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A patient was seen in the doctor's office. She presented with a history of severe pain to the right lower pelvic region
(intermittent), associated with dysmenorrhea. When asked if she had done a pregnancy test, she said yes, and that it was negative. An Abdominal USS was done which revealed that it was an ectopic pregnancy which could have been treated medically. When asked if she wanted her partner to come in for moral support she said no. She also begged that the partner was not to find out what had happened because he really wanted to have a child. On exiting the exam room, the partner and I came into contact and he asked if she was okay. I responded, " she will be out in a few minutes sir". The patient looked at me and gave a wink to say, thank you.

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A female patient admitted with shortness of breath, oxygen dependency with no improvement further investigation reveals patient was HIV positive , her husband a familiar person to the staff encouraged her to reveal her status to him , she was so reluctant to do so ,but had to do so after she was threatened that if she don’t the doctor will do so .Reluctantly she did so ,her husband was so disappointed but did not neglect he continued  to care for her until her death . He was able to access counseling and treatment.

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I admitted a young lady who was pregnant and hiv positive. Her mother who she is living with was unaware of her diagnosis. We had a discussion about her situation. She does not want her mother to know about her present status.  

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I admitted a young lady who was pregnant and hiv positive. Her mother who she is living with was unaware of her diagnosis. We had a discussion about her situation. She does not want her mother to know about her present status.  

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Respect for autonomy and confidentiality.

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Recently i did a follow up home visit to one of my Antenatal client who was already about 36 Weeks gestation and defaulted two appointments  i tried reaching her on phone  three times without success.
I decided to pay her a home visit. She voiced that she couldn't keep her appointment because she was waiting for her car to be fixed.  On assessment, i discovered that her ankle and feet was swollen [oedema 3+] On taking her blood pressure, it was very elevated. i immediately called the ambulance and she was taken to the hospital [ maternity ward]. She was diagnosed of pre-eclampsia ,had an emergency cesarean section the same day, delivered of a life male infant.

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I have a very good working relationship with my patients. There was a young man age 19yr  that i was working with on the unit. He was his first time being at the institution and was diagnosed with Cannabis Induced Psychosis. The young man was doing well and showed positive signs of recovery. One day he was caught with drugs and was sharing it with a few other clients. They wanted me to keep the secret and did not want me to mention what had happened to the other staff members. I could not keep the information a secret because it not only broke the unit rules, it also placed the clients in a position for relapse and it placed other patients on the unit at risk. I had to disclose the information to the team so that they can receive additional help.

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An elderly couple came to the facility for blood pressure monitoring. The husband voiced that his wife had been complaining of a headache and had been admitted at the intensive care unit at the hospital a couple of times over the past few months. The wife voiced that she was much better now that she had taken some pain killers and did not need to have her blood pressure check. After much coaxing by myself and her husband to have something as simple as her vital signs assessed. Showing her how serious the situation could be, she finally decided to have it checked. Her blood pressure was very elevated and an ambulance had to be called to take her to the hospital immediately. As soon as she got to the hospital she collapsed. The doctors said if she had waited any longer she could have died. She and her husband later came to say how grateful they were for the assistance and help.

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Had a young mother who came to clinic and want to immunize her 1 month old baby but the husband religious belief is against immunization so he did not consent to the child being immunize. The mother however consented and brought back the baby alone with out the father knowing. The child was immunize with the mother consent

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Our ICU consultant and his team have just completed their rounds when I went through my patient's medication list and saw a new order entered by the physician. The dosage was wrong so I asked him to check and confirm the order as I thought that the dose was too high. He told me not to worry because it was the right dose and just give the medication as entered into the system. I refused to administer the high dose which made him angry. After some time and a heated argument, he was forced to check the order and realized he added an extra zero. He apologized sheepishly and changed the order. I knew I had to stand my ground in order to be a good advocate for my patient.

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recently i had a patient who had malaria and didn't want his boss who came to the hospital with him to know as it would cause his relieve of duty.
after the investigation results were out and he had malaria , he was told and treatment commenced, on return of his boss , he asked about the diagnosis, he was told to talk with his subordinate as we were not obligated by ethics to divulge his staff's diagnosis to him.
the boss went into the patient room to speak with him and was told he had exhaustion and would require admission. that was how his confidentiality was held.

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As a rule in the intensive care unit, every admission to the unit should have a list of 4 visitors (these 4 persons are the only one who can visit the patient in the unit, give consent, and they are the only ones to give an update about patient's progress).
An unconscious patient admitted to the unit after having collapsed by the roadside. 5 days later a young lady came looking for her spouse, she claimed she had not seen for the past days, The unconscious patient already had gain consciousness after day 4 and was able to speak. The patient was then confronted about the young lady and he insisted that was his soulmate and wanted her as involved in his care, although he already had a list of 4 family members on his list.
The patient wanted to make amendment to his list It was only then that the list was amended at patients request .

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This is a situation where i was working in the treatment room of the casualty dept.A female adult patient came in for treatment after being triaged. Her complaint was severe abdominal pain and vomiting.She was accompanied by her spouse.On entering the room she quietly ask me if i could asked the spouse if he could leave the room whilst she was being treated which i did. her treatment chart showed that she was pregnant so she went on to explain to me that her spouse was away from home for awhile and she was involved with the neighbor for whom she was pregnant and did not want her spouse to know.She was known to PCOS so she said she told her spouse that is what was causing these signs and and symptoms. She asked me not to tell her spouse about the pregnancy because he would be asking me whats wrong with her. She asked me to tell him it was the PCOS that was causing her to be sick since she was planning to do an abortion so he would never know that she was pregnant.I promised her that i would not disclosed the pregnancy but i could not tell such a lie.After the discussion and treatment i allowed to enter the room. The first question he asked was" whats wrong with her nurse"? I asked him what did she told him the doctor said was wrong with her.He replied her cyst.I said there you have it.I was able to maintain confidentiality and fidelity without having to lie.

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Applying confidentiality:  A patient repeating to nurses all information she overheard about the patient in the room besides her. To maintain confidentiality. Any information of importance to be said regarding the patient should be discussed in the conference room or Dr's office. Inform the tattletale patient that she should not repeat what she has overheard.

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Male Diabetic who was non compliant with medication admitted with elevated blood sugars. On my assessment of the patient I discovered that he  had an infected wound under his foot with his socks on, when I asked him about it he told me I should not tell anyone about it, that he can take care of it.
I explained to him the complications of of and infected wound as a diabetic but he was insistent that I should not tell the doctor.
I told him of the possibility of him having his foot amputated if it was not addresses urgently therefore confidentiality had to be breached. His wound had to be debrided but he thanked me in the end.

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A pregnant mother with her 2nd baby who had c/section 4 years ago with her 1st pregnancy now wants to have a vaginal delivery. She was informed of the risk involved by the Gynecologist and she agreed and signed an informed consent. This implies to Autonomy.

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application of etical principles in health care practice

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application of etical principles in health care practice

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I have a post c/section who just received analgesic but was still complaining of pain. I reassured her and

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Recently my neighbor 's husband came into the Emergency Room with vomiting, lethargy and weakness. After several tests were carried out, he was diagnosed as being HIV positive. After being treated for symptoms, was sent home. His wife approached me a few weeks later, inquiring about his diagnosis. I had to explain to the wife that she needs to speak to her husband and that I couldn't breach patient confidentiality.

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Ethical principle of Autonomy
A 40 + Christian woman, divorced approx. 3 to 4years ago admitted to the unit with history of weight loss, oral candidiasis, cough, , cold and elevated temperature, blood investigation reveal a pos. HIV test during admission to the unit her 23 year old daughter was present ,the patient ask for her daughter not to be present during admission because she does not want her family to know that she is HIV pos. because of the shame and stigma she did not want her family to be exposed to that stigma, in this case the wishes of the patient was granted. My hope is that the patient has the courage to disclose to her family her condition.

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During my internship in the Antenatal Clinic one of my students that I taught in Sunday School came in for her checkup. I hadn’t seen her coming to church in a while but didn’t know she was pregnant. She went through the interview with the doctor while my other colleagues and I observed. I could see she was uncomfortable my being there but I never said anything about our relationship to the others present. However when the doctor asked her to go behind and undress for the physical examination, I asked to be excused knowing that this was the autonomy principle in nursing, although she didn’t ask me to. I believe that I as the nurse made the right decision and prevented an ethical dilemma by respecting and protecting her rights to making decisions/views concerning her treatment and diagnosis.

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https://youtu.be/dGvX7O_wbb8

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A patient had requested more pain medications after receiving it atleast 1 hour ago. I told the pain that i cannot administer this medication again because of its frequency (every 8 hours) and it can lead to an overdose if i do. I told him i would be committing a crime and putting your life in danger if i have him more mediation.  I suggested to the patient to practice diversional therapy, he listened to music that he liked, spoke to his family members and also did some reading. He was asleep soon and forgot about the pain.

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A patient had requested more pain medications after receiving it atleast 1 hour ago. I told the pain that i cannot administer this medication again because of its frequency (every 8 hours) and it can lead to an overdose if i do. I told him i would be committing a crime and putting your life in danger if i have him more mediation.  I suggested to the patient to practice diversional therapy, he listened to music that he liked, spoke to his family members and also did some reading. He was asleep soon and forgot about the pain.

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NO, i did not experience any challenges exercising this principle of not causing the patient any harm. Good was done because the patient eventually forgot about his pain.
There is always a solution and you should always behave as a prudent nurse.

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A few weeks ago a young lady who is sexually active came into the emergency room in severe pain accompanied by her siblings. Upon triage she denies being pregnant. After diagnostic test performed it was revealed that she had an ectopic pregnancy which ruptured.  She asked not to reveal the truth to her siblings and she told them it was a ruptured cyst. She had an emergency surgery that same day. Spent 3 days post op and left. And the truth was not revealed. She was in the right frame of mind to make her own decisions  therefore her autonomy was respected.

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Recently I had a  suspected teenage pregnancy where the 15yr old never wanted her mother to know of her actions. My challenge was whether I should breach fidelity in the child or be veracious to the doctor and mother. In the end we did an intervention and found of mom knew of her secret boyfriendall along therefore all information was disclosed in favor of all parties. The child was not pregnant and suggestions were made to avoid another teenage pregnancy scare.

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Recently I had a  suspected teenage pregnancy where the 15yr old never wanted her mother to know of her actions. My challenge was whether I should breach fidelity in the child or be veracious to the doctor and mother. In the end we did an intervention and found of mom knew of her secret boyfriendall along therefore all information was disclosed in favor of all parties. The child was not pregnant and suggestions were made to avoid another teenage pregnancy scare.