Consequences of Bad Choices

Nurses General Nursing

Published

  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

90 members have participated

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

choices.jpg

I think you may be able to allow the wife visitation but in a carefully controlled setting; either with a sitter or some sort of monitoring that she won't be cognizant of, like cameras in e-ICU's or certain psych rooms. I also find it extremely odd that she would find three such damaged men and these circumstances shouldn't be ignored. While our duty is to our patient first, I think our duty to the patient involves keeping him safe. You could probably allow her to visit but I certainly wouldn't leave her alone with him while he's so vulnerable.

I don't really believe in coincidences to this degree, and for this patient's sake I say she's guilty by suspicion until proven otherwise. It's like the moms with Munchausen by proxy thing going on with their children.

I, for one, would love to know how this turns out. Best of luck to this unfortunate soul. How lucky he is that you have such a cool job!

Specializes in LTC,Hospice/palliative care,acute care.
I can understand and appreciate the concerns about privacy violations in accordance with the Privacy Act of 1974 and more recent and ever evolving HIPAA legislation. That being said I can assure you there are no HIPAA violations here in this post so far. If you need to do some research on just exactly what constitutes a HIPAA violation may I humbly suggest the following link:

http://www.hipaa.org/

But be warned, it is a very long read....

-HBS

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......
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

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

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

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.

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

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

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

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Won't be touching this one.

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!!

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?

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

+ Add a Comment