A client on a general surgical unit tells a nurse that staff members are not answering the call light promptly. The client requests to be transferred to another unit. Which of the following actions should the nurse take first?

The correct answer is Choice D: Review the client's request with the family.

Choice D rationale: Reviewing the client's request with the family respects the client's autonomy and the directives stated in their living will. It allows the nurse to communicate and clarify the client's wishes with the family, helping them understand the decisions made by the client when they were competent. This action promotes open communication and may facilitate resolution of the conflict.

Choice A rationale: Inserting the tube and beginning feedings per the family's request disregards the client's living will, which explicitly declines the use of artificial enteral nutrition as a life-sustaining measure. This action goes against the ethical principle of autonomy and could have legal implications.

Choice B rationale: While asking the provider to discuss the issue with the family could be a subsequent step, it is not the primary action to take in this situation. The nurse should first review the client's request with the family to emphasize the importance of the living will and facilitate understanding between the parties involved.

Choice C rationale: Reporting the dilemma to the facility's dietitian does not address the ethical and legal concerns at hand. The dietitian's role is to manage nutritional needs, not to resolve ethical dilemmas or interpret legal documents such as living wills. Involving the dietitian may not be helpful in addressing the conflict between the client's wishes and the family's request.

Choice A rationale:

Notify the charge nurse of the client's request for transfer. This action might be taken eventually, but it is not the first step. The nurse should directly address the client's concerns before escalating the situation to the charge nurse.

Choice B rationale:

Assure the client that their concern has been shared with the staff. Tell the client that future calls will be answered in a timely manner. While it's important to reassure the client, promising timely responses to calls before understanding their expectations might not effectively address the underlying issue. It's better to communicate openly with the client first.

Choice C rationale:

Ask the client to verbalize their expectations. This is the correct choice. By asking the client to express their expectations, the nurse can gather crucial information about the client's concerns and needs. This allows the nurse to address the specific issues that led to the client's dissatisfaction and work toward a resolution that aligns with the client's preferences.