A psychiatric-mental health nurse is conducting an individual session with a 15-year-old client admitted for major depressive disorder. The adolescent reveals that a household member has been physically abusing them. The client becomes highly anxious and states, "Please do not tell anyone. I thought everything we talked about was protected by confidentiality laws." Which action should the nurse take?
- Validate the client's feelings while explaining that healthcare professionals are legally mandated to report suspected abuse, which is an exception to confidentiality.Cevap
- BPromise the client that the information will remain strictly confidential to maintain trust and preserve the therapeutic environment.
- CWithhold reporting the information until a thorough physical examination can be completed to gather objective evidence of the abuse.
- DDocument the disclosure in the electronic health record but wait until the client gives explicit permission before notifying child protective services.
Cevap
The nurse must inform the client that suspected abuse must be reported to protective services, as this is a legal exception to confidentiality.
HIPAA and professional nursing standards protect the vast majority of client health information. However, mandatory reporting laws require all healthcare professionals to immediately report suspected abuse or neglect of vulnerable populations (including minors, elders, and dependent adults) to the appropriate state authorities. This legal duty overrides the general rule of confidentiality. The nurse must be honest with the adolescent about the limits of confidentiality rather than making false promises that cannot be legally kept.
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Exceptions to Confidentiality: Mandatory Reporting