Professional Identity: Ethics, Legal Issues in Nursing Case Study

This case study delves into the ethical and legal complexities faced by a nurse, Sam, in a scenario involving a pregnant teenage patient, Jessica, who is brought to the emergency department after fainting. The core ethical dilemma revolves around confidentiality and trust: whether Sam should disclose Jessica's pregnancy to her mother, who is her legal guardian, despite Jessica's expressed desire for privacy. The case study explores the ethical principles of trust and honesty, and the legal principles of age and confidentiality, particularly within the Australian context, where the age of consent and confidentiality rights for minors vary by state. Sam has two options: respect Jessica's confidentiality or inform Mrs. Wilson. The assignment requires Sam to make a decision based on ethical and legal frameworks, considering the potential impact on Jessica's health, the nurse-patient relationship, and adherence to the International Council of Nurses' code of ethics. The solution emphasizes the importance of professional judgment, maintaining confidentiality, and the need for further testing to confirm the pregnancy before any disclosure. The student suggests a process of open communication with both Jessica and her mother, highlighting the ethical and legal responsibilities of nurses to act professionally and uphold ethical standards.

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PROFESSIONAL IDENTITY; ETHICAL AND LEGAL ISSUE IN NURSING
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Question 1
As stated by Dinc and Gastmans (2013), trust and confidentiality is a key factor in the
development of the nurse-patient relationship. Trust develops confidence in the patient that the
health practitioner will not reveal about his health condition other people. In the case study, the
patient, Jessica Wilson, have begun building trust with the nurse about her pregnancy. The nurse
had suspected that she is pregnant, though the nurse had not undertaken any test to confirm this
as Jessica had to be brought in the facility due to fainting. Besides, Jessica is worried about any
other person discovering the pregnancy especially her mother. Jessica’s mother comes in and
wishes to know the health condition of her daughter as she is the legal custodian.
The dilemma arises to Sam as to whether to breach the developed trust with her patient Jessica
and not to disclose the pregnancy to her mother, or break the trust and disclose the information to
Mrs. Wilson who has the right to know precise information about the health condition of her
daughter. Sam has to make his decision quickly. Keeping in mind that patient submission to
accurate information and compliance to medication depends on existing trust the health
practitioner and Mrs. Wilson is Jessica Wilson's mother and Jessica is not of legal age hence her
mother has all the legal rights to know about her medical condition.
Question 2
As conversed by Chadwick and Gallagher (2016), ethics are a set of values or principles that
guide the nurse in the health professional. Two of the ethical principles applying to the case
study are trust and honesty. As credited by Rørtveit et .al (2015), trust has been credited for long
as being a core ethical value that fosters nurse-patient relationship. In the case study, Jessica had
developed trust on Sum and had confided about the pregnancy. Jessica expected sum not to break
this trust and never disclose the information to anyone. Trust creates room for openness with the

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patient, friends and other family members. Trust also enables a nurse to develop good
communication skill; not only with the patient but with other health care providers. The other
ethical issue is honesty. After becoming a nurse, honesty is one of the ethical factors than one
must develop to assure becoming a successful nurse. Sam is faced with the ethical test of being
honest and giving out truthful and sincere information to Mrs. Wilson about Jessica's health
condition. A nurse being dishonest violates the trust that had been built between the patient-nurse
relationship.
The law, on the other hand, is a set of rules that govern behaviour in a society. Examples
of the legal principles that apply to the case study are Age and contest to confidentiality. In
Australia, a person under the age of 18 years is legally considered a minor. Jessica is 15 years of
age and hence a minor. Minors are not of legal capacity to make decisions of their own and
hence parents, or guardians, are consulted as to their custodians. Mrs. Wilson hence has the legal
right to the treatment for the best interest for Jessica. Treatment provided to minors calls for the
consent of their parent or guardian to treat the child to the best of the interest for the child.
Although the legal age of contest in given at 18 years of AGE, Alderman (2017), discuses that an
adolescent has also got automatic rights to confidentiality. However, this age changes from state
to state. Some State in Australia gives a teenager of as young as 14 is considered sober to contest
about his health without the contest of the parent. In Northern Territory is 14 years, in New
South Wales and South Australia on has an automatic right to confidentiality at 16 years while
this age remains to be 18 in any other part in the country.
Question 3
There are two options available to Sam;

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One of the options is to honour the confidentiality with Jessica and opt not to disclose the
pregnancy information to Mrs. Wilson. Legally, a health practitioner doesn’t have to discuss
your health status with the parent if you are maturity age- unless your safety is an issue. Another
point to support the option is that Jessica had been taken to the Emergency Department after
fainting and the health issue was on the hemoglobin level which was on a low range. About the
International Council of Nurses (2012), a health practitioner is supposed to inhibit
professionalism, a nurse should not carry out any health practice or a test without the contest of
the victim. With this basis, Sam is not on the capacity to discuss the pregnancy as he has not
carried a test to support the postulations. One of the element international code of nursing is
nursing and people. Here, a nurse responsibility is to provide nursing care in an environment
which values human rights, values, and customs. Here, Sam has the ethical responsibility to
provide health care to Jessica while maintaining friendliest environment achievable. If he
discloses the pregnancy issue to Mrs. Wilson, she may be upset and mayhem and chaos may
arise creating a scene. This will not provide the best environment to provide healthcare for
Jessica. A nurse should hold confidence for information for any personal information given by
the patient.
The other option is for Sam to disclose the Pregnancy speculation to MR. Wilson. We have
identified Mrs. Wilson as Jessica's custodians since she is not of legal age yet (depending on
State). In this consideration, the international code of ethics, (2012) calls for a nurse to provide
accurate, sufficient as well as timely information to the client in a manner that is culturally and
ethically appropriate with the treatment. Sam may disclose the pregnancy issue to Mrs. Wilson
and even request to carry out further Test to Jessica if he thinks that the pregnancy may affect
Jessica health. As discussed by Lopez, et.al (2016), pregnancy hemoglobin levels can lower to up

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to 0·20–0·80 mg/L representing an anemic condition in pregnancy. In such condition, symptoms
such as in Jessica’s case can be observed since the body’s hemoglobin level is not in the position
to meet the body’s oxygen demands. If such is the case, Sam has no choice but to discuss the
issue with the parent to set goals to improve Jessica’s iron levels through optimal nutrition and a
healthy diet.
Question 4
Registered Nurses are required to make a sober judgment about the legal and ethical issues about
dilemma case in nurse practice. It is hence the Nurses wit and professionalism to develop a way
to solve these unavoidable cases. As a health practitioner, what you discuss with the patient
should be confidential and the health practitioner should not discourse this information to any
other person not even a parent without the contest of the patient. According to the International
Council of Nurses (2012), confidentiality is a vital concept in any healthcare provider; nurses
have the ethical and legal responsibility to maintain confidentiality. However, according to the
Australian law, a nurse can be forced to breach a patient's confidentiality in some cases as
discussed by Atkins et.al (2017). One reason is when the health of the victim or others is under
siege or is disclosed to do so by a judge or the court. In our case study, Jessica health may be at
siege if her health matter fails to be disused together with the parent. The nurse carries the
responsibility of personal accountability and maintaining competence.
In Sam's Position, I think I could also uphold trust and confidentially. However, I would try to
gamble my cards to discourse on the issue of pregnancy. Though Jessica was not brought into the
healthcare due to the pregnancy, this condition is of significance to her health issues of
hemoglobin levels. Hemoglobin levels are generally lowered during pregnancy and it is the role

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of health practitioner to set goals to boost the levels. But first of all, I need to carry on a test to
confirm if Jessica is pregnant. However, to do this, I need to get the patient contest so that I can
conduct a further test to her. After carrying on further test it can get clear as to whether Jessica is
pregnant.
The other point that was on the dilemma is on whether to discourse the information to her
mother. It is unethical to disclose the information to her mother without first talking to Jessica
and making your intentions clear as to why her mother needs to know about the health condition
so that she can also be in a better position to take care of her. First, when Jessica’s mother asks
what could have been causing the tiredness and stomach upset in her daughter for the last few
days, I think it could be ethical to just confirm that I don't attest to what to have been causing
these symptoms until further test are carried. After talking to Jessica on the issue of the
confirmed pregnancy and the need to discuss it with her mother, I would then disclose the
information to both Mrs. Wilson and Jessica.
Nurses have the responsibilities to practice ethically and legally. Also, nurse regulatory agencies
and employer bodies have set guidelines that call for a nurse to act in a professional manner
upholding legal an ethical standard. Also, the nurse should demonstrate professional values such
as respectfulness, trustworthy, compassion, and integrity.

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Bibliography
Alderman, E. M. (2017). Confidentiality in pediatric and adolescent gynecology: when we can,
when we can't, and when we're challenged. Journal of pediatric and adolescent
gynecology, 30(2), 176-183.
Atkins, K., De Lacey, S., Britton, B. and Ripperger, R., 2017. Ethics and law for Australian
nurses. Cambridge University Press.
Breymann, C., 2015, October. Iron deficiency anemia in pregnancy. In Seminars in
hematology (Vol. 52, No. 4, pp. 339-347). WB Saunders.
Chadwick, R. and Gallagher, A., 2016. Ethics and nursing practice. Macmillan International
Higher Education.
Lopez, A., Cacoub, P., Macdougall, I.C. and Peyrin-Biroulet, L., 2016. Iron deficiency
anaemia. The Lancet, 387(10021), pp.907-916.
Rørtveit, K., Hansen, B.S., Leiknes, I., Joa, I., Tested, I. and Severinsson, E., 2015. Patients'
experiences of trust in the patient-nurse relationship-a systematic review of qualitative studies.