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Difficulty: Very hardLegal and Ethical Practice

A practical nurse (PN) makes a home health visit to an older adult client receiving palliative care. The client is alert and oriented, has a legally designated healthcare proxy, and possesses a valid out-of-hospital Do Not Resuscitate (DNR) order. During the visit, several situations arise. Which of the following actions by the PN demonstrate adherence to legal and ethical standards of practice? Select all that apply.

  1. Documenting the client's refusal to take prescribed oral palliative medications and immediately notifying the provider and supervising registered nurse (RN).Answer
  2. B
    Accepting a telephoned directive from the supervising RN to administer a newly prescribed intravenous (IV) push analgesic for breakthrough pain.
  3. C
    Delaying the report of suspected physical abuse by a caregiver until the next home visit to gather concrete evidence of the observed bruising.
  4. D
    Explaining the potential complications of a proposed palliative surgical procedure to the client before obtaining their signature on the informed consent form.
  5. E
    Reassuring a visiting neighbor who expresses concern by stating, 'I am not allowed to share specific details, but the client is resting comfortably today.'
  6. Refusing the healthcare proxy's demand to revoke the DNR order while the client remains alert, oriented, and capable of making independent medical decisions.Answer

Answer

The correct actions are documenting the competent client's refusal of oral medications and refusing the proxy's demand to override the competent client's DNR.
The correct choices demonstrate a thorough understanding of client autonomy and legal boundaries. A competent client always retains the right to refuse medications, and the nurse's duty is to document and report this refusal. Furthermore, a healthcare proxy's power is inactive while the client is alert and oriented, so the proxy cannot legally revoke the competent client's DNR order.

Step-by-Step Solution

1
Analyze the client's neurological status and legal rights.
The client is alert and oriented, meaning they retain full autonomy and decision-making capacity.
A healthcare proxy only has legal authority to make medical decisions when the client is deemed clinically incapacitated. The alert client's wishes and existing DNR cannot be overridden by the proxy.
2
Evaluate the medication administration request against the PN scope of practice.
Intravenous (IV) push medications are outside the standard PN scope of practice.
A PN must decline delegated tasks that exceed their legal licensure limits, regardless of whether the order comes from a physician or a supervising RN.
3
Assess the situations regarding mandatory reporting and confidentiality.
Suspected abuse requires immediate reporting, and speaking to a neighbor about the client's status violates HIPAA.
Nurses must report suspicions of abuse without waiting for concrete proof. Furthermore, acknowledging a client's medical status to an unauthorized neighbor, even vaguely, is a strict privacy breach.
4
Evaluate the informed consent process.
The provider must explain surgical risks, while the PN only acts as a witness.
It is legally outside the PN's scope to obtain initial informed consent or explain complications for a surgical procedure.

Key Concept

Legal and Ethical Practice in Practical Nursing (Scope of Practice, Informed Consent, Confidentiality, Client Autonomy, and Mandatory Reporting)
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Legal and Ethical Practice

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