Ethical Dilemma: What to do when I see a client outside of professional role?

[krg539]

Hi Everyone!

I'm writing a reflection paper regarding a recent situation. I'm doing a clinical rotation in a Community Mental Health setting. One of my client's just admitted he has an alcohol abuse problem (which I already knew about). He agreed to attend AA and try to stop drinking. However, I was at the liquor store one evening I saw him purchasing beer. He is also in a bit of a financial strain, which was another motivation to quit drinking. He also often drives while intoxicated; thus I did not know if I should talk to him or not at the store. I did not confront him at this time but plan to have a discussion with him at our next appointment. I'm looking for research to either support my actions or refute them.

Thanks!

[CrunchRN, ADN, RN]

Just leave it. That is not your role as a student and an important thing to learn is how to separate work from your non-work life.

[krg539]

Thanks. I do understanding separating is important. However, I'm looking for scholarly sources to support my paper.

[Rose_Queen, BSN, MSN, RN]

Two topics:

HIPAA (you know this information because he is a patient)

boundary issues (you are not participating in the care of the patient outside of work hours)

[Horseshoe, BSN, RN]

When you write your paper, be sure to correct your use of the apostrophe in the phrase "one of my client's."

What sources have you already searched?

[caliotter3]

You also might try "Common Sense" as a scholarly source.

[ItsThatJenGirl, CNA]

Maybe it's because I'm not in nursing school yet, but I don't see how this is an ethical dilemma. It's more like a "learning how to behave like a professional" lesson, IMO.

If my health care provider saw me in public and mentioned later that he disapproved of what he had seen me do, he would no longer be my health care provider.

[Horseshoe, BSN, RN]

You also might try "Common Sense" as a scholarly source.

That generally doesn't cut it when writing papers for a class.

[cbstarkey]

HIPPA. I'm sure you can find an appropriate topic that wouldn't compromise your ethics or the privacy of your client(s).

[FolksBtrippin, BSN, RN]

Maybe it's because I'm not in nursing school yet, but I don't see how this is an ethical dilemma. It's more like a "learning how to behave like a professional" lesson, IMO.

If my health care provider saw me in public and mentioned later that he disapproved of what he had seen me do, he would no longer be my health care provider.

This is definitely an ethical dilemma. You would hopefully know that if you were in nursing school.

[FolksBtrippin, BSN, RN]

You need to decide whether you will focus your paper on an ethical question or ethical dilemma.

Ethical question

1. Is it appropriate to acknowledge the client in any way outside of the professional setting? If no, why not? If yes, under what circumstances? In this case your source is the HIPAA law. How does it apply or not apply?

Ethical dilemma

An ethical dilemma is when 2 ethical principles conflict with each other. Decide which 2 ethical principles from the ANA ethics conflict in this situation. Your source is the ANA published articles that apply.

FWIW, i think the second one is a more interesting topic and i think the first would be easier to write.

[la_chica_suerte85, BSN, RN]

He also often drives while intoxicated; thus I did not know if I should talk to him or not at the store. I did not confront him at this time but plan to have a discussion with him at our next appointment.

Maybe it's because I'm not in nursing school yet, but I don't see how this is an ethical dilemma. It's more like a "learning how to behave like a professional" lesson, IMO.

If my health care provider saw me in public and mentioned later that he disapproved of what he had seen me do, he would no longer be my health care provider.

The key part of the OP is that this person is known to drink and drive and they saw them at a moment when the person would be possibly intoxicated (and therefore had driven himself to and from the liquor store). The question is intervening based on knowledge that was gathered from interacting with this person in a clinical setting. That's the ethical dilemma. Either use the information you know to intervene with the person in a public and non-clinical setting (which can violate boundaries) or refrain from doing so (which, while maintaining professional boundaries may be failing to intervene in a situation that puts the client and the public at risk). The OP is choosing instead to use this information in a clinical setting which poses it's own problems. This is definitely an ethical dilemma.

To the OP, if you were this person's neighbor and knew that they had problems with alcohol, would you have as much of a problem approaching them in that situation? It doesn't have to be in a clinical manner -- you can simply say 'what's up?' and assess them from whatever you gather from a conversation that neighbors who happen to meet at the liquor store might have. If he was clearly intoxicated, you could, as a neighbor (a nosy neighbor, but still), escalate intervention and either offer a ride home or call 911 and report that he is driving drunk. As the clinician in the actual scenario, calling 911 would be the more reasonable option. It's similar to you seeing a patient, maybe with poorly controlled seizures you have cared for multiple times in the past, lying unconscious out on the street. As a nurse who takes care of this patient, you may be able to offer information about their status as appropriate and certainly you can provide emergency assistance and call 911. You could do these things regardless of the person being a frequent flyer to you hospital.

But, since we don't know that the person in question was actually intoxicated since you didn't approach and assess, there is only prior history data to go off of. And, there's not really any harm in calling 911 so that he would be stopped and checked out. It really becomes a public safety issue at that point.