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Difficulty: MediumEthical Practice

A home health nurse is evaluating an older adult client with significant mobility deficits. The nurse notes unexplained, patterned bruising on the client's upper extremities. The client becomes visibly fearful when their adult child, who acts as the primary caregiver, enters the room. When the caregiver briefly steps away, the client whispers to the nurse, "Please do not report anything. It will only make my situation worse." Which of the following actions demonstrates the most appropriate ethical nursing response?

  1. Report the suspected maltreatment to the appropriate protective services agency despite the client's request.Answer
  2. B
    Honor the request for confidentiality since the client is alert and capable of making autonomous decisions.
  3. C
    Focus exclusively on treating the physical injuries before attempting to address the living situation.
  4. D
    Comfort the client by stating, "Do not worry, I will ensure that nobody hurts you ever again."

Answer

Report the suspected maltreatment to the appropriate protective services agency despite the client's request.
The correct action fulfills the ethical principle of nonmaleficence (doing no harm/preventing harm) and complies with the legal requirement of mandatory reporting. While nurses generally advocate for client autonomy and maintain confidentiality, these principles are limited when a vulnerable client's safety is at immediate risk due to suspected abuse.

Step-by-Step Solution

1
Analyze the ethical conflict presented in the clinical scenario.
The situation pits the principle of confidentiality (the client's request for secrecy) against nonmaleficence and legal obligations (suspected elder abuse).
Identifying the competing ethical principles is the necessary first step in resolving any clinical dilemma.
2
Determine the legal and ethical limits of client confidentiality.
Confidentiality is a fundamental ethical duty, but it must be breached when there is suspected abuse of a vulnerable adult.
Mandatory reporting laws override standard confidentiality agreements to protect clients who cannot protect themselves from ongoing harm.
3
Select the nursing action that fulfills both professional and legal obligations.
The nurse must report the objective findings of abuse to adult protective services.
Ensuring the safety of a vulnerable client and upholding the principle of nonmaleficence takes priority over maintaining absolute confidentiality.

Key Concept

Ethical Practice: Limits of Confidentiality and Mandatory Reporting
Estimated Time:1m 15s
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Topics

Ethical Practice

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