Discussion: Legal and Ethical Conduct
As emphasized in this week’s media presentation, all nurses need to be familiar with the laws and regulations that govern their practice: their state’s Nurse Practice Act, ANA’s Nursing: Scope and Standards of Practice, specialty group standards of practice, etc. In addition, basic ethical principles guide nurses’ decision-making process every day. ANA’s Code of Ethics and ANA’s Social Policy Statement are two important documents that outline nurses’ ethical responsibilities to their patients, themselves, and their profession. This said, there is a dilemma: The laws are not always compatible with the ethical positions nurses sometimes take. This week’s Discussion focuses on such a dilemma. To prepare: Review this week’s Learning Resources, focusing on the information in the media presentation about the relationship between the law and ethics. Consider the ethical responsibility of nurses in ensuring patient autonomy, beneficence, non-malfeasance, and justice. Read the following scenario: Lena is a community health care nurse who works exclusively with HIV-positive and AIDS patients. As a part of her job, she evaluates new cases and reviews confidential information about these patients. In the course of one of these reviews, Lena learns that her sister’s boyfriend has tested HIV positive. Lena would like to protect her sister from harm and begins to consider how her sister can find out about her boyfriend’s health status. Consult at least two resources to help you establish Lena’s legal and ethical position. These resources might include your state’s Nurse Practice Act, the ANA’s Code of Ethics, ANA’s Nursing: Scope and Standards of Practice, and internal or external standards of care. Consider what action you would take if you were Lena and why. Determine whether the law and the ANA’s standards support or conflict with that action. Discuss a description of the actions you would take in this situation, and why. Justify these actions by referencing appropriate laws, ethical standards, and professional guidelines. Discussion: Legal and Ethical Conduct .
The case of Lena is an ethical dilemma where she finds herself in a situation that requires a careful balance of cats. While she loves her sister and wants to protect her from her HIV positive boyfriend, Lena is bound by the State Nurse Practice Act which provides that the patient’s confidentiality and privacy on medical records must be upheld at all times. Equally, Lena is bond by the American Nurse Association’s code of ethics to always maintain the highest level of ethical behavior when handling patient medical records (American Nurses’ Association, 2017). Conversely, Lena is supposed to ensure that she keeps the medical records of her sister’s boyfriend private and confidential and never share it with another person. She is supposed to use the medical records solely for the purpose of medical procedures that benefit her sister’s boyfriend and not to the benefit if her sister
Lena finds herself in trick and painful situation. Whereas there is no knowledge of the kind of relationship she has with her sister, legally, she is barred from divulging patient information to any third party. This includes her being prevented from sharing with her sister medical information regarding the sister’s boyfriend. As Borten (2016) notes, according to the Health Insurance Portability and Accountability Act (HIPAA), Lena cannot divulge lab result information or the health status of any patient. As such, health information of her sister’s boyfriend must remain confidential. The ethical dilemma facing Lena is whether to divulge the information on the patient’s health status to her girlfriend who also happens to be her sister or to stick to the regulatory requirements.
Partner notification laws differ by state. In most states, however, an individual is obliged to inform their sexual partner of their HIV status, particularly when they are positive (HIV.gov, 2017). Additionally, in most states, health programs such as that run by the Ryan White HIV/AIDS program promote the disclosure of health status among partners through what is referred to as the ‘duty-to-warn’. Departments benefiting from such funding are expected to play a proactive role in ensuring that health departments create an environment for partners to open to each other about their health status. Such a program would be effective in helping Lena to overcome her dilemma.
In my capacity as a public health nurse just like Lena, it would be my responsibility to encourage patients who are HIV positive to be open with their sexual partners. This nonmaleficence approach will be the best ethical option. The duty to warn will help to advance both the professional and advocacy roles attached to the role of a public health nurse. It is noteworthy, however, that while it might be easy to inform my sister of her boyfriend’s HIV status, I have to be conscious of the ethical implications (Zahedi, Sanjari, Aala, et al., 2013). however, as things stand currently, Lena should not disclose the medicals status of her sister’s boyfriend because doing so will violate the HIPAA provisions, the ANA Ethical Code of practice, and the applicable state Nurse Practice Act. The repercussions of such violations may end up hurting Lena’s professions and thus she must refrain from engaging in any disclosure at all costs because she may end up violating the ANA’s Nursing Scope and Standards of Practice (American Nurses’ Association, 2016). Discussion: Legal and Ethical Conduct .
American Nurses’ Association. (2016). Nursing: Scope and standards of practice. American Nurses Association.
American Nurses’ Association. (2017). Nursing: Code of Ethics. American Nurses Association.
Borten, K. (2016, August). HealthIT Security. Retrieved from The Role of Nurses in HIPAA Compliance, Healthcare Security: https://healthitsecurity.com/news/the-role-of-nurses-in-hipaa-compliance-healthcare-security
HIV.gov. (2017, May). Retrieved from HIV Disclosure Policies and Procedures: https://www.hiv.gov/hiv-basics/living-well-with-hiv/your-legal-rights/limits-on-confidentiality
Zahedi, F., Sanjari, M., Aala, M., Peymani, M., Aramesh, K., Parsapour, A., Maddah, S. B., Cheraghi, M., Mirzabeigi, G., Larijani, B., … Dastgerdi, M. V. (2013). The code of ethics for nurses. Iranian journal of public health, 42(Supple1), 1-8. Discussion: Legal and Ethical Conduct.