Nowadays, consent for information sharing is pretty much always sought – except in some circumstances. Patients, clients and even service users are often formally asked to sign consent as to who can receive what information about them before it gets passed around.
It’s the right thing to do.
But this now means that anyone who gives out information on a patient – who hasn’t consented – is actively breaching a confidentiality. Which left me in a bit of a quandary today like this…..
Continue reading Case Study Vignettes – Confidentiality and Consent
I thought I ‘d trial a new idea on the MN site based on the precept that several student (and pre-student) nurses visit this site. I’ll open up a forum discussion for feedback on the idea in general but leave this thread for responses to the vignette.
The idea is to set a scenario and debate the issues it throws up – I explicitly invite “service users” to also jump in and stir the ethical stew-pot as well as our regular contributors.
#1 is around confidentiality (and risk).
Continue reading Case Study vignettes – Confidentiality
Did you all miss me? I decided to wait a couple of days after returning from the Comrade Stalin Expects Productive Diligence Recreational Facility, Scarborough before making any fresh posts. A bit of time to properly unwind from my sunny holiday and to allow the radiation poisoning to fade.
Since Mr Ian is suggesting we do some case study vignettes, here’s one from me, on the subject of anger management. I notice from the previous vignette that there’s requests in the comments thread that technical jargon is kept to a minimum. I’ve attempted to do so, but where I’ve been unable to I’ve included a wikipedia link for those who aren’t familiar with some of the terms.
Anger management is something that the CMHTs seem keen to give a wide berth (at least round where I live), but with child and adolescent mental health services it’s offered quite commonly. The following vignette is a semi-fictional amalgam of several cases.
Continue reading Anger Management
Mental health care most often becomes ethically clouded when it interacts with the law.
Jodie is a 19 year old female who is voluntarily admitted to the acute mental health unit following a suicide attempt whilst under the influence of alcohol. This is her first presentation to the service and you spend some time to get to know her the following day.
During the course of conversation Jodie tells you what caused her to act as she did.
Continue reading Case Study vignettes – the duty and boundaries of care
Saturday at 2pm you arrive for your afternoon shift as nurse in charge of the acute mental health unit to be informed of a new admission. Joe (from previous vignette), was reviewed by the community consultant psychiatrist and admitted voluntarily on Friday afternoon (with some persuasion).
Continue reading Case study vignettes – Nurse Holding Powers
A slightly simpler vignette, but one that happens quite often where I work…
You are a staff nurse on a locked ward. After supper, Bill the patient comes up to you, appearing agitated. He says he’s feeling stressed (or words to that effect) and needs a [...]
Joe, having managed to stay for the weekend and not get “sectioned”, is reviewed again by the treating team on Monday. Following review the registrar tends to the consultants requests to run “routine admission blood tests”. He writes out the pathology lab request form and pops it in the pending tray.
When the phlebotomist [...]
I like dropping in the odd buzz word.
Joe has consented to trial Clozapine. He has undergone all the tests, titration and monitoring is progressing without incident and is now at day 12. He’s receiving 50mg in the morning and 200mg a night and progress seems to be looking good.
Continue reading Case Study vignette – Complicated Concordance
My mind was wandering during a session today (my mentor can be very waffly) and the following little scenario drifted into my mind. So I thought I’d share….
Continue reading Quick mini-scenario
Sometimes on a psychiatric ward ward patients have had their cigarettes rationed by the nurses, so they’re only allowed one every hour or so. I’ve come across a few occasions when people have argued whether or not it’s ethical to do this, so I thought I’d do a case study vignette on the subject.
I’ve got my own opinions on this subject, but I think I’ll wait until others have commented on the vignette before adding my thoughts.
Continue reading Case Study Vignettes: Cigarette Rationing
A person moves to a local small community. One of the community team knows him from previous admissions to hospital in another region following “bizarre behaviour” in public.
The man is known to have a diagnosis of “Schizophrenia”. Anecdotal reports suggest that the person can become extremely unwell within a month if not taking [...]
Here’s a vignette from me, on the subject of eating disorders.
Kate is 15 years old, with a diagnosis of anorexia nervosa, currently being treated on an inpatient unit. She has a BMI of 14, which makes her severely underweight. She looks pathetically thin, is growing lanugo hairs, her periods have stopped and her [...]
