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Share information with the patient about other patients and why they are hospitalized. Sharing information about other patients violates confidentiality and does not help establish trust. This is unprofessional and goes against HIPAA guidelines.

Share his own personal experiences so that the patient gets to know him as a friend. Although occasional sharing of personal experiences may enhance rapport, extensive sharing can shift focus from the patient to the nurse, which is unprofessional and can create boundary issues.

Identify himself by name and title each time he introduces himself. Introducing oneself by name and title is essential, but it alone does not fully establish rapport. It is part of a courteous approach, but rapport-building requires deeper engagement.

Actions of the nurse are appropriate since his neighbor is his confidante, and the neighbor has assured him the information provided will not be shared. Confidentiality must be maintained regardless of assurances from others; sharing patient information outside a professional context is a violation of privacy.

Nurse has not violated the confidentiality of the patient because the patient is terminal; sharing this information will not harm the patient. Confidentiality must be maintained regardless of the patient's condition. Privacy and confidentiality are ethical requirements for all patients, terminal or otherwise.

Nurse is actively promoting nursing as a profession, and it is important to share information that might encourage others to pursue a nursing career. While promoting the profession is valuable, using a patient’s personal information is inappropriate and unprofessional. There are ethical ways to promote nursing without breaching confidentiality.

is packing belongings in preparation for discharge. Although discharge is an appropriate time for patient education, it may be too late to introduce complex information that requires practice or understanding. Teaching moments often occur earlier in the care process.

has just returned from surgery for a deviated septum. Immediately post-surgery, the patient may be under the influence of anesthesia or pain medication, limiting their ability to absorb information. Teaching at this time may not be effective.

has just been told of the malignancy of his tumor. Right after receiving bad news, patients may experience shock, grief, or distress, making it difficult for them to process additional information. This may not be the right time for education.

wrings her hands and paces around the room while denying that she is upset.This example reflects incongruence. The patient's body language (pacing, wringing hands) suggests anxiety or distress, which does not match her verbal denial of being upset.

states she is comfortable while she frowns, and her teeth are clenched.This example also reflects incongruence. Her facial expression and clenched teeth contradict her statement of comfort, indicating her communication is not aligned.

smiles and laughs while speaking of feeling lonely and depressed.This example reflects incongruence. Smiling and laughing contradict the verbal expression of loneliness and depression, indicating a mismatch in her communication.

"I don't feel like walking today either."This response shifts the focus from the patient to the nurse and does not encourage further discussion about the patient's reluctance or explore the reasons behind it.

"You have to walk today."This statement sounds forceful and dismissive, and may make the patient feel pressured rather than supported. It does not invite dialogue or provide understanding.

"Why don't you want to walk today?"This question can sound judgmental and may put the patient on the defensive. A more neutral response would help the nurse understand the patient's reluctance without pressure.

"Blood not drawn because tests are no longer desired by patient."This statement is vague and lacks specific details regarding the patient's exact refusal and the communication with the doctor.

"Doctor notified of failure to draw ordered blood work."This documentation lacks the reason for the blood draw failure (patient refusal) and omits the patient’s specific wording.

"Refuses to have blood drawn. Doctor notified."Although this documents the refusal and the doctor’s notification, it omits the patient’s exact words, which can provide additional context for the healthcare team.

"Blood not drawn because tests are no longer desired by patient."This statement is vague and lacks specific details regarding the patient's exact refusal and the communication with the doctor.

"Doctor notified of failure to draw ordered blood work."This documentation lacks the reason for the blood draw failure (patient refusal) and omits the patient’s specific wording.

"Refuses to have blood drawn. Doctor notified."Although this documents the refusal and the doctor’s notification, it omits the patient’s exact words, which can provide additional context for the healthcare team.

Motivated to learn about the health problem of this patient and is appropriately seeking knowledge during his clinical experience.Accessing information without being the assigned caregiver is inappropriate, regardless of motivation, as it breaches confidentiality and privacy protocols.

Doing appropriate research about nursing care as long as information is not divulged. Even without sharing information, accessing a patient’s chart without need-to-know status is a privacy violation and does not constitute appropriate research.

Neglecting the assigned patient load and should read the unassigned patient’s medical record only after his assigned work is completed.Reading an unassigned patient’s record, even after finishing other duties, is still a breach of confidentiality.

Defensive responseA defensive response would involve protecting oneself or one's position rather than addressing the patient’s concerns. The nurse’s statement here is more dismissive than defensive.

Asking probing questionsProbing questions would involve persistent questioning, which does not apply here, as the nurse is not asking questions but making a dismissive comment.

Changing the subjectChanging the subject would involve diverting attention to an unrelated topic. The nurse here is not introducing a new topic but is using a cliché instead.

interrupting frequently.Interrupting can make adolescents feel disrespected and unheard, which may hinder effective communication and trust.

using active listening.Active listening is essential in communication, especially with adolescents, as it shows respect and builds rapport. The nurse should not avoid this.

offering advice.Offering unsolicited advice can lead to resistance or defensiveness in adolescents. It’s often better to guide them towards their own conclusions.