Consequences of Bad Choices

Nurses General Nursing

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  1. Of the following criteria what has the greatest influence in your nursing practice?

    • 41
      Ethical Considerations
    • 12
      Legal Considerations
    • 31
      Sense of Duty
    • 6
      Self Preservation

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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 was consulted as my department does advanced 3D imaging work to include prosthetic reconstruction of such profound defects.

As I was sitting in this team meeting a question was raised by a social worker on the visitation rights for his wife. The social worker reported that this woman had been married twice before and both previous husbands had successfully committed suicide. This was husband number 3 who had survived his suicide attempt and the wife wanted to visit her husband to "comfort" him.

The question raised to the care team was the wife a danger to her husband knowing the general history as outlined above. We were not privy to all the details but there was some suspicion that the patient's wife may have been a contributing factor to the suicide attempt. I was surprised to see that the care team had differing opinions on this matter that pretty much split down gender lines. I found this interesting.

The men on this particular care team felt that visitation for the wife should be carefully monitored until it could be determined that the wife was not a contributing factor to the patient's suicide attempt. The women on the care team felt that since she had not been arrested by law enforcement that the question was irrelevant. In fact one member stated that perhaps the only thing she is guilty of is making bad choices. It wasn't her fault that the men she chose to marry kept killing themselves.

Since this BB is a wonderful place to sample such diverse, well educated and experienced opinion I thought it would be an interesting case study to present.

Any thoughts?

-HBS

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CEO failed to cite the whole quote as noted below:

"My job is simple. I just have to reconstruct his face. The psychosocial elements of this case are truly challenging and unique in my experience. The behavioral health aspects of this patient care scenario are going to be interesting to say the least."

This statement was nothing more than acknowledging the fact that behavioral health dynamics can be much more difficult to treat than other patient care interventions including mine in advanced 3D imaging.

-HBS

Thank you lgflamini for your astute observations.

:)

Thanks for posting tha thread HBS!! It livened up a couple of lunches around here!! We felt that "monitored" visits would be OK. Wife needs serious help!!

As to the facial reconstruction -- as a patient who has had major reconstruction for genetic jaw misalignments -- you should feel like your job is tremendously improtant!!! Thank God for people like you who help people like me get their face back!!! I have always been intensly grateful to the Dr.s and nurses who helped me!! They always said they were not "giving me a 'new me' but letting the real me out!!"" What a gift!!!

Thanks again for the post -- and for sticking to it for sso long! Real interesting and thought provoking too!!

Thanks for posting tha thread HBS!! It livened up a couple of lunches around here!! We felt that "monitored" visits would be OK. Wife needs serious help!!

As to the facial reconstruction -- as a patient who has had major reconstruction for genetic jaw misalignments -- you should feel like your job is tremendously improtant!!! Thank God for people like you who help people like me get their face back!!! I have always been intensly grateful to the Dr.s and nurses who helped me!! They always said they were not "giving me a 'new me' but letting the real me out!!"" What a gift!!!

Thanks again for the post -- and for sticking to it for sso long! Real interesting and thought provoking too!!

Very nice words and thanks for the encouragement. I am also very glad to hear that the "real you" was enhanced by the various interventions of your health care team. I am so very glad to hear that things turned out well for you. Very happy indeed.

Warmly,

-HBS

:)

Interesting comments. I'm curious about the concerns that this could be a violation. How is this different from other situations that are posted on this board? Is it because the circumstances are so unusual it could lead to identification? I'm just a student and would like to learn more about the concerns posted here ...
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
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

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.

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

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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