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Difficulty: HardEthical Practice

A 65-year-old competent client is recovering on the medical-surgical unit following a biopsy of a suspected malignant mass. The test results confirm terminal cancer. Before the healthcare provider discusses the findings with the client, the client's adult child pulls the nurse aside and states, "In our culture, we do not tell elders when they are dying because it destroys their spirit. Please tell my parent the tumor is benign." Shortly after, the nurse enters the room, and the alert client asks, "Did the results come back? Do I have cancer?"

Which of the following is the most appropriate ethical nursing action?

  1. A
    Inform the client that the tumor is benign, honoring the adult child's cultural request to preserve the client's hope.
  2. B
    State to the client, "Try not to worry about the test results right now; your priority should be resting and recovering."
  3. Acknowledge the client's request for information and immediately collaborate with the healthcare provider to facilitate a joint discussion of the results.Answer
  4. D
    Ask the unlicensed assistive personnel (UAP) to assess the client's psychosocial readiness to receive bad news before calling the provider.

Answer

The most appropriate action is to acknowledge the client's request for information and immediately collaborate with the healthcare provider to facilitate a joint discussion of the results.
The ethical principles of autonomy (the client's right to self-determination) and veracity (truth-telling) require that a competent client be informed of their medical status. While the family's cultural concerns should be approached with sensitivity, the competent client's direct question supersedes the family's request to withhold information. The nurse acts as an effective advocate by validating the client's inquiry and immediately collaborating with the healthcare provider. The provider must deliver the primary medical diagnosis, ensuring a coordinated and legally sound disclosure.

Step-by-Step Solution

1
Analyze the ethical conflict between the client's right to know and the family's request to withhold information based on cultural beliefs.
The competent client's right to veracity and autonomy takes precedence over the family's request.
Competent adults have a fundamental legal and ethical right to their own medical information to make informed healthcare decisions.
2
Identify the nurse's scope of practice regarding the disclosure of a new medical diagnosis.
The healthcare provider is responsible for delivering the initial medical diagnosis, while the nurse advocates, clarifies, and provides emotional support.
Delivering a new terminal diagnosis requires comprehensive medical knowledge to immediately address prognosis, pathology, and complex treatment options.
3
Evaluate the options to find the action that upholds the client's rights while maintaining professional boundaries and safe delegation.
Collaborating with the provider to facilitate the discussion is the best evidence-based action.
It ensures the truth is told by the appropriate interdisciplinary team member, rejects inappropriate delegation to unlicensed staff, and avoids non-therapeutic evasion.

Key Concept

Ethical principles of autonomy and veracity in the context of informed consent, interdisciplinary collaboration, and cultural competence.
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Ethical Practice

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