The practice of nursing is guided by strict moral and ethical principles. On daily basis, the nurses are confronted with complicated situations which require them to make decisions based on the societal expectations, internal convictions and most importantly the legal and regulatory guidelines. Although the ethical considerations may be relative across the various reasoning of nurses, there are predetermined and widely acceptable code of conduct that is meant to help the nurses make critical decision when confronted with ethical dilemmas. The guiding principles of all nursing decisions are motivated by the need to provide rational, correct and good care of patients. On the same note, the patients require opportunities for expressing their autonomy in determination of what they need to be cared for. Therefore, ethical nursing care is not only guided by the natural science knowledge but also critical decision making in handling of diverse situations. Regardless of the source of legal or regulatory guidelines, there are four underlying concepts which are critical in the practise of professional nursing. The concepts include the respect of patient’s autonomy, obligations to offer care with beneficence, avoid maleficence and uphold justice.
Whereas nurses are required to demonstrate care and compassion in execution of their duties based on the best knowledge possible, they should operate within the professional guidelines, ethical standards and the applicable clinical parameters ( American Nurses Association 2010) . Notably, there are instances where the nurses are faced with dilemma, especially when their convictions do not agree with the law. The thin line between law and ethics creates this dilemma in some instances, compelling the nurses to do what they do not necessarily agree with. In the case presented, Lena is confronted with a complicated situation of and need to make rational decision of whether she should inform her sister about the HIV status of her boyfriend, which she happened to know about in execution of her daily duties. The dilemma here is whether she should go ahead and inform her sister about the newly discovered status of the boyfriend or pursue the legal and regulatory requirement of maintaining the patient’s confidentiality.
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Although Lena is feeling compelled to divulge the information of one of her patients to the sister at the interest of helping her initiate treatment and care program, she must uphold the principle of maintaining the patient’s confidentiality and right to privacy as stipulated in the American Nurse Association code of ethics. The third provision of this code addresses the guiding principles which Lena should rely on in handling her dilemma. Provision 3 guarantees the right of a patient to privacy of any identifiable information, including but not limited to genetic information ( Fowler, 2008) . The code states that a patient has a unilateral right in deciding the circumstances and to whom the identifiable medical information should be disclosed to. This protection of confidentiality encompasses all forms of health records, imaging files, mental health notes and laboratory reports among others. With this guideline in place, Lena should resist the temptation of disclosing the identified information to her sister.
For the interest of enhancing her internal peace, Lena should explore the legal way of ensuring that the information regarding the HIV status gets to her sister. The only way she can do this is by counselling the patient and advising on the legal requirement for him to notify the partner. It will be of great importance and possibly beneficial if Lena’s sister is well informed about the HIV status of her boyfriend. The impediment here is that this can only be done by the patient. Therefore, while doing the counselling of the patient, Lena should enlighten him on the provisions of the Partner Notification Program under Iowa Code 141A.5. Under this program, a person who is found positive of HIV should be given post-test counselling and encouraged to refer any person they have had sexual relations to undergo counselling and testing (Partner Notification Program–HIV, 2007). Although the approach of educating the patient may not have immediate results, the conscience of Lena will be a bit free in the hope that the patient will pursue the requirements under the code. By pursuing the guidelines of this code, the health department where Lena is posted will be delivering education to the patient to inform the partner(s) of his status which in this case may not be limited to her sister.
The third legal guideline that Lena should rely on inn resolving her dilemma relates to Health Insurance Portability and Accountability Act, HIPAA. This law is elaborate on the handling of health records of patients and maintenance of privacy and confidentiality. The privacy portion of this act sets a limit on the access and use of patient’s health information. It requires that the health care institutions and insurance bodies can only use the collected information for the purpose of delivering treatment, seeking payments or any other specific use that is aimed at enhancing the quality of care ( O’herrin, Fost and Kudsk, 2004) . Further, it calls for patient notification in writing on the intended use of collected data.
In conclusion, it has been demonstrated that Lena has limited options for handling her current dilemma. The ethical and legal consideration in her profession calls for unequivocal adherence to confidentiality and maintenance of privacy of the patient. Therefore, she cannot divulge any information regarding the HIV status of the patient to her sister, whom she has a relationship with. However, she can only help by advising on the need to notify the partner(s). Finally, she may opt to avert the eminent conflict of interest by transferring this particular case to another nurse for close out.
References
American Nurses Association. (2010). Nursing: Scope and Standards of Practice . Silver Spring, MD: Nursesbooks.
Fowler, M. D. M. (2008). Guide to the Code of Ethics for Nurses: Interpretation and Application . Silver Spring, MD: Nursesbooks.
O’herrin, J. K., Fost, N., & Kudsk, K. A. (2004). Health Insurance Portability Accountability Act (HIPAA) Regulations: Effect on Medical Record Research. Annals of Surgery , 239 (6), 772. Partner Notification Program–HIV, art. 141A.5 §§ 1-5 (2007).
