A nurse in an acute facility is assisting with the development of an in-service about reducing environmental stressors to improve client’s sleep. Which of the following instructions should the nurse include?

A) Autonomy: Autonomy refers to the right of individuals to make their own choices and decisions. While the nurse’s actions may promote the client’s independence in the future, the nurse’s promise to walk with the client does not directly address or uphold the client’s autonomy. The nurse is offering support rather than encouraging the client to make independent decisions about their participation in the exercise.

B) Fidelity: Fidelity involves being faithful and keeping promises or commitments. In this scenario, the nurse promises to walk with the client in the courtyard each day, and this promise demonstrates the ethical principle of fidelity. The nurse is demonstrating trustworthiness and loyalty by committing to help the client overcome their anxiety and follow through with the daily exercise.

C) Justice: Justice is the ethical principle that focuses on fairness and equal treatment for all individuals. While justice is important in providing equal care to all clients, it is not the primary principle in this scenario. The nurse’s actions focus on meeting the specific needs of the individual client, which is more aligned with fidelity.

D) Nonmaleficence: Nonmaleficence means “do no harm.” While the nurse’s goal is to prevent harm by helping the client address their anxiety, the primary ethical principle at play here is fidelity, as the nurse is keeping their promise to provide consistent support. Nonmaleficence would be more relevant if the nurse were directly addressing potential harm or risk associated with the client’s situation, but the promise to walk with the client focuses more on the nurse’s commitment.

A) Oucher scale: The Oucher scale is a pain assessment tool that is appropriate for children ages 3 to 12 years. It uses a series of photos depicting facial expressions that range from no pain to extreme pain. While useful for older children, it is not the most appropriate choice for an 8-month-old infant.

B) Visual Analog scale: The Visual Analog scale is typically used for children and adults who are able to understand and use numerical ratings or visual representations of pain. Since an 8-month-old infant is unable to verbally communicate or use this scale, it would not be suitable for evaluating their pain.

C) FLACC scale: The FLACC scale (Face, Legs, Activity, Cry, Consolability) is designed for infants and young children who are unable to verbally communicate their pain. It is ideal for assessing the pain levels of infants, as it evaluates observable behaviors like facial expressions, leg movement, and crying, which are indicators of pain in nonverbal children.

D) FACES pain scale: The FACES pain scale is typically used for children as young as 3 years old, but it requires the child to be able to identify and select facial expressions that correspond to their pain. An 8-month-old infant would not be able to engage with this scale, as it requires some cognitive development and understanding of emotional expressions.