A patient tells his nurse during the initial assessment that he ...

[Wadzanai]

A patient tells his nurse during the initial assessment that he is angry with his girlfriend and plans to kill her with a gun as soon as he is released from the hospital. The nurse confirms that he does have a gun and ammunition.
 
  Which statement best describes the nurse's legal and ethical obligation?
  1. The nurse may not break confidentiality because of HIPAA.
  2. The nurse cannot disclose the information because it is considered privileged.
  3. The nurse has a duty to warn the girlfriend and law enforcement of the patient's plans.
  4. The nurse may not discuss the assessment with anyone except those caring for the patient.

Question 2

A nurse fails to check on her suicidal patient every 15 minutes per hospital policy. When she checks on him next, he has jumped off the bed and broken his ankle. Why could she be charged with negligence? Select all that apply.
 
  1. Failure to properly monitor
  2. Failure to communicate risk
  3. Failure to assess the risk of suicide
  4. Failure to maintain proper boundaries
  5. Failure to provide sufficient documentation

[jasonq]

Answer to Question 1

Answer: 3
Explanation: The right to privacy and confidentiality are very important aspects of care of the psychiatric-mental health patient. However, knowledge of a threat against a person's life is an exception to any confidentiality law and must be reported to avert danger to others. Privilege is a legal term and is only recognized in nurse-patient communications in a small number of states and would not apply in this case.

Answer to Question 2

Answer: 1, 3
Explanation: A primary nursing duty is to prevent harm. In this case, the nurse failed to assess the risk of suicide because she did not perform the required checks every 15 minutes. She also failed to properly monitor the patient. This case is not about boundaries, documentation, or communicating risk. As a licensed nurse, she is individually accountable for her failure to protect the patient. Because she failed to follow policy, the hospital may choose not to defend the nurse and could even seek damages against her if she is held liable for her actions.