American Academy of Child & Adolescent Psychiatry (AACAP). (2012). Practice parameter for psychodynamic psychotherapy with children. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 541–557.
American Psychological Association. (2017). Code of Ethics.
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental health. American Psychiatric Association Publishing.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer.
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.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.
In the YMH Boston vignette 5 video, the social worker established rapport with the patient to foster communication and trust. In doing so, she got Tony to talk about his feelings. The social worker showed compassion and empathy throughout her discussion with the patient and provided a comfortable therapeutic environment that helped the client feel comfortable enough to share his daily struggles. Areas in which the social worker can improve include the style of question utilized to elicit information during the patient assessment and her ability to obtain detailed information about the patient’s experiences and symptoms. Utilizing an open-ended technique to obtain detailed patient information geared to determining an appropriate therapeutic plan is ideal and essential.
The area of compelling concern noted in the video is the provider’s missed opportunity to obtain detailed information concerning the patient’s symptoms or to follow through with critical information such as the patient’s anger issues, struggles with school, and alcohol use (i.e., frequency of alcohol use, and reasons (if any) for alcohol use). For example, enquiring about what triggers the patient’s anger, how the patient’s anger is expressed (i.e., angry outbursts, destructive or violent behaviors), and coping mechanisms the patient utilizes to manage anger (if any) are questions to ask to develop a better understanding of the patient and his struggles. Asking in-depth questions about the patient’s struggles with school and current alcohol use is also essential to addressing the patient’s mental health challenges.
A thorough, comprehensive mental health evaluation of a child or adolescent is essential for early detection and making the proper diagnosis necessary to develop an appropriate, efficient, timely, and successful course of treatment suitable for the child or adolescent’s age and developmental stage. A thorough evaluation also offers a thorough grasp of the child or adolescent’s surroundings, encompassing social interactions, familial relationships, and academic achievement. Taking a comprehensive approach is crucial to creating interventions that touch on every facet of the child’s life. According to Srinath et al. (2019), clinical assessment’s main objective is to build a case that will serve as a guide for management choices; determining the presence or absence of a mental health condition and essential areas of concern can be accomplished by defining signs and symptoms through a thorough clinical history and examination.
Examples of two different rating scales utilized during the psychiatric assessment of a child or adolescent are the Child Behavior Checklist (CBCL) and the Children’s Depression Inventory (CDI). The Child Behavior Checklist (CBCL) is a popular tool for evaluating emotional and behavioral issues in kids. As a valuable instrument for assessing psychopathology, the Child Behavior Checklist (CBCL) is an inexpensive, easy-to-use tool derived from empirical research that parents complete to provide essential data on general and definite psychopathology and functional domains (Biederman et al., 2020). The Children’s Depression Inventory(CDI) is a self-report tool used by kids ages 7 to 17 to gauge the intensity of depression symptoms. According to Jelínek et al. (2021), the Children’s Depression Inventory (CDI), developed by Maria Kovacs and adapted from the Beck Depression Inventory, is the most widely used instrument for evaluating depression symptoms in adolescents and serves as a gauge for one’s present state of depression and can be used to track shifts in depressive states. Utilizing the CDI makes measuring the effectiveness of therapy strategies and diagnosing depression easier.
Two psychiatric treatment options utilized for children and adolescents are Play Therapy and Parent-Child Interaction Therapy (PCIT). Because children frequently do not have the linguistic abilities to communicate their feelings and ideas, play therapy is an ideal treatment option. Play therapy allows children to express themselves, comprehend their feelings, and resolve problems. Koukourikos et al. (2021) explain that play therapy is the methodical application of a theoretical framework that creates an interpersonal process whereby licensed therapists utilize play’s therapeutic potential to assist kids in preventing or resolving psychosocial issues and achieving their full potential. This kind of therapy works exceptionally well with younger patients who might not be able to participate in conventional talk therapy. Parent-child interaction therapy (PCIT) aims to modify how parents and children engage with each other and enhance the quality of the parent-child bond. The goal of parent-child interaction therapy (PCIT), an evidence-based behavioral parent education program for preschool-aged children, is to improve the quality of parent-child interactions and child behavior by supporting the parent-child interaction patterns (Vess & Campbell, 2022). According to Vess & Campbell (2022), in parent-child interaction therapy (PCIT), parents learn how to develop a safe, caring relationship with their child and increase their prosocial conduct while decreasing negative behavior.
Parents and guardians are essential during the child and adolescent assessment process because they can freely discuss their concerns and observations regarding the client’s conduct at home. Knowing one’s historical background is crucial to comprehending how symptoms begin and develop. Parents and guardians can provide priceless information regarding the child’s developmental history, family history of mental illnesses, previous medical conditions, and significant life events. Parental observations in various contexts might shed light on a child’s social relationships, academic success, and behavior at home. These insights give a complete picture of the child’s functioning in many contexts. According to Mackova et al. (2022), parents are essential to the process of giving psychological care to their children because teenagers are incapable of making decisions about their health; hence, caregiving begins with parents’ capacity to identify issues and seek help from the system, followed by their desire to collaborate and follow instructions through to the treatment’s completion. Including parents in the evaluation procedure encourages a team-based approach to treatment planning. In addition to being more involved in the therapy process, parents may help set reasonable goals and ensure at-home compliance with methods and treatment suggestions.
Finally, a thorough peer review has ensured that the scholarly publications used for this assignment are authentic, trustworthy, and relevant to the academic community. Experts in the area evaluate the publication’s approach, conclusions, and content before publication.
References
Biederman, J., DiSalvo, M., Vaudreuil, C., Wozniak, J., Uchida, M., Yvonne Woodworth, K., Green, A., & Faraone, S. V. (2020). Can the child behavior checklist (CBCL) help characterize the types of psychopathologic conditions driving child psychiatry referrals? Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 8(1), 157–165. https://doi.org/10.21307/sjcapp-2020-016Links to an external site.
Jelínek, M., Květon, P., Burešová, I., & Klimusová, H. (2021). Measuring depression in adolescence: Evaluation of a hierarchical factor model of the children’s depression inventory and measurement invariance across boys and girls. PLOS ONE, 16(4). https://doi.org/10.1371/journal.pone.0249943Links to an external site.
Mackova, J., Veselska, Z. D., Geckova, A. M., Jansen, D. E., van Dijk, J. P., & Reijneveld, S. A. (2022). The role of parents in the care for adolescents suffering from emotional and behavioral problems. Frontiers in Psychology, 13. https://doi.org/10.3389/fpsyg.2022.1049247Links to an external site.
Vess, S. F., & Campbell, J. M. (2022). Parent–child interaction therapy (PCIT) with families of children with autism spectrum disorder. Autism & Developmental Language Impairments, 7, 239694152211407. https://doi.org/10.1177/23969415221140707Links to an external site.
Mental health is a significant social parameter that influences well-being, quality of life, and human rights, as well as economic factors like creativity, productivity, and sustainable development (Samartzis & Talias, 2019). Mental health services are essential for the prevention and treatment of mental disorders, aiming to maintain, improve, and restore the mental well-being of individuals. The comprehensive psychiatric assessment is a priority to recognize mental health disorders in any age group in the early phase. It not only affects the general population but also clinicians. A study conducted by researchers from the American Medical Association (AMA) and the Mayo Clinic in 2014, revealed that 54 percent of U.S. doctors experience burnout, a rate higher than in other industries. Additionally, the suicide rate among clinicians is terrifyingly high; a 40-year review of clinician suicides found that male clinicians have a 70% higher likelihood of suicide compared to the general population, while female clinicians face a 250%–400% higher risk (Wang & Wang, 2022).
YMH Boston Vignette 5 video
Upon reviewing the YMH Boston Vignette 5 video, a few of the points the practitioner did well were ensuring the environment was quiet and free of distractions. The practitioner built a good rapport with the patient Tony and asked simple open-ended questions. The practitioner explored Tony’s symptoms of depression and anxiety and his responses to the symptoms. The practitioner validated the patient’s school struggles and the recent breakup that could potentially lead to the risk of self-harm.
The areas for improvement for the practitioner would be firstly the introduction part between her and Tony and the purpose of the assessment. This can help Tony feel more comfortable and build rapport. Secondly, the practitioner should have clarified Tony’s responses to the questions and tried to understand Tony’s feelings of anger, school struggles, and the impacts of the recent breakup on his daily activities.
At this point of the clinical interview, the compelling concern was whether Tony was having suicidal ideation or had initiated self-harm in the past. Since Tony verbalized that he does not want to be alive and had thought of self-harm he might require immediate safety attention. In addition, upon answering about substance use, Tony appeared to be discomfort and paused while answering.
The next questions as a practitioner for Tony are as follows,
Do you have any suicidal ideations?
Do you have any plans to act on your suicidal ideation?
Tell me more about the thoughts of hurting yourself, how are you coping with it?
The importance of a thorough psychiatric assessment of a child/adolescent is important
The thorough assessment of children/adolescents can be challenging but is vital to diagnose and create a treatment plan for mental health disorders. While children can describe the nature of their symptoms, they often struggle with accurately reporting the timing and duration of their issues. Most of the time children/adolescents are brought for visits by their parents. Additionally, they may suppress information about problems that they find embarrassing. Therefore, clinical assessments of children and adolescents are intricate and require clinicians to be astute and diligent in collecting information from multiple sources and settings, such as the child, parents, teachers, and other caregivers (Srinath et al., 2019). Despite discrepancies in reports, multi-source information is essential for accurate diagnosis and management. Typically, assessments and treatments involve a multidisciplinary approach. Information is often gathered gradually to avoid overwhelming the child and family, and it must be shared among all professionals involved in the child’s care (Srinath et al., 2019).
Two different symptom rating scales for a psychiatric assessment of a child/adolescent
There are several rating scales appropriate for a psychiatric assessment of a child/adolescent to measure the mental health disorder’s symptom severity. The first rating scale is the Children’s Yale-Brown Obsessive Compulsive Scale (OCD). This rating scale helps practitioners to evaluate the severity of obsessive and compulsive symptoms in children/adolescents between the ages of 6-17 years (Srinath et al., 2019). The second rating scale is the Conners Rating Scale which is commonly used in the assessment of attention-deficit/hyperactivity disorder (ADHD). Conners rating scale evaluates ADHD symptoms and different behavioral concerns among ages 6- 18 years.
Two psychiatric treatment options for children and adolescents
The psychiatric treatment option for children and adolescents are first being Parent-child interaction therapy (PCIT). PCIT is an evidence-based therapy for preschool children focused on enhancing parent-child interaction patterns to improve child behavior and strengthen the parent-child relationship (Vess & Campbell, 2022). PCIT is effective in treating children with disruptive behavior disorders like autism spectrum disorder (ASD). It helps improve children’s behaviors, functions, and relationships with siblings and parents by building safe, secure, and nurturing relationships. The key aspects of PCIT include direct coaching of parent-child interactions, data-driven treatment guidance, the use of specialized space and equipment, a positive and nonjudgmental approach, targeting various behavioral issues, and focusing on interaction patterns rather than isolated behaviors (Vess & Campbell, 2022).
The second treatment option is Play therapy. Play is a vital part of children during their growth and development which also helps in dealing with different behavioral issues. Play is effortless and helps children to express themselves and become socialized. Play therapy is defined as the systematic application of a theoretical model that creates an interpersonal process where trained therapists use the therapeutic power of play to help children prevent or resolve psychosocial difficulties and achieve optimal development (Koukourikos et al., 2021). It serves both as a psychotherapeutic approach and a psycho-diagnostic tool for children. Play therapy helps practitioners understand children’s level, their expression, understanding, and acceptance (Koukourikos et al., 2021).
Parents/Guardians play a huge role in mental health assessment for their children. The quality and effectiveness of treatment plans increase by the involvement of caregivers. Parents/guardians recognize the mental health problems of their children, which helps children to get proper care in the early phase of their life. Since they cannot make proper medical decisions, parents play a huge role in providing mental healthcare to their children. Parents go through five stages of seeking help first, parents initially become aware of their adolescent’s distress. Secondly, parents acknowledge that the problem is serious and needs attention. Thirdly, parents explore options to help their child, and fourth, parents decide to seek mental health services. Fifth, parents take steps to find appropriate mental health services (Mackova et al., 2022). Parents play a role in regular attendance and adherence to treatment plans for children/adolescents’ quality of living and better outcomes for their mental health.
Mackova, J., Veselska, Z. D., Geckova, A. M., Jansen, D. E. M. C., van Dijk, J. P., & Reijneveld, S. A. (2022). The role of parents in the care for adolescents suffering from emotional and behavioral problems. Frontiers in Psychology, 13, 1–12. https://doi.org/10.3389/fpsyg.2022.1049247Links to an external site.
What did the Practitioner do well, and in what areas can the Practitioner Improve?
The practitioner did a great job of interacting with the adolescent client. She was pleasant, friendly, and professional towards the client. She asked appropriate questions to gather vital information while allowing the client to open up more. The client shared that he likes playing basketball but doesn’t play as much because he sometimes doesn’t have enough energy to play. He was an A-B student, but his grades declined due to not wanting to do his homework. He admits to drinking 1-2 beers sometimes with his friends. He has been edgy and angry because his girlfriend ended their relationship two months ago without giving him a reason. He also admits to having tightness in his chest, a racing heartbeat, feeling hurt, and not wanting to be alive when he thinks about the breakup.
There were a few areas where the practitioner could have improved. The practitioner could have initially introduced herself and greeted the client to help build rapport. She could have asked more open-ended questions to gather more information on how he feels, his daily activities, his support system, and his relationship with his girlfriend.
Any Compelling Concerns during the Clinical Interview?
Suicide is an immediate health concern and a leading cause of preventable death (Bornheimer et al., 2022). The most compelling concern during the interview was the client’s suicidal thoughts. It should be an immediate priority for the Practitioner to assess suicidality. Assessing suicidality is a prompt warning for ensuing suicidal acts and also offers significant insights into the patient’s level of distress and their specific needs. This dual purpose emphasizes the significance of evaluating suicidality comprehensively (Harmer et al., 2024).
What would be your next Question and why?
My priority would be to ask the client if he has an active suicide plan. Suicidal ideation, demonstrated by thoughts of ending one’s life or self-harm, is a substantial mental health issue with the capability for critical outcomes if not adequately addressed. Recognizing suicidal ideation promptly and identifying the primary causes are vital steps in increasing a patient’s quality of life and reducing the probability of suicide (Harmer et al., 2024).
Explain why a Thorough Psychiatric Assessment of a Child/Adolescent is Important
Assessing children and adolescents can be challenging, especially for new PHMNPs. Children and adolescents may have difficulty reporting their symptoms and the timing and duration of their problems. A thorough psychiatric assessment is important for a child/adolescent because it allows PHMNPs to obtain all the necessary information to evaluate the patient’s needs and formulate a treatment plan for optimal patient outcomes (Srinath et al., 2019).
Describe two Different Symptom Rating Scales that would be appropriate to use during the Psychiatric Assessment of a Child/Adolescent
The Pediatric Symptom Checklist (PSC) is a rating scale for children ages 4-18 that screens for emotional and behavioral problems (Jeffrey et al., 2021). The Spence Children’s Anxiety Scale (SCAS) is another rating scale for children ages 8-15 that screens for anxiety symptoms (Reardon et al., 2018).
Describe two Psychiatric Treatment Options for Children and Adolescents that may not be used when Treating Adults
Play therapy is one psychiatric treatment option for children and adolescents. It allows them to express themselves, recognize, identify, and verbalize feelings through toys, dolls, blocks, puppets, drawings, and games. The therapist examines how the child uses play materials and identifies patterns or themes to understand the child’s problems. Children can better understand and manage their feelings, behavior, and conflicts through talk and play (Koukourikos et al., 2021).
Parent-child Interaction therapy is another psychiatric treatment option for children and adolescents. It helps children and parents with behavior problems. Children and parents interact with each other while therapists guide them toward positive interactions (Bhide, & Chakraborty, 2020).
Explain the Role Parents/Guardians Play in Assessment
Parents/guardians play a crucial role in assessing children/adolescents. Parents/guardians present during their child/adolescent assessment can help provide comfort, information, treatment wishes, needs, and concerns. Working closely together with parents/guardians enables providers to build a solid therapeutic relationship and improve outcomes for their children (Bhide, & Chakraborty, 2020).
References
Bhide, A., & Chakraborty, K. (2020). General principles for psychotherapeutic
Based on the YMH Boston Vignette 5 video, post answers to the following questions:
What did the practitioner do well? In what areas can the practitioner improve?
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
What would be your next question, and why?
Then, address the following. Your answers to these prompts do not have to be tailored to the patient in the YMH Boston video.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Explain the role parents/guardians play in assessment.
Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources.
Read a selection of your colleagues’ responses.
Week One Discussion Question One
What did the practitioner do well?
The practitioner interview techniques that were strong in the case scenario include having good eye contact with the client, sitting facing the client, nodding to confirm understanding, and actively listening to the client. Another positive technique is the provider was not charting or looking at a computer during the interview which could lead the client to think the clinician is not paying attention. Other strong qualities of the provider include asking questions that engaged the client to provide more information and lead to other questions that could provide more critical information. The provider asking about the duration of symptoms was appropriate to assist with diagnosis. When the client admitted to being angry, the provider informed the client that this could be further discussed which is supportive. The provider provided a summary of what the client reported which assists in not missing information and confirming understanding.
The clinician should introduce herself at the beginning of the interview. When asked if the client understood the purpose of the meeting, the client reported that he thinks the evaluation is taking place because his primary care physician sent him in for an evaluation. The practitioner could have explained the purpose of the evaluation more clearly. The interview should start with a warm greeting and asking the client about their interests prior to asking more sensitive questions. (Hilt & Nussbaum, 2016) The provider also interviewed in a checklist-style which is impersonal. Lastly, the provider should ask what the client’s goals are for treatment.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
The provider did not obtain consent or agreement from the client for the assessment. The provider informed the client that she would like to ask him some questions and started the interview prior to the client agreeing. Obtaining consent from the parents for treatment is important prior to the evaluation. A study was performed to assess adolescents’ understanding of treatment goals, decisions, and consequences of those decisions. “In summary, findings of this study suggest that, unless completed in collaboration with their parents or legal guardians, 12-to-17-year-old adolescents do not identify consequences and assimilate and integrate information when it comes to deciding about psychiatric mental health treatments” (Roberson & Kjervik, 2012, p. 10). The case scenario does not involve the parents. Parents could be interviewed prior to the client being interviewed alone to obtain any input and pertinent medical information and behavioral concerns.
What would be your next question, and why?
I would ask the client if he currently has an active plan to harm himself. If the client has an active plan, consideration for emergency evaluation and inpatient hospitalization may be appropriate for safety. I would then ask if the client has previously attempted suicide or self-harm. I would ask about access to firearms in the home. I would ask about available support systems. I would ask the client reasons he would not want to harm himself. The 2013 youth behavior risk assessment could be given to evaluate the immediate risk of a suicide attempt. This client is at a higher risk of committing suicide due to a recent breakup. “Suicide is the second leading cause of death for adolescents 15 to 19 years old” (Shain, 2016, p. 1098). Boys have a completed suicide rate 3 times higher than girls. (Shain, 2016) Suicide affects young people from all races and socioeconomic groups, although some groups have higher rates than others.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
“Clinical history taking, and interviewing are one of the most powerful tools available to the child and adolescent mental health professionals to make a diagnosis and plan management” (Srinath & et. al., 2019, p. 175). Rating scales can also assist in leading the clinician to the correct diagnosis. The clinician should consider age, culture, communication skills, and cognition when interviewing children and adolescents. The assessment, “Will often include some direct assessment of the child’s functioning, observations of the child, interviews with parents and, where appropriate, relevant information from school” (Thapar & et. al., 2015, p. 436). Finding the cause of the symptoms is essential to correct diagnosis. The provider should rule out if the symptoms the client is experiencing are situational or due to substance use.
The importance of a correct diagnosis in order to provide the correct treatment is imperative to the client receiving quality care. “A child can be inattentive for any number of reasons without having attention-deficit/hyperactivity disorder, and an adolescent can be sad for many reasons without experiencing a major depressive episode. If these kinds of behaviors and symptoms do not significantly impair function or can be better explained by another etiology, a formal mental health diagnosis should not be made” (Hilt & Nussbaum, 2016, p. 64). Children may be resistant to evaluation and treatment making assessment difficult. “In addition, the process of diagnosing disorders in a child typically involves gathering information from multiple informants and remembering an age- and developmentally adjusted–diagnostic differential” (Hilt & Nussbaum, 2016, p. 5).
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
“Preassessment screening tools engage a patient and his caregivers in the treatment, normalize conversations about mental distress, and assist you in identifying the chief complaint” (Hilt & Nussbaum, 2016, p. 60). Two rating scales could be used during the assessment including the Strengths and Difficulties Questionnaire and the Developmental Behavior Checklist. The strengths and difficulties questionnaire is used to evaluate emotional symptoms, conduct issues, hyperactivity, issues with peers, and prosocial behavior. The questionnaire is completed by parents, the teacher, and the child. (Español-Martín & et. al., 2021) “Two key uses of structured instruments are for (a) diagnostic interviewing, and (b) gathering descriptive information about various aspects of emotional, behavioral, and social problems” (Srinath & et. al., 2019, p. 165). The developmental-behavioral checklist evaluates emotional and behavioral problems for children and adults with intellectual and developmental disabilities. (Monash University, 2020)
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Play therapy, art therapy, IPT-A therapy, ACT therapy, and receiving treatment in an educational setting may be used as treatment options for children but may not be used when working with adults. “The need for non-clinic-based assessment is especially important when there is a discrepancy between the various accounts of behavior, for example, disagreements between parents and teachers concerning the nature or severity of the presenting difficulties, or when the behavior observed in the clinic does not tally with other reports” (Thapar & et. al., 2015, p. 438).
Explain the role parents/guardians play in assessment.
“There is a need to respect the child’s autonomy as well as look out for their best interests. Shared decision-making, with selective paternalism where needed, is the best form of practice, especially with children and families” (Srinath & et. al., 2019, p. 159). The therapist should educate the child and the family about interventions and diagnoses. There should be direct communication with the child. “Acknowledging the child’s emotion and communicating an interest in understanding the child’s perspective is crucial in reassuring the child that they will be heard and their concerns addressed without the use of any coercion or deception” (Srinath & et. al., 2019, p. 160). Building a therapeutic alliance is essential to increase the change of the child engaging in therapy. “It is imperative to get a narrative account of the clinical history from both parents and child” (Srinath & et. al., 2019, p. 161). The parents can provide information on their observations of the child and assist with providing medical history and development history.
Español-Martín, G. & et. al. (2021) Strengths and Difficulties Questionnaire: Psychometric Properties and Normative Data
for Spanish 5- to 17-Year-Olds. Assessment, 28(5), 1445-1458. – Peer-reviewed.
BY DAY 6 OF WEEK 1 COMPREHENSIVE INTEGRATED PSYCHIATRIC ASSESSMENT
Respond to at least two of your colleagues on 2 different days by offering additional insights or alternative perspectives on their analysis of the video, other rating scales that may be used with children, or other treatment options for children not yet mentioned. Be specific and provide a rationale with evidence.
I like your main post and learns from it. As I am reading your post, I have some questions about the parent consent before the psychological evaluation. So, I did some research and found out that psychological professors don’t need the parent’s or guardian’s consent to start psychological evaluation or service unless it is believed that the child or adolescent is not able to manage their care. On the contrary, the mental health professional provider should obtain the child or adolescent’s consent before they tell the parents or legal guardian.
Colorado HB 19-1120 was signed into law and went into effect on May 16, 2019. HB 19-1120 lowers the age of consent for psychotherapy services from 15 years old to 12 years old. Under this law, the professional person or licensed mental health professional rendering mental health services to a minor may, with or without the minor’s consent, advise the minor’s parent or legal guardian of the services given or needed (Sullivan, 2019).
Even though children and adolescents don’t have the legal right to give consent to their evaluation or treatment, they already possess the knowledge and cognitive ability to understand the decision they make. They are also emotionally mature enough to make their own decisions. Many children and adolescents are very reluctant to let their parents know about their mental situation and feel embarrassed or uncomfortable to know that they have no secret in front of their parents. According to a survey, only one-third of the underage participants were willing to obtain parental consent before they get any psychological evaluation or therapy. (Cavazos-Rehg, 2020).
References
Cavazos-Rehg, P., Min, C., Fitzsimmons-Craft, E. E., Savoy, B., Kaiser, N., Riordan, R., Krauss, M., Costello, S., & Wilfley, D. (2020). Parental consent: A potential barrier for underage teens’ participation in an mHealth mental health intervention. Internet interventions, 21, 100328. https://doi.org/10.1016/j.invent.2020.100328
Sullivan, J. (2019, July 16). Colorado Lowers Age of Consent for Psychotherapy Services to 12 Years Old | Insights | Greenberg Traurig LLP. Www.gtlaw.com. https://www.gtlaw.com/en/insights/2019/7/colorado-lowers-age-of-consent-for-psychotherapy-services-to-12-years-old
Hello xx, I enjoyed reading your post. I agree the interview should have begun warmer. Anxiety and depression are the two most prevalent mental disorders in teens and adolescents; however, only a small percentage of this population receives assistance for their condition. Barriers that teens have reported are feelings of embarrassment due to stigma and feeling as if reaching out for help is a sign of their weakness (Radez, 2022). The teens in Radez’s article reported elements that influenced them to seek help were encouraging supportive attitudes and if they had a favorable opinion of the communication utilized by the clinician when receiving services (Radez, 2022).
Two other rating scales are the Vanderbilt ADHD diagnostic (VADPRS) and the Young mania rating scale (YMRS). The Vanderbilt ADHD diagnostic rating scale is an assessment tool used to measure ADHD symptoms and their effects on the academics and behaviors of children. The two versions are used for parents’ and teachers’ input (Khalmbule, 2021). The young rating scale is completed by a trained clinician. Manic symptoms of the individual are evaluated. The total score indicates the severity of the person’s mania. Questions range from 0-5 in intensity and frequency using 11 elements. Other informants of information may also be included. There are 5 distinct levels of severity (irritability, disorderly or aggressive behavior, and thought content. The YMRS is used more than any other mania scale (Mohammadi, 2018).
References
Khambule, N. N. (2021). Investigating the psychometric properties of the Vanderbilt-Attention-Deficit-Hyperactivity-Disorder diagnostic rating scale (VADRS) within the South African context (Doctoral dissertation).
Mohammadi, Z., Pourshahbaz, A., Poshtmashhadi, M., Dolatshahi, B., Barati, F., & Zarei, M. (2018). Psychometric properties of the young mania rating scale as a mania severity measure in patients with bipolar I disorder. Practice in Clinical Psychology, 6(3), 175-182.
Radez, J., Reardon, T., Creswell, C., Orchard, F., & Waite, P. (2022). Adolescents’ perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study. European child & adolescent psychiatry, 31(6), 891-907.
Depression is a common disorder in teenagers. 41.6% of teenagers from age to 12-17 had at least one episode of major depressive disorder in 2020 (National Institute of Mental Health, 2022). Many things happen in a teenager’s life that can lead to depression, bullying, trouble at home or getting along with peers, peer pressure, and relationship issues are just a few. Depression can cause a lack of interest in activities, feelings of extreme sadness, irritability, lack of focus, and trouble sleeping (American Psychiatric Association, 2022). Severe depression can cause feelings of suicide and self-harm.
YMH Boston Vignette 5 Video
In this video I believe the practitioner did well. The client started off being very reluctant, superficial, but with the probing questions she continued to ask she was able to get him to disclose some important information. It appears that this is the first time these two individuals have met. The clinician jumped right into talking with the client. The client may have been more open at the beginning if she introduced herself or explained what their relationship would be like, including confidentiality (Sharma et al., 2019). At the finishing of the video, I would have continued assessing the client’s suicidal thoughts. I will want to find out if he has any plan or intent to act on his thoughts. If not, I would want to work with him on contracting for safety, working on talking to his parents about the thoughts. If he has a plan or intent, I would be looking at inpatient hospitalization. I would also assess if he had any homicidal ideation.
Why a thorough assessment is important
A thorough assessment is important in a child or adolescent aged client as they are typically more reluctant to talk about issues, out of fear of being in trouble or embarrassment (Sharma et al., 2019). Clinicians must be aware of this to get an accurate assessment. Collaborating with other individuals in the client’s life, such as teachers, parents, or other important people can help create a whole picture
Two different symptom rating scales
For rating depression, I would use a HAM-D or a PHQ-9 scale. The HAM-D scale is based off 17 different categories that are rated on severity of symptoms. A score of over 23 would indicate very severe depression. A score of 19-22 is severe depression, 14-18 moderate depression, 8-13 mild depression, and 0-7 normal. A PHQ-9 is a scale to rate severity of depression also. This scale consists of 10 total questions, 9 of them used to rate severity. All the categories are symptoms of major depressive symptoms. They rate how many days they have experienced these symptoms. For this scale a 1-4 would be considered minimal depression, a 5-9 mild depression, a 10-14 moderate depression, a 15-19 moderately severe depression, and a 20-27 severe depression.
Two psychiatric treatment options for children
One option for psychiatric treatment for a child is play therapy. Play therapy is good to use for children up to school age. This helps a child address and manage feelings in a way they can understand through playing with toys (Koukourikos et al., 2021). Play therapy allows a child to act out feelings and emotions that a therapist can interpret and find what they mean. Children often feel more at ease and comfortable when playing with toys, rather than expecting them to use language that an adult would use.
A second option for psychiatric treatment for a child is parent child interaction therapy. This therapy is used on children who are having a hard time connecting or interacting with their parents. You would typically see the child acting out behaviorally and unable to control their emotions (Lieneman et al., 2017). The therapist guides the parent on how to interact with the child to try to strength their relationship and work on how to handle behavioral issues.
Role guardians/parents play in assessment
For a thorough assessment it is imperative to include the guardian. The therapist needs to have a picture of everything that is going on with the child. Having a collaboration from multiple people in the child’s life would be beneficial. It also would be imperative to continue to include the guardian throughout treatment. Just to see how they think the child is progressing, if any further issues have come up. It is also important to the guardian to realize how the child may act with therapy. They may act out at times if they have had to discuss issues that trigger them. The guardian needs to be instructed of how to be supportive.
Conclusion
Childhood and adolescents can be a difficult time for children. They may need additional support at this time if they appear to be struggling with depression. There are plenty of options for the treatment of a child suffering with depression. It is imperative that guardians pay attention to their children during these times to catch symptoms more quickly and allow for treatment.
References
American Psychiatric Association. (2022). Diagnostic And Statistical Manual Of Mental Disorders, Text Revision Dsm-5-Tr. Amer Psychiatric.
Koukourikos, K., Tsaloglidou, A., Tzeha, L., Iliadis, C., Frantzana, A., Katsimbeli, A., & Kourkouta, L. (2021). An Overview of Play Therapy. Materia Socio Medica, 33(4), 293. https://doi.org/10.5455/msm.2021.33.293-297
Lieneman, C., Brabson, L., Highlander, A., Wallace, N., & McNeil, C. (2017). Parent–Child Interaction Therapy: current perspectives. Psychology Research and Behavior Management, Volume 10, 239–256. https://doi.org/10.2147/prbm.s91200
National Institute of Mental Health. (2022, January). Major Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression
Sharma, E., Srinath, S., Jacob, P., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(8), 158–175. https://doi.org/10.4103/psychiatry.indianjpsychiatry_580_18
In the assigned video, “Vignette 5 – Assessing for Depression in a Mental Health Appointment” Tony, a male adolescent was referred by his doctor to see a mental healthcare clinician to further screen and assess for depression and suicidality (YMH Boston, 2013). In her assessment, it is commendable how she took a moment to further clarify the objective of her questions— by offering the patient example responses to further guide his understanding to allow him to better articulate himself. The clinician also spoke with Tony directly. According to Srinath et al., (2019), “direct communication with the child, acknowledging the child’s understanding of the situation, and building a shared understanding, even if simplistic, is fruitful in the long run.” Recognizing risk factors that increase the likelihood of suicidal behavior, especially in patients with depression, is an important aspect of emergent psychiatric assessment. The assessment was not near thorough, there was no information about parent/guardian consent to treatment, the clinician did not explore any background history of family mental health and she also did not explore further when the patient voiced suicidal ideation. When the patient reported that he sometimes “felt so angry that he felt like fighting people,” the clinician did not explore further. One way of pursuing this statement could be to validate how challenging/ frustrating it must be to feel that way and explore coping mechanisms—or if the patient has acted upon it. Ensuring a thorough assessment allows the optimization of safety and the development of an appropriate plan of care for the patient (Sadock et al., 2015). Furthermore, given the delicate nature of that comment, her unintentional dismissal might have been the patient’s cry for help or his first admission of this delicate knowledge, which could have badly impacted the quality of her interaction with him.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
A thorough psychiatric assessment of a child/adolescent is imperative. Identifying signs and symptoms through a thorough clinical history and examination can assist in determining the presence (or absence) of a mental health issue and other critical areas of concern (Srinath et al., 2019). Placing the child within a psychosocial background, relating the presentation to his or her context, and gathering information about what has happened to the illness thus far, including what has been the treatment and response history, are necessary to fully comprehend the origins, maintenance, and factors affecting remission from the disorder (Srinath et al., 2019).
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
According to the CDC (2022), suicide is the common leading cause of death in youth, ages (10-24 years). As seen in the vignette, Tony experienced a breakup with his girlfriend and had suicidal thoughts so a screening to further explode the severity of his feelings is warranted. Typically, screening methods are used to identify instances that require more clinical assessment. King et al., 2015 acknowledged that the use of screening tools can be challenging- the high sensitivity but moderate-to-low specificity. However, some screening tools have proven reliability for successful identification of suicidal behavior and depressive symptoms (Weatherly & Smith, 2019). The Columbia Suicide Severity Rating Scale (C-SSRS) and the Patient Health Questionnaire-9 (PHQ-9) modified for teens are two tools used to screen patients with suicide ideation and depression (Weatherly & Smithith, 2019). The C-SSRS is a 6-question scale, with good sensitivity and specificity for evaluating suicide used to distinguish suicidal ideation and behavior and the PHQ-9 modified for teens is a 9-question screening tool used to assess patients with symptoms of depression and measure depression severity (Weatherly & Smith, 2019).
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
There are several treatment options for children and adolescents, two of which are play therapy and problem-solving therapy. Play therapy is described as a “protected and structured environment with games and toys provided by the therapist who observes the child’s behavior and conversation to gain insight into their thoughts and feelings,” respectively and problem-solving therapy (characterized as “a therapy where the child or youth meets with their therapist to identify problems and strategize possible solutions”) (Association for Children’s Mental Health, 2015).
Explain the role parents/guardians play in assessment.
These age groups are usually brought in by their parents or guardians and the chief complaint and background history from birth to present is usually provided by the parents/guardians. The parents/guardians’ role is to aid in the case formulation by providing information about the patient’s behaviors or symptoms that led to the visit. The parents/guardians play an integral role in the psychiatric assessment process of children/adolescents. According to Wheeler (2020), family involvement in treatment is appropriate to improve family interactions, keep families engaged in services, or increase their knowledge about mental health-however, the child/adolescent remains the center of the assessment. Children with conduct issues may require various systems that interact with the child; in this instance, family involvement is a critical element to both setting goals and keeping them (Wheeler 2020). The role of the parent varies in the assessment process, however, depending on the nature of the child’s visit, and other factors related to the patient’s relationship with the family, the family’s level of understanding/willingness to understand, etc.—their involvement may or may not be helpful. It is said that: “shared decision-making, with selective paternalism where needed, is the best form of practice, especially with children and families”—however, a common mistake clinicians make is the assumption that collaborating with parents is sufficient, and that interventions in children occur through parents” (Srinath et al., 2019).
King, C. A., Berona, J., Czyz, E., Horwitz, A. G., & Gipson, P. Y. (2015). Identifying Adolescents at Highly Elevated Risk for Suicidal Behavior in the Emergency Department. JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY, 25(2), 100–108. https://doi.org/10.1089/cap.2014.0049Links to an external site.
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer
Weatherly, A. H., & Smith, T. S. (2019, July 1). Effectiveness of Two Psychiatric Screening Tools for Adolescent Suicide Risk. Pediatric Nursing, 45(4), 180.
Wheeler, K. (Ed.). (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (3rd ed.). Springer Publishing.Chapter 17, “Psychotherapay with children”
What did the practitioner do well? In what areas can the practitioner improve?
The practitioner did well in assessing the patient for depression. The practitioner asked the questions directly, which made the patient guarded and dismissive at first. However, the patient was willing to share their feelings and their reasons. It enables the practitioner to acquire the necessary information to help treat the patient.
At this point in the clinical interview, do you have any compelling concerns? If so, what are they?
No, I do not have any concerns.
What would be your next question, and why?
I would ask the patient if they would be willing to undergo further assessment.
To measure the willingness of the patient to accept help and their probability of absconding the evaluation.
Explain why a thorough psychiatric assessment of a child/adolescent is important.
Adolescents are at a sensitive age when they experience puberty, and some do not know how to deal with it. The physical and hormonal changes make them feel misunderstood and prefer to be apart from everyone else, which brings about depression or mental illness. Thoughts of suicide and the ability to cause self-harm are critical indicators of accelerated mental disorders. Therefore, performing a thorough psychiatric assessment is crucial in preventing suicide or overdose on drugs and substances. In other words, their lives depend on the outcome of the psychiatric evaluation.
A thorough assessment is essential because it ensures easier identification of symptoms related to mental disorders or depression and anxiety. The review also helps the patient acknowledge how they feel and what attributes it has. It makes it easier for the patient to accept help and get better, especially if cooperative (Farley, 2020). Adolescents and children are quite sensitive and emotionally wired and are therefore at higher risk of having depression or mental disorders. The psychiatric assessment measures their interpersonal issues, mood, thought process, motor, speech, and memory. They enable the psychiatrist to identify the underlying problems or areas requiring further evaluation.
Describe two different symptom rating scales that would be appropriate to use during the psychiatric assessment of a child/adolescent.
Depression
This symptom rating is the most common in adolescents and is easily identified. It can be evidenced in mood, affect, thought process, and interpersonal issues. Adolescents with depression symptoms have low spirits with feelings of not caring about anything. They also think of themselves in a common way and as the problem which makes them withdraw from those around them. They also easily disagree with their parents and feel misunderstood and frustrated.
Substance abuse
The substance abuse risk assessment is meant to identify any influence of drugs or substances on the adolescent’s mental health. Adolescents are highly exposed to substances, especially now with the increasing use of technology and the accessibility of medicines. Most adolescents are easily influenced to engage in substance abuse and view it as an escape from their feelings of depression, anxiety, and even suicide (Fortney et al., 2017). Unidentified use of substances may lead to more problems, such as addictions or an overdose.
Describe two psychiatric treatment options for children and adolescents that may not be used when treating adults.
Play therapy is used in children and adolescents when they play with toys and puppets to reignite their inner child and enhance their imagination (Dulcan et al., 2017). They can put their worries aside and enjoy themselves. It might not work on adults since they might see it as silly and ineffective. Supportive therapy in adolescents uses art and music to keep their minds engaged and free from thoughts that trigger mental disorders. Engaging the children in physical activities like relaxation exercises makes the psychiatric treatment more successful.
Explain the role parents/guardians play in assessment.
Parents play the role of provider and guide to their children, but they should also learn to be their friends and confidants. They play a massive role in ensuring their children’s mental health is stable and therefore are the first to seek help anytime they notice unusual behavior. Adolescents rarely self-report their challenges in mental health since they find it difficult to acknowledge they have a problem or are scared to ask for help (Farley, 2020). Misunderstandings between parents and children tend to escalate during adolescence, and some may think their children are going through a phase and ignore the symptoms of mental disorders. Parents need to be more aware of their children’s mental health and be willing to seek help from psychiatrists.
They also ensure that the psychiatric treatment chosen for their children is successful by cooperating with the psychiatrist’s instructions. Patience and support are essential attributes that parents should have to ensure the safety of their children. They can also undergo counseling to unlearn any unhealthy habits that may trigger their children to have mental disorders.
The articles chosen in this assignment are scholarly because.
They are peer-reviewed, and every article was cited by many scholars in their papers. This shows that the information they provide is reliable.
The articles used are within the last five years which ensures that the information provided is up-to-date and correlates with the current situation and changes.
The articles are also evidence-based with one of them being a metanalysis of the findings of different authors.
References
Dulcan, M. K., Ballard, R. R., Jha, P., & Sadhu, J. M. (2017). Concise guide to child and adolescent psychiatry. American Psychiatric Pub.
Farley, Holly R. EdD, RN. Assessing mental health in vulnerable adolescents. Nursing: October 2020 – Volume 50 – Issue 10 – p 48-53 doi: 10.1097/01.NURSE.0000697168.39814.93
Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2017). A Tipping Point for Measurement-Based Care. Psychiatric Services, 68(2), 179–188. doi:10.1176/appi.ps.201500439
Méndez, J., Sánchez-Hernández, Ó., Garber, J., Espada, J. P., & Orgilés, M. (2021). Psychological Treatments for Depression in Adolescents: More Than Three Decades Later. International journal of environmental research and public health, 18(9), 4600. https://doi.org/10.3390/ijerph18094600
NRNP 6665 Discussion Wk 1 Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 5 video
Required Readings
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019). Clinical practice guidelines for assessment of children and adolescents. Indian Journal of Psychiatry, 61(2), 158–175. http://doi.org/10.4103/psychiatry.IndianJPsychiatry_580_18
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. • Chapter 31, “Child Psychiatry” (for review, as needed)
Support your response with at least three peer-reviewed, evidence-based sources and explain why each of your supporting sources is considered scholarly. Attach the PDFs of your sources. NRNP 6665 Discussion Wk 1 Comprehensive Integrated Psychiatric Assessment – YMH Boston Vignette 5 video
Ethical & Legal Foundations of PMHNP Care with Autonomy
The perception of autonomy in psychiatric and mental health care is pivotal for understanding and improving patient outcomes. This principle, deeply rooted in ethical practice, underscores the necessity of respecting patients’ self-governance, particularly in managing their health conditions. Recent studies, including the discussions on psychiatric advance directives (PADs), the influence of capacity-based mental health legislation in Norway, the measurement of autonomy through the Autonomy Scale Amsterdam (ASA), and innovations in autonomy via peer-facilitated interventions, each contribute subtle perspectives to this discourse. These articles collectively explore how autonomy can be both compromised by mental health conditions and potentially restored through innovative legal frameworks, validated scales, and peer support methodologies. They provide a comprehensive view of the challenges and opportunities within mental health practices aimed at enhancing autonomy, crucial for aligning treatment with the values and preferences of those with psychiatric disorders.
Autonomy
Autonomy in psychiatric and mental health care, particularly at the level of advanced practice such as that undertaken by Psychiatric-Mental Health Nurse Practitioners (PMHNPs), embodies a crucial principle in both ethical and clinical dimensions. The concept of autonomy signifies to the capability and right of patients to make knowledgeable and intentional decisions about their individual health care (Manderius et al., 2023). This is particularly distressing in psychiatric settings where patients may face challenges related to mental health conditions that can affect their decision-making capabilities (Manderius et al., 2023). Advanced practice professionals, like PMHNPs, navigate these complex waters by employing a patient-centered approach that emphasizes respect for the patient’s values and preferences while ensuring that decisions are made competently and with full understanding of the consequences.
In practice, fostering autonomy means that mental health practitioners must be adept in communicating complex medical information in an accessible manner, assessing the patient’s capacity to understand their condition and treatment options, and supporting their decision-making process. This can often involve a delicate balance of providing guidance and support without overstepping the patient’s right to self-determination, even when their choices raise ethical concerns or differ from clinical recommendations (Manderius et al., 2023). Furthermore, the extension of autonomy in mental health also includes advocacy for patient rights with larger health care systems and society, challenging stigmatization, and promoting access to necessary health care services.
Moreover, the role of autonomy extends beyond individual patient interactions. At a systematic level, PMHNPs and other mental health professionals must navigate policies and regulations that impact patient autonomy, such as involuntary treatment laws. These professionals must also contend with the ethical dilemmas that arise from these practices, advocating for policies that maximize respect for patient autonomy while ensuring safety and public health (Manderius et al., 2023). As such, autonomy in psychiatric and mental health care represents a foundational ethical principle that influences every level of clinical practice and policy-making, demanding continuous evaluation and adaptation in response to changing societal norms and medical advancements.
“Defining Autonomy in Psychiatry”
The article “Defining Autonomy in Psychiatry” by Jessy Bergamin et al. focuses on the impact of mental illnesses on personal autonomy, defined as the capacity to live a significant life of one’s own creation. The authors argue that mental disorders disrupt personal autonomy in various ways, affecting patients’ quality of life and their motivation to seek treatment. The paper discusses how different psychiatric conditions, including Major Depressive Disorder (MDD), Substance-use Disorders (SUDs), Obsessive Compulsive Disorder (OCD), Anorexia Nervosa, and Schizophrenia, specifically influence autonomy (Bergamin et al., 2022). These influences are characterized by two dimensions: competence being the aptitude to form and act on intentions, and genuineness, which is the alignment of actions with true personal values and desires. The article underscores the importance of considering these disruptions in clinical practice to enhance differential diagnosis, treatment, and patient recovery.
The ethical issues highlighted revolve around respecting patient autonomy in clinical settings, which involves recognizing and supporting patients’ decision-making capabilities even when these are compromised by mental illness. This respect is crucial for consent to treatment and for engaging patients actively in their care plans (Bergamin et al., 2022). Legally, the challenge is ensuring that patients who may not fully comprehend their condition or treatment options are still provided with opportunities to make informed decisions to the extent possible. This involves continual assessment of decision-making capacity and, potentially, the involvement of legal frameworks for those deemed incapable of making informed decisions, such as in cases of severe mental disorders.
In Florida, as in other states, practitioners including PMHNPs must navigate these ethical and legal landscapes carefully. Applying insights from the article could involve developing more subtle approaches to assessing and supporting autonomy in patients with mental disorders. This could include tailored interventions that enhance competence and authenticity, possibly through therapeutic techniques that foster self-reflection, self-awareness, and decision-making skills. For example, in the case of adolescents with mental health issues, enhancing autonomy could also involve working closely with families to support the young patient’s developing capacity for self-determination in line with ethical guidelines and state laws regarding minor consent.
Practically, these considerations imply adopting a more individualized approach to treatment planning that counts for the patient’s level of autonomy impairment. This could involve using tools and scales developed to assess autonomy specifically in psychiatric settings. Integrating strategies that focus not just on symptom management but also on enhancing the patient’s self-efficacy and authentic self-expression. Advocating for policy changes that support comprehensive approaches to mental health care, ensuring that legal standards in Florida regarding patient rights and consent procedures are rigorously applied and reflect the latest psychiatric insights. Such practices not only align with ethical and legal standards but also potentially improve treatment outcomes by aligning interventions more closely with each patient’s unique context and needs, ultimately supporting a more personalized and respectful approach to mental health care.
“Increased Autonomy with Capacity-based Mental Health Legislation in Norway: A Qualitative Study of Patient Experiences of Having Come Off a Community Treatment Order”
The qualitative study by Nina Camilla Wergeland and colleagues examines the impact of the 2017 capacity-based mental health legislation in Norway, specifically its effect on patients who were previously under community treatment orders (CTOs) but had them rescinded following assessments of their competence to consent. The study involved in-depth interviews with twelve individuals to explore their experiences post-revocation (Wergeland et al., 2022). The findings indicate that while patients continued to receive similar health care, their involvement in treatment decisions and sense of autonomy increased significantly. However, some still felt insecure and lacked initiative due to preceding coercive understandings.
A central ethical issue discussed in the article is the right to autonomy versus the need for protective care in mental health settings. Ethically, the legislation aims to respect patients’ self-determination and minimize coercion by ensuring that only those lacking the capacity to consent can be subjected to involuntary treatment (Wergeland et al., 2022). Legally, the challenge lies in accurately assessing a patient’s decision-making capacity and balancing this with the potential risk they may pose to themselves or others (Wergeland et al., 2022). The shift towards capacity-based consent aligns with international human rights standards, particularly the UN Convention on the Rights of Persons with Disabilities (CRPD), by advocating for equal treatment of individuals with mental disorders (Wergeland et al., 2022). As practitioners, it is our duty to abide what is legally and ethically right to the patient.
Implementing similar capacity-based principles in Florida could enhance the patient-centeredness of psychiatric care by prioritizing consent and capacity assessments. For practitioners, especially PMHNPs like myself, this approach would require careful evaluation of a patient’s understanding and decision-making ability regarding their treatment options. In Florida, where mental health laws also need to protect patients and the public, integrating capacity assessments could help tailor interventions more closely to individual needs and reduce reliance on involuntary treatment measures.
Specific implications for practice include enhanced training, policy advocacy, patient-centered care models, and continuous evaluation. Health care providers, including PMHNPs, may need additional training in techniques for assessing capacity, understanding patient rights under mental health laws, and engaging in ethical decision-making (Wergeland et al., 2022). Advocating for legislation in Florida that incorporates capacity-based criteria for involuntary treatment could improve mental health care practices and better align them with CRPD principles. Implementing care models that emphasize patient autonomy and informed consent, even within the constraints of existing laws that allow for involuntary treatment, could foster more collaborative and respectful relationships between patients and providers. Regularly assessing the effectiveness of these practices through qualitative feedback from patients could help refine approaches and ensure they meet ethical and legal standards while addressing patient needs effectively. In summary, adopting capacity-based mental health care practices could significantly impact the ethical delivery of psychiatric services, enhancing patient autonomy and aligning clinical practices with broader human rights frameworks.
“Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation”
Nicole Karasik’s article discusses the role of Psychiatric Advance Directives (PADs) in protecting the autonomy of patients with severe mental illness (SMI). The article highlights the low uptake of PADs despite their potential benefits in preemptively expressing patients’ treatment preferences, thereby ensuring that these preferences are respected during episodes where patient may lack decision-making capacity (Karasik, 2023). Karasik proposes the use of a peer-support model to facilitate the creation and execution of PADs, arguing that peer facilitators can overcome barriers at multiple levels: systematic (resource constraints), professional (deficiency of knowledge and distress of complete treatment refusal), and user-level (lack of trust and support).
The primary ethical issue revolves around the autonomy of patients with SMI and their right to participate actively in their treatment planning, especially when they are competent to make decisions. The legal landscape, underpinned by the Patient Self-Determination Act, mandates that healthcare facilities respect advance directives but has not effectively ensured their widespread adoption among patients with SMI (Karasik, 2023). This raises concerns about both ethical and legal compliance in respecting patient autonomy and the principle of beneficence, which seeks to act in the best interest of the patient without causing harm (Karasik, 2023). There is also an ethical imperative to ensure that the facilitation of PADs does not come under undue provider influence, which can undermine the authenticity of the patient’s own choices and preferences.
Implementing peer-facilitated PAD programs in Florida could enhance how mental health services respect and integrate patient autonomy, particularly for those with SMI. As a PMHNP, integrating such a model could help address ethical concerns about autonomy and informed consent by enhancing patient engagement, improving compliance and outcomes, and reducing coercive practices (Karasik, 2023). Utilizing peer facilitators can make patients feel more understood and supported, given the shared experiences. This could increase their willingness to engage in the PAD process, ensuring that their treatment preferences are documented and respected. Patients are more likely to adhere to treatment plans that they have actively participated in formulating, potentially leading to better health outcomes (Karasik, 2023). By respecting patients’ advance directives, involuntary treatments could be minimized, aligning practice with legal standards and ethical obligations to respect patient autonomy. Together these applications could make a significant difference in clinical practice.
For special implications for practice in Florida, initiating training programs and integrating them, policy advocacy, collaboration and monitoring, and resource allocation are significant to be aware of for the state of Florida. As a practitioner, initiating or participating in training programs for peer supporters could be vital. These programs should focus on equipping peers with the necessary skills to facilitate PAD discussions effectively. Advocating for state policies that support the implementation of peer-facilitated PAD programs could help standardize the practice across Florida, ensuring that all patients with SMI have the opportunity to benefit from such initiatives. Establishing collaborative practices between healthcare providers and trained peer facilitators can help monitor the effectiveness of PADs in enhancing patient autonomy and treatment outcomes. Regular reviews and adjustments to the PADs based on ongoing patient feedback and changes in their health status would be crucial (Karasik, 2023). Pushing for adequate funding and resources from healthcare organizations and state health departments to support the training and deployment of peer support specialists in mental health settings. In conclusion, Karasik’s proposal for peer-facilitated PADs offers a promising approach to enhance the autonomy and treatment outcomes of patients with SMI in Florida, aligning with both ethical principles and legal requirements (Karasik, 2023). This model not only respects the autonomy of patients but also potentially improves their engagement and satisfaction with the mental health care system, thereby fostering better health outcomes and reducing the reliance on coercive treatment methods.
“Development and Validation of the Autonomy Scale Amsterdam”
The article “Development and Validation of the Autonomy Scale Amsterdam (ASA)” by Jessy Bergamin and colleagues presents the creation and evaluation of a new scale designed to quantify autonomy in a psychiatric context. The study outlines the process of developing the ASA, which consists of 21 items across six dimensions: self-integration, engagement with life, goal-directedness, self-control, external constraints, and social support (Bergamin et al., 2024). The scale was validated using three separate samples from the general population, totaling 856 participants. Validation processes confirmed the scale’s strong psychometric properties, including reliability and both convergent and discriminant validity. The ASA was shown to have incremental validity over a remaining quantity of autonomy in predicting mental health outcomes, underscoring its potential utility in both research and clinical settings.
The ethical principle of autonomy, especially in mental health practice, emphasizes the right of individuals to make informed decisions about their own care. The ASA’s focus on measuring various aspects of autonomy can help clinicians understand the extent to which mental health issues might impair a patient’s ability to make informed decisions, which is crucial for ethical treatment planning and obtaining valid consent (Bergamin et al., 2024). As for patient rights and empowerment, by quantifying elements of autonomy, the ASA can guide interventions that aim to enhance patients’ self-governance and engagement with life. This aligns with ethical guidelines that prioritize patient-centered care and empowerment, a cornerstone of contemporary mental health ethics.
As a PMHNP, applying the ASA in your practice could enhance your ability to asses and address autonomy in patients with mental health disorders. This is particularly relevant in Florida, where understanding the subtle impact of cultural, social, and individual factors on autonomy can inform tailored therapeutic interventions. Specific implications include enhanced assessment, tailored interventions, and legal compliance (Bergamin et al., 2024). Using the ASA to assess autonomy levels in patients could help in identifying specific areas where interventions might be needed to improve autonomy, such as enhancing social support or goal-directed behaviors. Understanding a patient’s autonomy profile could guide personalized treatment plans that focus not only on symptom relief but also on enhancing life engagement and self-governance, leading to potentially better treatment outcomes (Bergamin et al., 2024). In Florida, as in other states, legal standards require that patients receive care that respects their autonomy, which is vital for legal compliance, especially when making decisions about the use of involuntary treatments or when there are concerns about a patient’s capacity to consent. Incorporating the ASA into your practice can provide a comprehensive tool to assess and enhance autonomy among your patients, aligning with both ethical considerations and legal requirements in mental health care. This approach not only aids in complying with patient rights standards but also supports the ethical mandate to treat patients as active participants in their own care, promoting their overall well-being and recovery.
Conclusion
In conclusion, the exploration of autonomy within psychiatric and mental health care, as discussed in the reviewed articles, highlights the critical intersection of ethical considerations, legislative frameworks, and clinical practices. The implementation of psychiatric advance directives, the transformative impact of capacity-based legislation in Norway, the psychometric validation of the Autonomy Scale Amsterdam, and the empowering potential of peer-support models, all underline the importance of fostering autonomy in mental health contexts. These studies collectively advocate for a paradigm shift towards more patient-centered care, where respecting and enhancing individual autonomy not only associates with ethical imperatives but also supplies to more effective and humane treatment outcomes. As such, these discussions reinforce the necessity for ongoing research, policy development, and clinical training focused on empowering patients within the mental health system, thereby ensuring that treatment plans are both respectful of personal autonomy and conducive to recovery.
Manderius, C., Clintstahl, K., Sjostrom, K., & Ormon, K. (2023). The psychiatric mental health nurse’s ethical considerations regarding the use of coercive measures – a qualitative interview study. BMC Nursing, 22(1), 23. https://doi.org/10.1186/s12912-023-01186-zLinks to an external site..
Wergeland, N. C., Fause, A., Weber, A. K., Fause, A. B. O., & Riley, H. (2022). Increased autonomy with capacity-based mental health legislation in Norway: A qualitative study of patient experiences of having come off a community treatment order. BMC Health Services Research, 22(1), 454. https://doi.org/10.1186/s12913-022-07892-9Links to an external site.
Literature Review: Ethical and Legal Considerations of Using Restraints in Psychiatry
The utilization of restraints poses a multifaceted ethical and legal concern. Restraints, whether they are physical or chemical, are frequently used as a final option to control violent or destructive behaviors displayed by individuals with mental illness. Restraints are designed to be utilized in situations to ensure the safety of patients. While the intention may be to prevent harm, initiating restraints can lead to negative consequences, such as retraumatization of the patients. The purpose of this literature review is to explain the ethical and legal complications associated with the use of restraints in psychiatric care. Enhanced comprehension by the psychiatric mental health nurse practitioner (PMHNP) can facilitate a secure and patient-centered approach.
Article #1- Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff’s perceptions and assessments
According to Bachmann et al. (2022), the study utilized a qualitative descriptive strategy. This study aims to investigate the perspectives and evaluations of nurses and ward personnel regarding patient care during the implementation of mechanical restraints. A qualitative description allows for gaining direct responses to topics that are particularly important to practitioners. It involves presenting the findings using the language often used by practitioners in their daily work. A qualitative descriptive design seeks to provide conclusions that closely align with the data and enables an investigation into the experiences and perspectives of the participants, to obtain detailed descriptions of the phenomenon under study. A group of 18 nurses and ward staff, ranging in age from 22 to 45 years old, with prior experience in implementing mechanical restraints, reported that their evaluations of the patients’ physical and mental states differed. Management-qualified professionals have shown a distinct disparity in their approach to handling circumstances both before and during the application of mechanical coercive measures. The research mostly examined the psychological effects, which were predominantly negative and associated with trauma or re-traumatization. This study determined that enhancing education and training is optimal when personnel are utilizing restraints. Notably, there are limitations to this study. The results should be taken cautiously due to the small number of health professionals who took part, their varying professional positions, and the fact that they were selected from only two small geographic locations in Norway.
Article #2 Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review
According to Chieze et al. (2019), compared to previous reviews, this systematic review includes a larger range of outcomes and study designs in its search for data regarding the impact of seclusion and restraints on psychiatric inpatients. Following PRISMA principles, a systematic search was carried out, yielding 35 publications out of 6,854 data entries. Research on the impact of isolation and restriction in adult psychiatry encompasses a broad spectrum of findings and methodologies. The estimated incidence of post-traumatic stress disorder following intervention ranges from 25% to 47%, indicating that it is a significant issue, particularly for patients who have experienced prior trauma. In terms of research, examining the literature makes it abundantly evident that finding meaningful findings regarding the consequences of restraint and seclusion in adult psychiatry is still challenging. The difference in the comparative issue and the difficulty of developing study designs for individuals who are upset appear to be contributing factors. These findings make it difficult to fully have an understanding of what negative effects follow patients and staff after seclusion and restraints are implemented on an inpatient unit.
Article #3 Is Physical Restraint Unethical and Illegal?: A Qualitative Analysis of Korean Written Judgments
According to Jang et al. (2024), physical restraint (PR) guarantees the security of individuals receiving care. Nevertheless, this difficulty arises due to conflicting principles of autonomy and dignity for the beneficiaries, and the need for health practitioners to provide appropriate treatment. The objective of this study was to examine legal and ethical scenarios about the utilization of public relations through published court decisions. This study was employed using a qualitative retrospective design. A qualitative content analysis was conducted on written judgments from South Korea. A cumulative total of 38 cases spanning from 2015 to 2021 were classified and grouped accordingly. An analysis was conducted to evaluate the various categories of court rulings and ethical dilemmas by the four principles of bioethics. The judgments rendered by the courts were then compared. It was concluded that in these cases assessing the necessity for PR and identifying the appropriate timing for its implementation. Nevertheless, the issue lies in the lack of clarity regarding the methodology used to determine these factors. In any case, the use of PR must be properly documented and show necessity and never be used in cases related to overstaffing or out of convenience to medical staff.
Article #4 Restraints and seclusion in psychiatry: striking a balance between protection and coercion.
According to Zammi et al. (2020), the utilization of restraint and seclusion (R&S) techniques in psychiatric settings is prevalent, even though there is a dearth of scientific data supporting their efficacy. Coercive interventions have intricate medical, ethical, and legal repercussions. International treaties, supranational agencies, scientific institutes, legislative authorities, and tribunals have established benchmarks for research and standards. Their use has been influenced by changes in norms, civil rights enforcement, judicial rulings, and the availability of new therapeutic choices. Healthcare professionals should adhere to precautionary guidelines and take into account the efficacy of R&S in achieving therapeutic objectives. Demonstrating the utilization of R&S as a component of a therapy regimen can aid in preventing negligence litigation.
Washington State Code (WAC) 246-322-180 specifically pertains to the utilization of restraints in healthcare establishments, particularly in mental environments. The regulations encompass several crucial aspects, including reasoning for restraints and other measures tried. Staff must promptly inform and obtain approval from a physician, physician assistant, or psychiatric advanced registered nurse practitioner within one hour of commencing patient restraint or seclusion. Assessments must be completed by a registered nurse and 15-minute checks must be implemented on all patients which include offering bathrooms to patients. Seclusion and restraint may not be applied in an outpatient office the PMHNP must be aware of the trauma that is caused by restraints and have conversations with patients that they are treating on an outpatient basis.
Conclusion
The research highlights the intricate interaction between ethical and legal factors related to the use of restraints in psychiatric care. Although restraints are commonly used to promote patient safety, they might result in adverse consequences such as retraumatization and ethical quandaries about patient autonomy and dignity. The qualitative investigations emphasized the significance of education and training for healthcare personnel to guarantee the prudent and empathetic utilization of restrictions. Furthermore, the systematic review uncovered the difficulties in evaluating the effects of restraint and seclusion on psychiatric inpatients, highlighting the necessity for additional study to fully comprehend the repercussions for both patients and staff.
Reference
Bachmann, L., Vatne, S., & Mundal, I. P. (2022b). Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff’s perceptions and assessment. Journal of Clinical Nursing, 32(3–4), 438–451. https://doi.org/10.1111/jocn.16249Links to an external site.
Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00491
Jang, S. G., Lee, W., Ha, J., & Choi, S. (2024). Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01781-8
Zaami, S., Rinaldi, R., Bersani, G., & Marinelli, E. (2020). Restraints and seclusion in psychiatry: striking a balance between protection and coercion. Critical overview of international regulations and rulings.55(1), 16–23. https://doi.org/10.1708/3301.32714
NRNP-6665 Week 2: Discussion Sample 3
USE OF RESTRAINTS
Ethical and Legal Foundations of PMHNP Care: Use of Restraints
Restraints are often used to ensure the safety of a patient, other patients, and the staff in psychiatric care settings. The practice involves restricting a patient’s mobility by tying their hands and legs to their bed using leather restraints. While the practice has been considered inevitable, particularly as a last resort among patients with violent tendencies, it has ethical and legal implications (Oh, 2021). In this paper, the author examines the subject of restraints in mental health practice by reviewing and summarizing four articles on the ethical and legal considerations related to restraints. The synthesis also outlines how the ethical and legal aspects influence the work of psychiatric mental health nurse practitioners (PMHNP).
Ethical Considerations for Restraints Use in Adults
In hospitalized adults, restraints are coercive measures that mental health practitioners take to protect and control patients. Cortinhal et al. (2024) scoping review indicated restraints are used in adult psychiatric settings, especially for aggressive and violent patients. The researchers noted the effects of the decision on the person and the nurse. The patient can have physical, psychological, and social impacts after being placed under restraints, such as high blood pressure, laceration, anger, anxiety, and social isolation. Also, the nurse may experience guilt and anxiety. The researchers identified ethical considerations for the nurses when deciding on using restraints. They urge mental health nurse practitioners to weigh the harms versus benefits. The nurses should also consider patient autonomy, which is mainly limited when coercive measures are used. Another ethical consideration is the protection of human dignity (Cortinhal et al., 2024). Overall, physical restraints in adult patients are beneficial, but a thorough examination of the harms and ethical issues is essential.
Ethical Considerations for Physical Restraints in Children and Adolescents
Additionally, physical restraints are used in children and adolescents. Lombart et al. (2020) observed that restraints are applied to children and adolescents. The restrictive practice allows the nurses to conduct some procedures to help pediatric patients. However, controversy surrounds the decision and amounts to ethical issues. It breaches the patient’s autonomy. Furthermore, restraining children could be counterproductive as the patients resist the action. The restrained children may distrust their care providers, threatening efforts to build therapeutic alliances (Lombart et al., 2020). Just as in adults, mental health practitioners should ensure the decision to restrain a child or adolescent is justified to avert the negative consequences.
Legal Considerations for Adults
There are legal considerations to make when applying restraints on adult patients. Donovan et al. (2023) noted that the unjustified or indiscriminate use of physical restraints is a violation of human rights. The law requires physical restraints to be used as a last resort after healthcare practitioners explore the least restrictive measures. A patient or family may sue a healthcare professional if they feel the restraining was not justifiable. Mental health practitioners should understand the legal guidelines for using restraints on adult patients to prevent associated ramifications.
Legal Considerations for Children/Adolescents
In children and adolescents, healthcare practitioners should use physical restraints cautiously. Preisz and Preisz (2019) explained that restraining children and adolescents for usual medical procedures has been a mainstay practice. However, the authors cautioned healthcare practitioners against using restrictive measures unless they are justified. Restraints are associated with harm to the patients and, in extreme cases, death through asphyxiation. Also, they go against the patient’s right to autonomy, human dignity, and privacy. If healthcare practitioners consider restraints for their pediatric patients, they should examine the pros and cons. It is also critical to inform the parents or guardians (Preisz & Preisz, 2019). Just as for adults, healthcare professionals should use physical restraints based on the guidelines of one’s practice jurisdiction.
Application to PMHNP Practice in New Jersey
New Jersey legislation allows physical restraints’ application on adults, adolescents, and children but under specific conditions. The state expects healthcare organizations to have a protocol that outlines the guidelines for applying physical restraints. However, PMHNPs are not allowed to order restraints. A physician designated to the patient is the only professional who can write a physical restraint for nurses to consider. However, the consequences of executing the restrictive measure affect the nursing professionals. The law recommends regular assessment of the patients to identify and manage physical distress, examine clinical status, and respond to basic needs. Also, healthcare providers should remove the devices as soon as they accomplish the intended goal (New Jersey Department of Health and Senior Services, 2005). Familiarizing oneself with the legislation on restraints’s use in nursing care can ensure that PMHNPs meet relevant ethical and legal obligations.
References
Cortinhal, V. S. J., Correia, A. S. C., & Fernandes, S. J. D. (2024). Nursing ethical decision making on adult physical restraint: A scoping review. International Journal of Environmental Research and Public Health, 21(1), 75. https://doi.org/10.3390/ijerph21010075Links to an external site..
Donovan, A. L., Petriceks, A. H., Paudel, S., Vyas, C. M., & Stern, T. A. (2023). Use of physical restraints in the emergency department: rationale, risks, and benefits. The Primary Care Companion CNS Disord, 25(3), 22f03320. https://doi.org/10.4088/PCC.22f03320Links to an external site..
Lombart, B., Stefano, C. D., Dupont, D., Nadji, L., & Galinski, M. (2019). Caregivers blinded by the care: A qualitative study of physical restraint in pediatric care. Nursing Ethics, 27(1), 230-246. https://doi.org/10.1177/0969733019833128Links to an external site..
New Jersey Department of Health and Senior Services. (2005). N.J.A.C. Title 8 Chapter 43GHospital Licensing Standards. Sub-Chapter 18: Nursing care: Use of restraints. New Jersey, NJ: New Jersey Gov. https://www.nj.gov/health/forms/NJAC%20%20%208%2043G%20licensing%20standards.pdf.
Oh, Y. (2021). A new perspective on human rights in the use of physical restraint on psychiatric patients based on Merleau-Ponty’s phenomenology of the body. International Journal of Environmental Research and Public Health, 18(19), 10078. https://doi.org/10.3390/ijerph181910078Links to an external site..
A restraint is any measure that reduces a person’s movement or action/behavior used in a healthcare setting to protect a patient from self-harm or harming others and keep people safe. However, restraining a patient is considered a high-risk intervention, and hence, it is the last resort in medical settings. There are different types of restraints, such as physical restraints such as vests, mitts, and side rails; chemical restraints like sedatives and tranquilizers; environmental restraints and seclusion. Healthcare workers need to consider legal and ethical considerations when determining a patient’s restraint, as there is an ethical dilemma between the autonomy and dignity of the patient. As a future PMHNP, using the best professional judgment, including ethical and legal concerns, is vital when giving restraint orders.
Ethical considerations or issues related to restraining children/adolescents:
Article: “Caregivers Blinded by the Care: A qualitative study of physical restraint in pediatric care.”
Physical restraints on the pediatric population can raise ethical issues in healthcare, schools, and mental health settings. The healthcare staff should use all alternatives before choosing a restraint. The decision to use restraints should be after careful assessment, consideration of other options, and adherence to legal and ethical guidelines. Study reveals that physical restraints cause negative consequences for a child’s mental and physical well-being. Restraints can also cause distress, fear, anger, anxiety, and traumatic psychological damage. In the article “Caregivers Blinded by the Care: A qualitative study of physical restraint in pediatric care.” Physical restraint in pediatric care is ethical because it challenges professionals with the dilemma of using force for the child’s best interest (Lombart et al., 2019). In mental health care settings, physical restraints of children and adolescents are used as a reactive behavior management approach, which results in physical injury and even death. As an advanced practice nurse, a PMHNP should consider some ethical aspects such as autonomy, respect, safety, communication, and harm before giving an order to restrain a patient. It is vital to respect the patient’s autonomy; hence, it is essential to get consent from the patient or the parents and explain the rationale for restraint; otherwise, it is against the law that we do not respect the patient’s autonomy. Though restraints are a safety measure for the patient or others, they can harm the patient, so proper assessment and care are essential and should be documented (Manderius et al., 2023).
Ethical considerations or issues related to restraining the Elderly:
Article:“Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments”.
The article discusses the analysis of ethical situations related to using physical restraints in older people. In 2014, an incident happened in a South Korean long-term care hospital where several elderly patients died due to a fire broke out. Investigation reports reveal that many elderly patients were found tied to their beds without being rescued. Further analysis of the situation by the court using the four principles of biomedical ethics discloses that the reasons for using the restraints on patients were not ethical. Many patients on restraint do not have consent, and they do not meet the Principle of autonomy. Numerous patients had adverse outcomes, such as falls and some deaths in the psychiatric unit, hence not meeting the Principle of non-maleficence. Some patients had restraints for unethical purposes such as punishment, staff convenience, and staff shortages, ignoring the Principle of beneficence and justice (Jang et al., 2024). As a PMHNP, it is essential to consider the ethical dilemma while ensuring the patient’s safety, dignity, and autonomy. Restraint should be individualized and least restrictive by respecting the patient’s privacy and dignity. Older people have decreased physical and mental capacity and are more prone to harm. It is essential to get consent, a legal document (Carrero-Planells et al., 2021).
Legal considerations or issues related to restraining children/adolescents:
Article: “Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis”
Restraint use in children or adolescents is one of the most debatable practices in mental health as they are the most vulnerable population. Restraints and seclusions can result In negative patient consequences and should be the last resort in treatment. The advanced practice nurse should follow the four fundamental ethical principles: autonomy, justice, beneficence, and non-maleficence, before considering the restraint option. In the case of chemical restraints, which are more common in mental health facilities, the provider should only prescribe medications that have a rapid onset with minimal side effects as a last resort in emergent situations. It is vital to monitor the patient for side effects and document how the problem was emergent and how the patient benefited from the restraint. The provider must check whether the patient or the legal guardian signs the consent to treatment to avoid common legal implications such as false imprisonment, potential liability for improperly detaining patients, false imprisonment, and related claims and properly document which demonstrates the need for restraint legally (Ye et al., 2019).
Legal considerations or issues related to restraining Elderly
Article: “Interface of Law and Psychiatric Problems in the Elderly.”
In a mental health setting, patients with aggressive behaviors who are at high risk for self or others are placed on restraints. Restraints can cause dire consequences on the physical and mental health of older adults. Improper use of restraint is a violation of law. Some legal considerations when restraining older people include, as a provider or PMHNP, it is essential to place the order only after getting consent and a proper explanation, as physical restraint is a violation of human rights. Legally, the provider should respect patients’ autonomy, dignity, and rights, and Breaching this duty can lead to liability for the facility and individual caregivers(Sivakumar et al., 2022).
Legal and Ethical implication in PMHNP Practice and Texas State Law
The advanced practice nurse must understand the code of ethics. The PMHNP practice is guided by ethical and legal codes, which help guide clinical decision-making. When restraints in psychiatric mental health facilities, it is important to consider legal implications, such as battery and false imprisonment. The provider should use professional judgment to determine if they are clinically necessary and adequately document the indication and the benefits for the patient. The ethical considerations include getting consent after a proper explanation and using the least restrictive method for the shortest time. According to Texas health behavior health policy, limit restraint used when other alternatives have failed and in emergencies, protect patient rights and dignity when restraints are unavoidable, use the least restrictive method and as a temporary intervention, use approved devices for restraining, and discontinue as early as possible, proper assessment and documentation every 15 minutes is essential (Mental Health Resources and Protections, n.d.).
Reference:
Carrero-Planells, A., Urrutia-Beaskoa, A., & Moreno-Mulet, C. (2021). The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health, 18(14), 7509. https://doi.org/10.3390/ijerph18147509
Jang, S. G., Lee, W., Ha, J., & Choi, S. (2024). Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments. BMC Nursing, 23(1). https://doi.org/10.1186/s12912-024-01781-8
Lombart, B., De Stefano, C., Dupont, D., Nadji, L., & Galinski, M. (2019b). Caregivers blinded by the care: A qualitative study of physical restraint in pediatric care. Nursing Ethics, 27(1), 230–246. https://doi.org/10.1177/0969733019833128
Manderius, C., Clintståhl, K., Sjöström, K., & Örmon, K. (2023c). 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
Mental health resources and protections. (n.d.). https://gov.texas.gov/organization/disabilities/mental_health_protections
Sivakumar, P., Mukku, S. R., Tiwari, S., Varghese, M., Gupta, S., & Rathi, L. (2022). Interface of law and psychiatric problems in the elderly. Indian Journal of Psychiatry/Indian Journal of Psychiatry, 64(7), 163. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_47_21
Ye, J., Wang, C., Xiao, A., Xia, Z., Yu, L., Lin, J., Liao, Y., Xu, Y., & Zhang, Y. (2019). Physical restraint in mental health nursing: A concept analysis. International Journal of Nursing Sciences, 6(3), 343–348. https://doi.org/10.1016/j.ijnss.2019.04.002
Discussion:Involuntary Hospitalization and Due Process of Civil Commitment
The legal process of involuntary hospitalization, also known as civil commitment, allows for the confinement of a person in a psychiatric hospital for treatment of a treatable mental disorder despite their objection (Aluh et al, 2023). This process involves a host of legal differences and thus needs a careful assessment of the need for involuntary hospitalization.
Ethical Considerations of Involuntary Hospitalization for Adult Patients
The article by Laureano et al. (2024) examines ethical issues that arise due to involuntary psychiatric treatment for adults. One of the ethical concerns is the tension that arises when faced with respecting the patient’s autonomy and the need for treatment. According to Laureano et al. (2024), mental health professionals are faced with ethical challenges when they have to use coercive measures since they raise ethical concerns due to its impact on patient’s autonomy and freedom.
Ethical Considerations of Involuntary Hospitalization for Children and Adolescent
The article by Walker et al. (2021), examines involuntary psychiatric hospitalization in children and adolescents. According to Walker et al. (2021), several factors are associated with involuntary hospitalizations and they include diagnoses of psychosis, substance misuse, and intellectual disability. The article argues that adolescents who presented a danger to themselves or others were more likely to be involuntarily hospitalized. The article explains that several ethical difficulties surround involuntary psychiatric hospitalization. While involuntary hospitalization is a potentially life-saving measure to restore mental health, it also raises concerns about potential trauma and infringement on individual autonomy. For example, it pits society’s need to protect vulnerable individuals (paternalism) against their right to make their own choices (autonomy). According to Walker et al. (2021), involuntary treatment, while it intends to assist and help patients often feels traumatic and discourages future engagement with mental healthcare. Additionally, due to the use of restrictive measures like seclusion and restraint, the use of involuntary hospitalization often raises further ethical concerns.
Legal Considerations of Involuntary Hospitalization for Adults
The article by Silva et al. (2021) look at factors associated with involuntary psychiatric hospitalization. It explores trends in involuntary hospitalization rates and examines the need to balance individual rights and public safety. According to Silva et al. (2021), there are several factors associated with involuntary hospitalization, such as psychosis diagnosis, lack of social support, and being admitted during economic crisis years. The article explains that the very nature of involuntary admission raises significant legal concerns that apply to adults in psychiatric care. One of the legal concerns is the principle of personal freedom and fundamental human rights. Involuntary admission often restricts a person’s freedom to choose their treatment thus raising concern about the violation of patient autonomy (Silva et al., 2021). It also raises the legal issue of adequate treatment and public safety. For example, it argues that involuntary admission should only be used when necessary to protect the patient or others from harm. Involuntarily hospitalizations represent a deprivation of personal liberty and as well the suspension of legal capacity for patients thus conflicting with the right to personal autonomy and the ability to make sound decisions about one’s treatment.
Legal Considerations of Involuntary Hospitalization for Children and Adolescent
The article by Schölin et al. (2024) examines the legal considerations surrounding involuntary detainment of children and adolescents for mental health evaluation and treatment. The article argues that the UN Convention on the Rights of the Child (UNCRC) and the UN Convention on the Rights of Persons with Disabilities (CRPD) emphasize the need for strong justification for detaining minors. These conventions advocate for respecting a child’s evolving capacities, avoiding arbitrary detentions, and ensuring non-discriminatory practices. To avoid unrecorded detentions, parents or guardians may consent to detainment on behalf of a child, raising ethical concerns if the child lacks understanding or is against it. According to Scholin et al., (2024), the increasing number of detentions globally highlights the need for legislative reform to establish clearer criteria for the detainment of children with mental health issues.
Implications of the Ethical and Legal Considerations of Administration of Involuntarily Hospitalizations to a Practice in Maryland State
The information on involuntary admissions can be instrumental and applicable to clinical practice. For example, it allows for a better understanding of the laws, procedures, and regulations governing involuntary commitment. The articles highlight factors influencing involuntary admissions beyond the patient (Silva et al., 2021). This helps understand that mental health providers should play a role by advocating for increased mental health funding and promoting mental health awareness within the communities, thus reducing reliance on involuntary commitment. Another ethical dilemma explored is balancing patient autonomy with safety. This meant that mental health professionals should be aware of these conflicts and strive to make decisions that minimize coercion while ensuring the well-being of the patient and potentially others at risk. It highlights the importance of understanding the ethical considerations, legal framework, and available resources in Maryland State, allowing mental health professionals to make informed decisions regarding involuntary admission. For example, prioritizing alternative interventions and collaborating with relevant parties to help ensure patient rights are protected while at the same time promoting positive patient outcomes.
References
Aluh, D. O., Aigbogun, O., Ukoha-Kalu, B. O., Silva, M., Grigaitė, U., Pedrosa, B., … & Caldas-de-Almeida, J. M. (2023, July). Beyond patient characteristics: A narrative review of contextual factors influencing involuntary admissions in mental health care. In Healthcare11 (14), p. 1986). MDPI. https://doi: 10.3390/healthcare11141986Links to an external site.
Laureano, C. D., Laranjeira, C., Querido, A., Dixe, M. A., & Rego, F. (2024, February). Ethical issues in clinical decision-making about involuntary psychiatric treatment: A scoping review. In Healthcare12 (4), p. 445). MDPI. https://doi.org/10.3390/healthcare12040445Links to an external site.
Walker, S., Barnett, P., Srinivasan, R., Abrol, E., & Johnson, S. (2021). Clinical and social factors associated with involuntary psychiatric hospitalization in children and adolescents: a systematic review, meta-analysis, and narrative synthesis. The lancet child & adolescent health, 5(7), 501-512. https://doi:10.1016/S2352-4642(21)00089-4Links to an external site.
NRNP-6665 Week 2: Discussion Sample 6
Main Discussion
Introduction
Psychiatric-mental health nursing presented its self as having some significant relationship with both Ethical and Legal issues. These principles ensure that patients are independent in various decisions concerning their care, all their rights and self-respect are upheld. Among the areas I consider to be most pivotal in this practice is informed assent/consent and the subsequent evaluation of a patient’s capacity. It is essential to understand and agree with the treatment to be provided in a health care facility hence making this process crucial. This paper aims to examine the issues of informed assent/consent and capacity within ethical and legal framework in psychiatric-mental health nursing practice where decision-making is made between healthcare professionals and adults or parents with decisional capacity for children and young people. In order to ponder over these issues and the consequences they pose for the subsequent practice of clinical psychological work, this discussion will draw from the materials of scholarly publications and requirements of legal norms.
Informed consent is a fundamental principle of medical professionalism but also the critical idea that patients must be knowledgeable and willing to accept the procedures or treatments they are about to embark on. Anderson (2012) reports on the typical psychological disorders LGBT children and adolescents, focusing on the concept of the rights of personal autonomy and privacy. Although the emphasis is made regarding younger generations, it will be relevant to the adults, as well. Informed consent in adults is a rigorous process whereby the patient is given all the necessary information disclosed with the true-picture of the situation encompassing the various risks, benefits and various options available other than the recommended course of treatment.
From an ethical perspective, it is equally acceptable that healthcare providers ought to guarantee that the consent of the patient was willingly given and made with adequate information. This involves explaining the matter to the patient and trying to establish if the patient comprehends the information provided to him/her. The exact concept of ethical principle of autonomy is your decision about your healthcare and it is imperative as patients may lack capacity in the mental health cases. These professional dynamics require practitioners to balance the process to respect the patient’s self-determination, at the same time as obtaining the patient’s appropriate treatment.
Ethical Considerations for Children/Adolescents
Article 2: Zakhari (2020)
Where children and adolescent are concerned consent issues becomes more challenging since young people are not equal in their ability to comprehend through the considerations of ethics. Zakhari (2020) stressed the importance of the continued need to seek assent from the children and consent from their parents or guardians. Consent means making the child understand the treatment that is going to be offered, thus making him/she willing to undergo it.
On every front of child and adolescent care, it is ethically necessary to inquire and educate the child as much as possible about their treatment options. This involvement also allows them to have a understanding of the kind of patients they are becoming and enhances the ability in the management of their treatment by feeling they have been involved in decision making process. Assentingly, ability differs with age maturity alongside focal ethical requirement that expects the practitioners to work smart in order to understand the specific developmental level of each child. It is especially important to honour the principles of autonomy when treating adolescents who are on the verge of becoming adults, as ethical practice implies their ability to make decisions independently.
Legal Considerations for Adults
Article 3: Thapar et al. (2015)
This paper’s legal aspects on informed consent for adults are based on human rights and legal standing. This accords with the legal theories for the capacity of individuals and the conditions of informed consent in mental health practice as outlined by Thapar et al. (2015). In the eyes of the law, individuals who are in their legal adulthood are assumed to have the ability to make these decisions in case they did not. This presumption implies that mental health practitioners are under a duty to furnish adequate information on those available treatments and also prove that the patient’s consent given was voluntary.
When an adult cannot make decisions for himself, this legal reference guides practitioners in the process of evaluating the competency of the adult. These assessments are very important in the preservation of some rights of patients and guarantee the proper treatment of patients. Inability cannot also violate the patient’s wishes when making decisions about his or her treatment echoing the legal autonomy principle that holds users to patient self-determination.
Legal Considerations for Children/Adolescents
Article 4: Hilt and Nussbaum (2016)
In the case of children and adolescents, legal aspects include both the liberties and the obligations of the child / teenager and his guardian. Hilt and Nussbaum (2016) have also addressed equalities–based aspects of diagnosis and capacity assessments in an Informed consent. Fraser E. Legally there is a requirement to obtain permission from the parents or guardians for a child who is below the age of majority to receive treatment but the child’s permission is also required.
Policies and regulations help to make sure that the patient or their parent/ legal representative has adequate information about the treatment proposed, to protect their best interest. It is important for the reader to know that although minors may be legally incompetent due to their age, the law understands their evolving capacity, and the rules may differ depending on the state. Certain states have exact guidelines on how the consent process must be done especially in situations where the patient is close in age to the legal adult age of emancipation and is thus capable of making his or her own decisions in healthcare. Legal requirements for mental health care providers should not be arbitrary and alien to the clinicians since the regulations aim at protecting the patients’ rights.
Application to Clinical Practice
Nurses’ consciousness and practice in ensuring ethical and legal perspectives in obtaining informed assent/consent and a capacity of clients need complete understanding and appropriate implementation in psychiatric mental health care (ANA, 2015). In my clinical practice, I would take a multifaceted approach to uphold these principles:In my clinical practice, I would take a multifaceted approach to uphold these principles:
Assessing Capacity: I would evaluate children and adolescents’ competency to consent the treatment, when they cannot consent for themselves and involve parents or lawful guardians; however when the pediatric patient is older and capable of making decisions for him or herself, I would uphold the patient’s autonomy by allowing them to consent to the treatment on their own accord. This assessment is to consider the patient’s cognitive assessment in the process of analysis of information concerning his treatment.
Thorough Documentation: Some important points that would require documentation are the capacity evaluation and discussions held with the key stakeholders for the informed consent/assent process. This documentation serves as an indication of the consent that the patient or the guardian has granted to the various procedures to be done as well as offers legal evidence of the whole process.
Staying Updated: To point out the key requirements for the position, the following points would be crucial when dealing with the legal and ethical considerations: • Long-term commitment to maintaining awareness of the legal and ethical standards trending in the state in question, as well as continuous education in the field. Keeping an updated knowledge on changes to the regulation and being familiar with standard concepts in the field is important towards making my practice meet all the regulatory requirements and ethical standards.
Consulting Experts: Additional input from fellow practitioners and lawyers for specialized or multiple dependant cases would serve as an extra safety measure to guarantee that I uphold the highest standards of getting reacquainted with the next patient. This working together assists in handling certain contingencies and may aid in making the right decisions on moral dilemmas.
Adhering to State Regulations: The following laws or regulations pertaining to informed consent and assessment of capacity in children and adolescents are crucial to be aware of or adhere to in the specific state where one practices: The legal regulations may be quite diverse across the states; hence, it is crucial to identify the specifics of these state requirements for legal compliance as well as to be able to provide adequate patient care.
In general, it has been ascertained that meeting the legal requirements and embracing ethical values is critical in addressing the needs of children, teenagers, and adults who require psychiatric-mental health services.
Conclusion
The topic of ethical and legal issues in psychiatric-mental health nursing practice is vast and encompasses informed assent/consent as well as capacity. This paper has also pointed down the chief active ethical standards and legal protocols that practitioners should follow when seeking permission from the adults and the minors with a view to treating them. This paper presents several principles that mental health professionals should be aware of in order to protect the rights of a patient and abide by the law while attending to them. This approach taken is not only improving the quality of the care that is delivered but it also shields the practitioners as well as the patients. One of the more general approaches is to read what contemporary novelists have to say about their work and, if necessary, seek an expert’s advice to adhere to the highest ethical and legal standards in practice.
References
American Academy of Child & Adolescent Psychiatry. (2014). Code of ethicsLinks to an
Hilt, R. J., & Nussbaum, A. M. (2016). DSM-5 pocket guide for child and adolescent mental
healthLinks to an external site.. American Psychiatric Association Publishing.
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.
Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual.
