Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

Review literature for moral/ethical issues encountered by a PMHNP.

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Select one of the articles you found that was published within the last 5 years to use as a focus for this assignment.

Summarize the moral/ethical issue in the article (no more than 1 paragraph). Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

Describe the moral and ethical dilemmas surrounding the issue.

Analyze the ethical issue and compare them to the state health laws and regulations in your state.

Outline the process of ethical decision making you would use to address this ethical dilemma.

Ethical and Moral Issues Faced by the Psychiatric-Mental Health Nurse Practitioner (PMHNP): Ethical Decision Making


Introduction and Summary of Ethical Issue

The psychiatric-mental health nurse practitioner (PMHNP) as a mental health clinician is often faced with situations that pose ethical dilemmas in the line of duty. One of the most common situations for the PMHNP is the use of coercion to subdue mentally ill patients and provide them with interventions. Hem et al. (2018) carried out a systematic review of 22 studies examining this subject. Coercion may involve using mechanical restraints, seclusion, and using medications that calms or modifies hostile behavior (Andersen & Nielsen, 2016; California Hospital Association, n.d.; Hem et al., 2018). The moral and ethical dilemma facing the PMHNP is that of the greatest benefit to the patient (beneficence), not causing the patient harm (nonmaleficence), and respecting the patient’s autonomy as justice is done (Hem et al., 2018). Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

Analysis of the Ethical Issue and Comparison with California State Laws and Regulations  

Many authors and authorities agree that the practice of coercion in psychiatry and mental health practice is a controversial and emotive subject. This is because it does not affect only the patient emotionally, but also the PMHNP who has to resort to it. Most of the time it is also related to forced admission, with some patients interviewed recounting bad treatment memories and psychological trauma (Anderson & Nielsen, 2016; Hem et al., 2018; Verbeke et al., 2019). The argument by proponents, however, is that coercion is justifiable as it is done for the sole benefit of the patient who needs treatment and might hurt either himself or the medical staff. Although on the face of it the practice appears to violate t ethical principle of autonomy, it promotes the principle of beneficence and does not strictly qualify as maleficence (causing harm to the psychiatric patient). However, it is not to be denied that a delicate balance has to be found between beneficence and maleficence (Hem et al., 2018).

California state law is very restrictive on the use of coercion in terms of restraint and seclusion. This law only applies to psychiatric-mental health patients admitted in mental health institutions. According to it, mental health patients have the right to be free of coercive actions including non-routine medication aimed at controlling behavior (California Hospital Association, n.d.). If it has to be done, the psychiatric patient has the right to be handled in a safe and right manner by all staff including the PMHNP. This California law provision on coercion of mental health patients is found in sections 1180.1 through to 1180.4 of the Health and Safety Code (California Hospital Association, n.d.). Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

Process of Ethical Decision Making that Could be Used in this Scenario

            Ethical decision-making involves the choice of the best alternative amongst several available (Regents of the University of California, 2016). This choice must be largely in agreement with the ethical principles of beneficence (doing good to the patient), nonmaleficence (not causing him any harm), autonomy (respecting his wishes), and justice. Additionally and in this case, the PMHNP must show a desire to do good (must be committed), must be concious of the implications of the ethical dilemma, and above all must be competent (Regents of the University of California, 2016). The act of ethical decision-making requires careful critical thought before acting (Valey et al., 2015). In this particular case, the PMHNP should first weigh the benefits the patient stands to gain and compare them with the harm he may be caused. The decision to use coercion should then only be taken if there is overwhelming consensus among the psychiatric team that benefits are far more. Also, mitigating factors must be clear and obvious given the fact that federal and state law largely prohibit this practice.    Assignment: Practicum Journal Entry: Analyzing an Ethical Decision


Andersen, K., & Nielsen, B. (2016). Coercion in psychiatry: The importance of extramural factors. Nordic Journal of Psychiatry, doi: 10.1080/08039488.2016.1190401

California Hospital Association (n.d.). Restraint and seclusion. Retrieved from

Hem, M.H., Gjerberg, E., Husum, T.L., & Pedersen, R. (2018). Ethical challenges when using coercion in mental healthcare: A systematic literature review. Nursing Ethics, 25(1), 92-110. Doi: 10.1177/0969733016629770

Regents of the University of California (2016). Making ethical decisions: Process. Retrieved from

Valey, T.V., Hartmann, D., Fuqua, W., Evans, A., Ing, A.D., Meyer, A…. & Walmsley, C. (2015). The process of ethical decision-making: Experts vs novices. Journal of Academic Ethics, 13, 45-60. Doi: 10.1007/s10805-014-9223-1

Verbeke, E., Vanheule, S., Cauwe, J., Truijens, F., & Froyen, B. (2019). Coercion and power in psychiatry: A qualitative study with ex-patients.  Social Science & Medicine, 223, 89-96. Doi: 10.1016/j.socscimed.2019.01.031

Assignment: Practicum Journal Entry: Analyzing an Ethical Decision

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