Ethical Dilemma...Need viewpoints please...

shay · May 27, 2002

Okay, I am talking to my mom as I write this....she's a marriage and family therapist who specializes in juvenile sex offenders and their victims, so she kinda knows what she's talking about.

She says that if the woman is 18, legally, you have no recourse. You can definitely be charged with breach of confidentiality if you say anything, as the woman is an adult and has not asked you for help.

She suggests you try talking to the woman privately, mentioning to her (especially if the baby is female) that incest is usually perpetuated within a family, and if not for her sake than for her BABY'S sake she should report the man. Her CHILD is at risk. She said to try to approach the woman from the 'baby' point of view, i.e., being able to protect her young.

Other than that, unfortunately, there is nothing you can do from a legal/ethical standpoint. Your hands are tied, I am sorry to say.

I pray for you and your patient.

l.rae · May 27, 2002

shay is right..... we as nurses are often burdened with information that we can't do anything about. i work in the er and i've heard my share of confessions, but this one is probably the worst. i also am a sexual assault nurse examiner and i can tell you that a victim as young as 14 years old has a right to privacy......you can't even tell their parents without their consent. sometimes it is just a no win situation. lr

jevans · May 27, 2002

We can only support you and give you sympathy

what a predicament!!!!!!!!!!!!!

Whilst you have been put in this situation if the patient is 18 there's nothing you can do! UNLESS you have a counsellor on you unit. Then you can mention that you have a patient with a problem but do not say what it is. Then let them do their job.

Was once in a simular predicament but with a 16yo overdose, father had raped her

This child however was GILLICK competent and wouldn't let me tell the doc's

But in the UK anyone who has OD must have a psych review. I told them there was more than meets the eye

Psych later informed me that eventually she told them after several months of councelling and that this was the only way I could have legally acted

hope that this helps

j

mother/babyRN, RN · May 27, 2002

Thanks everyone. I have to say this has been a difficult situation for me not only because of the episode related to me by this patient, but also due to the manner in which she chose to convey it. Seemed so manipulative to me. It enabled her to "get it off her chest" ( I KNOW it really isn't), and still maintain confidentiality.

Now some of the burden is on me and I was surprised that I was kind of angered by that. All that aside, perhaps the best lesson to learn beyond the fact that events in nursing are often beyond the control or intervention of we nurses, but newer grads and people still in school should see from this experience and those like them, that it takes a lot to disinguish between our own values and judgements, and those we impose on the patient.

This patient is in her early twenties and I question her judgement to bring her child back into the situation, male or female. It is her child that most concerns me. She has made her position clear with regard to herself.

I did attempt to approach her from the standpoint of the child. She didn't want to talk to me so I made a comment that I would respect her privacy, included our unit number and my particular shift on her discharge papers and mentioned that should she need to discuss what was happening or what happened, I would be available to speak with her or listen, but that if she related an element of danger to either her or her child, I would not be able to promise further silence....What a dilemma! Thanks for your support and prayers but SHE is the one who needs them!

Mary Dover · May 27, 2002

Your anger at her placing some of the burden on you, likely arises from your sense of helplessness. As nurses, our primary instinct is to HELP, and it sure does SUCK when we can't. But you know what, you have helped her. YOU LISTENED!! Sometimes that's all people want. Take care and God bless you.

mother/babyRN, RN · May 27, 2002

Mary, I think you are right about my anger stemming from the sense of helplessness. I was ashamed that I felt that way. Thankyou for reminding me that we can't save everyone and that sometimes all we CAN do is listen. I thought your quote from John Adams says it all.....God Bless to all of you too!

Dayray, RN · Jun 1, 2002

That's just terrible =(

I don't know what I would do in that situation but I did have similar experiences when I worked as a C.N.A. I'm one of those people that others feel they can tell anything and that's not always a good thing.

Once I had a young woman tell me her boyfriend was beating her up but that it wasn't to bad and she wasn't worried about it. It was almost hard for me to believe her at first because she didn't even look sad when she told me. After talking to her for a while I realized she was telling the truth and that she was just emotionally numb (probably a coping mechanism). So anyway, she too insisted that I not tell anyone and that it wasn't a big deal. I went home that night and read all I could about abuse looking for something I could do but of course I found out the same thing you did, you cant do anything unless the patient asks you too. The next day I went to work I didn't bring up the subject of abuse with the patient but the following day, I brought her some Xerox copes of my textbooks. The information I brought her was mostly about how to recognize an abused woman, like profiles and stuff. After she read the info she asked me what kind of things could be done for abused women. After a talking with her for a while I asked her if she could relate to any of the women in the profiles and she said yes then started to cry. To make an already long story a little shorter she let me call in the social worker who got a her a referral to a safe house for abused women (and from what I hear) she was eventually placed in something like witness protection. It turned out that the boyfriend was really sadistic and did awful things to that poor girl.

In my situation what she really needed was a reality check. I think people who go threw terrible things try to cope by telling them selves "it isn't so bad". For my patient all she needed was to see that the things she was going threw were in fact "not okay or not normal".

Unfortunately we don't usually have time to get to know that patient well enough to figure out what they need to get them to where they will do something about the abuse.

I am so sorry that happened to you mother/babyRN and I don't think there was anything you could have done to make it better it just stinks (

micro, RN · Jun 1, 2002

mother/baby rn......

anger is not a wrong feeling.......

and you seem to be controlling it well

wow, what anger and strife........that that poor women must be living and will live...........

micro and out

live4today, RN · Jun 2, 2002

Unfortunately, the patient was probably abused as a child herself which emotionally disabled her to confront the alleged incest against her by 'father in law' -- IF that's what really happened. If her father in law did such a thing to her, why was she staying with her husband's parents during his absence instead of her parents or someone else? Why did she choose to carry that baby to term? Why didn't she call the police and have him arrested? Did she tell her husband, and why not? She apparently doesn't see what she said as being detrimental to her baby - be it truth or fiction. For a young expectant mother to share something like that with you in an outburst of tears, that was a cry that she herself needed counseling to prevent potential abuse of her unborn child -- by her or a relative. Incest begats incest in many cases, but not in all cases. I guess I would have let the patient know that information like that could not be kept confidential since her baby was about to be born due to the nurse's right to report information that may send that baby home into a dangerous sexually abusive environment. I would not have stayed quiet, but would have spoken to one of the hospital social workers regarding that case to see what they were allowed to do to protect the baby she would be discharged with.

Whether the patient was telling the truth or not is here nor there. The 'key' element here is when a patient talks like that, especially about her baby, radar is going off loud and clear that she is a woman who needs professional help mentally and emotionally. You may not have been able to do anything for the woman since she was over 18, but the baby was a patient too AND a minor at that who is quite defenseless against attacks being made on its little body. That's where the nurse comes in.

It's not too late to help that woman if you feel the need to discuss it further with a social worker on staff, or at least alert her doctor to what she told you so he can be on the watch for any abuse with the baby, or further mental instability with the mother. My gut feeling is telling me that there's a BIG RAT stinkin' somewhere in that story, and the littlest patient is the REAL patient at risk here. It's a catch 22 situation - you help the mother to help the child. Just my take on this, that's all. You did the best you could do with what you knew how to do at the time, but it is still not too late to help that innocent baby. :)

mother/babyRN, RN · Jun 3, 2002

The patient was a "young" twenty something person who felt helpless away from her family. I don't know much beyond that as she didn't choose to share anything more than what I related here. Who knows? I can only pray that things work out well for her. The rest is up to her...DayRay, thankyou for your significant ideas and relating that very special story. I can see why YOU will be and I imagine, already are, a very special nurse...Thank you all but don't worry about me. I was horrified at my own reaction . This patient is the one who needs our sympathy and concern...