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Izzy is under 18 and the nurse might potentially not be delivering the best care possible due to her own personal opinions therefore we should be "challenging poor practice and discriminatory attitudes and behaviour relating to their care" (NMC Code)

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In the scenario trhe other nurse expresses opinions different to your own and ones that go against some of the principles of nurses (already stated here) It is also our job to "provide honest, accurate and constructive feedback to colleagues" and "deal with differences of professional opinion with colleagues" (NMC Code) Therefore it might be a good idea to talk to the fellow nurse about what she has said and maybe help here to understand how it is not appropriate.

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"When caring for women who are having an abortion, be aware of:

the anxiety they may have about perceived negative and judgemental attitudes from healthcare professionals

the impact that verbal and non-verbal communication may have on them.Services should be sensitive to the concerns women have about their privacy and confidentiality, including their concerns that information about the abortion might be shared with healthcare professionals not directly involved in their care."

(Recommendations | Abortion care | Guidance | NICE. 2019)

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NICE Public Guidelines - Contraceptive services for under 25s

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NICE Public Guidelines - Contraceptive services for under 25s

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https://www.nice.org.uk/guidance/ph51
This guideline covers contraceptive services for under-25s. It aims to ensure all under-25s are given advice and information on all types of contraception. This includes additional tailored support to meet the particular needs and choices of those who are socially disadvantaged or who may find it difficult to use these services.
(National Institute for Health and Care Excellence 2014)

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RCN Guidance Conscientious Objection (Termination of pregnancy) 2019. Available at: https://www.rcn.org.uk/professional-development/publications/pub-007690 (Accessed 20th April 2020)
NICE Public Health Guideline Contraceptive services for under 25s (PH51) 2014. Available at https://www.nice.org.uk/guidance/ph51 (Accessed 20th April 2020)

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https://www.rcn.org.uk/professional-development/publications/pub-007690
''If you have a conscientious objection to termination of pregnancy (TOP) you should discuss the issue with your manager and confirm your objection in writing. The issue should be dealt with sensitively, so that nurses, midwives and patients/clients can establish a successful therapeutic relationship.''
(RCN Guidance Conscientious Objection (Termination of pregnancy) 2019)

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There are many codes nurses must follow. In this particular scenario the code “Uphold the reputation of your profession at all time” is not being followed. Nurses must stay objective and maintain professional boundaries with patients. They must also act with honesty and integrity at all times.  It is obvious that the nurse has her own opinions and beliefs but according to the standards  nurses should not express “personal beliefs to people in an inappropriate way” which in this case the nurse has to another staff.

The first standard is to treat people as individuals and uphold their dignity. To do this they must treat people with kindness and respect, avoid assumptions and respect people’s human rights. In this scenario the nurse has not respected Izzy and has made assumptions for example “she is just using this instead of contraception”

The code also states that nurses should be good role models to others. The nurse in this scenario is showing bad practice which can influence the way other nurses treat patients for example they may think it is okay to talk about patients like this. The code also states that nurses should be “aware at all times of how your behaviour can affect and influence the behaviour of other people".

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The staff member believes that Izzy is a time waster, therefore, being judgemental to the patients situation. The staff member has no idea why Izzy might be having her second abortion and regardless of why, it is not their place to judge.

An ethical principle of nursing is having autonomy – “to respect a patient’s wishes, regardless if you do not agree with them.”

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Could this be a case of Child Sexual Exploitation?

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Could this be a case of Child Sexual Exploitation?

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https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/tog.12389
" Girls may present to antenatal services or repeatedly seeking emergency contraception or termination of pregnancy".
As Izzy is of an age where CSE is prevalent and has presented needing a TOP, CSE cannot be ruled out.
(Child sexual exploitation: a guide for obstetricians and gynecologists. 2017)

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Compassion is one of the 6CS and is “how care is given through relationships based on empathy, respect and dignity - it can also be described as intelligent kindness and is central to how people perceive their care”. The nurse in this scenario has not empathised or respected Izzy which is an integral part of compassion. This is shown in the scenario as the nurse is talking negatively and unprofessionally about Izzy to other staff.

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The Royal College of Nursing 8 Principles

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The Royal College of Nursing 8 Principles

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Principle A states that “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. Izzy may be very scared and worried, and it shows that the nurse is not sensitive towards her situation as well as Izzy’s dignity is being affected as the nurse is talking negatively behind her back to other staff.

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NICE Guidelines on Termination of Pregnancy

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NICE Guidelines on Termination of Pregnancy

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https://www.nice.org.uk/guidance/ng140/documents/draft-guideline
(Termination of Pregnancy. 2019)

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http://www.legislation.gov.uk/ukpga/1967/87
For an abortion to be carried out, there is a requirement for two registered medical practitioners to agree that:
"Up to 24 weeks:

the continuance of the pregnancy would involve risk, greater than if the pregnancy was terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family.

The woman’s actual or reasonably foreseeable future environment may be taken into account.

With no time limits:

the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman

there is a risk to the life of the pregnant woman, greater than if the pregnancy were terminated

there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.

ACCESS FOR UNDER 16S

A woman aged under 16 may have an abortion without parental knowledge or consent if both the required doctors agree that she has sufficient maturity and understanding to appreciate what is involved."

(Abortion Act 1967. 2018)

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In this scenario Izzy has had a termination before. According to Principle D 'nurses should provide and promote care to the patients and help them make informed decisions.' In this case it would be good to talk to Izzy about her options regarding contraception.

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Principles of nursing practice | Royal College of Nursing

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The eight Principles are used to describe what everyone, from nursing staff to patients, can expect from nursing.

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Their are eight principles which can be expected from nursing. They detail how effective nursing is established while covering how good care is supported by ones attitude and behaviour.

In the scenario, a staff member seems frustrated with the patient as it is the patients second time seeking an abortion.

Principle A states that everyone within the care of nurses should be treated 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 2020)
The staff member showed no compassion or sensitivity to the patient.

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Teenage pregnancy factsheet. 2010. Available at: https://www.fpa.org.uk/factsheets/teenage-pregnancy#yAtg [Accessed: 21 April 2020].
Abortion Act 1967. 2018. Available at: http://www.legislation.gov.uk/ukpga/1967/87 [Accessed: 21 April 2020].
Termination of Pregnancy. 2019. Available at: https://www.nice.org.uk/guidance/ng140/documents/draft-guideline [Accessed: 21 April 2020].
Child sexual exploitation: a guide for obstetricians and gynaecologists. 2017. Available at: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/tog.12389 [Accessed: 21 April 2020].
Recommendations | Abortion care | Guidance | NICE. 2019. Available at: https://www.nice.org.uk/guidance/ng140/chapter/Recommendations#choice-of-procedure-for-abortion [Accessed: 21 April 2020].

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https://www.fpa.org.uk/factsheets/teenage-pregnancy#yAtg
(Teenage pregnancy factsheet. 2010)