Nursing Ethics Case Study: Analysis of Ethical and Legal Issues

This case study presents a scenario involving a 15-year-old girl, Jessica Williams, admitted to the emergency department due to unconsciousness, with a potential pregnancy. The central ethical dilemma revolves around patient confidentiality, particularly whether to disclose Jessica's health status to her parents against her wishes. The analysis applies ethical principles, including the ICN Code of Ethics and relevant legal frameworks, such as the NSW Health policy on consent for minors and the Family Law Act. The student, playing the role of a nurse named Sam, considers establishing a therapeutic relationship with Jessica, respecting her autonomy, and advocating for her needs while adhering to the NMBA standards of practice. The case emphasizes the importance of balancing the rights of the adolescent patient with the responsibilities of healthcare professionals, highlighting the complexities of informed consent, privacy, and the nurse's role in patient advocacy.

Running head: NURSING ETHICS
Case Study
Name of the Student
Name of the University
Author Note

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Answer 1
A 15 year old girl Jessica Williams has been admitted to the Emergency Department,
following an event of unconsciousness at the cross-country program at her school. The major
problem in this case was related to possible pregnancy in a 15 year old girl. Teenage
pregnancies are associated with severe discrimination and stigma, in addition to threats
related to violence and poor health status. Jessica clearly stated her opinion of not letting
others, specifically her parents know about her qualms and uncertainties. Healthcare service
consumers should be able exert opinion regarding the medical care, without any influence of
a third person such as, family member and/or healthcare provider (Reach 2014). Safeguarding
the information shared by Jessica from her mother Mrs. Wilson is a matter of utmost concern
in the case. All healthcare consumers display more probability of seeking appropriate medical
care when they feel respected and secured. This makes them share an honest explanation of
their torments and signs (Kourkouta & Papathanasiou 2014). Therefore, efforts taken by a
nurse to foster a strong confidential relationship will possibly encourage self-assurance of the
service user and strengthen her faith in the care services being delivered.
Answer 2
The primary legal principle that can be applied to this case study is the Privacy Policy
formulated by the Department of Health. According to the health polict formulated by the
NSW, any healthcare consumer who is aged less than 14 years, does not have the right to
exercise self-opinions on any medical intervention or course of treatment, without the
guidance of parents. The policy makes it mandatory to seek the approval of guardian and/or
parents of adolescent patients (<14 years) before any form of treatment is implemented in the
healthcare setting (NSW Government Health 2005).

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Furthermore, children who have reached the age group of 14 years should be provided
with the right of exerting their informed consent and permission to any treatment or plan of
care that is utmost necessary for enhancing their health and wellbeing. However, it must be
ensured that the adolescent consumers have gained an appropriate understanding of the
nature, benefits and adverse effects of the proposed treatment, prior to providing their
informed consent (NSW Government Health 2005). Clinical events as this case study where
the patient is aged less than 15 years, all healthcare staff should carefully seek the
endorsement of the mother or father, unless a protest is made by the young client (NSW
Government Health 2005).
Moreover, under such circumstances when the adolescent patient exerts his/her
opinion regarding the treatment services, no further allegations can be drawn for assault
against the medical practitioners, in accordance to the Pursuant to the Minors (Property and
Contracts) Act 1970. The Family Law Act states that both parentages are entitled with equal
accountability for their children who are minors or aged below 18 years. The stage that is
measured suitable for an adolescent to deliver agreement to management and/or cure of a
disease or ailment, without any parental supervision also hinges on on the rigorousness of the
signs and symptoms for which cure requires to be executed, in contrast to the comparative
maturity intensity of the patient (NSW Government Health 2005).
Answer 3
Sam can adopt two approaches:
i. The ICN Code of Ethics are comprise of four basic elements that are responsible
for outlining the standards of the ethical behaviour and conduct that is expected of
health professionals. The code that can be used by Sam is encompassed by the

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first element, namely ‘Nurses and people’. The nurse has the duty of holding in
assurance all kinds of personal information that are furnished by the patient and
are also responsible for accurately judging the presenting complaints and needs of
the patient (ICN 2012). Furthermore, her consent must also be taken prior to
disclosure of any health related information to her parents, or other healthcare
providers.
ii. Mrs. Wilson should be informed about the health status of her daughter. This will
be based on the nursing standards of practice that makes it mandatory to engage in
a therapeutic and professional relationship with all clients (code 2)
(Nursingmidwiferyboard.gov.au 2018). Furthermore, a responsive and safe care
must be delivered to the patient (code 7), besides taking efforts to develop an
appropriate plan of care for the presenting complaints (code 5). The NBMA code
of ethics should also be followed that will provide guidance for recognising the
active participation of the service user in nursing care
(Nursingmidwiferyboard.gov.au 2018).
Answer 4
If I were to play the role of Sam, I would consider establishment of a confidential and
close therapeutic relationship with Jessica in order to gain her trust. This would make her feel
a sense of security and belonging, thus enabling her to share relevant information related to
her health. Although guardians have been found to play a crucial role in providing assistance
to adolescents for navigating the healthcare systems, I would not disclose Jessica’s current
health stauts to her mother, in order to preserve the former’s dignity and rights
(Nursingmidwiferyboard.gov.au 2018). Concerns of adolescents about maintaining
confidentiality regarding their health often act as major barriers in the pathway of accessing
care services (Hiriscau et al. 2014). This in turn will be enhanced by showing an adherence to

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the NMBA standards of practice for a registered nurse that will guide me to initiate effective
conversation with Jessica.
I would always try to how respect towards her personal beliefs and values, while
providing her care services. Patient advocacy is a specialised area of care where an effective
advocate is entrusted with the duty of acting on behalf of the patient, in the form of a
representative. Few things such as, sexuality are often considered more personal about the
human body and sharing such information is frequently embarrassing or sensitive for patients
(Fortenberry 2013). My duty of confidentiality would therefore require me to take all efforts
to uphold Jessica’s integrity and autonomy in relation to her disclosure of medical
information or treatment that she wants to be exposed to. I would also develop a nursing care
plan in accordance to the individual needs and demands of the client
(Nursingmidwiferyboard.gov.au 2018). Hence, all health related information would not be
disclosed to her mother. In other words, I would not breach the standards of patient
confidentiality and would always maintain privacy of my client.

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References
Fortenberry, J.D. 2013, ‘Puberty and adolescent sexuality’, Hormones and behavior, vol.64,
no.2, pp.280-287.
Hiriscau, I.E., Stingelin-Giles, N., Stadler, C., Schmeck, K. & Reiter-Theil, S. 2014, ‘A right
to confidentiality or a duty to disclose? Ethical guidance for conducting prevention
research with children and adolescents’, European child & adolescent
psychiatry, vol.23, no.6, pp.409-416.
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
Kourkouta, L. & Papathanasiou, I.V. 2014, ‘Communication in nursing practice’, Materia
socio-medica, vol.26, no.1, p.65.
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.

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Reach, G., 2014, ‘Patient autonomy in chronic care: solving a paradox’, Patient preference
and adherence, vol.8, p.15.