NURSING ASSIGNMENT 6: Ethical Dilemmas and Professional Identity

This nursing assignment presents a case study of a 15-year-old patient, Jessica, who faints at school and is suspected of being pregnant. The nurse faces an ethical dilemma balancing patient confidentiality and professional responsibilities. The assignment analyzes the ethical issues, including patien...Read More

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the University
Author note

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Table of Contents
Question 1........................................................................................................................................2
Question 2........................................................................................................................................2
Question 3........................................................................................................................................4
Question 4........................................................................................................................................5
References........................................................................................................................................7

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Question 1
The given case study is about a fifteen year old girl, Jessica, who was brought to the
emergency department after she fainted in the school. After the assessment was completed by the
nurse it was found that all of the observations were within normal level. Only the concentration
of hemoglobin was in the low-normal range (125 g/dl) where the normal range in in between
120-160 g/dl. The nurse was performing her duties of assessing the patient. She was asking that
whether the patient has taken breakfast or not, whether she used to take foods rich in iron or not,
whether she had been menstruating or not and whether she was sexually active or not. At that
time the patient herself accepted that she was thinking that she was pregnant. Jessica was very
afraid about this matter and she had asked the nurse not to tell her mother that she is pregnant.
However, the nurse could not detect anything relate to pregnancy when she assessed the patient
except that she got fainted. For maintaining the privacy of the patient, the nurse had to hide the
incidence from her parents. This is one of the ethical issue for the nurse as at one side the nurse
had to sustain the confidentiality of the patient and at the other she had to perform her role of a
nurse.
Question 2
The nurses and he physicians daily have to face several ethical dilemmas in several prospects
the care of the patients. The resolution of the ethical issues and the dilemmas must be achieved
by focusing on the fact of achieving the maximum of the benefits. The different ethical and legal
principles which can be applied to the case study are described below:
 Principle of autonomy- The principle of autonomy can be define as respecting the
confidentiality of the patients and also being truthful about the medical care that the

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patients are receiving. According to this principle the patients must be given the
opportunity to take decisions about the care processes of their own. The nurse must honor
the decisions of the patients. The patients also have the right to decline or refuse any
therapeutic information. In the give case study, it can be seen that the nurse had
maintained the autonomy of the patient (Hammersley, 2015).
 Beneficence- According to this principle the nurse must advocate the patient and act in
the best way of the interest of the patient. This principle may conflict with principle of
autonomy (Israel et al., 2017). .
 Non maleficence- This principle state that the nurse must avoid causing injury or any
suffering to the patient (Mascalzoni,et al., 2015) .
 Justice- This principle states that the patients must be treated fairly and equitably. The
nurses must make sure that the patient is receiving all the required treatments (Graham,
Powell and Taylor, 2015).
The decision making capability of nurse can also be addressed here. I order to take proper
decisions, a nurse has to understand the ability the patient in understanding the meaning of
the information conveyed to the patient and also the ability of the patient in using the
information provided by the nurse (Hallowell et al ., 2015). The decision making ability also
express the nurse to express the choice of the decisions. In the given case study, the nurse
commenced an ethical issue to maintain the autonomy of the patient. However the nurse was
about to tell the patient’s father about the original health issue that the patient was suffering
but she could not do this. The nurse herself was astonished about that the patient herself had
no clear idea about what she was going to do about the suspected pregnancy (Hallowell et
al ., 2015)..

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Question 3
The ICN code of ethics of the nurses describes that the nurses have four major
responsibilities which are to promote the health, to prevent people from illness, to restore the
health of the people and to relieve the sufferings. The two options which must be available to the
nurse are as per the ICN code of ethics for the nurses are the code 1 (nurses and people) and code
3 (nurses and profession). According to the code of the nurses and people, the chief
responsibility of the nurses is to provide the people with nursing care. For providing care to the
patient, the nurse must promote an environment that promotes the human rights, the values and
the spiritual beliefs of the individuals, the family or the community (ICN, 2019). The nurse need
to ensure that the patients are receiving sufficient, accurate and timely information in an
appropriate environment. The nurses should protect the confidentiality of the information and
reveal the information after properly judging the information. Not only are these the nurse
responsible for maintaining the equity as well as social justice regarding the fact of allocating the
resources and accessing the healthcare services to the patients (ICN, 2019). This code is
appropriate in addressing the ethical issue of this case study because the ethical problem arose as
the nurse had to maintain the confidentiality of the health issue of the patient. This code
addresses that the nurse has to respect the autonomy of the patient and in doing so the nurse
created the ethical problem.
The second code addressed in the case study is the nurses and profession. According to this
code the nurses must develop a research-based proficient knowledge supporting the evidence
based training. The nurse should be active in transferring and also in sustaining a core the
professional morals. The nurse at the time acting in the professional organization, participates in
generating a positive environment for practice and in maintaining safe, equitable social and

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economic conditions in the nursing environment (White, Phakoe, and Rispel, 2015). The nurse
also gives to an ethical environment of the organization and must also challenges the
unprincipled practices and settings (Epstein and Turner, 2015). This code can be addressed in the
case study as the nurse tried a lot in the development of the positive environment but failed in
developing an ethical environment. The nurse failed to challenge the unethical practice as she
could not tell about the original health issue to the parent of the patient.
Question 4
Both of the options that are discussed in the question 3 are significant in carrying out the
nursing practices. The code nursing and people emphasizes on maintaining the rights and beliefs
of the patient at the same time advocating on the maintenance of equity and social justice in
accessing the healthcare to the patients (Baykara, Demir and Yaman, 2015). The code 3, nurses
and problems emphasizes more on the creation of an ethical atmosphere and challenging the
unethical observes and settings. In the given case study, I think maintaining the profession of the
nurse is more important than maintaining the autonomy of the patient (Shahriari, et al., 2016).
The most important reason behind this is that the patient of the case study is only fifteen years of
age, she was no even as adult. At this age the patient has the right to tell the nurses about their
nursing choices but cannot take decisions of their own. It was very important further nurse to
discuss about this her illness to her parents rare than hiding from them. If I were in John’s
position I surely would have discussed about this incident to her parents. I would have acted in
the way so as to create a professional environment and a positive environment for practicing the
nursing practices. I would have created a safe, socially equitable working environment for
nursing.

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The nurse of the case study create the ethical problem in order to maintain the autonomy
of the patient. In doing this the nurse even lost her professional identity. For maintaining the
professional identity a nurse has to effectively conduct her duties. The nursing professional
identity shows that the nurses to maintain the professional activities along with maintaining the
autonomy of the patient. However, it is not possible for the nurses to maintain both the autonomy
and the therapeutic nursing practices (Spector, 2016). In the given case study also I think I was
undesirable from the nursing perspectives to maintain the autonomy of the patient rather than
performing her profession effectively. I would have taken decision on behalf of the patient and
informed about the whole incident to the family members of the patient. The should know about
the incidence of her being pregnant at the age of fifteen in order to avoid any further legal
consequences. I should not have created the ethical problems as this would surely affect my
professional identity. I think a nurse should take any decision after judging about all the
conditions and circumstances of the patient. As it is already mentioned that autonomy of the
patient has to be maintained but not in all cases. It is the responsibility of the nurse to decide
whether the autonomy of the patient should be considered or not.

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References
Baykara, Z.G., Demir, S.G. and Yaman, S., 2015. The effect of ethics training on students
recognizing ethical violations and developing moral sensitivity. Nursing Ethics, 22(6),
pp.661-675.
Epstein, B. and Turner, M., 2015. The nursing code of ethics: Its value, its history. OJIN: The
Online Journal of Issues in Nursing, 20(2), pp.1-10.
Graham, A., Powell, M.A. and Taylor, N., 2015. Ethical research involving children:
Encouraging reflexive engagement in research with children and young people. Children
& Society, 29(5), pp.331-343.
Hallowell, N., Hall, A., Alberg, C. and Zimmern, R., 2015. Revealing the results of whole-
genome sequencing and whole-exome sequencing in research and clinical investigations:
some ethical issues. Journal of medical ethics, 41(4), pp.317-321.
Hammersley, M., 2015. On ethical principles for social research. International Journal of Social
Research Methodology, 18(4), pp.433-449.
ICN (2019). [online] Icn.ch. Available at:
https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_
%20eng.pdf [Accessed 11 Sep. 2019].
Israel, B.A., Schulz, A.J., Parker, E.A., Becker, A.B., Allen, A.J., Guzman, J.R. and
Lichtenstein, R., 2017. Critical issues in developing and following CBPR
principles. Community-based participatory research for health: Advancing social and
health equity, pp.31-46.

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Mascalzoni, D., Dove, E.S., Rubinstein, Y., Dawkins, H.J., Kole, A., McCormack, P., Woods, S.,
Riess, O., Schaefer, F., Lochmüller, H. and Knoppers, B.M., 2015. International Charter
of principles for sharing bio-specimens and data. European Journal of Human
Genetics, 23(6), p.721.
Shahriari, M., Mohammadi, E., Fooladi, M.M., Abbaszadeh, A. and Bahrami, M., 2016.
Proposing codes of ethics for Iranian nurses: A mixed methods study. Journal of Mixed
Methods Research, 10(4), pp.352-366.
Spector, J.M., 2016. Ethics in educational technology: towards a framework for ethical decision
making in and for the discipline. Educational Technology Research and
Development, 64(5), pp.1003-1011.
White, J., Phakoe, M. and Rispel, L.C., 2015. ‘Practice what you preach’: Nurses’ perspectives
on the Code of Ethics and Service Pledge in five South African hospitals. Global health
action, 8(1), p.26341.