A resident in a skilled nursing facility for a short term rehabilitation following a hip replacement says to the nurse, "I don't want to have you draw any more blood for those useless tests." When the nurse fails to convince the patient to have the blood drawn, the most appropriate documentation would be:

A. 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.

Explanation: Even if the nurse's neighbor is considered a confidante, sharing specific patient information is still a breach of confidentiality. Healthcare professionals are obligated to follow strict guidelines regarding patient privacy, and sharing patient details with anyone outside the healthcare team, even if they promise not to share it further, is not ethically permissible.

B. The nurse is actively promoting nursing as a profession, and it is important to share information that might encourage others to pursue a nursing career.

Explanation: While it's positive for nurses to encourage others to pursue nursing, this should not involve sharing private patient information. There are many appropriate ways to promote the nursing profession, such as discussing the rewards of the job, the educational paths, or the impact nurses have on patient care. Patient confidentiality, however, should never be compromised in such attempts.

C. The nurse has violated the confidentiality of the patient by discussing personal information about the patient with his neighbor.

Explanation: This is the correct choice. As mentioned earlier, patient confidentiality is a fundamental ethical and legal principle in healthcare. Disclosing personal patient information to unauthorized individuals, even if unintentional or with good intentions, is a violation of this principle.

D. The nurse has not violated the confidentiality of the patient because the patient is terminal: sharing this information will not harm the patient.

Explanation: A patient being terminal does not change the rules of confidentiality. Regardless of a patient's condition, their right to privacy remains intact. Sharing information about a patient's terminal status without proper authorization is still a breach of confidentiality and is not considered ethical practice.

A. Evaluation:
Evaluation involves the assessment of a patient's response to nursing interventions and the effectiveness of the care plan. In this scenario, the nurse is not evaluating the patient's response to previous interventions but is rather in the process of conducting a new assessment.

B. Assessment:
This statement is correct. The nurse is in the assessment phase of the nursing process. She is collecting data by checking the patient's record, performing a physical examination (digital rectal exam), and noting the patient's complaint and signs of constipation (no bowel movement for three days, hard stool). Assessment is the first step of the nursing process and involves data collection to identify health problems and needs.

C. Nursing Diagnosis:
Nursing diagnosis involves analyzing the data collected during the assessment to identify actual or potential health problems. The nurse has not reached the stage of formulating a nursing diagnosis in this scenario; she is still gathering data.

D. Implementation:
Implementation is the phase of the nursing process where nursing interventions are carried out based on the nursing care plan. The nurse is not implementing interventions yet but is still in the process of data collection.