Dilemma 2 - Ismir

greenspun.com : LUSENET : Module Ten Discussion : One Thread

As the key worker you have worked very hard with Ismir over the past few weeks and have started to gain his trust and confidence. Your colleagues have even complimented your effort and have noticed Ismir was beginning to engage and relate to you. During a session with him you are delighted to find him calmer and happier. He wants to tell you something in complete confidence and you agree without really thinking. He tells you in detail how he plans to end his pain through taking his own life.

-- Anonymous, November 18, 2001


The safety and welfare of a client should be of paramount importance to a nurse.

-- Anonymous, November 20, 2001

I will make it clear to you julie l work within a team and this is a serious issue I ,m afraid l will have to tell the team about your intentions.

-- Anonymous, November 20, 2001

The nurse must first and foremost consider Ismir's safety. In this case the nurse can agree to keep it confidential about Ismir wanting to take his own life. Before considering agreeing to talk in complete confidence with Ismir nurse must make sure that it is not about agreeing with something detrimental to Ismir's health and safety.

-- Anonymous, November 20, 2001

Although confidentiality is stressed in the ukcc code of conduct, in this case i will have to ignore confidentiality and risk Ismir losing his trust in me, because this situation calls for a moral and ethical decision, and the first thing is Ismirs saftey and the reason Ismir is in hospital is so that he can get help not for me to help him to his destruction.

-- Anonymous, November 20, 2001

I will tell him that as a nurse I am looking out for his best interests and tell him that though I had agreed to keeping it in confidence, I cannot if it is matter of life and death.I would advice him that there are other ways of dealing with hte pain he is experiencing other than suicide.

-- Anonymous, November 20, 2001

Although Ismir is telling me these issues in confidence I cannot condone the plan nor may I collude with him. The fact that he wants to take is own life is serious and not doing anything about it will contravene the ukcc code to do good and not harm and also to act in the best interest of the client. I would therefore bring up the issue in the mdt and I would explain my position clearly to Ismir so that aware of my plan of action

-- Anonymous, November 20, 2001

I will have to tell Ismir that the team will have to know about this. According to the UKCC code of conduct, confidentiality will have to be maintained as long as it is in the best interst of the patient. In this case this will clearly not be Ismir's best interest so I will have to inform the team. A relationship can be mended but a life cannot be replaced.

-- Anonymous, November 20, 2001

l will inform lsmir that l work within a team and that confidentiality is mentained within the team as such l have to inform the team

-- Anonymous, November 20, 2001

As the keyworker I would discuss and explore his plans thoroughly by challenging his thoughts.I am aware I need to " work in an open and co-operative manner with patients, clients and their families, foster their independence and recognise and respect their involvment in the planning and delivery of the care" It is imperative that I make it clear at this point, to Ismir that I was not fully aware of the fact.Iwould admit that I could not keep this in confidence and the MDT would be informed. His plan to end his life is morally wrong. I could not condon his action plan. As highlighted by the UKCC (1992)"...aviod any abuse of your privileged relationahip with patients and clients..." Ethically morally and professionally, it would be wrong for me to withhold this information and it is legally against the law to knowingly allow someone to end their life. I would explain ending his life is not something I could keep in confidence and the decision was not mine alone anyway. I would place him on Level one observation, however, until he could be seen by the Consultant. I would add that I was acting to promote and safeguard his interests although I am aware his trust in me would be tarnished.

-- Anonymous, November 20, 2001

The UKCC Code of Conduct 1992 states that, as a registered Nurse...., Clause 1 - Act always in such a manner as to promote and safeguard the interests and well-being of patients and clients;

Clause 2 - Ensure that no action or omission on your part, or within your sphere of responsibility, is detrimental to the interests, condition or safety of patients and clients;

Clause 5 - Work in an open and co-operative manner with patients, clients and their families, foster their independence and recognise and respect their involvement in the planning and delivery of care.

Clause 8 - Report to an appropriate person or authority, at the earliest possible time, any conscientious objection which may be relevant to your professional practice;

clause 10 - Protect all confidential information concerning patients and clients obtained in the course of professional practice and make disclosures only with consent, where required by the order of a court or where you can justify disclosure in the wider public.

Using the above information, i would have to speak to Ismir again to make him aware that since i am not the only person involved in his care, i have to disclose information discussed when necessary but in confidential settings. i would discuss with him, to find out the reasons why he feels he wants to take his life. since Ismir has made detailed plans about taking his life, i will have to find out if he is going to act on them and whether he does not intend to act on them or not, i will document all this and inform the nurse in charge as will be upholding clause 1,2,8 and 10.The reason behind this, is that if Ismir decides to take his life, i as a professional will be accountable for the 'no action or omission on my part' of clause 2. if Ismir does not consent to me telling the other members of the team, then i will have to do it 'to do good and not to do harm'.

The Guidelines of Professional Practice (1996) states that ' it is impractical to obtain the consent of the patient or client every time you need to share information with other health professionals or other staff involved in the health care of that patient or client. what is important is that the client understands that some information may be available to others involved in the delivery of their care. However, the patient or client must know who the information will be shared with'.

-- Anonymous, November 20, 2001

Before I agree to listen to what Ismir is going to tell his confidentiality, I would tell him I have to share the information with my colleague. I can't keep the information myself because of 'code of conduct' of UKCC.It is up to Ismir to tell me his secret or not.

-- Anonymous, November 21, 2001

Ismir had voiced his plan to commit siucide . This should be taken seriously and he should be nursed on closed observation.The whole thing should be documented and the multi-disciplinary team informed.such an information cannot be kept in confidence and Ismir should be told about that.

-- Anonymous, November 21, 2001

I will have to inform the Mdt team about Ismir's plan and document everything because of moral, ethical and legal issues.I will aslo explain to Ismir that although he has trusted me enough to tell me his plan, it is my duty as his keyworker to act in accordance with the UKCC and the law.

-- Anonymous, November 22, 2001

in accordance to clause 2 of UKCC code of professional conduct 1992, i would inform ismir that i would have to inform the members of the MDT about his revelation so as to draw up a safe plan of action to ensure effective care delivery.

-- Anonymous, November 23, 2001

I will tell Ismir that in as much as I don't want to betray his confidence, I can't keep the information to myself. Rather I'll have to inform my line manager but we will do everything we can to treat his concerns in confidence.

-- Anonymous, November 23, 2001

I will tell Ismir that to the best of his interest , i will only share this important information with those people involve in his care to help him.

-- Anonymous, November 23, 2001

It is duty to act in the best interest of the patient. Although this is in confidentiality it is wise to report the issue ' if resoning does not work.

-- Anonymous, November 23, 2001

I wiil talk to him in trying to talk him out of it.However in his best interest i will report in if he is persistant in doing it

-- Anonymous, November 23, 2001

Nurses should never promise complete confidentialty to patients because some information needs to be shared with other members of the team to come up with the best care possible for the client hence despite having built a good relationship ,it has to be put at stake by explaining to him that the information he has given me will be passed on to the team.

-- Anonymous, November 23, 2001

It should be made clear to the client that not everything can be completely confidential, and that I have a professional responsibility within the MDT team.Its a matter of weighing Ismir's life versus jeopardising the relationship!!!!

-- Anonymous, November 23, 2001

The UKCC code of conduct admonish nurses to keep issues about patients confidential. However confedentiality can be broken if the information to the nurse provides enough evidence that it will harm the patient. In this instance, I will inform Ismir that I could not keep this plan secrete since I work as part of the team taking care of him and it's my responsibility to do good to him at all times.

-- Anonymous, November 26, 2001

As soon I hear the news, I will tell him that I am passing it on to the MDT as it is serious. Thereafter, I will then discuss it with other members of the MDT as his safety and well-being is more important than the relationship.

-- Anonymous, November 28, 2001

Ismir Iam sorry I know you had that confidence to tell me about your plans to end up your self But I will have to share this information with the rest of the team. Our relationship was purposely to ensure that you are safe in order to ensure your health and safety The team has to be aware of what happens in this relationship. Would you be in a position to share the reasons you want to end up your life I know you have this plan at hand iam here to help you in any difficulty you are facing, Please Ismir.......

-- Anonymous, December 06, 2001

Ismir is at the mercy of the nurses hand, therfore in this circumstances confidentiality must be broken and Ishmir's interest comes first. The nursing team must be informed about his intention to take his own life and Ishmir shoul be aware that it is no kept secret. As a nurse not taking any positive step to prtect Ishmir's life, i will be contradicting the UKCC Code to do good and not to harm and also to act in the best interest of our client. I am sure when Ishmir is well enough he will be thankful to the nurses for acting on his behalf. Our trust can be rectified when all is well. Ethically and professionally it is wrong to condon anyone to end their own life. I will also make it clear to Ishmir that not even in the court of England euthanasia is not allowed.

-- Anonymous, December 09, 2001

Just after listened to his confidentiality, I would explore more in depth the reasons for that. I would show understanding for his problems, but I would inform him that suicide is a serious matter, and that I could not keep this secret to the MDT, as we work as ateam and in its best interest of the patient, ensuring the patient's safety. I would offer time for him in order to explore this matterand put him on close observation, (level 1).

-- Anonymous, December 14, 2001

considering that I had agreed without really thinking about it,I would have to apologize and say that I can not keep the information confidential--despite the fact that he had come to trust me so much and that we were working well together,but for the good of his welfare,I would have to inform the MDT about his disclosure,and that I would understand if he began to have second thoughts about our relationship.To come to this decision,Iwould have taken clause 2 of the ukcc.

-- Anonymous, January 13, 2002

My actions and omissions should not put the life of client at risk, therefore by choosing not to report this l would have broken the ukcc code of conduct and would lose my job. at the same time if l tell l break the trust l have developed with Ismir. however l would justify my breaking that trust by the fact that Ismir is not well at the moment and if he was well this is something he would not do. l therefore would be helping him by making sure that the other members know this and we stop him from killing himself.

-- Anonymous, February 09, 2002

i would reassure the client that i will not be able to keep that sort of information between us. i will be there to help her but i am also required by law and proffession to use that information to help this client

-- Anonymous, February 21, 2002


-- Anonymous, March 12, 2002

Moderation questions? read the FAQ