Nurses Have a Code of Ethics, Essay Example

Nurses have a Code of Ethics of which to reference when they question the ethical course of action to take in a given situation. Unfortunately, despite the Code of Ethics situations occur in which the ethical course of action is unclear.  An ethical dilemma is a situation in which two principles of the Code of Ethics are in conflict with one another.  In the nursing profession ethical dilemmas are bound to occur as the Code of Ethics cannot account for every situation that takes place.  The Code of Ethics serves as a guideline on how nurses should conduct their practice in a manner that is ethical and serves to keep the best interest of the patient in mind.  On my unit, I was witness to one situation in which the ethical obligation of the practitioner seemed to be blurred.  This paper will explore this circumstance and the ethics of the decisions made.

The ethical dilemma at question occurred as follows. During her rounds, she stopped to speak with a patient whom was crying. She asked the patient if he was in pain or if there was anything she could do to make him more comfortable. The patient then began to confide in my friend that he had hit his child the last time the patient had seen the child. The patient was worried that he may not make it through the surgery and the last memory the child would have was of her father hitting her.  My colleague made attempts to put the client at ease and left the room. The nurse knew the patient had two children.  The patient resided with both his children and wife. The nurse had met the children before when they came to visit the patient and did not see any indication of abuse.  The nurse was concerned that when the patient went home he may abuse the children again and feared for the safety of these children.

The problem lies within the nurse’s duty to preserve confidentiality in conflict with the obligation we have to keep the public safe.  A nurse’s primary interest should always be the patient and looking out for the patient’s health and well-being. Breaking confidentiality and sharing information about a patients health or that the patient confides in the practitioner can be damaging to the practitioner-client relationship.  Trust is needed in the relationship if the patient is to share all medically necessary information and agree to receive treatment.  If trust is broken than patient care may suffer as the patient is no longer comfortable sharing their needs and concerns.  On the other hand, it is imperative that we also keep the concerns of the public in mind.  Nurses and most health professionals are required to report abuse, especially child and neglect.  It is also important for nurses to look beyond the primary situation at hand and evaluate the impact actions can have outside treatment.

My colleague consulted with the other nurses and health professions on staff.  It was decided that a call needed to be made to child protective services. Despite the patients right to confidentiality the child may be put in harm’s way once the patient is out of the hospital and back in the home.  The nurse made a report with child protective services and relayed all the information the client had spoken with her about regarding the children. The nurse relayed what she knew about the family and ages of the children and provided child protective services with the family address.

The client was informed by his wife that child protective service had come to their residence and he was accused of abusing his daughter.  Additionally, child protective services came to the hospital and interviewed the patient.  The patient was unaware of who made the call to child protective services and did not seem to connect that it was his nurse.  The rest of the patients stay went as expected and the patient was discharged from the hospital.  The patient did become more agitated and was somewhat distraught about the thought of losing his children.  The stress could have had an impact on his health, as stress often does.  However, the patient was still able to receive treatment and treatment was not interrupted despite the incident.

The option taken in this situation was to report the child abuse and break confidentiality.  Although the report had minimal consequence on patient care in the given situation, it may have played out differently if it was with a different patient was involved.  For example, the stress created by the report, and the consequences of the report, may have caused complications in treatment.  Another patient may have connected the comment made to the nurse with the call to child protective services.  This could have caused the patient to refuse care from this particular nurse.  That could be easily solved with the patient switching nurses and not affect care very much.  Alternatively, the patient could have demanded to be discharged and refused care.  In this case the health and well-being of the patient would be jeopardized.  This would be a worst case scenario but it could be severely detrimental to the patient’s health.  This patient needed an operation and refusal of the operation could have been life threatening.

Another possible action would have been for the nurse to disregard the disclosure and not report the abuse.  In this situation the patient-nurse trust would still be maintained and the nurse could continue to ensure the health and well-being of the patient.  However, if the nurse had not called child protective services there could also have be severe consequences. The child could have been harmed once the patient returned home. The nurse may have been the only individual with knowledge of the abuse. The level of abuse was unknown but even minor repeated abuse can result in psychological damage. The abuse could have caused the child could to sustained minor injuries, seriously injuries, or resulted in death. Additionally, the nurse would have been legally responsible for this abuse. If the nurse had knowledge of child abuse and did not report the abuse then she would be in part liable for the abuse.  Nurses are mandated reporters and as such are required by law to report abuse if they suspect abuse or have knowledge of abuse.

I believe that the actions taken were ethical in nature. As mandated reporters nurses are required to break confidentiality if abuse is suspected or there is evidence of abuse on a child. The legal mandate is above our duty to preserve confidentiality.  The duty of nurses to look out for the good of the people, additionally to the patient, does often take priority over our obligations to patients. In this case the patient was not affected y the breach in confidentiality.  Even if the patient did decide to refuse treatment or be transferred to another facility, I still believe reporting the abuse was the ethical decision.