Mrs. Brown’s Chart
Mrs. Brown has been diagnosed with invasive cancer. She has been having daily radiation treatments. Her husband is a frequent visitor and seems to be a devoted husband. They are both very interested in her progress and prognosis. Although they have asked many questions and you have given truthful answers, you know little because the physician has not shared much with the staff. Today, you walk into Mrs. Brown’s room and fi nd Mr. Brown sitting at Mrs. Brown’s bedside reading her chart. The radiation orderly had inadvertently left the chart in the room when Mrs. Brown returned from the x-ray department.
ASSIGNMENT: Identify several alternatives that you have. Discuss what you would do and why. Is there a problem here? What follow-up is indicated? Attempt to solve this problem on your own before reading the sample analysis that follows. Analysis The nurse needs to determine the most important goal in this situation. Possible goals include (a) getting the chart away from Mr. Brown as soon as possible, (b) protecting the privacy of Mrs. Brown, (c) gathering more information, or (d) becoming an advocate for the Browns. In solving the case, it is apparent that not enough information has been gathered. Mr. Brown now has the chart, and it seems pointless to take it away from him. Usually, the danger in patients’ families reading the chart lies in the direction of their not understanding the chart and thereby obtaining confusing information or the patient’s privacy being invaded because the patient has not consented to family members’ access to the chart. Using this as the basis for rationale, the nurse should use the following approach:
1. Clarify that Mr. Brown has Mrs. Brown’s permission to read the chart by asking her directly.
2. Ask Mr. Brown if there is anything in the chart that he did not understand or anything that he questions. You may even ask him to summarize what he has read. Clarify the things that are appropriate for the nurse to address, such as terminology, procedures, or nursing care.
3. Refer questions that are inappropriate for the nurse to answer to the physician, and let Mr. Brown know that you will help him in talking with the physician regarding the medical plan and prognosis.
4. When finished talking with Mr. Brown, the nurse should request the chart and place it in the proper location. The incident should be reported to the immediate supervisor.
5. The nurse should follow through by talking with the physician about the incident and Mr. Brown’s concerns and by assisting the Browns to obtain the information that they have requested.