A client has confided to the nurse that she would prefer hospice care

A client has confided to the nurse that she would prefer hospice care to receiving further radical treatment for terminal pancreatic cancer.

The nurse observes that the client fails to share her wishes with her family during a discussion regarding future treatment plans. Ethically, the nurse should first:
1. Tell the family of the client’s expressed wishes
2. Privately ask the client if her wishes have changed
3. Inform the client’s health care provider of her wishes
4. Share with the client the importance of expressing her wishes

ANSWER

ANS: 2
In health care settings, clients and families are often on unequal footing with professionals be-cause of the client’s illness, lack of information, regression caused by pain and suffering, and un-familiar circumstances. An ethic of care places the nurse as the client’s advocate, solving ethical dilemmas by attending to relationships and by giving priority to each client’s unique personhood. Initially the nurse must clarify the client’s wishes.
The nurse may evidentially be a part of a discussion between client and family, but it is not the initial action ethically required of the nurse as the client’s advocate.
The nurse may intervene between the client and health care provider, but only after discussing the situation with the client and receiving her permission to do so.
If the client reaffirms her previously stated wishes, then it would be appropriate for the nurse to discuss the importance of stating those wishes to the family.