Ethical and Legal Issues in Nursing: A Case Study on Confidentiality

This case study discusses the ethical and legal issues related to confidentiality in nursing, with a focus on a potential pregnancy in a 15-year-old girl. The article explores the NSW Health policy, the NMBA Code of Ethics, and the ICN Code of Ethics for Nurses. The author provides two options for the nurse in the case study and discusses the importance of confidentiality in healthcare.

Running head: CASE STUDY
Nursing Ethics
Name of the Student
Name of the University
Author Note

1CASE STUDY
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,

2CASE STUDY
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.
i. 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).
ii. 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

3CASE STUDY
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 (Nursingmidwiferyboard.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

4CASE STUDY
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.

5CASE STUDY
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

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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.