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Discussing about the ethical issues involved in child abuse

scenario # 2. A 12 year-old girl is hospitalized for an investigation of her recent episode of abdominal pain. The Enrolled Nurse (EN) who was assigned for her founds that she has been abused by her mother but the girl does not want to disclose this matter to anyone else. The EN discloses this matter to the concerned Registered Nurse (RN) to help Christine. Thoughtful decisions are the outcome of the ethical model of decision making. Here for ethical decision making, I am using the Kerridge’s model and discussing relevant ethical principles and the right and responsibilities with the help of “Code of ethics for nurses in Australia”, “Code of professional conduct for nurses in Australia”, “National competency standards for EN and “The Australian charter of healthcare rights”.

1) Clearly state the problem

Christine, a 12-year-old girl was admitted for observation and investigation of a recent severe abdominal pain. The EN who was assigned for Christine’s care found some bruises on her body. Christine reveals that she has been beaten by her mother regularly but she is afraid to disclose the matter. The EN considered the matter as a case of child abuse and reported to the concerned RN.

2) Get the facts

After Christine’s admission the EN realises that she has been abused by her mother. The girl does not want to disclose this matter to anyone else.

3) Consider the fundamental principles

The patient is abused by her mother; there are many ethical principles to be considered in the handling of her treatment. The ethical principles considered for this case are:

# Autonomy

# Beneficence

# Veracity

# Confidentiality

Nurses have the responsibility to always respect their client’s autonomy in regard to their treatment. After disclosing the history of her abuse by her mother Christine has requested this to be confidential otherwise it will result in more beatings from her mother. Autonomy states that every individual have a right to make choices, opinion, and self determination based on personal values and beliefs (Gault 2011). Autonomy of the girl has been breached as the EN discloses this matter to RN.

The nurse would like to respect and follow client’s wishes. But in this case due to Christine’s age and her alleged abuse from her primary care giver (her mother), the nurse has a responsibility to ensure Christine’s long term health and security so she tries to resolve this situation with the help of other health care professionals. Beneficence is the responsibility of actively doing good which benefits others (Gault 2011). The nurse to whom Christine has confided in must act to end Christine’s plight that will make her live in a safer environment.

Nurses also have the liability to uphold the ethical principles of veracity. Veracity means adherence to the truth in most circumstances while dealing with a patient. (Potter & Perry 2005). In Christine’s circumstance the nurse must practice veracity to the law, to tell the truth about her knowledge of Christine’s condition to the other health care professionals and the authorities. The nurse has a duty of care for Christine and must take the ‘appropriate actions to protect (her) safety’, (Funnell, Koutoukidis & Lawrence 2009).

Confidentiality means not sharing the information (private & confidential) of one person to others. In this scenario Christine does not want to disclose the private matters to anyone other than the nurse taking care for her. EN could not keep the confidentiality between them and she reports the matter to the RN because nurses have a moral responsibility towards law and this is a clear risk of serious & imminent harm to the client in near future (Megan-jane 2004).

4) Consider how the problem look from another prospective

There is an imbalance of power because Christine is 12-year-old girl (child). Parents have the power to make decision. But in this case parent (mother) itself is the abuser. EN has the moral responsibility towards the law to report the child abuse. The nurse wishes to end the abuse of Christine in future.

5) Identify ethical conflicts

There is conflict between the abused girl’s autonomy and the nurse taking up with beneficence and veracity. When we consider the ANMC Code of ethics for nurses have 8 value statements, three of these are 1, 2 & 5 (AHPRA 2011) in directly conflict with Christine case.

Value statement 1 states that “Nurses value quality nursing care for all people”. Christine is entitled to quality nursing care which includes help in trying to alleviate the situation of her alleged abuse. Everyone is entitled to live in a safe and healthy environment and as an alleged victim of abuse Christine also has no difference.

Value statement 2 outlines that “Nurses value respect and kindness for self and others”. The nurse must show her kindness towards Christine as she suffers from her mother. Significant vulnerability and powerlessness makes Christine to make decision and further management so the code of ethics helps the nurse to make the decision to help Christine by reporting this to another health care member.

Value statement 5 informs that “Nurses value informed decision making”. Nurses have a responsibility to respect their patients wishes however when they are in opposition to what is the best for their health the nurse must take a difficult decision about which is more important.

6) Consider the law

Christine is aged only 12, so legally she doesn’t have the legal capacity to make decision. Her fears are not a reason to hide the situation in fact they make the situation even more immediate. Parents have the legal capacity to make decision for her but in this case mother itself is the abuser. So the nurse has the legal responsibility to report this case to the RN under the Children, Youth and Families Act 2005 (Vic.) (aifs 2010)

When discussing the health care rights according to the Australian charter of healthcare rights, “Access, Respect, Communication, Participation, and Privacy” (Safety and quality 2010) are directly relevant to Christine’s case

Access: Everyone has the right to access healthcare facilities. In Christine’s case she has access to medical care in hospital; however the nurse can support Christine to receive further aid more appropriate to her situation.

Respect: This means that all participants are mindful of patient’s environment. In this case EN can respect Christine, her opinion and feelings by listening, offering comfort and giving advice.

Communication: Information should be in an open way to the patients as they have a right to know about services, treatment, options and costs. The nurse has a responsibility to communicate the options that she is taking as Christine’s advocate. They must be explained in a calm and comforting way so that Christine continues to feel safe in hospital with her fears soothed, as she is afraid of the outcome if her mother finds out the disclosure of abuse.

Participation: is the right to be included in decision and choices about care. Due to her age and the fact that she is a minor Christine does not get much say in her treatment or about where she will live, however her nurse can act in a way that will make Christine feel like she is participating in the decisions that affect her life.

Privacy: In this case the EN shared the information only to the concerned RN in a professional manner as this is a case of child abuse to keep the privacy of the child.

When considering the ANMC national competency standard to this scenario some of the competency standards are relevant to this case. The competency elements are 1.3, 1.4, 7.3, 8.1, 8.4, and 9.1. In brief, the EN is responsible to give care in consultation with RN. EN has to identify the situations where there is a potential for harm and should take actions to minimise or prevent harm. EN should ensure effective communication and consider the policies regarding the disclosure of information. She has to act appropriately to maintain the dignity, provides the nursing care in a manner respectful of privacy and provides comfort in consultation with individual needs & performance.

7) Make the ethical decision

Even though Christine doesn’t want to disclose this matter to anyone else, the EN reports this to the RN for her beneficence. She has the right to get quality nursing care, respect and kindness. Among all Christine has the right to live in a healthier and safe environment. The EN thought about the welfare of Christine and made a decision to report to RN as the parent itself is an abuser.