Nurses Have the Responsibility to Always Respect Their Clients Autonomy

In this assignment, I will be discussing about the ethical issues involved in

scenario # 2. A 12 year-old girl is hospitalized for an investigation of her recent episode of abdominal pain. The Enrolled Nurse (EN) who is assigned for her founds that she has been abused by her mother but the girl doesn’t 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 , The Australian charter of healthcare rights.

Clearly state the problem

Christine, a 12-year-old girl admitted for observation and investigation of a recent severe abdominal pain. The EN who is assigned to do Christine’s care found some bruises on her body. She reveals that this is a result of beating from her mother and she stated that her mother beats her regularly. One day she took some Panadol to stop beating. When she told that to her mother she laughed at her and told to go and sleep it off. The EN considered this is a case of child abuse and reported this to the concerned RN.

Get the facts

After Christine admission the EN realises that she has been abused by her mother. The girl doesn’t want to disclose this matter to anyone else. The EN discus this matter with another health care member who is responsible for cristins care.

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 regards to their treatment. After disclosing the history of her abuse by her mother Christine has requested that the nurse not to tell anyone because 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 is breached as the EN discloses this matter to RN.

The nurse would like to respect and follow client’s wishes 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 Christine’s long term health and benefit to try and resolve this situation with the help of other health care professionals. Beneficence is the responsibility of actively doing good and do benefits for others. The nurse who Christine has confided in must act to resolve the situation and put an end to Christine’s abuse so she can live safely.

Nurses also have the liability to uphold the ethical principles of veracity. Veracity means to tell the truth, in most circumstances truthfulness in directly dealing with a patient. 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 sharing the information (private & confidential) to others. In this scenario Christine doesn’t want the nurse to disclose the private matters to anyone other than the nurse taking care for her. EN couldn’t keep the confidentiality between her and Christine as telling 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 (Gault 2011).

4) Consider how the problem look from another prospective

Yes, 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 have the moral responsibility towards the law to report the child abuse. The nurse wish to stop any further harm causing to Christine in the future.

5) Identify ethical conflicts

There is conflict between the abused girl’s autonomy and the nurse take up with beneficence and the veracity. When we consider the ANMC Code of ethics for nurses have 8 value statements, three of these are 1, 2 & 7 are in conflict with Christine case.

Value statement 1 states that “nurses value quality nursing care for all people”.

Value statement 2 outlines that “nurses value respect and kindness for self and others”

Value statement 7 inform that “nurses value ethical management of information”

6) Consider the law

She is aged only 12, so legally she cannot make decision.

7) When discussing the health care rights according to the Australian charter of healthcare rights, “Access, Respect, Communication, Participation, Privacy” 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 hospital: however the nurse can support Christine to receive further air more appropriate to her situation.

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

Communication: “Patients have a right to be informed about services, treatment, options and costs in a clear and open way” ACSQH (2008). Christine’s nurse must take significant action in the further treatment of her patient, despite Christine’s fears and objections, though this does not mean that because Christine doesn’t want anything to be done that she should be left ignorant of the actions taken on her behalf. 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 and so that her fears can be soothed, she is very afraid that if her mother discovers that she told someone about the abuse that things at home will get much worse.