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

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

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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?

i honestly don't understand the paranoia re: hippa regulations. this is an extremely edited (i.e., names,dates, places have been changed to protect....) case presentation. i find the thread fascinating and also appropriate. it seems that hbs is merely trying to elicit a variety of different perspectives since we as nurses, deal with this type of duties and ethical dilemmas everyday.

i honestly don't understand the paranoia re: hippa regulations. this is an extremely edited (i.e., names,dates, places have been changed to protect....) case presentation. i find the thread fascinating and also appropriate. it seems that hbs is merely trying to elicit a variety of different perspectives since we as nurses, deal with this type of duties and ethical dilemmas everyday.

What we have here is the inner conflict created by the guiding and sometimes competing principles of ethics, law and duty. The responses you are seeing here in this thread are just a reflection of that. As you can see no one person will approach this "problem" in exactly the same way. Most people have an inner "paranoia" that keeps them out of trouble. We shouldn't fault people for that but at the same time we should have the courage to address difficult care problems such as the one presented here.

-HBS

i honestly don't understand the paranoia re: hippa regulations. this is an extremely edited (i.e., names,dates, places have been changed to protect....) case presentation. i find the thread fascinating and also appropriate. it seems that hbs is merely trying to elicit a variety of different perspectives since we as nurses, deal with this type of duties and ethical dilemmas everyday.

I'm not sure what Deb is referring to . . .the privacy violations (HIPAA) or the question I raised about monitoring the wife's visits and if that is legal. Deb?

steph

Specializes in Critical Care.

On another angle....

Has the wife been offered therapy? I would think anyone would deserve the offer rather it be the first time or the third..

Noney

I'm not sure what Deb is referring to . . .the privacy violations (HIPAA) or the question I raised about monitoring the wife's visits and if that is legal. Deb?

steph

There is no HIPPA violation. Anonymous case studies are presented in professional journals all the time.

In regards to the issue of legality concerning the wife's visitation the legal question (still not answered) is there a prescriptive duty for the incompetent patient to protect him from a potentially harmful spouse?

In regards to approving or disapproving such posts as these, that is your right as it is my right to raise such questions. One's approval or disapproval has a social consequence but is not in the realm of ethics, law and duty.

-HBS

I'm not sure what Deb is referring to . . .the privacy violations (HIPAA) or the question I raised about monitoring the wife's visits and if that is legal. Deb?

steph

That is a good question. I had to go back and read the post again due to the fact that after reading it and reading all the post I had it in my mind that the patient was on a mental health floor, which then you have every right to have monitored visitation. Now since I believe this is on a medical floor that does make one wonder. Personally I dont think you can legally stop the visitation or alter it on a case by case basis. I say alow the visitation and do what you can to "monitor" it legally.

On another angle....

Has the wife been offered therapy? I would think anyone would deserve the offer rather it be the first time or the third..

Noney

Good question and another idea not considered until now. Thank you.

-HBS

On another angle....

Has the wife been offered therapy? I would think anyone would deserve the offer rather it be the first time or the third..

Noney

Now that got my mind going...

We have another victim/patient that alot of us were not even considering. Lets say the woman is innocent. Could you imagine the trauma she is going through? This woman needs help as well.

That is a good question. I had to go back and read the post again due to the fact that after reading it and reading all the post I had it in my mind that the patient was on a mental health floor, which then you have every right to have monitored visitation. Now since I believe this is on a medical floor that does make one wonder. Personally I dont think you can legally stop the visitation or alter it on a case by case basis. I say alow the visitation and do what you can to "monitor" it legally.

Patients and other persons in our society are subjected to restrictions, confinement, and other regulated actions for many different reasons.

A patient who is not alert, oriented, and can not care for himself is deemed a ward of the institution charged with his care until he recovers or another entity assumes care and responsibility for that individual.

It would be helpful if someone could cite the case law and/or the principle of duty and ethics for opposing view points.

-HBS

I'll bite. It is highly unlikely that a woman would have 3 husbands attempting (or committing) suicide. Not impossible, but unlikely. Maybe she gets her kicks from talking men into committing suicide. Being abusive toward someone doesn't make them suicidal unless they have those leanings already IMHO. Maybe she is drawn to unstable men and pushes them over the edge. If that is true, she could be very damaging to a man who has a long road to heal physically, emotionally, and spiritually. Probably can't stop her from seeing him but I think the situation should definitely be monitored.

I'll bite. It is highly unlikely that a woman would have 3 husbands attempting (or committing) suicide. Not impossible, but unlikely. Maybe she gets her kicks from talking men into committing suicide. Being abusive toward someone doesn't make them suicidal unless they have those leanings already IMHO. Maybe she is drawn to unstable men and pushes them over the edge. If that is true, she could be very damaging to a man who has a long road to heal physically, emotionally, and spiritually. Probably can't stop her from seeing him but I think the situation should definitely be monitored.

If a visitor (spouse or not) is of potential harm to an incompetent patient the question remains what to do? The consensus seems to be allow monitored visits and then evaluate for further disposition?

Fair synopsis?

-HBS

I would have to agree with Texas. Ladies, especially those of us who are single, divorced, etc., how many times have we dated a person on a serious basis and then discover "Why is it that I seem to meet the same type of men? Do I have a sign on my forehead?" I know I am very guilty. Now, I have not had one to commit suicide but my ex husband did threaten a couple of times; he is with 3rd wife, probably doing the same thing.

I am not saying that this wife is innocent, however, co-dependency can mess your head up!

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.
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