Nursing Ethics: Case Study Analysis of Adolescent Pregnancy Dilemma

This case study examines the ethical dilemmas faced by a registered nurse (Sam) when dealing with a 15-year-old pregnant girl (Jessica) who does not want her mother to know about her condition. The analysis focuses on the ethical principles of autonomy, beneficence, non-maleficence, and confidentiality, as well as relevant legal frameworks in New South Wales. Sam must decide whether to respect Jessica's wishes for confidentiality or involve her mother in the care process, considering Jessica's capacity to provide informed consent. The solution explores two options: providing confidential care with Jessica's informed consent and involving her mother in the care process. Ultimately, the analysis suggests that obtaining informed consent from Jessica and providing confidential care is the most suitable option, as it respects her autonomy and empowers her to participate in self-management. The paper concludes by emphasizing the importance of effective communication and providing adequate literacy to Jessica regarding safe sexual practices and adolescent pregnancy management. Desklib is a platform where students can find similar solved assignments.

Running head: PROFESSIONAL IDENTITY
PROFESSIONAL IDENTITY
Name of the student:
Name of the university:
Author note

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Question 1:
The case scenario involves adolescent pregnancy of a 15 years old girl, named Jessica
who had been brought to the hospital, in the emergency department after fainting during a cross
country event at her school. While the patient does not want her mother to know her pregnancy,
health professionals must inform her other regarding the pregnancy as she is not aware of the
consequences of the pregnancy. Taking a deep insight into the situation, the registered nurse
(Sam) must address the ethical issue or dilemma regarding disclosure of the information to her
mother. Kangasniemi, Pakkanen and Korhonen, (2015) suggested that its legal responsibility of
nursing professionals to assess the ability of the adolescents for providing consent of the
recommended medical treatment while providing care. The prime reason behind this is that
consent respect autonomy of the patient which is the ethical principle of the nursing
professionals. According to Australian law reform commission (2019), during disclosure of the
information, the consent must be obtained from the patient and if the patient refuses to give
consent, then professional must keep it confidential from her parents. Hence, registered nurse,
Sam must know how to act for the best interest of the Jessica by respecting the autonomy and
address two ethical issues 1) disclosing the information without the consent of the patient 2) not
informing her mother regarding pregnancy.
Question 2:
Following ethical as well as legal principle is a fundamental part of safe and responsive
nursing care, especially when the care involves the individuals who are not adults. In this
context, the NMBA code of ethics considered beneficence, accountability, justice, veracity, and
non-maleficence (Nursingmidwiferyboard.gov.au 2019). While providing care to mature minor
for the complex health conditions where mature minor lacks the capacity to understand the
issues, it is the moral duty of health professionals to follow NMBA Code of ethics and provide
best possible care to the patient for the beneficence of the patient (Bortoletto et al. 2018).
However, considering this case scenario, the registered nurse may be subjected to the ethical
conflict between non-maleficence and beneficence since wellbeing of the patient can be affected
if the registered nurse fails to provide best possible care by respecting autonomy. Hence,
considering the ethical principle, beneficence, Sam must provide the best possible care to the
patient. In this case, the legal obligation of the nurse is to obtain consent from the patient before

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involving the patient in the care process. According to New South Wales government of health
(2019), during the sensitive care provision as observed in this case study where Jessica is
unaware of the adolescent pregnancy and management process, parental involvement is
necessary for the beneficence of the patient under Children and Young Persons (Care and
Protection) Act 1998. In this context, Sam must assess the ability of Jessica for providing
informed consent by considering the understanding ability of the situation, age and impact of the
clinical treatment. The professionals are obliged to provide the best treatment by following the
ethical principle of beneficence and non-maleficence even against the will of the patient if the
patient lacks the ability (Rhode & Bergren 2017). However, in the case scenario, Jessica is 15
years old who can provide informed consent for her treatment. According to New South Wales
policy, a child aged 14 years and above may consent to their care if they can understand the
nature of the treatment and impact of the treatment and health professionals must respect the
autonomy of the patient if the patient refuses to disclose the information by following ethical
principle of nursing (confidentiality) (New South Wales government of health 2019.). Breaching
the confidentiality of the patient and disclosing the information not only breach ethical principle
but also subject patient to the potential harms. Hence, the registered nurse may breach the
autonomy and confidentiality of the patient while informing her mother.
Question 3:
In this current context, it is the duty of care of the professionals to provide best possible
care to the patient by following the ethical principle of beneficence, with or without the informed
consent of the care. Hence, two options are available for registered nurse for addressing ethical
issues.
1. Confidential care to the patient:
According to the International Council of Nurses Revised (2012), the nursing
professionals must respect the autonomy of the patient and provide the best possible care to the
patient by obtaining informed consent from the patient. In New South Wales, under the Minors
(Property and Contracts) Act 1970, individuals of 14 years or above can provide informed
consent for the treatment due to developmental advancement (New South Wales government of
health 2019). Hence, in this context, Sam must Obtain informed consent from Jessica without

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any external influence and keep it confidential from her parents. Sam must provide her with
relevant information and provide adequate literacy to her so that she can understand the nature of
the treatment and obtain informed consent without the influence of external factors (Michaud
2017). After obtaining informed consent, Sam must provide confidential care to the patient under
the Privacy and Personal Information Protection Act 1998, which include literacy for the self-
management and keep the information of the patient confidential (Bourgeois, DesRoches & Bell
2018).
2. Involving the mother in the care process:
The case study highlighted that Jessica was unaware of adolescent pregnancy and
management of it which Sam identified after a long interrogation. According to the International
Council of Nurses (2012), it is the ethical and legal responsibility of nurses to ensure the best
interest of the patient and provide best possible care for beneficence and non-maleficence of the
patient. While providing care, nurses must reflect on being respectful, compassion,
responsiveness and empathy through their nursing practice (Hein et al. 2015). Hence, in this
context, Sam must provide the best care to the patient by involving her mother in the care
process and obtain consent from her mother on behalf of her. To involve her mother in the care
process, Sam must involve Jessica into communication regarding the present situation and need
for involving her parents in the care process (Matsumori 2019). Adequate literacy should be
given to her parents regarding why she is unaware of it and how to manage adolescent
pregnancy.
Question 4:
As discussed above, being a registered nurse, in order to resolve the ethical issues two
options are available to Sam. However, in order to provide the best safe and responsive care to
Jessica by following the ethical principle beneficence and justice, the most suitable option is
option one. This option not only resolves ethical issues regarding autonomy and confidentiality
but also empower patient for involving herself in the self-management (Matsumori 2019). The
rationale behind considering first option is that while not informing her mother may impact care
practice, obtaining consent from Jessica and providing confidential care restore privacy of the
patient and respect autonomy of patient (legal and ethical responsibility of the nurse) (Rhode &
Bergren 2017). As discussed above, during disclosure of the information, mature minors of 14

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years or more than 14 years have the rights to take their own decision apart without the influence
of parents if they have enough capabilities to understand the nature of the treatment (New South
Wales government of health 2019). In this context, it is the legal obligation of health
professionals to obtain consent from the patient and if the patient refuses to give consent, then
professional must keep it confidential from any third party (Lamont, Stewart & Chiarella 2019).
However, before obtaining consent, the professionals must assess the ability of the mature minor
to provide consent by understanding the nature of the treatment and impact of the treatment on
the patient. If the patient failed to show the capabilities to understand the health issues, treatment
and consequence of the treatment then health professionals must encourage parental involvement
and obtain the consent from the parents on behalf of the child for the best interest of the children
(Hildebrand et al. 2016). In this current context, the patient lacks the adequate literacy of the
adolescent pregnancy and management of the pregnancy. The long interrogation with Sam
suggested that while she was unaware of the pregnancy she refused to disclose the information.
Hence, Sam could choose the option two and involve her mother in the care process for the best
interest of the child but the ethical dilemma of disclosing information by breaching
confidentiality impact the common ethical practice of Sam (Jackson & Hutchinson 2015). At the
age of 15, she has the right to make her own decision and keep it confidential from her parents.
Therefore, Sam must obtain informed consent from her during the care process and provide
confidential care to the patient. It will not only empower patients but also respect her autonomy.
For providing the best confidential care, Sam must involve Jessica in effective communication
regarding the nature of the treatment. Sam must provide adequate literacy to the patient
regarding safe sexual practice and management of adolescent pregnancy (Hildebrand et al.
2016). In this way by providing confidential care the registered nurse respect the autonomy of
the patient and act according to the best interest of the patient and prevent her from possible
harm.

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