Consequences of Bad Choices - page 10

I was recently involved in a multidisciplinary team evaluation of a patient who attempted suicide by placing a shotgun in his mouth. He survived the attempt but was left with only half a face. I... Read More

  1. by   hbscott
    Quote from shezza
    It seems to me that if we are going to worry about confidentiality to the degree whereas we don't post case scenarios, how do we learn? I have no idea where this case came from and do not want to know, but I found the case very interesting. We're told that in case studies, we should not give any indication of the patients name, address, or any personal details at all, but we really can't worry about confidentiality to the degree that we are constained from asking advice, or seeking guidance. Anyway, what happened? Shezza
    The Rest of the Story

    Now that I got everybody thinking it is time to reveal the rest of the story. I consulted on this case a little farther back than what most people thought. In fact this patient has been treated and released. He has a new face and a 2nd chance at life.

    While the patient was unconscious the wife was allowed monitored visits and when the patient was fully alert and oriented he chose to meet with his wife in an area off the hospital floor he was staying. His wife would bring him things from time to time but one day she just stopped coming by. The patient soon discovered that his joint checking and savings account had been emptied and his soon to be ex-wife had run off with her girlfriend.

    I wanted to present this "case study" as an example to some of our students on the practice dilemmas they will sometimes face in their various working environments. This case study is currently being published in several journals. I thought I would share it with our audience since nursing care was an essential component of his recovery.

    The wife was consulted but remained distant to the care team. In my opinion mutual trust was never established with the wife and that prevented any progress for providing care and treatment to her if so indicated.

    -HBS
  2. by   bricur
    I know in school they always tell students that discussing pt's is a no-no. Like the one where two RN were working out in a gym 40 miles away and a family member of the pt beig discussed is on the exercise machine next door. The person posting the thread ID's his location, DC. So if one was to look at the letter of the law... busted. I agree there needs to be a vehicle to discuss stuff like this and learn from it.

    Now to discuss the case. Social services might have gotten a conservator appointed for just the reason to prevent what the wife did, it might have prevented her actions.
  3. by   hbscott
    Very nice input but keep in mind my location ID does not "bust" me in any way. It is always amazing to me how many amateur lawyers we have in our midst but nonetheless this case study was:

    * Sanitized of all patient demographics
    * The patient signed an informed consent form consenting to publication
    * My current location does not correlate with where the care was given
    * All data was presented to invoke critical thinking on how gender bias can effect care

    You really should be more careful about false assumptions. They can lead to bad outcomes.

    That being said the issue of appointing a conservator was never raised. I don't know of any specific case law that would allow that in this specific circumstance but it would be interesting to look up.

    Thanks again for your response. It is important.

    -HBS
    Last edit by hbscott on Mar 31, '04
  4. by   Keysnurse2008
    I would err on the side of caution and monitor the visits bc the patient meets the criteria for 1:1 care aeb he is a danger to himself.The pts wife may well be a contributing factor to his attempt.Until it is PROVEN that she is not then Id have a 1;1 with him at all times during every visit and just at all times until he is d/c to a psych hospital for a fulll eval.Pt safety!!!!

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