Question

 In a private unit a 15 year old boy is admitted voluntarily at the request of his parents because of violent, explosive behavior that seems to stem from his father’s recent remarriage after his parent’s divorce. A few days after admission, while in group therapy, he has an explosive reaction to a discussion about weekend passes for Mother’s Day. He screams that he has been abandoned and nobody cares about him. Several weeks later, on the day before his discharge, he elicits from the nurse a promise to keep his plan to kill his mother confidential.  ANA code of ethics, confidentiality, principles of psychiatric nursing, duty to warn.

1) Did the nurse use appropriate judgment in promising confidentiality?

2) Does the nurse have the duty to warn the client’s mother of her son’s threat?

3) Is the duty owed to the client’s father and stepmother?

4) Would a change in the admission status from voluntary to involuntary protect the client’s mother without violating the client’s confidentiality?  5) Do different states vary on this?

6) What nursing action, if any, should the nurse take after the disclosure by the client?

Answer 1

1. Yes the nurse uses an appropriate judgement in promising confidentiality. As, it a role of psychiatric nurse to maintain rappot and trust worthy relationship with the client. But side by side she should ask the client the cause behind to take this type of decision and understand him thet it is not a right decision.

2. Yes, the it is the nurses duty to worn the client's mother about the sons threat. As, he is a psychotic patient and very much aggressive if he worn like this he may implement his plan. So, it is not a matter to take lightly. And side by side the family members has to observe the client carefully that he not herm to himself.

3. Yes the client's father and step-mother should owed. As the present condition of the client is due to inappropriate behavior and improper decision taken by them. They also need counseling to change there attitude towards the boy and understand the his present condition and also to prevent relapse the his disorder.

4. Without violating the client's confidentiality by change in admission status it is possible to protect the client's mother. As the client is till now aggressive and give threat to kill his mother he is not fully recovered till then. He need farther treatment and counselling is required for him. Not only it is done to protect his mother but also to improve his mental condition it has to done.