The Daughter's Secret, the Resident's Question, and Twenty Dollars
Mrs. Pruitt is alert, oriented, and makes her own decisions. Before visiting hours her daughter takes you aside and says, 'The doctor told us it's cancer. Don't say anything to Mom - we haven't decided how to tell her.' Later, while you are helping Mrs. Pruitt with her hair, she asks, 'You were talking to my daughter. Did the doctor tell her something he didn't tell me?' That afternoon she asks you to sign your name as a witness on a paper and offers you twenty dollars 'for your trouble.'
1. How do you respond to the daughter's request?
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Be kind and clear that you cannot take on that promise: 'I understand this is hard, and I'm not able to talk with your mother about her medical information - that's the nurse's or doctor's job. I also can't agree to keep information from her. Let me get the nurse so the two of you can talk about how she wants to be told.'
Reasoning: an alert, oriented resident is her own decision-maker; family do not acquire the right to control her information unless she has given that authority through proper legal documents managed by the facility. Promising secrecy would put you in the position of either lying to the resident or breaking your word, and discussing the diagnosis with family members is outside your role either way.
2. What do you say when Mrs. Pruitt asks whether the doctor told her daughter something?
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Neither confirm nor invent: 'I don't know what the doctor discussed with your daughter, and I'm not the right person to explain your medical information. I'll ask your nurse to come talk with you this morning.' Then actually tell the nurse, promptly, and stay with her if she is upset.
Reasoning: 'I don't know' is true and honest; 'there's nothing to worry about' is a lie that she may later discover, and it shuts down the conversation. Saying 'yes, they told her it's cancer' would be disclosing information you were never given and have no authority to share. The question itself is a signal of distress worth reporting the same shift.
3. What do you do about the witnessing request and the twenty dollars?
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Decline both, warmly and without judgment: 'I'm sorry, I can't sign as a witness on a legal paper - that's not something I can do in my role, and I can't accept money from you. I'll ask the nurse or social worker to help you with the paper.' Then report both the request and the offer to the nurse.
Reasoning: witnessing a legal document can suggest the resident was influenced by staff, and residents may later question whether the document was freely signed. Accepting a gift, especially cash, creates an obligation and looks like exploitation even when the intent is pure. Never sign, never accept, and document nothing about the gift without the nurse's direction.