Legal Standards Of Care Research Articles

Teaching Psychotherapy to Psychiatric/Mental Health Nurse Practitioner Students in the Virtual Classroom

The aim of this quality improvement project was to evaluate student satisfaction and achievement of select core competencies in psychotherapy by Psychiatric Mental Health Nurse Practitioner (PMHNP) students enrolled in a newly developed, and virtually delivered psychotherapy course. Both qualitative and quantitative data were collected to assess students’ competencies in five domains (i.e. professionalism, cultural diversity, ethical/legal standards of care, reflective practices, and application of knowledge and skills) and satisfaction with content and delivery using simulation and virtual sessions. Using pre- and post-training surveys, we found that competencies in the five domains increased from an average score of 3.1 to 4.5. Integrating a virtual psychotherapy course in advanced nursing education, bringing PMHNP students together to learn about interviewing clients, applying various psychotherapeutic modalities and techniques across diverse cultures, and maintaining ethical and legal standards of care is a challenging but achievable endeavor. We found that using a version of an APA self-assessment tool that was used in psychiatric residency training programs was an effective way to assess PMHNP students’ knowledge, skills, and attitudes on these core competencies. Although this training course proved to be effective in imparting appropriate skills, there is a need to develop sophisticated methods to evaluate how students use complex psychotherapy skills in the clinical setting.

Capacity and consent: Knowledge and practice of legal and healthcare standards.

Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. This study explores healthcare practitioners' knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups invited via email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why 'duty of care' is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching.

Changes Across Three Editions of The Suicidal Patient: Clinical and Legal Standards of Care: Relevance to Counseling Centers

ABSTRACTTreating suicidality is one of the most challenging situations managed by college and university counseling centers. The first edition of Bongar’s (1991) The Suicidal Patient: Clinical and Legal Standards of Care, a compendium of empirical knowledge and clinical research regarding standard of care in the treatment of suicidality, was soon considered a valuable resource in the field. The volume was pivotal in the arena of clinical practice because, in addition to compiling state of the art information, it also positioned itself as a benchmark for determining whether standard of care has been met in treatment of suicidal people. Now in its third edition (Bongar & Sullivan, 2013), this resource continues to inform clinical practice. This article examines several noteworthy changes across the three editions of this seminal work. What has changed, possible trends suggested by the changes, and resulting implications of these changes are examined. Of particular importance are changes that represent significant developments in the field or make relatively new assertions of what constitutes sound practice. These trends, changes, and assertions regarding standard of care are discussed in terms of their relevance to the counseling center setting. In the third edition there are several instances in which Bongar and Sullivan (2013) clearly extended beyond reporting observations about clinical practice and arguably moved into the realm of attempting to set norms for standard of care. Even though these new assertions may essentially be the authors’ opinions, they may be treated as fact by regulators, expert witnesses, attorneys, and others in determining whether standard of care has been met in specific cases.

Treating Suicidality in College Counseling Centers: A Response to Polychronis

ABSTRACTThis is a commentary on the article by Paul D. Polychronis, “Changes Across Three Editions of The Suicidal Patient: Clinical and Legal Standards of Care: Relevance to Counseling Centers,” published in this issue of the Journal of College Student Psychotherapy.

Vehicle Automation, Legal Standards of Care, and Freeway Capacity

Automated-control technology for road vehicles is advancing rapidly, presenting novel challenges to transportation planners and policymakers. One such challenge is the possibility that the standard value of road network capacity (vehicles per lane per hour) may substantially change within the typical infrastructure-planning horizon of several decades from the present day. The study evaluates, in the context of freeway segments, the interaction between automated cars’ kinematic capabilities and the standard legal requirement for the operator of an automobile to not strike items that are in its path (known as the ‘Assured Clear Distance Ahead’ criterion). We then model ACDA-compliant operating strategies that are based on rationally-specified kinematic parameters, extending from earlier simulation studies in which controls on automated cars’ motion are defined arbitrarily. The specific contributions of this paper’s novel joint analysis of legal standards and engineering criteria comprise: 1) an in-depth assessment of the structural barriers to automated cars operating non-ACDA-compliant driving strategies, 2) a straightforward ACDA-compliant automated-driving model to estimate freeway ‘pipeline’ capacity analytically, placed in the context of comparable models of humans’ driving behavior, and 3) interpretation of quantitative findings which are based on a range of rationally-specified parameter values and explicitly account for kinematic uncertainty. Among other results, we demonstrate that automated cars pursuing ACDA-compliant driving strategies would have distinctive “fundamental diagrams” (relationships between speed and flow). Our results suggest that automated cars (under a baseline set of assumptions) may sustain higher flow rates at their free-flow speed than human drivers, however at higher traffic volumes the rate of degradation in speed due to congestion may be steeper for automated cars. ACDA-compliant automated cars also may have a higher level of maximum-achievable throughput (irrespective of speed) than human drivers, though the impact on maximum throughput at free-flow speed is ambiguous. We demonstrate that vertical grades (but not horizontal curves) are likely to have impacts on capacity that differ from when human are driving. We also present a novel quantification of the trade-off between freeway-capacity and various degrees of safety (one failure in 10,000 events, one failure in 100,000, etc.) that explicitly accounts for the irreducible uncertainty in emergency braking performance, by drawing on empirical distributions of braking distance testing. Finally, we assess the vulnerability of ACDA-compliant automated cars to lateral ‘cut-ins’ by vehicles making lane changes.The paper concludes with a brief discussion of policy questions and research needs.

Medical malpractice concerns and defensive medicine: a nationwide survey of breast pathologists.

"Assurance behaviors" in medical practice involve providing additional services of marginal or no medical value to avoid adverse outcomes, deter patients from filing malpractice claims, or ensure that legal standards of care were met. The extent to which concerns about medical malpractice influence assurance behaviors of pathologists interpreting breast specimens is unknown. Breast pathologists (n = 252) enrolled in a nationwide study completed an online survey of attitudes regarding malpractice and perceived alterations in interpretive behavior due to concerns of malpractice. Associations between pathologist characteristics and the impact of malpractice concerns on personal and colleagues' assurance behaviors were determined by χ(2) and logistic regression analysis. Most participants reported using one or more assurance behaviors due to concerns about medical malpractice for both their personal (88%) and colleagues' (88%) practices, including ordering additional stains, recommending additional surgical sampling, obtaining second reviews, or choosing the more severe diagnosis for borderline cases. Nervousness over breast pathology was positively associated with assurance behavior and remained statistically significant in a multivariable logistic regression model (odds ratio, 2.5; 95% confidence interval, 1.0-6.1; P = .043). Practicing US breast pathologists report exercising defensive medicine by using assurance behaviors due to malpractice concerns.

Promise and perils of digital psychiatry

Internet interventions and digital tools like cellular phones have tremendous potential to affect patient care positively; effects are rapidly expanding around the world, including in Asia (Aggarwal, 2012). However, in utilizing digital tools, such as text messaging or telepsychiatry, psychiatrists must be cognizant of the risks that their technology use may infringe on duties to maintain clinical, ethical, and legal standards of care. Because technologies, such as social media, are advancing at rates that may outpace professional or legal/ethical standards, it is difficult for clinicians to remain current with best practices; this difficulty affects many digital psychiatric tools, including text messaging, email, video chatting, social networking, websites, and blogs. This article aims to provide clinicians with information regarding potential pitfalls in technology usage, as well as to offer suggestions to ameliorate risk. Of course, nothing in this article should be construed as legal advice.

Chimerical Corporate Governance and Board Failure: A Modest Proposal to Eliminate the Traditional Role of the Board of Directors in Publicly Traded Corporations

The principal thesis of this paper is: the expectations for the role of the board of directors is based on historical conditions that no longer apply; those out-of-date expectations laid the foundation for legal standards of care that effectively render boards unaccountable to the shareholders; such that the combination of outdated expectations and relatively meaningless standards of care render the boards of directors of large, publicly traded corporations unnecessary and superfluous, beyond serving in a limited advisory capacity. To support this thesis, this paper first traces the historical development of corporations and the evolution of boards of directors and their legal standards of care to shed light on how modern laws and attitudes toward corporations and their boards developed. This paper then addresses the role of the board in the modern corporation, highlighting shortcomings and dysfunctions of boards of directors. The final part of this paper provides a foundation for the argument that, despite repeated calls for reform, the status quo of passive boards remains the norm, buttressing the argument there is no practical need for boards of directors in large publicly traded corporations, beyond merely an advisory role.

Public Health Emergencies and Legal Standards of Care

Public Health Emergencies and Legal Standards of Care

Book Review: The Suicidal Patient: Clinical and Legal Standards of Care, Nobody's Child: How Older Women Say Good-Bye to Their Mothers, Complicated Grieving and Bereavement: Understanding and Treating People Experiencing Loss, Health Care&Spirituality: Listening, Assessing, Caring

Book Review: The Suicidal Patient: Clinical and Legal Standards of Care, Nobody's Child: How Older Women Say Good-Bye to Their Mothers, Complicated Grieving and Bereavement: Understanding and Treating People Experiencing Loss, Health Care&Spirituality: Listening, Assessing, Caring

The Suicidal Patient: Clinical and Legal Standards of Care, 2nd ed.

The Suicidal Patient: Clinical and Legal Standards of Care, 2nd ed.

Inpatient standards of care and the suicidal patient. Part II: An integration with clinical risk management.

The authors elaborate on the standards of care for the assessment, management, and treatment of hospitalized suicidal patients. The authors attempt to synthesize the concepts of the minimal standard of care with clinical risk management and clinical judgment. They point out the areas of overlap and where optimum care diverges from legal standards of care. Case examples are provided to illustrate major areas of concern. Alleged failures of omission and commission are discussed. Tables are provided that differentiate duties and responsibilities between and among clinicians, hospital staff, and hospital administration.

The Suicidal Patient: Clinical and Legal Standards of Care

The Suicidal Patient: Clinical and Legal Standards of Care

The Suicidal Patient: Clinical and Legal Standards of Care—by Bruce Bongar; Washington, D.C., American Psychological Association, 1991, 311 pages, $40

<b>The Suicidal Patient: Clinical and Legal Standards of Care</b>—by Bruce Bongar; Washington, D.C., American Psychological Association, 1991, 311 pages, $40

Book Review The Suicidal Patient: Clinical and legal standards of care By Bruce Bongar. 311 pp. Washington, D.C., American Psychological Association, 1991. $40.

Book Review The Suicidal Patient: Clinical and legal standards of care By Bruce Bongar. 311 pp. Washington, D.C., American Psychological Association, 1991. $40.