A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day.
The nurse interrupts the bath and obtains a healthy meal for the client.
This action by the nurse is an example of which of the following?

The correct answer is Choice D.

Choice A rationale: Documenting the event in the client’s progress notes is not the most appropriate action in this situation. The client’s progress notes should contain information about the client’s health status and care, not about staff behavior. Furthermore, documenting this incident in the client’s notes could potentially violate the client’s privacy if the notes are accessed by individuals who do not need to know about the incident.

Choice B rationale: Submitting an incident report to the risk manager is not the most appropriate action in this situation. Incident reports are typically used for events that have caused or have the potential to cause harm to a client, such as medication errors or falls. In this case, while the APs’ behavior is inappropriate, it has not caused harm to the client.

Choice C rationale: Informing the client of the APs’ actions is not the most appropriate action in this situation. Doing so could unnecessarily worry or upset the client. The nurse’s role is to advocate for the client and protect their privacy and dignity, which includes not sharing information about inappropriate staff behavior with the client.

Choice D rationale: Telling the APs to stop the conversation is the most appropriate action in this situation. The nurse has a professional responsibility to address inappropriate behavior by other healthcare team members. Discussing a client in a public area, such as the nurses’ station, is a breach of client confidentiality. The nurse should remind the APs of the importance of maintaining client confidentiality and direct them to stop the conversation.

The correct answer is Choice A. Notify the charge nurse about the situation.

Choice A rationale: This is the correct answer because the nurse should notify the charge nurse or the provider who is responsible for obtaining informed consent from the client. The nurse cannot obtain informed consent from a client who does not understand the purpose, risks, benefits, and alternatives of the procedure. The nurse should also respect the client’s right to refuse or withdraw consent at any time. By notifying the charge nurse or the provider, the nurse ensures that the client receives adequate information and clarification before giving consent.This is consistent with the ethical and legal principles of informed consent in nursing

Choice B rationale: This is incorrect because the nurse should not ask the client to sign the consent form anyway. This would violate the client’s autonomy and right to make informed decisions about their health. It would also expose the nurse and the provider to legal and ethical consequences for performing a procedure without valid consent. The nurse should ensure that the client understands the information provided and agrees to the procedure voluntarily. Asking the client to sign the consent form anyway would undermine the trust and communication between the client and the healthcare team.

Choice C rationale: This is incorrect because the nurse should not explain to the client that the procedure will help treat his diagnosis. This is not the nurse’s role or responsibility in the process of obtaining informed consent. The nurse should not provide information that is beyond their scope of practice or expertise. The nurse should also not persuade or coerce the client to agree to the procedure. The nurse should refer the client to the provider who can explain the rationale and evidence for the procedure and answer any questions or concerns the client may have.

Choice D rationale: This is incorrect because the nurse should not remind the client about the specifics of the procedure. This is not the nurse’s role or responsibility in the process of obtaining informed consent. The nurse should not repeat or restate information that the provider has already given to the client. The nurse should also not assume that the client has forgotten or misunderstood the information. The nurse should respect the client’s right to ask questions and seek clarification from the provider who can provide accurate and comprehensive information about the procedure.