Consequences of Bad Choices - page 5

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   KMSRN
    I think the situation needs to be monitored. Whether she encouraged him to commit suicide or if she has "issues" that attract suicidal men, there is a problem. Family issues are the most difficult sometimes.
  2. by   hbscott
    Quote from earle58
    "allow" monitored visits? is there a choice? can anyone again, legally stop her without cause?
    Good question and from where I sit one that will be decided soon enough. It will be an interesting outcome I am sure.

    -HBS
  3. by   CCU NRS
    Quote from hbscott
    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
    This seems inplausible to me for instance if this person had stroked and was in a coma his wife would have full rights to be involved in planning care. So are you stating that the wife has lost her rights D/T the Pts incompetance? Second thought is to have Plice involved since attempted suicide is a crime you might (very long shot) get an Officer to stay with the Pt this would cover the monitored visits without invovling Hospital policy. I do not see how you can legally keep a spouse from visiting.
  4. by   CCU NRS
    Quote from hbscott
    Husband is not yet medically competent to render that decision.

    -HBS
    not medically competent or not communicationg?
  5. by   CCU NRS
    Kudos to HBS you run a very instructive and coherent thread I really enjoy your involvement and the way you continue to keep the ball rolling so to speak.
  6. by   Heather R.N.
    Reminds me of a case when I was a student doing my psych rotation. We had a patient who was in for depression and expressed desire to commit suicide. Before he went home, it was understand that the family gun was to be removed from the home. The wife had assured all that was involved in her husband's care that she would or had removed (long time ago) the gun. Anyway within 2 days of discharge this guy committed suicide with that very gun. From what I understood: 1. the wife forgot to remove the gun from the home 2. this was her second husband to have committed suicide. Kinda of creepy isn't it? Anyway my thoughts and prayers go out to this poor man. What a mess!!!!
  7. by   LauraF, RN
    I know two women in my distant family relations that had 2 husbands that committed suicide. I think it may be more common than anyone would have thought. Both cases they are related to me by marriage or divorce. But, one of the women does seem the overbearing type, the other one is just out there herself. What about an intensive education session for the spouse, knowing that she is going to have to deal with his emotions which will be at both ends of the spectrum I'm sure. Have the staff get to know her. Then go from there. I wish you and the team good luck in making the right decision and I hope for a pleasent outcome for this couple.
  8. by   irishrose53
    Quote from hbscott
    Since this case is so unusual I suspect you will be reading about it in many different professional journals in the months and years to come. There will be many interventions to include surgical and psychiatric that will be reported on for peer review.

    -HBS
    Ok. You guys are killing me. As a nursing student, I think I need to ask the question. What are the guidlines for asking advice here? If I can't ask this group of educated, experienced and proffessional people a question on a case who can I ask? If I leave out a name and make up a town, lie about the circumstances, and fudge anything else I can think of-will I be ok then? I have a best friend that happens to be a trauma nurse that I ask advice of ALL the time. She knows where I live. Alot of the stuff that happens in Chicago end up on the news. Could I somehow be setting myself up for trouble just by discussing it? Lord help me. I learn so much here. I never saw this format as a grave I coul;d be digging for myself. I try so hard to watch what comes out of my mouth-but I thought a case discussion would be ok here. Yes or no?
  9. by   Altra
    Thank you for posting this, HBS. A very thought-provoking case study for all.

    Several have pondered the issue of whether or how to restrict visits from the wife. As a student I don't know the circumstances under which visits could be disallowed, but surely they can be very limited -- a patient who had a close encounter with a gun to the face surely has had neurological trauma sufficient to warrant a low stimulation environment with very limited visits. And I'm just thinking off of the top of my head here, without the benefit of having done any coursework in psych nursing yet: when you have a suicide attempt, is it assumed that there is some problem in the family dynamic? What I'm thinking is ... a person who attempts suicide, even if family problems weren't the "cause", there is enough dysfunction in relationships that the patient didn't turn to family for help? Maybe I'm reaching with that one...?

    Also - does it stand out to anyone that the generally accepted wisdom is that men who attempt suicide are "successful" more often than women, partly because guns and other more lethal methods are used ... is it unusual that a man attempted suicide in what would seem to be a sure-fire manner - gun to the face/head, and survived? (I don't mean to sound insensitive)

    I've done my best to think about this intellectually ... however, in regard to the wife, my gut tells me that if it walks & quacks ... it's a duck. I suspect that she has some involvement - a passive-agressive kind of thing, if not overt encouragement.
  10. by   hbscott
    Quote from irishrose53
    Ok. You guys are killing me. As a nursing student, I think I need to ask the question. What are the guidlines for asking advice here? If I can't ask this group of educated, experienced and proffessional people a question on a case who can I ask? If I leave out a name and make up a town, lie about the circumstances, and fudge anything else I can think of-will I be ok then? I have a best friend that happens to be a trauma nurse that I ask advice of ALL the time. She knows where I live. Alot of the stuff that happens in Chicago end up on the news. Could I somehow be setting myself up for trouble just by discussing it? Lord help me. I learn so much here. I never saw this format as a grave I coul;d be digging for myself. I try so hard to watch what comes out of my mouth-but I thought a case discussion would be ok here. Yes or no?
    Case studies are okay to discuss as long as they have been "sanitized" of any identifying information. Case studies are an important tool to advance the body of knowledge and improve patient care outcomes in nursing.

    -HBS
  11. by   Tweety
    Quote from irishrose53
    If I can't ask this group of educated, experienced and proffessional people a question on a case who can I ask? If I leave out a name and make up a town, lie about the circumstances, and fudge anything else I can think of-will I be ok then?

    Yes you will be o.k. There are a lot of us who come in an say "I had a patient who................" and get very good advice.

    I don't think the op is in violation of hippa. However, someone familiar with the case and who can figure it out might make a stink. Trouble makers abound. Several people apparently have felt the sting of coworkers on this site.
  12. by   hbscott
    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.

    -HBS
  13. by   hitechlvn
    Excellent learning material. I am wondering how you can present such material that makes one's mind salivate and instantly people start with "HIPAA" or "Privacy violation" when this type of presentation is how we learn to do our jobs? I was wondering if any of the medical team sat down and conducted an in depth interview with the wife so they could better determine if she was a factor in the attempt or if she would be a negative factor in the rehabilitation of the patient?

close