Professional Identity 92434
Assessment 2: Case Study (40%)
Length: 1500 words
Intent: Registered Nurses are required to make sound judgements about legal and ethical issues that impact effective and safe patient care. This assessment is designed to assist students in the development of these skills through the identification, reflection on, and application of frameworks relevant to legal and ethical issues in nursing practice.
Task: Students are required to analyse a problem within the given case study and demonstrate their understanding of ethical and legal frameworks in order to provide proficient care. Sound judgement is critical to this task and requires students to give time and effort to reading and reflecting on the Nursing and Midwifery Board of Australia’s code of ethics and code of conduct.
Benefits of the assessment: This exercise is designed to help you develop your own capacity for making an informed, analytical and appropriate critical appraisal of the ethical texture of nursing practice. You develop these skills by building on your own current views through pre-class activities, reading, classroom discussion and reflection. It is important to use the readings (evidence) to SHAPE your thinking, however it is YOUR thinking about the situation that is important and how you apply the evidence to support your thinking. We want you to be a credible participant in the argument and not merely a reporter of what others have said.
Read the following scenario carefully and provide an analysis of the case by answering the questions that follow.
Jessica Wilson, fifteen years old, has been brought into the Emergency Department by ambulance after fainting during a cross-country event at school. Jessica’s mother has been notified by the school and is on her way from work.
On assessment, Jessica’s observations are within normal limits and her haemoglobin level is 125 g/dL, which is considered in the low-normal range (normal range: 120 – 160 g/dL). Therefore, the Registered Nurse (Sam) asks Jessica several questions to help determine why this may be and to determine why Jessica might have fainted. These questions include whether Jessica has eaten breakfast, whether she eats iron-rich food, whether she is menstruating and whether she is sexually active.
During this time, Jessica becomes upset and confides to Sam that she thinks she might be pregnant but that she does not want anyone else to know, especially her mother.
After further questioning, it becomes clear to Sam that Jessica has no clear idea of what she is going to do about the suspected pregnancy.
Before Sam could begin to think the situation through, Mrs Wilson arrives at Jessica’s bedside and is concerned for her daughter. Mrs Wilson informs Sam that Jessica has been very tired lately and has had an upset stomach the last few days. Mrs Wilson asks Sam ‘Do you have any idea what could have caused this?
As Sam prepared to respond to Mrs Wilson, Jessica remained silent and glared at Sam.
Case Study Questions
Having read the scenario on page 1, please answer the following questions:
Question 1 Ethical issue Sam must address
Ethical dilemmas or issues may conflict with the nurse’s ethical values or Code of Ethics. Four ethical considerations that nurses must comply with are justice, beneficence, autonomy and non-maleficence. In the adopted case study, Jessica’s mother Mrs Wilson has no idea about the reason why Jessica fainted. Jessica speaks to Sam that she might be pregnant but she does not want to share this information with her mother.
Sam might experience dilemmas whether she should disclose about the health condition to her mother or not to respect client’s right to privacy while promoting the welfare of the client as trust is the key to nurse-client relationship and thus do not share confidential information without Jessica’s consent. Jessica is a school student and she is able to make informed consent thus should be considered for the same right to confidentiality as adults. By maintaining confidentiality Sam may feel ethical issues whether to comply with the principle of Respect for autonomy as well as conduct statement 5 that recommends to consider personal information as confidential and private (Nursing and Midwifery Board of Australia, 2010). In contrast, health and wellbeing of the care user is of highest goal for nurses, if the health status of Jessica is not shared with her mother, she might be in trouble in making right decision and carrying on her treatment further.
Question 2 Ethical and legal principles
Different ethical principles that are applicable to the given case study are Fidelity, Accountability, and Autonomy. According to the principle of Fidelity, nurses must keep their promise and be true to their responsibilities and professional promises while providing safe, high standard care in efficient manner (Judkins-Cohn, et al., 2013). As per the given case study, Jessica wants Sam to keep the health information confidential especially from her mother as she is not willing to share those with her. Sam should remain true to her professional promises and responsibilities of maintaining confidentiality and thus comply with the principle of Fidelity.
Autonomy of the clients are ensured and promoted when nurses believe that clients are unique person who has right to have her own values, viewpoints, opinions and beliefs. Clients are encouraged by the nurses in making their own decision without any judgements (Kangasniemi, et al., 2013). Sam is likely to respect Jessica’s perceptions, opinions, values and beliefs as she is a unique person and possess all the rights of having her own opinions and that should be respected. Nurses also should accept responsibility of her own activities as per the principle of Accountability. Nurses should accept all outcomes that may derive from their actions. Therefore in compliance with the ethical principle of Accountability, Sam is likely to remain accountable and accountable of her action of not disclosing health related information with Jessica’s mother. Nurses are legally obliged to protect the privacy of health care consumers. Personal information should be protected in line with the Privacy Act 1988 in combination with the Guidelines to the National Privacy Principles 2001 (Code of conduct for nurses, 2018). Nurses are bound to adhere to the National Law and follow relevant laws in their practice and NMBA Guidelines. Nurses are obligated to respect the decisions made by the care users even if the decision is different than the decision that nurse considers appropriate. Nursing professional should protect the dignity and equal right to every human being and promotes universal human rights.
From the ethical perspective, trustworthiness especially between nurse and patient to achieve a collaborative and patient centred care practice are significant. In the given case study, confidentiality is the most important principle that is applied so that effective professional relationship and dependability develops between Jessica and Sam. Strong patient-nurse relationship will facilitate the health care consumers in sharing their health needs, different others vital aspects that will help in providing accurate care provision (Nursing and Midwifery Board of Australia, 2015).
Question 3 Identify 2 options
In accordance with the ICN Code of Ethics for Nurses (2012), Sam can address the ethical dilemma by upholding the needs of people requiring nursing care. In the given case study, Jessica needs care and she is reluctant to disclose her health related information to anybody, even her mother. Nurses should respect human rights, customs, values and beliefs of the people. Every individuals has right to access fundamental human rights while promoting the principle of “Nurses and people” ICN Code of Ethics for Nurses (2012). Confidentiality is one of the human rights that Jessica has asked for. The personal information are known to Sam and using her judgement she decides whom to share the information.
The nurses also should demonstrate professional values such as trustworthiness, responsiveness and respectfulness towards Jessica’s opinion of maintaining confidentiality of the health information (Australian Nursing and Midwifery Council, 2010). By respecting Jessica’s opinion of confidentiality, Sam would demonstrate her professional values such as respectfulness, responsiveness and trustworthiness. Such supportive attitude from Sam would encourage Jessica in developing more dependability on her resulting in more effective professional nurse-client relationship. Nurse-client relationship facilitates in effective treatment and care to the health care consumers that is likely to have positive impact on the health conditions of Jessica.
Another option that Sam may opt in addressing her ethical issue is discuss the health issue of Jessica with her mother so that the health care consumer can avail need based care support from care providing professionals as well as help her in managing the situation. Since Jessica is a school going girl, health related issues if not discussed with her mother may have negative outcome in future if some complications arises. By discussing the health related matters with Jessica’s mother Sam will be facilitated in supporting safe and healthy care plan. Jessica’s mother will help her in managing the situation as well support her in all possible manner.
Discussing the health related and mental aspects with Jessica’s mother, not only will help Jessica in managing the situation more efficiently with her mother’s support but this will also help care providers in developing an accurate health and wellness plan that meet Jessica’s health needs. Maintaining confidentiality although will help Sam in planning better care for Jessica, might not be possible if not discussed with her mother. Here Jessica’s safety and wellbeing is of highest significance and this option will help Sam in ensuring that these aspects are achieved.
Question 4 Rationale of selecting one of the options
If I was in Sam’s position, I would follow, Jessica’s thought of keeping her health related information confidential and would not disclose to any other member not even her mother without her consent. Nurses in different situations face ethical dilemmas when children are reluctant to keep information confidential. However, it depends on the registered nurse’s judgement to identify the risks associated with the information if not shared with others, for example if the minor has severe infection and that may affect not only the are user but also a large number of population if adequate measure not being taken. In such situation, breach of confidentiality is justified in compliance with the ethical principle of Beneficence that is doing good and right for the sake of patient’s health and wellbeing and Nonmaleficence is to protect patient’s safety through effective communication (Mosadeghrad, 2014).
I believe that confidentiality is the key in providing health care support to care users. When care users finds that their personal health information will be kept confidential is fundamental health care facilities in Australia. Confidentiality ensures Statement 7 of Ethical code that is nurses should value ethical management of information (Australian Nursing and Midwifery Council, 2010). Ethical management of information includes respecting care user’s privacy and confidentiality. Studies have further demonstrated that confidentiality is the key factor to build effective nurse-client relationship with the care user. I understand that productive collaboration between nurse and care users facilitates in more success treatment and consequences. Mosadeghrad, (2014) further has shown positive behaviour change of the children and share their issues with parents at their comfortable time when their opinion of confidentiality is respected by the care providing professionals.
However, like Sam I also would experience ethical issue in the situation she is into as Jessica wants to keep health information confidential while she is a school student. However, she has ability to make decision for herself as she is a mature minor. Mature minor’s confidentiality is permitted when out is considered for their best interest. However it would be my duty and responsibility to persuade Jessica or allow me to inform her mother for her wellbeing and health concerns (Australian Open Disclosure Framework, 2014). However if health issue demands that Jessica’s information needs to be shared to her parent in case she is affected by any infectious disease and that may threaten her as well as other’s life or the health conditions that she is into also may have detrimental impact on her health. In such circumstances I would breach principle of confidentiality for improved health and wellbeing of the care user.
Australian nurses are obligated to comply with conduct statement 5 of Code of professional conduct that states that nurses should keep personal information as confidential and private (Australian Nursing and Midwifery Council , 2010). However being in Sam’s position I would disclose health information of Jessica to health care team in order to provide competent care. However I would seek consent where practicable before disclosing the information to other staffs as Jessica has urged to maintain confidentiality. Despite of discussing the importance of disclosure of health information, Jessica is not willing to share the information with anyone while it may have detrimental impact in her as well as other’s health conditions, I would use my professional judgement about the importance of disclosure of information in regards to safety, health and wellbeing of the care user (Nursing and Midwifery Board of Australia, 2007).