A public health nurse is monitoring a client recently diagnosed with active pulmonary tuberculosis. The client states, 'I am stopping the prescribed antibiotics because they cause severe nausea. I forbid you from notifying the health department or my employer, as it will ruin my career. You are ethically bound to protect my privacy.' Which action should the nurse take?
- Inform the client that the diagnosis and treatment refusal must be reported to the public health department.Answer
- BMaintain the client's confidentiality but instruct them to implement strict droplet precautions to prevent transmission.
- CHonor the request for confidentiality, prioritizing the client's immediate psychosocial comfort over external reporting.
- DProvide reassurance that privacy will be strictly protected, then covertly notify the healthcare provider.
Answer
The nurse should truthfully inform the client that their diagnosis and refusal of treatment must be reported to the public health department due to legal mandates.
The ethical principle of confidentiality is fundamental to nursing practice but is not absolute. It must be breached when a client poses a direct, serious threat to public health. Active pulmonary tuberculosis is a reportable infectious disease. Medication nonadherence increases the risk of community transmission and the development of drug-resistant strains. The nurse has a legal and ethical duty to report this to the public health department and must adhere to the principle of veracity by informing the client truthfully about this mandate.
Step-by-Step Solution
Key Concept
Limits of Confidentiality and Mandatory Reporting