An 87-year-old woman is brought to the emergency department for treatment of a fractured arm. On physical assessment, the nurse notes old and new ecchymotic areas on the client’s chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. Which is the most appropriate nursing response?

“Oh, really? I will discuss this situation with your son.”“Let’s talk about the ways you can manage your time to prevent this from happening.”“Do you have any friends who can help you out until you resolve these important issues with your son?” “As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay.”

Explanation.

The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with nonmedical personnel or the client’s family or friends without the client’s permission. Clients should be assured that information is kept confidential, unless it places the nurse under a legal obligation. Options 1, 2, and 3 do not address the legal implications of the situation and do not ensure a safe environment for the client.