A practical nurse (PN) is providing discharge instructions to a competent, alert client who is accompanied by their adult child. The client's medical record contains a signed authorization form permitting the facility to share health information with this child. While discussing the home medication regimen, the child suddenly asks the PN, "Did the admission blood tests show that my parent was using illicit drugs?" The client becomes visibly tense, looks away, and remains silent. What is the most appropriate action for the PN to take?
- Request that the child step out of the room briefly to privately confirm the client's wishes regarding this disclosure.Answer
- BDisclose the laboratory findings since the child is explicitly listed as an authorized recipient on the signed consent form.
- CInform the child that providing toxicology results falls outside the practical nurse's scope of practice.
- DState that admission laboratory results cannot be discussed because they are unrelated to the current discharge instructions.
Answer
The nurse should ask the child to temporarily leave the room so the nurse can privately ascertain whether the client consents to sharing this sensitive information.
Although the child is listed on the signed authorization form, a competent client retains the right to control their protected health information and can limit or revoke consent at any time. The client's non-verbal cues indicate acute discomfort with the question. By asking the child to step out, the nurse acts as a client advocate, providing a safe, private environment for the client to express their true wishes without coercion or pressure from the family member.
Step-by-Step Solution
Key Concept
Client autonomy and dynamic consent regarding protected health information