Parties
Parties- Victoria Weller, a registered nurse at the Fortitude Valley Family planning clinic had been assigned the task of providing advice to a 16 year old female, Stella, regarding her reproductive health. Stella disclosed about being in a sexual relationship with her boyfriend and also stated that although they are quite aware of engaging in protective intercourse, they had unprotected sex few day ago. This has made the client worried about unwanted pregnancy, following which she decided to visit the healthcare facility to get a prescription for morning pills. Furthermore, the conversation also suggested that Stella wants to adhere to contraceptive pills in her near future for preventing any unwanted outcomes. This made the RN educate the client on the potential benefits and adverse effects of contraceptives for reproductive health. However, Stella disclosed that she does not share a cordial relationship with her Aunt that made her hide her relationships from the latter. Furthermore, bruise marks were also observed on the arms of the client, which were not explained properly upon questioning. Additionally, the client wanted the entire conversation and the following medication prescriptions to be kept confidential.
Issues- The major issue identified from this scenario is a risk of teenage pregnancy. Also referred to as adolescent pregnancy, this condition occurs when females under 20 years of age become pregnant, following an unprotected intercourse, after she has started ovulating (Copping, Campbell & Muncer, 2013). According to statements presented by the United Nations Population Fund, such pregnancies among girls aged less than 18 years creates irreparable consequences by directly violating their rights, and results in life-threatening situation for reproductive and sexual health (Unfpa.org, 2018). This issue is a direct manifestation of lack of parental supervision. Adult supervision generally involves a parenting technique that commonly involves monitoring or looking after the activities of children (Backman et al., 2015). However, death of Stella’s mother and her distant relationship with her Aunt resulted in lack of parental supervision, which in turn can be attributed as a major factor that resulted in her casual sexual relationship at a young age. Confidentiality is another problem in this case. Another prime issue is related to the signs of domestic violence that are quite apparent in the form of bruises on Stella’s arms. Domestic violence refers to all forms of abuse that are made by one individual against another, in a cohabitation or home setting (Root & Brown, 2014). It can be verbal, physical, religious, reproductive, and sexual as well. Thus, even though Stella does not disclose much about the exact reason that might have resulted in the bruise marks, there is a possibility that she is subjected to domestic violence (physical or sexual) from her Aunt’s boyfriend.
- ICN Code of Ethics- The four primary responsibilities of nursing professionals, as illustrated in the ICN ethical code are to prevent illness, promote health, restore health, and reduce suffering of all clients/service users. The principal elements of the ICN code are namely, (1) Nurses and people, (2) Nurses and practice, (3) Nurses and the profession, and (4) Nurses and co-workers (International Council of Nurses, 2012). The elements that are most relevant in this context are the first and third standards. The first element of ‘Nurses and people’ elaborates on the fact that the primary responsibility of nursing staff is to provide adequate nursing care to all people who require it. Thus, while providing care to Stella regarding her reproductive health, the RN must recognize her duties of fostering an environment that preserves and promotes the values, human rights, customs, and beliefs of the client, and her community.
Issues
Owing to the fact that sexual health issues are personal, and there exist strong taboos against them, the personal and cultural beliefs and preferences of Stella must be taken into account while advising her on different sexual protective measures to enhance reproductive health. Furthermore, the element will ensure that the RN provides timely and accurate information to Stella in a culturally appropriate manner, to prevent any adverse events such as, unwanted pregnancies. Applicability of the element can also be justified due to the emphasis it places on holding personal information in confidentiality, and using critical judgment skills for sharing them (International Council of Nurses, 2012).
Meeting the social and health needs of the client, who is vulnerable to teenage pregnancy and abuse, and advocating for her social justice and equity also establish the importance of this element. The case also requires a demonstration of compassion, responsiveness, and trustworthiness, all of which are encompassed in this element. The third element of ‘Nurses and the profession’ is also imperative in this context since it allows nursing professionals to adorn a key role in defining and realising a set of standards that are essential for nursing practice, research and education. This element will make the RN develop her professional knowledge, with respect to the prevention and management of teenage pregnancy and will also facilitate evidence-based practice. She will also be responsible for contributing to an ethical environment in the health organisation, while caring for the patient, besides challenging any practice that appears unethical in regards to the case scenario (International Council of Nurses, 2012).
- Ethical principles
- Autonomy- This commonly encompasses the right of a client to retain complete control over the body. Thus, the RN can provide suggestions and advice, but must provide complete authority to Stella to take her decisions regarding use of contraceptives and/or pills (Cole, Wellard & Mummery, 2014).
- Beneficence- Nurses must take all efforts to benefit their clients. Thus, all treatments and interventions must be recommended with the intention of doing well to Stella and enhancing her reproductive health (Grace & DRN, 2017).
- Non-maleficence- This commonly encompasses the act of ‘doing-no-harm’. Thus, it should be considered whether the intervention of contraceptives or pills are capable of harming Stella (Ivanov & Oden, 2013).
- Justice- This principle ensures an element of fairness in medical verdicts. Thus, the benefit and burden of the decisions must be adjudged, while making recommendations (Afshar, Joolaee, Vaskouei & Bagheri, 2013).
- Law/Legal issues- Civil Negligence is a major issue that can arise in this context, in relation to ‘Duty of Care’ if the RN does not show an obligation to avoid actions that could harm Stella, such as disclosing her case to other nursing professionals (Rogers v Whitaker) (Sokol, 2015). A ‘Breach of Duty’ can also arise if Stella is not provided adequate and correct information on the risks that are inherent in the intervention (pills and contraceptives) (Bolam v Friern Hospital Management Committee) (Quick, 2013). The ‘Nurses Act’ 1991 (NSW) might also be applicable in this scenario if the Nursing Registration Board fails to recognise the qualifications of the nurse practitioner (Part 2). ‘Confidentiality’ is another legal issue relevant in this case (NSW Legislation, 2018).
- NMBA Code of Conduct- The codes of conduct that are relevant to the case are given below:
- Legal compliance- The nursing professional must display awareness of the obligations under the National law and should abide by all reporting obligations (specifically sections 129, 130, 131, and 141). The RN is expected to respect relationship with Stella and not participate in any kind of unlawful behaviour. She should abide by the reporting legislation while caring for Stella who is vulnerable to abuse and neglect (NMBA, 2018).
- Person-centred practice- A safe and evidence-based practice must be delivered in accordance to the codes of conduct and relevant guidelines, while advocating for the client, supporting her rights and taking informed consent before administration of an intervention (NMBA, 2018).
- Culturally safe and respectful practice- The RN should respect the belief, gender identity, sexuality and culture of Stella to avoid any bias or discrimination during the treatment. Furthermore, respecting and safeguarding the privacy and confidentiality of the client is also crucial (NMBA, 2018).
- Options for Action/Steps for action-
- Report probability of abuse to the concerned doctor and the jurisdiction (Pietrantonio ET AL., 2013)
- Adopting a compassionate attitude towards the client to understand the underlying factors that have added to her vulnerability (Bramley & Matiti, 2014).
- Initiating an effective conversation to identify the rate and severity of domestic violence she is subjected to
- Initiating a person-centred practice where the priority will be identified and addressed, by maintaining dignity, compassion, and respect (Olsson, Jakobsson Ung, Swedberg & Ekman, 2013).
- Paying a home visit to identify the presence of triggers that indicate domestic violence or abuse towards Stella (Mejdoubi et al., 2013).
- Using community-based advocacy, and appropriate standards of law enforcement for increasing Stella’s safety and reducing the negative psychosocial impacts of domestic abuse (if any).
- Promoting sexual education.
- Engaging a therapist who will provide counselling services to Stella to help her gain an understanding of the negative impacts of sexual relationship in her teenage years.
- Facilitating a cordial relationship of Stella with her Aunt to promote parental supervision.
The decision taken in this respect is correct in terms of showing adherence to the ethical principles of practice. This can be attributed to the fact that confidential care for teenagers is the main tenet of adolescent reproductive health. However, just as it is an ethical obligation to provide support to adolescents, nurses should also act in the best interest of their clients, who portray limited judgment capabilities, owing to the young age. Thus, there is a need to discuss the scenario with the senior doctor in situation that requires breaking confidentiality, in relation to the legal obligation of mandatory reporting any incidents of abuse or violence.
References:
Afshar, L., Joolaee, S., Vaskouei, K., & Bagheri, A. (2013). Nursing ethics priorities from nurses aspects: a national study. Iranian Journal of Medical Ethics and History of Medicine, 6(3), 54-63. Retrieved from https://ijme.tums.ac.ir/article-1-5120-en.html
Backman, H., Laajasalo, T., Saukkonen, S., Salmi, V., Kivivuori, J., & Aronen, E. T. (2015). Are qualitative and quantitative sleep problems associated with delinquency when controlling for psychopathic features and parental supervision?. Journal of sleep research, 24(5), 543-548. https://doi.org/10.1111/jsr.12296
Bramley, L., & Matiti, M. (2014). How does it really feel to be in my shoes? Patients’ experiences of compassion within nursing care and their perceptions of developing compassionate nurses. Journal of clinical nursing, 23(19-20), 2790-2799. https://doi.org/10.1111/jocn.12537
Cole, C., Wellard, S., & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing ethics, 21(5), 576-582. https://doi.org/10.1177%2F0969733013511362
Copping, L. T., Campbell, A., & Muncer, S. (2013). Violence, teenage pregnancy, and life history. Human Nature, 24(2), 137-157. https://doi.org/10.1007/s12110-013-9163-2
Grace, P. J., & DRN, P. (Eds.). (2017). Nursing ethics and professional responsibility in advanced practice. Jones & Bartlett Learning. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=1OQlDgAAQBAJ&oi=fnd&pg=PR1&dq=beneficence+nursing+ethics&ots=eMKBJbCwq3&sig=txNtQ7KULQDuoIzk-R0q-f-9kM0#v=onepage&q=beneficence%20nursing%20ethics&f=false
International Council of Nurses. (2012). The ICN Code of Ethics for Nurses. Retrieved from https://www.icn.ch/images/stories/documents/about/icncode_english.pdf
Ivanov, L. L., & Oden, T. L. (2013). Public health nursing, ethics and human rights. Public health nursing, 30(3), 231-238. https://doi.org/10.1111/phn.12022
Mejdoubi, J., van den Heijkant, S. C., van Leerdam, F. J., Heymans, M. W., Hirasing, R. A., & Crijnen, A. A. (2013). Effect of nurse home visits vs. usual care on reducing intimate partner violence in young high-risk pregnant women: a randomized controlled trial. PloS one, 8(10), e78185. https://doi.org/10.1371/journal.pone.0078185
NSW Legislation. (2018). Nurses Act 1991 No 9. Retrieved from https://legislation.nsw.gov.au/#/view/act/1991/9/historical2000-01-14/part2
Nursing and Midwifery Board of Australia. (2018). Professional standards. Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx
Olsson, L. E., Jakobsson Ung, E., Swedberg, K., & Ekman, I. (2013). Efficacy of person?centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing, 22(3-4), 456-465. https://doi.org/10.1111/jocn.12039
Pietrantonio, A. M., Wright, E., Gibson, K. N., Alldred, T., Jacobson, D., & Niec, A. (2013). Mandatory reporting of child abuse and neglect: Crafting a positive process for health professionals and caregivers. Child Abuse & Neglect, 37(2-3), 102-109. https://doi.org/10.1016/j.chiabu.2012.12.007
Quick, J. (2013). The role of the surgical care practitioner within the surgical team. British Journal of Nursing, 22(13), 759-765. https://doi.org/10.12968/bjon.2013.22.13.759
Root, M. P., & Brown, L. (2014). An analysis of domestic violence in Asian American communities: A multicultural approach to counseling. In Diversity and complexity in feminist therapy (pp. 143-164). Routledge. Retrieved from- https://www.taylorfrancis.com/books/e/9781317714200/chapters/10.4324%2F9781315784335-7
Sokol, D. K. (2015). Update on the UK law on consent. BMJ: British Medical Journal (Online), 350. Retrieved from https://www.balfour-manson.co.uk/media/337236/210315plusBMJplusObservationsplusonplusConsent.pdf
Unfpa.org. (2018). Adolescent Pregnancy. Retrieved from https://www.unfpa.org/publications/adolescent-pregnancy
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