Ethical and Legal Issues in Psychiatric Nursing Practice
This paper offers a critical review of the article "Ethical and Legal Issues in Acting as a Client Advocate," examining the complex ethical, legal, and professional challenges confronting psychiatric nurses. The review explores the article's treatment of client autonomy, involuntary psychiatric treatment, and the nurse's obligations to clients, families, and society. It engages with contrasting perspectives — including Schaler's provocative comparison of involuntary treatment to historical persecution and Raines's emphasis on moral accountability — and evaluates the article's proposed five-step decision-making model. The review concludes that, despite a brief introduction, the article offers a valuable and nuanced framework for ethical practice in psychiatric nursing.
- Introduction: Overview of the article under review
- Definitions and the Complexity of Psychiatric Nursing Ethics: Role of definitions in clarifying ethical complexity
- Client Autonomy and Involuntary Treatment: Voluntary versus involuntary psychiatric treatment debate
- Stakeholders in Psychiatric Nursing Practice: Client, family, and societal roles in nursing ethics
- The Five-Step Decision-Making Model: Article's generic ethical decision-making framework explained
- Conclusion and Critique of the Article: Final evaluation and suggested improvements
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What makes this paper effective
- The review engages critically with the source article rather than simply summarizing it, weaving in contrasting scholarly perspectives (Schaler, Raines, Keatings) to evaluate the article's claims.
- The writer maintains a clear evaluative stance throughout, identifying both strengths (the client-centered focus, the decision-making model) and a specific weakness (the underdeveloped introduction).
- The progression from definitions to specific stakeholder contexts mirrors the article's own structure, giving the review logical coherence.
Key academic technique demonstrated
The paper demonstrates effective comparative critique: rather than reviewing the article in isolation, the author positions it against opposing viewpoints — most notably Schaler's provocative analogy between involuntary psychiatric treatment and historical persecution of heretics. By systematically dismantling Schaler's argument using evidence from the article and from Raines and Keatings, the writer shows how a reviewed source can be validated through triangulation with other scholarly works.
Structure breakdown
The review follows a modified evaluative structure: it opens with a general appraisal, moves through the article's major sections (definitions, client focus, stakeholder contexts, decision-making model) in roughly the same order as the source, and closes with a specific structural critique (the weak introduction) before a reaffirming conclusion. This mirrors the source's own logic while maintaining the reviewer's independent critical voice throughout.
Introduction
The article Ethical and Legal Issues in Acting as a Client Advocate focuses on issues facing the psychiatric nurse in his or her dealings not only with patients, but also with family members of patients as well as wider social and political issues. The article emphasizes the complexity of the ethical issues surrounding the psychiatric profession — not only because of the nature of patients' afflictions, but also because of the integrated factors and variety of beliefs surrounding those afflictions. In general, the article provides an excellent overview of the issues that nurses might expect to encounter, although it might have benefited from a more inclusive introduction.
Definitions and the Complexity of Psychiatric Nursing Ethics
The article provides only a brief introduction that sets the stage for a discussion of the issues facing psychiatric nurses. The introduction does make a good point in terms of focusing on the importance of ethics in the psychiatric nurse's dealings with clients.
One element about the article that is notable is the extensive definitions section, which takes up approximately half of the article's total volume. This somewhat detracts from the central point of the paper. On the other hand, as one works through the definitions, their central theme becomes clear: the ethics surrounding a psychiatric nurse's work with clients constitute an integrated and complex topic.
What particularly brings this home is the distinction drawn between ethics and other elements in the daily work with clients, including legal obligations, codes of conduct and ethics, hospital etiquette, hospital policy, public opinion, superior orders, and the "gut response" to what appears to be the best course of action at any given time.
Client Autonomy and Involuntary Treatment
The complexity of the issues surrounding psychiatric nursing can be compared to opinions such as those of Schaler (p. 23), who compares the current premise of the psychiatric profession to the burning of heretics in the past. The basis of this opinion is that involuntary psychiatric treatment is based upon the general public's conception — or indeed belief — in what constitutes insanity. If a "heretic" is identified in terms of the sanity paradigm, he or she is "punished" by means of involuntary treatment, either through psychiatric institutionalization or medication. The publication of such literature indicates that this is an opinion held by a significant sector of the public.
On the other hand, the article under review also indicates that psychiatric treatment should be voluntary in most cases. Problems arise, however, when the client in question poses a danger to him- or herself or to other members of the family or public. In such a case, the professional is under legal obligation to protect the public from preventable harm by either incarcerating or medicating the individual who suffers from mental illness.
This issue in itself illustrates the complexity of issues facing the psychiatric nurse. In this way, the article's many definitions also serve to bring home to the reader the necessity of clear definition in order to provide a coherent paradigm for navigating the ethical, legal, and other issues facing the profession.
Conclusion and Critique of the Article
The only change that might usefully be made to the article is a more integrated and lengthy introduction. The current introduction, for example, refers only very briefly to the importance of advocacy in the nurse's work with psychiatric patients. It does not mention the direction of the paper as a whole, nor its culmination in a decision-making model for such advocacy. If the introduction were to address all the elements the paper covers, the paper as a whole would have been clearer from the outset.
However, this shortcoming does not detract from the fact that the paper addresses a very important aspect of current nursing practice, especially in the field of psychiatry. It provides very important considerations, especially in light of potentially harmful opinions such as those raised by Schaler. It is vitally important that psychiatric nurses apply critical thinking at all times in their work with clients and within the profession as a whole. Only in this way can a consistent quality of care be ensured.
References
Ethical and Legal Issues in Acting as a Client Advocate. Retrieved from:
Keatings. Chapter 2: Ethical Theoretical Perspectives.
Raines, D.A. (1994, Jan–March). Moral Agency in Nursing. Nursing Forum, Vol. 29, No. 1.
RPNC (2010, March). Code of Ethics & Standards of Psychiatric Nursing Practice. College of Registered Psychiatric Nurses.
Schaler, J. Freedom, Psychiatry and Responsibility.
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