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Difficulty: EasyEthical Practice

A community health nurse is evaluating an older adult client who has unexplained, thumb-shaped bruises on both upper arms. The client appears fearful and avoids eye contact when the primary caregiver is present. The caregiver insists the client is just clumsy and falls frequently. Which of the following actions demonstrate appropriate ethical practice and client advocacy by the nurse? Select all that apply.

  1. Report the suspected abuse to the appropriate adult protective services agency.Answer
  2. Interview the client in private, separate from the primary caregiver.Answer
  3. Document the objective physical findings and the client's behavior accurately in the medical record.Answer
  4. D
    Delay reporting the findings to authorities until definitive proof of intentional harm is established.
  5. E
    Ask the client why they are allowing the caregiver to inflict physical harm.
  6. F
    Confront the caregiver directly about the bruises to protect the client from further immediate harm.

Answer

The correct actions are to report the suspected abuse, interview the client privately, and accurately document the objective findings.
Nurses act as advocates for vulnerable populations. In suspected abuse cases, ethical practice dictates that the nurse must prioritize client safety by conducting a private assessment, strictly adhering to mandatory reporting laws based on suspicion alone, and maintaining objective, factual documentation.

Step-by-Step Solution

1
Identify the primary ethical concern presented in the scenario.
The client shows signs of physical abuse and fear of the caregiver, highlighting a need for advocacy and protection (nonmaleficence).
Recognizing vulnerability is the first step in applying ethical nursing principles.
2
Determine the appropriate, legally mandated nursing interventions.
The nurse must report the suspicion to protective services and document the objective evidence.
Ethical practice requires compliance with mandatory reporting laws designed to protect vulnerable populations.
3
Evaluate communication and safety strategies.
The nurse must separate the client from the caregiver to communicate safely and avoid non-therapeutic or confrontational approaches.
Protecting the client from immediate harm and avoiding victim-blaming are core components of therapeutic communication and ethical care.

Key Concept

Ethical Practice: Advocacy and Mandatory Reporting
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Topics

Ethical Practice

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