Legal Obligations and Competency of Adolescents
1. Jessica Wilson is an adolescent of 15 years old who expects to have conceived and had asked the registered nursing professional caring for her to conceal the information from her mother. In the meantime, her mother had arrived and had asked the professional to disclose the suspected issue of her daughter. The main issue that the nursing professional caring for the patient would face is the ethical and legal dilemma of disclosing the confidential information to the mother. Researchers are of the opinion that different types of health problems that might develop in the adolescents. These are seen to include various mental issues, sexually transmitted infections, unwanted pregnancies as well as substance misuse (Harrison et al. 2017). Therefore, they suggest that prevention as well as early intervention for such sensitive issues is desirable. However, concerns of the adolescents about the confidentiality might become a barrier in their accessing of the health services. Again on the other hand, parents also have an interest in knowing about the health condition of the child. They get to get nervous, anxious as well as confused and might consider them guilty as of not taking enough care of their children (Olivari et al. 2015). Herein, the professionals caring for the teenager might face dilemma as to what to do. In the case study, the patient is seen to have achieved the age of maintaining confidentiality about the health issues and it becomes a duty of the professional to maintain the human rights of the patient. Again, on the other hand, the professional is not sure about the “minor competence” of Jessica in making safety decisions about her own health and this unwanted pregnancy might have additional negative health outcome of the patient. Going through the pregnancy days would be turmoil for the child and if she wants to terminate the pregnancy, the professional is not sure that she is competent enough to tackle the stress, medical procedures and other medical aspects with proper health literacy. So, this dilemma might be overcome, if her mother intervenes and both come to a decision where her mother can be one of her strongest support. However, this would again breach confidentiality of the teenager. This issue might give Sam a hard time to analyse what he should do.
2. It is always advisable for the healthcare professionals to understand the competency of the teenagers to understand the gravity of the situation. It is also expected to the professionals to understand the judgemental power of the teenagers to understand how their maintaining of confidentiality would affect their health and whether they are able to go through the healthcare procedures confidently without any support (Ahem and Bramlett 2016). However, there are legal obligations to this. Different types of statutory provisions have been finalised for people of 14 years age and above in the New South Wales called the section 49(2) of the Minors (Property and Contracts) Act 1970 as well as the people aged years or above called the SA (section 6(1) of the Consent to Medical and Dental Procedures Act 1985). It is said here that teenagers might give their consent without undertaking of any mature-minor forms of assessment. As teenagers of years and over are allowed in having their own mediocre record, therefore, Australian healthcare professionals can “bulk bill” a consultation with the adolescents using the family Medicare card even without the advice of their parents. These laws have faced many debates about whether avoiding the taking of the mature minor competence assessment is correct or not. The understanding the capability of the teenagers to take correct decisions might make them to take many decisions in an emotional state or in strenuous stress which might impact their health (Pogos et al. 2017). Again, many other professionals have said mature minor principle should be established in cases of low-risk, non-invasive procedure like that in taking oral contraceptive pills. The law should limit the capability of the adolescents for decision making according to gravity of many serious situations like termination of pregnancy. The professionals here need ensuring that the teenagers are enough competent for giving consent. All these might make Sam confused about exactly what he would be doing in this moment to tackle it. On the ethical basis, his maintain of the bioethical principle of confidentiality and privacy might affect beneficence and non-maleficence ethical principles. He might not be able to provide the information to the mother and might not provide her the safest interventions that could affect her. She might not be able to handle the crisis period alone and might need mental and physical support which her mother could have provided and this would affect the latter two principles. In this way ethical and legal issues might rise up from the situation.
Options for Nursing Professionals in Cases of Confidentiality
3. From the above discussion, the nursing professional might come to two options. Following the laws for people of 14 years age and above in the New South Wales called the section 49(2) of the Minors (Property and Contracts) Act 1970 as well as the people aged 16 years or above called the SA (section 6(1) of the Consent to Medical and Dental Procedures Act 1985), the nursing professional should not conduct any mature minor competence test. He should blindly follow the law and conceal the information from the mother (Petronio et al. 2015). He would ask the mother to go out respectfully to another room and discuss the case in details with the patient. Following the dignity and autonomy of the patient, discussions would be done with other members of the team and accordingly procedures, appointments, care interventions and diagnostic tests should be planned (Loke and Lam 2014). Following the decision of the teenager, the mother would be then informed by concealing the main information and allowing her to know different information. Although this would ensure maintenance of the mentioned laws, but it would result in risking the health of the teenager, as her competence to handle such situation is not known.
On the other hand, another option can be selected. After sending the mother to another room, the professionals although not formally but informally ask her several questions to understand her strength of handling such situation alone, her knowledge and idea about the procedures and many other things should be known. Moreover, her reasons of not telling her mother and the bond shared between the mother and daughter should be judged. In such situation, the professionals should always empower as well as encourage teenagers for informing their parents mainly for the complex as well as the different types of contentious procedures. This is mainly because parents are generally the best place for support of their child (Alderman 2017). It might happen that such encouragement change her mind and involving her family in this situation would help in releasing mental and emotional turmoil and their support would make the procedures easier (Lines, Hutton and Grant 2017). Accordingly, her mother should be counseled and discussed about the issues. She would be also stated about the behaviors that she needs to exhibit, the support her child needs and others. These would make the situation much easier for both patients and the professionals. Sam while undertaking such options need to maintain the ICN codes of ethics. He should be maintaining the “human rights, values, customs and spiritual beliefs of the individual, family and community”. Sam also needs to follow holding in confidence “confidence personal information and uses judgment in sharing this information” (The ICN Code Of Ethics For Nurses 2012).
Strategies for Developing Therapeutic Relationships with Adolescents
4. Following of laws and ethical principles are important for preventing legal obligation. However, as a nursing professional, I also need to maintain beneficence and non maleficence by which my care would ensure no suffering and bets quality care to patients. This might again conflict with confidentiality and autonomy and dignity of the patient especially in cases like that of Jessica. Nurses are the professionals who tend to provide life to individuals who make them happy and live in safety (Keedle et al. 2018). Therefore, before blindly following the laws and ethics of dignity, autonomy and confidentiality, I would put more effort on developing therapeutic relationship with the patient. I would try to assess her competence in decision making and handling such crisis situation singlehandedly. I would try to understand her bond and relationship and emotional attachment with her mother. Then I would encourage her to reveal such information to mother and taker her support in the decisions she makes. Therapeutic communication might change her mind and she would take the safest option. I would then counsel her mother about the issue and to be supportive of her. The main reason for doing this is that it would reduce the turmoil and suffering that she might go through if she handles the situation alone (Lloyd et al. 2018). Her mother would be supporting her and she would get more strength. If she is not yet ready, then I would blindly follow the laws and take help of my seniors to reach a decision and care for her accordingly.
References:
Ahern, N. R., and Bramlett, T. 2016. An update on teen pregnancy. Journal of psychosocial nursing and mental health services, 54(2), 25-28.
Alderman, E.M., 2017. Confidentiality in pediatric and adolescent gynecology: when we can, when we can’t, and when we’re challenged. Journal of pediatric and adolescent gynecology, 30(2), pp.176-183.
Harrison, M.E., Clarkin, C., Rohde, K., Worth, K. and Fleming, N., 2017. Treat me but don’t judge me: a qualitative examination of health care experiences of pregnant and parenting youth. Journal of pediatric and adolescent gynecology, 30(2), pp.209-214.
Keedle, H., Schmied, V., Burns, E. and Dahlen, H., 2018. The Design, Development, and Evaluation of a Qualitative Data Collection Application for Pregnant Women. Journal of Nursing Scholarship, 50(1), pp.47-55.
Lines, L.E., Hutton, A.E. and Grant, J., 2017. Integrative review: nurses’ roles and experiences in keeping children safe. Journal of advanced nursing, 73(2), pp.302-322.
Lloyd-Hazlett, J., Moyer, M.S. and Sullivan, J.R., 2018. Adolescent risk-taking behaviors: When do student counselors break confidentiality?. Journal of Child and Adolescent Counseling, 4(2), pp.178-193.
Loke, A.Y. and Lam, P.L., 2014. Pregnancy resolutions among pregnant teens: termination, parenting or adoption?. BMC pregnancy and childbirth, 14(1), p.421.
Olivari, M. G., Ionio, C., Bonanomi, A., and Confalonieri, E. 2015. Female adolescent attitudes and decision-making towards a hypothetical unplanned pregnancy: An exploratory research. Journal of Child and Family Studies, 24(10), 2934-2943.
Petronio, S. and Reierson, J., 2015. 18 Regulating the Privacy of Confidentialitv. Uncertainty, Information Management, and Disclosure Decisions: Theories and Applications, p.365.
Pogos, D., Yeo, M., Rushton, G., Cordell, M., Dennerstein, G., Robson, S., Hooker, J., Haultain, L., Daniels, B., Kaplanian, C. and Baird, K., 2017. Understanding the barriers: managing adolescent pregnancy. Women’s Health, 19(3).
The ICN Code Of Ethics For Nurses, 2012 International Council of Nurses, Retrieved from: https://bioetika.sam.lt/get_file.php?file=bnBTYXk1V2hZcVdkbTJWbXlKZVpsWjFrYk1PVXltdlR4cHh3MnBtZHg2UnZ4cDJTblo5a1oyNmprcGFYbTUyWm1LRnF4bWZVYlpPYXJuSE1rcDNHcFclMkZLbHRhZFlaV2ViWiUyQlhvNWVhYW1USGFwdVNsNCUyQlYxSm1ibmN6RWI4U0NtclBKcHNlUmFaMXRwR21leDZHZG1jaW9iTWxuajVuVXg1dWJ6Slp2bW5Sdw==
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