During the admission assessment to the mental health unit, a client reports that the people at the office, where the client works, are antagonistic and the client is thinking of shooting the supervisor. The client asks the nurse not to reveal this to anyone else. The nurse immediately notifies the client’s therapist and other team members of the client’s thoughts. The therapist then calls the client’s supervisor and shares the client’s thoughts about shooting the supervisor. Which outcome is best based on the action of the nurse?
A.
The nurse is reprimanded for divulging confidential patient information without obtaining informed consent.
B.
Both the nurse and therapist are reprimanded for divulging confidential patient information to others.
C.
The nurse and therapist will be asked to educate other team members on appropriate sharing of client information.
D.
The therapist is reprimanded for divulging confidential patient information without obtaining consent.
The Correct answer and Explanation is:
The correct answer is:
C. The nurse and therapist will be asked to educate other team members on appropriate sharing of client information.
Explanation:
In this scenario, the nurse and the therapist acted appropriately according to the legal and ethical responsibilities required in healthcare, particularly in mental health settings. The situation involves a serious and credible threat of violence, which overrides the general principle of patient confidentiality. This exception to confidentiality is rooted in the duty to warn and protect third parties from harm, a concept established by the Tarasoff v. Regents of the University of California case in 1976.
Key Points:
- Duty to Warn and Protect: Healthcare providers have an ethical and legal obligation to protect identifiable individuals if a client poses a serious threat of violence. In this case, the client’s statement about wanting to shoot the supervisor constitutes a credible threat that warrants immediate action. The nurse acted correctly by informing the therapist and the mental health team to manage this potential risk effectively.
- Confidentiality and Exceptions: While confidentiality is a cornerstone of therapeutic relationships, there are exceptions where breaching confidentiality is necessary. One such exception is when there is a duty to warn and protect others from harm. The client’s explicit threat of violence toward the supervisor is a situation where breaking confidentiality is justified to prevent potential harm.
- Legal and Ethical Standards: Both the nurse and therapist followed the correct legal and ethical guidelines. Not only did they protect the client’s rights to confidentiality to the extent possible, but they also acted on their duty to protect others. The therapist’s decision to inform the supervisor was also appropriate given the seriousness of the threat.
- Education and Awareness: Given the appropriateness of the actions taken, the best outcome would be for the nurse and therapist to educate other team members about the correct circumstances under which confidential information can and should be shared. This ensures that all healthcare providers understand their responsibilities and the boundaries of patient confidentiality, particularly when public safety is at risk.
In summary, the nurse and therapist acted appropriately, following both legal and ethical guidelines to prevent harm while managing confidentiality issues. Educating others on these principles is the most constructive outcome to ensure that similar situations are handled correctly in the future.