# data[].attributes.headline
‘If the woman is interested in
contraception, she requires accurate information to assist her in choosing the
most appropriate contraceptive method to meet her needs.’ (World Health Organisation,
2014) The nurses should offer Izzy advice and information on contraception that
may be able to help prevent any further unwanted pregnancy. Izzy’s age may be
one of the reasons why she has undergone this procedure on two occasions as she
may not be well educated on the different methods of contraception.

                                                                                       ‘Ultimately, the final
decision about whether to use contraception, and identification of a method to
use, is the woman’s alone.’ (World Health Organisation, 2014) It is important
as a nurse that they should be non-judgemental towards Izzy and her lifestyle choices.
This means that if Izzy chooses not to take the nurses advice and use
contraception they must respect this choice and prevent themselves from discussing
Izzy’s choices in a negative way.

# data[].attributes.subject
‘If the woman is interested in
contraception, she requires accurate information to assist her in choosing the
most appropriate contraceptive method to meet her needs.’ (World Health Organisation,
2014) The nurses should offer Izzy advice and information on contraception that
may be able to help prevent any further unwanted pregnancy. Izzy’s age may be
one of the reasons why she has undergone this procedure on two occasions as she
may not be well educated on the different methods of contraception.

                                                                                       ‘Ultimately, the final
decision about whether to use contraception, and identification of a method to
use, is the woman’s alone.’ (World Health Organisation, 2014) It is important
as a nurse that they should be non-judgemental towards Izzy and her lifestyle choices.
This means that if Izzy chooses not to take the nurses advice and use
contraception they must respect this choice and prevent themselves from discussing
Izzy’s choices in a negative way.

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RCN- Termination of pregnancy- nursing framework

Section 4 of the Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990) provides a right of conscientious objection which allows health care professionals to decline to participate in a termination of pregnancy. This right is limited only to the active participation in the termination of pregnancy where there is no emergency with regard to the physical or mental health of the pregnant woman.  So the nurse who does not agree with the termination as it is Izzys second time can refuse to not participate therefore maintaining patient rights and making sure the individual care is not effected by differing views, they must inform their employer at the earliest opportunity in order to refuse participation.

Every woman seeking a termination has the right to confidentiality so the health care professional should not be discussing the information as it is a breach of confidentiality as there is no emergency in which a referral needs to be made to another member of staff. So the nurse is breaking the confidentiality guidelines by discussing Izzys second termination with other members of staff.

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Legal standards 

Confidentiality

-

Nurses should not discuss a patient’s information even with
other colleagues unless it is required by for example a surgeon. As a nurse you
have the duty of confidentiality to all those in your care. This means
information is shared in an appropriate manner.

5.1 respect a person’s right to privacy in all aspects of
their care

5.4 share necessary information with other healthcare
professionals and agencies only when the interests of patient safety and public
protection override the need for confidentiality, and 

 (NMC codes)

 

As a nurse it is also vital to respect decisions made by the
patient in this case where the patient has decided to terminate her pregnancy.

A nurse must always respect the patient’s right to
confidentiality and privacy.

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Legal standards 

Confidentiality

-

Nurses should not discuss a patient’s information even with
other colleagues unless it is required by for example a surgeon. As a nurse you
have the duty of confidentiality to all those in your care. This means
information is shared in an appropriate manner.

5.1 respect a person’s right to privacy in all aspects of
their care

5.4 share necessary information with other healthcare
professionals and agencies only when the interests of patient safety and public
protection override the need for confidentiality, and 

 (NMC codes)

 

As a nurse it is also vital to respect decisions made by the
patient in this case where the patient has decided to terminate her pregnancy.

A nurse must always respect the patient’s right to
confidentiality and privacy.

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When people make ethical decisions, they don't always tend to focus one of the above principles, it generally tends to be a combination. For example, the healthcare professional in question may not have necessarily thought about the effects on Izzy if she was unable to have an abortion, or they may be a religious person who's teachings don't agree with abortion. But, as abortion is legal in the UK, up to 24 weeks, Izzy is legally within her right to have an abortion, regardless of their judgement.

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Consequentialism - e.g. Utilitarianism

- Utilitarianism decides whether actions are morally right or wrong depending on the effects or consequences. The decision which is acted upon the one with the best overall outcome.

Rule based e.g. Deontology or Kant's theory

- Deontology refers to the duty of obligation of an individual to do what is morally/legally correct within that society. E.g. looking after children and not committing murder.
- Kant's theory was focused mainly around 'fulfilling our duty' rather than the good/bad consequences of the actions.

Rights based e.g. Feminism

- Feminism is based around women's rights due to equality of the sexes

Religious based (tend to be rule based)

- Religious individuals follow rules and guidelines set out via their religious leaders, teachings and scripture to ensure their actions are morally right. E.g. A Christian would follow the teachings of Jesus/God and the Bible.

(http://www.iep.utm.edu)

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- Truthfulness
The member of staff who makes this comment might not be aware of the Izzy's personal situations such as her families opinion of her partaking in intimacy and becoming pregnant. This, therefore, making the member of staff appear unprofessional in her comments towards the young girl.
Izzy may also not be telling the team the whole truth, making it difficult for them to help her in the correct way.
-  Non-maleficence
The termination of the pregnancy could be viewed as doing harm to the unborn child as it could be viewed as ending a human life. However, the mother is the most important in this situation and although it is not clear if the pregnancy is doing Izzy any physical harm, it could cause psychological harm which could then effect the baby if it was to be born. Izzy's relationships with family and friends could also be effected, making her life very difficult. Therefore, although she should be careful when having sexual intercourse, the idea of her being a time waster is not necessarily true as she is a young girl who could be struggling.
- Fairness
Izzy's personal situation is not known apart from the fact that she is pregnant and has been before. Therefore is it fair for the member of staff to make comments about someone whom they do not know. Is this fair?
- Justice
If some cultures, Izzy's terminations would be seen as unjust and wrong due to the child, in some eyes, being alive from conception. It could also been seen as unjust to continue to use the NHS for lack of diligence. However, it is also unjust to not give her the help she requires.
- Respect for Autonomy
Izzy is expressing her autonomy as she is choosing to have a termination but she is also choosing to put herself in the situation where she needs one. As a nurse I would also respect her autonomy to an extent, unless i felt it nesseccary to inform her parents of her pregnancies.

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 Legal standards                            - Principle A                                         ‘’Nurses and
nursing staff treat everyone in their care with dignity and humanity – they
understand their individual needs, show compassion and sensitivity, and provide
care in a way that respects all people equally’’. RCN

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 Legal standards                            - Principle A                                         ‘’Nurses and
nursing staff treat everyone in their care with dignity and humanity – they
understand their individual needs, show compassion and sensitivity, and provide
care in a way that respects all people equally’’. RCN

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-‘’Nurses have a professional responsibility to act with integrity and ensure that their personal views do not affect or influence the care of the woman’’ (NMC, 2008).
Therefore the nurses personal view of Izzy being a 'time waster' should not influence or effect the care given.

-Good character is very important as a nurse or midwife must be honest and trust worthy. It is shown by your conduct, behaviour and attitude.
The staff member in which was told this comment should ''act as an advocate for the vulnerable'' and report what had been said. This is important as a negative attitude towards patients decisions could effect the quality of care given to Izzy, and future patients.

Compassion in practice
- patients have the right to receive high quality and compassionate care in order to achieve excellent health and well being outcomes.
(Department of Health)

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Legal Standards
- Nurses must not refer to patients in a disparaging manner, even if the patient is not identified
- It is important that nurses understand the complexity of decision-making around a woman’s decision to terminate her pregnancy
- Human rights act 1998 No torture, inhuman or degrading treatment.
-Fitness to practice proceedings. The NMC will investigate nurses suspected of
misconduct
•lack of competence
•bad character
•serious ill health

Examples of misconduct:
• physical or verbal abuse of colleagues or the public
•theft
•significant failure to deliver adequate care

-In some very serious cases, a panel of the Investigating Committee may put interim measures in place to suspend the nurse or midwife in question, or restrict their practice

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Beneficence - to do good

Non-maleficence - to do no harm

Respect for Autonomy

Fairness

Truthfulness

Justice

(Tingle and Cribb, 2014)

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Are there professional issues that need to be discussed?

The code discusses the treatment of people under you care. The entire first section of the code is called “Prioritising people”. This states the absolute importance of treating people as individuals and with respect.

This is further discussed in point 1.3 of the code which states “avoid making assumptions and recognise diversity and individual choice”. This is directly related to the case of Izzy as one of the nurses makes comments that violate this part of the code. It is a professional standard that the nurse must respect Izzy’s decisions and treat her like any other patient even if her own personal beliefs are different to Izzy’s.

Another standard set out in the prioritising people section of the code is point 2.4 “respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care”. It is obvious in this scenario that Izzy has taken this step herself and has likely had a huge amount of thought around her treatment. The nurse who comments negatively about Izzy is not respecting Izzy’s right as a patient to make her own decisions about her healthcare.

As the other Nurse who overhears the nurses negative comment it is important to remember point 3.4 of the code. “act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care”. The nurse making comments is displaying potentially discriminatory attitudes. This is most definitely is a professional issue and the code goes on to say that this must be challenged.

Point 4.4 may apply to the nurse who has made the comments in this situation. tell colleagues, your manager and the person receiving care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for that person’s care. If this nurse has such an issue with these procedures it may be possible that she may remove herself from that environment or even the entire surgical area, if she wishes. However, this must be done openly and In a professional way that informs all around her including the patient.

Although this may be situational and may not 100% relate to this case I personally think is it important to recognise point 14.2 “explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers”. Although this refers to physical harm or mistakes within care I feel that if Izzy or any of her friends/family has heard these comments it would be appropriate for the nurse involved to follow this part of the code as though she had caused physical harm.

In a latter section of the code “promote professionalism and trust” another relevant point around this matter is made. Point 20.2 “act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment” is very similar in many ways to point 1.3 however speaks more of how a professional should act at all times. Again the nurse making the negative comments has not treated Izzy fairly and has potentially discriminated against her with these comments. This breaks the professional values set out in point 20.2 and undermines the entire “professionalism and trust” section of the code.

What would you do?

As the nurse who hears these comments I would follow recommendations made in point 3.4 of the code and I would act as an advocate for Izzy and challenge her attitudes. This may be in the form of a quick, unofficial word with her in which I may just need to remind her of the code and how that may make Izzy feel. Hopefully at that point that would be all I need to do however if the nurse continued in her practice it may be necessary to inform her manager/ a person of authority who can give her a more formal warning around her conduct.

As the nurse making the comments it may be important for me to read the standards set out in points, 1.3, 2.4 & 20.2 and then adjust my practice based more strictly on the code. However if Izzy has heard these comments or anyone related to Izzy’s care has heard them, eg colleges, family etc it may be important to adhere to point 14.2 of the code and apologize to these people, let them know why I had done such a thing and how it will be corrected.

If it were a more extreme case of clashing ideologies or if that nurse felt she could no longer work in this environment then she may want to follow the guidance of point 4.4 of the code and request to be transferred or at the bare minimum to not be involved in those procedures in future.

What about the patient?

Izzy’s rights as a patient are enshrined throughout the code. Points 13., 2.4 & 20.2 of the code highlight how she should be treated while in care and in the presence of all NMC registered professionals. If she feels that this nurse is not respecting her rights then Izzy has good grounds to make a complaint. It may also be reasonable to request that another member of staff or even a whole new team of staff take over her care for the remainder of her stay. �