Examining Ethical Decision Making in Abdominal Pain case

In this essay, I am going to discuss the scenario of a 12 years old girl, Christine who has been admitted in a pediatric unit for observation and investigation for recent abdominal pain. I will try to solve the legal and ethical dilemma that the nurse has faced in this case with the use of Kerridge’s model, for ethical decision making with help of code of ethics, code of professional conduct, national competence standard and Australian charter of health care rights.

Kerridge’s model for ethical decision making:

Clearly state the problem

Client does not want the nurse to disclose her physical abuse from her mother, but Nurse has disclosed to the register nurse.

Get the facts

12 year old admitted with severe abdominal pain due to overdose of Panadol. Nurse observed bruises on her arm and back, patient told the nurse that her mother beating her regularly, and do not tell anyone because she fear it will be much worse for her if her mother finds out but the Enrolled Nurse told the Register Nurse for patient wellbeing.

Consider the fundamental ethical principles

Autonomy:  

Definition:  “Recognises the rights of a person to have an opinion, make choices, and take actions based on personal values and beliefs” (Gault, 2011)

In the case, EN has breaches Autonomy (patient’s choice) by telling to the Register Nurse.

Beneficence: 

Definition:  Beneficence is action that is done for the benefit of patient. Beneficent actions can be taken to help prevent or remove harms or to simply improve the situation of patient (Gault, 2011).

In the case, Nurse has done well by reporting to the RN. Reporting may prevent future harm to the client and may stop child abuse or inappropriate treatment.

Confidentiality:

Definition: Respect for confidentiality means that a nurse keeps information that a patient reveals in the context of a nurse-patient relationship to himself/herself (Degree Essays, 2011)

In the case, Nurse has breached the confidentiality of the patient by disclosing the information.

Veracity:

Definition: To recognized client’s right to important information concerning his/her wellbeing to make the informal decision, to tell the truth (Gault, 2011).

In the case, EN has expressed the duty of care by telling the truth to the RN for patient’s wellbeing.

Consider how the problem would look from another perspective

Patient, family (Patient’s Mother) and nurse are involve, nurse may lose the trust of the patient by disclosing the information, the information that client gave to the EN might be false if the patient has some underlying mental illness, patient’s might be in trouble if her mother come to knew that she has told to nurse, her mother might be embrace due to the child violence, patient will be protected by taking the case further.

Identify ethical conflicts

Conflicts between confidentiality and beneficence, conflict between veracity and autonomy.

Code of ethics, there is conflict between nurses value access to quality nursing and health care and respect and kindness and informed decision making.

1) Nurses value quality nursing care for all people.

Nurses should report to an appropriate person regarding patient’s safety and care when necessary. Nurses should take a reasonable action when patient’s safety is the issue as well as to prevent future harm to the patient (ANMC, 2008).

In the case of Christine, nurse has reported to an appropriate authority in regards to patient safety and wellbeing. By doing that, nurse has shown her duty of care towards the patient. l.

2) Nurses value respect and kindness for self and others.

Nurses preserve the dignity of the patient by recognizing the vulnerability of the patient and through practiced sympathy. Nurses should understand the powerlessness and vulnerability of the patient due to illness or other circumstances they are going through. There will be significant power problem between nurses, family of the patient and the patient, mainly where the patient has limited knowledge due to age and fear. In that case nurses must inform the management and addressed the issue (ANMC, 2008).

In the case, there is vulnerability of the patient due to age (below 18), fear of getting worse if her mother come to know that, Christine has told the nurse about her violent behavior. In that context, nurse reported the issue for the patient welfare as well as showed the kindness by recognizing patient situation. And by the law nurse has to inform the management and addressed the issue for client’s wellbeing.

3) Nurses value informed decision making

Nurses respect patient’s moral value, including children to involve in decision making process. When necessary nurses help the patient by giving information about choices they can have to make the decision. And assist as well as advocate for the patient right (ANMC, 2008).

In the case, nurse involved to advocate for the patient’s right not have any physical abuse. And try to discuses with other health care workers to manage the situation professionally.

5) Nurses value a socially, economically, and ecologically sustainable environment promoting health and wellbeing.

Nurses should take in to consideration about patient social, emotional, environmental circumstances for patient wellbeing and recovery of the patient. Nurses should consider culture sensitivity due to dealing with diversity of the culture. Overall aim should be patient centered (ANMC, 2008).

In the case, nurse took steps to manage the situation and for the patient safety as well as positive recovery for the patient. It can be resolved by educating and reassuring the patient and family by law (of child abuse) and also by involving social work, health professional.

Consider the law in this scenario.

Code of conduct:

Nurses should provide safe and competent nursing care in any circumstances,

That may compromise professional standards. If nurse observed any unethical or illegal issue related to patient, it must be addressed immediately to prevent further harm to patient. Nurse must involve other health professional such as social worker etc. nurses where should seek consent from the patient receiving or requiring care before disclosing the information. Nurses should use professional judgment to disclose details, taking in to considerations to the wellbeing, health and safety of the patient. Nurses recognise that, by law to disclose particular information for professional purpose (ANMC, 2008).

In the case, nurse has disclosed the information by law without consent from the patient in regards to patient safety, dignity, wellbeing.nurse informed registered nurse due to her duty of care and professional conduct to being safeguard of the patient. Above scenario nurse showed clinical decision making skills to protect patient’s right and safety.

Nurses should take all reasonable steps for the social, emotional, physical wellbeing for the patient. Nurse should develop trust with patient to share the clinical information (ANMC, 2008).

In the case, Nurse developed trust of the patient, so patient was able to share the information. This helped nurse to make a clinical judgment in regards to help the patients. Nurse discloses the information by law being safeguard for the patient and able to follow up with other member of the health to manage or resolve the situation.

In this case there are some competency standard that are relevant to this scenario, the elements are, 1.3, 1.4, 7.3, 8.1, 8.4, and 9.1

In the situation there is potential harm and should take some action to prevent the harm to the patient. EN discloses the information to RN and follow the policies according to the ANMC national competency standards.

Health care rights:

Respect

Patients are entitled to receive care in a way that is respectful of patient’s culture, age, gender.

In the case, patient is entitled to get the treatment which will give her the best outcome as well as she has the rights to treated according the health care standard. Her age should need to take in to consideration. Nurse has taken all rights of the patient to help the patient (ACHR, 2008).

Communication

Health care will tell the patient about the care, that patient receiving and help patient, understand what is happening to the client. Patient can contribute to the communication by being as open and honest as patient can be (ACHR, 2008)

In the case, nurse should communicate with patient regarding her treatment and her management plan but in this case her age should be taken onto consideration.

Patient has obvious bruises on her arm and back so it’s proves that it is a child abuse from her mother and in Victoria, it is a legal obligation to report suspected child abuse.

7. Make the ethical decision-

12 year old has a right to respect safety, have opinion and make choice. Code of ethics state that nurses value quality nursing care for all people, Nurses value ethical management of information (this includes cases where confidentiality must be breached).

Conclusion:

At the end, nurse has followed code of ethics of nursing, proper conduct of law according to situation. Nurse also reflects clinical judgment to protect patient’s rights and nurse has expressed duty of care towards the patient as well as informing appropriate person to try to manage the situation professionally.