Applying Ethical Frameworks in Practice

As a nurse it is common knowledge that patient confidentiality is of up most importance. We learn this in nursing school as it is part of the Nursing Code of Ethics and it is a nurse’s duty to keep patient information confidential. (American Nurses Association, 2012).

There are however, extenuating circumstances that may require and be appropriate for a nurse to break this rule. As a matter of fact, the nurse could be held responsible if harm came to the patient because she did not speak out. If a patient presents to the ER because he needs stitches in his wrist and tells the nurse that he wants to or was attempting suicide the nurse has a duty to report this and find help for the patient, or possibly the spread of sexually transmitted diseases that are required by law to report.

This paper will provide an overview of ethical implications of a breach of confidentiality, an ethical theory, and alternatives to breaching confidentiality using the framework of ethical decision making and the use and role of an ethics committee. Nurses are entrusted with very private information from patients and along with this the patient expects and the law requires this to be kept confidential The patient gives this information assuming and trusting that the information will be kept private and only used for medical treatment.

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A breach of confidentiality comes in when the patients’ information has been disclosed to a third party that is not directly involved in the patients care or given without appropriate consent from the patient. (American Medical Association, 2013). Confidentiality should always be maintained except in cases that the law requires reporting or where more harm may come to the patient by respecting this commitment. Some ethical implications that may arise as part of breaching patient confidentiality include loosing the trust and respect of our patient and you may cause increased harm to your patient by providing information to a third party that is not required by law. In an article “Bioethics on NBC’s ER: Betraying Trust or Providing Good Care? When is it OK to Break Confidentiality? ” The nurse caused more harm than good by divulging information to the girls’ school. If she would have called the school informing them of knowledge regarding risky and potentially harmful behavior it would have made it ethical. However, the appropriate action was action was taken in the decision to notify the girl’s parents about the cervical cancer.

This prevented further harm or death to the child. In this circumstance the ethical theory that would be appropriate is utilitarianism. In utilitarianism, balance is the key. The majority should benefit using this theory. (Purtilo & Doherty, 2011). In this case if the nurse had chosen not to inform the minor child’s parent more harm would have came to the child than good. She may not have received the appropriate care for her condition until it was too late and the cancer had spread.

In breaching the confidentiality the nurse created a balance by preventing further harm than necessary to her patient even though she broke the trust that her patient had in the nurse. The nurse however, did not cause a balance that worked towards a greater good when she called the girls school and notified them about the sex parties. She could have let the girl remain anonymous and that would have prevented the majority of the problem. In the nurses attempt to prevent further harm to other children, she actually put her original patient at greater risk by notifying the school and divulging too much information.

Using Uustals model of ethical decision making one can find the steps to make ethical and moral decisions to dilemmas that may arise (Grand Canyon University, 2013). In step one this is where the problem is recognized. The problem in the previously discussed case was that the nurse fought herself on whether or not to disclose the information to the girls parents regarding the cervical cancer diagnosis and on whether or not she should inform the school regarding the sex parties taking place. In the second step the nurse had to identify her own person values as they pertained to the problem at hand.

In this case she respected the minors rights but knew not telling would cause further harm and she felt like informing the school could also prevent further spread of STD’s to other students. In the third step the nurse must consider the factors that relate to the problem at hand and consider alternatives to resolve the dilemma. In this situation the factors are breaching confidentiality or protecting the patient from further harm by keeping the information confidential and the patient not being able to receive appropriate treatment for cancer.

Alternatives would have been for the nurse to educate the patient on the importance of getting treatment and possible assisting the patient in informing her parents and the other would have been for the nurse to report to the school that she had knowledge of the sex parties and keeping the names confidential. The fourth step would have been for this nurse to review and categorize the alternatives to come to a conclusion of the alternatives and to decide what is consistent or inconsistent with her own person values.

If the patient had been given the option of telling her parents herself this would have been consistent with the nurses values as long as the parents were informed and the patient received appropriate care. Not telling the parents was inconsistent with her values. The fifth step is predicting possible outcomes. If the patients informed her own parents confidentiality would not be breached, therefore; no harm would be caused to the nurse patient relationship.

The sixth step is to find appropriate alternatives from the greatest importance to the least. In this case the patient could have been given the option of informing her own parent and the least desirable option was the nurse telling the parents without the patient’s knowledge. The seventh step is developing an action plan. After giving the minor the option to inform her own parents and she still decided not to tell then the nurse should take actions in her own hands and inform the parents to prevent further harm to the patient.

The eighth step is implementation. The plan should have been for the nurse to educate the patient and assist her in telling the patients parents regarding her new diagnosis. The final step is evaluate the action plan. Confidentiality was breached when informing the patients parents but to prevent further harm, however; the school did not need to be given names the nurse should have simply notified the school of her knowledge. There are ethics committees in place to assist with situations such as this.

These committees are in place and help support patients rights, and assist clinicians with decision making. They assist with promoting ethical decisions amongst health care providers. These committees review medical records and hold meeting to determine case specific information and communicate between healthcare providers and families at time. The committee will write recommendations based on case information regarding any ethical dilemma that may have arisen during the patients care. (Pearlman, 2010).

Many ethical dilemmas will arise during a nurse’s career. Being equipped and knowledgeable in resolving the dilemma is important. It is important to remember that breaching patient confidentiality is against the Nursing Code of Ethics and should be avoided if possible. However, there are times that a nurse is legally liable to make a breach in confidentiality. This type of dilemma should be resolved by causing the least amount of harm to our patients. (Purtilo, 2010)

References

1. American Nurses Association (2012). Code of Ethics For Nurses with Interpretive Statements. , retrieved April 2013. , http://nursingworld. org
2. Pearlman, R. A. (2010). Ethics Committees and Ethics Consultation. In (pp. -). University of Washington School of Medicine. , retrieved, April 2013. , http://depts.. washington. edu/bioethics/topics/ethics. html
3. Purtilo, R. & Doherty,R. (2011). . In Ethical Dimensions in the Health Professions (p. ). , retrieved, April 2013. , http://pageburst. elsevier. com/books/978-4377-0896-7/outline/Root

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