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Question

Difficulty: HardClient Rights and Advocacy

An older adult client receiving home health services for wound care presents with bilateral bruising on the upper arms shaped like handprints. The client, who lives with a primary caregiver who struggles with alcohol use, tearfully tells the visiting practical nurse, 'Please do not tell anyone about how I got these. If they find out, I will be forced into a nursing home and I would rather die.' Which action by the practical nurse correctly upholds legal and ethical advocacy standards?

  1. A
    Defer the decision to report the abuse to the supervising registered nurse (RN) and wait for a full psychosocial assessment.
  2. B
    Reach out to the client's other relatives to quietly arrange an alternative living situation to protect the client's privacy.
  3. Contact adult protective services immediately to report the suspected abuse regardless of the client's plea for secrecy.Answer
  4. D
    Interview the primary caregiver separately to gather definitive evidence of physical abuse prior to making an official report.

Answer

Contact adult protective services immediately to report the suspected abuse regardless of the client's plea for secrecy.
Nurses are mandated reporters for suspected elder abuse. This legal obligation supersedes the client's right to confidentiality and self-determination, even if the client explicitly requests that the abuse be kept secret. The nurse's primary advocacy role in this situation is ensuring the vulnerable client's safety through appropriate legal channels.

Step-by-Step Solution

1
Identify the client's physical findings and statements as indicative of suspected elder abuse.
Recognize that the situation falls under mandatory reporting laws.
Bruising shaped like handprints and statements expressing fear of the caregiver are strong clinical indicators of physical abuse.
2
Evaluate the conflict between the client's request for confidentiality and the nurse's legal obligations.
Determine that mandatory reporting laws override the client's right to privacy and self-determination in this specific scenario.
Vulnerable adult protection laws require healthcare workers to report suspected abuse to prevent further harm, regardless of the client's wishes.
3
Select the most appropriate advocacy action that complies with legal requirements.
Choose to contact adult protective services immediately.
This fulfills the nurse's legal duty as a mandated reporter and initiates the process of securing the client's safety without conducting an out-of-scope investigation.

Key Concept

Mandatory Reporting and Client Confidentiality Exceptions
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Topics

Client Rights and Advocacy

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