Your HIV positive patient states he has transmitted the virus to his wife and plans to kill her. How should you proceed?

In a situation where a patient expresses intent to harm another person, the top priority is to ensure the safety of the individuals involved. Consulting psychiatric services is essential because they can evaluate the patient’s mental state and assess the risk of violence. Mental health professionals are trained to handle such crises and can provide the necessary intervention, including potential hospitalization for the patient's safety and that of others.

Additionally, engaging psychiatric resources can lead to appropriate treatment options that address any underlying mental health issues that may be influencing the patient's thoughts of violence. This step not only focuses on the immediate concern of safety but also addresses the broader context of the patient’s mental well-being.

While contacting law enforcement could be appropriate in a life-threatening situation, mental health intervention is critical since it addresses the patient’s immediate psychological needs and helps to de-escalate the situation. Consultation with social work is beneficial for support and resources, and documenting statements is a standard practice in nursing, but these actions may not provide immediate safety or mental health evaluation that the situation demands.