92434 Professional Identity

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 Nurses and Midwifery Board Australia code of ethics and code of conduct.

1.Clearly define the problem - Objectively note the ethical issue that the nurse (Sam) must address

2.Examine the ethical and legal principles that apply to the case study

3.Identify 2 options available to Sam in addressing the ethical problem identified in question 1 as they apply to the International Council of Nurses (ICN) Code of Ethics for Nurses (2012)

4.Reflect on the options identified in question 3 and present a rationale as to which ONE of the options you would follow if you were in Sam’s position.

Answer 1

The case study deals with a client Jessica Wilson who has been admitted to the Emergency Department, following an event of unconsciousness at a school event. Potential pregnancy in a 15 year old girl is the major problem in this case scenario. Owing to the fact that adolescent pregnancies play a major role in creating a negative economic and social impact on the girl and her family, the case study comprised of a sensitive issue. Confidentiality refers to the protection of personal information against unsuitable disclosure (Martin 2014).

All clients shows an increased likelihood to see proper medical care and provide an honest account of their ordeals and symptoms, upon feeling comfortable, secure and respected.  Presence of a health system that is characterised by the presence of a strong confidentiality mechanism will likely promote confidence of the service user and reinforce her trust in the care services being provided (Peabody 2015). Not telling Mrs. Wilson about the probable chances of pregnancy is one major ethical issues that will be faced by Sam.

Answer 2

The NSW Health policy states that that if a particular patient is aged below 14 years, it is imperative to seek the consent and permission of the parent and/or guardian, prior to the administration of any non-emergency interventions. A child belonging to the age group of 14 years and above are provided the right to exert their approval and voluntary permission to their treatment, provided they are able to sufficiently appreciate and understand the potential benefits, nature and magnitude of the intervention that is intended to be administered (NSW Government Health 2005). However, under situations as the case scenario where the child was aged 15 years of age, it is judicious for the healthcare practitioners to seek the approval of the parent and guardian, unless an objection is placed by the client. In this case scenario, Jessica objected to disclosing her health status and risk of potential pregnancy to her mother Mrs. Wilson.

The age that is considered appropriate for a young person to provide consent to treatment, in an independent manner also depends on the severity of the presenting complaints for which treatment needs to be implemented, in comparison to the relative maturity levels of the patient. Furthermore, the legal principle governed by Pursuant to the Minors (Property and Contracts) Act 1970 also elaborates on the fact that under circumstances where a minor who is 14 years or above provides permission for self-treatment, no further claims can be made for battery or assault (NSW Government Health 2005). Furthermore, according to the Family Law Act, both parents gave equal responsibility of children aged below 18 years. These were some of the major ethical and legal issues encountered in the case study.

Answer 3

Sam has two options available.

1. Jessica’s mother should not be informed about the chance of potential pregnancy. This is encompassed by the code 1 ‘Nurses and People’ that emphasises on the professional responsibility of nurses to care for their clients who need help (ICN 2012). Holding personal information of the patient Jessica in confidence would be one major step that can be taken by Sam, for the betterment of the client. Sam should also take efforts to provide satisfactory information to Jessica for obtaining her informed consent to nursing care, besides giving her the right to refuse or select a treatment (ICN 2012).
2. Sam should inform Mrs. Wilson about Jessica’s health condition and the factors that might have contributed to it. This will be in accordance to the standards of practice namely, engagement in a professional and therapeutic relationship (code 2), developing a plan for nursing (code 5), provide safe and responsive nursing practice (code 7). Furthermore, according to the NMBA Code of Ethics, Sam should identify the capacity for the client for an informed and active participation in self-health care (gov.au 2018). This is governed by the basic principle of preserving the respect and dignity of all service users by taking into consideration their powerlessness and vulnerability. Valuing the legal and moral right of the client is another ethical practice that is expected of Sam.

Answer 4

Presence of a confidential relationship between the patient and physician is crucial for the free dissemination of health related information, which in turn is imperative for an optimal medical care (You et al. 2013). Only in a healthcare setting of trust and conviction, can a client share personal and sensitive information for enabling caregivers to comprehend the health stayus and treat accordingly. If I were in Sam’s place, I would apply the first option of maintaining confidentiality in relation to all the information that has been shared by Jessica. Confidentiality concerns are most often heightened during the adolescent period and act as major barriers to the path of receiving suitable healthcare (Watts et al. 2015). I would show compliance to the NMBA standards of practice for a registered nurse and would take all efforts for engaging in an effective communication with the client, while being respectful of her values, rights, and beliefs (2.2) (Nursingmidwiferyboard.gov.au 2018).

I would also try to advocate on behalf of Jessica in a way that is able to preserve her autonomy in relation to medical treatment and their disclosure (2.3). This would be followed by constructing effective care plans that I intend to administer on Jessica, in accordance to the goals, care priorities and expected actions (5.2) (Nursingmidwiferyboard.gov.au 2018).  This concept would expect me to uphold all confidential healthcare information. Thus, I would give Jessica the power to take a decision regarding the disclosure of her sexual relationship and current health status. Moreover, I would also abide by the codes of ethics, in the processing of recognising and respecting the rights of Jessica. While engaging her in the process of shared decision-making, I would ensure that she provides her consent to treatment. Thus, I would not disclose her health status to her mother. This would help me in building a trustworthy nurse-client therapeutic relationship. I would also respect the wishes of my client on with whom she wants the information to be shared. This will help me in preserving client privacy to an extent that it does not suggestively confront or threaten her health and safety. In other words, I would value the ethical management of patient information, by taking efforts to preserve the confidentiality and privacy rights of Jessica.

References

International Council of Nurses. 2012, ‘THE ICN CODE OF ETHICS FOR NURSES’, Retrieved from https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf 

Martin, J.F. 2014, ‘Privacy and confidentiality’, In Handbook of global bioethics (pp. 119-137). Springer, Dordrecht.

NSW Government Health 2005, Consent to Medical Treatment - Patient Information, viewed 7 September 2018, https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2005_406.pdf.

Nursingmidwiferyboard.gov.au 2018, Code of Ethics for Nurses in Australia, viewed 7 September 2018, https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx.

Nursingmidwiferyboard.gov.au 2018, Nursing and Midwifery Board of Australia - Professional standards, viewed 7 September 2018, https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx.

Peabody, F.W. 2015, ‘The care of the patient’, Jama, vol.313, no.18, pp.1868-1868.

Watts, M.C.N.C., Liamputtong, P. & Mcmichael, C. 2015, ‘Early motherhood: a qualitative study exploring the experiences of African Australian teenage mothers in greater Melbourne, Australia’, BMC public health, vol.15, no.1, p.873.

You, L.M., Aiken, L.H., Sloane, D.M., Liu, K., He, G.P., Hu, Y., Jiang, X.L., Li, X.H., Li, X.M., Liu, H.P. & Shang, S.M. 2013, ‘Hospital nursing, care quality, and patient satisfaction: cross-sectional surveys of nurses and patients in hospitals in China and Europe’, International journal of nursing studies, vol.50, no.2, pp.154-161.