• Whenever possible, client autonomy and liberty must be ensured by treatment in the least restrictive setting and by active client participation in treatment decisions.

• Voluntary admission occurs when a client consents to confinement in the hospital and signs a document indicating as much.
• Commitment, or involuntary admission, may be implemented on the basis of dangerousness to self or others. Some states also have the criterion of prevention of significant physical or mental deterioration for involuntary admission.
• Adult clients can be held temporarily on an emergency basis until there is a court hearing determining the need for commitment.
• Commitment is for a specified period of time. At the end of this time, the client must be discharged or the court must be petitioned again for continued hospitalization.
• Clients can initiate advance directives to guide families and caregivers in making decisions when they are unable to make them for themselves.

• Competency is a legal determination that a client can make reasonable judgments and decisions about treatment and other significant areas of personal life.
• An adult is considered competent unless a court rules him or her incompetent. In such cases, a guardian is appointed to make decisions on that person's behalf.
• Clients who are committed are still capable of participating in health care decisions.

• Adherence to the principle of confidentiality is extremely important in the practice of psychiatric nursing.
• There are federal rules regarding chemical dependence confidentiality. Staff members are not allowed to disclose any admission or discharge information.
• Some states require written consent before HIV tests may be performed. States have laws regarding when HIV test results or the diagnosis of AIDS may be disclosed.

• Informed consent is a client's right not to be touched or treated without consent. Clients must be given enough information to make a decision, must be able to understand the information, and must communicate their decision to others.
• In an emergency situation with no time to obtain consent without endangering health or safety, a client may be treated without legal liability.

• Clients do not lose their constitutional or legal rights when they are admitted to the hospital to treat a mental disorder.
• Clients have the right to refuse psychotropic medications.
• If the court finds the client to be incompetent and medications are in the client's best interest, the judge may order the client to take the medications.

• All states make it mandatory for nurses to report suspected cases of child abuse or neglect. Some states have enacted similar adult abuse laws.

• The duty to disclose is the health care professional's obligation to warn identified individuals if a client has made a credible threat to kill them.

• Staff members must take precautions to prevent LAMA, or elopement, from the unit by those clients who are dangerous to self or others.

• This Act is a new initiative targeted to state legislatures to build a more comprehensive service-delivery program.

• Clients who have legal charges pending against them must be informed that the court may request their medical records.

• Criminalization of mental illness is one of the most disturbing trends in our nation and must be stopped.
• Clients with mental disorders may be jailed because their symptoms are mistaken for criminal behavior or there may be no other agencies available to respond to their psychiatric emergency.
• Clients with mental disorders who are imprisoned are vulnerable to abuse and victimization by other inmates and correction officers.
• The suicide rate among jail inmates is eight times that of the U.S. population.
• Congress is examining strategies to create alternatives to incarceration for people who have been charged with nonviolent crimes and who are mentally ill.

• Caring behaviors include attentive listening; providing comfort, honesty, patience, and responsibility; providing adequate information, touch, sensitivity, and respect; and calling the client by name.

• Nurses are required to make numerous ethical decisions every day. Client differences in values and lifestyles often present nurses with an ethical dilemma when clients are admitted to a mental health care facility.
• Competent care involves knowing what and how to do things, being open to criticism, and a willingness to admit to lack of knowledge or error when appropriate.
• The perspective of principalism in ethics ignores the socioeconomic and cultural contexts and is too abstract to have practical application in clinical practice.
• Nursing is based on an ethics of care, including medical indications, client preferences, quality of life, and contextual factors.
• Clients who are considering participation in nursing research must be fully aware of what the protocols involve, what risks they will face, what options they have, and who they should contact with questions or issues as they arise.
• The challenge is to continue to work with volunteers who have mental disorders to discover and develop better nursing interventions while at the same time doing all we can to protect the rights and well-being of those who participate in research.

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