To set something straight

[newtress, LPN]

Hello all, I am a first year nursing student. I thought perhaps it was possible that the home health nurses here could help me with this subject or at least back me up on my knowledge. I got into a terrible verbal confrontation with the boyfriend last night defending what I knew regarding nurses duties, scope of practice, obligation and ethics. I felt I could at least start here at the home health nurse forum first and then maybe hospice, but this applies to all in nursing.

I have a life long friend who I spoke with last night. She informed me that her brother, who I've also known over ten years, was just diagnosed with cirrhosis of the liver due to his severe alcoholism. This young man is somewhat mentally challenged, works, owns a home and recently married a woman who is also mentally challenged and a full blown alcoholic. I mean severe consumption of alcohol by both. He ends up at the ED very very sick, liver labs blown off the charts. Two doctors and his own tell him he must cease drinking immediately. They of course do not know the patients personal living conditions which have turned into very substandard unhealthy living conditions. No refridgerator as they don't get it fixed, no foods, not a space for water to run in a full dirty sink for months etc. He has a good job with very good health insurance. But we fear that because this couple is still actively hitting the whiskey very hard that he will go into a chrisis, hospitalization and then back to the house with co-alcoholic. In the event that he will choose to not further treatment in a hospital setting and stays at the house with home health or end stage with hospice coming in, here is what I'd like to hear from the nurses.

A validation that as nurses we have a responsibility to adhere to ethics to protect the patient. To report neglect and abuse or even suspected N/A. I told him that if a HH nurse or hospice nurse comes into the home and finds the deplorible conditions and a caregiver who can not care for her husband at all because she is consistantly intoxicated, giving him straight liqour to keep her drinking buddy, and is abusing and neglecting that she (nurse) would document and report to proper supervisors. My boyfriend blew up yelling at me that a nurse has no right at all to tell anyone these conditions because the patient and his wife are adults and can live any way they want. That it is not a duty or responsibility to report or say anything about what she finds while doing the visit at the home. To just go in, do your job, keep your mouth shut and leave the home. He told me to get real with it, that I don't know what the **** I'm talking about. I saw all my med law and ethics classes and books flash through my mind and wanted to throw them at him. How disrespectful to say that to me, and try to eliminate the HH and hospice nurses as not being a profession. Would like to hear a response from nurses who know exactly what I have been taught, to set it straight with validation. I very highly appreciate and value your knowledge and expertise on this subject.

[nservice]

Your boyfriend is wrong. Yes, these are adults, but there is self abuse too. It is our duty to report a situation like this to APS. I'm not saying that anything will be done about the situation, but the nurse should report.

[cisco]

In home health you can also refer your social worker to go in and do an assessment...I would first refer to social services and then back the call made into APS. Also, I would notify the primary care physician of the facts and document everything. I'm not sure how AA works, if they would come in and try an intervention if a call was made into them?! If both these adults being mentally challenged, do they have case workers? If they do, perhaps a call to the state agency case workers could help?! I had one case where the patient was passed out and I found a bottle of pills spilled by an empty bottle of booze. I called 911 and it was reported to the police as an attempted suicide based on the facts. The police came out with EMS, took report from me. Based on all these facts the client was taken into the hospital, a pysch consult and detox rehab were ordered for the patient. Of course when he sobered up, he refused and continued on his unhappy way and ended up going to ER again, being placed in long term care where he died two weeks later. It's nursings job to assess, assist, report, treat, educate and document. By the way, it's none of my business, however, your boyfriend sounds abusive to me, not treating you with the respect that you deserve. Please take good care of yourself, abuse nevers gets better, it only gets worse. Best wishes and have a blessed Easter.

[CapeCodMermaid, RN]

If you are a nurse involved in taking care of that patient, you are obligated to report the conditions the person is living in and anything that could be construed as abuse.

It hardly matters if they are both adults. If the husband was physically abusing the wife would you do nothing because they are adults?

PS. I agree with the previous poster about your boyfriend. He sounds abusive from what you said. Maybe that's why he is so against anyone reporting anything.

[newtress, LPN]

Thank you so much for the informative responses. I know I am on the right track in my thinking and rationale. That will never change. So far the most difficult time I've been having getting through my program is the boyfriend as you accurately guessed, has gotten more abusive since I started school. The same person who pushed 100% for me to go to nursing school and professed it is one of the best professions a woman can have. And now that a very sad and serious medical condition has been diagnosed on our beloved friend, he thinks I am throwing inaccurate, too far to be fetched untruths about what a nurse can and is capable of doing for a patient in their own home. He also doesn't think a PCP can be notified of the patients decline due to alcohol consumption or a caregiver/wife who can't see straight 90% of the time. This person has zero medical background or knowledge. In the heat of the argument I told him perhaps he needed to speak to some nurses who's specialty is home health or hospice. He will not take any information from me as the truth. Because to do so would mean him acknowledging that I am smart and only getting smarter. He must be getting angry with me that I am actually starting to sound and act like a nurse. Sad isn't it?

[Cattitude]

Thank you so much for the informative responses. I know I am on the right track in my thinking and rationale. That will never change. So far the most difficult time I've been having getting through my program is the boyfriend as you accurately guessed, has gotten more abusive since I started school. The same person who pushed 100% for me to go to nursing school and professed it is one of the best professions a woman can have. And now that a very sad and serious medical condition has been diagnosed on our beloved friend, he thinks I am throwing inaccurate, too far to be fetched untruths about what a nurse can and is capable of doing for a patient in their own home. He also doesn't think a PCP can be notified of the patients decline due to alcohol consumption or a caregiver/wife who can't see straight 90% of the time. This person has zero medical background or knowledge. In the heat of the argument I told him perhaps he needed to speak to some nurses who's specialty is home health or hospice. He will not take any information from me as the truth. Because to do so would mean him acknowledging that I am smart and only getting smarter. He must be getting angry with me that I am actually starting to sound and act like a nurse. Sad isn't it?

You also need to check your states nurse practice act. Adult protection is quite different than child protection. In my state, nurses are mandated reporters for CHILD abuse only. Sure for adult abuse, we definitely SHOULD call APS but I'll tell you right now, in the situation you just described, they will probably not do a thing.

APS has less staff than CPS. And for the poster that said something about having AA come in. they don't do that. AA is voluntary and you must always go to a meeting. Its members are anonymous and unless they are already connected to an AA group and have phone numbers, there really isn't anyone for them to call. The 800 # would direct them to a local meeting.

The bottom line is with addiction/alcoholism, the addict is not going to get help until they want it.

Your BF sounds a lot like my EX-husband. Please take care of yourself and know that you are smart and worthy of so much more.

[cisco]

newtress, your boyfriend sounds like my exhusband who was with me while I was going through nursing school. He became so threatened of my new knowledge and capabilities that he actually tried to burn some of my expensive school books. He even tried to hide my homework assignments and notes from me. I had to out think him and protect all my paperwork/books until I graduated. He never learned to treat me equally, nicely, lovingly or with respect. I left him less than 6 months after I graduated and have never looked back. Abusive men want to control their women by intimidation, ridicule, threats among other measures always at the womans' expense. Again, please take good care of yourself. When our self-esteem as women becomes beautifully strong, no man can ever abuse us because we would never allow it. Stay strong and beautiful!!!

[Kymmi]

Cisco----excellent post and advice for any person!! I hear and read alot about people in abusive relationships and I often wonder why anyone would tolerate such abuse and it infuriates me but then I also realize that alot of times it does have to do with control, money issues, co-dependency and the list goes on and on but unless whoever is in the abusive situation develops self esteem the abuser will always have the upper hand because they thrive on continuing to degrade in order to make them feel superior. I also know that it isnt always women being abused however thats what we hear about most but I believe there are alot of men that are taking abuse from controlling women but we dont hear about it as much because men do not talk about it as freely as women do.

To anyone that feels they've lost their self esteem and is in a abusive relationship the best thing that you can do is get professional help. You will not overcome the abuser on your own because they know exactly how to keep you where they want you and outside help in order to regain independence and self esteem is absolutely necessary.

[NRSKarenRN, BSN, RN]

great info in this ce program, answers some of your questions:

ce125d: managing legal risks in home healthcare

covers legal duty to notify protective services/physicians of patient non-compliance and potential harm.

contact physician for consult to social services is first thing i'd do in your scenerio along with notifying supervisor.

be aware in many states there is no protective laws for most adults between age 21-65. laws on books for child abuse

you have fine instincts and are to be commended for concern. education of s.o by leaving literature around home, might take the hint. do take care of yourself too.

[johnp127]

my ex did the same!!!

[caliotter3]

Nurses in home health have a moral and legal responsibility to report witnessed abuse or suspected abuse as well as situations where someone does not indicate that they are capable of self care. But at the same time, home health nurses are guests in the homes of their clients and can not just go in and get into people's personal lives and business with no good reason. That is one of the reasons why it takes someone who is capable of using critical thinking skills when observing and assessing home environments. When questionable observations are made, it is time to have a conference with the nursing supervisor and Director of Clinical Services to determine whether the agency wants to take further action regarding the situation. It is not always cut and dry. Sometimes judgment calls have to be made or a pattern has to be recognized before the agency takes action.