But How Do You Know?

Antikigirl, ASN, RN · Jun 6, 2006

I would have a psych eval done right away, and also get the police and community services involved, as well as her PCP and the attending. I would also ask if she would like to have her husband NOT be able to visit her in the hospital or know her medical information!!!

I have seen this done with older pts and their family members have been abusive! This is what was done at the first word of abuse, and seems to work well most times. But it is also up to the pt to follow the rules (and that is typically when it goes south fast...if they don't stay away from the abuser!).

You can't know for certain, so you have to go for the worse case first as mandatory abuse reporters that we all are and let the system get involved. Check out your facility's policy on mandatory report of abuse (some differ).

Don't forget...we have to do this for children, and we have to do it for adults too!!!!!!

MIA-RN1, RN · Jun 6, 2006

I was taught in school that we are only mandated reporters for children. Its not the same requirement for adults, so if you were to call the police, it could be construed as a HIPAA violation.

leslie :-D · Jun 6, 2006

i don't think it's a hipaa violation when it's a 'need-to-know' incident.

i too, think a psyche eval w/proper follow-up is in order.

leslie

MIA-RN1, RN · Jun 6, 2006

i don't think it's a hipaa violation when it's a 'need-to-know' incident.
i too, think a psyche eval w/proper follow-up is in order.
leslie

Right if you had absolute proof you can call the police but with domestic violence we are not mandated reporters. I guess its one for the ethics committee. If a woman comes in beat up by her husband and chooses not to press charges, we can't do anything but try to convince her to change her mind.

I agree about the psych evaluation and maybe talking w/ the pt and giving her the phone numbers to call and maybe even sitting with her while she called but I really don't think we can call it in.

mandana · Jun 6, 2006

It was the most challenging aspect of my mental health rotation for me. There are those people who have a mental health diagnosis and after 10 minutes of talking to them, you can say to yourself, "Yep, they are ___________." Then there are those other folks who have a diagnosis, but are "sane" for all intents and purposes and while what they are telling you sounds a little bit (or a lot) paranoid, you really don't know. So in answer to "how do you know?" I'd say you really don't and you can do all you can to check out the facts. It might be interesting to meet the husband, if at all possible, and see if you get a feeling from him, one way or the other. At any rate, I think it's worth checking out more thoroughly before she's just dismissed.

Amanda

Meerkat · Jun 7, 2006

She's had the psych eval...remember, that consists of ten minutes, maybe fifteen with the psychiatrist. He says she is delusional.

As far as the report...we ARE mandated reporters for adults if the adult is disabled or cannot care for herself. I made a report. The lady is technically disabled (chronic pain and anxiety disorder). It is not a HIPPAA violation if the report is done 'in good faith'.

grinnurse, RN · Jun 7, 2006

I have always been taught that if you suspect abuse, regardless of child, adult (domestic violence etc.) or elder we have to report it to our social worker and then they will make any reccomendations as to how far it goes. I work in Texas so I don't know if it will vary from state to state. I would not however just blow her off b/c I think I have watched too many of those movies on Lifetime where the poisoning can be so subtle................. :lol2:

chadash · Jun 7, 2006

She may be mentally ill and delusional, AND be being abused by her husband. Even a hypochondriac gets sick, so to speak....

So I am with the posters who say they should check it out.

SilentfadesRPA · Jun 7, 2006

Wow that is scary -- esp with a friend who is stating this is true

I surely would make sure the hospital administration and hospital legal dept are aware of this -- this may come back to bite big time.

I feel sorry for the poor woman no matter what the situation is.

I have to disagree about reporting.

A woman of battering as horrible as that is does make a choice. However I do think that we are mandated reporters if we suspect that a crime is taking place and the victim is not able to report due to mental deficiet or alteration of mental status. It is not like she has a choice it sounds if she is on PCP ? If it is true great if it is not then the truth will be found out. But IMO, not able to advocate for themselves then we to report to adult protective services. I would hate to face an attorney or the BON or my own conscience if I Did not and the patient was murdered.

Marc

Meerkat · Jun 7, 2006

Thanks for all the responses....I am anxious to see what comes of my report!

Antikigirl, ASN, RN · Jun 7, 2006

In Oregon we are mandatory reporters for all abuse, however...the trick is WHO you tell and when. For me as an RN in my facility I am to let the charge nurse and the MD know of my findings, and they will formulate a plan of care with social services or order that the police be notified. This is discussed with the patient and a patient can decline. The RN getting the info fills out a report, documents fully in the nursing notes, and needs to be available for question by police PRN. If need be you can be asked to come to court as well as a witness. (that is why nursing note documentation is so very important...they use that to question you, and you need it to answer so good documentation is vital).

Like I said, you have to check your own facilty policies so you know what path to follow in these cases. If in doubt...I always call the MD :).