Table of Contents
The case study of Emily White has invoked an ethical dilemma for the Registered Nurse (RN) Angela. As per the viewpoint of Johnstone (2016), the aspect of human right and especially the right of the patient is associated with nursing ethics. In the provided case study, the dilemma in the same ground has happened. As per the case study, Emily white, a patient of 14 years has been admitted to the emergency department (ED) for an episode of falling from the stairs of the local shopping mall. In the time of changing her to the hospital gown, the patient has asked for an emergency contraceptive pill, EllaOne and instructed her to conceal the matter from her mother. However, Mrs White, Emily’s mother has come in the time of administration of the mentioned drug and have enquired about the medication of the patient. As per the viewpoint of Kangasniemi et al. (2015), patient family or responsible patient associates have the right to know of the clinical issue, current condition and medication of the patient. This aspect has invoked an ethical dilemma for Angela about the sharing of information to the family members of patients.
Professional ethics is one of the major aspects which is always followed by the nurses to provide caregiving to the patients. As per the viewpoint of Butts and Rich (2019, p.177), the prioritisation of safety, security, beneficence and comfort of the patient should always be considered along with the human right in the process of caregiving. These aspects are also applicable to the caregiving of Emily White by her registered nurse. As per the case study, it has been identified that the patient does not want to reveal her medical condition, cause of left arm deformity and the administration of contraceptive medicine. The official report of the Nursing and Midwifery Board of Australia (NMBA), mentions that enrolled and registered nurses have to follow the basic four principles, namely beneficence, non-maleficence, justice and autonomy as well, to act ethically in the professional space (McDonald and Then, 2019, p. 24). In this case, the issue of Emily White is tagged with the domain of autonomy, justice and beneficence.
The aspect of taking contraceptive medicine is a very personal matter of a patient and is tagged with the personal right of the same. As per the legal standard, emergency contraception is always ethical, legal and unquestionable. Black and Hussainy (2017) have mentioned that contraceptive pills in emergency (EC) cases are obtainable without a prescription and are legally approved. Vergallo et al. (2017) has further added that International Consortium of EC has approved the providence of EC, irrespective of gender, age and sex and can be obtained in the public sector, emergency room, pharmacies and clinics. From this data, it can be analysed that this regulation is also applicable to Australia. Hence, the administration of EllaOne-pill to Emily White is completely ethical in the emergency department as per the wish of the patient.
Initially, NMBA ethical standard for RN has been discussed, which includes the comfort and safety of the patient. As per the report of NMBA code of ethics-7, is associated with the aspect of clinical information sharing (Nursing and Midwifery Board of Australia, 2010). Medical information is always a very personal and confidential aspect of a patient and is applicable even for the minors. As per the mentioned ethical standard, the ethical management of all the medical information should be performed by the nurses. Hence, from this angle, it can be mentioned that Emily White has the right to conceal the information of contraceptive administration from anybody and even from her patients as well. The official NMBA report has further clarified that the nurse has to show respect towards the privacy of the patient and confidentiality as well. However, this should be done by not compromising with the safety and security of the medicine from the clinical point of view. Personal information about treatment, illness and all other medical reports can only be regulated to another person with the concept of the patient or with lawful authorization. This ethical statement-7 of nursing practice has been analysed with the help of the four aspects like the person, self, colleague and community in which the aspect of a person is applicable for the context of Emily White. Security and confidentiality of medical information should be implemented for children, persons with disability or who may not speak English as well and nurses have to show respect towards the wishes of that individual (Nursing and Midwifery Board of Australia, 2010). Hence, this aspect is also aligned with the case of Emily White, as she is 14 and is still a minor in the eye of Australian jurisdiction.
However, there are multiple Acts applicable for Australian nursing domain regarding the privacy and security of the patient’s information. The enforcement of Privacy and Personal Information Act, 1998, has been helped in the maintenance of security and privacy of the clinical information of an individual. This act has included the privacy of the information of the parties who have not attained adulthood. Further association of Commonwealth Privacy act has helped in the management of the safeguarding of medical data breach.
The nursing practises of any country always considers professional ethics and especially, in Australia, there is a national ethical standard, which should always be followed by the caregivers. The case of Emily White is a sensitive one and in which the confidentiality of the personal information of the patient is needed. As per the case study, the patient has revealed to the nurse that she has a relationship with her boyfriend which she has not revealed to her parents and she has gone to the shopping mall, where the accident has happened, to meet her boyfriend. The patient does not want to reveal the background and the administration of contraception to her mother. ICN code of nursing has provided a transparent ethical guide which is needed to be followed by the enrolled nurses and the RNS in the process of caregiving. In the preamble of the ICN ethical code, it has been mentioned that the nurses have to prioritise human rights irrespective of class, age, culture, disability, illness and sexual orientation. The maintenance of confidentiality of the medical information of a person is tagged with the personal right of an individual. Hence, the RN of Emily White should conceal the information regarding the administration of contraception from the mother of the patient. Additionally, in the glossary of the ICN Code of ethical nursing, the definition of personal information has been transparently provided. The data which may invoke harm or embarrassment of a person or a family should be considered as the personal information (International Council of Nurses, 2012). The information regarding the relationship of the patient with her boyfriend and the administration of EC may invoke the embarrassment of the patient. Hence, this should not be breached to the mother of the patient. On the other hand, in the code-1, that is, Nurses and People, the caregiver has to hold the personal information of the patient with confidence and have to imply judgmental skill regarding saying the same. Hence, there are two options in front of the caregiver, either to conceal the entre information from Mrs White or to convenience the patient to provide consent for sharing information with Mrs White.
In this case, the first option will be the better choice for the RN of the patient. Being the RN of ED, Angela should conceal the information of contraceptive administration from the mother, of the patient, that is Mrs White. It has been noticed that in the context of Australia, there is an age-related demarcation for the legally minor patients. As per the report of RACGP (Royal Australian College of General Practitioner), the issue of sharing of information of the legal minors has special categories. Patients for 14 years age or older have the right to make decisions regarding the sharing of medical information in the NSW of Australia (RACGP, 2017). As per the case study, Emily White is a patient of 14years and from the previously mentioned standard of RACGP, she is sufficiently matured to decide on the maintenance of the privacy of her medical data from the other persons. His aspect has also been supported by the ICN standard of ethics for caregiving and the information regarding the administration of contraceptive pills may trigger embarrassment to the patient. The case study has mentioned that the patient is in the emergency department. Hence, any type of psychological stress may deteriorate the clinical condition of the patient. Hence, this should be avoided. Privacy and Personal Information Act, 1998 of Australia is also supporting the decision of concealing information from a patient's mother as division-1 section 29 of the mentioned law has been developed by focusing code of practice of privacy, in which privacy of an individual should always be conserved (NSW Legislation, 2020). Hence, from this angle, the RN should conserve the privacy of the patient for maintaining the medical safety of the same. Additionally, the NMBA standard has a major concern over the maintenance of the safety level of the patients and revealing personal information to MRS. White may invoke the crisis to the patient. Hence, this is another strong rationale to support the decision of safeguarding the if oration of EC from the mother of the patient.
Black, K.I. and Hussainy, S.Y., 2017, Emergency contraception: Oral and intrauterine options. Australian family physician, 46(10), p.722.
Butts, J.B. and Rich, K.L., 2019, Nursing ethics. Jones & Bartlett Learning.
International Council of Nurses, 2012, the icn code of ethics for nurses, International, Viewed 26 September 2020, <https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf>.
Johnstone, M.J., 2016, Key milestones in the operationalisation of professional nursing ethics in Australia: a brief historical overview. Australian Journal of Advanced Nursing, The, 33(4), p.35.
Kangasniemi, M., Pakkanen, P. and Korhonen, A., 2015, Professional ethics in nursing: an integrative review. Journal of advanced nursing, 71(8), pp.1744-1757.
McDonald, F. and Then, S.N., 2019, Ethics, law and health care: A guide for nurses and midwives. Macmillan International Higher Education.
NSW Legislation, 2020, Privacy and Personal Information Protection Act 1998 No 133, Australia, Viewed 26 September 2020, <https://www.legislation.nsw.gov.au/view/html/inforce/current/act-1998-133#pt.3-div.1>.
Nursing and Midwifery Board of Australia, 2010, Code of Ethics for Nurses in Australia, Australia, Viewed 26 September 2020, <https://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD10%2F1352&dbid=AP&chksum=GTNolhwLC8InBn7hiEFeag%3D%3D>.
RACGP, 2017, Privacy and managing health information in general practice, Australia, Viewed 26 September 2020, <https://www.racgp.org.au/getattachment/f15c7f47-9abb-48e7-9d31-082e7dd517fe/Privacy-and-managing-health-information-in-general-practice.aspx>.
Vergallo, G.M., Zaami, S., Di Luca, N.M. and Marinelli, E., 2017. The conscientious objection: debate on emergency contraception. Clin Ter, 168(2), pp.e113-e119.
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