Discussion post reply 250-to-350-word count minimum reply by sharing cultural considerations that may impact the legal or ethical issues present in their articles.

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3 three peer-reviewed references minimum within the last 5 years MUST INCLUED A PDF OF EACH ARTICLE USE FOR THE SOURSES.

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Discussion post Reply # 1

Jerin C

Ethical and Legal Foundation of PMHNP Care

Ethical and legal principles guide PMNHPs. The practitioners must experience stricter ethical and legal laws since they enjoy a large practicing scope. The discussion below is on ethical and legal issues relating to autonomy. Autonomy is an ethical issue where clients should be empowered to make decisions regarding their treatment. Below are some articles that clarify how client autonomy is realized, with a special focus on children with mental health-related challenges.

The first article by Al-Maraira et al. (2019) illustrated that it is unethical to coerce adolescents or their families into making decisions while trying to achieve patient autonomy. The discussion analyzes that the PMNHP needs to educate the client. Education is the presentation of facts to adolescents and not coercion into making relevant decisions. Client education helps eliminate ethical-related challenges. Another ethical issue is restrictive autonomy, as Doedens et al. (2020) illustrated. Restrictive autonomy is when the adolescent and their family make a decision that does not benefit the client. Ethically, the PMNHP is burdened to deliver the best treatment to adolescent clients. As a result, they are allowed to implement restrictive autonomy when the adult is making decisions that are not in any way helping the client. Below are two articles illustrating the legal aspects that influence the delivery of autonomy.

Vandamme et al. (2021) illustrate that the main legal issue associated with autonomy is refusal of treatment. The perspective illustrates that patient autonomy supersedes medical paternalism. As a result, when the patient refuses medical treatment even at the time of death, the PMNHP cannot override the decision. However, Chieze et al. (2021) illustrate that there is a need to implement coercive measures in the case of the child. Coercive measures are not an infringement of autonomy but the need to alleviate the patient’s mental health suffering.

Implication to the nurse and the state

The PMNHP applies the knowledge of coercive measures to patient autonomy by influencing positive patient outcomes. Also, it makes the nurse in practice to create a treatment plan for their patient. As a result, they have to create a patient-centered treatment plan that the patient can accommodate and accept. The same ethical and legal aspect applies to the state. Maryland can allow coercive measures when there is proof of interest in bettering the patient’s health care outcome. In conclusion, autonomy is an essential ethical and legal foundation for PMNHP practice. However, through coercive measures, the mental healthcare outcome for the patients can be improved for a perfect course and future.

Discussion post reply # 2

Rachael T

Reporting Child and Elder Abuse

                The topic I chose for this week is reporting elder and child abuse and the legal and ethical considerations related to this topic. According to the National Association of Mandated Reporters (NAMR), mandated reporters are obligated to report child abuse or neglect, and abuse of elderly and dependent adults. “Intimate partner violence (IPV) and the abuse of both dependent adults and adults with disabilities also fall within the realm of the mandated reporter” (Carlson, 2022). As a PMHNP one is a mandated reporter, with this there are legal and ethical considerations that we may face in practice. This post will discuss a few of those considerations to be aware of.

Ethical Dilemmas Child Abuse

                Many providers deal with the struggle of reporting child abuse/neglect due to their relationships with the patient and the promise of autonomy, beneficence, maleficence, and justice. Providers do not want to jeopardize the relationship they have with the patient/family; the patient or family may feel betrayed and may lose all the trust they had in the provider and may not return after the report has been made.  The provider does not have to be sure that abuse or neglect has occurred to report it, if abuse/neglect is suspected then reported it is the job of the child protective services to do the investigation. Providers might be uncomfortable saying the word abuse to caregivers, it is a priority and is important in fostering trust and partnership with families. Caregivers have a right to know and understand their child’s condition, including concerns about abuse. Providers are ethically bound to clearly convey concerns about abuse so that caregivers can partner with us in protecting their child (Letson & Crichton, 2023).

Legal Issues Child Abuse

“Mandatory reporting laws are mandated by law and leave no room for judgment on the part of the provider. Failure to follow these laws could lead to civil liability, fines, or other penalties and problems on the part of the physician” (Geiderman & Marco, 2020).  All the states have laws requiring the reporting of suspected or confirmed child abuse. Forty-six states have criminal penalties for failure to comply with these laws” (Geiderman & Marco, 2020).

 In the state of Georgia, where I live the obligation to report arises when there is ““reasonable cause to believe that child abuse has occurred.” “Reasonable cause” means you have an objective, factual basis to believe that the child may have been abused. This does not mean you that are sure beyond a reasonable doubt that the child has been abused. It means that your belief is based on more than a hunch” (2016). The provider needs to report possible abuse within 24 hours.  If not reported the person who is required to report will be guilty of a misdemeanor. Mandated reporters filing a report in good faith are protected under the law from civil or criminal liability for reporting (2016).

                                                Ethical Issues in Reporting Elder Abuse

According to the article “Examining the Ethical Challenges in Managing Elder Abuse: A Systematic Review” found in the National Library of Medicine, elder abuse is becoming more common, affecting 1 out of 6 elderly people are abused. Elderly abuse can be in the form of sexual, physical, mental, emotional, and financial abuse. When faced with the ethical dilemma of elder abuse, it is suggested that the PMHNP should use American Psychological Association (APA) codes.  “APA ethical codes should be in line with beneficence, non-maleficence, and respect for human rights and dignity” (Saghafi et al., 2019). Dementia patients are especially vulnerable due to the lack of competency in manners related to their own safety and care. Another ethical concern is that once reported, the elderly person may not want to leave the situation where they are being abused or neglected.

Legal Issues in Reporting Elderly Abuse

                In the United States, if a therapist is suspicious about abuse, It should be reported to authorities such as APS despite concerns over the patient’s privacy.  “According to code 4/05, psychologists are allowed to disclose patients’ private information to protect them against harm” (Saghafi et al., 2019).

                In the state of Georgia mandated reporters must make a report when they have “a reasonable cause to believe that 1) an at-risk adult has had an injury or injuries inflicted upon them by a caretaker or 2) has been neglected or exploited by a caretaker. Mandated reporters who do not fulfill their obligation to report elder or disabled adult abuse may be charged with a misdemeanor” (2023). As with the case of child abuse/neglect in Georgia, the reporter is free from the concern of civil or criminal charges due to reporting abuse/neglect in elderly patients in good faith.

                Knowing the ethical and legal considerations in reporting abuse and neglect is important for the PMHNP. Being able to report possible abuse without worry of prosecution is one thing that the PMHNP does not have to worry about, although the ethical side makes it more complicated. I would hope that in practice I will do what is best for my patient even if it means that it may break the relationship you have developed with the patient and family.