Learning Resources And Required Readings Buppert C 2021 Nurs

Learning Resourcesrequired Readings Buppert C 2021nurse Practiti

Explain Texas state laws for involuntary psychiatric holds for child and adult psychiatric emergencies. Include who can hold a patient and for how long, who can release the emergency hold, and who can pick up the patient after a hold is released.

Explain the differences among emergency hospitalization for evaluation/psychiatric hold, inpatient commitment, and outpatient commitment in the state of Texas.

Explain the difference between capacity and competency in mental health contexts.

Select one of the following topics and explain one legal issue and one ethical issue related to this topic that may apply within the context of treating psychiatric emergencies: a) patient autonomy, b) EMTALA, c) confidentiality, d) HIPAA privacy rule, e) HIPAA security rule, f) protected information, g) legal gun ownership, h) career obstacles (security clearances/background checks), i) and payer source.

Identify one evidence-based suicide risk assessment that you could use to screen patients.

Identify one evidence-based violence risk assessment that you could use to screen patients.

Paper For Above instruction

The management of psychiatric emergencies within Texas involves specific legal frameworks that safeguard both patient rights and public safety. Involuntary psychiatric holds, often crucial in emergencies, are governed by Texas laws that delineate who can initiate holds, their duration, and who can release them. According to Texas Health and Safety Code § 573.001, licensed physicians, qualified mental health professionals, and judges can initiate involuntary emergency holds. The duration varies: a patient can be held for up to 48 hours initially, with extensions possible under court orders. During this period, mental health professionals assess whether hospitalization is necessary and determine when a patient can be released. The law further stipulates that only licensed physicians or designated qualified professionals can release an emergency hold, and law enforcement or designated officials may facilitate transportation or engagement strategies. Once a patient is stabilized, the legal authority to pick up or discharge the patient rests with licensed physicians or designated mental health providers.

The distinction among emergency hospitalization for evaluation or psychiatric hold, inpatient commitment, and outpatient commitment is essential in Texas psychiatric law. Emergency hospitalization—also known as an emergency detention or evaluation order—is temporary and intended for immediate assessment, typically lasting up to 48 hours. It is initiated when a person presents an imminent danger to themselves or others or is gravely disabled. In contrast, inpatient commitment involves a longer-term stay when a patient is deemed mentally ill and poses a risk, requiring judicial or administrative approval for continued hospitalization. Outpatient commitment, or outpatient civil commitment, allows individuals to receive treatment while living in the community under court-supervised conditions, with regular monitoring to ensure compliance, often used for patients with ongoing mental health needs who are not a danger in the community.

In mental health contexts, capacity and competency represent related yet distinct concepts. Capacity refers to an individual's ability to understand relevant information, appreciate the consequences of decisions, and communicate choices at a specific point in time. It is decision-specific and can fluctuate based on mental state. Competency, however, is a legal determination made by a court, assessing whether an individual possesses the legal capacity to make particular decisions or manage personal affairs generally. While a person may have the capacity to make specific treatment decisions, they may not be deemed legally competent to manage broader legal or financial matters. Recognizing these distinctions is vital in psychiatric emergency care to respect patient autonomy while ensuring appropriate legal and protective measures are upheld.

Patient autonomy, a core principle in medical ethics, entails respecting a patient's right to make informed decisions about their own care. However, in psychiatric emergencies, legal issues often intersect with ethical considerations. One legal issue concerns involuntary treatment statutes—how to balance respecting autonomy with the need to protect patients and others from harm. Ethically, respecting autonomy may conflict with beneficence and non-maleficence when a patient's capacity is impaired, raising questions about the justification for involuntary interventions. For example, involuntary hospitalization may violate a patient's autonomy but be ethically justified if the patient lacks decision-making capacity and poses danger. These legal and ethical tensions require careful evaluation to ensure rights are protected while providing necessary emergency care.

The Columbia-Suicide Severity Rating Scale (C-SSRS) exemplifies an evidence-based tool for suicide risk assessment. It systematically evaluates suicidal ideation and behaviors, guiding clinicians in determining risk levels and appropriate interventions. Its evidence-based validity and reliability make it a preferred screening instrument in diverse clinical settings, providing a structured approach to identifying patients at imminent risk of suicide and informing treatment planning.

For violence risk assessment, the Violence Risk Appraisal Guide (VRAG) is an empirically supported instrument used to predict violent recidivism among psychiatric patients. The VRAG considers factors such as criminal history, psychological indicators, and demographic data, facilitating evidence-based evaluations of potential violence risk. Utilizing validated tools like the VRAG assists clinicians in making informed decisions about management, intervention, and legal reporting obligations to ensure patient and public safety.

References

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Center for Substance Abuse Treatment. (2005). The Brief Psychiatric Rating Scale (BPRS). Substance Abuse and Mental Health Services Administration.
• Flynn, A. R., Parente, S. T., & Nugent, K. (2020). Legal and ethical issues in mental health practice. Journal of Psychiatric Practice, 26(2), 107-114.
• Gross, R., et al. (2019). Texas mental health law: Procedures for involuntary hospitalization. Texas Law Review, 97(3), 625-644.
• Kim, S., et al. (2017). Understanding the capacity vs. competency distinction in mental health law. Law and Human Behavior, 41(3), 189–197.
• National Institute of Mental Health. (2020). Risk assessment tools for suicide prevention. NIMH.
• Prather, C., et al. (2019). Violence risk assessment in psychiatric settings: Current best practices. Psychiatric Services, 70(12), 1028-1034.
• United States Department of Veterans Affairs. (2019). VA/DoD clinical practice guideline: Management of patients at risk for suicide.
• Wonders, R. A., et al. (2018). Ethical dilemmas in psychiatric emergency treatment. Ethics & Behavior, 28(5), 359-370.
• Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing.