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Question

Difficulty: HardEthical Practice

A nurse is assessing an 85-year-old client admitted to the medical-surgical unit for severe dehydration. During the assessment, the nurse notes multiple distinctive, bilateral bruises on the client's torso and upper arms in various stages of healing. The client tearfully confides that their live-in family caregiver caused the injuries but begs the nurse, 'Please do not tell anyone. I will have nowhere else to live if they are arrested.' Which of the following ethical and legal actions should the nurse take? Select all that apply.

  1. A
    Reassure the client that their disclosure will be kept strictly confidential to preserve the nurse-client relationship.
  2. Document the objective physical findings and the client's exact statements in the medical record.Answer
  3. C
    Delay filing an official report until a social worker can conduct a comprehensive psychosocial evaluation of the home environment.
  4. Explain gently to the client that healthcare professionals have a legal obligation to report suspected abuse to ensure their safety.Answer
  5. Initiate a formal report to the designated state adult protective services or regulatory agency.Answer
  6. F
    Delegate the task of questioning the family caregiver about the origin of the bruises to the unlicensed assistive personnel (UAP).

Answer

The nurse should accurately document the physical findings and statements, truthfully explain the legal obligation to report the abuse to the client, and immediately initiate a formal report to adult protective services.
The nurse must balance the ethical principles of nonmaleficence, beneficence, and veracity with strict legal mandates. While nurses generally uphold client confidentiality and autonomy, the law mandates healthcare professionals to immediately report suspected elder abuse to protect vulnerable adults from further harm (nonmaleficence). The nurse also has an ethical duty to demonstrate veracity (truthfulness) by gently explaining this legal obligation to the client rather than making false promises. Accurate, objective documentation of both the physical findings and the client's direct quotes is required to maintain the standard of care and support any subsequent investigations.

Step-by-Step Solution

1
Identify the core ethical and legal conflict presented in the clinical scenario.
The scenario presents a conflict between the client's request for confidentiality (autonomy) and the nurse's legal mandate to protect a vulnerable adult from harm (nonmaleficence).
Recognizing the competing ethical principles is essential for determining the legally and ethically sound course of action.
2
Determine the legal limits of confidentiality regarding vulnerable populations.
Mandatory reporting laws dictate that healthcare providers must immediately report suspected elder abuse, which supersedes the general duty of confidentiality.
Statutes designed to protect vulnerable individuals from imminent harm override a client's request for secrecy.
3
Select the nursing actions that align with evidence-based practice, ethical standards, and legal requirements.
The correct actions involve truthful communication (veracity), immediate reporting (nonmaleficence/legal duty), and precise, objective documentation.
These actions fulfill the nurse's professional obligations while prioritizing the immediate safety of the client.

Key Concept

Limits of Confidentiality and Mandatory Reporting of Elder Abuse
Estimated Time:1m 30s
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Topics

Ethical Practice

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