How do we decide if a treatment is even needed?
First, we need to determine if a treatment is even needed. By having a clear accounting of the person’s symptoms and how they affect daily functioning, we can decide to what extent the individual is adversely affected.
Can a clinician defer medical decisions due to a psychiatric condition?
However, resolution of an underlying psychiatric condition may not occur immediately, and it may be impossible to defer medical decisions for the time required for the psychiatric condition to resolve. In such cases, the clinician would be expected to consult advance directives and/or defer to designated surrogate decision makers.
Who makes decisions about treatment for patients with lack of capacity?
Still other jurisdictions may require that a committee of physicians, hospital administrators, and spouse or other family member make treatment decisions regarding treatment for the patient who lacks capacity. Consultation with knowledgeable legal council in one's jurisdiction may be particularly helpful in clarifying which of these rules apply.
How is the final diagnosis of a diagnosis made?
The final diagnosis is based on the clinical interview, text descriptions, criteria, and clinical judgment. Subtypes and Specifiers – Subtypes denote “mutually exclusive and jointly exhaustive phenomenological subgroupings within a diagnosis” (APA, 2013).
Why is it important to include patients in decision-making?
Patients who participate in their decisions report higher levels of satisfaction with their care; have increased knowledge about conditions, tests, and treatment; have more realistic expectations about benefits and harms; are more likely to adhere to screening, diagnostic, or treatment plans; have reduced decisional ...
What factors affect a choice of treatment?
Based on the extant literature, these factors include:Patient's beliefs and values.Ethnicity.Decisional control preferences.Health related experience.Patient's perception of the decision-making process.Personal factors.
What four areas decide if a patient's treatment decision is competent?
In addition to performing a mental status examination (along with a physical examination and laboratory evaluation, if needed), four specific abilities should be assessed: the ability to understand information about treatment; the ability to appreciate how that information applies to their situation; the ability to ...
Why is decision-making important in mental health?
Effective decision-making has the potential to influence positive thinking and to enhance our mental health and wellbeing. For those living with mental health conditions or facing mental health challenges such as anxiety, decision-making can become more challenging.
What factors might a doctor consider before deciding which treatment to use for a patient?
Often the treatment goal is based on:risk of the disease - based on pathology results and clinical behavior FLIPI. ... age - being young sometimes favoring, or allowing for, more aggressive approaches to therapy.strength of the data* that supports the goal of the treatment for your clinical setting:
How is medical decision-making determined?
The guidelines consider risk to the patient in determining the level of medical decision making – risk of significant complications, morbidity and mortality – and they recognize three gauges of this risk: the presenting problems, any diagnostic procedures you choose and any management options you choose.
What determines decision-making competency?
To ensure that individuals retain as much autonomy or self-determination as is legally possible, the court makes a determination of one's competence in a task-specific manner. For example, one can be determined to be incompetent to execute a will, but may be deemed competent to make treatment decisions.
What is recommended to be used to determine capability when serious decisions are being considered?
Use of a formal assessment tool such as the Aid to Capacity Evaluation improves accuracy in determining a patient's decision-making capacity.
What disorders affect decision-making?
The decision-making circuits commonly associated with schizophrenia and substance use disorder include areas of the “cortex” – the outer part of our brain important for complex thought (especially the frontal lobe) – that “talk” to hub areas such as the “striatum”.
What does decision-making involve?
Decision making is the process of making choices by identifying a decision, gathering information, and assessing alternative resolutions. Using a step-by-step decision-making process can help you make more deliberate, thoughtful decisions by organizing relevant information and defining alternatives.
Can Mentally ill people make decisions?
In law, this is called the capacity to consent. Having a mental illness or disability doesn't automatically mean a person can't make their own medical decisions. Even people with a legal representative (mandatary, tutor or curator) might be able to make certain medical decisions on their own.
Why are some disorders not included in the main body of the APA?
Additionally, some disorders were not included within the main body of the document because they did not have the scientific evidence to support their widespread clinical use, but were included in Section III under “Conditions for Further Study” to “highlight the evolution and direction of scientific advances in these areas to stimulate further research” (APA, 2013).
How does a mental health professional assess a client?
For a mental health professional to be able to effectively help treat a client and know that the treatment selected worked (or is working), he/she first must engage in the clinical assessment of the client, or collecting information and drawing conclusions through the use of observation, psychological tests, neurological tests, and interviews to determine the person’s problem and the presenting symptoms. This collection of information involves learning about the client’s skills, abilities, personality characteristics, cognitive and emotional functioning, the social context in terms of environmental stressors that are faced, and cultural factors particular to them such as their language or ethnicity. Clinical assessment is not just conducted at the beginning of the process of seeking help but throughout the process. Why is that?
What are the three critical concepts of assessment?
The assessment process involves three critical concepts – reliability, validity, and standardization . Actually, these three are important to science in general. First, we want the assessment to be reliable or consistent. Outside of clinical assessment, when our car has an issue and we take it to the mechanic, we want to make sure that what one mechanic says is wrong with our car is the same as what another says, or even two others. If not, the measurement tools they use to assess cars are flawed. The same is true of a patient who is suffering from a mental disorder. If one mental health professional says the person suffers from major depressive disorder and another says the issue is borderline personality disorder, then there is an issue with the assessment tool being used (in this case, the DSM and more on that in a bit). Ensuring that two different raters are consistent in their assessment of patients is called interrater reliability. Another type of reliability occurs when a person takes a test one day, and then the same test on another day. We would expect the person’s answers to be consistent, which is called test-retest reliability. For example, let’s say the person takes the MMPI on Tuesday and then the same test on Friday. Unless something miraculous or tragic happened over the two days in between tests, the scores on the MMPI should be nearly identical to one another. What does identical mean? The score at test and the score at retest are correlated with one another. If the test is reliable, the correlation should be very high (remember, a correlation goes from -1.00 to +1.00, and positive means as one score goes up, so does the other, so the correlation for the two tests should be high on the positive side).
When was the DSM revised?
The Herculean task of revising the DSM began in 1999 when the APA embarked upon an evaluation of the strengths and weaknesses of the DSM in coordination with the World Health Organization (WHO) Division of Mental Health, the World Psychiatric Association, and the National Institute of Mental Health (NIMH).
When was the DSM 5 published?
3.2.2.1. A brief history of the DSM. The DSM-5 was published in 2013 and took the place of the DSM IV-TR (TR means Text Revision; published in 2000), but the history of the DSM goes back to 1944 when the American Psychiatric Association published a predecessor of the DSM which was a “statistical classification of institutionalized mental patients” and “…was designed to improve communication about the types of patients cared for in these hospitals” (APA, 2013, p. 6). The DSM evolved through four major editions after World War II into a diagnostic classification system to be used psychiatrists and physicians, but also other mental health professionals. The Herculean task of revising the DSM began in 1999 when the APA embarked upon an evaluation of the strengths and weaknesses of the DSM in coordination with the World Health Organization (WHO) Division of Mental Health, the World Psychiatric Association, and the National Institute of Mental Health (NIMH). This collaboration resulted in the publication of a monograph in 2002 called A Research Agenda for DSM-V. From 2003 to 2008, the APA, WHO, NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcoholism and Alcohol Abuse (NIAAA) convened 13 international DSM-5 research planning conferences “to review the world literature in specific diagnostic areas to prepare for revisions in developing both DSM-5 and the International Classification of Disease, 11th Revision (ICD-11)” (APA, 2013).
What are the two types of observation?
3.1.3.1. Observation. In Section 1.5.2.1 we talked about two types of observation – naturalistic, or observing the person or animal in their environment, and laboratory, or observing the organism in a more controlled or artificial setting where the experimenter can use sophisticated equipment and videotape the session to examine it at a later time. One-way mirrors can also be used. A limitation of this method is that the process of recording a behavior causes the behavior to change, called reactivity. Have you ever noticed someone staring at you while you sat and ate your lunch? If you have, what did you do? Did you change your behavior? Did you become self-conscious? Likely yes, and this is an example of reactivity. Another issue is that the behavior made in one situation may not be made in other situations, such as your significant other only acting out at the football game and not at home. This form of validity is called cross-sectional validity. We also need our raters to observe and record behavior in the same way or to have high inter-rater reliability.
What is predictive validity?
Predictive validity is when a tool accurately predicts what will happen in the future. Let’s say we want to tell if a high school student will do well in college. We might create a national exam to test needed skills and call it something like the Scholastic Aptitude Test (SAT). We would have high school students take it by their senior year and then wait until they are in college for a few years and see how they are doing. If they did well on the SAT, we would expect that at that point, they should be doing well in college. If so, then the SAT accurately predicts college success. The same would be true of a test such as the Graduate Record Exam (GRE) and its ability to predict graduate school performance.
What is the usual explanation for patient autonomy?
The usual explanation is that patient autonomy is being balanced against best interests. An alternative explanation, that we require greater room for error when the consequences are serious, implies a change to clinical practice and in the evidence doctors offer in court. INTRODUCTION. When a patient refuses medical treatment, the law in the UK, ...
What is the argument that respecting a legally incompetent choice leads to some harm but where the alternative,?
Erde extends this argument to instances where respecting a legally incompetent choice leads to some harm but where the alternative, going against the person's stated wishes, will do more harm.57One example is the refusal of medication in circumstances where the harm of enforcing compliance exceeds the harm of the patient doing without. More important than these utilitarian considerations, however, may be the fact that a proper respect for the wishes of others is not dependent on their having any particular level of intellectual or emotional capacity. One drawback of the balancing approach to competence, according to Checkland, is that it leaves no room for incompetent wishes that should nevertheless be respected.58,59Whatever it is about a person that leads us to owe them respect, they do not lose it by virtue of becoming legally incompetent.
What are the two considerations that affect the degree to which the level of capacity required for competence varies in response to?
Two other considerations seem further to affect the degree to which the level of capacity required for competence varies in response to what is at stake. Medical ethics. The principle of beneficence includes injunctions not to do harm, to prevent evil or harm, to remove evil or harm and to promote good.
What is the degree to which the threshold level of capacity necessary for legal competence varies in proportion to what is at stake?
The degree to which the threshold level of capacity necessary for legal competence varies in proportion to what is at stake is limited, it was suggested in the first section, by the effect of thresholds. There comes a point when someone's capacity is such that the law will regard him or her as legally competent, whatever the consequences. Two other considerations seem further to affect the degree to which the level of capacity required for competence varies in response to what is at stake.
What is the assessment of mental capacity?
Deciding whether someone is legally competent to make decisions regarding their own treatment requires an assessment of their mental capacity. The assessed capacity required for legal competence increases with the seriousness of what is at stake.
Why is the balancing approach important?
Because the consequences of different decisions are different, under the balancing approach the same patient can properly be allowed to decide whether or not to take medication but denied the right to decide whether to undergo a hazardous surgical procedure.27,39Because the consequences of consenting to a procedure are different from those of refusing to undergo it, a person can be competent to refuse to participate in research but not to agree,21and to consent to a treatment but not to refuse.4This aspect of the balancing approach seems to place a peculiar burden on the procedures for seeking consent. Whether or not a treatment decision is to be respected depends on the terms in which the question is couched.
What happens if there is a principle that operates to raise the threshold level of mental capacity required for legal competence?
If there is a principle that operates to raise the threshold level of mental capacity required for legal competence, therefore, the operation of that principle may be limited at extremes of capacity and gravity. The practical consequences have not been described systematically.
Who should clarify the order with the physician?
The nurse should clarify the order with the physician.
What is the purpose of evisceration?
Evisceration involves separation of all layers of the abdominal wall , resulting in protrusion of abdominal contents. The nurse's first priority should be to protect the client's abdominal contents. She should apply warm, sterile saline dressings over the protruding viscera. Next, the nurse should institute NPO status because the client will ultimately need surgery. The client is at risk for shock, so the nurse should monitor vital signs frequently after applying the sterile, moist dressing. The extensiveness of the protrusion is not important, it will need surgical repair regardless.
Do you need to monitor vital signs after sterile dressing?
The client is at risk for shock, so the nurse should monitor vital signs frequently after applying the sterile, moist dressing. The extensiveness of the protrusion is not important, it will need surgical repair regardless. Click again to see term 👆. Tap again to see term 👆.
