Analysis Of A Nursing Case Study: Ethical And Legal Considerations

Defining the ethical issue

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.

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 haemoglobin level is in the low-normal range, 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 he

1. Clearly define the problem - Objectively note the ethical issue

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.

A 15 years old, Jessica thought she might be pregnant. Nurse (Sam) ethical issue is that Jessica doesn’t want anyone to know about it especially her mother. And suddenly Jessica’s mother came up and nurse (Sam) doesn’t get time to think what she need to say. This is the ethical principle of confidentiality.

According to Legislation in all states and territories, to define a minor as under 18 years, the consequence was to throw into uncertainty of assumption for adolescent youth were inadequate to create their own decisions regarding on medical care (WORCESTER, 2005, p.40). So, parents of young children are legally entitled to determine on what medical care their children need to taken action for their children’s in most appropriate way (Desai & Goel, 2018, p. 330). And nurse (Sam) should follow legal and make a right choose to talk with Jessica’s mother in a positive way.

So, as a nurse, is really important to care for patient and also accesses, examine, communicates effectively and respectful of her dignity, culture, values, beliefs and rights (‘Registered nurse standards for practice’ 2016).

In this case study, there are different ethical as well as legal issues that apply or that are relevant. Confidentiality versus truth telling are the first ethical principles in this case study. The principle of confidentiality states that the nurse should not share patient information to another healthcare provider or any other person without the consent of the patient. In this case study, the patient who is the pregnant girl has the requested the nurse not to tell the mother about it (Heale & Shorten, 2016, p. 7). The nurse should therefore stick to that. Truth telling on the other hand is an ethical principle that states that the nurse should share any relevant health information to those who have a right to know. In this case, the mother is a very close family member and therefore has the right to be told any information regarding the status of her daughter. Other principle include informed consent. This is where the patient has to decide what should be done regarding her health conditions. If the patient feels he or she should not be subjected to a particular mode of treatment, then the nurse should abide by that.

Negligence-Negligence according to ANC is defined as the act by healthcare professionals to accomplish the intended nursing intervention purposefully .In this case study, if the nurse fails to share the pregnancy status to the mother yet Jessica is only 15 years old, this would be regarded as negligence since the mother ought to know everything so that she can assist in providing home based care to the daughter.

Examining ethical and legal principles

In their day to day nursing practice, nurses are often faced by challenges regarding the numerous options available while taking care of the patients. Nurses are always in a dilemma regarding what should be done or what should not be done .A good example is in this case study where the nurse in the name of Sam seems confused.

In this case study, there are two important ethical dilemmas (Judkins-Cohn, Kielwasser-Withrow, Owen, & Ward, 2013, p. 36). The ethical dilemmas as identified in question one include confidentiality and truth telling. The two options available for Sam in this case is either telling the truth or respecting the request of the patient of not telling anyone about the pregnancy.

According to the ethical principles that were stipulated by the International Council of Nurses Code of Ethics for Nurses in 2012, confidentiality is one of them. Confidentiality states that the nurse should not conceal any patient information against his or her will .In this case study, the pregnant lady requested the nurse not to conceal the information to the mother. The nurse therefore has the option of not telling the mother according to the principle of confidentiality.

The second option is telling the mother the truth. There is an ethical principle of truth telling. This principle allows the nurse to provide any patient information to those people who have the right to know. The people who have the right include family member’s .In this case, the mother is a very close family member and should therefore be told everything regarding the pregnant status of her daughter.

The nursing profession is accompanied by different challenges. This challenges sometimes lead to medical dilemmas. A dilemma in nursing practice is where the nurse if faced with an issue and it becomes very difficult for them to make decisions .Like in this scenario, the Nurse Sam is in dilemma. There is a 15 year old who is pregnant and there is her mother. The patient does not want the nurse to disclose her pregnancy status to the mother.

Such situations always calls for critical thinking. That is why during our induction in the program, we were told that critical skills are very vital. According to this case study therefore, the nurse has two options. First of all, the nurse is supposed to tell the mother about the pregnancy of her daughter and secondly, the nurse is supposed to go by the request of the patient and fail to conceal her status to her mother.

Identifying options for addressing the ethical problem

As discussed earlier, there are different ethical principles and legal aspects that guides the decision making process by the nurses. Whatever decision the nurse makes must fall within the ethical principles that were stipulated under the International Council of Nurses (ICN) Code of Ethics for Nurses in the year 2012.

Confidentiality is one of the ethical principles that can assist the nurse to make one of the decisions (Preshaw, Brazil, McLaughlin, & Frolic, 2016, p. 492). Under this ethical principle, the nurse is supposed to only conceal the patients information only under her permission .If the patients feels or instructs the nurse that no one is supposed to be told anything concerning her health status ,the nurse should respect that. Like in this case study, the pregnant girl told the nurse that he should not let the mother learn of her pregnancy. The nurse therefore has no otherwise but respect that.

Truth telling is another important ethical principle that can assist the nurse to make a wise decision. Truth telling is an ethical principle that allows the nurse or rather any healthcare provider to provide patient information to people who have the right to know .The people who have a right to access patient information include the family members. Like an example in this case study, the mother to the patient has the right to be informed about her daughter’s health condition. Despite the attempts by the daughter to hide information, the ethical code of truth telling dictates the healthcare professional to conceal all the information to her.

In this scenario, I would forego the ethical principle of confidentiality and go by the truth telling option. After carefully thinking critically and evaluating the consequences, I would prefer to tell the truth to the mother about the pregnancy of her daughter. This is because the patient in this scenario is still young at only 15 years old. Chances are that she is not mature enough to make any meaningful request or decision (Boozaripour, Abbaszadeh, Shahriari, & Borhani, 2018, p. 15). At 15 years old, it would be very difficult for the girl to take good care of herself with the pregnancy. The mother would therefore come in handy at this stage. Failure to disclose the information might also lead to abortion by the girl which is also not ethical at all.

References

Boozaripour, M., Abbaszadeh, A., Shahriari, M., & Borhani, F. (2018). Ethical values in nursing education: a literature review. Electronic Journal of General Medicine, 15(3). doi:10.29333/ejgm/85500

Desai, M., & Goel, S. (2018). Child Rights to Prevention of Conflict With Law. Rights-based Direct Practice with Children, 323-338. doi:10.1007/978-981-13-0417-0_11

Heale, R., & Shorten, A. (2016). Ethical context of nursing research. Evidence Based Nursing, 20(1), 7-7. doi:10.1136/eb-2016-102514

Judkins-Cohn, T. M., Kielwasser-Withrow, K., Owen, M., & Ward, J. (2013). Ethical Principles of Informed Consent: Exploring Nurses’ Dual Role of Care Provider and Researcher. The Journal of Continuing Education in Nursing, 45(1), 35-42. doi:10.3928/00220124-20131223-03

Preshaw, D. H., Brazil, K., McLaughlin, D., & Frolic, A. (2016). Ethical issues experienced by healthcare workers in nursing homes. Nursing Ethics, 23(5), 490-506. doi:10.1177/0969733015576357

WORCESTER, S. (2005). Teens' Access to Confidential Care Predicts Gynecologic Care. Family Practice News, 35(18), 40. doi:10.1016/s0300-7073(05)71757-6