A client in a psychiatric clinic tells the nurse, "I want to kill my wife. The moment I see her, I am going to kill her." Which of the following should be the nurse's next action?
A client in a psychiatric clinic tells the nurse, "I want to kill my wife. The moment I see her, I am going to kill her." Which of the following should be the nurse's next action?
A. Respect the client’s right to privacy and confidentiality
[0%]
B. Document the client’s statements
[6%]
C. Notify the client’s psychiatrist of the comments
[47%]
D. Explore the client’s feelings about his wife
[47%]
Statistics
Subject/Lesson
Subject
Mental Health
Lesson
Mental Health
Client Need
Test Plan
Psychosocial Integrity
Related Topic
Crisis Intervention
Item Type
Item Type
Analysis
Explanation
Choice C is correct. Confidentiality plays a critical role in client care; however, there may be certain circumstances where confidentiality must be breached to not only ensure the safety of the client, but also to protect a third party (or parties). This concept is referred to as the 'duty to warn' or 'duty to protect.' These types of situations most often arise when a client reports suicidal ideation (SI), homicidal ideation (HI), or when the client makes a threat against an identifiable third party, even if the threat was made during a private therapy session.
Choice A is incorrect. As mentioned above, confidentiality plays a critical role in client care; however, there may be certain circumstances where confidentiality must be breached to not only ensure the safety of the client, but also to protect a third party (or parties).
Choice B is incorrect. Clear and accurate documentation of the client's statements and the context of the conversation is vital; however, the priority for the nurse is to ensure the safety of the client and the client's wife, likely best achieved by prompt reporting of the client's statements to the client's psychiatric health care provider (HCP).
Choice D is incorrect. Assisting the client in exploring their feelings regarding their wife would potentially further increase the client's anger toward her. Therefore, this is not an appropriate action for the nurse to take at this time.
Learning Objective
When providing care for a client who threatens to kill a third party, recognize that notifying the client's psychiatric health care provider (HCP) of the client's comments is the next action for the nurse to take.
Additional Info
- There is a wide range of 'duty to warn' and 'duty to protect' legal variations across the country, with nurses being impacted in varying degrees.
- It is crucial for all health care providers (HCPs) of all levels to know the laws in the state(s) in which they practice, as there are significant legal variations from state to state.
- Failure to know the applicable state statutes and/or regulations may lead to inadvertent violations of the Health Insurance Portability and Accountability Act of 1996.
