Legal and Ethical Issues in Research
Legal and Ethical Issues in Research
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Spirituality encompasses the search for a purpose or meaning of life found beyond physical reality. Often, spirituality will include religious beliefs and values that an individual adheres. To add on, one way that this conception of spirituality would influence the way in which I care for patients is by understanding the patient’s spirituality to help them develop healthy coping mechanisms. According to a scholarly study, more than 80% of parents reported finding comfort and using religion as a coping mechanism to help overcome the loss of a child (Puchalski 2001). This is sometimes the sad reality that a nurse will have to face; hence, it becomes important for nurses to have a way or method to direct parents to handle grief. Moreover, I do believe in spiritual power and God’s existence. I use my beliefs with morals and manners to enhance nursing care I provide to my patients. Spiritual care improves people’s spiritual well-being and performance as well as the quality of their spiritual life. Spiritual care has positive effects on individuals’ stress responses, spiritual well-being such as the balance between physical, psychosocial, and spiritual aspects of self), sense of integrity and excellence, and interpersonal relationships (Zehtab & Adib-Hajbaghery, 2014).
Asthma is a chronic lung disease caused by inflammation of the lower airways and episodes of airflow obstruction. Asthma episodes or attacks can vary from mild to life-threatening. In 2007, about 7% percent of the U.S. population was diagnosed with asthma and there have been a growing number of new cases since that time. There are several known risk factors identified as triggers of asthma symptoms and episodes, including inhalation of allergens or pollutants, infection, cold air, vigorous exercise, and emotional upsets. There is also growing evidence relating body-mass index to asthma in both children and adults. Design a study to investigate whether there is such an association.\
Choose a study design and justify the reasons you chose the design over others.
Select a statistical measure you would use to describe the association (if there is one) between body mass index and asthma.
In addition, address:
Subject selection
Issues relating to the measurement of both the exposure and the outcome
Potential biases that the study might be prone to, and how they might be handled
Possible confounding factors and effect modifiers and how to overcome their effect
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Present the information in a 750-1000-word report, using section headings where each requirement is described and justified under each of the following headings: Study Design, Statistical Measures, Subject Selection, and Measurement Issues.
Refer to the “Key Elements of a Research Proposal.”
You are required to use a minimum of three scholarly resources.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center. Only Word documents can be submitted to LopesWrite.
Key Elements of a Research Proposal
If you need a review of study design components, view the resources below.
Review the Key Elements page of the Research Methods Knowledge Base website at http://www.socialresearchmethods.net/kb/guideelements.php
Key Elements of a Research Proposal
Background / purpose / rationale of the study
Literature review
Hypothesis/key questions
Research objectives
Research methods
• Study design
• Statistical bias
• Procedures/timeline
o Specific steps to be taken to complete the study
o Instruments/data collection methods
o Outcomes
• Proposed data analysis plan
o Statistical analyses planned
o Power analysis if appropriate
• Data safety monitoring if appropriate
Study participants
• Description of participates
• Recruitment of participates
• Confidentiality/human subject’s protection/legal-ethical issues (if appropriate)
• Sampling / rationale
o Inclusion/exclusion criteria
o Number of subjects
Statistical Analysis (only if applicable)
Anticipated Results and Potential Pitfalls
Implications for Practice
Adapted from “Key Elements of a Social Science Research Proposal: Statement of Research Plan†by the Office of Research at Northwestern University at www.research.northwestern.edu
Topic 1 DQ 1
Oct 3-5, 2022
What would spirituality be according to your own worldview? How do you believe that your conception of spirituality would influence the way in which you care for patients?
In essence, spirituality is the quest for the meaning of life (Bogue and Hogan, 2020). This vague term takes on many meanings depending on who is asked. Worldviews have a large impact on what path spirituality takes for someone. Personally, my worldview aligns with realism and optimism. Realism in the fact that what I can perceive and what is tangible in this world is what creates the majority of my experience. My optimistic worldview allows me to rely on such ideas as faith in order to maintain a positive view of my future. These play into my spirituality by allowing me to stay grounded in the present and accepting that the future is still unknown but has so much potential to be better than what I can comprehend now. My worldview allows my spirituality to be fluid and less of a daily burden mentally. The combination of my worldview and spirituality allow me to be present for my patients in their times of need, maintain positivity, be open to external experiences and worldviews, all while maintaining a tangible awareness of the physical ailments they are experiencing. Faith without realism does not benefit the patient because even if a grim prognosis exists, realism allows us to deal with the now and continue to move forward. Even if moving forward towards a terminal diagnosis, solace can be found in working through the physical realm to eventually be at peace in faith; knowing all that can be done in the now has been addressed.
Reference
Bogue, D. W. and Hogan, M. (2020). Foundational Issues in Christian Spirituality and Ethics. Practicing dignity: An introduction to Christian values and decision making in health care. Retrieved from https://lc.gcumedia.com/phi413v/practicing-dignity-an-introduction-to-christian-values-and-decision-making-in-health-care/v1.1/#/chapter/1
Psychiatric emergencies are severe mood, thought, behavioral and social disturbances that need immediate emergency interventions plan as defined by the family, patient and social care unit. These immediate interventions are critical in saving the patient and others from immediate harm to themselves and others. All states across the U.S. have laws and guidelines that offer directions on handling psychiatric emergencies and access to immediate interventions to deal with such cases. Three forms of involuntary treatment exist by civil commitment laws in 46 states and the District of Columbia. Therefore, one can only secure treatment during or following a psychiatric crisis when they understand the existing laws and standards in their states (Leo, 2019). The purpose of this paper is to explore the legal and ethical issues concerning psychiatric emergencies and identify evidence-based suicide and violence risk assessments in Illinois for patients with paraphilic disorders.
Illinois State Laws for Involuntary Psychiatric Holds
Psychiatric emergency hold laws allow individuals with mental health disorders like paraphilic disorders to get involuntary admissions to health facilities to get immediate interventions to reduce potential harm to themselves and others. The state of Illinois is among 17 states that offer access to treatment on a needs-basis with a consideration of possible risk or danger (Kenneally, 2022). The implication is that laws in the state allow individuals to get admitted to mental health facilities against their consent or wishes under the involuntary civil commitment. There are two ways individuals with mental illness can involuntarily be admitted to a mental health facility (Posner et al., 2019). These include by a court order where a state judge forces one to be admitted to a facility, and emergency admission by certification where due to the nature of one’s mental health, and posing immediate harm himself or other. The second scenario means that one does not require a court order as long as local authorities are aware of the immediate danger, they can take the individuals to a mental health facility to get treatment.
Proof of mental illness alone is not sufficient to admit an individual; either a minor or an adult, into a mental health facility. The issuance of a mental health warrant means that a sheriff’s office can detain a patient and transport them to a health facility for evaluation and subsequent treatment. A psychiatrist must provide a medical certificate to court upon assessment. The certificate is a proof that the individual may potentially harm themselves and even other. The court then issues an order of protective custody (OPC) where the individual is held for at most 72 hours before a judge holds a probable cause hearing to determine if the facility can hold or release the patient (Kenneally, 2022). The court is then mandated to hold a mental health hearing within 14 days.
For minors, the Illinois law mandates parents, managing conservator, or guardian to request for their admission to inpatient health facility. They can do this by filing a request with the administrator of the facility. A psychiatrist can only discharge such patient upon the determination that they do not pose any harm to themselves or others. Minors can only be released to parents, guardians and the managing conservator.
Psychiatric Hold, Inpatient Commitment & Outpatient Commitment in Illinois
Patients on psychiatric hold are confined in psychiatric facilities against their will for a maximum of 72 hours. Illinois laws require the individual to either be a danger to themselves or others, suffer from severe distress, and experiencing significant deterioration as well as lacking the ability to make rational and informed decisions to submit to treatment (Santillanes et al., 2018). Inpatient commitment occurs when a judge orders an individual to get hospital treatment when they meet the state’s criteria for civic commitment after being in psychiatric hold. On its part, outpatient commitment is a treatment intervention or alternative where a judge orders a qualifying individuals with mental illness symptoms to comply with a prescribed mental health plan while they live in the community.
Capacity and Competence in Mental Health Contexts
Capacity entails the evaluation of a person’s functional abilities to make rational choices and decision. Physicians conduct assessments to determine if one lacks the capacity to make reasoned medical decision. Under such situations, they grant others or surrogates to make decisions on their behalf. On its part, competency is assessment and legal determination by a court on one’s ability to rationally execute legally recognized acts and situation (Bipeta, 2019). The court determines the level of one’s incompetence where those deemed incompetent get assigned persons to make decisions on their behalf.
HIPAA: Legal and Ethical Issues in Psychiatric Emergencies
Caring for individuals with mental health issues, especially psychiatric emergencies needs a multidisciplinary team and families as well as friends. The implication is that these entities must share information about the care for effective care coordination to yield better outcomes. However, sharing of the information requires all involved to adhere to the provisions of the Health Insurance Portability and Accountability Act (HIPAA). This federal law protects the privacy of individual health information (Theodos & Sittig, 2020). The law is essential as it assists in protection of confidential mental health records for individuals with the problem. Ineffective communication hinders care process and HIPAA understands that individuals with mental illness may lack the competency and even capacity to make decisions. The law allows representatives of such individuals to request and obtain complete medical records for effective decision making.
An ethical issue also arises from the HIPAA law as it is more synonymous with privacy measure imploring providers to only make disclosures based on consent. Despite its good intention, many question its ethical viability as it obstructs or interferes with effective care coordination. Many assert that the law restricts providers from effective care delivery based on fast-changing technology (Theodos & Sittig, 2020). Consumers want seamless communication and believe that such should also happen in healthcare settings. For instance, patients feel comfortable texting their physicians directly or emailing their care team and getting what they want without using the patient portals. The implication is that these regulations raise ethical issues with providers being keen on offering better interventions by information sharing.
Suicide Risk Assessment Tool
The Columbia-Suicide Severity Rating Scale (C-SSRS) is an evidence-based suicide risk assessment tool that can be used in different care setting for psychiatric assessment. These include schools, campuses, fire departments and even the military. Multiple institutions and organizations developed the tool. These include Columbia University, National Institute of Mental Health and National Institute of Health as well as Substance Abuse and Mental Health Service Administration (SAMHSA) (Posner et al., 2019). The tool has a rating scale where individuals with suspected mental health issues are rated on their level of suicide ideation. The scale identifies specific behaviors and at least one must be among those identified by the scale to more likely lead to complete suicide.
Violence Risk Assessment Tool
Violence towards healthcare workers, especially in emergency rooms, continues to be a concern in healthcare and affects the quality of care that they can offer. Structured clinical tools can help healthcare providers to identify patients and their family members that can be potentially violent or aggressive. The Broset Violence Checklist (BVC) is a six-item instrument which evaluates the presence or absence of three aspects of patients that include confusion, irritability and boisterousness. The tool also measures patient behaviors like verbal threats, physical threats and attacking of objects which are indications of possible violence (Sarver et al., 2019). Individuals displaying any two or more of these aspects are likely to become violent with a 24-hour duration if no immediate interventions are put in place. The tool is effective in enhancing adherence to treatment interventions to reduce the possibility of violence.
Conclusion
Illinois state has laws that mandate involuntary admission of individuals into psychiatric facilities against their will if they pose danger to themselves and others. Those seeking such interventions must use the state’s legal system. Courts determine mental competency and but physicians determine mental capacity for individuals. The HIPAA regulations help protect patient privacy and health information. Ethical and legal concerns also arise from the use of HIPAA as it hinders effective care provision. The use of suicide risk assessment tools and violence risk tools is essential in offering better interventions to patients with mental health issues.
References
Bipeta, R. (2019). Legal and Ethical Aspects of Mental Health Care. Indian Journal of
Psychological Medicine, 41(2): 108-112. DOI: 10.4103/IJPSYM.IJPSYM_59_19
Kenneally, P. D. (2022). Mental Health Involuntary Commitment.
https://www.mchenrycountyil.gov/county-government/departments-j-z/state-s-attorney-s-office/divisions/civil-division/mental-health-involuntary-commitment
Leo R. J. (2019). Competency and the capacity to make treatment decisions: A primer for
primary care physicians. Journal of clinical psychiatry, 1(5), 251–256.
DOI: 10.4088/pcc.v01n0501.
Posner et al. (2019). The Columbia–Suicide Severity Rating Scale: Initial validity and internal
consistency. American Journal of Psychiatry, 168: 126 6 –1277.
DOI: 10.1176/appi.ajp.2011.10111704.
Santillanes, G., Kearl, Y. L., Lam, C. N., & Claudius, I. A. (2017). Involuntary psychiatric holds
in preadolescent children. Western Journal of Emergency Medicine, 18(6), 1159. DOI: 10.5811/westjem.2017.8.35114
Sarver, W., L., Radziewicz, R., Coyne, G., Colon, K., Mantz, L. (2019). Implementation of the
Brøset Violence Checklist on an Acute Psychiatric Unit. Journal of American Psychiatric Nurses Association, 25(6):476-486. DOI: 10.1177/1078390318820668.
Theodos, K., & Sittig, S. (2020). Health information privacy laws in the digital age. Perspectives
in health information management, 18(2), 15-21.
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