A nurse is caring for a client following a suicide attempt.
The client has a history of depression, substance abuse, and anorexia nervosa. Which of the following actions is the nurse's priority?

Choice A rationale:

While it's true that the nurse has released the client's information without their explicit consent, this action is justified under the duty to warn and protect.

This duty supersedes the general obligation to maintain confidentiality when there's a serious and imminent threat to identifiable individuals or the public.

In this case, the client's verbal threat to bomb a local church constitutes a credible and foreseeable risk of harm, necessitating the breach of confidentiality to protect potential victims.

Choice B rationale:

Although the nurse's actions may help to avoid malpractice charges by demonstrating responsible care and adherence to ethical obligations, this is not the primary reason for notifying the minister.

The primary goal is to avert harm and fulfill the duty to warn, not to shield oneself from legal liability.

Choice C rationale:

This is the correct answer. The nurse has acted in accordance with the duty to warn and protect, which is a legal and ethical obligation in healthcare.

This duty mandates that healthcare professionals take reasonable steps to warn potential victims and protect the public when a patient communicates a serious threat of harm.

Choice D rationale:

While confidentiality is a cornerstone of healthcare ethics, it's not absolute.

The duty to warn and protect allows for limited breaches of confidentiality when necessary to prevent serious harm, as in this case.

The nurse's actions align with ethical principles and legal requirements, even though they involve disclosing confidential information.

Choice A rationale: The statement “My arms often feel weak and spastic” does not indicate obsessive-compulsive disorder (OCD). This could be a symptom of a physical condition or a different mental health disorder, but it does not align with the common symptoms of OCD. OCD is characterized by unwanted, recurring thoughts and repetitive behaviors.

Choice B rationale: The statement “I check where my car keys are ten times” is indicative of OCD. One of the key symptoms of OCD is the need to check things repeatedly due to persistent, unwanted thoughts and fears. The individual may check something over and over again, such as whether the door is locked or where their car keys are, even if they know they’ve already checked. This behavior is a compulsion - an act the person feels compelled to perform to alleviate the distress caused by the obsessive thought.

Choice C rationale: The statement “I’m embarrassed to go out and speak in public” could be indicative of social anxiety disorder, not OCD. Social anxiety disorder is characterized by a fear of social situations and interactions, particularly those involving the possibility of scrutiny or judgment by others. While people with OCD can also have social anxiety disorder, embarrassment about going out and speaking in public is not a typical symptom of OCD12.

Choice D rationale: The statement “I keep reliving a car accident almost every day” is more indicative of post- traumatic stress disorder (PTSD) than OCD. PTSD is a mental health disorder that can develop after experiencing or witnessing a traumatic event, such as a car accident. Symptoms of PTSD include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event. While people with OCD can have intrusive thoughts, these thoughts are typically related to themes like contamination or orderliness, rather than reliving past traumas.