A nurse is caring for a client who has bipolar disorder and is refusing to take prescribed medications. Which of the following ethical principles is the nurse displaying when supporting the client's refusal of medications?

Indicates potential Improvement a. Hygiene b. Food intake c. Rapid change in mood

Indicates potential worsening a. Giving away car b. Condition of skin on right hand

Choice A: Giving away car

This could be a sign of the client’s worsening condition. Giving away possessions can sometimes be a sign of suicidal ideation. It’s important to monitor this behavior and report it to the healthcare provider.

Choice B: Hygiene

The client showered without prompting on the third day, which is an improvement from the first day when they declined to shower. Improved personal hygiene can be a sign of improvement in a client with obsessive-compulsive disorder.

Choice C: Food intake

The client ate 75% of their meals on the third day, which is an improvement from the first day when they refused to eat. Increased food intake can indicate an improvement in the client’s condition2.

Choice D: Condition of skin on right hand

The client’s hands remain reddened with a 1 cm x 1 cm area of peeling skin noted on the center of the right palm. This could indicate a worsening condition, as it may be a result of excessive handwashing, a common compulsion in OCD.

Choice E: Rapid change in mood

The client’s affect rapidly changed throughout the afternoon and early evening; the client is now talkative and appears content. This could indicate an improvement in the client’s condition, as they are engaging more with others and showing more positive emotions.

Choice A reason: This response is appropriate because it respects the client's autonomy and comfort level. It is essential to acknowledge the client's feelings and preferences, especially when dealing with mental health issues like panic disorder. Massage therapy, while beneficial for some, may not be suitable for everyone, particularly if the idea of being touched exacerbates the client's anxiety. By offering to communicate the client's concerns to the provider, the nurse acts as an advocate for the client's well-being and ensures that the treatment plan is tailored to the client's specific needs and comfort.

Choice B reason: While this option might seem like a compromise, it does not address the client's fundamental discomfort with being touched. Wearing gloves may not alleviate the distress associated with physical contact for someone with panic disorder. It is crucial to consider the client's psychological state and the potential for gloves to serve as a reminder of the unwanted touch, possibly leading to increased anxiety rather than relief.

Choice C reason: Asking the client to explain their discomfort could be seen as dismissive of the client's stated boundaries and may put them in an uncomfortable position to justify their feelings. It is important for healthcare professionals to create a safe and supportive environment where clients do not feel pressured to defend their preferences or feelings, especially when they are already experiencing distress.

Choice D reason: This choice minimizes the client's concerns and could be perceived as invalidating their feelings. Telling a client not to worry about their anxiety, particularly in the context of a panic disorder, overlooks the complexity of the condition. Anxiety disorders can significantly impact a person's life, and reassurances like this may not be helpful and could potentially worsen the client's anxiety.