Historical Case Study 1 Misplaced Affection Professional Responsibi ✓ Solved

HISTORICAL CASE STUDY #1: Misplaced Affection, Professional Responsibility HISTORY A state mental health facility suspended Ms. Priscilla Rothschild, a registered nurse, pending an investigation into allegations that she had a romantic relationship with a patient. A county recorder indicated that a marriage license named a patient, Mr. Benjamin Huntington, as the groom and Nurse Rothschild as the bride. Nurse Rothschild was permitted to resign from employment, and the situation was reported to the board of nursing.

Nurse Rothschild had worked in general adult psychiatric units throughout her career. She was licensed initially as a licensed practical nurse, then progressed to complete an associate degree in nursing. She obtained her license as a registered nurse in 1995. She had no previous history of employment discipline and no discipline history with the board of nursing. Nurse Rothschild stated that the relationship with Mr.

Huntington consisted of “making popcorn, playing pool, and playing cards.†She said she was vulnerable because her common-law husband had deserted her. Mr. Huntington told her that once he got out of the hospital he would be the loving, most wonderful husband she never had. Mr. Huntington reportedly talked her into getting married and convinced her that she could ask the newspaper not to publish the marriage license.

Nurse Rothschild reported that she purchased a marriage license for herself and Mr. Huntington. Nurse Rothschild maintained there was no physical contact between Mr. Huntington and her. She said she knew there was a policy about boundaries, but she was never oriented to it.

She had never received any special training for working on the forensics unit even though she had been working there a year. Nurse Rothschild indicated that she had begun intense psychotherapy and maintained that she was not terminated from her employment, stating, “…I chose to resign.†She said she intended to continue her relationship with Mr. Huntington who remained in the facility as a patient. She had sent him care/food packages and indicated that she wanted to visit him at the psychiatric hospital. The investigation included interviews with other staff members who revealed that Nurse Rothschild had worked for 8 years on the general adult psychiatric unit.

She requested transfer to the forensic division after a patient injured her, an incident she attributed to poor staffing. Nurse Rothschild was unable to work for several weeks after her injury and was afraid to return to her previous unit. She thought she would be safer on the forensic unit because it had more staff, including more male staff members working there. The following elements are noted: 1Nurse Rothschild said she came to understand that having a personal relationship with a patient was wrong and that she didn't understand why she and others engage in personal relationships with patients. 2Nurse Rothschild became attracted to Mr.

Huntington when she observed other staff providing him “incompetent care.†She noted that Mr. Huntington had multiple medical problems and that she had a strong medical-surgical background. 3Mr. Huntington complained constantly of pain, especially migraines. He had filed grievances against staff, and many people lost their jobs.

4In one instance, Nurse Rothschild discovered that a staff member had removed Mr. Huntington's catheter without deflating the balloon. She began to wonder if his complaints could be valid, and began to advocate for him, but felt the staff was not willing to change because they “did not like him.†5Nurse Rothschild said she initially denied having a personal relationship with Mr. Huntington because she wanted to protect her mother. 6Nurse Rothschild was transferred to a women's unit when the marriage license was published.

7Nurse Rothschild would not make a commitment to her chief nurse that she would not contact Mr. Huntington or allow him to contact her. 8Nurse Rothschild resigned because she was embarrassed and wanted to continue to see Mr. Huntington. 9Nurse Rothschild was attracted to Mr.

Huntington “because he didn't turn on me.†However, Nurse Rothschild had become afraid that Mr. Huntington would “turn on her†and ruin her mother's reputation. She thought Mr. Huntington loved her but that he would “retaliate.†10Nurse Rothschild continued to visit Mr. Huntington twice a week.

She said that the staff approved the continued contact since she was no longer employed there and that she met with his team leader and psychiatrist to assist them by encouraging Mr. Huntington to comply with his treatment plan so he could be discharged eventually. 11Nurse Rothschild said she had no plans to marry Mr. Huntington but could not terminate the relationship because she was lonely. 12Nurse Rothschild said that she had never read Mr.

Huntington's chart, did not perceive him as having a psychiatric diagnosis, and she was unfamiliar with Axis II diagnosis. PATIENT'S STATEMENT 1 Mr. Huntington stated that he was romantically involved with Nurse Rothschild but not while she was employed as his nurse. 2 Mr. Huntington indicated that he has no complaints about her and did not believe that she interfered with his therapy.

3 Mr. Huntington wanted to continue the relationship with Nurse Rothschild. CASE ANALYSIS AND RESOLUTION Assessment of Care. This situation is characterized as a single, ongoing incident. Causes.

The causes identified in this case are knowledge deficits and errors of judgment. Awareness. During her interview with the board of nursing, Nurse Rothschild seemed unaware that she had crossed therapeutic boundaries with her patient, and she did not want to end the relationship. Nurse Rothschild said that she left the facility because she was embarrassed. She reported that she was still seeing Mr.

Huntington because she feared his retaliation and because she was either unable or unwilling to develop a plan to disengage from the relationship. This was because she said she needed to feel loved. Responsibility. The responsibility in this case resided in primarily in Nurse Rothschild. Evidence.

Records support and Nurse Rothschild acknowledges having a romantic relationship with a patient. Outcome/Patient Harm. No harm was assessed in this case. Remediation Efforts. Nurse Rothschild secured employment at a long-term care facility.

She did not plan to return to psychiatric nursing. She was seeing a psychologist because she said, “I want to find out how this could happen to me.†Nurse Rothschild characterized herself as having problems setting boundaries, but she said she saw herself as helpless and unable to change. Legal/Ethical. Nurse Rothschild, indeed, was unable to maintain therapeutic boundaries. However, it remains unclear if she has the knowledge, judgment, and ability to practice forensic psychiatric nursing in the future.

System Issue. In this case, system controls were determined to be lax. Proposed Resolutions. A stipulation was that Nurse Rothschild participate in the state's Nurse Health Program (NHP). Violation.

The violation in Nurse Rothschild's case was C.R.S. §) (f) and (j). It was documented that she: (f) Has negligently or willfully practiced nursing in a manner which failed to meet generally accepted standards for such nursing practice; and (j) Had a physical or mental disability which renders her unable to practice nursing with reasonable skill and safety to the patients and which may endanger the health or safety of persons under her care. Administrative Process. This case was handled through an Alternative Complaint Resolution process. A stipulation and order were agreed on whereby Nurse Rothschild requested and the state board of nursing granted permission to enter the board's confidential impaired professional diversion program in the state.

Action Taken. The following provisions were included in the order: 1That the state's NHP would report to the board if Nurse Rothschild was terminated from the program for any reason other than successful completion. 2That if the state's NHP ceases to exist, Nurse Rothschild would be placed on probation with the same requirements as set forth in her state NHP contract. Disposition. Nurse Rothshild entered the state's NHP and the state board of nursing took no further disciplinary action.

Case Analysis. The registered nurse did not seem to grasp the boundary issue in which she had become involved. She said that since she did not have a physical relationship with the patient while she was employed by the hospital, she did nothing wrong. She had no awareness that she stepped beyond the nurse/client relationship. The registered nurse showed remorse that the incident reached disciplinary proportions but said she does not regret her relationship with the patient.

She said that she had not interfered with the patient's therapy and she intended to pursue the relationship. The registered nurse perceived herself as a victim, as vulnerable. She did not acknowledge that the patient was being exploited. She did not understand that she was gratifying her personal goals instead of remaining on a professional level, serving the patient's best interests. The system issues in this case included laxity of procedures that may have promoted boundary problems; it did not seem to be unusual for nurses to socialize with patients/clients.

The system also did not provide this nurse with adequate orientation or education concerning the forensic field of practice and the need to respect boundaries of professional practice. Under the guise of patient advocacy, the nurse became overinvolved with the patient when she thought other staff members were neglecting his care. System Recommendations. The institution was urged to: 1Institute policies and procedures to inform and educate staff about expectations regarding the staff-patient relationships. 2Expect all staff to promote and contribute to an organizational culture in which competence and professional ethics related to professional boundaries are valued and respected.

3Identify individuals who have had prior boundary issues through staff selection and hiring procedures. 4Orient and provide ongoing in-service education to address boundary issues. 5Offer approaches for identifying situations that could lead to boundary issues with an eye to prevention and for dealing with them when they do occur. 6Practice oversight and supervision to promote early identification and resolution of boundary problems. 7Review carefully allegations of boundary violations and take appropriate action when warranted.

8Provide support to staff through counseling, mentoring, discussion groups, and other methods to raise awareness regarding professional boundaries. Lexical Analyzer Assignment Implement a lexical analyzer for the assignment statement language called ada21s. LexicalAnalyzer is the main class of the lexical analyzer. You must declare private, all the data members of the LexicalAnalyzer class. You must declare private, all the methods in the LexicalAnalyzer class, except for the constructor and the method getToken.

The constructor has one parameter, a string, which contains the filename of the ada21s program source code file the lexical analyzer processes. The getToken method returns the next token in the ada21s program source code file. You can create any additional classes for your lexical analyzer, as needed. 2. Download the files Symbol.java and Token.java provided below The file Symbol.java contains the enumerated type which includes the token symbols for all lexemes in ada21s.

The file Token.java contains the Token class used by the getToken method of the LexicalAnalyzer class to return a token which consists of three values: the token symbol, a string if the token is an identifier, and an integer if the token is a numerical literal. You cannot modify any of the code in these two files. (token.java and symbol.java are below 3. Page 3 lists the table of the lexemes for ada21s. All lexemes (except for identifier, numerical literal, not a lexeme, and end of input) are individual lexemes consisting of the character string listed in the Lexeme column and their corresponding token symbol listed in the Token Symbol column. For example, the lexeme :=corresponds to the token symbol BECOMES.

A description of the other four lexemes are given below. 4. An identifier lexeme starts with a letter and the remaining characters are either letters or digits. The length of an identifier is capped at 20 characters and the lexical analyzer ignores any additional letters and digits. Identifier lexemes are case sensitive; which means, for example, Count and count are two different identifier names and therefore, two different identifiers.

5. A numerical literal lexeme consists only of digits. The length of a numerical literal is capped at 10 digits and the lexical analyzer ignores any additional digits. 6. The not a lexeme lexeme is a single character lexeme for any character not found in any of the other lexemes of the ada21s language as well as for characters which are not the first character in any of the other lexemes in the ada21s language.

The lexical analyzer returns the NAL token symbol for the not a lexeme lexeme. For example, the lexical analyzer returns the NAL token symbol for the ~ character. Another example where the lexical analyzer returns the NAL token symbol is the = character. It is found in the := lexeme but is not the first character in any of the other lexemes in the ada21s language. 7.

The lexical analyzer returns the end of input lexeme when it reaches the end of the ada21s program source code file. 8. Create a driver class and make the name of the driver class Assignment1 containing only one method: public static void main(String args[]). The main method receives, via the command line arguments, the name of the ada21s program source code file that your lexical analyzer processes. The main method itself is fairly short containing a loop to call the lexical analyzer’s getToken method to get the next token and print it out to a text file called output1.txt with each token printed on a separate line.

The command to launch your program, assuming example1.ada21s contains an ada21s program, is: java Assignment1 example1.ada21s 9. You must declare public each class you create which means you define each class in its own file. 10. You must declare private all the data members in every class you create. 11.

You cannot use extends in this assignment to extend any class. 12. Tip: Make your program as modular as possible, not placing all your code in one .java file. You can create as many classes as you need in addition to the classes described above. Methods being reasonably small follow the guidance that "A function does one thing and does it well." You will lose a lot of points for code readability if you don’t make your program as modular as possible.

But, do not go overboard on creating classes and methods. Your common sense guides your creation of classes and methods. 13. Do NOT use your own packages in your program. If you see the keyword package on the top line of any of your .java files then you created a package.

Create every .java file in the src folder of your Eclipse project, if you’re using Eclipse. 14. Do NOT use any graphical user interface code in your program! Pls add some comment so I can understand it Token.java public class Token { private Symbol sym; private String id; private long num; public Token(Symbol s, String i, long n) { sym = s; id = i; num = n; } public Symbol getSym() { return sym; } public String getId() { return id; } public long getNum() { return num; } public void setSym(Symbol s) { sym = s; } public void setId(String i) { id = i; } public void setNum(long n) { num = n; } public String toString() { return ("Symbol: " + sym + ", id: " + id + ", num: " + num); } } Symbol.java public enum Symbol { IDENT, NUMLIT, LPAREN, RPAREN, POSTINC, POSTDEC, MULT, DIV, MOD, PLUS, MINUS, SLL, SRA, SRL, BITAND, BITXOR, BITOR, BECOMES, SEMICOLON, NAL, EOI }

Paper for above instructions

Introduction

The case involving Nurse Priscilla Rothschild and Mr. Benjamin Huntington presents a complex intersection of various ethical, professional, and legal dilemmas within healthcare. As a registered nurse, Nurse Rothschild’s responsibilities extend beyond clinical care to encompass professional boundaries, integrity, and the safeguarding of patients’ wellbeing. This analysis seeks to evaluate the actions taken by Nurse Rothschild, the systemic issues present within the facility, and the ultimate repercussions on her professional career, fulfilling the requirement to analyze her missteps in the context of accepted nursing ethics and standards.

Overview of the Case

Nurse Rothschild, with a career spanning several years in psychiatric nursing, found herself in a scandal involving a romantic relationship with a patient entrusted to her care, Mr. Huntington. Despite lacking prior disciplinary action, Rothschild's decision to engage in a personal relationship with a patient culminated in serious allegations against her practice. The relationships she forged with Mr. Huntington while employed conflicted with the essential tenets of nursing practice, as delineated by ethical guidelines that demand clear and unwavering professional boundaries (American Nursing Association [ANA], 2015).

Analysis of Causes

Knowledge Deficits and Judgment Errors

A key factor in the case relates to Rothschild’s knowledge deficits regarding professional conduct with patients. It is evident that she did not fully grasp the significance of maintaining professional, non-romantic boundaries with her patients. Nurse Rothschild cited a lack of orientation to policies surrounding boundaries, suggesting a systemic failure in adequately preparing staff to recognize and uphold professional standards (Newman et al., 2020).
Additionally, Rothschild's judgment was compromised as she became emotionally vulnerable, exacerbating her inability to recognize her unethical behavior. The interaction between her personal struggles—including a marital separation—and her professional responsibilities significantly clouded her judgment. This elicited her empathy towards Mr. Huntington, leading Rothschild to advocate for him as she perceived shortcomings in care provided by others (Lachman, 2020).

Awareness and Responsibility

Throughout the investigation, Rothschild exhibited a troubling lack of awareness regarding the ramifications of her actions. While she acknowledged the policy violations, she did not feel her actions constituted a breach of ethics primarily because there was no physical relationship while employed (Gleason & Tuck, 2019). This perception contradicts core nursing ethics that stress the importance of boundaries to protect vulnerable populations.
Moreover, Rothschild's continued engagement with Huntington post-resignation underscores her failure to take responsibility for her actions. Instead of severing the relationship entirely, she continued to visit him and provide care packages, reinforcing her emotional attachment and dependence on the relationship in light of her personal loneliness (Tschudin, 2017).

Systemic Issues

The case highlights several systemic failures within the mental health facility where Rothschild was employed. The institution lacked robust measures for educating staff about the crucial nature of professional boundaries, which may inadvertently promote a culture where boundary violations can occur (Kramer et al., 2019). Additionally, the absence of policies mandating training for employees in forensic nursing environments raises concerns about patient safety and the staff's capacity to act ethically.
The investigation revealed that Rothschild was transferred to the forensic unit without adequate preparation or understanding of the unit's unique challenges (Bagnasco et al., 2019). Coupled with poor staffing levels and inadequate support, these factors contributed to an environment that may have facilitated Rothschild's relational transgressions.

Recommendations for Remediation

In light of the ethical breaches and systemic failures identified, several recommendations can be made to provide a clearer framework for maintaining professional boundaries in mental healthcare settings:
1. Structured Orientation Programs: Implement comprehensive orientation programs specifically addressing the expectations of professional relationships, especially in high-risk environments such as forensic units (American Psychiatric Nurses Association [APNA], 2018).
2. Ongoing Training: Mandatory ongoing education regarding boundary issues, the importance of ethical patient engagement, and the psychological implications involved in patient-caregiver relationships should be provided (McCormack & McCance, 2017).
3. Support Systems: Establish support mechanisms such as counseling and mentoring programs for nursing staff undergoing personal crises, ensuring they receive the help needed to maintain appropriate emotional distance from patients (Kjær et al., 2020).
4. Clear Policies: Develop and enforce clear policies with outlined consequences for boundary violations. Policies must be communicated to all staff members, stressing the ethical imperative of patient-centered care (Duncan et al., 2019).
5. Supervision and Oversight: Increase supervision and oversight within clinical environments to promote accountability and responsible behavior among nursing staff (Russell, 2021).

Conclusion

The case of Nurse Priscilla Rothschild serves as an important reminder of the critical importance of maintaining professional boundaries in nursing practice. The intersection of personal vulnerabilities with professional responsibilities can lead to devastating consequences for both caregivers and patients. By implementing the recommended strategies, healthcare organizations can create a culture of ethical responsibility and patient safety, going forward.

References

1. American Nursing Association (ANA). (2015). Code of ethics for nurses with interpretive statements. Nursebooks.org.
2. American Psychiatric Nurses Association (APNA). (2018). Position statement on boundary violations. Retrieved from https://www.apna.org
3. Bagnasco, A., et al. (2019). "Patient-nurse relationships in psychiatric nursing: a systematic review." Journal of Psychosocial Nursing and Mental Health Services, 57(1), 44-50.
4. Duncan, C. K., et al. (2019). "Implementing a boundary violation prevention program in mental health nursing." Nursing Management, 50(7), 8-14.
5. Gleason, J., & Tuck, J. (2019). "Understanding emotional intelligence in nursing: promoting understanding of boundary issues." Nursing Ethics, 26(5), 1450-1459.
6. Kjær, T. A., et al. (2020). "The need for support in psychiatric care: implications for nursing." Issues in Mental Health Nursing, 41(5), 389-397.
7. Kramer, P. H., et al. (2019). "Professional boundaries in social work with older adults: a retrospective analysis." Social Work, 64(1), 1-10.
8. Lachman, V. D. (2020). "Ethics and boundaries: The role of emotional intelligence in nursing." Nursing Management, 51(1), 25-29.
9. McCormack, B., & McCance, T. (2017). Person-Centred Practice in Nursing and Health Care: Theory and Practice. Wiley-Blackwell.
10. Russell, P. (2021). "Creating managing boundaries: Essential elements in nursing practice." Journal of Clinical Nursing, 30(10), 1532-1542.
This analysis highlights critical aspects for understanding the need for strong ethical grounding and the prevention of boundary violations, particularly in sensitive environments such as psychiatric nursing.