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Question

Difficulty: Very hardLegal and Ethical Practice

A surgeon completes an explanation of a bowel resection to an older adult client who has mild cognitive impairment. The surgeon then leaves the room, instructing the practical nurse (PN) to witness the client's signature on the informed consent form. The client looks at the form and says, "I will sign it, but I do not really understand what they are going to cut out." Before the PN can respond, the client's adult child forcefully grabs the client's hand, physically guides the pen to sign the document, and whispers threateningly, "If you do not do this, I am putting you in a state home." A neighbor who is visiting the room then turns to the PN and asks, "What kind of surgery are they having?" Which of the following is the most appropriate legal and ethical action for the PN to take?

  1. A
    Refuse to witness the signature and accept the surgeon's delegated task to re-explain the bowel resection until the client understands, before reporting the child's behavior.
  2. B
    Sign the consent form as a witness since the surgeon already completed the explanation, answer the neighbor's question using non-medical terms, and document the adult child's actions.
  3. C
    Halt the consent process, ask the neighbor to leave the room to protect privacy, document the physical coercion, and wait for confirmation from the social worker before filing an abuse report.
  4. Decline to witness the coerced signature, inform the neighbor that the client's information is confidential, and immediately report the suspected elder abuse to the nursing supervisor and state authorities.Answer

Answer

The practical nurse must decline to witness the coerced signature, maintain confidentiality by refusing to share information with the neighbor, and immediately report the suspected elder abuse.
The practical nurse must immediately halt the informed consent process because the client explicitly stated a lack of understanding and was physically coerced, rendering the consent legally invalid. Furthermore, the nurse must uphold confidentiality by refusing to disclose medical information to the visiting neighbor without the client's explicit permission. Most importantly, the adult child's physical threat and forced signature constitute elder abuse, which requires immediate, mandatory reporting to authorities and the nursing supervisor.

Step-by-Step Solution

1
Evaluate the validity of the informed consent process.
The consent is determined to be invalid.
The client explicitly stated a lack of understanding, and the signature was physically forced by the adult child, negating voluntary comprehension.
2
Determine the appropriate response to the visiting neighbor's question.
Refuse to disclose the requested surgical details.
The neighbor does not have explicit authorization to receive the client's protected health information, making disclosure a breach of confidentiality.
3
Identify the legal obligation regarding the adult child's abusive behavior.
Immediate reporting to the nursing supervisor and appropriate state authorities is required.
The physical coercion and threats constitute elder abuse, and the practical nurse is a mandated reporter who cannot delay notification.

Key Concept

The practical nurse must navigate intersecting legal duties by halting invalid consent procedures, strictly maintaining client confidentiality, and immediately fulfilling mandatory reporting requirements for suspected abuse.
Estimated Time:2m 0s
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Topics

Legal and Ethical Practice

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