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

choices.jpg

Specializes in Emergency & Trauma/Adult ICU.

Thank you for posting this, HBS. A very thought-provoking case study for all.

Several have pondered the issue of whether or how to restrict visits from the wife. As a student I don't know the circumstances under which visits could be disallowed, but surely they can be very limited -- a patient who had a close encounter with a gun to the face surely has had neurological trauma sufficient to warrant a low stimulation environment with very limited visits. And I'm just thinking off of the top of my head here, without the benefit of having done any coursework in psych nursing yet: when you have a suicide attempt, is it assumed that there is some problem in the family dynamic? What I'm thinking is ... a person who attempts suicide, even if family problems weren't the "cause", there is enough dysfunction in relationships that the patient didn't turn to family for help? Maybe I'm reaching with that one...?

Also - does it stand out to anyone that the generally accepted wisdom is that men who attempt suicide are "successful" more often than women, partly because guns and other more lethal methods are used ... is it unusual that a man attempted suicide in what would seem to be a sure-fire manner - gun to the face/head, and survived? (I don't mean to sound insensitive)

I've done my best to think about this intellectually ... however, in regard to the wife, my gut tells me that if it walks & quacks ... it's a duck. I suspect that she has some involvement - a passive-agressive kind of thing, if not overt encouragement.

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?

Case studies are okay to discuss as long as they have been "sanitized" of any identifying information. Case studies are an important tool to advance the body of knowledge and improve patient care outcomes in nursing.

-HBS

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

Yes you will be o.k. There are a lot of us who come in an say "I had a patient who................" and get very good advice.

I don't think the op is in violation of hippa. However, someone familiar with the case and who can figure it out might make a stink. Trouble makers abound. Several people apparently have felt the sting of coworkers on this site.

Now that I got everybody thinking it is time to reveal the rest of the story. I consulted on this case a little farther back than what most people thought. In fact this patient has been treated and released. He has a new face and a 2nd chance at life.

While the patient was unconscious the wife was allowed monitored visits and when the patient was fully alert and oriented he chose to meet with his wife in an area off the hospital floor he was staying. His wife would bring him things from time to time but one day she just stopped coming by. The patient soon discovered that his joint checking and savings account had been emptied and his soon to be ex-wife had run off with her girlfriend.

I wanted to present this "case study" as an example to some of our students on the practice dilemmas they will sometimes face in their various working environments. This case study is currently being published in several journals. I thought I would share it with our audience since nursing care was an essential component of his recovery.

-HBS

Excellent learning material. I am wondering how you can present such material that makes one's mind salivate and instantly people start with "HIPAA" or "Privacy violation" when this type of presentation is how we learn to do our jobs? I was wondering if any of the medical team sat down and conducted an in depth interview with the wife so they could better determine if she was a factor in the attempt or if she would be a negative factor in the rehabilitation of the patient?

Excellent learning material. I am wondering how you can present such material that makes one's mind salivate and instantly people start with "HIPAA" or "Privacy violation" when this type of presentation is how we learn to do our jobs? I was wondering if any of the medical team sat down and conducted an in depth interview with the wife so they could better determine if she was a factor in the attempt or if she would be a negative factor in the rehabilitation of the patient?

The wife was consulted but remained distant to the care team. In my opinion mutual trust was never established with the wife and that prevented any progress for providing care in that regard.

-HBS

Specializes in Critical Care.

Very interesting thread.

I been thinking about the different views on gender. If you had presented it as a case of a lady who had shot herself in the head and the husband had 2 previous wifes commit suicide I wonder how different our reactions would have been.

Noney

Very interesting thread.

I been thinking about the different views on gender. If you had presented it as a case of a lady who had shot herself in the head and the husband had 2 previous wifes commit suicide I wonder how different our reactions would have been.

Noney

As a former "male nurse" I can assure you there is more gender bias ingrained in our collective personalities than we care to admit.

-HBS

:wink2:

Specializes in ICU.

My thoughts were - how do we know for sure that the wife hass had tow previous husbands commit suicide - was this just rumour - how much fact was there? It would not be the first time that something said in an aside to a member of staff has been blown out of proportion.

On the other hand I was watching the first part of the Katherine Folbigg story - Austrlia's worst female serial killer. When I was reading this story I kept hearing the words of the policeman "We did not want to believe that it was the children's mother who had done this and we would have believed almost anything else." Katherine Folbigg killed 4 children before the police were almost accidentally involved. Sometimes there is no legal charge because the police are unaware of the "crime".

My thoughts were - how do we know for sure that the wife hass had tow previous husbands commit suicide - was this just rumour - how much fact was there? It would not be the first time that something said in an aside to a member of staff has been blown out of proportion.

On the other hand I was watching the first part of the Katherine Folbigg story - Austrlia's worst female serial killer. When I was reading this story I kept hearing the words of the policeman "We did not want to believe that it was the children's mother who had done this and we would have believed almost anything else." Katherine Folbigg killed 4 children before the police were almost accidentally involved. Sometimes there is no legal charge because the police are unaware of the "crime".

We received the report about the wife's marital history through social services in a multi-disciplinary care team meeting. I did not ask how she obtained the information.

-HBS

Specializes in ICU.

I don't doubt your veracity - it is just I have seen these sorts of rumours start before and they can have serious consequences.

I don't doubt your veracity - it is just I have seen these sorts of rumours start before and they can have serious consequences.

I didn't feel slighted at all. You raise a very legitimate question and as my response implied we acted on information provided by the social worker. How did we know the social worker had her facts straight? Good question!

-HBS

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