A girl named Christine, aged 12 years old has been admitted to hospital for observations and investigation due to a severe episode of abdominal pain. The nurse assigned to her care has noticed bruising on her arms and back. Christine tells the nurse the bruises are from her mother beating her with a wooden coat hanger and this is a regular occurrence. Christine discloses to the nurse that a few weeks ago she tried to over dose on panadol and her mother laughed at her telling her she was stupid and to go and ‘sleep it off’. Christine has asked the nurse not to tell anyone as it will cause more beatings if the mother finds out. The nurse reassures her that she won’t tell anyone, but as soon as Christine is settled the nurse informs the registered nurse about Christine’s beatings and drug overdose. Has the nurse done the right thing? (Maree Gault, Ethics Assignment hand out, February 2011)
According to Kerridge’s model for ethical decision making we must consider the correct ethical path of management in this case.
Clearly state the problem – in this case the problem is the recurrence of beatings to Christine and her attempted drug overdose. Also the fear of her mother that she has expressed to her nurse in confidentiality.
Get the facts – the facts are the bruises all on her arms and back. Christine has also told the nurse of her beatings and attempted drug over dose. The Code of Professional conduct refers to nurses’ duties as practicing in a safe and competent manner. The nurse in this scenario has an obligation not to compromise Christine’s welfare.
Consider the fundamental ethical principles – we must consider Christine’s right of autonomy, privacy, confidentiality and justice. In this case are these justified? Is Christine reaching out for help? According to the nurses Code of Professional Conduct it is a nurses’ responsibility to provide safe and appropriate nursing services. It is her job to safeguard Christine and notify appropriate authorities where necessary, as this is an agreed standard of her profession.
Consider how the problem would look from another perspective – is there an imbalance of power Christine feels with her mother? How will this impact on Christine’s quality of life at home? The Professional Code of Conduct refers to a nurse having the responsibility of ensuring a client’s perspective is represented. In this case the nurse is an advocate for Christine as she is too frightened to speak independently and as a minor her autonomy rights are overridden.
Identify ethical conflicts- we must also consider the ethical conflicts the nurse is facing with regard to beneficence, non- maleficence and veracity.
‘A nurse must treat personal information obtained in a professional capacity as confidential’. (ANMC Code of Professional Conduct for nurses in Australia, 2008)
Consider the law – The nurse has an obligation, according to the law to report suspected child abuse, regardless of her reassurance to Christine that she won’t tell anyone. ’A nurse must practice in accordance with the laws relevant to the nurse’s area of practice’. (ANMC Code of Professional Conduct for nurses in Australia, 2008)
Make an ethical decision – Is it the nurse’s duty to disregard the confidentiality and autonomy of Christine’s welfare? What are the nurse’s obligations in this scenario?
We must consider the fundamental ethical principles in detail in regard to this case scenario to try and make the right ethical decision.
Autonomy is the power we have over our own body and the decisions we make. Are we respecting Christine’s request not to tell anyone? Is Christine’s disclosure of her personal issues to the nurse allowing her to maintain ‘the quality of having the ability of tendency to function independently?’ (Mosby’s dictionary, 2nd edition, 2010, p. 164).
Beneficence is ‘the ethical principle exhorting people to act in others’ best interests’. (Mosby’s Dictionary, 2nd Edition, 2010, p. 192). Is the nurse considering Christine’s best interests when she reports the suspected abuse to her superior? Is she acting on Christine’s behalf in reporting her case or is it her own moral judgement? Is she considering compassion, empathy, sympathy and kindness by reporting this suspected abuse? (Funnell, Koutoukidis and Lawrence, 2009). Or is she ‘reading between the lines’ and realises Christine actually wants help?
Non- maleficence is the consideration of making sure that what we do as nurses does more good than harm, ‘to avoid harm or hurt’. (Funnell, Koutoukidis and Lawrence, 2009, p.34) Is the nurse acting on Christine’s best interest or will her reporting make Christine’s home situation worse?
Justice is the ‘principle of fair and equal treatment for all’. (Mosby’s Dictionary, 2nd Edition, 2010, p. 951). This involves having Christine’s needs met according to what she needs. Is the nurse justified in reporting this suspected child abuse? Is it fair to Christine? Are we considering her wellbeing and future? (Funnell, Koutoukidis and Lawrence, 2009).
Veracity is our obligation to tell the whole truth. It recognises a client’s right to important information concerning their own wellbeing. Is the nurse obliged to report what Christine has told her? Will she breach the code of conduct if she does not report what she has been told? (Funnell, Koutoukidis and Lawrence, 2009).
Confidentiality and Privacy is the patients right in a healthcare environment. It is the right of the patient to confide in a nurse and to know that their information is kept confidential. In this case is confidentiality being breached? Does the nurse have an obligation to disclose personal information? (Australian Charter of Health Care Rights, 2008).
‘A nurse must treat personal information obtained in a professional capacity as confidential’. (ANMC Code of Professional Conduct for nurses in Australia, 2008).
Christine’s situation of suspected child abuse is required, by law, to be reported by the nurse. It is mandatory for the nurse in her position of care to report any suspected abuse. The patient in this case has told her nurse that she is being physically abused with a coat hanger and that she has attempted an over dose on panadol. The nurse has seen the bruising on her body and is concerned. It is the nurse’s mandatory obligation to report this to a higher authority. In Australia we have a law which requires a nurse to report any suspicion of child abuse.
’Mandatory reporting requirements take precedence over professional codes of practice where confidentiality or client privilege is claimed’. (Department of Human services Victoria 2010).
Even if the nurse did not see Christine’s bruises she still has an obligation, by law to report suspected abuse because Christine has told her that her mother beats her regularly and she attempted an overdose. Reporting this to the registered nurse was the right choice in this situation if that is hospital policy. Otherwise she could report it directly to Child Protective Services. This must be reported and I support the nurses’ decision as she is supporting the health and wellbeing of her client. Apart from the nurses legal requirements she also has a moral responsibility to report the abuse she has been informed about to protect the patient in her care. (ANMC Code of Professional Conduct, 2008)
The Code of Ethics for Nurses (2008) provides a reference with guidelines and standards so nurses’ have a reference point on how to conduct themselves in different situations. It includes maintaining quality of care and respecting the diversity of different people, as well as how to manage an ethical decision. The duty of the nurse in Christine’s case is to care for her client and provide a safe environment for her. The management of this case is difficult because the nurse has an obligation to report the beatings, but her client has specifically asked her not to. It is her duty to report the incidence (as a nurse) even though she is breaching the confidentiality of her patient. She must maintain a professional code of conduct and not get emotionally involved to be able to manage this situation effectively. ( ANMC Code of Ethics for Nurses, 2008)
The Australian Charter of Healthcare Rights (2008) maintains the values of providing a safe and high quality of care to persons in a healthcare environment. People requiring care have the right to be shown respect and be informed about treatment and services available to them. Their personal health issues are to be treated confidentially and they have a right to participate or comment on any concerns they may have. Christine has a right to access appropriate services to guide her in this difficult situation.
Although Christine’s autonomy, privacy and confidentiality have been breached, the nurse has conducted herself in the appropriate manner with regard to reporting her case. It is the nurses’ professional obligation of veracity and a law requirement that suspected child abuse is reported. We must consider that this situation is non-maleficent and that beneficence will prevail, so that Christine is provided with a respected and valued future.
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