An Ethical Dilemma

  1. Hello! I'm a second year nursing student with UWO, andwas hoping for some input. I'm taking a professional nursing course where I need to validate an ethical dilemma that was given to us and just wanted some opinions.
    Here it goes...

    A 14 y.o. female has just completed a 6 month checkup for a fractured ankle. The fracture had healed completely and with complications, but her blood results showed that her hemoglobin was in the low-normal range. As a percautionary measure, her doctor sent her to a nurse practitioner for diet counseling. Before long the patient had confided that she thought she was pregnant and she did not want anyone else to know, especially her mother. With more discussion it became evident that the 14 y.o. patient had no clear idea what she was going to do about the suspected pregnancy. Before the nurse practitioner could begin to help the patient think it through, the mother walks in. The mother tells the nurse that the patient has been nauseated and very tired lately, and asked the nurse if she had any idea what could be causing it. As the nurse prepares to respond, the patient is silent and glaring at her. The nurse has a dilemma.

    So is this dilemma is based on confidentiality? Or being able to make decisions for herself?

    It is essentially doing the most for the patient, without sacrificing her rights.?!

    I'm just hoping for some opinions for a basis to my thoughts.

    Thanks for your help in advance!
    Sara
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  2. 7 Comments

  3. by   Tina_RN2007
    Hi Sara, I'm a 2nd year student too and doing the exact same assignment (different scenerio). I would say that this is a client confidentiality issue. I am using the College of Nurses of Ontario's standards of practice to base my response on. I don't know where UWO is, but if it's in Ontario you might want to consider it. If I were you I would use the standards entitled "ethics" and "confidentiality". They can be downloaded for the CNO's website. I hope this helps!

    Tina


    Quote from StudentRN_Sara
    Hello! I'm a second year nursing student with UWO, andwas hoping for some input. I'm taking a professional nursing course where I need to validate an ethical dilemma that was given to us and just wanted some opinions.
    Here it goes...

    A 14 y.o. female has just completed a 6 month checkup for a fractured ankle. The fracture had healed completely and with complications, but her blood results showed that her hemoglobin was in the low-normal range. As a percautionary measure, her doctor sent her to a nurse practitioner for diet counseling. Before long the patient had confided that she thought she was pregnant and she did not want anyone else to know, especially her mother. With more discussion it became evident that the 14 y.o. patient had no clear idea what she was going to do about the suspected pregnancy. Before the nurse practitioner could begin to help the patient think it through, the mother walks in. The mother tells the nurse that the patient has been nauseated and very tired lately, and asked the nurse if she had any idea what could be causing it. As the nurse prepares to respond, the patient is silent and glaring at her. The nurse has a dilemma.

    So is this dilemma is based on confidentiality? Or being able to make decisions for herself?

    It is essentially doing the most for the patient, without sacrificing her rights.?!

    I'm just hoping for some opinions for a basis to my thoughts.

    Thanks for your help in advance!
    Sara
  4. by   Lys
    Just another tweak in the (hopefully right direction):

    Yes, this is totally about client confidentiality...but we'll likely need to take the client's age into account.

    If you look up when clients are allowed to consent and age (or conditions) when one is defined as "adult" and therefore self-determining, I think it will become a bit clearer ;-)

  5. by   canoehead
    Pregnancy and sexual activity are confidential at any age. I would say to the mom "we were just talking about that...would you mind stepping out for a few minutes and we'll see if we can come up with a solution?" That gives you time to find out was it consensual, where does the 14yo want to go from here, initial prenatal counselling and testing, discuss options, etc.
  6. by   NotReady4PrimeTime
    I concur with Canoehead. The patient is the one to decide when or if she shares that information with her mother. The nurse should provide support and guidance without making value judgments while gathering the details Canoehead listed.
  7. by   Sarah, RNBScN
    Quote from canoehead
    Pregnancy and sexual activity are confidential at any age. I would say to the mom "we were just talking about that...would you mind stepping out for a few minutes and we'll see if we can come up with a solution?" That gives you time to find out was it consensual, where does the 14yo want to go from here, initial prenatal counselling and testing, discuss options, etc.
    ------------------

    I agree.
  8. by   BETSRN
    Quote from StudentRN_Sara
    Hello! I'm a second year nursing student with UWO, andwas hoping for some input. I'm taking a professional nursing course where I need to validate an ethical dilemma that was given to us and just wanted some opinions.
    Here it goes...

    A 14 y.o. female has just completed a 6 month checkup for a fractured ankle. The fracture had healed completely and with complications, but her blood results showed that her hemoglobin was in the low-normal range. As a percautionary measure, her doctor sent her to a nurse practitioner for diet counseling. Before long the patient had confided that she thought she was pregnant and she did not want anyone else to know, especially her mother. With more discussion it became evident that the 14 y.o. patient had no clear idea what she was going to do about the suspected pregnancy. Before the nurse practitioner could begin to help the patient think it through, the mother walks in. The mother tells the nurse that the patient has been nauseated and very tired lately, and asked the nurse if she had any idea what could be causing it. As the nurse prepares to respond, the patient is silent and glaring at her. The nurse has a dilemma.

    So is this dilemma is based on confidentiality? Or being able to make decisions for herself?

    It is essentially doing the most for the patient, without sacrificing her rights.?!

    I'm just hoping for some opinions for a basis to my thoughts.

    Thanks for your help in advance!
    Sara
    The NP needs to ask the mother to leave the room so she can conduct ther est of her exam in provacy. After the NP and the girl have spoken, then they can explore how to involve the mother. Until the NP has a definitive diagnosis, there is nothing to discuss, really.
  9. by   RNinRubySlippers
    the principles of bioethics may help you decide what you ought to do. Pt autonomy outweighs all unless harm is possible to the pt. Look into the principles of beneficence and non malificence.THey will guide you. And yes, the age of consent is out the window I believe (meaning it is the pts right not to tell her mother). There is usually no RIGHT answer, as every case is pt specific. She is unencumbered, therefore able to make her own decisions.

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