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

-HBS

True. But are most anonymous case studies this unusual? How many cases of three husbands committing suicide -- all married to the same woman -- could there be? Not to mention, two of the husbands are dead and the other survives with half of his face missing. I wouldn't be surprized if there is only one case like this in the entire country. No matter how much you edit the other details, I guess I just don't understand how this can be completely anonymous. Or, maybe I'm just too paranoid and dumb to know the difference. ;)

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!

Interesting. I did say in the original post that on the care team opinions about the potential harm of the spouse was split down gender lines. After reading these posts I now better understand why. It seems that experience does color one's perspective.

-HBS

True. But are most anonymous case studies this unusual? How many cases of three husbands committing suicide -- all married to the same woman -- could there be? Not to mention, two of the husbands are dead and the other survives with half of his face missing. I wouldn't be surprized if there is only one case like this in the entire country. No matter how much you edit the other details, I guess I just don't understand how this can be completely anonymous. Or, maybe I'm just too paranoid and dumb to know the difference. ;)

Since this case is so unusual I suspect you will be reading about it in many different professional journals in the months and years to come. There will be many interventions to include surgical and psychiatric that will be reported on for peer review.

-HBS

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

"allow" monitored visits? is there a choice? can anyone again, legally stop her without cause?

I think the situation needs to be monitored. Whether she encouraged him to commit suicide or if she has "issues" that attract suicidal men, there is a problem. Family issues are the most difficult sometimes.

"allow" monitored visits? is there a choice? can anyone again, legally stop her without cause?

Good question and from where I sit one that will be decided soon enough. It will be an interesting outcome I am sure.

-HBS

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

This seems inplausible to me for instance if this person had stroked and was in a coma his wife would have full rights to be involved in planning care. So are you stating that the wife has lost her rights D/T the Pts incompetance? Second thought is to have Plice involved since attempted suicide is a crime you might (very long shot) get an Officer to stay with the Pt this would cover the monitored visits without invovling Hospital policy. I do not see how you can legally keep a spouse from visiting.

Husband is not yet medically competent to render that decision.

-HBS

not medically competent or not communicationg?

Kudos to HBS you run a very instructive and coherent thread I really enjoy your involvement and the way you continue to keep the ball rolling so to speak.

Reminds me of a case when I was a student doing my psych rotation. We had a patient who was in for depression and expressed desire to commit suicide. Before he went home, it was understand that the family gun was to be removed from the home. The wife had assured all that was involved in her husband's care that she would or had removed (long time ago) the gun. Anyway within 2 days of discharge this guy committed suicide with that very gun. From what I understood: 1. the wife forgot to remove the gun from the home 2. this was her second husband to have committed suicide. Kinda of creepy isn't it? Anyway my thoughts and prayers go out to this poor man. What a mess!!!!

Specializes in Pediatrics, Geriatrics, Call Center RN.

I know two women in my distant family relations that had 2 husbands that committed suicide. I think it may be more common than anyone would have thought. Both cases they are related to me by marriage or divorce. But, one of the women does seem the overbearing type, the other one is just out there herself. What about an intensive education session for the spouse, knowing that she is going to have to deal with his emotions which will be at both ends of the spectrum I'm sure. Have the staff get to know her. Then go from there. I wish you and the team good luck in making the right decision and I hope for a pleasent outcome for this couple.

Since this case is so unusual I suspect you will be reading about it in many different professional journals in the months and years to come. There will be many interventions to include surgical and psychiatric that will be reported on for peer review.

-HBS

Ok. You guys are killing me. As a nursing student, I think I need to ask the question. What are the guidlines for asking advice here? If I can't ask this group of educated, experienced and proffessional people a question on a case who can I ask? If I leave out a name and make up a town, lie about the circumstances, and fudge anything else I can think of-will I be ok then? I have a best friend that happens to be a trauma nurse that I ask advice of ALL the time. She knows where I live. Alot of the stuff that happens in Chicago end up on the news. Could I somehow be setting myself up for trouble just by discussing it? Lord help me. I learn so much here. I never saw this format as a grave I coul;d be digging for myself. I try so hard to watch what comes out of my mouth-but I thought a case discussion would be ok here. Yes or no?

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