Consequences of Bad Choices - page 3

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 earle58
    duly noted. but if the care team ultimately decides she will be hurtful, then on what grounds can you deny her access for visitation without being legally implicated?
    This is a legal question that I have been told comes under the hospices of prescriptive authority. I can't cite to you the legal precedent but I am told it is part of the care planning regiment until the patient is competent to decide for himself. I should do some homework on the legal basis and limits of prescriptive authority. Of course if anyone participating in this thread knows of such precedent or practice law it would be very kind of you to share that information.

    -HBS
  2. by   hbscott
    Quote from ktwlpn
    It might not fall exactly under HIPPA but when you post to a board like this,revealing where you are from in your profile and a link to your homepage that shows pictures of you and your family you sorta blew your anonimity,ya know? Anyone in your organization could be a member here....You have to be very careful-members have had problems at their places of employment from their participation on this board......
    True enough but this patient consultation is not in the geographical location you have referenced. And I am sure you have read many a professional and very public journal articles by well known practitioners citing case studies for professional review. This type of case study review is well precedented in law, the review of literature and practiced daily in our profession.

    -HBS
  3. by   Tweety
    The bottom line is that is her husband. She has the right to see her own husband. If the nurses feel she is interferring with his recovery it's one thing. But to deny a spouse the right to see their own spouse is probably wrong. I'm only taking the present situation under consideration, not the past. None of us would like it if we couldn't see our spouse.

    However, being the cynical person I am would be very suspect that she could be a black widow murderess.
  4. by   Spidey's mom
    Quote from TexasNS
    Personally I do think it is odd but I will try to present a different point of view. I think it is extreamly plausable that a woman could find three men that would eventually commit or attempt suicide. This of course would be on the extreme side of co-dependancy. What an awsome case to learn from though. Emotional abuse is very possible but I dont think there would be three that would go to that extreme. Maybe one but surely the others would just leave. But on the other hand for 1 woman to seek out "broken people" and try and be their healer (co-dependant) is very possible. Give the visitation monitered and see what can be learned about her personality.
    Texas . . your last point is just what I was thinking. There are women who seek out "broken people". Hey, look at all the women who respond to men in prison who have murdered people.

    I'm wondering though about the "monitoring" of her visits. If she hasn't been charged with anything, isn't this illegal? A violation of her rights? And actually his rights too?

    Can you just set up a system to spy on their visits? On your own without a court order? Or put a person in the room to spy? I don't think so.

    steph
  5. by   hbscott
    Quote from 3rdShiftGuy
    If the nurses feel she is interferring with his recovery it's one thing.
    That is the question that is the basis for this thread. A question that is being answered in many different ways...

    -HBS
  6. by   hbscott
    Quote from stevielynn
    I'm wondering though about the "monitoring" of her visits. If she hasn't been charged with anything, isn't this illegal? A violation of her rights? And actually his rights too? steph
    We have multiple issues that involve law, ethics, and duty. The duty to the patient is to do no harm until the patient is competent enough to decide for himself on the appropriate course of treatment and various care parameters that contribute to that goal.

    -HBS
  7. by   SmilingBluEyes
    Won't be touching this one.
  8. by   nekhismom
    what a complex issue! Perhaps visits could be limited to very short periods of time, say 15-30 minutes, with the nurse or someone just "stopping in" q few minutes just to make sure everything is ok. You know, empty trash, assess pain, etc, basically anything just to keep an eye on things. I would think that with the severity of the injury, the team could easily justify the limited visitation as a safety issue for the pt (infection control, maybe? or maybe self-concept related, since he is missing half his face??). The frequent check-in's could also be justified d/t the severity of injury, I would think. Now of course I haven't seen this pt, but I from what I have read, it sounds pretty complex. Hope you find a way to work this out!!
  9. by   Sheri257
    Quote from SmilingBluEyes
    Won't be touching this one.
    This post is strange. But then, this is a strange case and a strange thread.

    Will people somehow get in trouble by commenting on this? Is that what you're saying?
  10. by   hbscott
    Quote from nekhismom
    Hope you find a way to work this out!!
    My job is simple. I just have to rebuild the wound defect. The psychosocial issues are what makes this case complicated. The goal of course is to heal the patient and when he is competent let him participate in his care. Time will tell where this will lead and the ultimate outcome which preveals.

    -HBS
  11. by   leslie :-D
    Quote from lizz
    This post is strange. But then, this is a strange case and a strange thread.

    Will people somehow get in trouble by commenting on this? Is that what you're saying?
    i honestly don't understand the paranoia re: hippa regulations. this is an extremely edited (i.e., names,dates, places have been changed to protect....) case presentation. i find the thread fascinating and also appropriate. it seems that hbs is merely trying to elicit a variety of different perspectives since we as nurses, deal with this type of duties and ethical dilemmas everyday.
  12. by   hbscott
    Quote from earle58
    i honestly don't understand the paranoia re: hippa regulations. this is an extremely edited (i.e., names,dates, places have been changed to protect....) case presentation. i find the thread fascinating and also appropriate. it seems that hbs is merely trying to elicit a variety of different perspectives since we as nurses, deal with this type of duties and ethical dilemmas everyday.
    What we have here is the inner conflict created by the guiding and sometimes competing principles of ethics, law and duty. The responses you are seeing here in this thread are just a reflection of that. As you can see no one person will approach this "problem" in exactly the same way. Most people have an inner "paranoia" that keeps them out of trouble. We shouldn't fault people for that but at the same time we should have the courage to address difficult care problems such as the one presented here.

    -HBS
    Last edit by hbscott on Mar 15, '04
  13. by   Spidey's mom
    Quote from earle58
    i honestly don't understand the paranoia re: hippa regulations. this is an extremely edited (i.e., names,dates, places have been changed to protect....) case presentation. i find the thread fascinating and also appropriate. it seems that hbs is merely trying to elicit a variety of different perspectives since we as nurses, deal with this type of duties and ethical dilemmas everyday.
    I'm not sure what Deb is referring to . . .the privacy violations (HIPAA) or the question I raised about monitoring the wife's visits and if that is legal. Deb?

    steph

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