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.
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.
There's nothing in the post to indicate that the patient was drunk, purchasing the beer for his own consumption, or was even driving a car (he could have been with a friend, or walked). There are too many unknowns, IMO. The only ethical dilemma I could possibly see is the provider stepping in unnecessarily and isolating the patient, undoing any progress that has been made towards getting him to attend his AA meetings and ceasing drinking.
Again though, I'm not a nursing student yet, so what do I know?
I think we are all missing the point here. I understand that everyone thinks they know the "right answer to this dilemma." Did anyone stop and think that all this is, is an assignment. Her instructor could have simply stated to her that she should come up with an ethical dilemma and to give examples of different approaches (right or wrong) and try to find scholarly sources to support each side.
I honestly can't even believe approaching him would be even considered. Would you approach one of your diabetic patients who is buying cake at the grocery store? I believe it's none of your business, ESPECIALLY if you are a just a student. He is coming to the clinic to get help and discuss options. That certainly doesn't mean he will never drink again. All this would do is cause excess shame and possibly more drinking. From a therapeutic approach, let him talk to you about how he is seeing his progress with his drinking and do not mention seeing him at the liquor store. Oh and by the way, 911 is for emergencies and she had no proof whatsoever that he was intoxicated. Spare yourself the improper use of 911 charge.
Oh and by the way, 911 is for emergencies and she had no proof whatsoever that he was intoxicated. Spare yourself the improper use of 911 charge.
I guess you've never known people who drink and drive like it's their birth right. If someone suspects another person they know has a history of drinking and driving is about to go drive somewhere under the influence, they can absolutely drop a dime on them and get them stopped and checked out. It is NOT improper use of 911 -- at least not in my state (and you can absolutely remain anonymous when making the call).
However, I was posing a hypothetical to the OP who had mentioned they knew the person had a history of drinking and driving and happened to see them in a situation that might point to that occurring again in the very near future. You'd be surprised how many people don't happen to make it much further past the exit of the liquor store and get behind the wheel -- only to fall asleep and be woken up by a LEO knocking loudly on the window, hoping they aren't dead. Ultimately, though, the OP didn't see any signs that would point to that situation but, had they approached them with a friendly acknowledgement, they may have gathered more information. Otherwise, since the OP didn't, it is what it is and, assuming the guy makes it back to the clinic intact and not having gotten hooked for a DUI, they shouldn't bring up seeing them in the liquor store either.
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Buyer beware, BSN
1,139 Posts
Horseshoe,
You are right about the apostrophe.
Right about the common sense issue when it comes to schlorship. (although the turn of phrase was humorous)
But somehow your remonstrations bring out the self-flagellating tendencies in those of us who wish to be perfect also.
But keep up the attention to detail as it does make most of us want to straighten up and fly right.