Case Study: Maintaining Professionalism in Nursing, Ethics

This case study analysis examines an ethical dilemma faced by a nurse, Anh, who is asked by a patient to connect on social media after discharge. The paper delves into the ethical considerations, professional boundaries, and the nursing code of ethics relevant to this situation. It discusses the importance of maintaining a therapeutic relationship, avoiding personal entanglements, and adhering to guidelines regarding social media use. The analysis explores the strategies nurses should employ, emphasizing critical thinking, therapeutic communication, and maintaining professional capability. The paper highlights obligations related to social media use, emphasizing adherence to professional conduct, confidentiality, and privacy regulations. The conclusion reinforces the need for nurses to prioritize patient well-being, maintain ethical standards, and seek guidance when faced with boundary-related challenges, drawing on sources such as the Nursing and Midwifery Board of Australia and the Australian Nursing and Midwifery Federation guidelines.

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

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Table of Contents
Introduction......................................................................................................................................2
Discussion........................................................................................................................................3
The Nursing code of ethics..........................................................................................................3
The strategies followed by Registered Nurses (RN) as per the RN standards............................6
RN thinks critically and analyses the situation:.......................................................................6
RN should engage the patient in therapeutic communication and professional relationships:7
Maintains the capability of practice:........................................................................................7
Obligations while using Social Media.........................................................................................8
There are certain obligations nurses, midwives and assistants should take into account while
using social media and online networking:.............................................................................9
Conclusion.....................................................................................................................................10
References:....................................................................................................................................11

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CASE STUDY ANALYSIS
Introduction
The professional boundaries between nurse and patient is essential for successful
outcome of patient’s care and it allows the nurses to apply their professional knowledge, skills
and abilities towards promoting health of a patient. Professionalism is highly essential when it
comes to treating and interacting with a patient as it is directed towards meeting the needs of a
patient both physically and mentally (Nursingmidwiferyboard.gov.au, 2019). It is not sufficient
to only be treated by medical professionals to solve the problem, wellbeing of a human body
prior to treatments is necessary in order to make him medically fit which falls under the
responsibility of nurses (Nursingmidwiferyboard.gov.au, 2019). Taking into considerations the
responsibilities of a nurse, laws, ethical issues, professional self-care strategies, professional
boundaries and maintenance of therapeutic communication comes into play
(Nursingmidwiferyboard.gov.au, 2019). This paper is an illustration of the ethical standards that
creases a dilemma in making decisions with regards to maintaining further relation with the
patient via social media and by sharing personal details, thus, violating the professional
boundaries and nursing code of ethics which are against nursing strategies. The paper also
discusses on what measures Anh should take being in that position by analysing the situation
from the ethical perspective, professional boundaries and codes of ethics in nursing and the
obligations needs to be considered while interacting on social media.

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CASE STUDY ANALYSIS
Discussion
The case study depicts the situation of a nurse working in a tertiary care hospital in the
orthopaedics ward after the completion of TPPP. She finds her job interesting and engaging
while treating patients with care, however, at times it becomes stressful for her to handle patients
who are aged and semi dependent. Considering that Anh was allocated for taking care of a
patient named, Maddie, she gradually developed an emotional attachment since Maddie was
close to her age. On the day of discharge, Maddie suggested that they should remain in contact
on social media and requests Anh’s personal details to enable this to occur. The case study
reveals the possibility of a breach that can take place with regards to violation of professional
boundaries and code of ethics in nursing.
The Nursing code of ethics
According to the nursing code of ethics, nurses need to maintain certain standards while
practicing like maintaining professionalism, not engaging the patient in personal matters and
avoid connecting with patients through social media (Kangasniemi, Pakkanen, & Korhonen,
2015). The professional boundaries and therapeutic communications that are the two aspects of
nursing strategies that can be hindered if Anh connects to her patient through social media
(Harvey et al., 2013). Violation of professionalism can led to confusion between the needs of a
patient and the needs of a nurse (Kangasniemi, Pakkanen, & Korhonen, 2015). The relationship
between nurses with that of the patient should be dynamic and goal oriented in order to meet the
needs of a patient in both medical and mental terms (Harvey et al., 2013). It is important to
develop trust worthy relationship between a patient and a nurse to get the desired outcome but

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that should not be confused with creating a personal relationship with the patient (Kangasniemi,
Pakkanen, & Korhonen, 2015).
The case study reveals a scenario where Anh’s decision based on her judgment should
align with the Nursing code of ethics and usage of social media that is responsible for clearing
the line between their professional and personal lives (Peck, 2014). The nurse should avoid
situations of indulging themselves with the patient creating a personal relationship (Harvey et al.,
2013). It should be note that nurses must work within the therapeutic relationship
(Nursingmidwiferyboard.gov.au, 2019). Professional boundaries should be maintained in order
to fill the gap between a nurse’s power and patient’s vulnerability
(Nursingmidwiferyboard.gov.au, 2019). It should work in a balanced proportion in order to avoid
the imbalance of nurse-patient relationship (Nursingmidwiferyboard.gov.au, 2019). Nurses
should put every effort to maintain professionalism neither by not accessing a patient’s personal
sensitive information nor by sharing one’s own personal information
(Nursingmidwiferyboard.gov.au, 2019). Professional boundaries is bridge between the nurse’
powers and patient’s vulnerability and should be taken care of to maintain a patient centred
relationship (Niezen, Maartje & Jolanda, 2014). Therapeutic communication allows the nurse to
be able to apply their professional skills and abilities to promote patient’s health and work
towards building a patient centred relationship (Nursingmidwiferyboard.gov.au, 2019). The
therapeutic nurse patient relationship is aimed at protecting and promoting patient’s dignity,
privacy and autonomy and allows for developing trust and respect between the nurse and the
patient (Tastan et al., 2014). According to the Australian code of ethics, “The nurse, in all
professional relationships, practices with compassion and respect for the inherent dignity, worth,

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CASE STUDY ANALYSIS
and uniqueness of every individual, unrestricted by considerations of social or economic status,
personal attributes, or the nature of the health problem” (Tastan et al., 2014).
The nurse patient relationship should be maintained in such a way that focuses on the
benefit of the patient and not the personal gain of the nurse (Nursingmidwiferyboard.gov.au,
2019). There are some behavioural considerations in order to maintain professional relationship
and stay within the professional boundaries (Niezen, Maartje & Jolanda, 2014). Nurses needs to
be more mindful of their practice acts, code of conduct and employer or organizational policy
(Harvey et al., 2013). They should not engage themselves in any behaviour with the patients that
confuses the relationship between them (Nursingmidwiferyboard.gov.au, 2019). Anh, must have
shown excessive self-disclosure that is responsible for clearing the line between personal and
professional relationship (Niezen, Maartje & Jolanda, 2014). Factors such as the care setting,
nature of the therapy provided, community influences, community influences and the degree of
involvement contributes to the complexity of establishing professional boundary (Harvey et al.,
2013). In such a situation where the nurse has confronted with such a situation that can violate
professional boundary should know how to handle or manage (Harvey et al., 2013). However, if
the nurse lacks the knowledge of managing such situation or unsure of the behaviour and seeks
guidance, they should consult with a trusted supervisor or colleague and then take decision
wisely considering the ethical guidelines (Nursingmidwiferyboard.gov.au, 2019). Nurses should
be aware of the ethical codes of conduct and are expected to comply with the legal and ethical
guidelines. Anh may have shown some inappropriately disclosing her personal information while
providing care to Maddie about her private circumstances while is not consistent with the
professional conduct of a nurse (Harvey et al., 2013). According to
Nursingmidwiferyboard.gov.au, 2019, it is considered to be unethical to share personal

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CASE STUDY ANALYSIS
information of a nurse with the patients because personal information should be confidential and
self-disclosure should be limited to revealing information that has therapeutic value and only
occurs in the course of providing treatment to the patients (Nursingmidwiferyboard.gov.au,
2019).
The strategies followed by Registered Nurses (RN) as per the RN standards
RN thinks critically and analyses the situation:
According to Australian nursing code of Ethics, RN uses a various strategies for thinking
and analysing the situation and makes use of the best available evidence to make decisions and
provide safe and quality based nursing practice within patient centred therapeutic
communications (Kourkouta, Lambrini, & Ioanna, 2014). It is the responsibility of the
Registered Nurse to develop and improve their practice quality through their experiences, the
knowledge they have gained, through actions, feelings as well as beliefs to identify the practice
(Tastan et al., 2014). According to the Australian code of ethics, the RN should respect the
culture and treat the patient’s with dignity, which also includes responding to the role of family
and community (Fowler, Marsha & Anne, 2013). The responsibilities should go hand in hand
with legislation, regulations, guidelines, policies and satisfying other nursing standards. It is
important for RN to stick to or abide by the ethical issues involved and use their critical analysis
to make decision (Nursingmidwiferyboard.gov.au, 2019). With respect to the RN standards, the
nurse shown in the case study was not maintaining professional boundaries and therapeutic
communications and involved the patient in her personal matter, which should not have been
done (Nursingmidwiferyboard.gov.au, 2019). The RN should have taken proper measures
towards maintaining a formal and professional communication with the patient
(Nursingmidwiferyboard.gov.au, 2019).

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CASE STUDY ANALYSIS
RN should engage the patient in therapeutic communication and professional relationships:
The nurse seems to have violating the practice of therapeutic communication and
professionalism and engaging the patient in her private matters (Nursingmidwiferyboard.gov.au,
2019). According to the Australian code of ethics, the Registered Nurse should establish and
maintain relationship with patient in such a way that differentiates the boundaries between
professional and personal relationships (Nursingmidwiferyboard.gov.au, 2019). The RN should
know how to communicate effectively and respect a person’s dignity, value, cultures and beliefs
(Rich & Butts, 2013). The RN should provide support and work towards promoting Patient’s
health. It is also the responsibility of the nurse to provide safe environment and report notifiable
conduct to medical professionals, supervisors and others (Rich & Butts, 2013).
Maintains the capability of practice:
RNs are responsible for ensuring they are safe and they have capability of practicing
(Nursingmidwiferyboard.gov.au, 2019). RNs are also responsible for providing proper
information and they contribute to educating people and enable them make decisions in relation
to their health (Fowler, Marsha & Anne, 2013). They should actively engaged with the
profession and identify their roles of influencing people to achieve better health outcomes. They
should seek and respond to the feedback they have received (Nursingmidwiferyboard.gov.au,
2019). In this case, Anh should not have developed an emotional attachment with Maddie at the
first place. Now, as she developed a good bond with her that should not be against nursing code
of ethics. Anh should not provide her personal details to Maddie. It is against nursing code of
ethics.

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CASE STUDY ANALYSIS
Obligations while using Social Media
However, if using social media, nurses and other health practitioners, should be abide by
the National law, National Board’s code of Ethics and professional conduct and guidelines that
regulates health services (Ahpra.gov.au, 2019). If Anh connects with her patient in social media
and post information, that must comply with professional obligations, confidentiality and privacy
obligations (Fowler, Marsha & Anne, 2013) (Peck, 2014). In order to comply with the
obligations Anh should not discuss patients or post pictures of the procedures, case studies,
patients or any other sensitive information, present information in an evidence based context or
in an unbiased way (Henderson, 2015).
The code of conduct has certain guidelines that constitute professional standards that are
applied when a registered health practitioner interacting online (Ahpra.gov.au, 2019). The code
of conduct also has certain standards in relation to protecting privacy and confidentiality of
patient information (Ahpra.gov.au, 2019).
The guidelines of Australian Nursing and Midwifery Federation aims to clarify roles, and
obligation of nurses, midwives and assistants in nursing in their use of social media and online
networking in both their personal and professional lives (Ahpra.gov.au, 2019). The guidelines
came into force with the purpose to guide nurses and others about the usage of social media and
the issues they need to consider while using online networking platforms (Ahpra.gov.au, 2019).
It also clarifies the responsibility and obligations of employers in providing safeguards around
the usage of social media technologies in the workplace (Numminen, Meretoja, Isoaho & Leino-
Kilpi, 2013). Therefore, if Anh uses social media, she should stick to these guidelines and not
breach the regulations and standards set by them. It is mandatory for Anh to understand and
abide by the obligations both professional and legal, including evidence based practice and the

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CASE STUDY ANALYSIS
policies of workplace related to the use of social media (Fowler, Marsha & Anne, 2013). Anh
should consider the professional obligations that relates to the privacy, confidentiality and
consent.
There are certain obligations nurses, midwives and assistants should take into account while using
social media and online networking according to the Australia social media policy:
When posting pictures online on social media or online networking, one should keep in
mind that the picture should not contain and content intend to create racial hatred, discrimination
and defamation (Ahpra.gov.au, 2019). In the social media environment, one should be respectful
and not criticize the people, workmates, colleagues or employer (Scruth, 2015). The devices used
should be in accordance with the organizational policies. One should avoid making references to
the registration as a health practitioner, qualifications or any information relating to employment
(Ahpra.gov.au, 2019). One should not post any solicited or unsolicited information in relevance
to healthcare service, especially when it is out of scope or expertise. One should avoid any type
of inappropriate communication (Scruth, 2015). Nurses should not post individually identifiable
patient content or information online. They should know legal and ethical responsibilities as well
as the policies of their organization in relation to their responsibility in protecting patient’s
privacy (Ahpra.gov.au, 2019). Nurses interacting with patients in social media should consider
the ethical boundaries in nurse-patient relationship (Ahpra.gov.au, 2019).

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Conclusion
Anh should take decision that justifies the relationship between the nurse and the patient
which is supposed to be therapeutic and only within professional boundary. It is the
responsibility of the nurse to respect patient’s decision and protect their views and beliefs.
According to the RN standards, RNs has to make wise decisions applying their knowledge, skills
and work towards promoting patient’s health. Providing a safe environment, taking a good care
of them and reporting the notifiable changes regarding the medical condition of the patient to the
medical professionals, medical supervisors, health workers or others, fall under their
responsibility. There is a fine line between personal and professional relationships, which gets
blurred while practicing these unprofessional behaviours including sharing personal information.
The RN standards of nursing states that a nurse-patient relationship should be patient centred and
goal oriented and active measures should be taken to maintain professional boundary. Therefore
Ahn should make wise decision that align with nursing code of ethics. She should not disclose
her personal information with her patient. However, if Ahn uses social media then she has to
stick to the guidelines for nursing code of ethics.

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CASE STUDY ANALYSIS
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Kangasniemi, M., Pakkanen, P., & Korhonen, A. (2015). Professional ethics in nursing: an
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Kourkouta, Lambrini, & Ioanna V. Papathanasiou. "Communication in nursing practice."
Materia socio-medica 26.1 (2014): 65.

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Niezen, Maartje GH, & Jolanda JP Mathijssen. "Reframing professional boundaries in
healthcare: a systematic review of facilitators and barriers to task reallocation from the
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