Nursing Specialty: Analysis of Aged Care Safety and Ethical Dilemmas

This nursing assignment explores critical ethical and safety issues within the context of aged care. The assignment addresses two primary areas: elder abuse and patient confidentiality. The first part of the assignment examines the prevalence of elder abuse, discussing its causes, the role of nurses in addressing it, and the importance of adhering to the Aged Care Act and the Registered Nurse Standards for Practice. It highlights the challenges nurses face in recognizing and reporting abuse due to factors like understaffing, cognitive impairment of patients, and fear of retaliation. The second part of the assignment focuses on the ethical considerations of sharing patient information, emphasizing the importance of respecting patient privacy and confidentiality, as well as the ethical code of conduct for healthcare professionals. It discusses the dilemmas nurses face in balancing patient autonomy with the need to share information for optimal care, especially for patients with cognitive impairments. The assignment also includes a reflection on the learning experience, summarizing the key takeaways from the modules and identifying gaps in understanding, such as the detailed health risks associated with elder abuse. The document concludes by referencing relevant research and literature to support the analysis.

Running head: NURSING SPECIALTY
Nursing specialty
Name of the student:
Name of the University:
Author’s note

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Answer 1
In aged care, one of that major safety or legal issues that is seen is mainly due to
incidence of abuse in older clients. According to the Aged Care Act, it is the responsibility of
carers to maintain the rights and responsibilities of aged care such as well treating the client and
ensuring the highest quality of care by meeting all health and safety standards of care. However,
despite legislations and organizational protocol on aged care, prevalence of elder abuse and
neglect has become common (Yon et al., 2017). As a nurse, I explored this issue in my clinical
setting where many nurses did not had appropriate attitude towards caring for older adults and
they violated their core responsibility of providing safe, appropriate and responsive quality
nursing care according to the standard 6 of the registered nurse standards for practice (Registered
nurse standards for practice., (2017). Nurses were found to be irresponsive to address elder
abuse and report about such issues to relevant authorities.
The review of studies has revealed that elder abuse has become prevalent due to
understaffed nursing facility, lack of quality caregiver and other societal, cultural and familial
influence (Burnes et al., 2015).. In addition, Dong, X. Q. (2015) showed that risk of abuse
including physical, financial, emotional abuse and neglect is more in older women compared to
older men. Shared living, low income and presence of large family members also increase the
risk of financial, emotional and physical abuse. Another issue facing residential aged care in
Australia is that professional carers find it difficult to recognize signs of abuse and adequately
respond to them. Many staffs do not go ahead with reporting about abuse because of the increase
in risk to people due to cognitive impairment, physical frailty and fear of retaliation in elder
clients. In this situation, it is necessary nurse understand their professional role in safety of
patient and identify differential response to alleviate or prevent mistreatment of elder clients in

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health care setting. According to the position statement of the Australian College of Nursing on
the role of registered nurse in residential aged care facilities, the registered nurse should be
present on-site and available at all times to promote safety and well-being of residents. To reduce
the incidence of adult abuse, it is necessary for nurses to develop different skills mix such as
communicating with clients over difficult topics. The residential care homes or other health care
setting should also integrate adult protection principles in daily practice to ensure and develop
skills of nurses in recognizing and reporting about abuse in the right time.
Answer 2
In the process of treatment and delivery of care, nurses are often required to share
information with patients or other members to optimize the care process. However, there are
ethical considerations related to sharing of patient’s information. According to the ethical code of
conduct for health care professionals, all of them have the legal and ethical responsibility to
protect and respect the privacy and confidentiality of client (Haug, 2017). This is in relevance
with the ethical code of autonomy as it enables patient to decide how and with whom their
information needs to be shared. HIPAA also reminds regarding health information privacy and
suggest that health care professionals who have access to patient records have the obligation to
keep the information in confidence. This means clinicians as well as nurse need to advocate,
uphold and defend patient’s right to privacy while sharing patient’s information with others
(Prater, 2017). In addition, the right to privacy has links with patient autonomy as it states that
individual patients should be allowed to take their own decision regarding how information is
shared.

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Despite the implementation of legal and ethical standards for maintaining privacy and
confidentiality of client’s information, nurses are often confronted with challenges in complying
with the obligation. This risk is particularly seen when nurses have to look after older patients or
those with cognitive impairment who lacks decision making skills. In this situation, they face the
biggest dilemma of maintaining the safety of client as well as protecting the privacy of such
clients. To take decision for elder people with poor mental and decision making capacity, the
nurse have a critical role to balance the best interest of client.
Suzuki, C., Ota, K., & Matsuda, (2015) also points out that although ethics in information
sharing is long recognized while collaborating with other health care organization, however
staffs often experience challenges in the extent to which the information should be shared. One
of the most important dilemma for nurses is that whether they should give more priority to
protecting client confidentiality over the need to share important information with others or vice
versa. Other factors that cause conflicts for nurses in information sharing include abuse, mental
health problems and poor mental capacity of patient. Conflict mainly arose between autonomy
and right to beneficence of client. To balance both the obligation in nursing practice, it is
necessary to balance various interests in client information. Nurse and other health professional
must also contribute to following all organizational standards established for patient privacy and
confidentiality of patient information (Hutchinson et al., 2014).
Answer 3
The learning exercise for module 1 mainly gave the idea about legal or safety issues in
aged care due to the prevalence of elder abuse. The main knowledge gained from the exercise
was that elder abuse has become common and in clinical setting, it is mainly seen due to low

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staffing level and burden of other task in clinical setting. The review of research also pointed out
to the fact that identifying and responding to abuse becomes difficult for nurses due to the fear of
retaliation and vulnerability to harm in older clients. However, one gap in the task was that it did
not explained in detail about the health risk to older clients due to incidence of abuse. Hence,
gaining knowledge in this area will further motivate the nurses to understand why reporting and
responding to elder abuse is a critical responsibility. Considering the health related
consequences of abuse in elder adults, it can be said that both physical and psychological effects
are huge in affected people. Physical effects of abuse included sleep disturbances, susceptibility
to new diseases, exacerbation of existing health issues, sleep disturbance and physical pain. In
addition, the psychological effects of elder abuse included high level of stress and depression in
patients (Dong et al., 2013). A nurse who is sensitive to the consequences of elder abuse are
likely to take prompt response in both reporting and treating such patients.
The exercise done for second module mainly gave knowledge regarding ethical
obligations for health care professionals in maintaining privacy and confidentiality of client
information. The nursing dilemma in this context was also seen in people with poor mental
capacity and those having illness like dementia. This research points out to the need to improve
personal practice by building better nurse-patient relationship. Better interaction with patients
regarding decision making for sharing information is likely to minimize conflicts and balance the
needs of beneficence and client confidentiality in care too. The success of decision making
process in clinical practice is also dependent on nurse’s capability to understand patients need
(Campos & Graveto, 2009).

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Reference
Burnes, D., Pillemer, K., Caccamise, P. L., Mason, A., Henderson, C. R., Berman, J., ... &
Salamone, A. (2015). Prevalence of and risk factors for elder abuse and neglect in the
community: a population‐based study. Journal of the American Geriatrics Society, 63(9),
1906-1912.
Burnes, D., Pillemer, K., Caccamise, P. L., Mason, A., Henderson, C. R., Berman, J., ... &
Salamone, A. (2015). Prevalence of and risk factors for elder abuse and neglect in the
community: a population‐based study. Journal of the American Geriatrics Society, 63(9),
1906-1912.
Campos, D. C. F. D., & Graveto, J. M. G. D. N. (2009). The role of nurses and patients'
involvement in the clinical decision-making process. Revista latino-americana de
enfermagem, 17(6), 1065-1070.
Dong, X. Q. (2015). Elder abuse: systematic review and implications for practice. Journal of the
American Geriatrics Society, 63(6), 1214-1238.
Dong, X., Chen, R., Chang, E. S., & Simon, M. (2013). Elder abuse and psychological well-
being: A systematic review and implications for research and policy-A mini
review. Gerontology, 59(2), 132-142.
Haug, C. J. (2017). Whose Data Are They Anyway? Can a Patient Perspective Advance the
Data-Sharing Debate?. New England Journal of Medicine, 376(23), 2203-2205.

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Hutchinson, K. M., Shedlin, M. G., Gallo, B., Krainovich-Miller, B., & Fulmer, T. (2014).
Ethics‐in‐the‐Round: A Guided Peer Approach for Addressing Ethical Issues Confronting
Nursing Students. Nursing education perspectives, 35(1), 58-60.
Prater, V. (2017). Confidentiality, privacy and security of health information: Balancing
interests. [online] Available at:
http://healthinformatics.uic.edu/resources/articles/confidentiality-privacy-and-security-of-
health-information-balancing-interests/ [Accessed 10 Oct. 2017].
Registered nurse standards for practice., (2017). Registered nurse standards for practice. [online]
Available at: http://file:///C:/Users/User00/Downloads/1773726_1981687386_Module1-
NMBAstandardracticeofr.PDF [Accessed 10 Oct. 2017].
Suzuki, C., Ota, K., & Matsuda, M. (2015). Information-sharing ethical dilemmas and decision-
making for public health nurses in Japan. Nursing ethics, 22(5), 533-547.
Yon, Y., Mikton, C. R., Gassoumis, Z. D., & Wilber, K. H. (2017). Elder abuse prevalence in
community settings: a systematic review and meta-analysis. The Lancet Global
Health, 5(2), e147-e156.