Discussion: Ethical and Legal Foundations of PMHNP Care

NRNP 6665 Discussion: Ethical and Legal Foundations of PMHNP Care

Legal and Ethical Principle of Mandatory Reporting

Mandatory reporting of child and elder abuse falls on several professions and agencies.  Some of these professions or

agencies include hospital employees, school employees, child care agencies, social workers, law enforcement, clergy, and

many more.  Definitions of mandatory reporting vary by state and between children and elders but generally involve

reporting a reasonable belief that the individual has undergone physical, sexual, or in some cases, emotional abuse law

enforcement or designated agencies.   The purpose of this discussion is to examine legal and ethical principles of both

child abuse and elder abuse.

Mandatory Reporting of Abuse

Mandatory reporting of child abuse refers to the legal obligation of certain individuals to report suspected abuse to

appropriate agencies.  In general, a mandatory reporter is obligated to report any reasonable belief that a child is being, or

has been abused or neglected.  Child abuse and neglect, defined by the Washington State Department of Health and Social

Services is mental or physical injury, sexual abuse or exploitation, negligent treatment, or maltreatment that results in

Discussion Ethical and Legal Foundations of PMHNP Care

Discussion Ethical and Legal Foundations of PMHNP Care

harm to the child’s health, welfare, and safety (Department of Children, Youth & Families, n.d.).  Mandatory reporting of

elder abuse includes many of the same individuals responsible for reporting child abuse and includes the same criteria,

but adds financial abuse.  In Washington, elder abuse can be intentional or unintentional acts that cause harm incidences

of intimidation or punishment (Vulnerable Adult Abuse/Washington State, n.d.).

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Legal Considerations

According to Liu and Vaughn (2019), legal implications of mandatory reporting of child abuse can be brought against

both the alleged abuser as well as the reporter.  This article also informs the reader that in 2016, child abuse and

Discussion Ethical and Legal Foundations of PMHNP Care

Discussion Ethical and Legal Foundations of PMHNP Care


resulted in 1,750 fatalities, 70% of which involve children under 3 years of age (Liu & Vaughn, 2019).  Unfounded reports of

child abuse have been reported, however, the potential benefits of reporting a false positive abuse case outweigh the risks

of not reporting a true abuse case, known as a false negative.  This article also discusses several case reports of child abuse

reporting cases and explains that reporters can be held liable for false reporting, however, not when acting with

reasonable suspicion and with good intent (Liu & Vaughn, 2019).  Elder abuse is considered by many to be a human rights

and civil rights issue in many contexts (Jackson, 2015).  Conceptualizations of elder abuse have changed throughout the

years and definitions vary, but in any context, it is a social issue that goes beyond care providers (Jackson, 2015).

Ethical Issues

There are certainly ethical issues that pertain to mandatory reporting of child and elder abuse.  Brashler et al. (2016)

explain that this obligation of physicians will certainly cause false positives when reported and the hesitancy of not

reporting can result in false negatives.  Ethical considerations of child abuse include uncertainty about the abuse, disbelief

that the individuals are capable of abuse, worry that the report may cause worsening problems within the family dynamics,

and concern that the report will ruin a trusting client-provider relationship (Brashler et al., 2016).  Ethical considerations of

elder abuse include violations of human rights, loss of autonomy, beneficence, and non-maleficence; as well as issues of

competency of the individual in question (Saghafi et al., 2019).  The protection of an individual’s health and welfare is

important and can be done when these ethical principles are taken into consideration without bias or personal beliefs of

different cultures (Saghafi et al., 2019).

Implications for Practice


Mandatory reporting of child and elder abuse presents challenges, but also promotes the well-being of at-risk

individuals.  The protection of these individuals is of utmost importance and therefore, any reasonable suspicion that

abuse has or is taking place should be promptly reported.  It is our duty as practitioners to do no harm and lack of action

in these cases causes harm.  Making a report about suspected abuse does not necessarily imply that children will be taken

from their home or that parents will be charged with a crime, nor caregivers when elder abuse is suspected.  A thorough

professional investigation will occur and all findings will be evaluated.  Making a report is simple and can sometimes be

done online.  In Washington State, mandatory reporters are obligated to report reasonable suspicion of child or elder

abuse of varying forms.


Child or elder abuse can happen in different ways and by anyone close to the victim.  Mandatory reporters, such as

health care providers, teachers, and social workers are obligated to report to the appropriate agency any reasonable belief

that the well-being of an individual is threatened.  Legal and ethical issues exist within the context of mandatory reporting,

but mandatory reports are well accepted when made without malicious intent and on the basis of reasonable suspicion.

All health care practitioners are obligated to report such beliefs and should be done regardless of any negative

consequence that may occur, as the risk of not reporting a false negative is superseded by the potential benefits of

reporting actual abuse.


Brashler, R., Finestone, H. M., Nevison, C., Marshall, S. C., Deng, G., Bismark, M., & Mukherjee, D. (2016). Time to Make a Call? The Ethics of Mandatory Reporting. PM&R8(1), 69–74. https://doi.org/10.1016/j.pmrj.2015.11.009

Department of Children, Youth & Families. (n.d.). DCYF. https://www.dcyf.wa.gov/safety/what-is-abuse

Jackson, S. L. (2015). The shifting conceptualization of elder abuse in the United States: from social services, to criminal justice, and beyond. International Psychogeriatrics28(1), 1–8. https://doi.org/10.1017/s1041610215001271

Liu, B. C. C., & Vaughn, M. S. (2019). Legal and policy issues from the United States and internationally about mandatory reporting of child abuse. International Journal of Law and Psychiatry64, 219–229. https://doi.org/10.1016/j.ijlp.2019.03.007

Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of Medical Ethics and History of Medicine12(12), 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642445/

Vulnerable Adult Abuse | Washington State. (n.d.). Www.atg.wa.gov. https://www.atg.wa.gov/vulnerable-adult-abuse

File  JMEHM-12-7.pdf (317.492 KB)

Tort Law

The topic chosen is tort law. Tort law addresses a wrong act done to an individual to ensure justice is given and relief from the wrong acts is provided to the affected individuals. It mainly involves monetary awards to the victims to compensate them for the wrong acts committed by other individuals. The person committing the act suffers the cost/ pain of inflicting wrong acts on others. The law ensures that the victim suffering the wrongful act is compensated to relieve them from the pain of experiencing the wrongful acts.

Tort law provides guidelines on the different approaches of individual victims of a committed wrong act (Mor & Pikkel, 2019). The law guides on the steps to undertake in cases where the individuals who have committed the offense, where a child (minor) or an adult face different punishments as guided by the law. The punishment aims at compensating the individuals suffering the offense. Therefore, the individuals who have committed a crime, depending on the type of crime/ offense, both the minor and adults face different punishments.

The law obeys various ethical and legal issues/ considerations while executing its laws on individuals. The most salient ethical and legal issue identified in and utilized by the law is justice. The law ensures justice prevails through compensation of the affected victims/ individuals. Justice is ensured by enforcing compensation from the offender; for instance, if the individual is an adult, he or she pays for the damages caused to the other individual.

Tort law protects adolescents and children, the minor, from facing the consequences out of the innocence of their actions. The law ensures that the child’s/ minor’s parent or guardian is responsible for the actions committed by the minor. The law states that if the minor commits a crime/ causes damages while under supervision, the supervisor carries the burden of the damages caused (Zdraveva, 2021). The supervisor is held responsible since the child committed the damage while under his/her care and supervision. However, the compensation depends on the type of damage caused and the minor’s ability to make abstract reasons and judgments of their actions and possible consequences.

Moreover, the law also obeys the ethical consideration of beneficence. It ensures that good is done to the affected victims by ensuring accountability of the offender. These ethical and legal considerations concern mental and psychiatric health for both adults and minors, that is, children and adolescents(Mor & Pikkel, 2019). The ethical considerations help protect and promote the mental well-being of an individual. Providing compensation ensures mental stability by relieving the individual from the ill actions of the offender.

Tort law is applicable in clinical practice because it ensures fairness and compensation for committed ill acts. Protection of children against abuse is key, and the law is applied in ensuring the children are covered and well taken care of. The child might be innocent and commit a task that he/she doesn’t know the consequences of. The la ensures their well-being by ensuring that their parents and guardians are responsible for their actions. The law promotes the mental well-being of adolescents, minors, and adults through enacting activities and laws that ensure justice and fairness.

The mental well-being of an individual is necessary and should be considered when passing laws and regulations. The consequences of some acts might affect an individual’s mental state; therefore, there is a need to ensure the wellness of an individual. Children’s mental state and experiences play an important role in their wellness in their adult stages. The consequences or compensatory measures should ensure that the mental status is not affected. Tort law favors all individuals of any age and promotes morality among populations.



Mor, S., & Pikkel, R. B. (2019). Disability, Rights, and the Construction of Sexuality in Tort Claims. Law & Society Review53(4), 1016-1050.

Zdraveva, N. (2021). The Children in the Macedonian Tort Law. Balkan Social Science Review17(17), 143-161.

Ethical/Legal Discussion of Abuse

Child and elder abuse are disturbing, unfathomable issues due to the helpless nature of the victims; however, many people are affected daily by maltreatment. Healthcare providers often discover this abuse by assessment rather than self-disclosure. It can also be an issue family members bring up to a healthcare provider. Abuse can occur in many forms such as neglect, emotional, stealing their belongings, or sexual abuse. It is vital for health professionals to recognize maltreatment and know how to handle the situation properly for the sake of the patient’s safety. This post will cover four resources covering ethical and legal aspects of child and adult abuse and how they concern psychiatric mental health practitioners in their field.

Elder Abuse Ethics

            Saghafi et al. (2019) studied the ethical dilemmas healthcare professionals face while trying to manage elder abuse. The ethical concerns they discuss cover the difficulties care team members face when the abused elder chooses to stay in an abusive situation, the legality of telling other team members secretive patient information for help with how to properly intervene, and the issue of how nurses should intervene for patients with neurocognitive disorders. They also discuss federal law mandating elder abuse reporting and the importance of protecting the autonomy of elders without forcing what another person believes is best for them. This can overlap when it comes to what the healthcare provider believes is best for a patient but it is not what the patient wants.  Saghafi et al. (2019) pointed out the importance of clinical guidelines to help support care teams with making these ethical decisions.

Child Abuse Ethics

                        Glover and Justis (2015) discussed how many people believe taking care of child abuse when discovered is easy and should be taken care of immediately without realizing how many ethical dilemmas can make child abuse issues difficult to resolve. When people think of sexual or physical abuse, it seems understandable to know and report such abuse. However, when the abuse comes in the form of obese children, underweight children, verbal, or end of life care decisions, the ethics of what is right and wrong can become more difficult (Glover & Justis, 2015). Decisions that are difficult for all parties involved, including the health care provider that would be mandated to report it. Glover and Justis (2015) stated health care providers sometimes might find themselves having to intervene with parents and discuss decisions if not found to be in the child’s best interest, with a threshold of not reporting as mandated as long as their decisions do not cause harm.

Legal Considerations for the Elderly

                        Hess (2011) provided multiple types of elder abuse to assist health care providers to recognize what is legally mandated to be reported. Besides the more obvious physical or sexual abuse, she discusses psychological abuse that can present as being upset, withdrawn, agitated, or unusual behaviors such as biting, and also financial abuse, neglect, or abandonment. She provides the three R’s in detecting and reporting abuse of recognize, respond, and report. Health care teams should legally follow their reporting procedures for documentation, reporting abuse if needed, and following up to ensure patient safety. Hess (2011) points out a law in place to protect the elderly like the Older Americans Act of 1965. She also provides web sites like (http://www.apsnetwork.org/Abuse/index.htm that provide resources for reporting and http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx for numbers to call.

Legal Considerations for the Children

            Fishe and Moffat (2016) discussed the Child Abuse Prevention and Treatment Act

(CAPTA) of 1974 that causes the Department of Human Services (DHS) to collect data and monitor the effectiveness of each state’s practices. By law, there are certain people required to report any type of child abuse. Fishe and Moffat (2016) provided those who are mandated to report child abuse which includes any medical or mental health professional and should be done quickly in most states (Fishe & Moffat, 2016). If abuse is discovered after a patient turns 18 or a while after the abuse happens, then the occurrences should still be reported (Fishe & Moffat, 2016). Another action required of healthcare professionals is collecting evidence by documenting findings, taking photos of evidence, and presenting lab results if ordered (Fishe & Moffat, 2016).

Personal Practice

            Considering all medical or mental health professionals are mandated to report witnessed or suspected child or adult abuse, this directly affects my personal practice by providing an understanding of what, when, and who the information needs to be reported to. I was not aware that if patients report abuse from years ago, that I am mandated to report it so that changes my personal practice as well. According to Fishe and Moffat (2016), the state of Arkansas requires abuse to be reported immediately. Although it can be difficult to report suspected abuse, not knowing if more harm is being done than good, I would much rather live with that on my conscious than not reporting and having a terrible outcome for a patient.


Fishe, J. N., & Moffat, I. F. L. (2016). Child Abuse and the Law. Clinical Pediatric Emergency Medicine, 17(4), 302–311. https://doi.org/10.1016/j.cpem.2016.09.003

Glover, J., & Justis, L. (2015) Ethics and the Identification and Response to Child Abuse and Neglect. General Law. https://lawexplores.com/ethics-and-the-identification-and-response-to-child-abuse-and-neglect/

Hess, S. (2011). The Role of Health Care Providers in Recognizing and Reporting Elder Abuse: [1]. Journal of Gerontological Nursing, 37(11), 28–37. http://dx.doi.org/10.3928/00989134-20111012-50

Saghafi, A., Bahramnezhad, F., Poormollamirza, A., Dadgari, A., & Navab, E. (2019). Examining the ethical challenges in managing elder abuse: a systematic review. Journal of medical ethics and history of medicine, 12, 7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6642445/


Fidelity in Mental Health Nursing

            Fidelity describes the responsibility of the PMHNP to provide the best possible care to his or her clients according to evidence-based practice guidelines, the client’s choice, or desire for treatment interventions (honoring autonomy), and available resources. Conflict can arise when the PMHNP feels there are safer or more effective treatment options than what the facilities policy is, when financial constraints exist or there are differences in postop treatment according to the client’s ability to pay, or when the action taken by a PMHNP is the ethical one, but maybe not the legal one. The American Nurses Association has published the code of ethics for nurses with interpretative statements (2015). The provisions of this that I am opening for further review in this discussion include 4.2, 4.3, 5.1, and 5.5 as follows:

Code of Ethics for Nurses

  • Provision 4.2 Accountability for Nursing judgements, decisions, and actions: nurses are accountable for the care of the patient; if a medication error occurs because of an IV pump failure or electronic M.A.R. glitch- you as the providing nurse are still responsible for the care of the patient.
  • Provision 4.3 Responsibility for Nursing judgements, decisions, and actions: there is a shared responsibility with nursing administration who make the policies of care; issues include staffing ratios and safeguarding care of the patient and staff.
  • Provision 5.1 Duties to self and others: we need to take care of our own emotional and physical selves to be fit for providing care to others.
  • Provision 5.5 Maintenance of competence and continuation of professional growth: nurses owe it to themselves and to their patients to engage in continuing education, to stay up to date with controversies and issues effecting the population (American Nurses Association, 2015).

The American Psychological Association has their own code of ethics, or set of “aspirational” ideals. Principle B addresses the ethics of fidelity and responsibility. Within this set of values, it is proposed that you should be attentive to not only your own practice, but also your colleagues (American Psychological Association, 2017).


Legal and Ethical implications of Fidelity in the Adult population

Legal and Ethical implications of Fidelity in the child and adolescent population

            I will share an anecdotal story. As a charge nurse of an adolescent unit, the intake office informs me that we have a patient coming in with an active history of being sexually assaultive to others. My professional judgment is that this patient requires his own room to protect the safety of others. Our unit is full and it is not possible to make this patient a no roommate order. I have a responsibility to the safety and wellbeing of my unit- including patients and staff. I examine my options and report to the psychiatrist on call to request admitting orders to include 1:1 supervision until we can accommodate a no roommate order. Now, to switch roles from an RN to an APRN and be the PMHNP providing admitting orders.    In this scenario, I am focused on the safety, well-being, and treatment of this 1 singular patient. To not admit him, I would be refusing treatment. Could this be considered bias d/t diagnosis or personal values? Is my education, continued education, and experience relative to the situation? Do I have staff available that I can collaborate with?