A patient being treated in an alcohol rehabilitation unit reveals ...

[BRWH]

A patient being treated in an alcohol rehabilitation unit reveals to the nurse, I feel terrible guilt for sexually abusing my 6-year-old child before I was admitted. Based on state and federal law, the best action for the nurse to take is to:
 
  a. anonymously report the abuse by telephone to the local child abuse hotline.
  b. reply, I'm glad you feel comfortable talking to me about it.
  c. respect nurse-patient relationship of confidentiality.
  d. file a written report on the agency letterhead.

Question 2

Several nurses are concerned that agency policies related to restraint and seclusion practices are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
 
  a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
  b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
  c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
  d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.

[covalentbond]

Answer to Question 1

ANS: A
Laws regarding reporting child abuse discovered by a professional during a suspected abuser's alcohol or drug treatment differ by state. Federal law supersedes state law and prohibits disclosure without a court order except in instances in which the report can be made anonymously or without identifying the abuser as a patient in an alcohol or drug treatment facility. Anonymously reporting the abuse by telephone to the local child abuse hotline meets federal criteria. Respecting nurse-patient confidentiality and replying, I'm glad you feel comfortable talking to me about it do not accomplish reporting. Filing a written report on agency letterhead violates federal law.

Answer to Question 2

ANS: A
Nurses are professionally bound to uphold the American Nurses Association (ANA) standards of practice, regardless of lesser standards established by a health care agency or state. Conversely, if the agency standards are higher than the ANA standards of practice, the agency standards must be upheld. The courts may seek to establish the standard of care through the use of expert witnesses when the issue is clouded.