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‘Did I do the right thing?’


Can you advise this student nurse?

“I’m really interested to know how other students and qualified nurses would have handled this…

“I’m on placement on an acute mental health ward. Whenever a patient is admitted they’re meant to be asked to sign a confidentiality sheet that says we can give information to certain people – then if they don’t want us to talk about their care to anyone, or to certain people, they have the chance to say.

“So when a service user’s Mum rang yesterday and asked how her son was, I asked her to wait while I checked his confidentiality sheet. It hadn’t been filled out so I went and checked with him.

“This service user is currently psychotic and some of his delusions involve his Mum. I’m not even sure he understood the question but he just said “Nah” and then walked away.

“I know that he wouldn’t really mind me telling his Mum that he was fine but instead I explained to her that I couldn’t tell her anything without her permission. She started crying and said “But I’m his Mum”. She was worried that I was holding something back even though there was genuinely no change.

“I felt awful. Was I right to stick to the rules so tightly? Should I just have told her there was no change?”

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Readers' comments (4)

  • you were 100% right, please don't worry. it's understandably upsetting for the patients mother but at that moment in time he said no. He may have been paranoid and not believed what you were saying. When she rings again he may well have changed his mind again.

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  • michael stone

    This is apparently the same issue as something I came across somewhere last year (probably in the Law Commission MCA/DoLS consultation). Some MH workers are, it seems, trying to get patients to indicate in advance consent to things which they might subsequently refuse when they have become psychotic, or whatever. I seem to recall some sort of 'biblical' name for these 'agreements' ('Jericoh' sprang to mind, but I'm no sure it was Jericoh).

    The legality of this type of agreement, seems questionable: but the problem, of a patient when 'mentally clear' wanting you to do something, but then saying 'no' after entering some sort of 'mental episode' [and I know I'm probably getting the terms wrong here], is easy to see (but much harder, to solve !).

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  • We tap into peoples emotions as nurses but we have to be able to understand the legal rights of the patient inorder to prevent abuse ,breach of confidentiality. its an art you will learn with practise

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  • michael stone

    As 11th June implied, with 'its an art', this isn't an issue for which there is genuine clarity of law. Probably, the 'legally safe' thing for a nurse to do, is to follow the patient's instruction until there is a documented 'expert opinion' that the patient lacks mental capacity - at that point, the rules about 'patient confidentiality' and the requirements of the Mental Capacity Act potentially conflict. Even for simpler situations than those involving mental health issues such as psychosis, that is conflict which has yet to be properly disentangled by clinicians and courts, as I've explained:

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