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.
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:
Ethical code of conduct
With the ramified economic changes, in the nursing practice and set code of conducts, ethical dilemmas are increasing. It is considered that for the ethical consideration nurses needs to comply with the beneficent, non-maleficence act and set autonomy in their nursing practice. However, in the given case, Jessica’s mother Wilson had no idea of Jessica being fainted. Jessica had word with same and she perhaps pregnant but does not want to share this information with her. At that time, Sam had a dilemma to describe whether she could disclose this information to her mother or respect the privacy of the patient to her only. It was the ethical dilemma whether she should respect the nurse privacy or should disclose the information to her mother (Kangasniemi, Vaismoradi, Jasper, & Turunen, 2013). It is analyzed that trust is the key to the nurse and client relationship and it should not be shared with the confidential information without Jessica's consent. In addition to this, she is a school student and she could make the informed decisions therefore, she is covered in the confidentiality of the information. Therefore, by maintaining the confidentiality, Sam may fall in the ethical dilemma in context with complying with the principle of the respect for set autonomy and confidentiality of the data. In this case, Sam had an issue that if the right information is not shared with her mother then it may be problematic to make the right treatment of the patient (Mosadeghrad, A., 2014).
There are several ethical and legal principle implicated in this case study it was evaluated that accountability, autonomy and ethical nursing code of conducts are the practice which needs to be followed by the nursing practitioners while handling the patients (Judkins-Cohn, et al. 2013). However, as per the principle of Fidelity, it is found that nurses should keep the promise and must reflect the true and fair information to the patient and their guardian. It helps in keeping the patient safe. In the given case, Jessica is having to the wish to keep her information confidential and should not be shared with her mother. However, in this case, Sam is bound to remain true and fair with her professional and maintain confidentiality to comply with the principle of Fidelity (Nursing and Midwifery Board of Australia, 2007).
It is found that Autonomy of the patients are promoted when the nurses believe that client is unique and has the right to have her value, perception, and viewpoints. Patients are encouraged by the nurses in their own decisions without considering any judgments. It is found that Sam should respect Jessica's values perception belief and ideas as she is unique and possess the rights of her own decisions (Nursing and Midwifery Board of Australia, 2010). Nonetheless, all the nurses are bound to accountability, autonomy and ethical nursing code of conducts are the practice which needs to be followed by the nursing practitioners while handling the patients. Therefore, in compliance with the set code of conduct and accountability, all the personal information should be disclosed to her mother so that doctors and nurses could take the right treatment for her medical condition (Code of conduct for nurses, 2018). It is found that all the nurses are legally bound to the accountability, autonomy and ethical nursing code of conducts and at the same time they need to save the personal information of the patients as per the National Privacy Principles 2001. Therefore, all the nurses need to be adhered by these rules and keep the information safe and secure. However, nurses are also obliged to accountability, autonomy and ethical nursing code of conducts are the practice which needs to be followed by the nursing practitioners while handling the patients. Therefore, by assessing available ethical perspective, it could be inferred that Sam should disclose all the information to the mother so that Jessica could be treated better and effectively. This will set a strong patient ‘use relationship and give accurate care to her (Nursing and Midwifery Board of Australia, 2015).
After assessing the ICN Code of Ethics for Nurses (2012), it was found that Sam needs to address the ethical dilemma faced by patients in nursing care. However, in the given case, Jessica needs proper care and love and affection from her mother in this situation. Sam should respect the human rights and perception of Jessica but in context with the promotion of the principle for the nurse code of ethical conducts and practice, 2012, confidentially is the human right which Jessica is asking from Sam (Australian Open Disclosure Framework, 2014).
In this case, Sam needs to divulge his professional values considering the trustworthiness, accountability, autonomy and ethical nursing code of conducts if he wants to practice ethical nursing work in the hospital. If he keeps her information confidential then he might demonstrate professional values and trustworthiness. If it was done by Sam then such a supporting attitude might help Jessica for her recovery and her situation better. In addition to this, this might also have a positive impact on the health recovery program (THE ICN CODE OF ETHICS FOR NURSES, 2012).
In addition to this, another option which lays in Sam is addressing the ethical dilemma and disclosing the same information to Jessica’s mother. This will help doctors and nurses to take the necessary decisions and given the best treatment to Jessica (Australian Nursing and Midwifery Council, 2010).
In the given case, it could be inferred that since Jessica is just school going girl and if her health condition is not shared with her mother then it might negatively impact in future and may result to high complications. By disclosing all the information with her mother, it will help doctors and nurses to take the necessary decisions and given the best treatment to Jessica (Australian Nursing and Midwifery Council, 2010).
The health and mental related discussion with the mother of Jessica will not only help Jessica to handle the situation efficiently but also help the care providers in making an adequate wellness plan for the health of Jessica's mother. Although it will help Sam to plan better care for Jessica by maintaining confidentiality it might not be possible without discussed with her mother. In this situation, Sam is highly concerned about the wellbeing and safety of Jessica and ensuring to achieve these aspects.
If I was at Sam's place then I would keep Jessica's health-related information confidential and would not even discuss that with her mother without her consent. In different situations, the nurses suffer from ethical dilemmas when the patient wants to keep the information confidential. However, it depends on the situation as per which the nurse decides to reveal or to keep the information confidential. For example, if the patient is suffering from severe infection and that may affect a large number of people in case of non-adequate measures has taken then it is justified to perform a breach of confidentiality as per the ethical principle of beneficence. This principle allows you to do good and right in favor of the patient even without the consent of the patient and for the sake of the patient.
The confidentiality id considered as a key to take care of a care user. To keep the health information confidential as per the will of the patient is the fundamental health care facility in Australia. Statement 7 of Ethical code of confidentiality guides that nurses should value the ethical management of information. The ethical management of information involves maintaining the privacy and confidentiality of user's information. Studies say that confidentiality builds an effective nurse-client relationship but in my belief production collaboration plays a better role between them for more successful treatment and consequences (Code of conduct for nurses, 2018)
Here Sam was experiencing an ethical issue because Jessica is a school student and wants to keep her health information confidential. She can take her decisions as she has enough maturity. If it is best in the interest of minor then the confidentiality of information of mature minor is permitted. However, if Jessica has some serious health issue or suffering from some severe infection then it is my responsibility to inform her parents. Hence the issue which can threaten her life, as well as other's life, shall be shared with her parents. In these circumstances, the breach of confidentiality principle is justified for the improved health and wellbeing of the care user (Code of conduct for nurses, 2018)
As per statement 5 of Code of professional conduct, all Australian nurses are obligated to keep the personal information of care user as confidential and private. However, being in Sam's place I would prefer to discuss the information of Jessica with her parents to provide her complete medical care. I would also prefer to take prior consent before sharing her health information if possible. Here in such a situation, I would go with my professional judgment about the importance of disclosure of information in regards to safety, health, and wellbeing of the care user.