Hildegard Peplau came up with the phases of the nurse-patient relationship. What does the nurse address during the orientation phase with a patient diagnosed with a psychiatric disorder?

Choice A reason: Autonomy involves respecting a patient’s right to make decisions. While relevant in mental health, the scenario focuses on differing treatments for similar conditions, not patient choice, making autonomy less directly applicable than the principle of fair treatment across patients.

Choice B reason: Beneficence emphasizes promoting patient well-being. Both restraints and supervision aim to prevent harm, fulfilling beneficence, but the concern is about unequal treatment, not the intent to benefit, making this principle less relevant than justice.

Choice C reason: Justice involves fair and equitable treatment for all patients. Using restraints for one self-mutilating patient and supervision for another raises concerns about consistency and fairness in care, directly aligning with the ethical principle of justice, making this the correct choice.

Choice D reason: Nonmaleficence focuses on avoiding harm. Both interventions aim to prevent self-mutilation, fulfilling this principle, but the ethical issue is about equitable application, not harm avoidance, making justice the more relevant principle in this scenario.

Choice A reason: Suggesting the adolescent share with the psychiatrist avoids the nurse’s duty to report imminent threats. Ethical and legal standards require immediate action for safety, making this response inadequate, as it delays intervention in a potential crisis.

Choice B reason: Reporting a threat to harm others is a legal and ethical duty in psychiatric nursing, as it indicates imminent danger. Sharing with the team ensures safety interventions, aligning with mandatory reporting laws, making this the correct response.

Choice C reason: Discussing feelings is therapeutic but does not address the immediate safety risk of a threat. Prioritizing exploration over reporting violates ethical standards for managing dangerous behaviors, making this response incorrect in this context.

Choice D reason: Promising confidentiality in the face of a threat violates nursing ethics and legal mandates to report harm risks. This undermines patient and public safety, making it a non-therapeutic and incorrect response to a serious threat.