Professional Identity 92434: Case Study on Nursing Ethical Dilemma

This case study presents an ethical dilemma faced by a nurse named Sam, who is dealing with a 15-year-old patient, Jessica, who is pregnant and does not want her mother to know. The core issue revolves around the ethical principles of truthfulness and confidentiality. The study examines relevant ethical and legal principles, including autonomy, informed consent, truthfulness, and confidentiality. It explores two options available to Sam, based on the International Council of Nurses (ICN) Code of Ethics: upholding patient confidentiality or informing the mother. The analysis concludes that, considering the patient's age and potential consequences, truth-telling is the preferred option, balancing ethical guidelines with the well-being of both the patient and her family. The case study references various articles to support its arguments.

Professional Identity 92434
Assessment 2: Case Study
Due: 9th September 2018
Name:
Student Number:
_______________________________________________________________
1. Clearly define the problem - Objectively note the ethical issue that the
nurse (Sam) must address
In this case study, there is one major problem. The problem is that the
healthcare provider who is Sam is in dilemma. The dilemma is that the patient
who is a 15 year old teenager has presented with pregnancy which she feels that
the mother should not know (Preshaw, Brazil, McLaughlin, & Frolic, 2016,
p. 496) The ethical dilemma in this case is truth telling. As a nurse, it is
necessary to share the patient information with their family members and with
them too. The nurse is supposed to share crucial information regarding
proposed treatment plans(Ramos et al., 2014, p.429). However in this case, the
patient Jessica does not want the nurse to tell her mother of her pregnancy
status. This therefore presents a very big headache to the nurse. It is therefore
not clear if Sam should disobey the confidentiality of the patient and share the
issue of pregnancy with the mother.
2. Examine the ethical and legal principles that apply to the case study
There are different ethical principles in this case study. One of the ethical
principle is Autonomy. This is a principle that allows every patient the self-
determination, freedom and independence to make their choices. In the
healthcare perspective, the principle of autonomy allows the patient to make
decisions regarding their health status (Parahoo, 2014, p.12). Like in this case
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study of Jessica, she has the freedom to dictate if the nurse should share the
information with the mother or not.
Informed consent is another important ethical principle in this case study.
Informed consent is a principle which allows the patient to decide what medical
procedures should be done regarding their health status. Jessica has no idea of
what she should do concerning the pregnancy(Trobec & Starcic, 2014, p. 340).
It is therefore the role of the nurse to provide an outline of what procedure
should be carried out and the consequences of failing to accomplish the
procedure. From there, Jessica can then decide.
The other ethical principles are truthfulness and confidentiality. Truthfulness is
the ethical principle which allows the healthcare profession to tell the truth to
whoever has the right to know. Like in this case, the mother has the right to
know the medical status of her daughter and therefore the nurse should share
the information with him.
Contrary to truthfulness is another ethical principle called confidentiality. This
principle urges the healthcare provider to keep any patient information as a
secret. Even if the family members ask for it, the nurse has no mandate to
disclose the information unless the patient gives permission. In this case study,
Jessica does not want the nurse to disclose her pregnancy status to the mother
and the nurse should therefore obey her confidentiality.
3. Identify 2 options available to Sam in addressing the ethical problem
identified in question 1 as they apply to the International Council of Nurses
(ICN) Code of Ethics for Nurses (2012)
According to the International Council of Nurses (ICN) Code of Ethics for
Nurses (2012), there are two options in this case study that Sam can utilize to
address the ethical problems identified. One of the options is to obey the ethical
principle of confidentiality and keep away from sharing Jessica’s pregnancy
status with the mother(Trobec & Starcic, 2014, p. 48). The other option is to go
by the ethical principle of truthfulness and share the true information with one
of the family members who is the mother in this case. Both of the two options
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have consequences, in the vent of withholding information, sometimes it is
beneficial. This is because it can save the negative emotions of the family
members. Like in this case, the mother might be completely heartbroken by the
fact that the daughter is pregnant. Such information can be heartbreaking to the
extent of leading to other medical conditions like high blood pressure. The
International Council of Nurses always advocates truth telling and it is
therefore the duty of the nurse to find out a way in which to finally deliver the
news or the information to the mother .About obeying confidentiality of the
patient, this is a good option yes but if you look at the long term impacts, it can
be very detrimental (Judkins-Cohn, Kielwasser-Withrow, Owen, & Ward, 2013,
p 36). This is still a young girl who does not understand much and can therefore
make healthcare demands out of ignorance. The nurse should therefore take
time and educate her on the importance of sharing the information with the
parents. Disclosing the information would also make her peaceful at mind
rather being curious of how her mother would react if she came to learn of the
situation.
4. Reflect on the options identified in question 3 and present a rationale as to
which ONE of the options you would follow if you were in Sam’s position.
In this case study, there are two important ethical principles that include
confidentiality and truth telling. This two ethical principles often present
dilemmas to nurses in their routine practices. Like in this case study of a girl
who is pregnant yet she does not want the mother to know, there are two
options. The two options identified in the case study are telling the mother the
truth or obeying the wishes of the patient who is Jessica. All the two options will
however have consequences. As for me, the best option would be truth telling.
According to the ethical principle of truth telling, the nurse has the mandate to
share any relevant information to the people who have the right to know. The
mother of the patient is therefore entitled to any information regarding her
daughter. Besides, the patient is very young since she is only 15 years. You
realize that at this age, the patient is not yet mature enough to make any sound
decision. Failure to conceal the necessary information would lead to severe
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consequences. One of the potential consequence is abortion. Abortion is the
termination of pregnancy before the fetus fully matures. Abortion is another
ethical principle that has had heated debates over the decade. Jessica is still a
minor and entirely depends on her parents and therefore as a nurse, I would tell
the mother the truth so that she can be watched over keenly (Heale & Shorten,
2016, p 7). As a nurse, I would weigh the two options keenly and find out which
one would benefit both the mother and the daughter before eventually deciding.
In as much as ethical guidelines are important frameworks that provides the
scope of operation of the nursing practices, the nurses should at tomes think
critically and act in the interest of both the patient and the family members as
long as it has quality or better outcome for the two parties involved.
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References
Heale, R., & Shorten, A. (2016). Ethical context of nursing research. Evidence Based
Nursing, 20(1), 7-7. doi:10.1136/eb-2016-102514
Judkins-Cohn, T. M., Kielwasser- Withrow, K., Owen, M., & Ward, J. (2013). Ethical
Principles of Informed Consent: Exploring Nurses’ Dual Role of Care Provider and
Researcher. The Journal of Continuing Education in Nursing, 45(1), 35-42.
doi:10.3928/00220124-20131223-03
Parahoo, K. (2014). The Research Process and Ethical Issues. Nursing Research,
24(2),95-109. doi:10.1007/978-1-137-28127-2_7
Preshaw, D. H., Brazil, K., McLaughlin, D., & Frolic, A. (2016). Ethical issues
experienced by healthcare workers in nursing homes. Nursing Ethics, 23(5), 490-506.
doi:10.1177/0969733015576357
Ramos, F. R., Brehmer, L. C., Vargas, M. A., Trombetta, A. P., Silveira, L. R., &
Drago, L. (2014). Ethical conflicts and the process of reflection in undergraduate
nursing students in Brazil. Nursing Ethics, 22(4), 428-439.
doi:10.1177/0969733014538890
Trobec, I., & Starcic, A. I. (2014). Developing nursing ethical competences online
versus in the traditional classroom. Nursing Ethics, 22(3), 352-366.
doi:10.1177/0969733014533241
Walls, P. (2014). Understanding Research for Nursing Students Ellis Peter
Understanding Research for Nursing Students 168pp £16.99 Sage/Learning Matters
9871446267615 144626761X. Nurse Researcher, 22(1), 48-48.
doi:10.7748/nr.22.1.48.s5
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