A newly licensed nurse is in the elevator with several other people, including two nurses from his unit. The nurses are discussing a client's medical condition.
Which of the following actions should the newly licensed nurse take first?

Choice A rationale

Lack of progress toward goals is a clinical indicator of the client's condition or the effectiveness of the care plan, not necessarily a sign of blurred professional boundaries due to over-involvement by the nurse. It suggests a need for care plan revision or reassessment.

Choice B rationale

Increased requests for assistance can be a normal part of a client's hospitalization, especially in prolonged stays, indicating evolving needs or dependency. It does not inherently suggest blurred professional boundaries but rather a need for careful assessment of the client's actual requirements.

Choice C rationale

Expressed feelings of isolation are a common emotional response to prolonged hospitalization. This indicates a need for psychosocial support and interventions to enhance social interaction, rather than being a direct sign of blurred professional boundaries initiated by the nurse's over-involvement.

Choice D rationale

The client starting to bring the nurse gifts and treats is a clear indication that professional boundaries have been blurred due to over-involvement by the nurse. This behavior often suggests a personal rather than professional relationship, potentially compromising objectivity and professional distance.

Choice A rationale

Paternalism in healthcare involves a professional making decisions for a patient without their full consent, often justified by the belief that it is for the patient's own good. This approach can override patient autonomy and self-determination, potentially leading to ethical conflicts regarding individual rights and the role of the healthcare provider in decision-making processes, contrasting with upholding directives.

Choice B rationale

Altruism describes a selfless concern for the well-being of others, often involving personal sacrifice. While nurses generally act altruistically, this principle specifically refers to the motivation behind an action, not the adherence to a legal or ethical directive regarding patient care, which falls under different ethical frameworks focusing on patient rights.

Choice C rationale

Autonomy is the ethical principle recognizing an individual's right to self-determination and independent decision-making regarding their own healthcare. By upholding the client's advance directive, the nurse is respecting the client's previously expressed wishes, even when the client is currently unable to communicate them, thereby honoring their right to choose.

Choice D rationale

Beneficence is the ethical principle that obligates healthcare providers to act in the best interest of their patients, doing good and promoting well-being. While providing artificial nutrition could be seen as beneficial, the specific act of upholding a pre-existing directive directly relates to respecting the patient's autonomous wishes rather than simply acting beneficially.