Ethics, Legal Issues, and Interprofessional Collaboration
Ethics, law, and working with others
Ethical practice rests on autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity. Informed consent requires capacity, adequate information, voluntariness, and understanding, documented through teach-back. Capacity is decision-specific and clinical; competence is legal. Confidentiality is a duty with limited exceptions - risk of serious harm, child or elder abuse, court orders, and necessary care - and must be explained in advance. Duty to protect may require warning or protective steps when an identifiable person is at serious risk, under applicable law and with team and legal consultation; it is not a blanket rule for every angry statement.
Involuntary commitment requires statutory criteria, usually mental disorder plus risk to self or others or grave deterioration, and the least restrictive alternative. Restraint and seclusion require imminent risk, orders, monitoring, documentation, debriefing, and notification per policy. Advocacy includes challenging stigma, protecting privacy, supporting appeals, and ensuring language access. Mandatory reporting, documentation standards, and research ethics (consent, vulnerability, minimal risk) are examinable.
Interprofessional collaboration requires role clarity, respectful challenge, and structured communication such as SBAR. Nurses delegate within scope and escalate concerns through the chain of command. Conflict is resolved by focusing on the patient's interests, using evidence, and following policy; moral distress should be named and addressed, not silently absorbed.
Traps: confusing capacity with compliance or "insight"; assuming families automatically receive information; believing confidentiality is absolute; applying duty to warn to every threat; and accepting orders outside scope. Legal questions usually favor the least restrictive, most autonomy-preserving option consistent with safety.
Worked example. A client with capacity refuses a recommended antidepressant but agrees to therapy. Rule of thumb: capacity plus refusal equals respect, not abandonment - document the discussion, offer alternatives, ensure safety, and reassess.