A patient incidentally shares with you that he has difficulty controlling his anger when around children because their play irritates him, leading to resentment and fantasies about attacking them. He has a history of impulsiveness and assault, escalates easily on the unit, and has a poor tolerance for frustration. This weekend he has an overnight pass, which he will spend with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brother because he usually helps her watch the children, and she has to work this weekend and needs him to babysit. The patient becomes visibly apprehensive upon hearing this. Which of the following responses would best reflect appropriate nursing practice relative to the

Question

conflict this situation presents between safety and the patient's right to confidentiality?

1. Cancel the pass without explanation to the sister, and reschedule it for a time when
babysitting would not be required of the patient.
2. Suggest that the sister make other arrangements for child care, but withhold the
information the patient shared regarding his concerns about harming children.
3. Speak with the patient about the safety risk involved in babysitting, seeking his
permission to share this information and advising against the pass if he declines to share
the information.
4. Meet with the patient's sister, sharing with her the patient's previous disclosure about his
anger towards children and the resultant risk that his babysitting would present.

Answer 1

Ans: 4. Meet with the patient's sister, sharing with her the patient's previous disclosure about his
anger towards children and the resultant risk that his babysitting would present.