Final answer:
Nurses should engage in therapeutic communication, involve the healthcare team and social work resources, and respect the principle of autonomy, ensuring informed consent is documented when a patient wants to leave against medical advice.
Step-by-step explanation:
If a patient who is alert and oriented expresses the intention to leave the hospital against medical advice, the nurse should take the following steps. Firstly, use therapeutic communication to understand the patient's concerns and provide comprehensive information about the potential risks of leaving prematurely. Next, involve the healthcare team, including consulting with a social worker or counselor, to seek collaborative input that might address the patient's concerns or offer suitable alternatives. Lastly, if persuasion is not successful, the nurse should ensure that the patient is making an informed choice by clearly explaining the consequences of their decision, which respects the principle of autonomy. Throughout this process, the nurse should also be aware of the legal and ethical framework within which they are operating and ensure that the patient's informed consent is documented.