Case Study for Professional Identity - The Sandy Wilson Case Study - Nursing Assignment

The Sandy Wilson Case Study : 

Professional judgement requires that the nurse recognise the full range and complexity of issues involved in the ‘Sandy Wilson’ scenario, be able to ‘weigh these in the balance’ and come to a considered decision about what was [most] important, what she needs to do, how she should go about these things etc ... in order to be properly ‘available’ to Sandy. In the scenario, there are legal, ethical and clinical issues which the nurse must attend to. Such judgement improves with experience – and reflective attention to that experience. Following are a few comments on clinical skills and related legal and ethical matters.

 Some specific law and ethics

 Children and consent : 

Unless Maria had reason to believe otherwise, it seems clear that Sandy is an ordinarily legally competent girl. She will be able to consent to ‘ordinary medical and dental treatment’, which is what is initially involved here. If this is the case, then Sandy has status as a patient, and therefore has the right to confidentiality. An implication is this: that it is up to Sandy to decide whether her mother is to be informed of her situation. Maria has no obligation to say anything about Sandy to the mother, nor would she have any right to say anything without Sandy’s permission.

 Sexual relations and 15-year old’s : 

You will be aware of what the Crimes Act (NSW) has to say about sexual intercourse with 15- year- old girls. However, the following points should be noted:

•  If the nurse, having discussed things with Sandy, learns that Sandy has been sexually involved with a boyfriend, and that this was consensual, then normal practice is to simply note this and move on to whatever therapeutic business might be necessary, This practice shows that the law is no longer viewed as applying absolutely and without exception: gradual changes in sexual mores have resulted in a more restricted application of the law.
• Suppose the nurse learns that there has been coerced sex – forced by a family member: father, brother, uncle. The nurse is required by law to notify welfare authorities – under the provisions of the children and Young Persons (Care and Protection Act) (NSW). Note that the nurse would be indemnified in this situation: she is required to report even suspected abuse, but cannot be prosecuted if it turns out that no abuse actually occurred, in this situation, Sandy’s right to confidentiality is overridden by the requirements to notify.
• If the nurse learns that Sandy was raped by someone outside the home, then while this is a clearly criminal matter, its handling involves complexity. Even if Sandy is in her care at home. The question of whether the police are to be notified, and by whom, is also complicated. Much would depend, for example, on whether the rapist was a stranger, or someone known to Sandy, and therefore identifiable to the police.

How to respond to the mother : 

Mother’s question to Maria [“Do you have any idea...?”] is very awkward for the nurse. She has a very clear idea of the possibilities here, even if she does not know for sure about any one of them.  However, Sandy is owed confidentiality [already established], and given the delicacy of the issue she has raised, would need ‘protective space’ for the moment so that she can make use of the help she has sought from the nurse. Maria has a dilemma: either she answers truthfully – in which case she opens up a conversation which would likely expose Sandy: or she answers by deception [even lying] – which could afford protection for Sandy, but at the cost of an ethically troubling act. Note that some ‘in between’ action – evasion, but not deception, yet not the truth about Sandy’s concerns- would likely only stimulate further questions from the concerned mother... questions which would ultimately bring Maria back to the basic dilemma....

Questions : 1. The problem is.... (a sentence or two - short paragraph at the most) 2. Make a list of all the issues [what kind of issues do you need to think about?] that you will be discussing in Q4 3. List two options that are realistic for the Nurse Practitioner 4. Provide a discussion on the best course of action for the Nurse Practitioner. 5. So what do you need to find out? 6. What do you need to read? 7. Where are the key readings?