A client with terminal cancer says: 'I don't want my family to know how bad the pain is — they worry so much.' What does the nurse do?

PATIENT CONFIDENTIALITY AND PAIN MANAGEMENT:

Patient autonomy: The client has the right to control what medical information is shared with family — even at end of life; confidentiality does not end when prognosis is terminal.

Competing obligation: The nurse also has an obligation to ensure adequate pain management — if the client is suffering in silence, that is a care quality issue.

Therapeutic approach: Explore the client's concern ('Tell me more about what you're worried about when your family sees your pain'); problem-solve alternatives ('Is there a way we can manage your pain that wouldn't worry them as much?'); address the underlying fear (burden, family distress) rather than just the surface request.

Ensure adequate pain control: The request not to tell family does not mean accepting inadequate pain management — work with the client to address pain within their disclosure preferences.

Documentation: Document the client's expressed wishes about information sharing in the medical record.

Ethical balance: Patient autonomy is primary; the nurse advocates for the client's wellbeing while respecting their choices.